Die Ophthalmologie最新文献

Background: Due to the short duration of inpatient stays and increasing outpatient treatment it is assumed that the incidence of delirium in ophthalmology is underestimated. The overall aim of this study was to record the incidence of delirium in ophthalmology through long-term follow-up.

Method: The study was divided into 2 groups. In group A delirium events were recorded retrospectively based on the discharge reports of all inpatients at the University Clinic Freiburg, Clinic for Ophthalmology from 1 January 2020 to 31 December 2022. In group B delirium events were recorded prospectively by the Augennetz Südbaden (Eye Network South Baden, ANSB) in the period 60-120 days after ophthalmological surgery.

Results: During the study period of the retrospective analysis a total of 16,384 patients were treated as inpatients. There was evidence of a total of 7 new delirium events. This corresponds to a proportion of 0.04%. A total of 12,381 patients were assessed by the ANSB, including 11,530 outpatient cataract operations. There were indications of 31 delirium events, which corresponds to a proportion of 0.25%.

Conclusion: The long-term prospectively recorded delirium events suggest that the incidence of delirium in the inpatient setting is underdiagnosed; however, postoperative delirium appears to be rare in ophthalmology in relation to the high number of procedures.

Background: To evaluate the different treatment strategies for eyes with vitreomacular traction (VMT) and macular holes (MF) regarding the indications and initiation of treatment.

Objective: The aim of this study is to facilitate clinical decision making by presenting the opinions of experienced retinal specialists in the context of the current literature and the changed approval situation for ocriplasmin.

Material and methods: Members of the German Retina Society (RG) were questioned in an online survey. Based on a literature review a 100-question questionnaire was created and sent to all members of the RG via an electronic link to the online platform "LimeSurvey". Voluntary participation was possible from 15 October 2021 to 15 November 2021. Data collection and statistical analysis were anonymized.

Results: The responses of the 115 participants were congruent with the presentation of the new S1 guidelines on this topic. The indications for active treatment of focal VMT without MF were postponed in favor of watchful waiting, with the individual symptoms of the patient playing a major role in the proposed temporal management. The results on the indications for vitrectomy are consistent and convincingly confirm the opinions on the efficacy and risk assessment of this therapeutic procedure.

Conclusion: The results presented provide an overview of the consensus and controversies in the current treatment options for VMT and MF. With the help of a homogeneous and experienced group of retinal experts, it was possible to develop individual treatment strategies.

Background: Full-thickness macular hole (FTMH) is a rare disease. Not all FTMHs can be closed by primary surgical intervention.

Objective: This work aims to characterize a large patient population with FTMHs and to detect possible predictive factors for anatomical treatment success.

Materials and methods: The study comprises a retrospective analysis of all consecutive idiopathic macular holes between March 2008 and June 2019 at the University Eye Hospital Cologne. Epidemiologic data, preoperative parameters (size of the FTMH), and surgical technique were examined in relation to the closure rate following primary surgery.

Results: The anatomical closure rate for idiopathic FTMH after primary surgery was 83.6%. No association between age, gender, and lens status and closure rate could be shown. Regarding anatomical surgical success, the favorable prognostic factors identified were a small FTMH size, short symptom duration, performance of transconjunctival 23-gauge vitrectomy, and application of the inverted flap technique of the internal limiting membrane (ILM).

Conclusion: Surgical treatment represents a valuable treatment option for patients with macular holes due to good prospects of success. Prompt intervention after diagnosis using 23-gauge vitrectomy and an ILM flap with gas tamponade seems to result in the most favorable outcomes.

Background: Uveitis leads to blindness in 10-15% of all cases in industrialized nations. The prevalence varies depending on the literature, ranging from 9 to 730 cases per 100,000 inhabitants. Local and systemic steroid applications, along with treatment involving immunomodulators, are the primary treatment options. In cases of chronic and refractory uveitis, especially with the manifestation of uveitic macular edema, intravitreal corticosteroids can contribute to reduce or completely replace systemic immunomodulatory therapy with disease-modifying antirheumatic drugs (DMARDs), biologics or corticosteroids.

Objective: This review article presents the currently available intravitreal corticosteroid implants used in the treatment of noninfectious uveitis. The indications, effectiveness, and side effect profiles are discussed within the context of the current literature. A total of 6 randomized controlled studies about FAc and DEX implants with more than 100 patients were included in this review. One subgroup analysis from a multicentric randomized study with 315 patients has been included as well. The outcome is discussed in this article.

Conclusion: The efficacy and safety profile of intravitreal corticosteroids in uveitic macular edema have been evaluated in several studies in recent years. In some studies, they have been compared to systemic treatment options. With long-acting corticosteroid implants the number of relapses can be reduced and the time interval between relapses can be prolonged. Short-acting corticosteroid implants represent a treatment option during acute uveitic activity. The adverse effects of corticosteroids can be well-controlled in most cases. In phakic and/or young patients, however, adverse effects (such as cataract development) should be discussed in depth before treatment initiation as most corticosteroids are applied as long-term treatment.