PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). D...PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.展开更多
Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced st...Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.展开更多
Background: Cerebral and retinal vessels behave similarly under the influence of vascular risk factors. Several groups have shown that retinal microvascular abnormalities represent an independent risk factor with rega...Background: Cerebral and retinal vessels behave similarly under the influence of vascular risk factors. Several groups have shown that retinal microvascular abnormalities represent an independent risk factor with regard to strokes and heart attacks. Aim of the Study: The aim of this study was to perform a prospective screening examinationwith regard to retinalmicrovascular abnormalities as well as an extended vessel diagnosis in a subgroup of patients with lower arteriovenous risk values. Methods: In the course of a prospective cross-sectional study (“Talking Eyes”) between 1.9.2001 and 1.8.2002 a telemedical-supported screening of the retina (study 1) was carried out in 7,163 subjects. The patients were selected without any inclusion or exclusion criteria. The mean age was 48.2±8 years (18-83 years) with a sex distribution of 39.2%females to 60.8%males. Digital fundus photos of the right and left eyes were taken for all patients. The pictures were taken without pupil dilation using a CANON-NM camera. The pictures and case histories were stored in a central server using web-based software (MedStage, Siemens). In a central reading centre, the arteriovenous ratio of both eyes was determined telemedically using the Parr-Hubbard formula and the retinas subjected to a standardised examination by an ophthalmologist. The retinal risk factor was calculated on the basis of the arteriovenous ration, the presence of microvascular abnormalities and the case history. The reproducibility of measurement of the arteriovenous ratio (Kronbach alpha coefficient) was evaluated by double measurements on 1,332 images. In a subgroup of study 1 with arteriovenous ratio values < 0.76 (N=107), an extended vessel diagnosis with measurement of 24-h blood pressure and vessel-relevant blood values (homocysteine, cholesterol, LDL, HDL, CRP, TG, HbA1c) was carried out (study II). Results: Study 1: The Kronbach alpha coefficient as a measure of reproducibility amounted to 0.77. The mean arteriovenous ratio of the retinal vessels was 0.83±0.09 and showed a pronounced age dependence (R=0.9, p< 0.0001). On multivariate testing the arteriovenous ratio correlated significantly (R=0.33, p< 0.001) with the factors age, systolic blood pressure, diastolic blood pressure and body mass index. Diastolic blood pressure followed by age had the largest influence. The prevalence of microvascular abnormalities in the right (RE) and left (LE)-eyes, respectively were: cotton wool foci RE 0.0015%, LE 0.003%, retinal haemorrhage RE 0.1%, LE 0.1%, focal stenoses RE 3.4%, LE 3.4%, tortuositas vasorumRE 4.1%, LE 4.0%, arteriovenous crossing signs RE 11.2%, LE 11.2%. On multivariate testing the occurrence of microvascular abnormalities correlated significantly (R=0.38, p < 0.001) with the factors high blood pressure known from case history, body mass index, and gender. Arterial hypertension had the strongest influence followed by diastolic blood pressure. The calculated retinal risk factor correlated with the prevalence of angina pectoris. Study 11: 2/3 of the subjects with arteriovenous risk factor values < 0.76 exhibited pathologically high 24-h blood pressure values. For these patients there were significant correlations between the arteriovenous ratio and the low-density lipoprotein concentration as well as the Framingham risk score. Conclusion: In the course of a prospective, telemedical-supported screening examination of the retinal vessels of more than 7,000 subjects the arteriovenous ratio exhibited a strong dependence on age and blood pressure. Among the subjects with lowered arteriovenous ratio values, 2/3 exhibited arterial hypertension in the 24-h blood pressure determination.展开更多
