Klinische Monatsblatter fur Augenheilkunde最新文献

Objective: To assess the effect of corneal thinning and changes in intraocular pressure (IOP) on the distribution of corneal stress induced by Goldmann applanation tonometry (GAT).

Methods: A 2D model of a human cornea was created using a computer-aided design and finite element analysis software, employing previously reported corneal biomechanical properties. The GAT procedure was simulated, and the magnitude and distribution of stress in the corneal stroma were obtained for several corneal thicknesses, stiffnesses, and IOP.

Results: A significant increase in stress was found in the outer and inner layers of the central cornea and in the inner layers of the surrounding central region. The maximal stress value was observed in the central outer layers when the stiffness was doubled, as in our theoretical baseline cornea (125.16 kPa). Minimal stress was observed in the central inner layers for a central corneal thickness of 300 µm (28.17 kPa). The thickness and stiffness of the cornea significantly influenced the magnitude of the stress, whereas the stress distribution in the cornea did not show significant changes. The change in IOP did not induce significant changes in either stress magnitude or stress distribution.

Conclusions: The changes and distribution of corneal stress when a GAT procedure is performed support the idea that variations in corneal thickness and stiffness induce changes in corneal biomechanics that may be relevant for IOP readings. These findings are relevant for assessing IOP in corneas that have undergone surgical procedures or have diseases that alter their layers.

Purpose: To establish a national consensus on assessing visual function for fitness to drive in Switzerland.

Methods: The minimum medical requirements for visual function for fitness to drive are regulated by Swiss Federal Law, namely, by the Traffic Licensing Ordinance (TLO). The medical examination techniques relevant in this context and their assessment are not further specified therein, which leads to legal inequality among drivers and uncertainty among examiners. We established a study group of representatives of the Traffic Medicine Section of the Swiss Society of Forensic Medicine and the Traffic Commission of the Swiss Society of Ophthalmology to develop a national consensus on assessing visual function for fitness to drive in Switzerland. In structured meetings, the authors discussed medical examination techniques and available international and local recommendations on this topic, with respect to Swiss legislation. In the event of a contrary opinion, the topic was discussed again in a follow-up session until we reached an agreement. We defined consensus as complete agreement on the subject under discussion.

Results: The study group held five in-person meetings between March 2019 and January 2023. The authors developed recommendations intended for all professional groups assessing driving fitness. We prepared an aid for daily practice on how to examine the minimum medical requirements for visual function listed in the TLO Annex 1, using standardized test procedures and considered how to interpret the findings obtained, accounting for aspects of traffic medicine and ophthalmology.

Conclusions: A consensus on the assessment of visual function for fitness to drive in Switzerland is crucial to ensure legal equality for drivers and legal certainty for examiners. Regular review of the consensus is imperative if we are to consider future legal developments and new scientific evidence in assessing fitness to drive.

Visual deficits/ametropia are particularly significant obstacles in sports because the visual system controls/corrects all of an athlete's movements. However, athletes are at increased risk for eye injuries caused by high-velocity objects e.g. balls or physical contact with opponents. This article presents the current (German) figures on eye injuries in club and school sports and evaluates the risk of eye injuries in various sports.2392 eye injuries, selected from the 221273 club sports injuries recorded in the Ruhr University Bochum and ARAG Sports Insurance database for the period 1987-2017 were evaluated. The school sports eye injuries recorded by the German Social Accident Insurance for 2019 were also analyzed.Of all the club sports injuries recorded, 1.08% were eye injuries; of these, 19.7% had to be treated in hospital, 13.9% required surgery, and 56.9% prevented the injured athletes from working. Blunt trauma was the most common cause of injury, comprising more than 50% of cases. Eye injuries were strongly overrepresented in club sports injuries sustained during water polo, squash, badminton, and tennis (injury proportion ratio [IPR] = 5.1-8.8). In school sports, eye injuries comprised 1.83% of the reported cases.Eye injuries in sports are relatively rare, but often serious. Based on the increased IPR found for some sports, further studies must analyze the risk of eye injury in more detail. Eye protection in the form of sport-appropriate glasses should be used.In addition, the article addresses the problem of "defective vision in sport" and its adequate correction and shows the requirements for spectacles suitable for (school) sport using the example of DIN 58184 "Spectacles suitable for school sports - Requirements and test methods".

Inherited retinal dystrophies (IRD) are the most frequent cause for severe visual loss in the working age. The heterogeneous group of IRDs is associated with loss of visual function and has a severe impact on personal and familial life. Early diagnosis is of high relevance for patients and their families, to facilitate possible therapies and professional help for the individual situation. This review summarizes a diagnostic protocol for an efficient diagnosis of IRD including non-invasive retinal imaging, functional and molecular genetic testing as well as examination in specialized centers for IRD.

