[Incidence of delirium in ophthalmology]. / Delir-Inzidenz in der Augenheilkunde.

BACKGROUND: Due to the short duration of inpatient stays and increasing outpatient treatment it is assumed that the incidence of delirium in ophthalmology is underestimated. The overall aim of this study was to record the incidence of delirium in ophthalmology through long-term follow-up. METHOD: The study was divided into 2 groups. In group A delirium events were recorded retrospectively based on the discharge reports of all inpatients at the University Clinic Freiburg, Clinic for Ophthalmology from 1 January 2020 to 31 December 2022. In group B delirium events were recorded prospectively by the Augennetz Südbaden (Eye Network South Baden, ANSB) in the period 60-120 days after ophthalmological surgery. RESULTS: During the study period of the retrospective analysis a total of 16,384 patients were treated as inpatients. There was evidence of a total of 7 new delirium events. This corresponds to a proportion of 0.04%. A total of 12,381 patients were assessed by the ANSB, including 11,530 outpatient cataract operations. There were indications of 31 delirium events, which corresponds to a proportion of 0.25%. CONCLUSION: The long-term prospectively recorded delirium events suggest that the incidence of delirium in the inpatient setting is underdiagnosed; however, postoperative delirium appears to be rare in ophthalmology in relation to the high number of procedures.

[Chemokines in ophthalmology]. / Chemokine in der Augenheilkunde.

Chemokines are chemotactically active cytokines, which coordinate the distribution of immune cells within the body and also regulate the migration of leukocytes in malignant and inflammatory processes. Chemokines are a heterogeneous group of short-chain proteins that are divided into different subgroups on the basis of their structure. In addition to the chemokines (ligands) various chemokine receptors also exist. The chemokine system is given its complexity by the high redundancy of ligand-receptor interactions: one single ligand can bind to different receptors and a single receptor can interact with different ligands. In terms of receptors, distinct immune cell types have characteristic receptor expression patterns, which can be used for the immunological characterization of leukocytes. Important basic research is currently leading to a better understanding of the chemokine system. The essential importance of the chemokine system in various diseases of the anterior and posterior eye segments is becoming increasingly apparent. The following synopsis explains the individual clinical aspects as well as the underlying scientific work in the context of "chemokines in ophthalmology".

[Pathophysiology of atopic blepharokeratoconjunctivitis]. / Pathophysiologie der atopischen Blepharokeratokonjunktivitis.

Atopic dermatitis (AD) is a systemic inflammatory disease, which is characterized by pronounced eczema and pruritus. In addition to the involvement of the entire integument, the periocular lid skin and the surface of the eye are frequently involved. Ocular involvement may occur solely without dermatitis of facial or body skin. Pathophysiologically, besides a dysregulated immune response, genetic changes can occur in various dermal structural proteins which will lead to a disturbed skin barrier. Furthermore, there is a regular colonization with bacterial pathogens and an increased susceptibility for viral skin infections. The lid margin reveals a loss of Meibomian glands whereas the conjunctiva shows reduced goblet cells. Consecutively, eye surface defects and recurrent conjunctival and corneal defects can be found. Increased mechanical manipulation in atopia-associated pruritus is seen as a cause of increased comorbidity with keratoconus. In addition, individual cases are reported of various malignomas of the eye surface, which are present in patients with AD. Understanding of the pathophysiological connections is essential for the correct diagnosis and therapy of this clinically very complex disease picture.

[Ocular involvement in atopic dermatitis : Clinical aspects and therapy]. / Augenbeteiligung bei atopischer Dermatitis : Klinik und Therapie.

Patients with atopic dermatitis frequently complain of ocular symptoms. The general dermatitis can directly affect the periocular skin and patients often present with chronic atopic blepharokeratoconjunctivitis. Early diagnosis of the characteristic ophthalmological alterations, such as blepharitis, allergic conjunctivitis, keratoconjunctivitis sicca, conjunctival scarring with formation of symblepharon and lid malpositioning, filiform keratitis, corneal plaques, (persistent) epithelial defects, corneal ulcers and keratoconus as well as appropriate stage-adapted treatment, including lid hygiene with preservative-free lubricants, topical and sometimes systemic anti-inflammatory therapy and surgical treatment are important for patients to prevent long-term damage of the ocular surface leading to severe visual impairment.