Background: Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by ac ute subretinal haemorrhage. We analysed possible predictiv...Background: Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by ac ute subretinal haemorrhage. We analysed possible predictive factors and function al results of eyeballs with rupture of the choroid after ocular contusion. Patie nts and Methods: We performed a retrospective study of 376 consecutive inpatient s (Erlangen Ocular Contusion Registry-EOCR, over a 10-year period), who were t reated because of a blunt eye injury at our eye hospital (86%males). Detailed n otes regarding the anterior and posterior segments were extracted from the stand ardised charts. Mean age was 28.8±16.1 years (4 to 84 years). Eyes with previou s trauma or globe ruptures were excluded. Results: Twenty-six of 376 patients d eveloped choroidal rupture due to ocular contusion (6.9%). A choroidal rupture was more frequent in females (9.4%) than in males (6.5%). Patients with choroi dal rupture were treated as inpatients 5 days longer than patients without (10.7 vs 5.5 days; P< 0.001). Twenty-two percent of the injuries occurred during wor k time. Main causes of choroidal ruptures were water jet (19%), fireworks (12% ), elastic cords (12%), metal pieces (12%), gotcha (8%) and champagne corks ( 8%). The risk for developing a choroidal rupture due to water jet or fireworks injuries was increased 9 or 4 times. Ninetytwo percent of choroidal ruptures wer e located at the posterior pole and concentric, 40%were submacular, 12%outside the large temporal vessels (4%were located both centrally and peripherally). I nitial visual acuity (VA) and VA at discharge were decreased significantly in ey es with rupture of the choroid (20/200 and 20/60) in contrast to eye swithout (2 0/40 and 20/25; P< 0.001). Choroidal ruptures were often associated with iridodi alysis, lens dislocation and contusion cataract (3 x), vitreous haemorrhage (4 x ), complete retinal defects (6 x), ciliary body clefts (7 x) or hyphema rebleedi ng (4 x). No association between the height of hyphema and choroidal ruptures wa s found. The predictive level of choroidal ruptures was 40%in eyes with a combi nation of lens dislocation, traumatic cataract and vitreous bleeding. The final VA was 20/200 or less in 11 eyes associated with a prevalence of 55%of ruptures submacularly. In contrast to this, eyes with VA >20/200 developed 26 %submacul ar choroidal ruptures. Conclusions: Additional severe traumatic changes of the a nterior and posterior II segment were found 2-7 times more frequently in eyes w ith choroidal ruptures compared to eyes without those ruptures. The visual impro vement was limited due to submacular ruptures. Frequent ophthalmological control s are recommended to III minimise the risk of choroidal neovascularisation in a submacular location.展开更多
文摘PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.
文摘Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.
文摘Background: Cerebral and retinal vessels behave similarly under the influence of vascular risk factors. Several groups have shown that retinal microvascular abnormalities represent an independent risk factor with regard to strokes and heart attacks. Aim of the Study: The aim of this study was to perform a prospective screening examinationwith regard to retinalmicrovascular abnormalities as well as an extended vessel diagnosis in a subgroup of patients with lower arteriovenous risk values. Methods: In the course of a prospective cross-sectional study (“Talking Eyes”) between 1.9.2001 and 1.8.2002 a telemedical-supported screening of the retina (study 1) was carried out in 7,163 subjects. The patients were selected without any inclusion or exclusion criteria. The mean age was 48.2±8 years (18-83 years) with a sex distribution of 39.2%females to 60.8%males. Digital fundus photos of the right and left eyes were taken for all patients. The pictures were taken without pupil dilation using a CANON-NM camera. The pictures and case histories were stored in a central server using web-based software (MedStage, Siemens). In a central reading centre, the arteriovenous ratio of both eyes was determined telemedically using the Parr-Hubbard formula and the retinas subjected to a standardised examination by an ophthalmologist. The retinal risk factor was calculated on the basis of the arteriovenous ration, the presence of microvascular abnormalities and the case history. The reproducibility of measurement of the arteriovenous ratio (Kronbach alpha coefficient) was evaluated by double measurements on 1,332 images. In a subgroup of study 1 with arteriovenous ratio values < 0.76 (N=107), an extended vessel diagnosis with measurement of 24-h blood pressure and vessel-relevant blood values (homocysteine, cholesterol, LDL, HDL, CRP, TG, HbA1c) was carried out (study II). Results: Study 1: The