Ophthalmologe最新文献

Background: Smartphone-based adapters for fundus photography offer a cost-effective alternative to traditional fundus cameras. The various offers vary widely in design, size, purchasing costs, user-friendliness, and image quality when compared to each other and to traditional fundus cameras.

Objective: The aim is to enable the reader to understand the technical and optical aspects of fundus photography and therefore to evaluate the various offers of traditional fundus cameras and adaptors for smartphone-based fundus photography with respect to their personal requirements.

Material and methods: The technical and optical principles and aspects of fundus photography are explained and the various approaches to illumination, imaging, image capture and alignment are discussed. The association between field of view, pupil size, mydriasis and image quality are discussed as well as the challenges and difficulties of aligning the fundus camera relative to the patient's eye.

Results: The most important technical aspects of a fundus camera are the avoidance of disturbing reflections when taking photographs, an acceptable field of view angle, the user-friendliness during alignment, success rate of imaging and the question whether mydriasis is necessary.

Conclusion: The development of adapters for smartphone-based fundus photography has resulted in interesting offers, which make fundus photography available to a wider user spectrum at low purchase costs. The offers on the market vary widely. It is therefore difficult to reach a definitive evaluation; however, smartphone-based adapters mostly have limitations with respect to user-friendliness, the size of the field of view and image quality.

Background: Three groups of iris prostheses can be distinguished for the surgical treatment of iris defects: (1) segmental iris implants, (2) combined iris diaphragm intraocular lenses (IOL) and (3) pure iris implants. Most iris reconstructions are accompanied by aphakia correction with secondary IOL implantation. Although the primary goal is to create a pupil and to improve glare perception, contrast sensitivity and visual acuity, the esthetic result is also a relevant component.

Objective: Functional and esthetic results after replacement of an aniridia IOL implant with a custom-made artificial iris with IOL.

Material and methods: In this retrospective study with seven eyes from seven patients, an iris diaphragm IOL (Morcher GmbH, Stuttgart, Germany) was exchanged for medical reasons (subluxation) against a custom-made artificial iris made of silicone (ArtificialIris, HumanOptics, Erlangen, Germany) in combination with a sutured IOL. The follow-up period was at least 3 months. Best corrected distance visual acuity (BCVA), endothelial cell count (ECC), complications, glare perception as well as esthetic outcome and patient satisfaction were evaluated.

Results: The BCVA and ECC showed no statistically significant change between the preoperative and postoperative values (p > 0.05). There was a decentration of the iris IOL implant of 0.27 ± 0.19 mm three months postoperatively. On a visual analogue scale (VAS) from 1 to 10 (1 = not satisfied at all, 10 = extremely satisfied), satisfaction with the overall result was rated 8.6 ± 2.5. Subjective glare perception improved to 5.6 ± 3.5 and subjective esthetic impairment improved to 2.4 ± 2.0 on the VAS (1 = none, 10 = extremely strong). Postoperative complications included transient intraocular hypotonia in two eyes, intraocular pressure increase in two eyes, retinal detachment and transient vitreous hemorrhage in one eye each. Of the seven patients six would repeat the procedure.

Conclusion: Compared to a rigid aniridia IOL implant, replacement with a custom-made artificial iris in combination with an IOL provides not only a good functional result but simultaneously also an esthetically pleasing result.

Background: Patients and refractive surgeons have a legitimate interest in the long-term results of the most commonly used laser procedures for correction of ametropia.

Objective: To assess the safety, predictability, stability and late complications according to the current recommendations of the committee for refractive surgery (KRC).

Methods: Literature search in PubMed with the search term "long-term outcome" combined with either "PRK", "LASIK" or "SMILE". Articles about PRK and LASIK with a minimum follow-up of 10 years and SMILE with a minimum follow-up of 5 years were evaluated and duplications were eliminated.

Results: From a total of 440 articles that matched these search terms 15 articles were selected and analyzed. The results of PRK were described in 4 studies with a total of 666 eyes, 7 studies (566 eyes) described the results of LASIK and 5 studies (188 eyes) the results after SMILE.

Conclusion: Long-term studies with follow-up periods of at least 10 years have shown that PRK and LASIK treatment carried out in the early days of medical excimer lasers have a very high level of safety and late complications occurred only rarely. The effectiveness of particularly high corrections declined over time. In contrast, there was no clinically significant regression within the indications recommended by the KRC. The results of SMILE were not inferior to those of PRK and LASIK. In direct long-term comparisons no procedure showed a clear superiority. Due to technological improvements in hardware and software for both preoperative diagnostics and lasers, treatment performed nowadays is presumably even safer, more efficient and also more stable over a long period of time.

Background: With the surgical methods continuously developed in recent years, macular surgery has become an increasingly less traumatic procedure for the eye. For patients with additional lens opacification, a 1-stage procedure with combined cataract surgery is recommended.

Objective: The aim of this retrospective study was to record the functional results and complications after elective macular surgery with and without combined phacoemulsification and artificial lens implantation.

Material and methods: The retrospective study included all patients who were operated on with a pars plana vitrectomy (ppV; 25 gauge) for epiretinal membrane, macular hole or vitreoretinal traction between 2010 and 2016 and who had a follow-up period of at least 3 months. The functional results and possible risk factors as well as complications that occurred were then recorded.

Results: A total of 781 eyes were identified of which 517 (66%) had a phacoemulsification and artificial lens implantation with a 25-gauge vitrectomy, membranectomy, ILM peeling and SF6 gas or air tamponade. The mean follow-up time was 17 months. The mean logMAR visual acuity was 0.59 preoperatively and 0.4 postoperatively. From 64 phacic eyes which did not receive a combined phacoemulsification and artificial lens implantation 40 (62.5%) required phacoemulsification and artificial lens implantation within 13.6 months due to complicated cataract, 18 even within 6 months. In terms of complications, there were comparable results between ppV alone and the combined operation, particularly with respect to an IOL dislocation or iris capture.

Conclusion: Overall elective macular surgery is a procedure with few complications both without and above all with combined phacoemulsification and artificial lens implantation. Therefore, a combined operation makes sense in terms of surgical management and postoperative rehabilitation, especially in times of a pandemic with limited surgical resources.

Keratoconus is morphologically associated with increasing deformation, thinning and scarring of the cornea. This functionally leads to refractive changes and visual deterioration. In the early stages there are often no clear clinical signs in the slit-lamp examination; however, confirming the diagnosis as early as possible is important in order to provide patients with an appropriate treatment. For the early diagnosis of keratoconus, various diagnostic devices have been introduced in recent years and decades. These include keratometry with reflection-based or elevation-based systems and optical coherence tomography. High-frequency ultrasound microscopy and corneal biomechanics can also be used to establish the diagnosis of keratoconus by the measurement of other parameters. The necessity and the available possibilities for early diagnosis of keratoconus are presented in more detail in this article.

Digital applications on mobile devices are also becoming more widespread in medicine and increasingly support the diagnostics and treatment. Smartphone-based fundus photography (SBF) is a mobile and cost-effective form of ocular fundus imaging and offers many new applications in healthcare. For its practical implementation there are various adapters that are connected to commercially available smartphones, so that the adapter can be used as an ophthalmoscope with the integration of the smartphone. The use of corresponding software applications and adapters for smartphones poses challenges in terms of both medical product law and IT security, which are discussed in this article from the perspective of the German Federal Institute for Drugs and Medical Devices (BfArM) and the German Federal Office for Information Security (BSI).