Klinische Monatsblatter fur Augenheilkunde最新文献

Introduction: Infectious keratitis (IK) has been reported as the leading cause of corneal blindness worldwide, but is potentially avoidable by timely and accurate diagnosis followed by appropriate treatment. Bacterial pathogens remain the most frequently isolated organisms in IK. Fungal keratitis, although less common, is often associated with delayed healing and may require prolonged management. While most studies on IK originate from hospital-based settings, little is known about the incidence and characteristics of cases managed in office-based ophthalmic practices.

Methods: This investigator-initiated, retrospective, single centre chart review investigated cases of bacterial and fungal keratitis managed in an office-based, primary care ophthalmology clinic in Switzerland. We reviewed electronic patient charts for positive bacterial or fungal culture or polymerase chain reaction results, from anterior-segment scrapings and contact lenses. Antimicrobial susceptibility testing of clinically relevant isolates was performed according to the EUCAST guidelines at the time of isolation.

Results: Between 2014 and 2024, we identified 112 patients, 52 (46.4%), of whom were female. The median (IQR, range) age was 46 (33 to 63, 13 to 94) years. Across all cases, we detected 157 bacterial and 10 fungal isolates. Staphylococcus epidermidis was the most commonly isolated microorganism, followed by other coagulase-negative Staphylococci and Staphylococcus aureus.

Discussion: This study overviews bacterial and fungal species distribution among keratitis cases encountered in an office-based ophthalmology setting over ten years. The findings illustrate the microbial diversity seen in private practice, with a predominance of staphylococcal species and a small but notable number of fungal isolates. These findings highlight the importance of maintaining local diagnostic vigilance.

Background: Accurate ocular biometry is essential for achieving optimal refractive outcomes in cataract surgery. In patients with prior myopic LASIK, however, biometric calculations remain particularly challenging due to altered corneal anatomy.

Purpose: This study aims to compare preoperative biometric measurements obtained from the Zeiss IOL Master 700 and the CSO Ray-Tracing MS-39 in patients with a history of myopic LASIK. The goal is to assess the consistency and clinical relevance of these measurements to support intraocular lens (IOL) power selection in this complex patient group.

Setting: Longitudinal, monocentric, retrospective study, conducted at the Ophthalmology Department of the University Hospital of Modena.

Methods: Patients over 18 years of age scheduled for cataract surgery with a history of myopic LASIK and available preoperative biometry from both the IOL Master 700 and MS-39 were included. Exclusion criteria were incomplete clinical records, prior intraocular surgery, or significant ocular pathologies affecting measurement accuracy. The primary outcomes were differences in calculated emmetropic IOL power and predicted postoperative refraction. Secondary outcomes included comparisons of anterior chamber depth (ACD), central corneal thickness (CCT), average keratometry (K-avg), total corneal power (total keratometry [TK] from IOL Master 700 vs. mean pupil power [MMP] from MS-39), and predicted post-operative spherical equivalent (SE) by using the same IOL power, calculated from the IOL Master 700.

Results: Seventy-six eyes from 41 patients (mean age 46.54 ± 12.70 years; 60.98% female) were analysed. The average axial length was 25.93 ± 1.55 mm. An IOL constant of 119.0 was used uniformly across both devices. Statistically significant differences were found in all biometric parameters: ACD (p = 0.00 001), CCT (p = 0.0189), K-avg (p = 0.00 009), and total keratometry (p = 0.00 001). However, no significant differences were observed in the selected IOL power for emmetropia (p = 0.72 527), the predicted postoperative SE of the IOL Master 700 vs. the MS-39 (p = 0.81 642), or the predicted postoperative SE by using the same IOL power, calculated from the IOL Master 700, (p = 0.38 938).

Conclusions: Despite statistically significant differences in individual biometric parameters between the IOL Master 700 and MS-39, these did not impact final IOL power selection or predicted refraction in post-myopic LASIK patients. Utilizing multiple biometry devices may still enhance confidence and accuracy in surgical planning for this complex group of patients.

Autoimmune uveitis is an orphan disease with a prevalence of 0.4% and normally very effectively prevented by the immune privilege of the eye. The immune privilege can be overcome, because an immune response that is activated outside the eye against foreign antigens enables T cells to enter the eye and also recognises intraocular antigens via cross-reactivity (antigenic mimicry) and thus triggers uveitis. This leads to the migration of lymphocytes into the eye, followed by the invasion of inflammatory cells that cause the destruction of intraocular structures. Antigenic mimicry can also be used therapeutically to induce oral tolerance. The discovery of the tolerance-inducing but non-pathogenic mimicry epitope B27PD made it possible to treat therapy-refractory uveitis patients by inducing oral tolerance. All 8 treated patients were able to reduce their steroid therapy, with stable or improved visual acuity, and two have been free of recurrence and therapy since oral tolerance induction 30 years ago. Later, the establishment of two new animal models for spontaneously recurrent and chronic uveitis has provided new insights into the role of different T cell types in the eye and allowed us to develop and test new therapies in ongoing autoimmune reactions, as corresponding to the situation in uveitis patients. These new animal models also enabled the development of a small molecule dihydroorotate dehydrogenase (DHODH) inhibitor PP-001/KIO-100 for the treatment of uveitis, which inhibits lymphocytes but has no toxic effects on intraocular cells (in vivo: rat) and human retinal pigment epithelial cells (RPE, in vitro). This was followed by a successful phase I trial for patients with non-infectious posterior uveitis, by intraocular application of PP-001/KIO-100 - without side effects, but with improvement of visual acuity and reduction in inflammation and CME.

Background: Canaliculitis is often mis- or underdiagnosed, leading to delayed and sometimes inadequate treatment.

Patients and methods: Thirteen patients with in total of 17 affected canaliculi were analysed. Collected data included demographic characteristics, the affected canaliculus (upper or lower, right or left), duration of symptoms until the correct diagnosis, and previous misdiagnoses and treatments. The objectives of this study were to determine the diagnostic delay and frequency of misdiagnosis, to identify characteristic clinical features, and to evaluate treatment outcomes following surgical management. Additionally, the presence of Actinomyces species in removed concretions from the canaliculi were histologically assessed.

Results: The mean age was 61 ± 11 years (range 36 - 73 years). The mean duration of symptoms before correct diagnosis was 14 ± 13 months (range 1 - 48 months). All 17 affected canaliculi were treated surgically by canaliculotomy. At a mean follow-up of 12 ± 10 months (range 2 - 52 months), all canaliculotomies remained patent. Twelve of 13 patients (92%) were completely symptom-free, and no recurrence of canaliculitis occurred. In 15 out of 17 canaliculi, concretions were found intraoperatively. Histological examination identified Actinomyces species in 11 of 15 concretions (73%; 95% confidence interval, Wilson method: 48 - 89%), supporting their leading role as causative organisms of canaliculitis.

Conclusion: Canaliculitis remains a mis- or underdiagnosed condition despite its characteristic clinical presentation. Increased awareness and recognition of its typical signs are essential to avoid misdiagnosis and unnecessary treatments. Surgical canaliculotomies allow complete removal of bacterial concretions which are found in the canaliculi for the most part. Therefore, timely canaliculotomy should be regarded as the treatment of choice for this often-overlooked condition.