Subthreshold Nanosecond Laser

Zusammenfassung Ziel Diese Studie zielt darauf ab, die klinische Entwicklung von Symptomen und Komplikationen bei Patienten mit früher und mittelschwerer AMD (altersbedingte Makuladegeneration) zu bewerten, die mit einer unterschwelligen Nanosekunden-Lasertherapie (SNL) behandelt werden. Die SNL-Therapie ist eine nicht-invasive, schmerzfreie Behandlungsmethode mit einem frequenzverdoppelten Nanosekunden-Pulslaser mit diskontinuierlicher Strahlenergieverteilung. Methoden An einer einzigen Institution wurde eine Kohort-studie durchgeführt. Zwischen 2015 und 2018 wurden 438 Patienten mit früher und mittlerer AMD (Alter 55-80) identifiziert. 160 Patienten wurden nach der Ausschlusskriterien identifiziert. Die Patienten, die der SNL- Therapie zustimmten, waren 64 Patienten, die anderen Patienten lehnten die SNL-Therapie ab und wurden als Kontrollgruppe eingeschlossen. Die Patienten mit Pseudodrusen wurden identifiziert und ausgeschlossen. Die primären Endpunkte waren die Verringerung der Anzahl und Drusenfläche als Umkehrung früher klinischer Indikatoren für AMD. Die sekundären Endpunkte waren die Veränderung der mittleren Sehschärfe nach dem 6. Monat und das Fortschreiten zu einer fortgeschrittenen altersbedingten Makuladegeneration (AMD) im behandelten Auge. Um teilnahmeberechtigt zu sein, sollten die Patienten zuvor keine anderen Augenerkrankungen haben, die die interessierenden Ergebnisse beeinflussen könnten, wie z. B. diabetische Retinopathie, Katarakt, schweres Glaukom oder Behandlung während der Studie. Ergebnisse Es wurde eine Umkehrung früher klinischer Anzeichen von AMD dokumentiert, die sich in einer Verringerung der Anzahl und Größe der Drusen zeigten (jeweils p < 0,001). Innerhalb des 6-monatigen Follow-up war die Progressionsrate der Drusengröße und -anzahl in der SNL-Gruppe signifikant niedriger (26 %) als in der Kontrollgruppe (69 %; p < 0,001). Keine Verbesserung der Sehschärfe (LogMar) wurde in der SNL-Gruppe im Vergleich zur Nicht- SNL-Gruppe dokumentiert (jeweils p 0,59). Fazit Diese Studie hebt die SNL-Therapie als mögliche Therapieoption hervor, um die frühen klinischen Anzeichen von AMD umzukehren. Die vorliegende Studie liefert neue Hinweise darauf, dass Patienten mit früher und mittlerer AMD von der minimal-invasiven SNL- Therapie profitieren könnte

Iris lymphoma-a systematic guide for diagnosis and treatment

Iris lymphomas are rare malignant neoplasms arising either as primary tumors in the iris or as secondary tumors involving the iris. We summarize previously published data and make recommendations for work-up strategies for cases of suspected iris lymphoma. Our objective is to provide a structured overview of the typical clinical symptoms and signs, the pathologic, ophthalmic as well as hematologic work-up for diagnosis, treatment, and follow-up of iris lymphomas and offer a flowchart on how to diagnose and treat these tumors

Temporary Filtering Bleb Failure Induced by Anterior Chamber Sulfur Hexafluoride Gas: A Complication after Descemet Membrane Endothelial Keratoplasty

Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF6) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF6 gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF6 volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF6 gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery

Perceived Stress Levels in Adult Patients With Uveitis

Background: The aim of this study was to examine perceived stress levels in adult patients with uveitis. Patients and Methods: One hundred seventy-three adult consecutive uveitis patients (age range 18 to 85 years) were analyzed in a cross-sectional design for their perceived stress, according to the Perceived Stress Questionnaire (PSQ). Stress levels were classified into normal stress, moderate stress, and high stress. Results: In the majority of uveitis patients a normal stress level (82%) within the last 2 years was detected. In a subgroup analysis, perceived stress of the patients with active uveitis compared with patients with non-active uveitis was significantly higher within the last 2 years (n=80 active/n = 45 non-active; p = 0.005). Conclusions: Overall 18% of the uveitis patient had raised perceived stress, similar to the general population but patients with active uveitis were significantly more stressed. Therefore, consideration of stress levels may be important in the therapy of uveitis patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries