Klinische Monatsblatter fur Augenheilkunde最新文献

Background: Unexpected intracameral foreign bodies during regular cataract surgery appear relatively often but seem to be underreported, since they are almost often immediately removed. They rarely remain in the anterior chamber and can be the source of inflammation, infections, or lead to corneal endothelial decompensation. We report two series of cases with different materials of different origins and review the literature.

Patients and methods: During several cases of uncomplicated phacoemulsifications under topical anesthesia, unknown foreign bodies visibly flushed in through the sleeve of the phaco handpiece. The material was always removed and submitted to the (Eidgenössische Materialprüfungs- und Forschungsanstalt; Federal Institute for Materials Testing and Research) for further investigations.

Results: Spectral analysis revealed that, in our cases, the foreign bodies were remnants of otherwise intact phaco sleeves that had not been cleaned properly during production. In another case series, the resin granules from the water filtration system for the instrument washing machine had found their way into the phaco handpieces.

Conclusion: Many shapes and materials of different origins might unexpectedly appear during cataract surgery in the eye. Their immediate extraction is necessary, as they might cause corneal endothelial damage, chronic inflammation, or could be the source of infections. Vigilance reporting is also important for the controlling medicinal organizations and companies to assure early recognition of systematic problems.

Background: Giant-cell arteritis (GCA) requires immediate diagnosis and therapy. The University Hospital of Würzburg established the Centre for Giant-cell Arteritis (ZeRi) to improve interdisciplinary collaboration.

Aim of the study: Retrospective evaluation of five-year data to assess the clinical relevance of several diagnostic methods, including temporal artery biopsy.

Patients and methods: Retrospective evaluation of 101 patients with suspected GCA who had undergone interdisciplinary examination and biopsy between 2017 and 2022. We analysed specificity and sensitivity in clinical symptoms, ESR, CRP, scalp MRI, temporal artery sonography, and temporal artery biopsy.

Results: GCA was diagnosed after completing diagnostic testing in 75 of 101 patients with suspected GCA. By definition, biopsy showed a positive predictive value of 100% and a specificity of 84.6%; however, negative predictive value was 51.2%. Sonography of the temporal artery and MRI showed a positive predictive value of more than 93% and sensitivity of 62.5% and 76.1%, respectively. Clinical symptoms showed the highest sensitivity at 92% with a specificity of 57.7%. ESR and CRP were significantly higher in patients with GCA than in patients without GCA, whereby CRP values showed higher predictive power than did ESR.

Conclusions: Most GCA cases can be detected with a precise medical history as well as ESR and CRP assessment. Sonography and MRI on the scalp can usually confirm suspected GCA, only requiring temporal artery biopsy in exceptional cases.

Corneal stromal opacities can severely impact visual acuity if they are located in the visual axis. Homologous penetrating keratoplasty (HPK) is usually the preferred surgical option in such clinical circumstances. However, autologous penetrating keratoplasty (APK) could be an immunologically safer alternative. The purpose of this study was to report the surgical technique, indications, and (dis)advantages of ipsilateral rotational and contralateral APK, as well as pre- and postoperative clinical findings of four patients who underwent contralateral APK. In ipsilateral rotational APK, eccentric trephination places the central corneal opacity at the excision edge, whereafter the corneal button is rotated to clear the visual axis. Contralateral APK is suitable for more specific clinical situations with corneal opacity in a functionally much better eye. Clear cornea of the (almost) blind eye suffering from a noncorneal pathology is transplanted to the potentially better seeing eye suffering from a corneal pathology, followed by HPK in the (almost) blind donor eye. After 18 months, potentially better-seeing eyes improved from logMAR 1.3 to 0.6 in visual acuity, with most HPK-treated weaker eyes matching preoperative levels. Considering ipsilateral rotational and contralateral APK before moving on straight towards HPK is crucial in select cases. Autologous contralateral keratoplasty should be preferred for patients with (1) corneal scars in a potentially better seeing eye and (2) a clear cornea in an (almost) blind eye, especially in cases of high risk for graft rejection.

Due to the close anatomical, functional and trophic relationships between the optic nerve and retina, a wide variety of diseases affecting both structures have reciprocal effects on each other, which must be considered in the differential diagnosis to avoid misdiagnosis. Therefore, it is essential to assess pathological changes in both structures in context to differentiate the type and location of the primary lesion from its consequences, as well as to correctly classify coincidences and disease-specific lesion patterns in both organ components.This article highlights the typical symptom constellations and lesion patterns of optic neuropathies and retinopathies. An attempt is made to identify the reciprocal characteristic relationships of the respective lesions in both structures in various disease groups, as well as to present their respective roles in the differential diagnosis.In the first part of the article, typical optic neuropathies in the context of various syndromic and non-syndromic retinal dystrophies are initially examined. Subsequently, the relationships between different hereditary and acquired mitochondriopathic optic neuropathies and possible accompanying retinal changes are analysed, and their pathogenesis and relevant differential diagnoses are discussed.It is demonstrated and exemplified how important it is in general, but also specifically in regard to the disease groups discussed in this article, to have a careful and targeted diagnostic approach in each case, considering both the retinal and optic nerve findings, in order to avoid misdiagnosis.

