Klinische Monatsblatter fur Augenheilkunde最新文献

Purpose: To assess the prevalence of microfibre contamination in the anterior segment during and after cataract surgery and to evaluate the use of polymer-based disposable materials in ophthalmic operating theatres in Germany and Switzerland.

Methods: A web-based survey was distributed to senior ophthalmic surgeons across hospitals, private clinics, and surgical centres in Germany and Switzerland. The questionnaire collected data on professional background, use of disposable versus reusable materials, and observations of microfibres intra- and postoperatively. Descriptive and comparative analyses were performed using Excel and chi-square testing with p < 0.05 considered significant.

Results: Of 226 contacted surgeons, 184 (81%) were reached and 38 (21%) completed the survey. Most respondents (76%) were department heads or chairholders, and 68% had > 20 years of professional experience. Disposable, polymer-based textiles were used by ≥ 87% of respondents for surgical clothing, drapes, and table coverings. Microfibres in the anterior chamber were observed intraoperatively by 89% and postoperatively by 87% of surgeons. The estimated relative frequency was > 0.1 - 5% of eyes in most cases. Microfibres on or within instruments were reported by 71% of participants. Observation frequency correlated significantly with higher personal surgical volume (p < 0.03) and with senior institutional position (p < 0.02), but not with years of experience or total institutional case volume. Instrument reprocessing method (in-house vs. external) and the use of reusable irrigation/aspiration handpieces were not associated with increased microfibre observations.

Conclusions: Microfibre contamination of the anterior segment remains a frequent finding in contemporary cataract surgery despite the near-universal adoption of polymer-based disposable textiles. Further studies are needed to characterise the material composition of intraocular fibres and identify their sources to reduce this complication.

Background: Visual field testing is essential for glaucoma diagnostics; however, patient cooperation can affect the reliability of the results. The COMPASS perimeter (COM; CentreVue-iCare, Padua, Italy) offers an innovative approach to enhance test quality by compensating for fixation losses and automatically adjusting light stimuli. Additionally, it enables simultaneous fundus photography during perimetry. In this prospective study, we compare the COM perimeter with the Humphrey Field Analyzer (HFA) in glaucoma patients and healthy subjects in terms of visual field parameters, reproducibility, and patient satisfaction. The aim is to evaluate the clinical applicability and potential added value of the COM perimeter.

Materials and methods: 113 eyes (67 glaucoma, 46 healthy) were tested using both COM (24 - 2 ZEST) and HFA (24 - 2 SITA-Standard). Mean deviation (MD), pattern standard deviation (PSD), test duration (TD), and subjective patient experiences were recorded. Reproducibility was assessed by analysing repeated measurements in ten healthy subjects.

Results: In the overall cohort, the COM measured a mean deviation (MD) of - 2.8 ± 5.7 dB and a pattern standard deviation (PSD) of 4.3 ± 3.5 dB. In comparison, the HFA showed an MD of - 4.4 ± 5.6 dB and a PSD of 3.2 ± 3.1 dB. The average test duration was 412 ± 94 seconds for COM and 341 ± 72 seconds for HFA. Subjective patient satisfaction was significantly higher with COM (p < 0.00 001) than with HFA. Both tests demonstrated high reproducibility with no significant differences in repeated measurements.

Conclusions: The COM perimeter and the HFA Field Analyser demonstrated significant differences in the parameters MD, PSD, and test duration. Higher patient satisfaction and potentially better diagnostic specificity suggest that COM is a promising method for detecting visual field defects in glaucoma patients. The observed higher specificity of the COM perimeter may be attributed to its integrated eye-tracking system. The use and further refinement of this technology could enable greater precision in glaucoma diagnostics in clinical practice.

Purpose: Direct ophthalmoscopy (DO) teaching in medical curricula may be performed as classical or simulator-based DO. This interventional study evaluated both options.

