Klinische Monatsblatter fur Augenheilkunde最新文献

The numbers of low vision patients will steadily increase because of increasing longevity. If patients are no longer able to receive medical treatment to improve their vision, they should be fitted with visual aids, e.g. magnifiers, as soon as possible. In addition, it should always be clarified whether comprehensive care is also necessary for various areas of life. After optical rehabilitation had already been discussed in a previous article in 2018 2, this article describes the approach and content of comprehensive care for patients for different areas of competence in different life situations.

As retinal vein occlusion is such a complex systemic disease, its underlying risk profile should be narrowed down individually. Ophthalmologists should always rule out glaucoma or ocular hypertension while also screening the patient for systemic vascular diseases or risk factors in particular. Intravitreally applied medication (VEGF inhibitors or steroids) and laser coagulation (focal or panretinal) or a combination thereof can be considered to treat such retinal anomalies.

In recent years, techniques for the secondary implantation of intraocular lenses have undergone significant further development. Despite the wide range of surgical indications, IOL dislocation and aphakia following complicated cataract surgery or other complicated intraocular procedures and trauma remain the most common reasons for secondary IOL implantation. In cases where it is not feasible to place the artificial lens in the capsular bag due to zonular weakness or insufficient stability of the capsular bag, the intraocular lens can be implanted in the anterior chamber or fixed in the ciliary sulcus, on the iris or on the sclera. The techniques differ not only in the anatomical structure of the fixation, but also in the type of intraocular lens and materials used. While some methods are technically easier and quicker to perform, the learning curve for other techniques is flatter and takes more time. The experienced ophthalmic surgeon should be familiar with several of these methods and be aware of the advantages, disadvantages and contraindications of the individual techniques in order to be able to choose the most suitable method based on the findings of the individual patient.

Introduction: Congenital dacryocystoceles are a rare condition caused by nasolacrimal duct obstruction. Symptoms include epiphora, nasal obstruction, and swelling in the medial canthus. Treatment usually entails probing Hasner's valve open and, if necessary, intubating the nasolacrimal duct. We present a minimally invasive, endoscopic procedure with marsupialisation of the endonasal portion of the cele. The operation avoids additional manipulation of the lacrimal duct to prevent iatrogenic injury.

Methods: This retrospective analysis included a total of nineteen infants or young children (21 eyes) aged 3 days to 39 months. Two of the patients were suffering from acute respiratory distress, seven from recurrent infections with persistent epiphora, and twelve from acute dacryocystitis with orbital phlegmon.

Results: The endonasal portion of the dacryocele was detected in all cases and resected endonasally using an endoscope. Recurrences required revision surgery involving dacryocystorhinostomy after primary surgery in two patients aged of 22 and 39 months. All other seventeen patients were free of recurrence.

Summary: Our results show endoscopic endonasal marsupialisation without additional intubation or probing of the lacrimal ducts to be a successful treatment strategy for congenital dacryocystoceles. This avoids iatrogenic scarring, false passages, or postoperative bacteraemia. The surgical technique presented here shows a lower success rate in older children with a history of inflammation.

Background: Noninfectious posterior and panuveitis may exhibit a chronic relapsing clinical course and are challenging to treat. Most affected patients are continuously treated with systemic immunosuppressive therapy, which is potentially associated with significant adverse side effects.

Methods: A cohort of 18 patients presenting with severe noninfectious posterior or panuveitis were evaluated with respect to the clinical course of the disease, with particular focus on best-corrected visual acuity (BCVA), treatment duration, remission rates, reported negative side effects, and the necessity for switching medication.

Results: The mean follow-up was 27.8 months. Although BCVA improved significantly, complete or partial remission was observed in only 66.7% of patients. Of the patients, 72.2% underwent a change in medical treatment due to either adverse events or inefficacy of medication.

Conclusion: Despite new immunosuppressive therapies, effective treatment of severe noninfectious posterior and panuveitis remains a major challenge. We discuss the urgent need for novel treatment strategies in order to prevent systemic adverse effects, and to improve visual outcome and quality of life.

Background: Anti-VEGF therapy is the standard treatment for exudative neovascular age-related macular degeneration (nAMD) caused by the development of macular neovascularisation (MNV) with associated fluid exudation. The therapeutic strategies (T&E or PRN) assumed a scarring transformation of the MNV and exit strategies and were formulated accordingly. The present study investigates this hypothesis as a real-life long-term analysis.

Patients: 150 eyes of 97 patients were continuously followed up over a mean period of 5.1 years (1 - 14 years) after initiation of anti-VEGF therapy between 2009 - 2017 until 2022. Treatment was based on the PRN regimen analogous to the IVAN study with ranibizumab, aflibercept or bevacizumab. The length and intensity of therapy were evaluated.

Results: Of these 150 eyes, 119 (79.3%) required ongoing anti-VEGF therapy, while in 18 eyes (12.0%) therapy could be discontinued due to stabilisation of the situation. In 13 eyes (8.7%), therapy was discontinued due to deterioration in visual acuity to < 0.05. With ongoing therapy, therapy was often protracted, with an indication for therapy at the last documented doctor's visit, while stabilisation was often achieved within the first 2 years of treatment. The treatment intensity increased to 7.7 - 8.0 injections/year, especially after 2013, with the introduction of OCT-based treatment criteria. Most eyes (74.8%) with ongoing therapy required 6 - 9 injections/year even in the last three years of treatment.

