Der Ophthalmologe最新文献

{"title":"[The painless foreign body].","authors":"S Zwingelberg, P Hamrah, A Hamprecht, S Walker, B Bachmann, C Cursiefen, S Roters","doi":"10.1007/s00347-019-01017-0","DOIUrl":"10.1007/s00347-019-01017-0","url":null,"abstract":"","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"33 1","pages":"575-578"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82520639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Appearance, recurrence and prognosis of immunological graft rejection after penetrating keratoplasty].","authors":"Yasmin Molter, Georgia Milioti, Achim Langenbucher, Berthold Seitz","doi":"10.1007/s00347-019-00975-9","DOIUrl":"10.1007/s00347-019-00975-9","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to examine the patterns of immunological graft rejection reactions (IAR) after penetrating keratoplasty (KPL) and to assess the prognosis for preservation of transparency of the corneal graft.</p><p><strong>Patients and methods: </strong>In the period from 2006 to 2015 a total of 190 IAR, which occurred in 120 eyes of 119 patients, were retrospectively analyzed. The underlying disease, number of previous KPL and IAR and measures of best corrected visual acuity (BCVA, logMAR) and pachymetry at the time points T1 = postoperatively, T2 = acute IAR, T3 = follow-up at 6 weeks and T4 = follow-up at 3-12 months were recorded. A successful treatment was defined as a lack of early recurrence (6-12 weeks after treatment) or the necessity for repeating the KPL. Data were compared using the χ²-test and Wilcoxon-Mann-Whitney U‑test with a significance level of 5%. The Kaplan-Meier procedure was used to define the rejection-free interval after KPL.</p><p><strong>Results: </strong>The temporal analysis showed a median rejection-free interval of 19.3 months after the previous KPL (95% confidence interval, CI 14.7-26.6 months). In 138 out of 190 cases (72.6%) the IAR could be successfully treated, 12 (6.3%) suffered an early recurrence and 40 (21%) were irreversible. Despite a significant decrease of BCVA at T2 from 0.5 ± 0.4 at T1 to 0.7 ± 0.5 at T2 (p < 0.001), the comparison with the follow-up at 3-12 months (T1 vs. T4) showed no significant differences. The pachymetry at the thinnest point showed significant changes from T1 (535.4 ± 64.1 µm) to T2 (636.1 ± 102.1 µm; p < 0.001). Despite a significant reduction in thickness at T3 (607.3 ± 114.0 µm, p = 0.03), the corneal grafts were still significantly thicker in the follow-up at 3-12 months (591.8 ± 116.8 µm; p < 0.001; T1 vs. T4).</p><p><strong>Conclusion: </strong>With closely monitored aftercare following surgery IAR after KPL is rare. In most cases IAR typically occurs in the second postoperative year after KPL and under adequate treatment is reversible in approximately 75% of the cases. While BCVA showed a good recovery until the end of the follow-up period, the corneal grafts were still significantly thicker in the long-term after IAR (7.7-9.7%).</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"3 1","pages":"548-556"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88639326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ocular lymphoma : Precise diagnostics and classification as key for successful personalized treatment].","authors":"Vinodh Kakkassery, Anselm M Jünemann, Nikolaos E Bechrakis, Salvatore Grisanti, Mahdy Ranjbar, Marco Zschoche, Ludwig M Heindl","doi":"10.1007/s00347-019-01020-5","DOIUrl":"10.1007/s00347-019-01020-5","url":null,"abstract":"<p><strong>Background: </strong>Personalized medicine is nowadays the standard of care for patients with oncological diseases. A prime example is the lymphoma, which has substantial points of contact with ophthalmological care due to the intraocular and periocular involvement.</p><p><strong>Objective: </strong>This article provides a description of the current personalized diagnostics and treatment of ocular lymphomas.</p><p><strong>Methods: </strong>This article constructs a relationship between the current knowledge in the literature, guidelines and recommendations and the clinical experience with ocular lymphomas. It explains in particular the molecular and also individual personalized treatment concepts.</p><p><strong>Results: </strong>The primary suspicion of lymphatic or other ocular oncological diseases is raised by an ophthalmologist based on clinical symptoms. The exact diagnostic procedure is carried out with molecular biological techniques, such as immunohistology and polymerase chain reaction analyses. A staging of the mass is indispensable and the stage classification according to the Ann Arbor criteria for a correct assignment of the lymphoma is of clinical importance. Based on these precise diagnostics an individualized choice of treatment and subsequent personalized follow-up care are carried out. During the complete process from the diagnostic procedure to treatment and aftercare, psycho-oncological support should be offered to the patient.</p><p><strong>Conclusion: </strong>Personalized medicine is already actively performed in the care of ocular lymphomas. The patient is in the forefront and plays a decisive role. By considering the special features of the tumor and patient parameters, the life expectation and relapse-free interval as well as quality of life have been improved for many types of lymphoma. It must be assumed that these advantages also apply to ophthalmology.