Ziel dieser Studie war es, die Ergebnisse chirurgischer Eingriffe bei neovaskulärem Glaukom (NVG) und schlechter Sehkraft zu analysieren. Dazu wurden NVG-Patienten mit einer Sehschärfe von 20/200 oder weniger verglichen, die entweder ein Ahmed-Glaukom-Ventil (AGV) oder eine Zyklophotokoagulation (CPC) erhalten hatten. Zu den Hauptergebnisgrößen zählten die chirurgische Erfolgsrate, Veränderungen des Augeninnendrucks (IOD), die Anzahl der Antiglaukom-Medikamente, die korrigierte Fernvisusschärfe und die Reoperationsrate bei Glaukom. 12 Monate nach Operation zeigten beide Verfahren gute Ergebnisse mit ähnlichen IOP-Werten. Im Vergleich zur CPC zeigte das AGV allerdings insgesamt eine höhere Erfolgsrate und einen geringeren Medikamentenbedarf.
{"title":"Welche Glaukom-Operation bei fortgeschrittener Funktionsschädigung?","authors":"Klaus Rohrschneider","doi":"10.1159/000538735","DOIUrl":"https://doi.org/10.1159/000538735","url":null,"abstract":"Ziel dieser Studie war es, die Ergebnisse chirurgischer Eingriffe bei neovaskulärem Glaukom (NVG) und schlechter Sehkraft zu analysieren. Dazu wurden NVG-Patienten mit einer Sehschärfe von 20/200 oder weniger verglichen, die entweder ein Ahmed-Glaukom-Ventil (AGV) oder eine Zyklophotokoagulation (CPC) erhalten hatten. Zu den Hauptergebnisgrößen zählten die chirurgische Erfolgsrate, Veränderungen des Augeninnendrucks (IOD), die Anzahl der Antiglaukom-Medikamente, die korrigierte Fernvisusschärfe und die Reoperationsrate bei Glaukom. 12 Monate nach Operation zeigten beide Verfahren gute Ergebnisse mit ähnlichen IOP-Werten. Im Vergleich zur CPC zeigte das AGV allerdings insgesamt eine höhere Erfolgsrate und einen geringeren Medikamentenbedarf.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"65 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus. Design: Prospective, interventional case series. Methods: Twenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL graft was «stretched» onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and 2 subgroups (group 1: preoperative maximum keratometry [Kmax] <69 diopters [D; n = 7); group 2: preoperative Kmax ≥69 D [n = 14]). Follow-up ranged from 6 to 36 months (mean 21 ± 11 months). Results: All 21 surgeries were uneventful. Overall, Kmax changed from 76 ± 12 D preoperatively to 72 ± 9 D at 6 to 36 months postoperatively (P = .015). Kmax decreased by 6 D in group 2 (P = .002) but did not change in group 1. Average BSCVA remained stable for group 1 and improved from preoperatively 0.8 ± 0.4 to 0.4 ± 0.2 logarithm of the minimum angle of resolution postoperatively in group 2 (P = .032); BCLVA remained stable (P > .05). Within the first postoperative weeks, 2 eyes required BL graft repositioning after inadvertent bandage lens removal and 4 eyes underwent BL retransplantation for incomplete re-epithelialization. One eye underwent BL regrafting 12 months postoperatively after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up. Conclusion: BL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to 6 D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.
