RESUMO
PURPOSE: The purpose of this study was to obtain insight into cellular processes after CyPass microstent implantation into the supraciliary space. With this knowledge, we expected to find some reason for surgical failure. METHODS: Nine CyPass microstents of 8 patients with primary open-angle glaucoma (n = 1), pseudoexfoliation glaucoma (n = 5), uveitic glaucoma (n = 1), and posttraumatic open-angle glaucoma (n = 1) were explanted due to recurrence of IOP elevation, corneal decompensation, or persistent hypotony. The explants were processed for light and transmission electron microscopy. RESULTS: Fibrotic material, consisting of collagen fibrils, microfibrils, pseudoexfoliation fibrils produced by activated fibroblasts, was detected in the stent lumen of 4/5 pseudoexfoliation glaucoma patients and also in posttraumatic open-angle glaucoma. Fibrotic material was also present on the outer surface and within fenestrations of the majority of stents. Complete absence of fibrotic reaction was noticed in 3 of 9 microstents. CONCLUSION: Although MIGS is known to be less invasive than conventional surgery, implants placed in the suprachoroidal space may be adversely affected by a fibrotic tissue reaction resulting in implant failure. Understanding mechanisms and risk factors leading to fibrotic scarring following antiglaucomatous surgery may help to develop novel strategies that improve surgical outcome.
Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/etiologia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Stents/efeitos adversosRESUMO
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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COVID-19 , Síndrome de COVID-19 Pós-Aguda , HumanosRESUMO
Background: Laser-induced ocular injuries are of public interest, especially when caused by strangers. Clinical signs and follow-up: Two laser-induced maculopathies were presented which had been caused by strangers. Morphological findings were shown by funduscopy and Spectralis Domain OCT follow-up. Conclusion: Severe retina injuries can be induced by laser pointers of higher classes.
Assuntos
Traumatismos Oculares/etiologia , Traumatismos Oculares/patologia , Lasers/efeitos adversos , Retina/lesões , Retina/patologia , Doenças Retinianas/patologia , Diagnóstico Diferencial , Traumatismos Oculares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Retina/cirurgia , Doenças Retinianas/etiologia , Doenças Retinianas/cirurgia , Retinoscopia/métodos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Adulto JovemRESUMO
Onchocerca lupi, a nematode parasite infecting dogs and cats with a hitherto unknown arthropod vector, is also being recognised as a parasite also responsible for human eye infections. Here we describe a case of human eye infection diagnosed molecularly by nematode 12S rDNA PCR in a German patient who had travelled to Tunisia and Turkey. The patient recovered after treatment with antibiotic and anti-inflammatory therapy.
Assuntos
Onchocerca/genética , Onchocerca/isolamento & purificação , Oncocercose Ocular/diagnóstico , Viagem , Adulto , Animais , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , DNA Ribossômico/genética , Alemanha , Humanos , Masculino , Onchocerca/classificação , Oncocercose Ocular/tratamento farmacológico , Oncocercose Ocular/parasitologia , Reação em Cadeia da Polimerase , Resultado do Tratamento , Tunísia , TurquiaRESUMO
Endothelial dysfunction and vascular dysregulation play a role in the multifactorial pathogenesis of glaucomatous optic nerve atrophy. Dyslipidaemia as a risk factor for endothelial dysfunction is associated with glaucoma and cardiovascular morbidity and mortality. In additional to a genetic disposition, a potential mechanism for the pathogenesis of endothelial dysfunction could be an additive effect of several risk factors, like dyslipidaemia, smoking, arterial hypertension, diabetes and hyperhomocysteinaemia. This paper reviews the literature concerning the association between dyslipidaemia and glaucomatous disease and explains the possible role of dyslipidaemia for the pathogenesis and progression of glaucoma. The role of exogeneous modifiable risk factors for prevention and therapy of glaucoma and their neutralisation by changing life style like weight reduction, modifications of nutrition and physical activity, are discussed.
Assuntos
Dietoterapia/métodos , Dislipidemias/epidemiologia , Dislipidemias/prevenção & controle , Terapia por Exercício/métodos , Glaucoma/epidemiologia , Glaucoma/terapia , Causalidade , Comorbidade , Dislipidemias/diagnóstico , Medicina Baseada em Evidências , Glaucoma/diagnóstico , Humanos , Incidência , Fatores de RiscoRESUMO
BACKGROUND: Symptoms and clinical findings in patients with carotid-cavernous fistulas are specific. Nevertheless, they can be very mildly expressed. This study aims to point out the potential diagnostic value of ultrasound of the orbit. METHODS: A total of 25 patients with a reliable angiographic diagnosis of a fistula were reviewed retrospectively. We analyzed the symptoms, clinical findings and demonstrability in ultrasound of the orbit. RESULTS: The most common clinical findings were nerve palsy, dilation of episcleral vessels and exophthalmos. If an ultrasound had been part of the examination a dilation of the superior ophthalmic vein could be demonstrated in all cases. CONCLUSION: The expeditious ultrasound investigation provides valuable information for the diagnosis of red eyes which are resistant to treatment. The examiner has to consider a fistula and perform an ultrasound especially when diplopia has newly occurred. Finally, the expedient neuroimaging can be arranged.