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"40 1","pages":"499-507"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83011660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment adherence and effectiveness of anti-Vascular Endothelial Growth Faktor(VEGF) treatment of diabetic macular edema in the clinical routine : Comparison between cooperative and unicentric organization of treatment].","authors":"H Faatz, K Rothaus, D Westhues, B Heimes-Bussmann, M L Farecki, M Ziegler, M Gutfleisch, G Spital, A Lommatzsch, D Pauleikhoff","doi":"10.1007/s00347-019-00977-7","DOIUrl":"10.1007/s00347-019-00977-7","url":null,"abstract":"<p><strong>Background: </strong>Intravitreal injection of anti-vascular endothelial growth factor (VEGF) is an established method for treatment of diabetic macular edema (DME); however, to ensure the best possible functional results continuous treatment of patients over a long period with regular control visits are necessary. The adherence of patients to the treatment is of great importance for success.</p><p><strong>Methods: </strong>In order to make implementation of treatment easier for patients, an internet-based referral platform was established to enable the follow-up examination to be performed by an ophthalmologist using spectal domain optical coherence tomography (SD-OCT) close to the patients place of residence. Based on 50 patients the effectiveness of this cooperative treatment (IT-Cooperation) was compared to 50 patients who were controlled in the treatment center for DME patients over a period of 2 years.</p><p><strong>Results: </strong>Patients in the IT-Cooperation group received an average of 6.3 injections in the first year of follow-up compared to the lower number of 5.2 injections for patients attending the treatment center. During the second year the average number of injections decreased to 2.7 (IT-Cooperation) and 2.4 (treatment center). Patients of the IT-Cooperation showed an average of 12.0 control visits in contrast to the average number of 9.6 visits (p < 0.01) for patients attending the treatment center in the first year of observation. This difference between the two groups was significant and was confirmed in the second year of follow-up with 8.3 visits in the IT-Cooperation group compared to 4.4 visits in the treatment center group (p < 0.01).</p><p><strong>Conclusion: </strong>The greater number of follow-up examinations close to the patient's place of residence for the IT-Cooperation group significantly improved the quality of treatment adherence in DME patients; however, intensive exchange of information between the ophthalmologist performing the control examinations and the treatment center where the injections were carried out is mandatory.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"29 1","pages":"557-565"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89005307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recurrent choroidal detachment in a patient undergoing hormone therapy for prostate cancer].","authors":"G Lehmann, R Wienrich, M Fiorentzis, A Viestenz","doi":"10.1007/s00347-019-00956-y","DOIUrl":"10.1007/s00347-019-00956-y","url":null,"abstract":"<p><p>An 85-year-old male patient receiving hormone therapy for prostate cancer and secondary open-angle pseudoexfoliation glaucoma developed peripheral choroidal detachment in both eyes. The patient had been admitted to the eye hospital for clarification of a vascular occlusion in the left eye. Cerebral magnetic resonance imaging could exclude metastases and a cerebral space-occupying lesion as the cause of the ocular findings. The local antiglaucomatous treatment was interrupted and as a result the intraocular pressure normalized and the choroidal detachment receded completely. Patients with prostate cancer who receive hormone therapy should also undergo regular ophthalmological screening including funduscopy and measurment of intraocular pressure.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"77 1","pages":"456-460"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74197952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Explantation of two historical posterior chamber phakic intraocular lenses 31 years after implantation].","authors":"V Tahmaz, B Bachmann, E Tahmaz, S Schickhardt, H Fang, G Auffarth, C Cursiefen","doi":"10.1007/s00347-019-0942-y","DOIUrl":"10.1007/s00347-019-0942-y","url":null,"abstract":"<p><p>This article reports the case of a 56-year-old male patient who had undergone implantation of posterior chamber phakic intraocular lenses in 1987 in Russia. The patient presented to this clinic 31 years after the initial surgery with anterior cortical cataracts and initial stages of corneal decompensation in both eyes. Strategic planning and execution of surgical treatment and the further clinical course are portrayed in this report.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"43 1","pages":"452-455"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77501295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Masquerade lacrimal duct stenosis: prevalence of lacrimal sac tumors].","authors":"Nataša Mihailovic, Julius Steenken, Sandra Elges, Ralph-Laurent Merté, Ulrike Grenzebach, Nicole Eter, Maged Alnawaiseh","doi":"10.1007/s00347-019-00971-z","DOIUrl":"10.1007/s00347-019-00971-z","url":null,"abstract":"<p><strong>Background: </strong>Tumors of the lacrimal sac are a rare entity. Malignancies are often associated with a high mortality rate. Lacrimal sac tumors often present as lacrimal duct stenosis with dacryocystitis and are often only diagnosed after an intraoperative biopsy. The aim of this study was a retrospective analysis of all cases with lacrimal sac tumors, which presented with a lacrimal duct stenosis at this medical center in the past 10 years.</p><p><strong>Methods: </strong>All patients who were treated by external dacryocystorhinostomy (DCR) at the University Medical Center Münster during the period January 2009-December 2018 were retrospectively analyzed for the presence of a lacrimal sac tumor. Symptoms, clinical and histopathological findings, diagnostic and therapeutic procedures as well as long-term follow-up were analyzed.