Klinische Monatsblatter fur Augenheilkunde最新文献

Purpose: To evaluate the visual and corneal outcomes of Keratorefractive Lenticule Extraction (KLEx) using a large lenticule diameter with a 7.7 mm optical zone and 7.9 mm cap diameter. The study aimed to determine the feasibility, refractive precision, and potential benefits of larger optical zones in improving visual quality and reducing myopic regression, particularly in patients with larger scotopic pupils.

Methods: This retrospective case series included 40 eyes from 20 patients who underwent KLEx surgery with the VisuMax800 femtosecond laser. The programmed lenticule diameter was 7.7 mm, and the cap diameter was 7.9 mm, with a cap thickness of 140 µm and a 2.5 mm incision. Preoperative spherical equivalents ranged from - 1.5 D to - 4.75 D. Postoperative evaluations were conducted at 3 months, and assessed refractive outcomes, uncorrected visual acuity (UCVA), and residual astigmatism. Surgical planning was based on a personalized nomogram with refractive adjustments for low astigmatic values.

Results: At 3 months, 100% of eyes achieved a UCVA of 20/20, and 25% reached 20/16 or better. The mean postoperative spherical equivalent was + 0.14 ± 0.27 D. Refractive predictability was high, with 97.5% of eyes within ± 0.5 D of intended spherical correction and 90% within ± 0.5 D of cylindrical correction. Residual astigmatism was ≤ 0.50 D in 87% of cases. No adverse events were reported.

Conclusions: KLEx using large lenticules is safe, effective, and highly accurate. Larger optical zones may enhance refractive stability and visual quality in patients with large pupils.

Purpose: To evaluate the long-term outcome of intravitreal bevacizumab in eyes with diabetic macular oedema (DME) following a PRN (pro re nata) regimen. Additionally, we investigated the effect of the presence of disorganisation of the retinal inner layers (DRILs) and pachychoroid (PC) at baseline on clinical outcome.

Methods: This retrospective study included 112 naïve eyes with DME that were followed up for 2 years. All eyes were treated with six initial bevacizumab injections at monthly intervals and then received treatment according to a PRN regimen. In case of poor response to bevacizumab, therapy was switched to other agents. Main outcome measures included: best-corrected visual acuity (BCVA), central macular thickness (CMT), and number of intravitreal injections (IVI s). In addition, we examined the effect of the presence of DRILs and PC at baseline on clinical outcome.

Results: BVCA improved significantly and CMT decreased significantly during the first 2 years of treatment. The number of IVI s per eye was 11.1 ± 4.8 at the end of the second year. Treatment had to be switched to other agents in 47 eyes (42%). The timing of switching was 12.4 ± 6.1 months after a mean of 9.2 ± 3.3 IVI s. Patients with DRILs at baseline (29.5%) had significantly worse BCVA at all time points before and after treatment, although CMT was significantly lower before treatment and comparable to patients without DRILs during treatment. Patients with PC at baseline (35.7%) had no significant differences in BVCA and CMT at all time points compared with patients without PC.

Conclusions: This study demonstrates statistically significant functional and anatomical improvement in patients with DME treated with intravitreal bevacizumab after 2 years. However, more than 40% of eyes required a switch in therapy. The presence of DRILs at baseline had a negative effect whereas the presence of PC at baseline had no effect on clinical outcome.

Uveitis diseases are generally rare and therefore often pose a significant challenge in treatment. In developed countries, non-infectious uveitis is one of the most common causes of severe functional impairment and even blindness. The current guidelines provide information on when and how to initiate treatment, but do not include recommendations on when and how to reduce or discontinue treatment. The Treatment Exit Options for Uveitis Register (TOFU) was initiated over five years ago, with the aim of improving the evidence for therapy reduction and termination. Over the past five years, the register has been established nationally with funding from the German Federal Ministry of Education and Research (BMBF), the Eye Foundation and industry partners and has since been expanded in individual European countries. The registry is under the auspices of the Uveitis Section of the German Ophthalmological Society (DOG). The analysis of baseline data from around 1000 patients shows that, in the prospectively documented patient population, intermediate uveitis is most common, followed by posterior uveitis, panuveitis and retinal vasculitis. The disease was bilateral in 75.9% of cases. The mean visual acuity was 0.22 ± 0.36 logMAR. Patients with panuveitis had the worst visual acuity, with 0.27 ± 0.39 logMAR. Severe visual impairment (> 1.0 logMAR) was observed in only 1% of patients at baseline. The continuation and European expansion will ensure the continuous generation of high-quality data in the coming years and thus help to develop recommendations on the end of therapy.