{"title":"Bowman-Layer-Onlay-Transplantation (BLOT) als minimal invasive Methode zur Therapie des fortgeschrittenen Keratokonus","authors":"Mohamed Ghaly","doi":"10.1159/000538791","DOIUrl":"https://doi.org/10.1159/000538791","url":null,"abstract":"Purpose: To analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus. Design: Prospective, interventional case series. Methods: Twenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL graft was «stretched» onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and 2 subgroups (group 1: preoperative maximum keratometry [Kmax] <69 diopters [D; n = 7); group 2: preoperative Kmax ≥69 D [n = 14]). Follow-up ranged from 6 to 36 months (mean 21 ± 11 months). Results: All 21 surgeries were uneventful. Overall, Kmax changed from 76 ± 12 D preoperatively to 72 ± 9 D at 6 to 36 months postoperatively (P = .015). Kmax decreased by 6 D in group 2 (P = .002) but did not change in group 1. Average BSCVA remained stable for group 1 and improved from preoperatively 0.8 ± 0.4 to 0.4 ± 0.2 logarithm of the minimum angle of resolution postoperatively in group 2 (P = .032); BCLVA remained stable (P > .05). Within the first postoperative weeks, 2 eyes required BL graft repositioning after inadvertent bandage lens removal and 4 eyes underwent BL retransplantation for incomplete re-epithelialization. One eye underwent BL regrafting 12 months postoperatively after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up. Conclusion: BL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to 6 D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":" 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To evaluate socket outcomes of enucleation for uveal melanoma. Methods: This study was a retrospective chart review conducted in December 2022 of all patients who underwent enucleation surgery for uveal melanoma between 2010 and 2015 in the Royal Victoria Eye and Ear Hospital, to evaluate socket outcomes including completion of revision surgery, type of surgery, and completion of multiple revision surgeries, and potential associations. Results: Between June 2010 and December 2015, 72 patients underwent enucleation for uveal melanoma in the ocular oncology service, including 25 females and 47 males, mean age 65, range 11–91 years old. There were 68 primary enucleations and 4 secondary enucleations. Complete follow-up data was available for mean 4 years, range 1–11 years. Fourteen patients underwent further surgery, including one exenteration for local recurrence. Oculoplastic surgery (n = 6, 8%), implant exposure repair (n = 3, 6%), and orbit volume expanding surgery (n = 4, 6%) were also performed. Eight patients (11%) underwent one further surgery and five patients (7%) underwent a series of procedures. There was a significant association with younger age at enucleation (age <65) with undergoing further surgery (p = 0.03, Fisher’s Exact Test (FET)), and also an association of younger age with undergoing multiple further surgeries (p = 0.02, FET). There was no association found with other predictor variables, including primary versus secondary enucleation status. Most patients (75%) with PESS underwent more than one surgery. Conclusion: Post enucleation surgery 82% of patients did not undergo further surgery, but younger patients were more likely to undergo anophthalmic socket revision or oculoplastic surgery. Management of post enucleation socket syndrome was challenging and usually involved a series of procedures.
{"title":"Komplikationen nach Enukleation – das Post-Enucleation Socket Syndrome","authors":"Ira Seibel","doi":"10.1159/000538408","DOIUrl":"https://doi.org/10.1159/000538408","url":null,"abstract":"Purpose: To evaluate socket outcomes of enucleation for uveal melanoma. Methods: This study was a retrospective chart review conducted in December 2022 of all patients who underwent enucleation surgery for uveal melanoma between 2010 and 2015 in the Royal Victoria Eye and Ear Hospital, to evaluate socket outcomes including completion of revision surgery, type of surgery, and completion of multiple revision surgeries, and potential associations. Results: Between June 2010 and December 2015, 72 patients underwent enucleation for uveal melanoma in the ocular oncology service, including 25 females and 47 males, mean age 65, range 11–91 years old. There were 68 primary enucleations and 4 secondary enucleations. Complete follow-up data was available for mean 4 years, range 1–11 years. Fourteen patients underwent further surgery, including one exenteration for local recurrence. Oculoplastic surgery (n = 6, 8%), implant exposure repair (n = 3, 6%), and orbit volume expanding surgery (n = 4, 6%) were also performed. Eight patients (11%) underwent one further