Klinische Monatsblatter fur Augenheilkunde最新文献

{"title":"[Endodiathermy-assisted Iris Reconstruction after Excision of a Rapidly Progressive Iris Cyst].","authors":"Clara Eileen Englisch, P. Szurman, Bert Bier, André M. Trouvain, Philipp Ken Roberts, Annekatrin Rickmann","doi":"10.1055/a-2283-2088","DOIUrl":"https://doi.org/10.1055/a-2283-2088","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descemet Membrane Endothelial Keratoplasty (DMEK) Anesthesia Analysis.","authors":"Christoph Andres, André M. Trouvain, P. Szurman, Berthold Seitz, F. N. Fries, Annekatrin Rickmann","doi":"10.1055/a-2268-9295","DOIUrl":"https://doi.org/10.1055/a-2268-9295","url":null,"abstract":"PURPOSE\u0000Comparison of safety and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in topical, peribulbar, or general anesthesia.\u0000\u0000\u0000METHODS\u0000Retrospective, post hoc matched study of 346 patients who received DMEK surgery with different types of anesthesia (n = 54 topical, n = 137 peribulbar, n = 155 general anesthesia). Outcome criteria were intraoperative complications, endothelial cell count (ECC), central corneal thickness (CCT) and graft rejection rate, rebubbling rate, and visual acuity (VA). Mean follow-up time was 9.4 ± 2.8 months.\u0000\u0000\u0000RESULTS\u0000The group with topical anesthesia showed intraoperative difficulties such as vitreous pressure (p = 0.01) and difficult graft unfolding (p = 0.4), possibly leading to a higher rebubbling rate (p = 0.03) and therefore graft failure (p = 0.39). However, rebubbling and graft failure occurred more often when the graft preparation was more difficult (p = 0.2, p = 0.13, respectively), which was independent of anesthesia. All three groups achieved comparable functional results regarding VA, ECC, and CCT after 6 months.\u0000\u0000\u0000CONCLUSION\u0000DMEK under topical anesthesia is feasible and shows comparable final visual outcomes but should be limited to selected cooperative patients and performed by experienced surgeons due to the potential for increased intraoperative challenges.","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140742795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor- and Radiation-Related Complications after Ruthenium-106 Brachytherapy in Small to Medium Uveal Melanomas (Part 1).","authors":"Fotios Lalos, Dirk Flühs, Maja Guberina, Norbert Bornfeld, Martin Stuschke, Wolfgang Sauerwein, Nikolaos E Bechrakis","doi":"10.1055/a-2268-0985","DOIUrl":"10.1055/a-2268-0985","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to analyze tumor-related complications after ruthenium-106 brachytherapy in patients with uveal melanoma, with respect to local tumor control, insufficient radiation response, enucleation, and metastasis rate.</p><p><strong>Patients/methods and materials: </strong>This retrospective study included 608 patients treated consecutively with ruthenium-106 brachytherapy between January 2008 and December 2010 at the Department of Ophthalmology, University Hospital Essen. The occurrence of radiation-induced results was analyzed by estimating the risk by applying the Kaplan-Meier method, i.e., the \"time to event\" analysis. The Cox model test was used for the univariate and multivariate risk factor analyses. The median follow-up was 51 months after primary treatment.</p><p><strong>Results: </strong>Tumor recurrence was found in 21 patients (3.5%) and repeated treatment due to insufficient effect after the initial ruthenium-106 brachytherapy was performed in 40 patients (6.6%). The 5-year cumulative risk of recurrence was 4.0% and that of insufficient effect was 7.3%. Thirteen patients (2.1%) underwent a secondary enucleation; 8 because of a local recurrence and 5 because of severe post-brachytherapy complications. The cumulative enucleation risk was 2.3% after 5 years and 2.9% after 10 years, corresponding to eye preservation of 97.7 and 97.1%, respectively. In forty-two patients (7.2%), metastatic disease was diagnosed during the follow-up. The metastatic rate as calculated by the Kaplan-Meier method was 9.0, and 13.1% at 5 and 10 years, respectively.</p><p><strong>Conclusion: </strong>Our study demonstrated that ruthenium-106 brachytherapy is an excellent treatment option for achieving local tumor control and eye preservation in well-selected patients. The metastatic rate is in agreement with that of previous studies analyzing small to medium size uveal melanomas.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139735489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravitreal Injections: Improving Sustainability by Reducing Clinical Waste.","authors":"Johannes Birtel, Maximilian Hammer, Nicolas Feltgen, Laurenz Pauleikhoff, Ariel Yuhan Ong, Gerd Geerling, Martin S Spitzer, Peter Charbel Issa","doi":"10.1055/a-2184-9492","DOIUrl":"https://doi.org/10.1055/a-2184-9492","url":null,"abstract":"BACKGROUND\u0000Intravitreal injections are one of the most commonly performed procedures in ophthalmology. It is estimated that over 1 million intravitreal injections are performed in Germany annually. The aim of this study was to quantify the waste and carbon footprint associated with single-use injection sets, and to establish a waste reduction strategy.