Klinische Monatsblatter fur Augenheilkunde最新文献

Purpose: To investigate the early outcome of intravitreal aflibercept 8 mg in treating neovascular age-related macular degeneration (nAMD) of eyes that either received prior intravitreal anti-VEGF treatment or were treatment-naïve - under real-world conditions.

Methods: This is a retrospective study of a total of 83 eyes with nAMD treated with aflibercept 8 mg. 61 of these eyes completed an initial loading phase of 3 monthly intravitreal injections (IVI) and were included in further analyses. Outcome parameters included best-corrected visual acuity (BCVA, logMAR), presence of intraretinal (IRF) and subretinal fluid (SRF), extent of pigment epithelium detachment (PED height, µm) and central subfield retinal thickness (CSRT, µm) in spectral domain optical coherence tomography (SD-OCT). Patients were assessed at the beginning of aflibercept 8 mg treatment and 4 weeks after completing the loading phase. The McNemar test was used to test for changes in distribution of eyes showing IRF and SRF, and the paired t test was performed to test for changes in BCVA, PED height and CSRT.

Results: 51 eyes had been previously treated with intravitreal anti-VEGF, while 10 eyes were treatment-naïve. Mean BCVA after completed loading phase was 0.49 ± 0.31 logMAR and did not show changes to baseline BCVA, which was 0.49 ± 0.32 logMAR (p = 0.89). A significant reduction was observed in all disease activity parameters in SD-OCT. The proportion of eyes showing IRF and SRF decreased from 54.1% to 26.2% (p < 0.001) and 65.6% to 24.6% (p < 0.001), respectively. A reduction in PED height from 227.7 ± 114.6 µm at baseline to 191.9 ± 111.4 µm (p < 0.001) and a decrease in CSRT from 375.2 ± 126.2 µm to 308.8 ± 93.7 (p < 0.001) were recorded. Of all eyes (n = 83) that had received at least one IVI aflibercept 8 mg, 5 eyes (6.0%) developed symptomatic, non-infectious intraocular inflammation (IOI), which resolved completely with topical treatment.

Conclusion: Our results demonstrate good effectiveness of intravitreal aflibercept 8 mg in the real-world setting, with significant reduction in disease activity parameters in SD-OCT after the loading phase with 3 monthly injections - while BCVA remained stable. While the PULSAR trial only included treatment-naïve eyes, our study underlines the value of aflibercept 8 mg, even for pre-treated eyes that responded insufficiently to previous anti-VEGF treatment. Further studies are needed to evaluate long-term outcome in real-world setting, in order to verify the extended IVI intervals shown in the PULSAR trial.

This comprehensive review evaluates the current evidence and expert opinion regarding the use of extended depth of focus (EDOF) intraocular lenses (IOLs) in patients with macular disease. A literature review and a survey of European Society of Cataract and Refractive Surgeons (ESCRS) committee members were conducted. The review found a growing body of evidence suggesting potential benefits of EDOF IOLs in selected patients with mild to moderate macular disease, although concerns remain. The survey found that while 59% of respondents considered EDOF IOL implantation in this population "worth trying", only 37% reported performing the procedure occasionally, and a minority did not consider it at all. Further research is needed to determine optimal patient selection criteria and long-term outcomes for EDOF IOLs in eyes with macular pathology.

Wherever consumer fireworks are used, incidents with eye injuries do occur. In Germany, their number has increased in the past nine years, a clear overrepresentation of minors and bystanders is documented. Eyes are affected by a very individual combination of thermal, chemical and mechanical impact, resulting in minor to most complex injuries to adnexes, eye surface, iris, lens, sclera and/or posterior segment. Diagnostics may be complicated and require a structured approach, that is proposed here. Open globe injuries and intraocular foreign bodies necessitate early surgical intervention. In thermal and chemical burns early rinsing and antiphlogistic therapy is major for prevention of scarring and secondary glaucoma. The need for early or late replacement of limbal stem cells may yet emerge. Consequences of blunt trauma can be traumatic cataract, phakic or pseudophakic lens luxation, ruptures to all structures of the eye with long-term effects such as retinal detachment, choroidal or retinal pigment epithelial rupture and formation of choroidal neovascular membranes (CNV). Medical and surgical strategies are discussed. Despite all proven and innovative care strategies of therapy, functional and cosmetic outcome of fire work induced eye injuries might be impaired. In cases of severe injuries, social security coverage and rehabilitation must be considered early on.