surgery and five patients (7%) underwent a series of procedures. There was a significant association with younger age at enucleation (age <65) with undergoing further surgery (p = 0.03, Fisher’s Exact Test (FET)), and also an association of younger age with undergoing multiple further surgeries (p = 0.02, FET). There was no association found with other predictor variables, including primary versus secondary enucleation status. Most patients (75%) with PESS underwent more than one surgery. Conclusion: Post enucleation surgery 82% of patients did not undergo further surgery, but younger patients were more likely to undergo anophthalmic socket revision or oculoplastic surgery. Management of post enucleation socket syndrome was challenging and usually involved a series of procedures.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"24 4‐5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140700590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Das Ziel dieser systematischen Übersichtsarbeit ist die Ermittlung der Art der Meldung von Komplikationen bei der mikroinvasiven Glaukomchirurgie (MIGS) in randomisierten kontrollierten Studien (RCTs) und die Bestimmung der Qualität dieser Meldungen im Vergleich zur CONSORT-Erweiterung für Schäden. Aus einer Datenbank mit systematischen Übersichtsarbeiten und der aktuellen Literatur wurden MIGS-Verfahren bewertende RCTs ermittelt. Die Studien wurden im Vergleich zur CONSORT-Erweiterung für Schäden bewertet, um die Qualität der Berichterstattung über Schäden zu quantifizieren. Für die CONSORT-Checkliste wurden einfache deskriptive Statistiken berechnet. 21 Studien wurden als geeignet zur Einbeziehung ermittelt, davon untersuchten 14 Studien iStent, 1 Trabectome, 3 Hydrus, 1 Cypass, 1 PreserFlo MicroShunt und 1 Studie die Excimer-Laser-Trabekulotomie. Die durchschnittliche Anzahl der von den Studien erfüllten Punkte der CONSORT-Checkliste für Schäden betrug 10 von 16. Keine der Studien verwendete ein validiertes Instrument, um die Schwere der Schäden zu melden, und nur 4 hatten eine Liste oder Definition der unerwünschten Ereignisse. Eine Analyse der Schäden wurde in 19 von 21 Studien (90%) durchgeführt. In 19 von 21 Studien wurden geeignete Metriken für die Meldung von Raten unerwünschter Ereignisse verwendet, aber in nur 4 Studien wurde versucht, diesen unerwünschten Ereignissen einen Schweregrad zuzuordnen. Zusammenfassend lässt sich sagen, dass die meisten der die MIGS-Verfahren bewertenden Studien sich bemühen, Daten zu Schäden anzuerkennen, dies jedoch nicht einheitlich gut oder auf die gleiche Weise geschieht. Ein validiertes Instrument zur Meldung des Schweregrads und eine Standardliste der Komplikationen für die MIGS würden entscheidend zur Lösung dieses Problems beitragen.
{"title":"Systematische Übersicht über die Methoden und Qualität der Meldung von Komplikationen in Studien zur Beurteilung von innovativen glaukomchirurgischen Verfahren","authors":"J. Bonnar, Augusto Azuara-Blanco","doi":"10.1159/000538411","DOIUrl":"https://doi.org/10.1159/000538411","url":null,"abstract":"Das Ziel dieser systematischen Übersichtsarbeit ist die Ermittlung der Art der Meldung von Komplikationen bei der mikroinvasiven Glaukomchirurgie (MIGS) in randomisierten kontrollierten Studien (RCTs) und die Bestimmung der Qualität dieser Meldungen im Vergleich zur CONSORT-Erweiterung für Schäden. Aus einer Datenbank mit systematischen Übersichtsarbeiten und der aktuellen Literatur wurden MIGS-Verfahren bewertende RCTs ermittelt. Die Studien wurden im Vergleich zur CONSORT-Erweiterung für Schäden bewertet, um die Qualität der Berichterstattung über Schäden zu quantifizieren. Für die CONSORT-Checkliste wurden einfache deskriptive Statistiken berechnet. 21 Studien wurden als geeignet zur Einbeziehung ermittelt, davon untersuchten 14 Studien iStent, 1 Trabectome, 3 Hydrus, 1 Cypass, 1 PreserFlo MicroShunt und 1 Studie die Excimer-Laser-Trabekulotomie. Die durchschnittliche Anzahl der von den Studien erfüllten Punkte der CONSORT-Checkliste für Schäden betrug 10 von 16. Keine der Studien verwendete ein validiertes Instrument, um die Schwere der Schäden zu melden, und nur 4 hatten eine Liste oder Definition der unerwünschten Ereignisse. Eine Analyse der Schäden wurde in 19 von 21 Studien (90%) durchgeführt. In 19 von 21 Studien wurden geeignete Metriken für die Meldung von Raten unerwünschter Ereignisse verwendet, aber in nur 4 Studien wurde versucht, diesen unerwünschten Ereignissen einen Schweregrad zuzuordnen. Zusammenfassend lässt sich sagen, dass die meisten der die MIGS-Verfahren bewertenden Studien sich bemühen, Daten zu Schäden anzuerkennen, dies jedoch nicht einheitlich gut oder auf die gleiche Weise geschieht. Ein validiertes Instrument zur Meldung des Schweregrads und eine Standardliste der Komplikationen für die MIGS würden entscheidend zur Lösung dieses Problems beitragen.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"37 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lauren Ton, Wanling Zhang, Murtaza Saifee, Anushka Walia, Julius Oatts, Ying Han