Assuntos
Fístula Carótido-Cavernosa , Seio Cavernoso , Exoftalmia , Fístula Carótido-Cavernosa/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Humanos , Estudos Retrospectivos , UltrassonografiaRESUMO
Zoledronate-induced (Aclasta®) uveitis is a rare iatrogen-induced inflammation of ocular structures, which can result in substantial morphological and functional limitations. This case report describes the clinical course of a female patient with zoledronate-induced panuveitis. Additionally, the diagnostic procedure, therapy and follow-up are presented.
Assuntos
Pan-Uveíte , Feminino , Glucocorticoides , Humanos , Pan-Uveíte/induzido quimicamente , Ácido ZoledrônicoRESUMO
The management of glaucoma therapy to reduce intraocular pressure commonly consists of a gradual approach with local monotherapy, combined therapy, laser surgery and finally filtration surgery. The local side effects of glaucoma medications and the lack of adherence and persistence to the medical therapy as well as the complication profile of the established glaucoma surgical techniques justify the introduction of new surgical procedures. Micro-invasive glaucoma surgery (MIGS) is a promising new surgical approach. Microstents can reduce the medication burden and prolong the need for filtration surgery. This review article presents the different trabecular implants (iStent, iStent inject, HydrusTM Microstent) in detail and discusses the effectiveness and safety of the procedures based on the currently available data.
Assuntos
Cirurgia Filtrante , Implantes para Drenagem de Glaucoma , Glaucoma , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Tonometria OcularRESUMO
Bilateral persistent hyperplastic primary vitreous (PHPV) represents a rare entity of a congential malformation. This casuistic presents for the first time in the German literature the case of a 4-month-old child with bilateral posterior PHPV.
Assuntos
Vítreo Primário Hiperplásico Persistente , Diagnóstico Diferencial , Humanos , Lactente , Corpo VítreoRESUMO
Reports of laser-induced ocular injuries have become more frequent in recent years, especially due to high-energy laser pointers. The article presents for the first time in the German literature a case of self-inflicted laser-induced maculopathy in an adolescent. In addition to the clinical findings, the results of funduscopy and spectral domain optical coherence tomography (SD-OCT) follow-up are presented.
Assuntos
Queimaduras Oculares/diagnóstico , Queimaduras Oculares/etiologia , Lasers/efeitos adversos , Retina/lesões , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/diagnóstico , Adolescente , Queimaduras Oculares/terapia , Humanos , Masculino , Oftalmoscopia , Comportamento Autodestrutivo/terapia , Tomografia de Coerência Óptica/métodos , Resultado do TratamentoRESUMO
PurposeTissue clearing has been used in anatomy for the first time in Germany over a century ago. Neuronal tissue, like cortex, was investigated in mice using a water-based optical clearing method termed See Deep Brain (SeeDB). However, although the eye belongs to the central nervous system, this histological technique was not applied in the eye up to date. We applied SeeDB for the visualization of intraocular structures.Patients and methodsFour eyes of cornea donors (two male, two female: 73-84 years) obtained from the Cornea Bank of the Department of Ophthalmology Erlangen, four chicken eyes and two mices' optic nerve were used. Bulbi were fixed in 4% paraformaldehyde in phosphate-buffered saline and treated with increasing concentrations of aqueous fructose solution with 0.5% α-thioglycerol. After SeeDB, transscleral macrophotographs of the choroid were performed.ResultsComplete transparency of the sclera was obtained in enucleated human and chicken eyes after SeeDB treatment. Macroscopical anatomy of the choroid (partially transparent due to the remaining retinal pigment epithelium and melanocytes) showing vessels and other related structures was possible without preparing slides. Mice optic nerves were also transparent after SeeDB treatment.ConclusionThe SeeDB method allows visualization of intraocular structures through a completely translucent sclera. This innovative processing technique could facilitate comprehensive qualitative and quantitative topographical anatomical studies of human and animal eyes, preserving their 3D architecture. Supra- and intrachoroidal ganglionic plexus could potentially be visualized transsclerally. Finally, clinical-pathological correlations of intraocular diseases-for example, retinal tumors-will be possible in non-dissected eyes.
