Die Ophthalmologie最新文献

The technique of 2‑photon microperimetry is an emerging procedure that combines measurement of retinal sensitivity with retinal imaging and offers substantial improvements compared to conventional microperimetry. Conventional microperimetry relies on 1‑photon linear absorption while 2‑photon microperimetry relies on the simultaneous absorption of two photons, leading to enough energy for photoisomerization of visual pigments and perception of colors, such as green. This 2‑photon absorption process has shown a lower spread of measurements at one retinal location, leading to more reproducible data compared to conventional microperimetry. The current literature also suggests that 2‑photon microperimetry provides more reliable measurements in the presence of lens opacities, a common issue in an aging eye. Furthermore, it has been successfully utilized to assess retinal function in patients with diabetic retinopathy, age-related macular degeneration and glaucomatous neuropathy. These advantages highlight the very promising application in clinical settings. Future adjustments focusing on implementing this technology in the clinical practice could improve outcomes in the early detection and monitoring of retinal diseases.

Background: External dacryocystorhinostomy (DCR) has been performed to date with excellent functional and esthetic results. With the development of rigid endoscopy in the 1980s, endonasal DCR (EnDCR) became an effective treatment alternative. In Germany, EnDCR is currently predominantly performed by ear, nose and throat (ENT) specialists, although the indications are usually given by ophthalmologists. We describe the establishment of EnDCR at a German university eye hospital.

Methods: After setting up the necessary infrastructure (endoscopy tower, instruments), three oculoplastic ophthalmgic surgeons of the institution performed the first 6 operations under the supervision of an experienced external EnDCR surgeon. Patient age, gender, indications, operating time, learning curve (based on operating time), follow-up time, best corrected visual acuity (BCVA) preoperatively and at last presentation (logMar) as well as the subjective and objective results of lacrimal duct drainage after extubation were recorded.

Results: A total of 15 EnDCRs were carried out in 14 patients (female = 10, male = 4). The mean patient age was 63 ± 14 years. The most frequent indication for EnDCR was a status after dacryocystitis (n = 10, 71.4%), followed by primary nasolacrimal duct obstruction without previous dacryocystitis (n = 4, 28.6%). The mean operating time was 74 ± 25 min. The operating time of the first 7 procedures was significantly longer than that of the following 8 procedures (93 ± 20 min vs. 57 ± 14 min, p = 0.007). The follow-up time was 2.8 ± 2 months. The visual acuity remained unchanged during this period (0.16 ± 0.2 vs. 0.17 ± 0.2, p = 0.173). Of the patients 13 (including the bilateral EnDCR case) were symptom-free and lacrimal ducts were free of obstructions. In one patient the eye was subjectively still sticky in the morning, irrigation was normal and endoscopy was recommended for clarification.

Conclusion: The EnDCR technique can be quickly learned by experienced oculoplastic surgeons under supervision with a flat learning curve. The success rate over the short-term course (here in the small cohort so far above 90%) is comparable to the success rates of external DCR in the literature.

Background: Gene therapies offer promising approaches for the treatment of genetic diseases. With the approval of Neparvovec (Luxturna®, Novartis) in 2018, a gene therapy for the treatment of retinitis pigmentosa and Leber's congenital amaurosis in RPE65 mutations, this innovation has also reached ophthalmology practice. Despite their potential, gene therapies raise significant ethical and economic issues, particularly with regard to distributive justice, which could limit access and increase inequalities.

Aim of the paper: This article examines distributive justice from an ethical perspective, focusing on the just rationing of health resources and the affordability of gene therapies for rare diseases. The aim is to highlight areas of tension between ethical demands, economic interests and the financial sustainability of the healthcare system.

Methods: Selected literature will be reviewed to shed light on the distribution of scarce healthcare resources, potential financing models and the evaluation of appropriate pricing. In addition, challenges specific to ophthalmology are addressed.

Results: Pay-for-performance models link costs to effectiveness, but do not address all challenges. Centralized data collection and negotiation structures increase efficiency and strengthen the position vis-à-vis manufacturers, while fund models such as the HIF promote the predictability of healthcare expenditure. In ophthalmology, questions arise regarding the prioritization of patient groups, intervention thresholds and the distribution of scarce resources, for example when treating the second eye after successful treatment of the first.

Background: The increasing shortage of specialists in ophthalmology and the rising burden on university eye clinics raise questions about the appropriateness of the utilization of university resources. This study investigates the relationship between various sociodemographic determinants, such as age or social status, and the appropriateness of first presentation in a university ophthalmology outpatient clinic.

Methods: A retrospective analysis was conducted using routine data from 182,170 patients of the university outpatient clinic at the University Medical Center Freiburg (2006-2023). The appropriateness of the first presentation was operationalized by a follow-up visit within 100 days. Social status was assessed using the social index of the City of Freiburg at the postal code level. The data analysis considered relevant covariates such as age, gender, type of consultation, insurance status, distance from residence, and the social index of Freiburg.

Results: Of the included patient visits, 42.7% were classified as appropriate. An older age (odds ratio (OR) 1.36 per standard deviation (SD), 95% confidence interval (CI): 1.34-1.37) was the strongest predictor of the appropriateness of the presentation. The social index showed a weaker but significant effect (OR 1.05 per SD, 95% CI: 1.02-1.07): a lower social status was associated with increased appropriateness. The distance from residence had no significant influence.

Conclusion: The results indicate an association between increased urgency of care and both higher patient age and lower social status, with the latter potentially reflecting care gaps or delayed utilization. The study provides important insights for needs-based resource planning and health policy measures aimed at optimizing ophthalmological care structures.