Klinische Monatsblatter fur Augenheilkunde最新文献

This study aims to explore the associations and the underlying mechanism among dry eye disease (DED), air pollution, and meteorological conditions. DED is positively correlated with air pollutants (i.e., PM_2.5, PM₁₀, O₃, NO₂, CO, and SO₂) and meteorological conditions (i.e., high altitude and wind speed), while negatively associated with relative humidity. Both low and high air temperatures effect DED. Atmospheric pollutants affect DED mainly through necroptosis or autophagy, inflammatory responses, and oxidative stress. Meteorological factors affect DED not only by their own affects but also by dispersing the concentration of air pollutants, and then reducing the negative exposure. In summary, this review may expand the understanding of the effects of air pollution and meteorological factors on DED and emphasize the importance of air environmental protection.

The Section on Tissue Transplantation and Biotechnology of the German Ophthalmologic Society presented its 11th annual report for the year 2021. The number of corneal samples has still risen in comparison to former years. Nevertheless, there is still a need for import of transplants from abroad. Therefore, the transplant bottleneck has not yet been eliminated.

Background: Chorioretinopathy centralis serosa (CCS) is a common disease that leads to the loss of retinal ion/fluid homeostasis due to decompensation of the retinal pigment epithelium, resulting in fluid accumulation with detachment of the neurosensory retina and/or retinal pigment epithelium. We investigated the effect of eplerenone, a mineralocorticoid receptor inhibitor, on chronic recurrent CCS (cr-CCS).

Methods: A retrospective study with data analysis of 17 eyes (12 patients) between 2014 - 2021 with cr-CCS in whom other methods were not effective, not applicable, or not desired, was performed. Duration of CCS was at least 12 months with at least one recurrence. Each patient received 25 mg (1st week) and 50 mg (from the 2nd week) for at least 3 months. In each case, best-corrected visual acuity and central and peripheral retinal thickness were measured by spectral-domain optical coherence tomography. Side effects were rated by the patients as "none", "mild" (noticeable but not affecting), "tolerable" (affecting but acceptable because of good effect), and "not tolerable" (then discontinuation of therapy).

Results: There was no significant reduction in central or peripheral retinal thickness. A complete reduction of subretinal fluid was achieved in 5 of 17 eyes (29.4%). In 12 eyes, no effect of eplerenone could be detected, so other therapies were required. Visual acuity change was mainly dependent on the duration of CCS and the degree of photoreceptor damage. Side effects were reported by 11 patients as "none" and 1 patient as "mild" (arterial hypotension). No other side effects were observed.

Conclusion: The response rates of therapy with eplerenone were relatively low, and no significant effect could be demonstrated. Eplerenone should not (no longer) be routinely used in the therapy of cr-CCS.

Background: Glaucoma is a leading cause of blindness worldwide. We evaluated the efficacy, confounders, and safety of the Preserflo Microshunt over a one-year follow-up period.

Methods: In this retrospective monocentric study, 111 eyes were evaluated. 83 eyes had primary open angle glaucoma, and 28 eyes secondary open angle glaucoma. Intraocular pressure (IOP), visual acuity, number of glaucoma medications, complications, and reoperations were evaluated postoperatively, at 1, 3, 6, 9, and 12 months. The influence of age, sex, type of glaucoma, previous surgery and lens status was also analysed. Bleb revision was indicated if corrected IOP exceeded 18 mmHg.

Results: Intraocular pressure significantly decreased from 24.50 ± 8.94 to 14.62 ± 4.86 mmHg (4 - 32 mmHg; p < 0.001), the number of medications from 3.19 ± 1.14 to 0.98 ± 1.39 (0 - 4; p < 0.001). Confounders of interest did not affect efficacy. Bleb revision was performed in 22.5% of eyes and a cyclophotocoagulation was performed in 9.9% of eyes. Complete surgical success (IOP ≤ 17 mmHg, IOP reduction ≥ 20%, without medication) was achieved in 36.9% (n = 41) and qualified success (with medication) in 51.4% (n = 57) of eyes. Transient hypotension (≤ 5 mmHg) occurred in 19.8% after primary implantation and in 1.8% after bleb revision (duration ≤ 3 months).

