Die Ophthalmologie最新文献

{"title":"[Efficacy and safety of the new generation of excimer laser trabeculotomy in a heterogeneous patient population-1-year follow-up].","authors":"Stefanie Gniesmer, Svenja Rebecca Sonntag, Swaantje Grisanti","doi":"10.1007/s00347-024-02126-1","DOIUrl":"https://doi.org/10.1007/s00347-024-02126-1","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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).</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482269","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":"[The utilization of ophthalmological emergency departments is on the rise : 14-year results from a German tertiary university outpatient department].","authors":"I P Seitz, M Zarzo Vargas, T Strasser, E Nasyrov, K U Bartz-Schmidt","doi":"10.1007/s00347-024-02121-6","DOIUrl":"https://doi.org/10.1007/s00347-024-02121-6","url":null,"abstract":"<p><strong>Background: </strong>The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time.</p><p><strong>Objective: </strong>The aim of this study is to make a well-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived.</p><p><strong>Material and methods: </strong>Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1 January 2010 to 31 December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, a questionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022.</p><p><strong>Results: </strong>The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, a shift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without a referral from a doctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic.</p><p><strong>Discussion: </strong>The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to a double burden: providing treatment for emergency cases with specialist referrals and at the same time acting as a catchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395717","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":"[Bilateral fibrinous iridocyclitis with extensive myopization].","authors":"Peter Werkl, Gerald Seidel, Christoph Singer, Hrvoje Tomasic, Tobias Peschaut, Astrid Heidinger, Katharina Valentin, Michael Sommer","doi":"10.1007/s00347-024-02087-5","DOIUrl":"10.1007/s00347-024-02087-5","url":null,"abstract":"","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"835-837"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899099","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":"[Pathogenesis of Fuchs endothelial corneal dystrophy, the fibrillar layer and individualized treatment].","authors":"Antonia Howaldt, Thomas Clahsen, Mert Mestanoglu, Margarete Odenthal, Volkan Tahmaz, Claus Cursiefen, Mario Matthaei","doi":"10.1007/s00347-024-02123-4","DOIUrl":"10.1007/s00347-024-02123-4","url":null,"abstract":"<p><p>Fuchs endothelial corneal dystrophy (FECD) is a genetic and age-associated corneal disease characterized by an accelerated loss of corneal endothelial cells and an increased subendothelial deposition of extracellular matrix (ECM). Clinically, advanced disease leads to corneal edema with subsequent reduction in visual acuity. In the majority of patients with advanced FECD, a fibrillar layer (FL) appears on the posterior corneal surface. This FL is mostly localized in the inferotemporal corneal quadrant, marks areas with significantly reduced endothelial cell density and increased corneal thickness in the sense of edema and can be visualized and measured using Scheimpflug backscatter analysis due to increased backscatter. FECD is currently the most common indication for corneal transplantation worldwide, usually in the form of Descemet membrane endothelial keratoplasty (DMEK). New treatment approaches include variations of DMEK surgery such as hemi- or quarter DMEK with individualized and smaller grafts or Descemet membrane stripping only (DSO). In the future, clinical imaging of the FL as a particularly affected endothelial area could be important for FECD progression assessment and planning of surgical interventions. This article provides an overview of the current state of research on the clinical aspects, pathogenesis, fibrillar layer and individualized treatment of FECD.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"787-795"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333700","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":"[How to talk to relatives about corneal donation].","authors":"Roberto D'Amelio, Loïc Hamon, Berthold Seitz, Isabel Weinstein","doi":"10.1007/s00347-024-02111-8","DOIUrl":"10.1007/s00347-024-02111-8","url":null,"abstract":"<p><p>Corneal donation counselling is an important part of the process to inform and support potential donors and their relatives. In this article various aspects of the conversation techniques on corneal donation are discussed, including raising awareness of the importance of donation, clarifying questions and concerns, emphasizing the potential of donation and considering the emotional burden on the relatives of potential donors. Also emphasized is the role of the counsellor as a trustworthy and empathetic contact who can help family members of potential donors make an informed and positive decision. It is pointed out that a professional and empathetic approach to corneal donation can help to increase the willingness to donate and ultimately that a donation can help visually impaired or blind people regain their sight and quality of life through donation.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"845-856"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302447","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":"[Enucleations, eviscerations and orbital implants in German eye hospitals].","authors":"Anna Schuh, Nicolas Pensel, Siegfried Priglinger, Christoph Hintschich","doi":"10.1007/s00347-024-02088-4","DOIUrl":"10.1007/s00347-024-02088-4","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of the number of enucleations and eviscerations performed in Germany and the orbital implants used.</p><p><strong>Method: </strong>Analysis of the quality reports of German ophthalmological clinics for the years 2012-2021 provided by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA).</p><p><strong>Results: </strong>Almost 10 times as many enucleations (8368) as eviscerations (975) are performed in Germany. After enucleation, alloplastic implants are used most frequently (44.6% alloplastic, no further specification, 30.0% alloplastic coated, no further specification; 14.1% microporous implants) and autologous dermis-fat grafts in 6.1% of the cases.</p><p><strong>Conclusion: </strong>In Germany, significantly more enucleations than eviscerations are performed. Alloplastic orbital implants are preferred for primary reconstruction following enucleation.