Mitchellpeele8106
Silicone oil is an established intraocular surgical aid, which enables the treatment of the most complex starting situations but no other alternative has been found; however, the available data indicate that an unclear loss of visual acuity during or after an intraocular silicone oil tamponade possibly occurs more frequently than assumed from the clinical routine. Various pathological mechanisms are under discussion as causes, but the exact causes are actually unclear. In addition to atrophic alterations in the optical coherence tomography (OCT) examination, there are a clear reduction in visual acuity and mostly a central scotoma with otherwise inconspicuous findings. Unclear loss of visual acuity can also occur after removal of the silicone oil. Whether this is caused by the same pathological mechanism is unclear. Furthermore, there are no reproducible risk factors that appear a priori to possibly cause an unclear loss of vision under silicone oil; however, oil removal as soon as possible and a good adjustment of the intraocular pressure are recommended by the authors. Overall, a silicone oil tamponade should be carefully weighed up even when using modern highly purified silicone oils and it should therefore continue to be reserved particularly for unfavorable initial situations or complicated courses with the necessity for a silicone oil tamponade. Against this background, a study for systematic recording and processing of cases of unclear loss of visual acuity after silicone oil tamponade seems to be meaningful.
The aim was to analyze and compare the refractive results of anxious patients treated with transepithelial photorefractive keratectomy (TransPRK) while under general anesthesia (ITN) versus patients treated under local anesthesia (TRO).
The TransPRK treatment was performed with the AMARIS 1050 RS laser (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) in agroup of patients with ITN and agroup of patients, treated as usual with TRO. The method used an aspheric aberration neutral ablation profile, as well as SmartPulse technology and 7D eyetracking. In ITN propofol and rocuronium were injected intravenously. The artificial respiration was via aresuscitation bag after intubation with alaryngeal mask. To achieve pain insensitivity in the group of patients in TRO three drops of Conjucain Edo 0.4% were instilled at intervals of afew minutes. Follow-up examinations were performed after1 and 4days and after1 and 3months.
Atotal of 35consecutive TransPRK laser treatments under ITN were retrospectively com for LASIK surgery.
The TransPRK performed in ITN led to equal refractive results than when treated as usual in TRO. For anxious patients there is the possibility of laser vision correction in ITN. Because of shorter treatment time and accordingly shorter time under general anesthesia, TransPRK is an advantage for LASIK surgery.
Ocular toxoplasmosis (OT) is the most common infectious cause of posterior uveitis. This survey aimed to evaluate the current diagnostic and therapeutic approach to OT in Germany.
Adetailed questionnaire with specific patient examples was sent in July 2021 to the members of the Uveitis Section of the German Ophthalmological Society (DOG) and the Retinological Society (RG).
The questionnaire was answered by 53 (29RG and 24DOG) ophthalmologists. Of the respondents 16 (30%) work in private practice, 18 (34%) in aclinical facility and 19 (36%) in university hospital, 9 (17%) colleagues see < 50, 28 (53%) 50-200 and 16 (30%) more than 200 uveitis patients per year. The clinical results are still the gold standard (87%) for the diagnosis of OT and in cases of first manifestation 60% are supported by serological antibody investigations, while 10out of 53 (19%) ophthalmologists rely on the clinical presentation only. An IgM test is requested by 25 (47%) respondents, 6 expected an increase in IgG titer (11%) uniform approach to diagnosis and treatment of OT. The high request rate for serum IgM antibodies indicates a widespread uncertainty about the importance of serological findings. This should be viewed critically, given the continued high seroprevalence in Germany.The visual system is highly complex. Monocular or binocular disorders can develop, for example during tractive alterations of the macula, such as in epimacular membranes, and result in symptoms, such as double vision, aniseikonia or metamorphopsia. These symptoms are also observed following vitreomacular or vitreoretinal surgery, especially after treatment of large retinal detachment involving the macular area using pars plana vitrectomy or scleral buckle surgery but also as a result of vitreomacular interventions, such as membrane peeling in epimacular gliosis. Some patients have preoperatively existing latent conditions, which are not explicitly addressed during routine preoperative diagnostics. For patients and surgeons it is worth noting that these troublesome symptoms are often manifested in patients with good restoration of best corrected visual acuity following vitreomacular surgery. In such cases, patients tend to be dissatisfied with the surgical result despite good visual acuity. PP1 Treatment of postoperative metamorphopsia, aniseikonia and double vision is often difficult. In clinical studies, the maximum depth of tractive retinal folds has been described as a reliable morphological biomarker for the occurrence of metamorphopsia in epimacular gliosis. As metamorphopsia tends to postoperatively resolve slowly and even persist in ca. 30% of cases, this biomarker can have an impact on preoperative consulting and postoperative monitoring. Persistent binocular discomfort is often treatable by exact refraction correction and by applying a vertical and, if necessary, a horizontal prism. This often requires patience on the part of both the patient and the physician but is mostly successful due to fusion and adaptability.