[Alterations in intraocular pressure and the CorVis parameters after LASIK]. / Änderung des Augeninnendrucks und der CorVis-Parameter nach LASIK.

INTRODUCTION: The reduction of corneal thickness following laser-assisted in-situ keratomileusis (LASIK) requires a correction of intraocular pressure (IOP) measurements. The corneal visualization Scheimpflug technology (CorVis ST, Oculus, Wetzlar, Germany) not only measures the IOP and central corneal thickness (CCT) but also determines 10 additional corneal parameters, such as the time to first and second applanation and velocity. Besides CCT we compared various corneal parameters before and after LASIK in order to detect possible correlations and to correct IOP measurements. METHODS: Measurements with CorVis ST were made before and after LASIK in 45 myopic patients (45 left eyes). We compared the IOP and CorVis ST parameters using a paired t­test before and after LASIK and corrected for possible correlations in a multifactorial linear model. Finally, we correlated the changes in IOP to changes in biomechanical parameters. RESULTS: We observed a direct correlation between the IOP measurements and the corneal thickness. The IOP was underestimated by 0.039 mm Hg per micrometer in reduction of corneal thickness. The multifactorial linear model showed a correlation of IOP change to A2 velocity and the radius of applanation. CONCLUSION: Surgical thinning of the central cornea via LASIK demonstrated a direct correlation between corneal thickness and IOP measurements using the CorVis ST technique. Postoperative changes of the A2 velocity and the applanation radius also had a statistically significant influence on post-LASIK IOP measurements. Our findings could be useful to obtain more precise post-LASIK IOP measurements.

[Morphological analysis of corneal refractive lenticules--is there a correlation with refractive results?]. / Ultrastrukturelle Analyse von Hornhautlentikeln nach fs-Lentikelextraktion gibt es einen Zusammenhang mit den refraktiven Ergebnissen?

BACKGROUND: ReLEx®flex is a corneal refractive procedure performed by removing corneal lenticules with a femtosecond (fs) laser system. Using electron microscopy, tissue parameters of extracted lenticules were analysed for potential correlations to the refractive results. Furthermore, the effect of previous contact lens (CL) wear on refractive stability (regression) was tested. PATIENTS AND METHODS: 19 lenticules from 11 patients (age 24-56 years, 8 f, 3 m) were prepared for EM. The central areas of the samples were photographed and the distance between the collagen fibres and their diameters were digitally measured. ANOVA analysis was used to correlate postoperative refractional stability with time of preoperative CL use, fibre diameter and the coefficient of variation (CV) of fibre distance. RESULTS: 14 of 19 lenticules were from patients who had worn CL preoperatively. The cumulative duration of CL wear averaged around 31.2 ± 35.5 thousand hours. Preoperative CL use significantly influenced the postoperative regression: the longer time patients had worn CL, the greater was the regression towards myopia (p = 0.01). Additionally, the morphological parameters collagen fibre diameter (p = 0.09) and CV of fibre distance (p = 0.07) had an impact on regression. CONCLUSIONS: Prolonged CL use and alterations in ultrastructural patterns affected the refractive stability after ReLExflex. Although the pathophysiological relationships between CL use, corneal morphological parameters, and refractive stability are still poorly understood, these findings could potentially be used as prognostic markers for postoperative refraction after ReLExflex.

[Immunosuppressives to prevent rejection reactions after allogeneic corneal transplantation]. / Immunsuppressiva zur Verhinderung von Abstoßungsreaktionen nach allogenen Hornhauttransplantationen.

