Ophthalmologe最新文献

Background: Full-thickness retinal folds are an unpleasant complication after vitrectomy or buckle surgery with gas tamponade for the treatment of retinal detachment. If the retinal folds involve the macula, the visual function of the patients will be severely impaired. This article describes a surgical technique for the management of such full-thickness macular folds.

Method: Between January 2017 and June 2020 a total of 6 patients were treated with the following technique. A redetachment was induced with balanced salt solution (BSS), followed by a subretinal air injection with filtered air. The retinal fold was mechanically smoothed out with the aid of perfluorocarbon (PFC). A postoperative drainage of air and BSS was not necessary due to spontaneous resorption.

Results: None of the patients experienced visual loss after redetachment of the retina. The visual acuity improved in 4 of the 6 patients, perception of metamorphopsia improved in 5 out of 6 patients, 2 reported complete disappearance of metamorphopsia and in 1 patient distorted vision was unchanged despite an anatomically smoothed central retina after surgery.

Conclusion: With careful consideration of the indications, this surgical technique has shown to be a safe and promising therapeutic strategy for the treatment of macular full-thickness retinal folds after retinal detachment surgery.

Background: Good visibility over the entire fundus is mandatory for optimal diagnostics and treatment of retinal pathologies. If an IOL implantation is planned in the context of retinal pathologies, a model with an enlarged optic diameter offers various advantages. The two most important benefits are an enhanced view at the fundus periphery and an improvement of the IOL positional stability especially with combined vitrectomy and the use of gas or silicone oil tamponades. The purpose of this study was to evaluate the performance and positional stability of a new 7 mm IOL.

Material and methods: This prospective study included 55 eyes of 39 patients who were scheduled for standardized cataract surgery and received a monofocal 7.0 mm optic IOL (Aspira-aXA, HumanOptics). An incision size of 2.0 mm was chosen. Follow-up visits were performed 1 week (1W), 1 month (1M), 4 months (4M) and 1.5 years (1.5J) postoperatively. Measurements included subjective refraction, uncorrected and corrected distance visual acuity (UDVA and CDVA) as well as IOL stability regarding decentration, tilt and rotation (IOLs had a pseudomarking on the periphery of the optics).

Results: Except for the postoperative occurrence of an Irvine-Gass syndrome in one eye, no intraoperative or postoperative complications were reported. The CDVA did not change significantly (p = 0.40) within the postoperative course from 1 month (median 0.00 logMAR; -0.10 to 0.22 logMAR) to 1.5 years (median 0.00 logMAR; -0.10 to 0.10 logMAR). The IOL was found to be stable over the postoperative course as decentration was < 0.02 mm and tilt < 5.5°. There was a median rotation of 1.8° (0.0-13.4°) within the first postoperative week, which was not significantly different from the rotation between surgery and 1.5 years (median 1.4°; 0.0-10.9°).

Conclusion: With comparable functional performance and the same small incision size as with usual 6.0 mm IOLs, the Aspira-aXA offers the advantages of a 7.0 mm optic in the diagnostics and treatment of peripheral retinal pathologies. In addition, the lens shows good position stability in the capsular bag.

Background: Keratoconus is classified as a corneal ectasia and is a multifactorial disease. In those affected, mostly adolescent patients visual deterioration occurs due to the development of irregular astigmatism. Treatment by corneal cross-linking (CXL) has been indicated in progressive disease for several years.

Objective: To present the pathophysiology and histological changes in keratoconus as well as wound healing processes after CXL and their potential complications.

Material and methods: Histological changes in keratoconus as well as wound healing processes after CXL and their potential complications are presented based on histological examination of corneal specimens with keratoconus with and without a condition after CXL. Relevant literature and own data are analyzed and discussed.

Results: Besides inflammatory processes, atopic and genetic dispositions play a role in the development of keratoconus. The histological characteristics of keratoconus include changes in the epithelium, Bowman's layer and stroma. Wound healing processes after CXL include healing of the surface epithelium and transient loss of keratocytes and nerve fibers.

Conclusion: Keratoconus shows characteristic histopathological changes, such as epithelial irregularities, stromal thinning and breaks of Bowman's layer, whereas the endothelium and Descemet's membrane remain unchanged (apart from cases of corneal hydrops). After CXL wound healing processes can be followed primarily in vivo by confocal microscopy. Complications after CXL are rare. Persistent loss of keratocytes can be clinically manifested as a visually relevant scar.

Background: The COVID-19 pandemic in 2020 and 2021 severely restricted the care of ophthalmology patients. Teleophthalmological services, such as video consultation or medical telephone advice could, at least partially, compensate for the lack of necessary controls in the case of chronic diseases; however, teleophthalmological options are currently still significantly underrepresented in Germany.

Objective: In order to determine the willingness of patients to use telemedicine and the virtual clinic, we conducted a survey using a questionnaire on the subject of teleophthalmology in university medicine patients with known glaucoma as a chronic disease during the first wave of the COVID-19 pandemic.

Methods: A total of100 patients were interviewed. The questionnaire contained 22 questions with multiple choice possible answers. The inclusion criterion was the presence of glaucoma as a chronic disease, age over 18 years, and sufficient linguistic understanding to answer the questions. The data were collected, analyzed and anonymously evaluated.

Results: In the patient survey it could be shown that the respondents with glaucoma are very willing to do teleophthalmology and that this would be utilized. Of the patients surveyed 74.0% would accept telemedicine and virtual clinics. Of the ophthalmological patients surveyed 54.0% stated that their visit to the doctor/clinic could not take place due to SARS-CoV‑2 and 17.0% of the patients stated that the SARS-CoV‑2 pandemic had changed their opinion of telemedicine.

Discussion: The acceptance of telemedicine in patients with chronic open-angle glaucoma seems surprisingly high. This has been increased even further by the SARS-CoV‑2 pandemic. These results reflect a general willingness of patients with chronic eye disease but do not reflect the applicability and acceptance and applicability from a medical point of view; however, this form of virtual consultation is accepted by the majority of patients with glaucoma and could be considered for certain clinical pictures.