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3.
Curr Opin Ophthalmol ; 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33630788

RESUMO

PURPOSE OF REVIEW: After removing the native vitreous during vitreoretinal surgery, an adequate substitute is required to ensure homeostasis of the eye. Current clinically used endotamponades (silicone oil, gases, semifluorinated alkanes) are effective in promoting retinal reattachment, but lead to complications such as emulsification, prolonged inflammation, blurred vision, raised intraocular pressure, cataract formation or the need for revision surgery. The aim of this review is to provide an update on novel vitreous substitutes with a focus on polymer-based systems. RECENT FINDINGS: Polymeric hydrogels provide favourable properties such as high water content, optical transparency, suitable refractive indices and densities, adjustable rheological properties, injectability, biocompatibility and their ability to tamponade the retina via viscosity and swelling pressure, comparable to the native human vitreous body. Here, vitreous replacement strategies can be divided into chemically or physically crosslinked hydrogel systems that are applied as preformed or in-situ gelling matrices. SUMMARY: Several hydrogel-based vitreous substitutes have already been positively evaluated in preclinical tests and have the potential to enter the clinical phase soon.

6.
Artigo em Inglês | MEDLINE | ID: mdl-33502628

RESUMO

PURPOSE: To show that an immediate vitrectomy with an intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections. METHODS: We reviewed all cases of clinical endophthalmitis caused by an intravitreal injection that were treated in our department between March 2012 and November 2019. Only patients that underwent a vitrectomy within 6 h after presentation to the clinic and with a documented visual acuity shortly before the causative event were included. Baseline best-corrected visual acuity (BCVA) before the causative event was compared to BCVA measured within a follow-up period of 8 months (up to 14 months). RESULTS: In total, 30 eyes of 30 patients were included. The BCVA before the intraocular infection was a mean value of 0.55 logMAR, and the BCVA on the day of the endophthalmitis decreased significantly to 1.66 logMAR. Within 2 months following the pars plana vitrectomy (PPV), the mean BCVA improved to 0.83 logMAR. Eight months following PPV (mean value, 8.20 months; SD, 3.59 months), the mean BCVA was 0.63 logMAR. In the last follow-up interval most of the eyes recovered, and the BCVA did not differ significantly from baseline. Two eyes underwent further pars plana surgery during the follow-up period. No enucleation was required. CONCLUSION: In this study, we have shown that an immediate vitrectomy with subsequent intravitreal injection of antibiotics is an effective option for treating post-injection endophthalmitis and frequently results in recovery of vision; thus, it should be performed as early as possible, where available.

7.
Acta Ophthalmol ; 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33502099

RESUMO

PURPOSE: To analyse the factors influencing the primary patency of clear corneal incisions in femtosecond laser-assisted cataract surgery (FLACS). METHODS: In this prospective single-centre study, the graphical user interfaces of 159 patients undergoing femtosecond laser-assisted cataract surgery were documented by video. Subsequently, the quality of limbus detection along with the incidence of vessels and an arcus lipoides were assessed by a grading system and analysed in relation to the primary patency of the incisions. In particular, the differences between a superior and a temporal main incision were analysed. RESULTS: The designed grading system could be applied in all cases without any problems. Limbus detection was highly inhomogeneous but had no influence on the patency of the incisions (46.3% poor, 18.4% moderate, 35.1% good). The characteristics of the arcus lipoides had little influence on the patency of the main incisions. Pronounced vascular ingrowth caused more tissue bridges but did not reduce the patency of the incisions. Temporal access was generally easier to open than a superior one (97.1% versus 88.9%). CONCLUSION: We showed a patency rate of superior FLACS incisions of over 97% with the Femto LDV Z8 in our study. Temporal main incision is preferable to superior main incision in more difficult situations. The new grading system is suitable for further studies to provide information on the quality of the incision.

8.
Ophthalmol Glaucoma ; 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33358988

RESUMO

PURPOSE: To evaluate in glaucoma patients the feasibility and use of remote monitoring of intraocular pressure (IOP) with an implanted telemetry sensor during the coronavirus disease 2019 (COVID-19) lockdown. DESIGN: Cross-sectional study. PARTICIPANTS: Patients previously implanted with a telemetric IOP sensor (Eyemate; Implandata GmbH) were included. METHODS: Intraocular pressure measurements acquired by the patients during the lockdown were collected by physicians who were located remotely. A questionnaire was sent to 10 participating study centers to evaluate the clinical impact of remote monitoring of IOP via the IOP sensor system. MAIN OUTCOME MEASURES: Number of patients who obtained home IOP measurements. RESULTS: Data were available from all centers and from 37 eyes of 37 patients (16 patients with a sulcus-based sensor and 21 patients with a suprachoroidal sensor). Thirty-four patients obtained IOP measurements during the lockdown. Mean age of the patients was 69.3 ± 9.6 years, and 48.6% were women. A total of 8415 IOP measurements from 370 measurement days were obtained. Based on remote IOP measurements, treatment was changed in 5 patients. In another 5 patients, treatment change was considered when physicians received the IOP measurements after the lockdown. Nine of the 10 study centers judged remote IOP measurements to have a clinical impact. CONCLUSIONS: These results show the feasibility of patient-acquired measurement of IOP in conjunction with remote IOP monitoring by physicians with an implantable sensor. The data obtained impacted clinical decision making, including adjustment of ocular hypotensive therapy and avoiding unnecessary office visits during the COVID-19 pandemic.