In order to prevent rejection of an allogeneic corneal transplant after perforating (high risk) keratoplasty, active agents from different classes of pharmacological substances are used, as with solid organ transplantation. In addition to glucocorticoids, antiproliferative agents, small molecule inhibitors and antibodies, those belonging to the group of macrolides with their many derivatives represent an interesting class of substances in this context. As a supplement to cyclosporin A (CSA) the most successful macrolide in transplantation medicine, animal experiments are currently being carried out to test newer macrolide derivatives, such as sanglifehrin A (SFA). This overview describes the classes of drugs and modes of action of currently administered standard medications in the clinical routine and new developments are presented.

[Human leukocyte antigen (HLA) system in ophthalmology]. / Humanes Leukozytenantigensystem in der Augenheilkunde.

Various inflammatory and non-inflammatory eye diseases are associated with specific HLA isotypes. Therefore, HLA isotyping can be a useful diagnostic tool for these diseases and has already been shown to reduce the rejection rate of corneal allografts. Unfortunately, the volume of published data and the varying quality of these publications complicate obtaining good overview in this field. This review briefly summarizes the genetic structure of the HLA system and elucidates differences between HLA classes I and II in the context of antigen presentation. Possible mechanisms of HLA associations in the field of ophthalmology are discussed, and finally different tools (e.g. genome wide association studies) for assessing associations of HLA isotypes with different ocular diseases are examined.

[Old immune system- new information? Importance of mononuclear phagocytes in corneal allograft rejection]. / Altes Immunsystem - Neue Erkenntnisse? : Bedeutung mononukleärer Zellen bei der allogenen Hornhauttransplantatabstoßung.

Mononuclear phagocytes are derived from bone marrow precursor cells and are part of the innate immune system. These cells circulate in the blood as monocytes but differentiate in the peripheral circulation into tissue macrophages and dendritic cells under the influence of various cytokines. In addition to antimicrobial properties, macrophages also participate in wound healing; however, they also support degenerative and inflammatory processes. In cases of acute corneal allograft rejection, mononuclear cells initially form the main component of the cellular anterior chamber infiltrate. How monocytes are recruited into the anterior chamber is currently uncertain. Furthermore, no information is available about the possible cytotoxic effects on corneal endothelial cells. Gaining insight into these mechanisms may lead to potential pharmacological interventions.

[Corneal tumour following anterior chamber lens implantation in a patient with Marfan syndrome. Case study of a 57-year-old patient]. / Kornealer Tumor nach Vorderkammerlinsenimplantation bei Marfan-Syndrom. Kasuistik eines 57-jährigen Patienten.

A 57-year-old male patient with Marfan syndrome presented at our clinic with a whitish gelatinous corneal tumour in the right eye. The initial examination revealed pronounced corneal oedema, bullous keratopathy, as well as an iris-fixed anterior chamber lens implanted 7 years previously. After the tumour was removed, the anterior chamber lens was explanted and keratoplasty was explanted and a two stage keratoplasty was performed. Histological analysis of the tumour and the cornea revealed vimentin and a number of smooth muscle actin (SMA)-positive tumour cells. The cornea below the tumour displayed a partially absent Bowman's layer and extensive pannus tissue. The characteristics of the corneal tumour and the subjacent cornea as described above are typical of secondary corneal myxoma. The influence of Marfan syndrome, a systemic connective tissue disorder present in the patient, on the etiopathogenesis of the corneal myxoma could not be fully determined.

[Sudden appearance and rapide progression of bilateral visual deterioration]. / Plötzlich aufgetretene und rasch progrediente beidseitige Visusverschlechterung.

This article describes the case of a 49-year-old patient with incomplete Vogt-Koyanagi-Harada syndrome. The anamnesis showed that intermittent alternating visual problems had begun 2 weeks before. The best corrected vision was 0.1 bilateral. In addition to a right-sided anterior uveitis multiple blister-like retinal alterations of both fundi were seen in fundoscopy. The fundoscopic findings could be confirmed by spectral domain optical coherence tomography (SD-OCT) as multiple intraretinal cysts and areas with neurosensory detachment. Topical and systemic steroid therapy resulted in a rapid reduction of these symptoms. The reversal in SD-OCT corresponded with a visual improvement.