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"814-820"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914742","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":"[Rosette-shaped coatings on the anterior surface of the lens after silicone oil implantation].","authors":"Maximilian Berger, Fabian Norbert Fries, Berthold Seitz","doi":"10.1007/s00347-024-02081-x","DOIUrl":"10.1007/s00347-024-02081-x","url":null,"abstract":"","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"784"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763071","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":"[EndoArt®: results in patients with glaucoma drainage devices].","authors":"Johanna Wiedemann, Mert Mestanoglu, Anne Rekate, Caroline Gietzelt, Claus Cursiefen, Björn Bachmann","doi":"10.1007/s00347-024-02122-5","DOIUrl":"10.1007/s00347-024-02122-5","url":null,"abstract":"<p><strong>Background: </strong>EndoArt® (Eye Yon Medical, Ness Ziona, Israel) is a novel artificial corneal inner layer transplant and an innovative treatment alternative for patients at high risk for graft failure after posterior lamellar corneal transplantation (EK).</p><p><strong>Aim of the study: </strong>We present the initial results of the EndoArt® implantation in patients with glaucoma drainage devices (GDD).</p><p><strong>Patients and surgical procedure: </strong>In this study 12 eyes with GDD were retrospectively evaluated. All had a high risk of transplant rejection in cases of EK (previous other glaucoma surgery in addition to GDD, n = 8, condition following Descemet membrane endothelial keratoplasty, DMEK, n = 9, uveitis, n = 2, or synechiae, n = 2). The EndoArt® was secured with a gas bubble and one to three holding sutures. The preoperative and postoperative best spectacle-corrected visual acuity (BSCVA) and central corneal thickness (CCT) were determined. The need for additional gas injections (rebubbling) was analyzed.</p><p><strong>Results: </strong>Octafluoropropane (C3F8) 12% was used in nine patients and sulfur hexafluoride (SF6) 20% in three patients as anterior chamber tamponade to ensure adhesion of the EndoArt®. At least one rebubbling was necessary in four eyes. The preoperative BSCVA was 1.6 (± 0.5) logMAR and significantly improved to 1.1 (± 0.6) logMAR after 12 weeks (p = 0.028). The preoperative CCT was 719 µm ± 145.7, which significantly decreased to 622.4 µm ± 174.9 after six weeks (p = 0.004) and to 591.7 µm ± 190.8 after 12 weeks (p = 0.096). In one eye, the prosthesis was explanted due to a suspected fibrotic remodelling of the cornea following multiple previous DMEKs.</p><p><strong>Discussion: </strong>EndoArt® led to a significant improvement in BSCVA and reduction in CCT; however, there was a high rebubbling rate in patients with GDD. In high-risk patients, the use of EndoArt® may be advantageous in avoiding graft failure after EK.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"803-813"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360716","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":"[Digital remote monitoring of chronic retinal conditions-A clinical future tool? : Remote monitoring of chronic retinal conditions].","authors":"Jan Henrik Terheyden, Matthias M Mauschitz, Maximilian W M Wintergerst, Petrus Chang, Philipp Herrmann, Raffael Liegl, Thomas Ach, Robert P Finger, Frank G Holz","doi":"10.1007/s00347-024-02109-2","DOIUrl":"10.1007/s00347-024-02109-2","url":null,"abstract":"<p><strong>Background: </strong>In view of the predicted increase in incidence and prevalence of chronic retinal diseases and undersupply of care in the population, telemedicine could contribute to reducing access barriers to healthcare and improving the results of treatment.</p><p><strong>Objective: </strong>A literature review on remote monitoring of chronic retinal diseases was carried out.</p><p><strong>Material and methods: </strong>The medical literature was searched for publications on remote monitoring of chronic retinal diseases. The results were compiled in a narrative overview.</p><p><strong>Results: </strong>The four main topics in the literature are: validation studies, implementation strategies, acceptance/target group analyses and health economic analyses. Remote monitoring systems are based on visual function tests, imaging or patient reports and have been particularly investigated in age-related macular degeneration (AMD) and diabetic eye disease (DED). Studies indicate positive effects regarding an optimization of clinical care and a favorable safety profile but randomized controlled trials are lacking for the majority of monitoring tools.</p><p><strong>Conclusion: </strong>Remote monitoring could complement existing care structures for patients with chronic retinal diseases, especially AMD and DED. Promising systems are based on hyperacuity or optical coherence tomography, while patient-reported data are not commonly used; however, there is currently insufficient evidence justifying the use of remote monitoring systems in chronic retinal diseases in Europe and more research on the validation of remote monitoring systems is needed.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"826-834"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302446","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":"[Innovative surgical treatment approaches for endothelial dysfunction : Descemet stripping only (DSO) and endothelial cell injection].","authors":"V Tahmaz, M Mestanoğlu, A Howaldt, B O Bachmann, M Matthaei, C Cursiefen","doi":"10.1007/s00347-024-02119-0","DOIUrl":"10.1007/s00347-024-02119-0","url":null,"abstract":"<p><p>Currently, due to a rising number of patients Germany and many other countries experience a large deficit of donor eyes for posterior lamellar keratoplasty procedures in the treatment of corneal endothelial diseases. To address this unmet need there is an ongoing investigation of treatment modalities which do not rely on donor tissue or enable clinicians to treat more patient eyes per donor eye. The authors introduce a promising approach for both treatment principles. First, the technique of Descemet stripping only (DSO) is detailed, in which a central part of the Descemet's membrane including the endothelium is surgically removed without replacement with donor tissue. This then allows endothelial cells from the periphery of the cornea to migrate into the central area and can reduce corneal opacification and swelling. As a representative technique of the second group, the authors introduce endothelial cell injection, in which human corneal endothelial cells are cultivated in vitro and then, after removal of the diseased endothelium, injected into the anterior chamber of the recipient's eye to form a new and healthy endothelium. This is supported by injection of Rho kinase inhibitors and a face-down positioning of the patient after surgery. It is postulated that endothelial cell injection could possibly enable clinicians to treat up to 300 patient eyes with the tissue generated from 1 donor eye. Whether and how these novel approaches will become established in Europe remains to be seen.</p>","PeriodicalId":72808,"journal":{"name":"Die Ophthalmologie","volume":" ","pages":"796-802"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402207","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}