Over the past decade, atropine has emerged as an effective intervention for preventing myopia in children. Multiple randomized controlled trials, mainly from Asia, have demonstrated the safety and efficacy of topical atropine for myopia control. Both efficacy and side effects exhibit a positive dose-response relationship. This review focuses on new data from studies with predominantly white populations, ethnicity-dependent differences in efficacy and side effects, and primary prevention of incident myopia with atropine.

The rising prevalence of myopia among children and adolescents necessitates effective interventions to mitigate long-term risks, such as retinal detachment and macular degeneration. Traditional approaches like undercorrection with single-vision lenses have proven ineffective. Recent research underscores the significance of peripheral vision in managing myopia progression. While hyperopic defocus in the peripheral retina may encourage axial elongation, multifocal lenses designed to induce peripheral myopic defocus can potentially curb this elongation. Randomized controlled trials (RCTs) have demonstrated that spectacle lenses with peripheral modifications, such as highly aspherical lenslets (HAL) or defocus incorporated multiple segments (DIMS), reduce myopia progression and axial elongation over 2 years. Similarly, multifocal contact lenses, especially those with high-add power (+ 2.50 D), have shown comparable reductions over 3 years. Safety is a critical consideration in myopia control. Multifocal spectacle lenses with peripheral plus designs are generally well tolerated, with only transient side effects, like dizziness and blurred vision. Soft multifocal contact lenses also exhibit a favorable safety profile, with low rates of serious adverse events. Thorough monitoring and reporting in these studies are essential to provide assurance about the safety of these interventions for children. Future research should aim to include more diverse populations in order to ensure the generalizability of findings across various demographic groups. Additionally, real-world data would offer valuable insights into the performance of these treatments in everyday scenarios. Observational studies, less influenced by industry sponsorship, could further validate these findings. Lastly, the clinical significance of the observed effects should be critically assessed to confirm that the reported benefits lead to meaningful reductions in myopia progression.

Background: To measure the success of three different artificial intelligence chatbots, ChatGPT, Bard, and Bing, in correctly answering questions about glaucoma types and treatment modalities and to examine their superiority over each other.

Materials and methods: Thirty-two questions about glaucoma types and treatment modalities were asked using the ChatGPT, Bard, and Bing chatbots. The correct and incorrect answers were also provided. Accuracy rates were compared.

Outcomes: Questions asked: ChatGPT answered 56.3%, Bard 78.1%, and Bing 59.4% correctly. There was no statistically significant difference between the three artificial intelligence chatbots in the rate of correct and incorrect answers to the questions asked (p = 0.195).

Conclusion: Artificial intelligence chatbots can be used as a tool to access accurate information regarding glaucoma types and treatment modalities. However, the information obtained is not always accurate, and care should be taken when using this information.

Background: Eye injuries range from minor to severe and may lead to permanent visual impairment. There is still little in the way of epidemiological data on eye injuries in Germany.

Aim: The aim of this study was to obtain an objective record of minor and severe eye injuries in Germany by evaluating hospital quality reports. We also investigated the relevance of injuries from fireworks in relation to the total number of eye injuries and the general population.

Methods: This retrospective routine data study entailed analysing hospital quality reports from 2008 to 2022 in XML format. The R programming language was used for data processing and statistical analysis. The number of ICD-coded eye injuries was exported and analysed together with location data. We also included data from a prospective survey study on fireworks-related eye injuries from 2016 to 2023.

Results: Eyeball and/or orbital contusions are the most common eye injuries treated in Germany at up to 2,500 cases per year. The most severe injuries comprise traumatic globe rupture with loss of intraocular tissue at up to 990 cases per year. Numbers of eye injuries of any type have been declining since 2020. As a percentage of population, Mecklenburg-Western Pomerania treats the most eye injuries at up to 0.017%; in absolute numbers, North Rhine-Westphalia leads the country at up to 1,600 injuries. Private firework displays are probably responsible for 1.4% of annual globe ruptures and 8.3% of eyeball contusions.

Conclusion: Our analysis of hospital quality reports has provided the first comprehensive epidemiological record on eye injuries in Germany. Firework-related injuries account for a relevant proportion of total injuries. These results could serve as a basis for preventive measures and health policy decisions.