Klinische Monatsblatter fur Augenheilkunde最新文献

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.

Cataracts are the world's leading cause of blindness. Cataract surgery is a highly effective and safe procedure for treating the condition, and - since it is widely considered a refractive intervention, particularly in the developed world - it often leads to excellent visual acuity and spectacle independence. Patients require detailed counselling about the various intraocular lens (IOL) designs and their potential, as well as potentially disturbing optical phenomena, which are more common with multifocal IOLs. There are two highly successful techniques: phacoemulsification and femtosecond laser cataract surgery. The latter offers greater precision and has produced remarkable results, even in complex cases such as advanced cataracts, corneal comorbidities and paediatric cataracts. Using a laser to fragment the lens significantly reduces the amount of ultrasound energy required for subsequent manual removal, or even eliminates the need for ultrasound energy altogether. The most feared complication is endophthalmitis, which requires immediate treatment, while the most common side effect, posterior capsule opacification (PCO), is generally harmless. In uncomplicated cases, the attending ophthalmologist normally recommends 3-4 postoperative check-ups.

Congenital nasolacrimal duct obstruction (CNLDO) represents the most prevalent cause of epiphora in infancy, with a reported incidence of approximately 6-20% of newborns. In the majority of cases, a membranous occlusion at the valve of Hasner is responsible, with spontaneous resolution occurring in up to 96% within the first year of life.Clinical signs comprise persistent tearing, an elevated tear meniscus and recurrent mucopurulent discharge; digital pressure on the lacrimal sac may induce retrograde reflux. Ophthalmic examination is indispensable to exclude differential diagnoses such as congenital glaucoma, keratoconjunctivitis or eyelid malposition.Given the high probability of spontaneous resolution, conservative management is the treatment of choice during the first 6-12 months of life, including parental instructions, consistent lid hygiene, and lacrimal sac massage. Topical antibiotics should be restricted to short-term application in the presence of bacterial superinfection.In cases of persistent obstruction or complicated disease lacrimal probing is indicated, usually after 12 months of age in general anaesthesia. Silicone intubation is recommended for complex or recurrent obstructions, failed probing, or in older children, and associated with substantially improved success rates. Endoscopic techniques including transcanalicular dacryoendoscopy, ballon dacryoplasty, and endonasal endoscopy can be helpful in refractory and anatomically complex cases. Dacryocystorhinostomy serves as ultima ratio surgery in treatment-refractory or bony stenosis and should not be performed before the age of one year.A staged, evidence-based therapeutic management beginning with conservative measures and escalating to age- and anatomy-adapted interventions, is recommended to achieve favourable outcomes.