Klinische Monatsblatter fur Augenheilkunde最新文献

Background: Attending information presented in the peripheral visual field is crucial for many tasks, such as car driving and playing sports. A substantial body of research addresses the performance in detecting visual information across the visual field. However, there is a lack of studies presenting targets in a naturalistic visual environment and controlling the location of fixation by recording gaze objectively. The present study aims to close this gap and contribute to the knowledge on role of retinal periphery in information processing.

Method: Central and peripheral targets were presented on a dynamic background consisting of car driving, as seen from the position of the driver. Targets consisted of six-digit numbers presented for 200 ms, either in the central visual field or at a ± 15.3° periphery on the horizontal meridian. The acuity demand of the target was 0.1, exceeding peripheral acuity. In 50% of cases, the target included the digit "3". Participants were instructed to report as quickly and accurately as possible, whether or not the presented number included the digit "3". While performing the test, the gaze of participants was recorded with a commercial device. Correct and incorrect responses were analysed separately for responses occurring while the target was fixated and responses given without fixation of the target.

Results: Participants were 53% female with a mean (SD) age of 29.7 (1.6) years. Number of correctly detected targets was found to be significantly higher (p < 0.0001, binomial test, two-tailed) than the number of targets reported incorrectly, no matter whether the target was fixated or not.

Conclusions: Findings from this study suggest that target recognition in a naturalistic environment operates in the central and in the peripheral visual field as well, provided the acuity demand of the target exceeds the acuity of the peripheral visual field. Fixation of the target is beneficial for performance but not required. Further studies will explore whether patients with central vision loss improve their peripheral visual processing as a compensatory mechanism.

The cornea plays a pivotal role in visual quality, accounting for most of the eye's refractive power. It is also frequently affected by a wide range of pathological conditions. Accurate diagnostics are therefore fundamental for making therapeutic decisions. This review provides an overview of established and emerging methods for examining the cornea, ranging from slit-lamp biomicroscopy and vital dyes to corneal topography, tomography, pachymetry, assessments of the endothelium and nerves, anterior segment optical coherence tomography, and biomechanical measurements.

The cornea plays a pivotal role in visual quality, accounting for most of the eye's refractive power. It is also frequently affected by a wide range of pathological conditions. Accurate diagnostics are therefore fundamental for making therapeutic decisions. This review provides an overview of established and emerging methods for examining the cornea, ranging from corneal pachymetry, assessments of the endothelium and nerves, anterior segment optical coherence tomography, and biomechanical measurements. Advances in high-resolution imaging and multimodal platforms have significantly improved the early detection of disease, risk stratification and monitoring. Furthermore, AI-supported multimodal approaches integrate topo-/tomography data for personalized risk assessment and mark the future of corneal diagnostics.

Purpose: To evaluate patient-reported satisfaction, visual performance, and refractive predictability of the ELON extended depth-of-focus (EDoF) intraocular lens (IOL), as compared to monofocal IOLs in a Swiss single-centre clinical cohort.

Methods: This was an observational cohort study of 32 patients who underwent cataract surgery with implantation of the ELON IOL. A matched monofocal control group was used to enable comparison. Patient-reported satisfaction included visual performance, expectation fulfillment, and satisfaction. Secondary outcomes included postoperative refractive error, best corrected distance visual acuity (BCVA), and reported incidence of halos/glare.

Results: The ELON group reported high visual performance (mean 4.19/5), expectations met (mean 4.45/5), and overall satisfaction (mean 4.94/5). Compared to the adapted monofocal group (visual performance 4.05/5, expectations 4.18/5), ELON patients reported equivalent or superior scores across all measures. Halos or glare were reported in 9.4% of ELON patients. Refractive predictability was high, with 90.6% of eyes within ± 0.50 D spherical equivalent. Mean BCVA was logMAR 0.04.

Conclusion: The ELON IOL provides great patient satisfaction, strong refractive predictability, and minimal dysphotopsia. These results suggest that ELON is a promising alternative to monofocal IOLs for patients desiring enhanced functional vision with a continuous range of focus.