Kronbach alpha coefficient as a measure of reproducibility amounted to 0.77. The mean arteriovenous ratio of the retinal vessels was 0.83±0.09 and showed a pronounced age dependence (R=0.9, p< 0.0001). On multivariate testing the arteriovenous ratio correlated significantly (R=0.33, p< 0.001) with the factors age, systolic blood pressure, diastolic blood pressure and body mass index. Diastolic blood pressure followed by age had the largest influence. The prevalence of microvascular abnormalities in the right (RE) and left (LE)-eyes, respectively were: cotton wool foci RE 0.0015%, LE 0.003%, retinal haemorrhage RE 0.1%, LE 0.1%, focal stenoses RE 3.4%, LE 3.4%, tortuositas vasorumRE 4.1%, LE 4.0%, arteriovenous crossing signs RE 11.2%, LE 11.2%. On multivariate testing the occurrence of microvascular abnormalities correlated significantly (R=0.38, p < 0.001) with the factors high blood pressure known from case history, body mass index, and gender. Arterial hypertension had the strongest influence followed by diastolic blood pressure. The calculated retinal risk factor correlated with the prevalence of angina pectoris. Study 11: 2/3 of the subjects with arteriovenous risk factor values < 0.76 exhibited pathologically high 24-h blood pressure values. For these patients there were significant correlations between the arteriovenous ratio and the low-density lipoprotein concentration as well as the Framingham risk score. Conclusion: In the course of a prospective, telemedical-supported screening examination of the retinal vessels of more than 7,000 subjects the arteriovenous ratio exhibited a strong dependence on age and blood pressure. Among the subjects with lowered arteriovenous ratio values, 2/3 exhibited arterial hypertension in the 24-h blood pressure determination.
文摘Background: Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by ac ute subretinal haemorrhage. We analysed possible predictive factors and function al results of eyeballs with rupture of the choroid after ocular contusion. Patie nts and Methods: We performed a retrospective study of 376 consecutive inpatient s (Erlangen Ocular Contusion Registry-EOCR, over a 10-year period), who were t reated because of a blunt eye injury at our eye hospital (86%males). Detailed n otes regarding the anterior and posterior segments were extracted from the stand ardised charts. Mean age was 28.8±16.1 years (4 to 84 years). Eyes with previou s trauma or globe ruptures were excluded. Results: Twenty-six of 376 patients d eveloped choroidal rupture due to ocular contusion (6.9%). A choroidal rupture was more frequent in females (9.4%) than in males (6.5%). Patients with choroi dal rupture were treated as inpatients 5 days longer than patients without (10.7 vs 5.5 days; P< 0.001). Twenty-two percent of the injuries occurred during wor k time. Main causes of choroidal ruptures were water jet (19%), fireworks (12% ), elastic cords (12%), metal pieces (12%), gotcha (8%) and champagne corks ( 8%). The risk for developing a choroidal rupture due to water jet or fireworks injuries was increased 9 or 4 times. Ninetytwo percent of choroidal ruptures wer e located at the posterior pole and concentric, 40%were submacular, 12%outside the large temporal vessels (4%were located both centrally and peripherally). I nitial visual acuity (VA) and VA at discharge were decreased significantly in ey es with rupture of the choroid (20/200 and 20/60) in contrast to eye swithout (2 0/40 and 20/25; P< 0.001). Choroidal ruptures were often associated with iridodi alysis, lens dislocation and contusion cataract (3 x), vitreous haemorrhage (4 x ), complete retinal defects (6 x), ciliary body clefts (7 x) or hyphema rebleedi ng (4 x). No association between the height of hyphema and choroidal ruptures wa s found. The predictive level of choroidal ruptures was 40%in eyes with a combi nation of lens dislocation, traumatic cataract and vitreous bleeding. The final VA was 20/200 or less in 11 eyes associated with a prevalence of 55%of ruptures submacularly. In contrast to this, eyes with VA >20/200 developed 26 %submacul ar choroidal ruptures. Conclusions: Additional severe traumatic changes of the a nterior and posterior II segment were found 2-7 times more frequently in eyes w ith choroidal ruptures compared to eyes without those ruptures. The visual impro vement was limited due to submacular ruptures. Frequent ophthalmological control s are recommended to III minimise the risk of choroidal neovascularisation in a submacular location.
