Klinische Monatsblatter fur Augenheilkunde最新文献

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.

The corneal endothelium is the innermost layer of the human cornea and it acts as a barrier between the aqueous humor and the corneal stroma, thus maintaining the hydration of the cornea. Both congenital dystrophies including (1) Fuchs' endothelial corneal dystrophy (FECD), (2) posterior polymorphous corneal dystrophy (PPCD), (3) congenital hereditary endothelial dystrophy (CHED), (4) X-linked endothelial corneal dystrophy (XECD) and age-related degenerations like (5) pseudoexfoliation-related (PEX) keratopathy, (6) pseudophakic bullous keratopathy (PBK), (7) iridocorneal endothelial (ICE) syndromes and endothelial graft rejection after keratoplasty can impair this function and are described in this review article.