Introduction: The oregis registry operated by the German Ophthalmological Society (DOG) serves as a central digital platform for collecting and analysing ophthalmological healthcare data in Germany. The aim of oregis is to provide a comprehensive picture of the current healthcare situation and promote healthcare research using real-world-data from inpatient and outpatient facilities. Since its launch in 2020, oregis has continuously expanded its database to enable scientific analyses on a wide range of topics. This paper presents the new dashboard feature allowing participating centres to compare their own patient data with aggregated data in real time while also covering privacy aspects of the system.

Materials and methods: The oregis steering committee opted to implement the oregis dashboard based on existing medical registries. First, forty-nine national and international registries were analysed to identify common features such as benchmarking functionality. This was followed by technical realisation and implementation.

Results: Each centre connected to oregis has secure access to the oregis dashboard, which displays key indicators for patients, diagnoses, and treatments. Dynamic filtering options allow targeted data analysis, comparing each centre's results anonymously with aggregated data from other centres. The dashboard uses Apache Superset data visualisation software [! etwas informativer]. Data is synchronised using an integrated oregis Konnektor module to anonymise patient data according to defined standards. Extensive security and privacy measures ensure data security, including server-side encryption, transport encryption, and two-factor authentication. The dashboard is part of a comprehensive privacy policy developed and validated for oregis by privacy experts.

Conclusion: The number of centres connected to oregis is still growing. The new web-based dashboard allows flexible analysis of data and comparison with other centres without allowing conclusions to be drawn about any individual care centre; this ensures data privacy and independence in each centre. More features can be added to provide a more thorough overview of eye care in Germany as oregis grows.

Purpose: To examine the change in corneal endothelial cell density (ECD) after gonioscopy-assisted transluminal trabeculotomy (GATT) surgery alone or in combination with phacoemulsification (phaco).

Methods: In this prospective monocentric comparative study, consecutive patients were enrolled with open angle glaucoma (OAG) and who had been treated with GATT or phaco + GATT, with complete endothelial cell data and at least 6 months of follow-up. Patients who underwent phaco surgery alone during the same period were recorded as the control group. The main outcomes were ECD changes.

Results: The study included 64 OAG (40 eyes in the GATT and 24 eyes in the GATT + phaco groups) and 30 control eyes (phaco group). There was a significant decrease in mean ECD compared to baseline in the GATT, phaco + GATT, and phaco groups (p < 0.001 for all). At the end of follow-up, percent cumulative ECD reduction values were 6.89%, 14.47% and 10.32% in the GATT, phaco + GATT, and phaco groups, respectively (p = 0.01 for all groups). The ECD reduction in the phaco + GATT group (p = 0.02) and in the phaco group (p = 0.04) was significantly higher than in the GATT group. ECD reduction was similar in the phaco + GATT and phaco groups (p = 0.69).

Conclusions: A significant ECD loss was observed in 6 months period after GATT surgery compared to the baseline. The ECD reduction observed after GATT combined with phacoemulsification was greater than with GATT alone. There was no significant difference between phaco-GATT combined surgery and phaco alone.

Background: While the incidence of herpes zoster has been reported to exhibit seasonal patterns in different global regions, with some studies suggesting correlations with weather data, data specific to Germany has been lacking. We investigated the seasonality of herpes zoster incidence in Germany and compared weather data.

Patients and methods: We conducted a single centre, interdisciplinary retrospective analysis of all herpes zoster cases at the Department of Dermatology and the Eye Centre from the Medical Centre, University of Freiburg from January 1st 2009 to December 31st 2022. 2,829 patients were identified using ICD-10 code B02.0 - 9. Monthly and cumulative daily incidences were calculated and plotted. Weather data were compared, including mean monthly temperature, sunshine duration, and UV-index.

Results: The analysis revealed two distinct incidence peaks: a summer peak correlating with weather factors, and an unexpected winter peak from late December through early January that did not correlate with the investigated weather parameters.

Conclusions: Our findings suggest that weather factors, like temperature, and UV-index, influence the incidence of herpes zoster in Germany. The previously undescribed "new year spike" indicates that additional, non-meteorological factors may trigger herpes zoster reactivation. This study provides insights into herpes zoster epidemiology in Germany and highlights the need for further research into trigger factors.