Retinal artery occlusion (RAO) remains one of the most vision-threatening conditions in ophthalmology. Most patients experience a dramatic, unilateral and painless loss of vision, which can lead to blindness. No causal therapy has yet been established, which is why there is currently no obligation to treat. Intravenous fibrinolysis therapy is currently being investigated in clinical trials and is the most promising option to date, but its benefits have not yet been proven. This therapy is established for ischaemic stroke but is based on the very narrow 4.5-hour time window which is comparable to stroke therapy. This time window has not yet been definitively established for RAV, but clinically every minute counts. Emergency admission to a neurological clinic is recommended, as there is an increased risk of further embolic and ischaemic events. Even though underlying giant cell arteritis (GCA) is rare, GCA must always be considered as a possible cause.

Background: Treatment modalities for band keratopathy (BK), which consists of calcium phosphate deposits in Bowman's layer and upper corneal stromal lamellae, are ethylenediamine tetraacetate (EDTA) chelation and phototherapeutic keratectomy (PTK). In this retrospective study, we compared the effectiveness and the recurrence rate for both methods.

Patients/material and methods: We conducted a retrospective study of patients with idiopathic BK who had been treated with EDTA-chelation or PTK and who had no other relevant corneal disease. Of 81 patients, 34 were treated with EDTA chelation and 47 with PTK. Demographic data, comorbidities, pre- and postoperative visual acuity, preoperative severity of the disease and technical surgical parameters were recorded. The results were compared descriptively. A telephone survey was conducted to investigate the subjective outcome after surgery and the development of recurrences.

Results: Regardless of the preoperative severity of BK, treatment intensity and comorbidities, this study confirmed an equal improvement in visual acuity with both EDTA chelation and PTK. The telephone survey showed that the recurrence rate after PTK was significantly lower than after EDTA-chelation (chi-square = 4.74; p = 0.03, n = 25). However, the postoperative symptomatic relief was similar in both groups.

Conclusion: EDTA chelation and PTK as treatment of BK provide equivalent improvement in visual acuity and postoperative symptomatic relief. A lower recurrence rate may be expected with PTK. Further prospective studies would be necessary to confirm our results.

Purpose: To evaluate whether the lens status of donor eyes (phakic vs. pseudophakic) influences graft preparation, graft handling, and postoperative outcomes in Descemet membrane endothelial keratoplasty (DMEK).

Methods: Retrospective analysis of 1171 DMEK cases, comparing phakic (n = 870) and pseudophakic (n = 301) donor eyes. Graft preparation characteristics, surgical complications, and postoperative outcomes including endothelial cell count (ECC), visual acuity (VA), central corneal thickness (CCT), rebubbling and repeat keratoplasty rates were assessed with a three-year follow-up.

Results: Pseudophakic donor tissue was significantly more difficult to prepare, with higher rates of tissue tears and need for manual dissection (both p < 0.001), though preparation times did not differ significantly. These challenges were linked to increased repeat keratoplasty risk (p = 0.041) and lower postoperative ECC (p = 0.047 at 1 year), while CCT and VA remained comparable. Intraoperative difficulties in graft manipulation occurred more frequently during implantation in the pseudophakic group (p = 0.14) and were associated with a significantly lower endothelial cell count after one year (p = 0.08) as well as a significantly higher risk of graft failure (p = 0.028). Overall, rebubbling (37% vs. 26%, p < 0.001) and repeat keratoplasty (12% vs. 7%, p = 0.045) were significantly more frequent in the pseudophakic group. Despite these complications, both groups showed comparable and significant visual improvement (p < 0.001).

Conclusion: Although pseudophakic donor tissue increases the technical complexity of DMEK resulting in significantly higher rates of rebubbling and repeat keratoplasty, successful grafts yield comparable visual outcomes to those from phakic donors. Pseudophakic corneas should therefore be considered a valuable additional donor source in times of tissue scarcity, provided that preparation and implantation are performed by experienced surgeons.