Background: Dacryoliths (DL) are found in up to 18% of patients with chronic dacryocystitis (CDC). In particular, the role of neutrophil granulocytes in stone development needs to be clarified.

Material and methods: 40 histological specimens from patients with CDC and existing lacrimal sac ectasia were examined. For this purpose, sections of the medial saccus wall were obtained during a transcutaneous dacryocystorhinostomy. Twenty samples showed CDC without DL (group 1), 20 patients showed advanced dacryolithiasis (group 2). The histological criteria (inflammation, fibrosis, lymphocytes, plasma cells, macrophages, neutrophil granulocytes) were scored (0 = not present; 1 = few; 2 = moderate; 3 = numerous/strongly pronounced).

Results: The gender ratio was balanced (1 : 1; 10 female and 10 male patients per group) and the age difference between groups 1 and 2 was not significant (median 53 vs. 56 y; p = 0.482). The histological parameters showed no significant differences between groups 1 and 2 (inflammation: 39/36, p = 0.292; fibrosis: 21/20, p = 0.385; lymphocytes: 37/32, p = 0.149; plasma cells: 25/24, p = 0.407; macrophages: 19/17, p = 0.152; neutrophil granulocytes: 10/13, p = 0.197).

Conclusions: The histological changes in the medial lacrimal sac wall are not dependent on the presence of dacryoliths. In particular, the presence of neutrophilic granulocytes is not increased in patients with long-standing dacryolithiasis.

Purpose: To evaluate the vision-related quality of life (VRQL) of patients with chronic chorioretinopathy centralis serosa (CCS).

Patients and methods: A prospective study included patients who visited our Department of Ophthalmology due to their chronic CCS and were asked to complete "The National Eye Institute Visual Function Questionnaire NEI-VFQ-39". Similarly, controls without any signs of macular disease were asked to complete the same questionnaire.

Results: A total of 75 participants were included: 45 with chronic CCS and 30 as a control group. In the CCS group, 4 patients (% 9) had chronic CCS in both eyes. The mean age (years) was 52 ± 10 in the CCS group compared to 52 ± 11 in the control group (p = 0.90). In the CCS group, 33 patients were men (73%), compared to 21 (70%) in the control group (p = 0.75). Best-corrected visual acuity (BCVA, logMAR) was 0.05 ± 0.08 in the CCS group and 0.03 ± 0.06 in the control group (p = 0.50). The overall score of VRQL was significantly lower in the CCS group than in the control group (77 ± 11 vs. 89 ± 7, p = 0.0001). Similarly, there were also significantly lower scores in the CCS group for other subscales, such as near and distance activities, dependence on others, mental health, social functioning, driving, social role impairment, and peripheral vision (p < 0.05). However, there was no significant difference between the two groups regarding eye pain and colour vision. In the CCS group, there was no statistically significant correlation between the total score of VRQL and age or gender of the patients, BCVA or duration of the disease (p > 0.05).

Conclusion: Although the BCVA was not significantly different between the CCS and control groups, patients with chronic CCS had a significantly lower total NEI-VFQ score. This suggests that the BCVA alone might not provide an adequate assessment of VRQL in patients with CCS.

Background: Monocanalicular intubation systems such as Mini-Monoka and Monoka are well established in the treatment of adult patients with nasolacrimal duct obstruction (NLDO). This retrospective study aimed to analyse the occurrence and subjective burden of postoperative foreign body sensation (FBS) following DCR using either intubation method.

Methods: A total of 130 adult patients who underwent DCR with monocanalicular nasolacrimal duct intubation for 3 months via the upper punctum were included. Group 1 (n = 68) received Mini-Monoka, while Group 2 (n = 62) received Monoka (4 mm) intubation. FBS was assessed via a standardised patient questionnaire.

Results: Mean age was 63.7 years (range 22 - 91) in group 1 and 61.2 years (range 25 - 79) in group 2. The male-to-female ratio was 3.25 : 1 and 4.64 : 1, respectively. Postoperative FBS was reported by 22.1% in group 1 and 40.3% in group 2. Moderate to severe discomfort was reported by 40% and 56% of affected patients, respectively. Logistic regression revealed a significant influence of the stent system (p = 0.024), but not gender (p = 0.617).

Conclusion: Both stenting systems are associated with postoperative FBS in a considerable proportion of patients. Due to the higher rate of perceived discomfort under Monoka, Mini-Monoka should be preferred whenever anatomically feasible.