Klinische Monatsblatter fur Augenheilkunde最新文献

The Section on Tissue Transplantation and Biotechnology of the German Ophthalmologic Society presented its 11th annual report for the year 2021. The number of corneal samples has still risen in comparison to former years. Nevertheless, there is still a need for import of transplants from abroad. Therefore, the transplant bottleneck has not yet been eliminated.

Background: Glaucoma is a leading cause of blindness worldwide. We evaluated the efficacy, confounders, and safety of the Preserflo Microshunt over a one-year follow-up period.

Methods: In this retrospective monocentric study, 111 eyes were evaluated. 83 eyes had primary open angle glaucoma, and 28 eyes secondary open angle glaucoma. Intraocular pressure (IOP), visual acuity, number of glaucoma medications, complications, and reoperations were evaluated postoperatively, at 1, 3, 6, 9, and 12 months. The influence of age, sex, type of glaucoma, previous surgery and lens status was also analysed. Bleb revision was indicated if corrected IOP exceeded 18 mmHg.

Results: Intraocular pressure significantly decreased from 24.50 ± 8.94 to 14.62 ± 4.86 mmHg (4 - 32 mmHg; p < 0.001), the number of medications from 3.19 ± 1.14 to 0.98 ± 1.39 (0 - 4; p < 0.001). Confounders of interest did not affect efficacy. Bleb revision was performed in 22.5% of eyes and a cyclophotocoagulation was performed in 9.9% of eyes. Complete surgical success (IOP ≤ 17 mmHg, IOP reduction ≥ 20%, without medication) was achieved in 36.9% (n = 41) and qualified success (with medication) in 51.4% (n = 57) of eyes. Transient hypotension (≤ 5 mmHg) occurred in 19.8% after primary implantation and in 1.8% after bleb revision (duration ≤ 3 months).

Conclusion: To date, the Preserflo Microshunt has demonstrated good efficacy and a low risk profile.

Background: Chorioretinopathy centralis serosa (CCS) is a common disease that leads to the loss of retinal ion/fluid homeostasis due to decompensation of the retinal pigment epithelium, resulting in fluid accumulation with detachment of the neurosensory retina and/or retinal pigment epithelium. We investigated the effect of eplerenone, a mineralocorticoid receptor inhibitor, on chronic recurrent CCS (cr-CCS).

Methods: A retrospective study with data analysis of 17 eyes (12 patients) between 2014 - 2021 with cr-CCS in whom other methods were not effective, not applicable, or not desired, was performed. Duration of CCS was at least 12 months with at least one recurrence. Each patient received 25 mg (1st week) and 50 mg (from the 2nd week) for at least 3 months. In each case, best-corrected visual acuity and central and peripheral retinal thickness were measured by spectral-domain optical coherence tomography. Side effects were rated by the patients as "none", "mild" (noticeable but not affecting), "tolerable" (affecting but acceptable because of good effect), and "not tolerable" (then discontinuation of therapy).

Results: There was no significant reduction in central or peripheral retinal thickness. A complete reduction of subretinal fluid was achieved in 5 of 17 eyes (29.4%). In 12 eyes, no effect of eplerenone could be detected, so other therapies were required. Visual acuity change was mainly dependent on the duration of CCS and the degree of photoreceptor damage. Side effects were reported by 11 patients as "none" and 1 patient as "mild" (arterial hypotension). No other side effects were observed.

Conclusion: The response rates of therapy with eplerenone were relatively low, and no significant effect could be demonstrated. Eplerenone should not (no longer) be routinely used in the therapy of cr-CCS.

Artificial intelligence (AI) has already found its way into ophthalmology, with the first approved algorithms that can be used in clinical routine. Retinal diseases in particular are proving to be an important area of application for AI, as they are the main cause of blindness and the number of patients suffering from retinal diseases is constantly increasing. At the same time, regular imaging using high-resolution modalities in a standardised and reproducible manner generates immense amounts of data that can hardly be processed by human experts. In addition, ophthalmology is constantly experiencing new developments and breakthroughs that require a re-evaluation of patient management in routine clinical practice. AI is able to analyse these volumes of data efficiently and objectively and also provide new insights into disease progression and therapeutic mechanisms by identifying relevant biomarkers. AI can make a significant contribution to screening, classification and prognosis of various retinal diseases and can ultimately be a clinical decision support system, that significantly reduces the burden on both everyday clinical practice and the healthcare system, by making more efficient use of costly and time-consuming resources.

There are only about 100 case reports on the Acute Idiopathic Blind Spot Enlargement Syndrome (AIBSES). This is characterised by the eponymous visual field loss in the blind spot area, acute onset photopsia, and funduscopically little or no change in the optic disc area, with conspicuous outer retinal bands on optical coherence tomography (OCT). Typical is the unilateral occurrence. Predominantly young women are affected. While previous reviews of AIBSES either predate the introduction of OCT or focus on differentiation from potentially related outer retinal conditions (e.g., multiple evanescent white dot syndrome and acute zonal occult outer retinopathy), the present review will concentrate on the current perspective and treatment strategies that have been developed and will aim to help increase awareness. Since the first description of AIBSES in the late 1980s, the introduction of OCT has simplified the diagnosis and characterisation of AIBSES as a disease of the outer retina. Nevertheless, misdiagnosis remains common in the spectrum of optic neuritis, as AIBSES may be ignored in differential diagnosis.

Purpose: To report a case of severe verrucous posterior polymorphous corneal dystrophy (PPCD) and cataract, which was treated with Descemet membrane endothelial keratoplasty (DMEK) and simultaneous cataract surgery as a triple procedure (Triple-DMEK).

Methods: A 62-year-old female patient presented to our department for co-evaluation of advanced PPCD with cataract and progressive light sensitivity in both eyes. The clinical examination demonstrated unusual clinical findings with prominent verrucous lesions on the posterior surface of the cornea without corneal decompensation. We performed a Triple-DMEK in case of simultaneous cataract. The corneal tissue was examined by light and transmission electron microscopy.

Results: Intraoperatively, it was difficult to remove the verrucous structures completely after classical descemetorhexis. Light microscopic examination demonstrated epithelium-like transformation of the corneal endothelium by immunostaining (cytokeratin AE1/3 staining). Transmission electron microscopy revealed thickening of Descemet's membrane (18.5 to 30.0 µm). The anterior banded layer had a normal structure and was slightly thickened (3.5 to 5.5 µm). A normal posterior non-banded layer (PNBL) was observed but thinned (2.5 to 4.0 µm) or missing. It was followed by an altered PNBL with abnormal fibrillary inclusions, which was strongly and variably thickened (11.0 to 24.5 µm). The corneal endothelium was degenerated, partially absent, and epithelial-like altered. The nodular lesions were found to consist of a few degenerated cells that were embedded in an amorphous extracellular matrix interspersed with collagen fibers, which were not arranged in regular lamellae, forming the corneal stroma. The occurrence of pigment granules among the cellular debris suggested that the cells were endothelial cells. The corrected distance visual acuity improved from 20/50 to 20/30 in the right eye (+ 0.00/- 1.75/157°) and from 20/60 to 20/30 in the left eye (+ 0.00/- 1.75/33°), with significant improvement in light sensitivity.

Conclusion: The clinical and ultrastructural findings seem to be an unusual variant of the typical characteristic appearance of a PPCD. This case demonstrates that Triple-DMEK is feasible even in very advanced dystrophic changes of the posterior corneal surface, with good morphological and functional results.