9.
Acta Ophthalmol ; 2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33354909

RESUMO

PURPOSE: To investigate the ultrastructure of the cleavage plane of human cornea after liquid-bubble-prepared tissue for Descemet's membrane endothelial keratoplasty (DMEK). METHODS: Experimental study with scanning electron microscopy (SEM) and block-face SEM of 18 corneal specimens. Fresh human research donor corneoscleral discs (n = 12) were prepared with liquid-bubble technique or examined as untreated controls (n = 3). In addition, Descemet's membrane samples, n = 3, were obtained in DMEK surgery. RESULTS: The cleavage plane after liquid-bubble Descemet's membrane (DM) preparation was consistently located between interfacial matrix and posterior stromal collagen lamellae, providing a largely smooth surface exposing the amorphous interfacial zone without any significant amounts of adherent stromal remnants. No demarcation of a distinct pre-DM layer could be detected. CONCLUSION: The DMEK graft preparation performed by liquid-bubble technique showed a smooth cleavage plane and could not reveal any demarcation of a distinct pre-DM layer.

10.
Acta Ophthalmol ; 2020 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-33369248

RESUMO

PURPOSE: Effectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out a systematic literature review and meta-analysis of ocriplasmin studies conducted in real-world settings (RWS) and compared outcomes with those from randomized controlled trials (RCTs). METHODS: We included prospective and retrospective studies from RWS documenting effectiveness of ocriplasmin in patients with VMT with or without MH, and RCTs of ocriplasmin versus control. Key end-points were vitreomacular adhesion resolution (VMAR), nonsurgical MH closure, need for vitrectomy and safety. We conducted meta-regression on pooled results to evaluate effects of baseline covariates and study design on outcomes. RESULTS: Thirty RWS (2402 patients) and 5 RCTs (737 patients) were included epiretinal membrane (ERM) and broad VMA were more prevalent in RCTs. Primary VMAR, vitrectomy and MH closure rates were comparable between RWS and RCTs. Rates of nsVMAR were significantly higher in RWS than RCTs (odds ratio 1.66; 95% confidence interval [CI]: 1.18-2.34). nsVMAR rates were inversely associated with ERM prevalence (odds ratio 0.20; 95% CI: 0.08-0.51). Compared with the recent OASIS trial, RWS reported a higher incidence of new/worsening subretinal fluid cases and less photophobia, photopsia, vitreous floaters, electroretinogram abnormalities and MH progression. CONCLUSIONS: Ocriplasmin was significantly more effective in achieving nsVMAR in RWS than in RCTs. Lower ERM prevalence in RWS was the single significant explanatory variable for this difference. Conclusions on ocriplasmin safety in RWS are limited due to inconsistent reporting.

11.
Acta Ophthalmol ; 2020 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-33381918

RESUMO

PURPOSE: To analyse the cytotoxic and antiproliferative effect of methotrexate (MTX) and fluorouracil (5-FU) in vitro on fibroblasts, retinal pigment epithelial (RPE) and photoreceptor cells as an adjunct for reducing the incidence of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment surgery. METHODS: Methotrexate and 5-FU were dissolved separately in balanced salt solution (BSS) with concentrations ranging from 0-8000 µg/ml and 0-4000 µg/ml, respectively. All solutions were analysed in terms of pH and osmolarity and applied for 1 h to fibroblasts (BJ), RPE (ARPE-19) and photoreceptor (661W) cell lines adherently cultivated in 96-well cell culture plates (10 000 cells/well). 24 h after incubation, the proliferative (BrdU), metabolic (CellTiter-Glo) and apoptotic (Caspase 3/7) activity of the cells were examined in vitro. RESULTS: 5-FU had an antiproliferative effect on BJ and ARPE-19 cells starting from low concentrations (2 µg/ml). However, the viability of 661W cells decreased and apoptosis was induced with increasing 5-FU concentration. In contrast, MTX up to a concentration of 266 µg/ml did neither result in a significant loss of viability nor in increased caspase 3/7 activity of BJ, ARPE-19 and 661W cells and inhibited the proliferation of ARPE-19 already at low concentrations starting from 8 µg/ml. CONCLUSIONS: Methotrexate dissolved in BSS is biocompatible up to a concentration of 266 µg/ml and may act as an intraoperative rinse solution to inhibit RPE proliferation in PVR-diseased eyes. Contrary, the use of 5-FU within the posterior segment of the eye is limited by its cell-damaging effect on photoreceptor cells.