Ziel: Wir berichten über einen ungewöhnlichen Fall von schwerer Proptose während der Phakoemulsifikation bei einer 58-jährigen Frau mit Morbus Crohn, bilateraler chronischer Panuveitis, einem vorherigen bilateralen zentralen Netzhautvenenverschluss und unkontrollierter steroidassoziierter okularer Hypertonie, die die bilaterale Implantation eines Ahmed-Glaukom-Drainagegeräts (GDD) mit Pars-plana-Platzierung des Tubus erfordert. Beobachtungen: Während der Phakoemulsifikation des rechten Auges entwickelte die Patientin eine signifikante Proptose. Nach Entfernung des Lidspekulums und mechanischer Augenlidmanipulation löste sich die Proptose innerhalb von 20 Minuten auf, ohne dass eine laterale Kanthotomie erforderlich war. Die Patientin hatte keine dauerhaften visuellen Komplikationen. Schlussfolgerungen und Bedeutung: Die wahrscheinliche Pathophysiologie der intraoperativen Proptose war in diesem Fall die Ansammlung von Flüssigkeit im retrobulbären Raum aufgrund eines funktionierenden Ahmed-Tubus-Shunts mit dem in der Glaskörperhöhle platzierten Tubus. Um diese Komplikation zu vermeiden, kann bei Patienten mit Pars-plana-Tubusplatzierung beim GDD-Eingriff eine gleichzeitige Kataraktoperation in Betracht gezogen werden.
目的：我们报告了一例不寻常的病例，患者 58 岁，患有克罗恩病、双侧慢性泛眼炎、既往双侧视网膜中央静脉闭塞以及无法控制的类固醇相关性眼压，需要植入双侧 Ahmed 青光眼引流装置 (GDD)，并在平面旁放置导管。观察结果：在右眼的乳化手术中，患者出现了明显的眼球突出。移除眼睑窥器并进行眼睑机械操作后，眼球突出在 20 分钟内缓解，无需进行外侧角膜切开术。患者没有出现永久性视力并发症。结论和意义：本例患者术中突眼的病理生理学原因可能是由于艾哈迈德管分流术在玻璃体腔内进行，导致球后间隙积液。为避免这一并发症，在进行 GDD 手术时，可考虑对在平面旁放置导管的患者同时进行白内障手术。
{"title":"Schwere Proptose während einer Kataraktoperation","authors":"Lauren Ton, Wanling Zhang, Murtaza Saifee, Anushka Walia, Julius Oatts, Ying Han","doi":"10.1159/000538412","DOIUrl":"https://doi.org/10.1159/000538412","url":null,"abstract":"Ziel: Wir berichten über einen ungewöhnlichen Fall von schwerer Proptose während der Phakoemulsifikation bei einer 58-jährigen Frau mit Morbus Crohn, bilateraler chronischer Panuveitis, einem vorherigen bilateralen zentralen Netzhautvenenverschluss und unkontrollierter steroidassoziierter okularer Hypertonie, die die bilaterale Implantation eines Ahmed-Glaukom-Drainagegeräts (GDD) mit Pars-plana-Platzierung des Tubus erfordert. Beobachtungen: Während der Phakoemulsifikation des rechten Auges entwickelte die Patientin eine signifikante Proptose. Nach Entfernung des Lidspekulums und mechanischer Augenlidmanipulation löste sich die Proptose innerhalb von 20 Minuten auf, ohne dass eine laterale Kanthotomie erforderlich war. Die Patientin hatte keine dauerhaften visuellen Komplikationen. Schlussfolgerungen und Bedeutung: Die wahrscheinliche Pathophysiologie der intraoperativen Proptose war in diesem Fall die Ansammlung von Flüssigkeit im retrobulbären Raum aufgrund eines funktionierenden Ahmed-Tubus-Shunts mit dem in der Glaskörperhöhle platzierten Tubus. Um diese Komplikation zu vermeiden, kann bei Patienten mit Pars-plana-Tubusplatzierung beim GDD-Eingriff eine gleichzeitige Kataraktoperation in Betracht gezogen werden.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"24 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To this day, the use of oily eye drops and non-invasive retinal delivery remain a major challenge. Oily eye drops usually cause ocular irritation and interfere with the normal functioning of the eye, while ocular injections for retinal drug delivery cause significant adverse effects and a high burden on the healthcare system. Here, the authors report a novel topical non-invasive ocular delivery platform (NIODP) through the periorbital skin for high-efficiency anterior and posterior ocular delivery in a non-human primate model (NHP). A single dose of about 7 mg JV-MD2 (omega 3 DHA) was delivered via the NIODP and reached the retina at a Cmax of 111 μg/g and the cornea at a Cmax of 66 μg/g. The NIODP also delivered JV-DE1, an anti-inflammatory agent in development for dry eye diseases, as efficiently as eye drops did to the anterior segments of the NHP. The topical NIODP seems to transport drug candidates through the corneal pathway to the anterior and via the conjunctiva/sclera pathway to the posterior segments of the eye. The novel NIODP method has the potential to reshape the landscape of ocular drug delivery. This is especially the case for oily eye drops and retinal delivery, where the success of the treatment lies in the ocular tolerability and bioavailability of drugs in the target tissue.
