RESUMO
BACKGROUND: The conditions for long-term graft survival in infants and children are unfavorable, due to the different immunological features, the impaired clinical examination and the reduced compliance and treatment adherence. However, penetrating keratoplasty is often the only option to prevent amblyopia and there may be no alternative. We examined the different indications, graft survival and complications in two specialised centres. MATERIAL AND METHODS: We identified all patients who were under the age of 18 years at the time of their penetrating keratoplasty. We then assessed the electronic file on indications, graft failure, visual acuity, enucleation and further complications. RESULTS: A total of 104 eyes of 95 patients (54â% female) were identified. Median age at the time of surgery was 14 years (quartiles 8 and 16 years). Median follow-up was 2.7 years. The following indications were identified: keratoconus (39â%), penetrating injury (18â%), non-herpetic corneal scars (12â%), herpetic corneal scars (6â%), sclerocornea (3â%), chemical burn (3â%) and miscellaneous indications (19â%). Clear graft survival according to the Kaplan-Meier method ranged from 100â% (keratoconus) to 35â% (sclerocornea). Enucleation was only necessary in patients with penetrating injuries (n = 2). Kaplan-Meier analysis estimated the failure of all grafts after one year in infants. In older patients, 90â% of grafts were still clear at that time. CONCLUSION: Prognosis of penetrating keratoplasty in children is related to the indication, and therefore the underlying disease, as well as the patients' age. In particular, infants exhibited poor prognosis, with only a very short period of clear graft survival. In indications, keratoconus showed the best prognosis, whereas sclerocornea and penetrating injuries had the worst prognosis.
Assuntos
Ceratoplastia Penetrante/métodos , Complicações Pós-Operatórias/diagnóstico , Adolescente , Criança , Pré-Escolar , Enucleação Ocular , Feminino , Seguimentos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/fisiopatologia , Rejeição de Enxerto/terapia , Sobrevivência de Enxerto/fisiologia , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Cooperação do Paciente , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Disfunção Primária do Enxerto/diagnóstico , Disfunção Primária do Enxerto/fisiopatologia , Disfunção Primária do Enxerto/terapia , Acuidade Visual/fisiologiaRESUMO
Background Optical coherence tomography angiography (OCTA) offers the possibility to visualize, non-invasively, blood vessels of the retina. In vascular tumors, especially hemangioblastomas in Hippel-Lindau disease, new information can be obtained with OCTA concerning structure of the tumor, tumor activity and treatment success. Patients Ten eyes of 10 patients with retinal hemangioblastoma in Hippel-Lindau disease were included. The age of the patients ranged from 19 years to 65 years (median 44 years). Results A total of 10 active and one inactive hemangioblastomas were examined with OCTA. In larger tumors, only the superficial blood flow could be visualized. Four hemangioblastomas were not treated due to their location near the optic nerve head. Six hemangioblastomas in the peripheral retina were treated with laser photocoagulation. In 4 eyes, a reduced blood flow could be shown directly after the treatment. The visualization of the perfusion was partially blocked after laser treatment. Conclusion OCTA enables innovative methods of pre- and postoperative assessment of retinal hemangioblastomas. It has the potential to give new information about the morphology, activity and effects of treatment. Prospective studies with longer follow-up are needed to evaluate the therapeutic relevance of this new imaging method.
Assuntos
Angiografia/métodos , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/cirurgia , Neoplasias da Retina/diagnóstico por imagem , Neoplasias da Retina/cirurgia , Tomografia de Coerência Óptica/métodos , Doença de von Hippel-Lindau/diagnóstico por imagem , Doença de von Hippel-Lindau/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Reoperação , Adulto JovemRESUMO
Purpose Central serous chorioretinopathy (CSC) is a commonly acquired maculopathy characterized by the accumulation of subretinal fluid at the posterior pole. This study aims to analyze optical coherence tomography angiography (OCTA) findings in patients with acute and chronic CSC and to compare them to conventional imaging methods. Methods A series of 43 consecutive eyes of 29 patients diagnosed with CSC and 18 eyes of 9 healthy control subjects were included in this retrospective study. The OCTA images were assessed and compared to conventional fluorescence (FAG) and indocyanine green angiography (ICG). Results All CSC patients demonstrated abnormal areas of focal hypo- and hyperperfusion in the choriocapillaris. These were particularly evident in patients with chronic atrophic CSC. FAG and ICG imaging revealed leakage points in 10 of 43 eyes and choroidal neovascularization (CNV) in 3 of 43 eyes. OCTA imaging confirmed leakage points in 4 out of 10 cases and choroidal neovascularization in 2 out of 3 cases. In one case, OCTA demonstrated a CNV which was not detectable by FAG/ICG. Conclusion OCTA reveals areas of focal hypo- and hyperperfusion in the choriocapillaris in patients with CSC. Due to the inability to detect plasma flow, OCTA is not suitable to detect leakage points in CSC with confidence. However, OCTA reliably detects CNV in CSC even in the absence of exudative activity and may, therefore, represent an important supplement in the diagnosis of CSC.
