Klinische Monatsblatter fur Augenheilkunde最新文献

Background: Corneal and epithelial thickness maps obtained with high-frequency ultrasound were first used to diagnose keratoconus. Anterior segment OCT has recently become widely used in many conditions especially in preoperative planning before refractive surgery, keratoconus diagnosis, keratoconus progression monitoring, hydrops formation, and epithelial healing monitoring. We compare epithelial and pachymetric thickness-based parameters from two different Fourier-domain optical coherence tomography (OCT) devices as to whether they can be used interchangeably.

Methods: Retrospective, comparative chart review. This study comprises 24 normal consecutive eyes and 32 consecutive post-SMILE eyes with corneal thickness and epithelial thickness maps obtained using two different OCT devices (Cirrus 5000, Carl Zeiss Meditec, Germany and Avanti RTVue 100, OptoVue Inc., USA). The following common parameters in the print-out of the two OCT devices were examined: minimum corneal thickness (Pachy min), minimum corneal thickness minus median corneal thickness (Pachy min-med), average corneal thickness of the superonasal octant minus the average corneal thickness of the inferotemporal octant (Pachy SN-IT), average corneal thickness of the superior octant minus average corneal thickness of the inferior octant (Pachy S-I), minimum epithelial thickness (Epi min), and maximum epithelial thickness (Epi max).

Results: Pachy min and Epi max measurements matched well between the two devices (ICC at 0.906 and 0.839, respectively). We found a significant correlation in Pachy min (p = 0.040), Pachy min-med (p = 0.033), and Epi max (p < 0.001) in the normal eye group. Only Pachy min and Epi max measurements (p < 0.001 for both) exhibited a significant correlation between the two devices in the post-SMILE group.

Conclusion: Anterior segment OCT is a valuable method for evaluating quantitative corneal and epithelial thickness measurements. However, measurements may differ between devices, and they should not be used interchangeably.

Purpose: To investigate the efficacy of switching treatment from 2 mg aflibercept to high-dose 8 mg aflibercept in neovascular age-related macular degeneration (nAMD).

Methods: The database was screened for eyes with nAMD switched from 2 mg to 8 mg aflibercept. Demographic data, multimodal imaging, treatment parameters and outcomes were recorded. Efficacy of 2 mg vs. 8 mg aflibercept was compared four injections prior to, and four injections after switching by analysing central subfield thickness (CST), subretinal fluid (SRF) and intraretinal fluid (IRF) as well as visual acuity (VA).

Results: Sixteen consecutive eyes of 16 patients (mean age 78.5 ± 5.5 years) were identified. There were 13 women (81.3%) and 3 men (18.7%). Prior to switching, mean anti-vascular endothelial growth factor (VEGF) treatment duration for nAMD was 8.1 ± 2.1 years and pretreatment amounted to a mean of 27.8 ± 23.6 injections. Mean injection intervals were similar prior to and after switching (5.05 vs. 5.13 weeks; p = 0.76). CST remained stable before and after switching (p = 0.25). After switching, the percentage of eyes with a dry macula increased from 0% to 37.5% (p = 0.02) and the percentage of eyes with SRF decreased from 93.8% to 56.3% (p = 0.037). There was a trend, but no significant effect towards a reduction of IRF (18.8% to 6.3%, p = 0.60). Visual acuity remained stable irrespective of treatment (p = 0.78).

Conclusions: Concerning CST on OCT, no clear advantage of high-dose 8 mg aflibercept over conventional 2 mg aflibercept was seen in this study. However, with high-dose 8 mg aflibercept the number of eyes with a dry macula increased, and the amount of eyes with SRF decreased significantly. In pretreated eyes, the analysis of macular fluid compartments (as compared to CST) might be more sensitive for comparing treatment effects between 2 mg and 8 mg aflibercept.

The corneal endothelium is the innermost layer of the human cornea and it acts as a barrier between the aqueous humor and the corneal stroma, thus maintaining the hydration of the cornea. Both congenital dystrophies including (1) Fuchs' endothelial corneal dystrophy (FECD), (2) posterior polymorphous corneal dystrophy (PPCD), (3) congenital hereditary endothelial dystrophy (CHED), (4) X-linked endothelial corneal dystrophy (XECD) and age-related degenerations like (5) pseudoexfoliation-related (PEX) keratopathy, (6) pseudophakic bullous keratopathy (PBK), (7) iridocorneal endothelial (ICE) syndromes and endothelial graft rejection after keratoplasty can impair this function and are described in this review article.

Purpose: The study aimed to assess the reliability of tele-education in training a Malawian ophthalmology resident to interpret optical coherence tomography (OCT) images of patients with macular conditions.

Methods: This was a retrospective analysis of 1000 macula-centered OCT image series from 1000 eyes of 1000 consecutive patients from Malawi, which involved initial interpretation by a German retina specialist (observer 1) (T₀). Observer 1 then trained a Malawian resident (observer 2) via email, and observer 2 independently interpreted images at T₁, followed by face-to-face training in Malawi and reinterpretation at T₂ and T₃ (3-month intervals). The observers had to recognize, on OCT imaging, the normal macular structure, vitreofoveal traction (VFT), absent fovea depression (FD), epiretinal membrane (ERM), lamellar macular hole (LMH), full-thickness macular hole (FTMH), foveoschisis, intraretinal pseudocyst (IPC), intraretinal hyperreflective foci (IHF), subretinal fluid (SRF), pigment epithelial detachment (PED), and drusen. Cohen's Kappa statistic measured inter-observer agreement.