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Corioide/anatomia & histologia , Córnea/anatomia & histologia , Frutose/farmacologia , Glicerol/análogos & derivados , Modelos Anatômicos , Nervo Óptico/anatomia & histologia , Vasos Retinianos/anatomia & histologia , Soluções/farmacologia , Preservação de Tecido/métodos , Idoso , Idoso de 80 Anos ou mais , Animais , Cadáver , Galinhas , Feminino , Glicerol/farmacologia , Humanos , Masculino , Camundongos , Microscopia de Fluorescência por Excitação Multifotônica , Modelos AnimaisRESUMO
BACKGROUND: Functional tests in glaucoma diagnosis can monitor a potential perimetric progression. However white-on-white perimetry is limited in advanced glaucoma, whereas contrasts were detected reproducibly. Especially when stressing (i. e. adapting) the visual system, subsequent measurements yielded different results-the visual system needs a "recovery time". In the present study the recovery time was investigated in patients with advanced glaucoma. Additionally correlation analysis was done with standard perimetric parameters. MATERIAL AND METHODS: Temporal contrast sensitivity (TCS) and recovery time (RT) were measured using the Erlanger Flicker Test in 61 probands (15 normals, 25 primary open-angle glaucomas, 17 secondary open-angle glaucomas, 4 narrow-angle glaucoma). Additionally, ophthalmological examinations and perimetry (Octopus G1) was done. RESULTS: (1) TCS was significantly reduced in patients with advanced glaucoma (p < 0.001). (2) Test stimuli with 3 and 5 % contrast showed a large variability in contrast to higher contrasts (12 %, 25 %, 35 %). (3) RT12%, RT25% and RT35% were significantly prolonged in advanced glaucoma (p < 0.001). (4) RT25% correlated significantly with mean defect (p = 0.015). CONCLUSION: Recovery time seems to be a potential parameter in advanced glaucoma follow-up, as it is reproducible, independently of cataract and fixation.
Assuntos
Progressão da Doença , Fusão Flicker , Glaucoma/diagnóstico , Atrofia Óptica/diagnóstico , Estimulação Luminosa/métodos , Testes de Campo Visual/métodos , Idoso , Feminino , Glaucoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Óptica/etiologia , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Sympathetic ophthalmia is a rare form of bilateral granulomatous panuveitis, occurring after penetrating trauma. Hitherto, sympathetic ophthalmia after vitrectomy has only occasionally been described in the literature. This case report presents a female patient with sympathetic ophthalmia after repeated pars plana vitrectomy on the basis of clinical findings and follow-up with fluorescein angiography, spectral domain OCT, and histopathology.
Assuntos
Oftalmia Simpática/diagnóstico por imagem , Oftalmia Simpática/etiologia , Oftalmoscopia/métodos , Tomografia de Coerência Óptica/métodos , Vitrectomia/efeitos adversos , Diagnóstico Diferencial , Enucleação Ocular , Feminino , Humanos , Pessoa de Meia-Idade , Oftalmia Simpática/cirurgia , Reoperação/efeitos adversos , Resultado do TratamentoRESUMO
Amusement park injuries have become more common in recent years. Especially neurological symptoms dominate clinical findings. In this article, the case of a 15-year-old child with homonymous hemianopia due to an atypical intracranial bleeding with subdural hematoma after a giant swing ride is described for the first time.
Assuntos
Aceleração/efeitos adversos , Hematoma Subdural/etiologia , Hemianopsia/etiologia , Hemorragia Intracraniana Traumática/etiologia , Atividades de Lazer , Parques Recreativos , Adolescente , Angiografia Digital , Feminino , Seguimentos , Hematoma Subdural/diagnóstico , Hemianopsia/diagnóstico , Humanos , Hemorragia Intracraniana Traumática/diagnóstico , Imageamento por Ressonância Magnética , Lobo Occipital/patologia , Remissão Espontânea , Testes de Campo VisualRESUMO
Frosted branch angiitis is a special form of retinal vasculitis, which has only rarely been reported in the literature. Although the majority of cases of frosted branch angiitis are idiopathic, a systematic clinical work-up should be done in order to exclude other causes, such as infectious and autoimmune diseases. The aim of this study was to correlate the clinical findings with the images obtained during follow-up by spectral domain optical coherence tomography (OCT).
Assuntos
Aumento da Imagem/métodos , Vasculite Retiniana/diagnóstico por imagem , Vasculite Retiniana/patologia , Tomografia de Coerência Óptica/métodos , Criança , Cortisona/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Doenças Raras/diagnóstico por imagem , Doenças Raras/tratamento farmacológico , Doenças Raras/patologia , Vasculite Retiniana/dietoterapiaRESUMO
BACKGROUND: In contrast to all other glaucoma surgeries, filtration surgery is associated with biomicroscopically visible wound healing, which enables the surgeon to perform revision surgeries if necessary. OBJECTIVES: The aim of this review is to provide general considerations and to give a structured overview about bleb revisions after trabeculectomy. MATERIALS AND METHODS: The different revision techniques are explained in detail and in the context of perioperative management. RESULTS: Preoperative preparation and modifications of the surgical techniques reduce the incidence of postoperative revisions. The site of the fibrosis defines the revision technique (bleb needling, needle revision, bleb revision with reopening). The increased percolation rate of aqueous humor in postoperative hypotony contributes to fibrosis and may lead to maculopathy, choroidal effusion, and suprachoroidal hemorrhage. DISCUSSION: Discontinuing administration of local medication and pretreatment with steroids without preservative for at least one week prior to surgery increase surgical success of trabeculectomy and reduce the incidence of postoperative revisions. Postoperative management after filtration surgery should be performed after consulting the surgeon. The primary endpoint of trabeculectomy is an intraocular pressure between 8 and 12 mm Hg without local antiglaucomatous medication. In postoperative hypotony revisions should be done earlier and based on the pathological findings.