{"title":"Eine neue Plattform zum nicht invasiven Einbringen schlecht wasserlöslicher Substanzen ins Auge","authors":"O. Strauss","doi":"10.1159/000538628","DOIUrl":"https://doi.org/10.1159/000538628","url":null,"abstract":"To this day, the use of oily eye drops and non-invasive retinal delivery remain a major challenge. Oily eye drops usually cause ocular irritation and interfere with the normal functioning of the eye, while ocular injections for retinal drug delivery cause significant adverse effects and a high burden on the healthcare system. Here, the authors report a novel topical non-invasive ocular delivery platform (NIODP) through the periorbital skin for high-efficiency anterior and posterior ocular delivery in a non-human primate model (NHP). A single dose of about 7 mg JV-MD2 (omega 3 DHA) was delivered via the NIODP and reached the retina at a Cmax of 111 μg/g and the cornea at a Cmax of 66 μg/g. The NIODP also delivered JV-DE1, an anti-inflammatory agent in development for dry eye diseases, as efficiently as eye drops did to the anterior segments of the NHP. The topical NIODP seems to transport drug candidates through the corneal pathway to the anterior and via the conjunctiva/sclera pathway to the posterior segments of the eye. The novel NIODP method has the potential to reshape the landscape of ocular drug delivery. This is especially the case for oily eye drops and retinal delivery, where the success of the treatment lies in the ocular tolerability and bioavailability of drugs in the target tissue.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"10 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dry eye disease is an umbrella term that includes a variety of symptoms and signs. A link between diabetes mellitus and dry eye disease exists, but the associated phenotype needs further examination. Thus, our aim was to determine how diabetes mellitus relates to the dry eye disease phenotype. A prospective, cross-sectional study was conducted at the Miami Veteran Affairs Medical Center ophthalmology clinic between October 2013 and September 2019. Participants included a volunteer sample of 366 South Florida veterans with one or more symptoms or signs of dry eye disease [Dry Eye Questionnaire-5 ≥ 6 OR tear break-up time ≤ 5 OR Schirmer’s test score ≤ 5 OR corneal fluorescein staining ≥ 2]. Participants were divided into three groups: (1) individuals without diabetes mellitus (controls); (2) individuals with diabetes mellitus but without end-organ complications; and (3) individuals with diabetes mellitus and end-organ complications. Dry eye metrics were compared across groups. The main outcome measures included ocular symptom questionnaires [e.g., 5-item Dry Eye Questionnaire, Ocular Surface Disease Index, and ocular pain assessment] and clinical parameters obtained from an ocular surface evaluation. A total of 366 individuals were included (mean age 59 ± 6 years; 89% males; 39% White; 11% diabetes mellitus and end-organ complications; 15% diabetes mellitus but without end-organ complications). Individuals with diabetes mellitus and end-organ complications had lower symptom scores on the dry eye disease and pain-specific questionnaires compared to individuals with diabetes mellitus but without end-organ complications and controls (Ocular Surface Disease Index: 42.1 ± 24.5 vs. 38.9 ± 25.1 vs. 23.6 ± 16.2; p < 0.001; numerical rating scale of ocular pain intensity: 4.9 ± 3.2 vs. 4.3 ± 2.7 vs. 3.5 ± 2.7; p = 0.02). Eyelid laxity was also more severe in the group with diabetes mellitus and end-organ complications (0.69 ± 0.64 vs. 0.73 ± 0.72 vs. 1.08 ± 0.77; p = 0.004) compared to the two other groups. The diabetic dry eye disease phenotype is driven by signs more so than by symptoms, with anatomic eyelid abnormalities being more frequent in individuals with diabetes mellitus and end-organ complications. Given this, ocular surface abnormalities in individuals with DM may be missed if screened by symptoms alone. As such, individuals with DM should undergo a slit lamp examination for signs of ocular surface disease, including anatomic abnormalities.
