Die Ophthalmologie最新文献

Background: Extracellular vesicles (EV), especially small EV and microvesicles, are considered promising biomarkers as they transport molecular information from their tissue of origin and can thus reflect pathological processes. They are increasingly being investigated as biomarkers in ocular diseases.

Objective: The aim of this study was to present the current state of knowledge on the role of EV as biomarkers for ocular diseases, to compare sample sources and to discuss the associated methodological challenges as well as clinical perspectives.

Material and methods: This work is based on a literature search of current original articles and reviews, complemented by tabular overviews of identified EV-associated markers for ocular diseases.

Results: The potential of EV as biomarkers for ocular diseases is currently being studied in tears, aqueous humor, vitreous humor, blood and urine. Alterations in EV concentration and size as well as disease-specific signatures have been reported. Numerous EV-associated molecules, particularly microRNA (miRNA) and proteins, have been proposed for diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma, myopia and ocular tumors.

Conclusion: Although EV hold great promise as diagnostic and prognostic tools in ophthalmology, validated markers and standardized isolation and detection methods are still lacking. Key challenges include lipoprotein contamination, limited sample volumes and interindividual variability (e.g. age, sex, fasting status). In the future, after overcoming these technical challenges, small EV and microvesicles could serve as liquid biopsy tools for screening, disease monitoring and personalized management of ocular diseases.

Background: For neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents currently represents the standard of care. Both treatment intervals and the choice of the optimal agent are critical determinants of therapeutic outcomes.

Objective: This study evaluated the effect of switching from established anti-VEGF agents (ranibizumab, bevacizumab or aflibercept) to faricimab on injection intervals in patients with nAMD or DME.

Material and methods: Data were collected in a routine outpatient ophthalmology practice. Inclusion criteria were: (I) treatment according to a treat-and-extend protocol, (II) at least six intravitreal injections prior to switching to faricimab and (III) at least three subsequent faricimab injections. To assess disease-specific effects, patients were stratified into nAMD and DME subgroups.

Results: A total of 86 patients with a mean of 37 prior injections were included. The mean injection interval before switching to faricimab was 44 days. In the nAMD subgroup (n = 74, mean age 72 years), the interval significantly increased from 46 to 53 days (mean difference 7.45 days, p < 0.05). In the DME subgroup (n = 12, mean age 65 years), the interval significantly increased from 42 to 57 days (mean difference 15.25 days, p < 0.05). The effect size was moderate (Cohen's d = 0.56) with high statistical power (99.93%).

Conclusion: Switching to faricimab resulted in a significant extension of treatment intervals in both indications, with patients with DME deriving the greatest benefit. Limitations include the small sample size and potential selection bias. These findings suggest an improved benefit-risk profile through reduced injection frequency. Additional real-world data and meta-analyses may help identify biomarkers to further individualize anti-VEGF therapy in the future.

Indications: The aim of the multilevel revision is a single-stage, ideally definitive surgical treatment of corneal-endothelial-epithelial decompensation and bullous keratopathy caused by an anterior chamber iris claw intraocular lens (IOL) by means of IOL explantation, complete pars plana vitrectomy, secondary IOL implantation and simultaneous Descemet membrane endothelial keratoplasty (DMEK). The prerequisite for surgery is the absence of pre-Descemet corneal scars.

Surgical technique: For complete mobilization of the dislocated anterior chamber IOL the haptics are severed and the lens is removed through a 6 mm wide superior sclerocorneal tunnel. Complete anterior and posterior 25-gauge vitrectomy is performed including removal of the active posterior vitreous detachment. After manual iris tissue stretching, a retroiridal iris claw IOL is implanted. In the end, DMEK with a donor graft size of 7.5 mm is performed via temporal access for treatment of the corneal decompensation.

Conclusion: In patients with corneal-endothelial-epithelial decompensation and bullous keratopathy due to a dislocated anterior chamber IOL, IOL explantation with complete vitrectomy, secondary implantation of a retroiridal, iris-fixated IOL and combined DMEK is an effective, single-stage surgical treatment.

Video online: The online version of this article contains a video.

Background: Rhegmatogenous retinal detachment (RRD) is a potentially acute vision-threatening condition. While scleral buckling (SB) was considered the standard treatment for decades, it has increasingly been replaced by pars plana vitrectomy (ppV).