</p><p><strong>Results: </strong>A total number of 878 patients underwent an external DCR at the University Medical Center Münster during the study period. Of these patients 13 were diagnosed with a lacrimal sac tumor and included 9 malignant lymphomas, 2 squamous cell carcinomas, 1 oncocytic adenoma and 1 transitional cell papilloma.</p><p><strong>Conclusion: </strong>Neoplasms of the lacrimal sac can masquerade as lacrimal duct stenosis or dacryocystitis and must be considered as a differential diagnosis in cases with an atypical clinical course. A lacrimal sac biopsy during an (external) DCR with subsequent histopathological examination is strongly recommended in such cases.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"26 6 1","pages":"439-444"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88194425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[360° trabeculotomy for pediatric glaucoma].","authors":"Esther M Hoffmann","doi":"10.1007/s00347-019-01002-7","DOIUrl":"10.1007/s00347-019-01002-7","url":null,"abstract":"<p><p>Congenital glaucoma disease leads to blindness if left untreated. It is estimated that 1 child in 10,000 in Germany is born with congenital glaucoma. In adults the disease develops slowly and insidiously, whereas congenital glaucoma leads to a rapid growth of the eye (buphthalmos) mostly directly after birth due to a very high intraocular pressure. The cause is dysgenesis of the iridocorneal angle. Successful operative treatment of congenital glaucoma is possible in the majority of cases (approximately 80-90%). The treatment of childhood glaucoma is primarily surgical. Since 1960 classical probe trabeculotomy has been the most commonly used procedure, which has the advantage that unlike goniotomy, it can also be performed in cases with clouding of the cornea. In this surgery the canal of Schlemm is probed and the inner wall as well as the trabecular meshwork is opened inwardly over approximately 120°. In recent years the 360° trabeculotomy procedure has become established, in which an illuminated catheter filled with viscoelastic material is used (as with conventional canaloplasty) to dilate the canal of Schlemm. The trabecular meshwork is then inwardly opened by pulling on the ends of the catheter. The results of this method are explained in this article.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"45 1","pages":"210-214"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80001367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Young male patient with unusual space-occupying lesion of the lower eyelid].","authors":"Alexander C Rokohl, Heike Löser, Joel M Mor, Niklas Loreck, Konrad R Koch, Ludwig M Heindl","doi":"10.1007/s00347-019-00948-y","DOIUrl":"10.1007/s00347-019-00948-y","url":null,"abstract":"<p><strong>Background: </strong>A space-occupying lesion of the eyelid in young adults is often a sign of an inflammation, a trauma or a benign neoplasm. The aim of this case report is to demonstrate a rare basal cell carcinoma, which presumably already arose in adolescence without further high-risk factors.</p><p><strong>Methods: </strong>A 28-year-old male patient presented for a second opinion on a painless swelling of the right lower eyelid. According to the patient's history the swelling had been present since the age of 16 years and originally resembled a molluscum contagiosum. An ophthalmologist in private practice made the diagnosis of a suspected trichoepithelioma. The extended patient history revealed a blood coagulation disorder. The clinical ophthalmological examination revealed a nodular space-occupying lesion with a border wall and telangiectasia. The further ophthalmological examination was bilaterally inconspicuous. Due to the suspicion of a malignant process, an operation was promptly carried out using local anesthesia with complete tumor excision and pedicled flap plasty as well as a histopathological investigation to confirm the diagnosis.</p><p><strong>Results: </strong>The histopathological investigation revealed underlying infiltrates of a basaloid tumor with bale-shaped trabecular growth, sometimes with peripheral palisading of the cells. The cells were predominantly monomorphic with isolated pleomorphic nuclei and sometimes enclosed mitoses. Immunohistochemically the cells were strongly positive for BerEP4 and negative for epithelial membrane antigen (EMA). The diagnosis of a nodular basal cell carcinoma of the right lower eyelid was made. All incision margins were free of tumor cells (R0 resection). In the dermatological screening no further manifestations were detected.</p><p><strong>Conclusion: </strong>Despite the occurrence of a space-occupying lesion of the eyelid in a young adult patient and also with no further risk factors, in addition to an inflammatory event and a benign tumor, a malignant disease, such as a basal cell carcinoma should also be taken into consideration. A tissue biopsy or complete excision with subsequent histological examination including an immunohistochemical analysis are essential for differentiation from other tumor entities.</p>","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"29 1","pages":"73-77"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84844412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardvorgehensweise bei Basalzellkarzinom am Auge","authors":"V. Kakkassery, L. Heindl","doi":"10.1007/s00347-019-01019-y","DOIUrl":"https://doi.org/10.1007/s00347-019-01019-y","url":null,"abstract":"","PeriodicalId":11105,"journal":{"name":"Der Ophthalmologe","volume":"78 1 1","pages":"124"},"PeriodicalIF":0.0,"publicationDate":"2019-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78287442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}