Methods: 110 medical students received a multiple-choice questionnaire (four theory questions, six fundus photographs) prior to simulator-based (EyeSi Direct, Haag-Streit Simulation, Germany) and classical DO training (Heine BETA200, Heine Optotechnik GmbH, Germany). Training was performed in groups of eight students. Thereafter, they underwent an objective standardised clinical examination containing questions about (1) pupil dilation, (2) mydriasis contraindication, (3) ophthalmoscope adjustment and a practical test checking whether (1) optic nerve head, (2) macula, (3 - 6) upper/lower vessel arcade nasally versus temporally were identified correctly. Subsequently, classic DO was performed mutually and they reported the recognised funduscopic structures. Finally, the questionnaire was repeated one week later in combination with an evaluation of simulator-based versus classic DO.

Results: Students improved from an average of 4.0 ± 1.5/10 before to 8.8 ± 1.5/10 correctly answered questions after training (p < 0.0001, Wilcoxon matched-pairs test). 87|34|61 students named pupil dilating time|mydriasis contraindication and adjusted the ophthalmoscope correctly. They successfully identified the optic nerve head (n[simulator]|n[classic] DO: 110|68, p < 0.0001, Fisher's exact test), the macula (93|22, p < 0.0001), the upper (98|75, p = 0.0002) and lower temporal vessel arcade (101|91, p = 0.0672), the upper (84|56, p = 0.0001) and lower nasal vessel arcade (87|48, p < 0.0001). They wished for more simulator-based training, indicated more interest in ophthalmology after training and indicated an improvement in their ophthalmoscopy skills.

Conclusion: A standardised simulator-based approach improves medical students' skills in ophthalmoscopy and arouses professional interest in ophthalmology.

Background: This study investigates whether the myopia control efficacy of Peripheral Defocus spectacle lenses (PDL), as established in controlled trials, holds true in a real-world clinical environment.

Patients and methods: This single centre, retrospective study analysed clinical records from the University Eye Hospital Basel (2019 - 2024). Patients included had myopia diagnosis, had undergone at least three axial eye length measurements (approximately at 6, 12 and 18 months after starting therapy), and were treated with either PDL or Single Vision (SV) spectacle lenses exclusively, with no concurrent myopia treatments (e.g., atropine or contact lenses). Axial elongation and spherical equivalent (SE) were compared using independent t-tests. Statistical significance was set at p < .05.

Results: Of 177 patients, 30 were treated with PDL and 37 with SV lenses. Compared to SV lenses, PDL lenses significantly reduced axial elongation over 6, 12, and 18 months. At 6 months, average axial elongation in the left eye was 0.024 mm (CI: 0.007 - 0.041) in the PDL group compared to 0.101 mm (CI: 0.082 - 0.140) in the SV group (p = 0.005); in the right eye, - 0.003 mm (CI: - 0.040 - 0.034) vs. 0.112 mm (CI: 0.081 - 0.143) (p < 0.001). At 12 months, average axial elongation in the left eye was 0.088 mm (CI: 0.036 - 0.140) with PDL vs. 0.167 mm (CI: 0.119 - 0.215) with SV (p < 0.05); in the right eye 0.080 mm (CI: 0.029 - 0.131) vs. 0.191 mm (CI: 0.146 - 0.236) (p < 0.005).At 18 months, left eye elongation was 0.110 mm (CI: 0.028 - 0.192) with PDL vs. 0.229 mm (CI: 0.182 - 0.276) with SV; right eye 0.078 mm (CI: 0.008 - 0.148) vs. 0.254 mm (CI: 0.208 - 0.300) (p < 0.001 for both).No significant differences in SE were observed at 6 or 12 months. A significant difference in right eye SE was noted at 18 months (p = 0.044); however, no consistent trend emerged.

Discussion: This study confirms that PDL lenses significantly reduce myopic axial elongation compared to SV lenses in a real-world clinical setting. These results reinforce prior controlled trial findings and support the clinical adoption of PDL for effective myopia management.