Objective: This study aims to re-evaluate the role of SB within the current therapeutic context by comparing the clinical outcomes of SB versus primary ppV for RRD, based on data published from 2005-2025.

Material and methods: A systematic literature search across five databases identified 24 studies (2005-2025) comparing SB and ppV in primary RRD. Exclusion criteria included patient age under 18 years and proliferative vitreoretinopathy (PVR) greater than grade B. Outcomes were analyzed in terms of preoperative and postoperative corrected distance visual acuity (CDVA) and single surgery anatomical success (SSAS).

Results: Across all included studies the mean preoperative CDVA was 1.22 logMAR. Postoperatively, visual acuity improved to 0.49 logMAR with SB and to 0.5 logMAR with ppV. In phakic eyes, SB resulted in an average postoperative CDVA of 0.17 logMAR, whereas ppV achieved a mean of 0.23 logMAR in the same subgroup. The SSAS was reported to be up to 93.8% for SB and up to 96.3% for ppV.

Conclusion: Scleral buckling remains an effective therapeutic option for selected patient populations, particularly those with a phakic lens status. Given its clinical relevance, SB should continue to be an integral part of surgical training programs.

Background: A large number of physicians with a migration background work in Germany. Political changes in their countries of origin might affect the healthcare situation in Germany. In the case of Syria, the consequences of possible emigration of Syrian doctors have already been publicly discussed. The aim of this study was to survey the self-assessment of Syrian doctors in Germany regarding their future professional orientation.

Method: Anonymous exploratory survey among Syrian doctors and medical students. Data collection took place from January to March 2025 using REDCap (Vanderbilt University, Nashville, TN, USA). The survey was distributed via the Syrian Society of Physicians and Pharmacists in Germany (SyGAAD e.V.), the German-Arab Ophthalmological Society (DAOG e.V.) and all medical student councils in Germany. Information collected included training status, current employment, the timeframe in which respondents could imagine working in Syria, and the reasons influencing their decision-making. The distribution of participants by federal states was assessed descriptively.

Results: 191 Syrian doctors, including 92 ophthalmologists, and 41 medical students participated. 91% of the doctors were born in Syria, 83% completed their medical studies in Germany. 41% were younger than 35 years. Of the ophthalmology specialists, 32% worked in hospitals and 66% in practices. Overall, 27% of all participating Syrian doctors could imagine working in Syria within the next five years, and another 35% within the next ten years. Political, religious, or cultural reasons (60%) and family factors (52%) were selected far more frequently than economic (29%) or career reasons (23%). The highest proportion of participating Syrian doctors was in Saarland and the lowest was in Schleswig-Holstein.

Conclusion: The data suggest that Syrian doctors in Germany are predominantly young and mostly trained in Germany. Almost two-thirds could imagine working in Syria within the next ten years. Representative surveys of the regional distribution could help assess the risk of healthcare shortages more accurately. The Federal Ministry for Economic Cooperation and Development plans programs for German-Syrian hospital partnerships that could be beneficial for both countries.

Background: Keratoconus is a progressive corneal disease that can lead to substantial impairment of vision. While conventional treatment, such as glasses, contact lenses or corneal grafting are well established, minimally invasive tissue-additive procedures are becoming increasingly more important. The goal is to achieve biomechanical stabilization and optical reconstruction of the cornea with minimal invasiveness.

Objective: This review explores what role novel tissue-additive procedures, such as stromal lenticule addition keratoplasty (SLAK), Bowman membrane transplantation and xenotransplantation, play in modern keratoconus treatment and how effective they are in terms of vision improvement and corneal stabilization.

Material and methods: Review paper presenting the physiological principles, technical implementation and clinical results of various tissue-additive procedures. Case series, clinical studies and meta-analyses on efficacy and safety were included.

Results: Tissue additive procedures, such as SLAK showed significant improvements in visual acuity and corneal topography. The central corneal thickness also increased. Combinations with corneal crosslinking (CXL) enable an expanded range of applications. Bowman's membrane transplantation also showed structural improvements in advanced keratoconus. Xenogeneic transplants from porcine stroma are promising but require further evaluation.

Conclusion: Tissue additive techniques offer customizable, reversible alternatives to traditional transplantations with shorter recovery times. The combination with CXL improves long-term stability. Limitations include tissue availability and standardization of procedures. In the future, artificial intelligence (AI)-supported planning and image-guided treatment customization could further improve precision and outcomes.