13.
14.
Klin Monbl Augenheilkd ; 237(10): 1225-1229, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33059379

RESUMO

One of the most controversial discussions in retinal surgery is currently being held about the importance of intraoperative OCT (iOCT). The background is the desire to combine the 2-dimensional fundus view of the surgeon with the layered depth information of OCT to achieve a 4-dimensional "augmented reality" (3-D plus change over time). This should help to visualise fine structures, which have been hidden from the surgeon's view. Therefore, retinal surgery seems to be predestined for the use of iOCT. The great hope is that a dynamic live 3-D image with real-time feedback will provide the surgeon with additional information and improve safety. Although fascinating at the first glance, in the surgical routine, however, iOCT technology is disappointing, especially in macular surgery. It rarely provides substantial information that would not be obtainable without iOCT or that would not be available in much better quality through preoperative diagnostic testing. Only some special indications remain, particularly related to subretinal surgery.


Assuntos
Retina , Tomografia de Coerência Óptica , Fundo de Olho , Procedimentos Cirúrgicos Oftalmológicos , Retina/diagnóstico por imagem , Retina/cirurgia , Corpo Vítreo
16.
Curr Eye Res ; : 1-7, 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32715800

RESUMO

PURPOSE: To evaluate the long-term efficacy and safety of the modified canaloplasty technique with additional suprachoroidal drainage in patients with pseudoexfoliation glaucoma. METHODS: This retrospective clinical trial included 131 patients with pseudoexfoliation glaucoma who underwent canaloplasty with suprachoroidal drainage (scD). One hundred and eleven of 131 patients underwent the follow-up examination after 48 months. Primary endpoints were the pressure-lowering and drug-sparing effect as well as the success rates. Secondary endpoints were intra- and postoperative complications and the occurrence of secondary surgical interventions. RESULTS: The IOP was reduced by 45.8% after 12 months (from baseline 23.4 ± 5.1 mmHg to 12.7 ± 2.2 mmHg) and by 45.1% after four years (12.8 ± 2.2 mmHg) (p < .001). The mean number of IOP-lowering medication decreased significantly from 3.4 at baseline to 0.6 after 12 months and to 1.0 after four years. The IOP-reducing effect was even stronger in those cases in whom canaloplasty+ scD was combined with cataract surgery (49.4% after 12 months and 47.6% after four years). No serious complications were observed. CONCLUSIONS: The modified surgery technique of canaloplasty with suprachoroidal drainage is a safe and effective way of reducing IOP in patients with pseudoexfoliation glaucoma.

17.
Int Ophthalmol ; 40(10): 2683-2689, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32488594

RESUMO

PURPOSE: A stable and reliable vacuum is crucial for the correct planning and performance of femtosecond laser-assisted cataract surgery (FLACS) in order to avoid complications such as suction loss and cyclorotation. This study investigates, for the first time, the impact of different vacuum levels on the stability of the application of a liquid patient interface for FLACS in view of break-away forces. METHODS: Break-away forces were measured using a multifunctional material testing machine with a mounted digital manometer. Sixteen porcine eyes were docked to the patient interface of a femtosecond laser platform (FEMTO LDV Z8), and the impact of different vacuum levels between 300 and 500 mbar investigated. RESULTS: Mean break-away forces for each vacuum level were as follows: 1.78 N (± 0.58 N) for 300 mbar; 2.24 N (± 0.68 N) for 350 mbar; 2.66 N (± 0.68 N) for 400 mbar; 2.86 N (± 0.77 N) for 420 mbar; and 3.49 N (± 0.86 N) for 500 mbar. CONCLUSION: The stability increases with the vacuum in a nearly linear manner. Vacuum levels higher than 500 mmHg and lower than 350 mmHg are not recommended for FLACS.

19.
Graefes Arch Clin Exp Ophthalmol ; 258(10): 2151-2161, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32583283

RESUMO

INTRODUCTION: Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. METHODS: Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. RESULTS: The mean duration of the MH prior to SR-fluid application was 17 months (6-96 months). The mean age of the patients at the time of surgery was 72 years (54-88). The mean preoperative aperture diameter of the opening was 1212 µm (239-4344 µm), base diameter 649 µm (SD 320 µm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. CONCLUSION: Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.

20.
J Cataract Refract Surg ; 46(5): 799-800, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358284
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