干眼症是一个统称，包括各种症状和体征。糖尿病与干眼症之间存在联系，但相关表型需要进一步研究。因此，我们的目的是确定糖尿病与干眼症表型之间的关系。2013 年 10 月至 2019 年 9 月期间，我们在迈阿密退伍军人事务医疗中心眼科诊所进行了一项前瞻性横断面研究。参与者包括366名南佛罗里达州退伍军人志愿者样本，他们都有一种或多种干眼症症状或体征[干眼症问卷-5≥6或泪液破裂时间≤5或Schirmer测试评分≤5或角膜荧光素染色≥2]。参与者分为三组：(1) 无糖尿病者（对照组）；(2) 有糖尿病但无内脏器官并发症者；(3) 有糖尿病和内脏器官并发症者。对各组的干眼症指标进行了比较。主要结果测量包括眼部症状问卷（如 5 项干眼症问卷、眼表疾病指数和眼痛评估）和眼表评估获得的临床参数。共纳入了 366 人（平均年龄为 59 ± 6 岁；89% 为男性；39% 为白人；11% 患有糖尿病和内脏并发症；15% 患有糖尿病但无内脏并发症）。与患有糖尿病但无内脏器官并发症的患者和对照组相比，患有糖尿病且有内脏器官并发症的患者在干眼症和疼痛特异性问卷中的症状评分较低（眼表疾病指数：42.1 ± 24.5 vs. 42.1 ± 24.5）：42.1 ± 24.5 vs. 38.9 ± 25.1 vs. 23.6 ± 16.2；p < 0.001；眼部疼痛强度数字评分表：4.9 ± 3.2 vs. 23.6 ± 16.2；p < 0.001；p < 0.001：4.9 ± 3.2 vs. 4.3 ± 2.7 vs. 3.5 ± 2.7；p = 0.02）。与其他两组相比，糖尿病和内脏并发症组的眼睑松弛程度也更严重（0.69 ± 0.64 vs. 0.73 ± 0.72 vs. 1.08 ± 0.77；P = 0.004）。糖尿病干眼症的表型是由体征而非症状驱动的，眼睑解剖异常在糖尿病和内脏器官并发症患者中更为常见。因此，如果仅凭症状进行筛查，可能会漏掉糖尿病患者的眼表异常。因此，糖尿病患者应接受裂隙灯检查，以发现眼表疾病的迹象，包括眼表解剖异常。
{"title":"Symptome des trockenen Auges bei Diabetes mellitus","authors":"A. Augustin","doi":"10.1159/000535686","DOIUrl":"https://doi.org/10.1159/000535686","url":null,"abstract":"Dry eye disease is an umbrella term that includes a variety of symptoms and signs. A link between diabetes mellitus and dry eye disease exists, but the associated phenotype needs further examination. Thus, our aim was to determine how diabetes mellitus relates to the dry eye disease phenotype. A prospective, cross-sectional study was conducted at the Miami Veteran Affairs Medical Center ophthalmology clinic between October 2013 and September 2019. Participants included a volunteer sample of 366 South Florida veterans with one or more symptoms or signs of dry eye disease [Dry Eye Questionnaire-5 ≥ 6 OR tear break-up time ≤ 5 OR Schirmer’s test score ≤ 5 OR corneal fluorescein staining ≥ 2]. Participants were divided into three groups: (1) individuals without diabetes mellitus (controls); (2) individuals with diabetes mellitus but without end-organ complications; and (3) individuals with diabetes mellitus and end-organ complications. Dry eye metrics were compared across groups. The main outcome measures included ocular symptom questionnaires [e.g., 5-item Dry Eye Questionnaire, Ocular Surface Disease Index, and ocular pain assessment] and clinical parameters obtained from an ocular surface evaluation. A total of 366 individuals were included (mean age 59 ± 6 years; 89% males; 39% White; 11% diabetes mellitus and end-organ complications; 15% diabetes mellitus but without end-organ complications). Individuals with diabetes mellitus and end-organ complications had lower symptom scores on the dry eye disease and pain-specific questionnaires compared to individuals with diabetes mellitus but without end-organ complications and controls (Ocular Surface Disease Index: 42.1 ± 24.5 vs. 38.9 ± 25.1 vs. 23.6 ± 16.2; p < 0.001; numerical rating scale of ocular pain intensity: 4.9 ± 3.2 vs. 4.3 ± 2.7 vs. 3.5 ± 2.7; p = 0.02). Eyelid laxity was also more severe in the group with diabetes mellitus and end-organ complications (0.69 ± 0.64 vs. 0.73 ± 0.72 vs. 1.08 ± 0.77; p = 0.004) compared to the two other groups. The diabetic dry eye disease phenotype is driven by signs more so than by symptoms, with anatomic eyelid abnormalities being more frequent in individuals with diabetes mellitus and end-organ complications. Given this, ocular surface abnormalities in individuals with DM may be missed if screened by symptoms alone. As such, individuals with DM should undergo a slit lamp examination for signs of ocular surface disease, including anatomic abnormalities.