Conclusion: The fact that in the present study there is a long-term and intensive need for therapy in the majority of patients (approx. 80%) with exudative nAMD, supports the assessment that nAMD should be regarded as a chronic disease. Therefore, a proactive treatment strategy with consistent therapy at any sign of lesion activity might be recommended. Particularly in view of the risk of irreversible loss of vision, long term adherence of patients is also crucial for the best possible long term therapeutic outcome.

Purpose: The aim of this study was to compare the biometric measurements and different formulas for calculating intraocular lens (IOL) power by using the Lenstar LS900 biometer for optical low-coherence reflectometry before and after induction of cycloplegia in the adult population.

Materials and methods: In this cross-sectional study, 168 eyes of 168 healthy volunteers aged 40 - 86 years (59.22 ± 11.57) were included. Biometric measurements, including axial length (AL), anterior chamber depth (ACD), keratometry (K1 and K2), and white-to-white (WTW) were compared using a Lenstar LS900 optical biometer before and after induction of cycloplegia with 1% cyclopentolate. The IOL power was also compared using six different formulas (Barrett Universal II, Haigis, SRK/T, Hoffer Q, Holladay, and SRK-II) for the AcrySof MA60AC IOL before and after induction of cycloplegia.

Results: There were no statistically significant differences in AL, K1 and K2, or WTW measurements before and after induction of cycloplegia. There was a significant increase only in ACD from the biometric parameters after the induction of cycloplegia (p < 0.05). Despite this change, there were no significant changes in IOL power calculations using the six different formulas before and after induction of cycloplegia.

Conclusions: This study demonstrated that IOL power measurements using the Lenstar LS900 can be performed after cycloplegia.

Background: The aim of the study was to capture images that form on the human retina after the simulated implantation of an intraocular lens (IOL). White light was used rather than the commonly used near-infrared light, which is unsuitable for the examination of diffractive IOLs. For this purpose, a special optical setup was developed to investigate the influence of the IOL design on two-dimensional retinal images in vivo.

Materials and methods: A double-pass ophthalmoscopic setup with a scientific CCD camera system was developed. Imaging the retinal image of a white LED located at infinity provides access to the double-pass point spread function of the natural eye. Subsequently, a see-through device for simulated IOL implantation (VirtIOL, 10Lens S. L. U., Terrassa, Spain) was integrated to investigate the influence of the IOL design on the retinal image quality of complex scenarios.

Results: Retinal images were acquired from an incoherent white point light source. Combined with simulated IOL implantation, retinal images were acquired from the point light source, letters, and a United States Airforce target on a 6-m distant monitor. As expected, the double-pass images obtained with a monofocal IOL were sharper than those obtained with a multifocal IOL.

Conclusion: The method opens up access to double-pass point spread function for white light, thus solving the problem of infrared light-based methods providing incorrect results when examining diffractive IOLs. This approach may be helpful for the investigation of perception in the future.

Objectives: To investigate the correlation between postoperative endothelial cell loss (ECL) and donor, host, and surgical parameters, and to assess the clinical impact of maintaining a high endothelial cell density (ECD) of ≥ 1500 cells/mm² 5 years after penetrating keratoplasty (PKP).

Methods: This retrospective cohort study included 216 eyes with 5 years of follow-up, of which 94 had annual visits, and who underwent normal-risk elective PKP for noninfectious indications by one corneal microsurgeon (B. S.) between 2009 and 2016.

Results: Among the 216 eyes, ECL (39.1%) over 5 years postoperative exhibited weak positive correlations with storage solution time (p = 0.024) and postmortem time (p = 0.028), and moderately positively correlations with the preoperative ECD (p < 0.001). The 5-year postoperative ECL differed significantly between in domo-prepared (36.8%) and ex domo donor corneas (46.3%; p = 0.001). In the 94 eyes, no significant differences were found between the two groups for central pupil pachymetry (CCT) and BCVA (p > 0.074). However, CCT increased significantly between 1 and 4 years (p = 0.034) and 1 and 5 years postoperatively (p = 0.012), respectively. BCVA improved significantly at 1 year postoperatively and continued to improve until 2 years postoperatively (p < 0.001).

Conclusion: The Lions corneal bank Saar-Lor-Lux achieved a significantly reduced ECL (36.8%) over 5 years compared to ex domo donor corneas (46.3%). A weak positive correlation was found between ECL with the storage solution time and the postmortem time, as well as a moderate positive correlation with the preoperative ECD. Although CCT increased significantly over 5 years, BCVA improved significantly from the first to the second postoperative year and remained stable thereafter.

Optical biometry has fundamentally transformed cataract surgery, and 2024 marked 25 years since the introduction of the first optical biometer. In the early 1980 s, Fercher and colleagues pioneered the optical noncontact eye length measurement, leading to the first interferometric A-scan of the eye. This innovation, patented and later developed by Zeiss, culminated in the release of the IOLMaster in 1999, enabling more accurate and reproducible eye diagnostics. Over the years, optical biometry has evolved into advanced swept-source optical coherence tomography devices, accompanied by numerous formulas for calculating intraocular lens power. Today, this technology is crucial not only for cataract surgeries, especially in eyes previously treated with refractive surgery, but also in advancing our understanding of diseases across fields like cardiology and oncology.