Assuntos
Angiografia/métodos , Coriorretinopatia Serosa Central/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Feminino , Angiofluoresceinografia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Sensibilidade e Especificidade , Estatística como Assunto , Líquido Sub-Retiniano/diagnóstico por imagemRESUMO
Keratoconus leads to progressive thinning and protrusion of the cornea. Young patients exhibit the highest risk for progression. Corneal crosslinking was introduced in 1998 and is intended to prevent progression of keratoconus. Only a few prospective controlled trials have been published. Six randomised controlled trials have been published. All these trials confirmed the efficacy of crosslinking through keratometric data. In two trials, progression was reported in some patients of the treatment group. This indicates that not all patients benefit from corneal crosslinking. The risks of the procedure include corneal scarring, haze, endothelial cell damage and infections of the cornea. In order to avoid these risks, patients without progression should not be treated with crosslinking.
Assuntos
Ceratocone/diagnóstico por imagem , Ceratocone/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/administração & dosagem , Terapia Ultravioleta/métodos , Reagentes de Ligações Cruzadas/uso terapêutico , Medicina Baseada em Evidências , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Cataract is one of the most common diseases in ophthalmology. Up to now the only way to estimate the total number of carried out surgeries in Germany were the surveys done by DOG, BVA, DGII and BDOC or reports of the federal statistical office. OBJECTIVES: Objective of this paper is to evaluate the annual quality reports of the Federal Joint Committee with a view to how the hospitals are participating in the nationwide comprehensive coverage concerning cataract surgery and if there is a continuing trend to more outpatient cataract surgeries in German eye hospitals. MATERIAL AND METHODS: The number of outpatient and inpatient cataract surgeries included in the annual quality reports of 2006, 2008 and 2010 were put into relation with population density for every provincial state. RESULTS: In 2006, 2008 and 2010 a total of 765,179 cataract surgeries were recorded. Median number of cataract surgeries per 1000 inhabitants showed an only slight increase (2006: 2.8; 2008 and 2010: 3.0; p = 0.82). The ratio of outpatient to inpatient surgeries showed only a slight increase from 0.84 (2006) to 0.86 (2010). CONCLUSIONS: Lack of spatial and temporal variations imply that hospitals take a part in supplying the population with cataract surgery. There is no trend to more outpatient cataract surgeries at the moment. This implies that there might be a stable patient population that is not suitable for outpatient care.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Extração de Catarata/estatística & dados numéricos , Catarata/epidemiologia , Catarata/terapia , Pesquisas sobre Atenção à Saúde , Padrões de Prática Médica/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Assistência Ambulatorial/tendências , Extração de Catarata/tendências , Alemanha/epidemiologia , Humanos , Padrões de Prática Médica/tendências , PrevalênciaRESUMO
Optical coherence tomography provides high-resolution images of the anterior segment (AS-OCT). When used as a measuring tool, corneal thickness, anterior and posterior chamber depths, anterior chamber diameter and chamber angle configuration are defined reproducibly. In terms of an optical biopsy by cellular imaging, tissue infiltration, deformation and deposits can be analysed microstructurally. A comparison of pre- and post-operative, as well as long-term follow-up of pathological findings are possible. Examination with AS-OCT is a no-contact procedure, and is well tolerated by the patient. The following instruments were used: Visante-OCT and Cirrus HD-OCT (Carl Zeiss Meditec GmbH, Germany) and SS100 CASIA (Tomey Europe, Erlangen).
Assuntos
Segmento Anterior do Olho/anatomia & histologia , Oftalmoscópios , Tomografia de Coerência Óptica/instrumentação , Desenho de Equipamento , Falha de Equipamento , Humanos , Sensibilidade e EspecificidadeRESUMO
Penetrating keratoplasty in children is associated with very specific difficulties for the surgeon as well as for the patient and the parents. Special features are specific pediatric indications, which do not occur in adults, a more difficult examination and treatment adherence depending on the parents. Diseases with a favorable prognosis include keratoconus and herpetic keratitis. Especially sclerocornea and the Peters' anomaly often have a limited prognosis regarding vision and graft survival due to secondary malformations of the eye. In addition, younger age represents a risk factor. This is most likely due to the impaired examination during follow-up and reduced compliance. For successful penetrating keratoplasty in children the timing for the operation, in which the risk for the graft is weighed up against the risk for amblyopia, is crucial.