\u0000\u0000\u0000MATERIAL AND METHODS\u0000The clinical waste and associated carbon footprint from standard disposable injection sets used by tertiary referral centres in Germany (n = 6) and the United Kingdom (n = 2) were assessed. The safety of performing intravitreal injections with a minimalistic material-sparing approach was evaluated.\u0000\u0000\u0000RESULTS\u0000The average weight of an injection set (and hence the waste generated from each injection) was 165 g. On average, each injection set comprised 145 g (88%) of plastic, 2.1 g (1.3%) of metal, 4.3 g (2.6%) of paper), and 12.9 g (7.8%) of gauze/swabs. For 1 million injections, this equates to 145.2 tonnes (t) of plastic, 2.1 t of metal, 4.3 t of paper, and 12.9 t of gauze/swabs. A material-sparing approach can reduce injection set-associated waste by 99% without necessarily compromising safety.\u0000\u0000\u0000CONCLUSION\u0000A resource-saving approach to intravitreal injections can minimise the generation of clinical waste and its associated carbon footprint, thereby supporting sustainability.","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Involvement in Selected Rheumatic Diseases - Clinical Manifestation in Adulthood.","authors":"Karoline Baquet-Walscheid, Thomas Rath, A. Heiligenhaus","doi":"10.1055/a-2239-0412","DOIUrl":"https://doi.org/10.1055/a-2239-0412","url":null,"abstract":"Ocular manifestations of rheumatic diseases are common and contribute significantly to the morbidity and reduced quality of life of affected patients. Knowledge of typical clinical manifestations is important for the rheumatologist in order to support the reference of patients with corresponding symptoms for ophthalmological consultation at an early stage of disease, or to initiate regular screening examinations (e.g. in patients with Behçet's syndrome). Conversely, a (possibly urgent) rheumatological assessment is crucial for certain ophthalmological diseases, in order not to overlook a (possibly fatal) systemic associated disease. Patients with rheumatic or inflammatory ocular diseases should always be informed by the treating physician about possible symptoms of other organ manifestations, in order to avoid a delayed diagnosis. \"Classic\" associations for uveitis are (HLA-B27-associated) spondyloarthritis and acute anterior uveitis, as well as retinal vasculitis with or without panuveitis and Behçet's syndrome. In patients with rheumatoid arthritis or ANCA-associated vasculitis, however, scleritis (with or without peripheral ulcerative keratitis) typically occurs, but a variety of other findings are also possible. Close interdisciplinary collaboration, particularly regarding therapeutic decisions, is crucial to ensuring a good prognosis for the patient.","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitätskontrolle in der Hornhautbank mit KI: Vergleich des neuen Deep-Learning-basierten Ansatzes mit der konventionellen Endothelzelldichtenbestimmung durch das Rhine-Tec System","authors":"Michelle Dreesbach, D. Böhringer, Paola Kammrath Betancor, Mateusz Glegola, Philip Christian Maier, Thomas Reinhard, S. Heinzelmann","doi":"10.1055/a-2299-8117","DOIUrl":"https://doi.org/10.1055/a-2299-8117","url":null,"abstract":"\u0000 Die Endothelzelldichte ist ein objektiver Parameter für die Freigabe von Hornhauttransplantaten zur Operation. In der Lions Hornhautbank Baden-Württemberg wird für diese Quantifizierung das \"Rhine-Tec Endothelial Analysis System\" verwendet, das auf der Methode des festen Zählrahmens basiert und nur eine kleine Stichprobe von 15 bis 40 Endothelzellen berücksichtigt. Das Messergebnis hängt daher von der Platzierung des Zählrahmens und der manuellen Nachkorrektur der im Zählrahmen gewerteten Zellen ab. Um den Stichprobenumfang zu erhöhen und eine höhere Objektivität zu schaffen, haben wir auf Grundlage von \"Deep-Learning\" eine neue Methode entwickelt, die alle sichtbaren Endothelzellen im Bild vollautomatisch erkennt. Ziel dieser Studie ist der Vergleich dieser neuen Methode mit dem konventionellen Rhine-Tec-System 9.375 archivierte phasenkonstrastmikroskopische Bildaufnahmen von konsekutiven Transplantaten aus der Lions-Hornhautbank wurden mit der Deep-Learning-Methode evaluiert und mit den korrespondierenden archivierten Analysen des Rhine-Tec-Systems verglichen. Zum Vergleich der Mittelwerte wurden Bland Altman- und Korrelationsanalysen durchgeführt. Es ergaben sich vergleichbare Ergebnisse beider Methoden. Die mittlere