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"423 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140480178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Early inflammatory thyroid eye disease (TED) can lead to symptomatic chronic disease including disabling proptosis. Teprotumumab, an IGF-1 receptor inhibitor, previously demonstrated efficacy in acute, high-inflammation TED trials. Objective: We present data from the first placebo-controlled trial with teprotumumab in chronic/low disease activity TED. Design: This was a randomized double-masked, placebo-controlled trial. Setting: The study was conducted in 11 US centers. Participants: Adults with TED duration 2–10 years, Clinical Activity Score (CAS) ≤ 1 or no additional inflammation or progression in proptosis/diplopia for ≥ 1 year, proptosis ≥ 3 mm from before TED/from normal, euthyroid/mildly hypo/hyperthyroid, no prior teprotumumab, and no steroids within 3 weeks of baseline participated. Intervention: Patients received (2:1) intravenous teprotumumab or placebo once every 3 weeks (total 8 infusions). Main outcome measures: The primary endpoint was proptosis (millimeter) improvement at Week-24. Adverse events (AEs) were assessed. Results: 42 teprotumumab and 20 placebo patients were randomized. At Week-24, mean (SD) proptosis improvement was greater with teprotumumab (-2.41 [0.228]) than placebo (-0.92 [0.323]), difference -1.48, 95%CI -2.28, -0.69, P = .0004. Proportions of patients with AEs were similar between groups. Hyperglycemia was reported in 6(15%) vs 2(10%) and hearing impairment in 9(22%) vs 2(10%) with teprotumumab and placebo respectively. AEs led to discontinuation in one teprotumumab (left ear conductive hearing loss with congenital anomaly) and one placebo patient (infusion-related). There were no deaths.
{"title":"Wirksamkeit von Teprotumumab bei der chronischen endokrinen Orbitopathie","authors":"E. Bertelmann","doi":"10.1159/000535780","DOIUrl":"https://doi.org/10.1159/000535780","url":null,"abstract":"Context: Early inflammatory thyroid eye disease (TED) can lead to symptomatic chronic disease including disabling proptosis. Teprotumumab, an IGF-1 receptor inhibitor, previously demonstrated efficacy in acute, high-inflammation TED trials. Objective: We present data from the first placebo-controlled trial with teprotumumab in chronic/low disease activity TED. Design: This was a randomized double-masked, placebo-controlled trial. Setting: The study was conducted in 11 US centers. Participants: Adults with TED duration 2–10 years, Clinical Activity Score (CAS) ≤ 1 or no additional inflammation or progression in proptosis/diplopia for ≥ 1 year, proptosis ≥ 3 mm from before TED/from normal, euthyroid/mildly hypo/hyperthyroid, no prior teprotumumab, and no steroids within 3 weeks of baseline participated. Intervention: Patients received (2:1) intravenous teprotumumab or placebo once every 3 weeks (total 8 infusions). Main outcome measures: The primary endpoint was proptosis (millimeter) improvement at Week-24. Adverse events (AEs) were assessed. Results: 42 teprotumumab and 20 placebo patients were randomized. At Week-24, mean (SD) proptosis improvement was greater with teprotumumab (-2.41 [0.228]) than placebo (-0.92 [0.323]), difference -1.48, 95%CI -2.28, -0.69, P = .0004. Proportions of patients with AEs were similar between groups. Hyperglycemia was reported in 6(15%) vs 2(10%) and hearing impairment in 9(22%) vs 2(10%) with teprotumumab and placebo respectively. AEs led to discontinuation in one teprotumumab (left ear conductive hearing loss with congenital anomaly) and one placebo patient (infusion-related). There were no deaths.