Klinische Monatsblatter fur Augenheilkunde最新文献

Purpose: To describe the risk management at a university eye hospital after two outbreaks of nosocomial endophthalmitis cases after pars plana vitrectomy.

Methods: In two series of postoperative endophthalmitis cases after in-house vitrectomy, the basic workflows in direct patient care were evaluated with regard to patient safety. Hygienic microbiological environmental examinations were performed on relevant materials and surfaces. In particular, the direct surgical utensils were inspected with regard to possible bacterial colonisation.

Results: Pathogens (Staphylococcus aureus) were detected in 2 of 7 endophthalmitis cases. The S. aureus strains showed no clonality. The procedures were 23 G and 25 G vitrectomies for retinal detachment (3× rhegmatogenous, 1× PVR), subretinal macular hemorrhage (1×) and vitreous haemorrhage for proliferative retinopathy (2×). The duration of surgery was between 20 min and 65 min; the time between initial vitrectomy and the surgery for endophthalmitis was between 2 and 5 days (mean 3.6 days). A silicone oil filling was instilled once during the first operation and otherwise the eye was tamponaded with gas (4×) or air (2×). The surgical teams were heterogeneous; n = 5 surgeons were involved and the initial procedures took place in n = 4 different operating theatres. In all cases, general anaesthesia was applied (6× laryngeal mask, 1× endotracheal intubation). No definitive source of infection was found. The interventions with regard to patient safety were therefore aimed at strengthening compliance with existing measures for preventing infection and adapting work processes. In the acute phase, antibiotics were instilled intraoperatively into the anterior chamber after vitrectomy, contrary to the usual in-house procedure. Other types of intraocular surgery were not affected.

Conclusion: The accumulation of in-house endophthalmitis cases is a catastrophic event in an eye clinic and stringent risk management is required to identify the causes. Openness and transparency are essential factors for an adequate workup. This manuscript shows what the individual steps could look like and how the results can be dealt with. The problem of not having found a clear point source for the infections is discussed.

The conjunctiva is a central component of the ocular mucosal system and, together with the Meibomian glands of the eyelids and the lacrimal glands, fulfills nutritive and defensive functions on the ocular surface. The conjunctiva is integrated into a dense neural and immunological network called the "Conjunctiva-associated Lymphoid Tissue" (CALT) 1 2. This network perceives various stimuli and responds in a finely tuned manner to provide protection while minimizing collateral damage. This must be viewed in the context of resident microorganisms ("commensal flora") colonizing the conjunctiva (microbiome), and numerous biophysical factors that can disrupt the homeostasis of the ocular surface. Inflammatory changes are of primary concern and are differentiated according to their origin as either infectious or non-infectious. This CME article provides an overview of non-infectious inflammatory pathologies.

Purpose: To determine the most common reasons for treatment discontinuation in patients with retinal diseases undergoing intravitreal injections (IVI s).

Methods: A retrospective study was conducted with all patients who underwent IVI therapy in our Department of Ophthalmology between January 2016 and January 2024. We investigated the reasons for therapy discontinuation, including non-persistence (declining therapy). Patients who declined therapy (non-persistence) were compared with the remaining patients to determine the potential factors responsible for their decision.

Results: The mean age of the 2218 patients (1155 women, 1063 men) who took part in the study was 77.6 ± 12.0 years. A total of 1029 patients (46.4%) achieved a dry macula in both eyes at the time of the study. Treatment was discontinued in 865 patients (39%) due to poor prognosis (visual acuity < 1.3 logMAR) (188, 8.4%), change to another medical centre (175, 7.9%), comorbid systemic diseases (128, 5.7%), loss of contact (128, 5.7%), financial problems with health insurance (13, 0.5%) or death (59, 2.6%), while 174 patients (7.8%) declined IVI therapy (non-persistence). Compared to the other patients, non-persistence patients were significantly older (76.2 ± 12 vs. 81.2 ± 11, p < 0.001), had significantly worse visual acuity (logMAR) at the last visit (0.50 ± 0.5 vs. 0.29 ± 0.2, p = 0.001), received a significantly higher number of IVI s (10 ± 11 vs. 14 ± 15, p < 0.001) and had a significantly higher proportion following the pro re nata treatment protocol (59% vs. 72%, p = 0.001).

Conclusion: The most common reason for treatment discontinuation was the poor prognosis, which related to the nature of macular diseases. Advanced age, higher number of injections, pro re nata protocol and reduced visual acuity during therapy were identified as factors that affected patient non-persistence to treatment.

Lasers are present in nearly every aspect of modern life - in daily activities, medicine, and industry. While this innovative technology offers great benefits to society, it can also be misused, whether intentionally or unintentionally. Globalisation has fostered rapid development and wider distribution of high-energy lasers, including illegal trade and unregulated use, and has resulted in a rising number of laser-related eye injuries in recent years. This review addresses these concerns and compiles current knowledge on the subject. It begins with an overview of laser basics and historical milestones, then examines the physical and biological fundamentals of laser-tissue interactions. We discuss the latest laser innovations and the challenges they pose in introducing new technologies. An up-to-date overview of relevant laws and DIN standards for ophthalmic laser applications is provided, followed by a clinical perspective on laser attacks in civilian and military contexts and strategies for eye protection. The aim is to raise awareness of the potential risks associated with everyday laser use and to highlight the importance of safety measures alongside the many uses of lasers.