Die Ophthalmologie最新文献

Due to the global effects of climate change numerous infectious diseases are increasingly spreading to regions that were previously hardly or only slightly affected. As ocular involvement is possible in many of these infectious diseases, we must also adapt to new pathogens and clinical pictures in Germany in the medium to long term. Using selected bacterial, viral and mycotic pathogens and diseases as examples, the causes of the increase in dissemination and the consequences for ophthalmology are presented.

Background: The ocular surface is directly exposed to environmental influences. Noxae that have already been identified for the ocular surface are heat, air dryness, pollutant gases, fine dust particles and ultraviolet radiation.

Methods: The current literature was used to investigate the relationship between frequent ocular surface diseases and various environmental factors and to analyze their development over the years.

Results: Epidemiological studies on dry eye disease and allergic conjunctivitis have shown an increase in the incidences in recent years. Environmental pollutants have been identified as disease triggers. In addition, the prolonged pollen season and increased pollen concentrations are also risk factors. There is also a higher prevalence of pterygium in population groups with high UV exposure. Other diseases with potential environmental pathogenesis are acute photokeratitis, photoconjunctivitis and malignant melanoma of the conjunctiva.

Conclusion: For ocular surface diseases, large epidemiological cohorts have shown climate-related increases in the incidence. A further increase in environmentally associated noxious substances can be expected in the coming decades. In addition to measures to mitigate climate change, the underlying mechanisms of disease development and new approaches to prevention and treatment, such as room humidification, air filters or contact lenses with UV filters, should be investigated.

Background: Microinvasive procedures have become established in glaucoma surgery and are preferred for patients with target pressure values that are not too low. Excimer laser trabeculotomy (ELT) represents such a minimally invasive approach and can easily be combined with cataract surgery.

Objective: Over 12 months the reduction in intraocular pressure (IOP), the number of antiglaucoma drugs and the incidence of adverse events were evaluated using the new Elios^TM method (Elios Vision GmbH, Germering, Germany) for real-life data from a heterogeneous patient population undergoing ELT in combination with cataract surgery (phaco-ELT).

Material and methods: In this study 20 eyes of 13 patients who underwent phaco-ELT were retrospectively analyzed. After standard phacoemulsification with posterior chamber lens implantation, 10 microchannels were created using the excimer laser. The patients were followed for 12 months and the intraocular pressure (IOP), number of antiglaucoma drugs and the occurrence of adverse events were analyzed.

Results: The average age was 65 years. The preoperative IOP was 17.5 (± 5.3) mm Hg. The mean IOP reduction was 4.8 mm Hg (27.4%, p < 0.001) on the first postoperative day, 3.2 mm Hg (18.3%, p = 0.22) after 6 months and 2.5 mm Hg (14.3%, p = 0.14) at 12 months. The number of antiglaucoma drugs decreased from an average of 3.2 (± 1.3) preoperatively to 0.5 (± 0.9) on day 1 (p < 0.001), 1.9 (± 1.2) after 6 months (p = 0.008) and 2.2 (± 1.3) after 12 months (p = 0.013).

Discussion: In our cohort ELT in combination with cataract surgery is a safe minimally invasive procedure leading to an IOP reduction of 14.3% and a reduction of pressure-lowering medication by 1 active ingredient in patients with low initial pressure at 1‑year follow-up. As no implant is used in ELT and the conjunctiva remains untouched, subsequent procedures, including bleb-related surgery, are not negatively affected.