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"38 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139447691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The glucagon-like peptide 1 (GLP-1) agonist showed anti-hyperglycemic and anti-inflammatory effects, which may retard the risk of external eye disease. The protective effect of GLP-1 agonist and dry eye disease (DED) was found, while the relationship between GLP-1 agonist and other corneal diseases was not clear. Herein, we aim to evaluate the association between the usage of GLP-1 agonists and the development of the following external eye disease in type 2 diabetes mellitus (T2DM) patients. A retrospective cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan was conducted. The T2DM patients were divided into those with GLP-1 treatment and those without GLP-1 treatment and matched with a 1:2 ratio. The main outcomes were the development of dry eye disease (DED), superficial keratitis, and infectious keratitis. The Cox proportional hazard regression was adopted to produce the adjusted hazard ratio (aHR) with a 95% confidence interval (CI) of external eye diseases between groups. There were 115, 54, and 11 episodes of DED, superficial keratitis, and infectious keratitis in the GLP-1 group. Another 280, 168, and 31 events of DED, superficial keratitis, and infectious keratitis were recorded in the control group. The GLP-1 group demonstrated a significantly lower incidence of DED (aHR: 0.853, 95% CI: 0.668–0.989, p = 0.0356) and superficial keratitis (aHR: 0.670, 95% CI: 0.475–0.945, p = 0.0107) compared to the control group. In the subgroup analyses, the correlation of GLP-1 agonist and DED development was more prominent in patients younger than 60 years old (p = 0.0018). In conclusion, the GLP-1 agonist treatments are significantly associated with a lower incidence of subsequent DED and superficial keratitis, while the relationship was not significant between GLP-1 agonist usage and infectious keratitis.
{"title":"Trockenes Auge bei Typ-2-Diabetikern: GLP-1-Agonisten scheinen einen protektiven Effekt zu haben","authors":"Björn Bachmann","doi":"10.1159/000535820","DOIUrl":"https://doi.org/10.1159/000535820","url":null,"abstract":"The glucagon-like peptide 1 (GLP-1) agonist showed anti-hyperglycemic and anti-inflammatory effects, which may retard the risk of external eye disease. The protective effect of GLP-1 agonist and dry eye disease (DED) was found, while the relationship between GLP-1 agonist and other corneal diseases was not clear. Herein, we aim to evaluate the association between the usage of GLP-1 agonists and the development of the following external eye disease in type 2 diabetes mellitus (T2DM) patients. A retrospective cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan was conducted. The T2DM patients were divided into those with GLP-1 treatment and those without GLP-1 treatment and matched with a 1:2 ratio. The main outcomes were the development of dry eye disease (DED), superficial keratitis, and infectious keratitis. The Cox proportional hazard regression was adopted to produce the adjusted hazard ratio (aHR) with a 95% confidence interval (CI) of external eye diseases between groups. There were 115, 54, and 11 episodes of DED, superficial keratitis, and infectious keratitis in the GLP-1 group. Another 280, 168, and 31 events of DED, superficial keratitis, and infectious keratitis were recorded in the control group. The GLP-1 group demonstrated a significantly lower incidence of DED (aHR: 0.853, 95% CI: 0.668–0.989, p = 0.0356) and superficial keratitis (aHR: 0.670, 95% CI: 0.475–0.945, p = 0.0107) compared to the control group. In the subgroup analyses, the correlation of GLP-1 agonist and DED development was more prominent in patients younger than 60 years old (p = 0.0018). In conclusion, the GLP-1 agonist treatments are significantly associated with a lower incidence of subsequent DED and superficial keratitis, while the relationship was not significant between GLP-1 agonist usage and infectious keratitis.","PeriodicalId":508305,"journal":{"name":"Kompass Ophthalmologie","volume":"39 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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