Minimally invasive glaucoma surgeries (MIGS) offer an alternative approach, aiming to be both safe and effective. Defined by their ab interno technique, which avoids creating a bleb, MIGS procedures seek to reduce intraocular pressure (IOP) by enhancing the outflow pathways of aqueous humor. Techniques include stenting, incisions, and excisions of the trabecular meshwork, canaloplasty of Schlemm's canal, and drainage implants that enhance uveoscleral outflow to the subchoroidal space. Many of these methods show promise in reducing intraocular pressure and decreasing the need for medication. Nevertheless, with the increasing number of these procedures and devices on the market, it is difficult to keep track of the evidence supporting these methods. Although randomized controlled trials exist for many of the new MIGS procedures, the sample sizes are often small, and follow-up periods are limited. Additionally, there are no randomized controlled trials comparing different MIGS techniques or MIGS with traditional glaucoma surgery. These factors continue to make it challenging to select the most appropriate method for each patient. Therefore, it is essential to persist in conducting randomized controlled long-term studies to gain a deeper understanding of the applications of MIGS.

Background: Extended monovision is a novel mix-and-match approach that has been recently introduced. It involves implanting an aspherical monofocal intraocular lens (IOL) for distance vision in the dominant eye, and a bifocal extended depth-of-focus (EDOF) IOL in the nondominant eye. The target refraction for the nondominant eye is - 1.25 diopters (D), and provides good intermediate vision at 80 cm, with an additional 1.5 D power for near vision at 36 cm. This study evaluates the visual outcomes and patient-reported experiences with this extended monovision strategy in cataract patients.

Patients and methods: Patients underwent uneventful conventional or femtosecond laser-assisted cataract surgery and implantation of an aspherical monofocal IOL (Hoya Vivinex XC1-SP, Hoya Surgical Optics, Tokyo, Japan) in the dominant eye [with a target refraction closest to the spherical equivalent (SE) of 0 D] and a rotationally asymmetric refractive bifocal EDOF IOL with an additional power of + 1.5 D (Lentis Comfort-LS-313 MF15, Teleon Surgical B.V, Spankeren, Netherlands) in the nondominant eye (target refraction closest to SE - 1.25 D). These patients were included in this retrospective study. Uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, and UNVA, respectively), and binocular defocus curves were determined. Additionally, uncorrected contrast sensitivity, stereoscopic depth perception, and halometry were measured. Patient satisfaction was evaluated using the PRSIQ and NEI-RQL-42 questionnaires.

Results: A total of 26 eyes from 13 patients were included in the study. The mean postoperative binocular UDVA, UIVA, and UNVA were 0.05 ± 0.09, - 0.08 ± 0.11, and 0.06 ± 0.07 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m), with a mean visual acuity of 0.04 ± 0.09 logMAR. Functional vision above the cutoff value of 0.3 logMAR extended across the defocus steps from + 1.0 to - 3.5 D. The mean dependence on correction score reached a mean of 89.4 ± 23.9, with an overall satisfaction rate of 83.1 ± 13.2.

Conclusions: To our knowledge, this is the first study to describe the combination of a monofocal IOL for distance vision and a rotationally asymmetric refractive bifocal EDOF IOL for intermediate and near distances, with the aim of achieving extended monovision. This approach demonstrated good visual acuity for all distances and a high patient satisfaction. It may be considered a promising alternative to multifocal IOLs.

Background: Refractory corneal edema is the foremost reason for endothelial corneal transplantation (EK) in the world. Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) offer good clinical outcomes. However, human donor tissue is limited in availability and has a complex logistical chain. Many patients in need do not have access to EK. Success of the human donor tissue depends on its quality, the number of rebubbles, repeat keratoplasties, and patient-related risk factors. The use of an endothelial corneal keratoprosthesis could benefit patients with a high risk for graft failure and human graft rejection, and patients in underserved areas where tissue banking is unavailable.

Patients and methods: Case cohort series of 10 eyes of 10 patients implanted with the EndoArt, with a follow-up of up to 4.5 years. Outcome measures are device adherence, central corneal thickness, visual acuity, and incidence of adverse events.

Results: In the first seven eyes, the EndoArt was implanted in eyes with low visual potential within the first-in-human (FIH) trial, and in the three remaining eyes, implantation was performed because of either guarded posterior or anterior segment prognosis or the patient's wishes. In 9/10 eyes, device adherence was obtained and maintained throughout the follow-up period. Mean corneal thickness decreased from 927 + SD 241 microns to 621 + SD 140 microns. In 6/10 eyes, visual acuity improved from a mean preoperative value of logMAR 1.94 + 0.63 to a mean postoperative value of logMAR 0.8 + 0.64. No pathological thinning or corneal metabolic changes were seen. The surgical technique was developed during the follow-up period.

Conclusion: The EndoArt provided a stable decrease in central corneal thickness, improved vision in 60% of eyes, and had no device-related adverse events. The EndoArt is an additional treatment modality for special cases like repeat corneal graft failure in the population of the Western world, or as a primary procedure in underserved areas worldwide.