Differenz zwischen Rhine-Tec-System und der Deep-Learning-Methode betrug lediglich -23 Zellen / Quadratmillimeter (95%-Konfidenzintervall -29 bis -17). Es zeigte sich eine statistisch signifikant positive Korrelation zwischen den beiden Methoden mit 0,748. Auffällig in der Bland-Altman-Analyse waren gehäufte Abweichungen im Zelldichtenbereich zwischen 2000 und 2500 Zellen pro Quadratmillimeter mit höheren Werten beim Rhine-Tec-System. Die vergleichbaren Ergebnisse bezüglich der Zelldichtenmesswerte unterstreichen die Wertigkeit des “Deep-Learning-” basierten Verfahrens. Die Abweichungen im Bereich der formalen Schwelle für eine Transplantatfreigabe von 2000 Zellen pro Quadratmillimeter sind sehr wahrscheinlich durch die höhere Objektivität der Deep-Learning-Methode erklärbar und der Tatsache geschuldet, dass Messrahmen und manuelle Nachkorrektur unter Berücksichtigung des Gesamtbildes aus der Endothelbewertung jeweils gezielt ausgewählt worden waren. Diese vollständige Sichtung des Transplantatendothels und Qualitätsbeurteilung kann aktuell noch nicht durch das Deep-Learning System ersetzt werden, und ist somit weiterhin die wichtigste Grundlage der Transplantatfreigabe zur Keratoplastik. Endothelial cell density (ECD) is a crucial parameter for the release of corneal grafts for transplantation. The Lions Eye Bank of Baden-Württemberg uses the \"Rhine-Tec Endothelial Analysis System\" for ECD quantification, which is based on a fixed counting frame method considering only a small sample of 15 to 40 endothelial cells. The measurement result therefore depends on the frame placement and manual correction of the cells counted within the frame. To increase the sample size and create higher objectivity, we developed a new method based o","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-Related Complications and Functional Results after Ruthenium-106 Brachytherapy in Small to Medium Size Uveal Melanomas (Part 2).","authors":"Fotios Lalos, Dirk Flühs, Maja Guberina, Norbert Bornfeld, Martin Stuschke, Wolfgang Sauerwein, Nikolaos E Bechrakis","doi":"10.1055/a-2275-5575","DOIUrl":"10.1055/a-2275-5575","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the treatment-related complications after ruthenium-106 brachytherapy in patients with uveal melanoma in terms of radiation-induced optic neuropathy, maculopathy and retinopathy, radiation-related vitreous hemorrhage, and retinal detachment, as well as secondary glaucoma and radiogenic cataract. In addition, the course of visual acuity was analyzed.</p><p><strong>Patients/methods and materials: </strong>This retrospective study included 608 patients treated with ruthenium-106 brachytherapy between January 2008 and December 2010 at the Department of Ophthalmology, University Hospital Essen. The follow-up time was 11 years. The occurrence of the radiation-induced complications was analyzed using the Kaplan-Meier method. Cox regression was used for univariate and multivariate risk factor analyses. Hazard ratios were calculated for each variable.</p><p><strong>Results: </strong>Regarding the complications, 34% (N = 207) of the patients had no reported side effects or complications during follow-up. Radiation optic neuropathy was observed in 18.8% (N = 114) of the patients, with a median time to onset of 16 months (range: 3 - 78 months). Radiation maculopathy occurred in 8.2% (N = 50) after a median time of 17 months (range: 3 - 67 months). Radiation retinopathy was observed in 20.1% (N = 122), with a median time to onset of 21 months (range: 6 - 67 months). Secondary glaucoma developed in 9.7% of the patients (N = 53) and radiogenic cataract in 46.8% (N = 227). Vitreous hemorrhage (11.8%, N = 72) and scleral necrosis (2.1%, N = 13) occurred relatively rarely.</p><p><strong>Conclusion: </strong>The observed radiogenic complication rate is comparable with that reported in previous studies.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139940173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Case of MOGAD.","authors":"Ehtesham Shamsher","doi":"10.1055/a-2252-5601","DOIUrl":"https://doi.org/10.1055/a-2252-5601","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic Macular Hemorrhage after Dexamethasone Implant Injection.","authors":"Anna Friesacher, Sascha Mathias Jung, Scott Tschuppert, C. Valmaggia, M. Todorova","doi":"10.1055/a-2282-3278","DOIUrl":"https://doi.org/10.1055/a-2282-3278","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Successful Treatment of Therapy-refractory Acanthamoeba Keratitis with Systemic Miltefosine and Topical Voriconazole].","authors":"Petra Schwarzer, Frank Blaser, Miriam Sellner, Stephan Christian Rauthe, Tamer Tandogan, Christoph Tappeiner, D. Goldblum","doi":"10.1055/a-2196-6011","DOIUrl":"https://doi.org/10.1055/a-2196-6011","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}