Conclusion: To date, the Preserflo Microshunt has demonstrated good efficacy and a low risk profile.

There are only about 100 case reports on the Acute Idiopathic Blind Spot Enlargement Syndrome (AIBSES). This is characterised by the eponymous visual field loss in the blind spot area, acute onset photopsia, and funduscopically little or no change in the optic disc area, with conspicuous outer retinal bands on optical coherence tomography (OCT). Typical is the unilateral occurrence. Predominantly young women are affected. While previous reviews of AIBSES either predate the introduction of OCT or focus on differentiation from potentially related outer retinal conditions (e.g., multiple evanescent white dot syndrome and acute zonal occult outer retinopathy), the present review will concentrate on the current perspective and treatment strategies that have been developed and will aim to help increase awareness. Since the first description of AIBSES in the late 1980s, the introduction of OCT has simplified the diagnosis and characterisation of AIBSES as a disease of the outer retina. Nevertheless, misdiagnosis remains common in the spectrum of optic neuritis, as AIBSES may be ignored in differential diagnosis.

Artificial intelligence (AI) has already found its way into ophthalmology, with the first approved algorithms that can be used in clinical routine. Retinal diseases in particular are proving to be an important area of application for AI, as they are the main cause of blindness and the number of patients suffering from retinal diseases is constantly increasing. At the same time, regular imaging using high-resolution modalities in a standardised and reproducible manner generates immense amounts of data that can hardly be processed by human experts. In addition, ophthalmology is constantly experiencing new developments and breakthroughs that require a re-evaluation of patient management in routine clinical practice. AI is able to analyse these volumes of data efficiently and objectively and also provide new insights into disease progression and therapeutic mechanisms by identifying relevant biomarkers. AI can make a significant contribution to screening, classification and prognosis of various retinal diseases and can ultimately be a clinical decision support system, that significantly reduces the burden on both everyday clinical practice and the healthcare system, by making more efficient use of costly and time-consuming resources.

Purpose: Evaluation of changes in the ocular surfaces in children with a diagnosis of atopic dermatitis (AD).

Methods: Thirty-six children with a diagnosis of AD (Eye-AD group) and 40 healthy subjects (Eye-HS group) were enrolled in this prospective case-control study. Tear film break-up time (T-BUT), Schirmer tear test (STT), conjunctival impression cytology (CIC), tear meniscus height (TMH), tear meniscus area (TMA), and ocular surface disease index (OSDI) were measured.

Results: The participants were similar in terms of demographic characteristics, such as mean age and gender (p > 0.05). The mean T-BUT was 9.3 ± 2.22 s (5 - 16) in the Eye-AD group and 11.83 ± 2.03 s (7 - 16) in the Eye-HS group. The mean STT was 11.12 ± 3.28 mm (5 - 21) in the Eye-AD group and 15.44 ± 3.8 mm (8 - 20) in the Eye-HS group (p < 0.001, p < 0.001, respectively). The mean OSDI scores were 13.12 ± 1.41 (10 - 15) in the Eye-AD group and 13.97 ± 2.93 (8 - 20) in the Eye-HS group (p = 0.052). Mean TMH and TMA were 306.48 ± 7.29 µm and 0.22 ± 0.004 mm², respectively, in the Eye-AD group, and 312.94 ± 5.31 µm and 0.027 ± 0.005 mm², respectively, in the Eye-HS group. In the CIC analyses, 22 of the samples in the Eye-AD group and 35 in the Eye-HS group had a classification of grade 0, 10 in the Eye-AD group and 5 in the Eye-HS group had a classification of grade 1, and 4 in the Eye-AD group and none in the Eye-HS group had a classification of grade 2 (p = 0.015).

Conclusion: Pediatric patients with AD may have significant changes in conjunctival histopathology. These changes can be manifested in the tests used to measure the tear film. Dry eye was shown to be present in the majority of children with AD.