Assuntos
Opacidade da Córnea , Transplante de Córnea , Criança , Seguimentos , Humanos , Ceratoplastia Penetrante , Complicações Pós-Operatórias , Estudos RetrospectivosAssuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Sobrevivência de Enxerto/fisiologia , Ceratoplastia Penetrante , Complicações Pós-Operatórias/patologia , Contagem de Células , Lâmina Limitante Posterior/patologia , Células Epiteliais/patologia , Epitélio Corneano/patologia , Feminino , Humanos , Pessoa de Meia-Idade , ReoperaçãoAssuntos
Lesões da Córnea/diagnóstico , Lesões da Córnea/patologia , Epitélio Corneano/patologia , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/patologia , Ceratomileuse Assistida por Excimer Laser In Situ , Complicações Pós-Operatórias/diagnóstico , Lesões da Córnea/cirurgia , Epitélio Corneano/lesões , Epitélio Corneano/cirurgia , Corpos Estranhos no Olho/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , ReoperaçãoAssuntos
Acetazolamida/uso terapêutico , Cegueira/diagnóstico , Dor Ocular/diagnóstico , Dor Ocular/prevenção & controle , Hemorragia Retrobulbar/diagnóstico , Hemorragia Retrobulbar/terapia , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Cegueira/etiologia , Cegueira/prevenção & controle , Terapia Combinada , Diagnóstico Diferencial , Dor Ocular/etiologia , Feminino , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Hemorragia Retrobulbar/complicações , Resultado do TratamentoRESUMO
AimThe objective of the study was to evaluate the long-term results of allogenic penetrating limbo-keratoplasy. This method allows simultaneous transplantation of a corneal graft and limbal stem cells of the donor by means of eccentric trephination of the donor button.MethodThe data of 192 consecutive cases of allogenic penetrating limbo-keratoplasty from 1995 to 2015 were reviewed. These had been performed exclusively in eyes with complete failure of the limbal stem cells, in combination with deep corneal scarring. Indications were predominantly eye burns, inflammatory conditions, and congenital aniridia. Graft survival and rejection rates were assessed using Kaplan-Meier analysis.ResultsFollow-up averaged 2.1±2.2 years. Median graft survival was 3.4 years in eye burns, 3.9 years in inflammatory disease, and 3.2 years in congenital aniridia. Median survival was 3.9 years in the heterogenous group of other indications.ConclusionAllogenic limbo-keratoplasty is a suitable option used to treat patients with bilateral complete failure of the limbal stem cells and deep opacification of the central cornea. The main reasons for graft failure are the loss of graft-limbal stem cell functioning and endothelial graft rejection.
Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Penetrante/métodos , Limbo da Córnea/cirurgia , Transplante de Células-Tronco/métodos , Adulto , Queimaduras Oculares/cirurgia , Feminino , Seguimentos , Sobrevivência de Enxerto/fisiologia , Humanos , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Limbo da Córnea/citologia , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêutico , Acuidade Visual/fisiologiaRESUMO
BACKGROUND: Keratoconus is a progressive corneal disease with thinning and scarring of the cornea. Diagnostic and treatment options are usually evaluated in large prospective or retrospective trials. Big data and smart data provide the possibility to analyze routine data for clinical research. In this article we report the generation of a monocentric keratoconus registry by means of computerized data analysis of routine data. This demonstrates the potential of clinical research by means of routine data. METHODS: A "clinical data warehouse" was created from all available routine electronic data. At the time of first presentation, each eye was classified into one out of four categories: suspected, early disease, late disease and status postkeratoplasty. Through integration of multiple data sources the clinical course for each patient was documented in the registry. RESULTS: A total of 3681 eyes from 1841 patients were included. The median follow-up time was 0.54 years. Patient age was higher in the groups with more severe stages of keratoconus, the proportion of female patients was higher in the group of suspected keratoconus and patient age and male to female ratios showed statistically significant differences between the groups (p < 0.001). CONCLUSION: We were able to create a "clinical data warehouse" by linking multiple data sources and normalizing the data. With this tool we established a novel, monocentric keratoconus registry. Only the grading of disease severity and the exclusion of false positive results were carried out manually. In our opinion establishing a structured clinical data warehouse has a huge potential for clinical and retrospective studies and proves the value of the Smart Data concept.
Assuntos
Mineração de Dados/métodos , Conjuntos de Dados como Assunto/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Ceratocone/diagnóstico , Ceratocone/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto JovemAssuntos
Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/terapia , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Ensaios Clínicos como Assunto , Comportamento Cooperativo , Eletrorretinografia , Angiofluoresceinografia , Hemodiluição , Humanos , Comunicação Interdisciplinar , Terapia a Laser , Lasers de Gás/uso terapêutico , Edema Macular/diagnóstico , Edema Macular/terapia , Anamnese , Oftalmoscópios , Oftalmoscopia , Equipe de Assistência ao Paciente , Exame Físico , Ranibizumab , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/terapia , Oclusão da Veia Retiniana/etiologia , Fatores de Risco , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
Congenital esophagobronchial fistula occurring in infancy and childhood is a well-recognized entity necessitating urgent surgical treatment. Persistence of such a communication into adulthood is rare and would seem possible only if the tract were small so that aspiration into the lung could be tolerated. The case of a 38-year-old woman is presented in this report who was cured of lifelong symptoms of aspiration by surgical division of a presumed congenital esophagobronchial fistula.