Klinische Monatsblatter fur Augenheilkunde最新文献

Inherited retinal diseases (IRDs) represent a heterogeneous group of genetically driven conditions that frequently lead to progressive vision loss. Due to their complexity and the limited therapeutic options available, they pose a significant challenge for ophthalmology. This article provides a comprehensive overview of current evidence-based therapeutic approaches, including pharmacological strategies, gene therapy, and stem cell therapy, as well as innovative developments such as optogenetics and retinal implants. While gene therapies like Luxturna for RPE65-associated retinitis pigmentosa have paved the way for causal treatments, initial successes are also being observed in other retinal dystrophies, such as Stargardt disease and Usher syndrome. Rehabilitative measures and interdisciplinary care remain essential to improving the quality of life for affected individuals. Future research efforts focus on enhancing the efficacy and accessibility of therapies while addressing challenges such as inflammatory reactions, high costs, and genetic variability. The perspectives outlined highlight promising advancements in the treatment of genetic retinal diseases.

Background: We observed cases of unilateral upper eyelid retraction (UER) with unclear pathogenesis, where a definitive diagnosis of Graves' orbitopathy (GO) could not be made and other pathologies were ruled out. The aim is to present patients' findings, discuss possible underlying mechanisms, and to describe diagnostic testing and therapeutic approaches.

Patients and methods: Patients were retrospectively analyzed who presented to the Department of Ophthalmology of LMU Munich between 2016 and 2021 without a definitive diagnosis of GO or other pathological causes.

Results: Thirteen patients with unexplained UER were included; all showed thickening of the levator complex in imaging. When biopsy was performed, no malignancy could be detected. Therapeutic strategies included oral steroids and surgical upper eyelid blepharotomy.

Conclusion: As regards to pathogenesis, in 7/13 patients, a condition of idiopathic UER due to an idiopathic inflammatory response can be postulated rather than a variant of GO.

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.

Purpose: To evaluate the utility of intraoperative optical coherence tomography (iOCT) in guiding the optimal positioning of the Preserflo MicroShunt (PMS) during glaucoma surgery, with the aim of preserving endothelial cell density (ECD) and improving postoperative outcomes.

Patients and methods: This case series includes three patients who underwent PMS repositioning due to tube-endothelium (T-E) contact identified on the anterior segment OCT (AS-OCT). Reoperations were performed using microscope-integrated iOCT to guide and verify the intraoperative position of the implant. Final T-E distance was confirmed postoperatively with AS-OCT.

Results: In all cases, AS-OCT revealed T-E contact with associated epithelial ingrowth, prompting surgical repositioning of the PMS. iOCT provided real-time visualisation during surgery, enabling accurate adjustment of tube positioning and increased T-E separation. Postoperative assessments demonstrated stable or minimally reduced ECD; intraocular pressure was effectively controlled without topical therapy, and corneal transparency was preserved in all patients.

Conclusions: iOCT is a valuable tool in PMS implantation, allowing real-time assessment and optimisation of tube positioning. Ensuring adequate T-E distance minimises endothelial trauma and reduces the risk of long-term ECD loss. Routine use of iOCT during primary implantation may enhance surgical precision and reduce the need for reinterventions.