In ophthalmologic surgery, there are usually short operation times and thus many changes between the individual operations, which are not subject to remuneration. As in maximum care hospitals consecutive different operations with different durations are often performed, emergency operations have to be inserted and further training of colleagues is practiced, it is particularly important to generate the shortest possible transfer times in order to have both sufficient operation time and to be able to treat as many cases as possible. The aim of this work is to evaluate the efficiency of the surgical performance of auniversity eye hospital.
The surgeries performed in 2021 at the MHH Eye Clinic were evaluated with respect to the spectrum, number, surgery duration, transfer times and process times. In terms of personnel, each operating room was staffed with one assistant anesthesiologist, one nurse anesthetist, two operating room nurses, one surgeon, and 20% senior anesthesiologist supervision. Based on atheorhile also for alarge hospital in order to enable and optimize overlapping transfers of anesthesia and surgical care. This should therefore also be considered separately, contrary to standardized staffing of the overall hospital, in order to use existing resources with their fixed costs as optimally as possible.
An increase of the personnel expenditure in the operating room for surgical subjects such as ophthalmology with shorter interventions and many changes is economically worthwhile also for a large hospital in order to enable and optimize overlapping transfers of anesthesia and surgical care. This should therefore also be considered separately, contrary to standardized staffing of the overall hospital, in order to use existing resources with their fixed costs as optimally as possible.
Bottlenecks in drug supply in the field of ophthalmological are continuously increasing in Germany. So far, these have hardly been communicated and discussed. We see the transparent presentation of the problem as afirst step in compiling concepts to counteract this development.
Presentation of the supply shortages in ophthalmological drugs.
A listing and discussion of the shortages in drug supply to the best of our knowledge are presented.
We distinguish between the problems in (1)supply shortages, (2)discontinuation of production, (3)lack of availability in Germany and (4)manufacture of drugs in specialized pharmacies often lacking approval for the ophthalmological indications.
The reasons for drug supply shortages in ophthalmology are complex and therefore no easy solutions can be expected; however, industrial and regulatory authorities at the national and European levels are called upon to analyze the underlying problems and to find appropriate solutions.
The reasons for drug supply shortages in ophthalmology are complex and therefore no easy solutions can be expected; however, industrial and regulatory authorities at the national and European levels are called upon to analyze the underlying problems and to find appropriate solutions.
Trabeculectomy (TE) with mitomycinC (MMC) is considered the gold standard in glaucoma surgery. Anew modification is the use of an Ologen® implant (AEON Astron Europe B.V., Leiden, Netherlands) during TE, which was analyzed and compared to the standard TE in this retrospective study.
On 70eyes Ologen® was applied during surgery (group2), whereas 98eyes were operated on without the implant (group1). Both surgical procedures were compared regarding the efficiency of lowering the intraocular pressure (IOP), the number of glaucoma medications, the rate of complications and follow-up treatment. Data were collected up to 24months after surgery.
In group1 the IOP was lowered from 28.0 mmHg (95% confidence interval, CI 26.6-29.4 mmHg) to 16.0 mmHg (14.0-18.1) after 24months. In group2, the pressure dropped from 28.5 mmHg (26.8-30.1) to 14.3 mmHg (11.7-17.0). The IOP reduction was significant in both groups (p < 0.001), there was no significant difference between the groups (p > 0.05). Glaucoma-related follow-up treatments were performed more often in group1 but the difference was not significant.
Both procedures significantly lower the IOP and the number of glaucoma medications. For our cases, TE with Ologen® and MMC is considered to be superior to TE with MMC regarding the lower rates of follow-up treatments as it is less time-consuming for the patients and the clinic.
Both procedures significantly lower the IOP and the number of glaucoma medications. For our cases, TE with Ologen® and MMC is considered to be superior to TE with MMC regarding the lower rates of follow-up treatments as it is less time-consuming for the patients and the clinic.
Restoration of eyelid and lacrimal functions are important steps on the way to an intact ocular surface. Clinically available substitute tissues or therapeutic options for eyelid reconstruction and lacrimal gland regeneration often reach their limits in patients with severe diseases of the adnexa oculi. Several approaches in regenerative medicine have been intensively researched and clinically tested in recent years. These range from reconstructive approaches with novel tissue matrices in the field of eyelid surgery to stem cell therapies to regenerate lacrimal gland function.
The state of the art in the current literature is presented and an overview of clinically applied or currently researched tissues for eyelid reconstruction is given. Furthermore, approaches in stem cell therapy of the lacrimal gland as well as own results are presented.
Acellular dermis has been successfully used for eyelid reconstruction and represents aviable option in cases of limited availability of autologous tissue. In vitro grown cellular constructs or tissues with genetically modified cells have already been successfully applied in dermatology for the treatment of burns or severe genodermatoses.