Results: At T₁ post-tele-education, almost perfect agreement (κ = 0.86; 99.6% agreement) was observed for FTMH. Agreement remained high at T₂ post-face-to-face training (κ = 0.9; 99.7%) and decreased substantially at T₃ (κ = 0.77; 99.4%). Following tele-education (T₁), substantial agreement (κ range: 0.77 - 0.86) was found for IPC, PED, IHF, and FD, while ERM showed fair agreement (κ = 0.33; 81%). Face-to-face training notably improved agreement for SRF (T₁ κ = 0.6, T₂ κ = 0.63), LMH (T₁ κ = 0.6, T₂ κ = 0.67), and normal macular structure (T₁ κ = 0.6, T₂ κ = 0.62).

Conclusion: There was good agreement in the detection of the majority of the OCT features seen in most of the macular pathologies following training through tele-education and the results did not change significantly following face-to-face teaching. Tele-education could reliably complement training in vitreoretinal diagnostic skills in resource-limited settings.

Purpose: To evaluate the visual and corneal outcomes of Keratorefractive Lenticule Extraction (KLEx) using a large lenticule diameter with a 7.7 mm optical zone and 7.9 mm cap diameter. The study aimed to determine the feasibility, refractive precision, and potential benefits of larger optical zones in improving visual quality and reducing myopic regression, particularly in patients with larger scotopic pupils.

Methods: This retrospective case series included 40 eyes from 20 patients who underwent KLEx surgery with the VisuMax800 femtosecond laser. The programmed lenticule diameter was 7.7 mm, and the cap diameter was 7.9 mm, with a cap thickness of 140 µm and a 2.5 mm incision. Preoperative spherical equivalents ranged from - 1.5 D to - 4.75 D. Postoperative evaluations were conducted at 3 months, and assessed refractive outcomes, uncorrected visual acuity (UCVA), and residual astigmatism. Surgical planning was based on a personalized nomogram with refractive adjustments for low astigmatic values.

Results: At 3 months, 100% of eyes achieved a UCVA of 20/20, and 25% reached 20/16 or better. The mean postoperative spherical equivalent was + 0.14 ± 0.27 D. Refractive predictability was high, with 97.5% of eyes within ± 0.5 D of intended spherical correction and 90% within ± 0.5 D of cylindrical correction. Residual astigmatism was ≤ 0.50 D in 87% of cases. No adverse events were reported.

Conclusions: KLEx using large lenticules is safe, effective, and highly accurate. Larger optical zones may enhance refractive stability and visual quality in patients with large pupils.

Purpose: To assess the functional outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial corneal dystrophy in fellow eyes.

Methods: Retrospective study of 28 eyes (14 patients) undergoing UT-DSAEK in one eye and DMEK in the fellow eye with a follow-up of at least one year. Main outcomes were best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), and anterior and posterior tomographic parameters, including corneal higher-order aberrations (HOAs).

Results: The UT-DSAEK and DMEK groups showed no differences in donor characteristics or preoperative corneal tomographic parameters. BCVA improved in both groups, but visual recovery was faster in the DMEK group. CCT and ECD decreased in the UT-DSAEK and DMEK groups, but without differences between the groups. Posterior mean keratometry and posterior Q-value increased in the UT-DSAEK and DMEK groups with higher values of both parameters in the UT-DSAEK group. As regards corneal aberrations, higher root mean-square values for HOAs of the posterior cornea and higher values of posterior Trefoil were evident in the UT-DSAEK group than in the DMEK group.

Conclusion: Visual quality after endothelial keratoplasty might depend not on visual acuity alone, but also on corneal aberrations and asphericity of the anterior and posterior corneal surface. The results support the benefits of DMEK over UT-DSAEK, suggesting the need for long-term studies with a larger number of patients.

Background: Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a pathognomonic manifestation of ocular syphilis. Although formerly considered as being uncommon, its incidence appears to be increasing in recent years. Advances in multimodal imaging, particularly spectral domain optical coherence tomography (SD-OCT), have provided new insights into its pathophysiology and natural course.

Case series: We present three cases of ASPPC with multimodal imaging and long-term follow-up. Clinical history, fundus findings, fluorescein and indocyanine green angiography, fundus autofluorescence and SD-OCT were reviewed. All patients exhibited systemic symptoms prior to ocular involvement and presented with bilateral uveitis, vitritis, and placoid yellowish macular lesions. SD-OCT demonstrated granular RPE thickening, ellipsoid zone disruption, followed by RPE-nodular elevations. These findings likely reflect an inflammatory response in the choroid and choriocapillaris, causing vascular alterations and metabolic impairment of the RPE and the outer retina. With appropriate systemic antibiotic therapy, OCT findings progressively normalised in parallel with gradual visual acuity improvement over 1 - 2 months.

Conclusions: These cases illustrate the characteristic clinical features of ASPPC and highlight the role of SD-OCT in both diagnosis and follow-up. Prompt recognition of ocular syphilis remains crucial and particularly rewarding for the ophthalmologist, who is often the first to recognise ocular syphilis, thereby preventing life-threatening systemic complications and achieving successful treatment of ocular manifestation.