Die Ophthalmologie最新文献

Introduction: Analysis of visual acuity, keratometry and aberrometry (coma) after intrastromal corneal ring segment (ICRS) implantation in keratoconus (KC) and the evolution of visual acuity after subsequent excimer laser-assisted penetrating keratoplasty (PKP).

Patients and methods: Retrospective analysis of a case series of 7 patients from the Homburg Keratoconus Center (HKC), who received excimer laser PKP for unsatisfactory visual acuity 3.2 ± 3.0 years after ICRS implantation. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) in logMAR, flat (K1), steep (K2) and mean keratometry, (Kmean), higher order aberrations (HOA, coma) and regularity of astigmatism were analyzed via tomography. Data of the PKP group (PG) were compared to a control group (CG) of 7 age-adapted satisfied patients after ICRS implantation without the need of PKP. Data analysis was performed before and 7.4 ± 4.5 months after PKP.

Results: Prior to PKP, data analysis showed a significantly lower UCVA of 0.94 ± 0.54 and BCVA of 0.49 ± 0.07 in the PG compared to the CG (UCVA 0.40 ± 0.35; CDVA 0.06 ± 0.05, p < 0.01). The K1 was significantly higher in the PG prior to PKP compared to the CG (47.1 ± 3.1 vs. 43.0 ± 2.7 D, p = 0.02) but K2 (p = 0.86) and Kmean (p = 0.12) were not. Regularity of peripheral (p = 0.54) and central (p = 0.69) astigmatism as well as coma (p = 0.39) did not show significant differences between the PG and KG prior to PKP. Excimer laser-assisted PKP was possible without any obstacles in all 7 eyes. In addition, BCVA increased significantly from 0.49 ± 0.07 to 0.33 ± 0.1 (p < 0.001) 6 months after PKP. The K1 decreased significantly after PKP (p = 0.002).

Conclusion: After unsuccessful ICRS implantation, patients seem to present with lower visual acuity and higher K1 despite similar values for K2, Kmean and coma. These patients may profit from an excimer laser assisted PKP, which can be performed without any obstacles despite the ICRS in place.

The spontaneous reporting system for cases of suspected side effects is a central instrument for detecting possible side effects after a pharmaceutical preparation has received marketing authorization. It provides important information (signals) on the occurrence of rare, previously unknown side effects, on increases in the frequency of known side effects that may also be due to quality defects, or on changes in the type or severity of known side effects. In recent decades, this system has made a significant contribution to the identification of drug-related risks that only arise upon widespread use following approval and to the introduction of appropriate measures to minimize risk.

Progression monitoring is essential for glaucoma management. In addition to perimetry, optical coherence tomography (OCT) has become established as a valuable supplement. It provides morphological information on the retinal nerve fiber layer (RNFL), the neuroretinal rim and the density of retinal ganglion cells in the macula. Event-based and trend-based analyses can be used for the quantitative analysis of glaucoma progression. Various biomarkers have stage-dependent strengths and weaknesses and should be complementarily applied. The minimization of measurement errors is important for valid progression analyses. In the future other techniques and artificial intelligence (AI) could improve the progression analysis.

Keratectasias including keratoconus are pathological curvature anomalies of the human cornea, which can progress and lead to permanent visual impairment. Corneal crosslinking can be used to stabilize the disease. Criteria for performing crosslinking have been defined by legislation in Germany, including an increase of the maximum anterior surface curvature Kmax by ≥ 1 diopter within 12 months. Unfortunately, there is still a lack of generally applicable standards for assessment of keratectasia progression. This overview presents the possibilities of topographic, tomographic and biomechanical assessment of progression in keratoconus.

Antibody-drug conjugates (ADC) are a class of targeted anticancer therapy that consist of a monoclonal antibody (linker) and a cytotoxic substance. Ocular adverse events (AEs) are common among ADCs with tubulin-targeted active agents, such as belantamab mafodotin, tisotumab vedotin and mirvetuximab soravtansine (MIRV). The substance MIRV targets folate receptor alpha (FRalpha) and has a tubulin-acting agent (the maytansinoid DM4). The use of MIRV received full approval in the USA (March 2024) for FRalpha-positive platinum-resistant ovarian cancer (PROC) and is the first novel agent to demonstrate a significant survival advantage against single agent chemotherapy in a phase 3 PROC trial. The use of MIRV was recently approved by the European Medicines Agency (EMA) for the same indication, as assessed in the MIRASOL trial. Ocular AEs associated with MIRV primarily include blurred vision and keratopathy, due to transient corneal alterations; however, the mechanism by which MIRV causes ocular AEs is thought to be a result of "off-target" effects or non-specific uptake by corneal epithelial cells. Results from clinical trials of MIRV demonstrate that these AEs can be resolved and monitoring/prophylactic strategies are in place to mitigate their incidence, including prophylactic corticosteroid eye drops, daily lubricating eye drops, dose modifications and regular ocular examinations. Support from ophthalmologists is essential to AE management to allow MIRV therapy to continue. This review provides ophthalmologists with a clinical overview of ocular AEs associated with certain tubulin-acting ADCs, with a focus on MIRV, and the prophylactic/mitigative measures that can allow patients to stay on MIRV therapy longer.

The global increase in myopia prevalence and associated secondary complications necessitates adequate monitoring of myopia progression. This review highlights the advantages and disadvantages of the most commonly used target parameters for assessing myopia progression: refractive error and axial length. Although refractive error is essential for the diagnosis and optical correction of myopia, axial length proves to be a more reliable and clinically relevant parameter for monitoring progression and guiding preventive interventions. Axial length correlates more strongly with the risk of ocular complications and is less susceptible to diurnal variations and interventions that alter the eye's refractive power. Assessing myopia progression under preventive measures requires consideration of age-dependent physiological changes in axial length. Standardized comparison parameters, such as the cumulative absolute reduction in axial elongation (CARE) can facilitate the objective evaluation of the efficacy of the intervention. Regular monitoring of refraction and axial length should also be performed in young adults with risk factors, as myopia onset and progression can occur even at this age.