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Said S, Schwotzer R, Muth DR, Fasler K, Barthelmes D, Zweifel S, Blaser F. Monoclonal Gammopathy of Ocular Significance - A Case Report. Klin Monbl Augenheilkd 2024; 241:468-471. [PMID: 38653278 DOI: 10.1055/a-2211-9351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Sadiq Said
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Katrin Fasler
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
- Save Sight Institute, University of Sydney CAR, Glebe, Australia
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
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Wiest MRJ, Schuknecht A, Hamann T, Fasler K, Said S, Bajka A, Muth DR, Barthelmes D, Blaser F, Zweifel S. Evaluation of Increase in Retinal Thickness as Diagnostic Marker in Central Artery Occlusion. Klin Monbl Augenheilkd 2024; 241:441-444. [PMID: 38653296 DOI: 10.1055/a-2239-0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE To evaluate the increase in retinal thickness as a marker in predicting the onset of central retinal artery occlusions. METHODS Retrospective clinical study conducted at one Swiss hospital. Electronic records were filtered for patients with artery occlusions. Optical coherence tomography data, including time between the imaging and ischemic event, were reviewed. Increase in relative retinal thickness was measured, defined as an increase in retinal thickness compared to the unaffected partner eye. This was correlated with the time from symptom onset. A cutoff value of relative increase of < 24.5% was applied, as suggested in previous studies. The results were compared to the time gathered from the electronic records, and sensitivity, specificity, positive predictive value as well as negative predictive value were calculated for predicting an ischemia time of < 4.5 h. RESULTS Forty-two eyes from 41 patients with central artery occlusions were identified. Fourteen were female. Mean age was 66.4 ± 15.8 years. Initial corrected visual acuity was 2.41 ± 0.68 logMAR, and 2.13 ± 0.87 logMAR at the last follow-up (p > 0.05). Of eyes with a visual acuity of counting fingers (n = 38) or worse, 89.5% showed no improvement during follow-up, while eyes with logMAR 1 or better (n = 4) improved. Thirteen eyes (13 patients) presented within 4.5 h of the ischemic event. Four patients received i. v. thrombolysis, with visual recovery in one. In 12 eyes with an ischemia time of < 4.5 h, relative increase was below 24.5%. In the remaining 29 eyes with > 4.5 h, relative increase was below 24.5% in 4 eyes and above 24.5% in 25 eyes. This yielded a sensitivity of 92.3%, a specificity of 86.2%, with a positive predictive value of 75.0% and a negative predictive value of 96.2%. CONCLUSION Central retinal artery occlusion is associated with severe vision loss. There is no current established therapy. Parameters that objectify the presence of a therapeutic window for thrombolysis are gaining in importance as patient history is often imprecise. Relative retinal thickness increase proved a noninvasive imaging parameter demonstrating adequate performance in detecting patients within the therapeutic window of thrombolysis. Further investigation of this parameter in central retinal occlusion is warranted.
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Affiliation(s)
| | | | - Timothy Hamann
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Katrin Fasler
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Sadiq Said
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
- Division of Eye and Vision, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Sweden
| | - Daniel Barthelmes
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
- Save Sight Institute, The University of Sydney Save Sight Institute, Sydney, Australia
| | - Frank Blaser
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Sandrine Zweifel
- Department of Ophthalmology, UniversitätsSpital Zürich, Zürich, Switzerland
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Blaser F, Meneau I, Mihic-Probst D, Muth DR, Barthelmes D, Zweifel S, Said S, Bajka A. A Novel Technique of Aseptic Manufacture of Autologous Serum Eye Drops (ASEDs) and Sterility Analysis of the Bottled Ophtioles. Klin Monbl Augenheilkd 2024; 241:392-397. [PMID: 38653293 DOI: 10.1055/a-2249-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE To introduce a novel technique of the aseptic manufacture of autologous serum eye drops (ASEDs) with a prefiltered closed system and to analyze the sterility of the produced ophtioles between 2018 and 2022. METHODS This is a prospective single-center study conducted at the Department of Ophthalmology at a Swiss University Hospital between 2018 and 2022. For regulatory reasons, closed systems for manufacturing ASEDs are strongly recommended. We attached an upstream sterile filter (Sterivex PES0.22 µm Burlington, USA) to a commercially available closed system (COL System Modena, Italy) for manufacturing ASEDs. The goal of this novel approach was to reduce the microbiological contamination of the donated autologous blood. Using the presented manufacturing method, we are able to produce, on average, 56 ophtioles per batch, containing either 1.45 mL or 2.5 mL of autologous serum per ophtiole. For each batch of ASEDs, we performed a microbiological analysis by automated blood culture testing (BACTEC). This system examines the presence of bacteria and fungi. RESULTS We analyzed all manufactured batches between 2018 and 2022. None of the 2297 batches and the resulting 129 060 ophtioles showed bacterial or mycotic contamination. During the analyzed period, two batches were discarded: one due to fibrin-lipid aggregations, further microbiological and histological work-up excluded any contamination; another due to false-positive HIV in serological testing. Overall, the contamination rate was 0%, and the batch discharge rate was 0.09%. CONCLUSIONS The combination of upstream sterile filtration with a commercial closed system for manufacturing ASEDs proved to be effective in ensuring sterility without any contamination over the past 4 years. This is becoming crucial, as the demand for autologous blood products for treating ocular surface disorders, such as refractory dry eyes or nonhealing defects of the corneal epithelium, is on the rise.
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Affiliation(s)
- Frank Blaser
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
| | - Isabelle Meneau
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, UniversitätsSpital Zürich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
- Department of Clinical Neuro Science, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Barthelmes
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
- Save Sight Institute, University of Sydney CAR, Glebe, Australia
| | - Sandrine Zweifel
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
| | - Sadiq Said
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, UniversitätsSpital Zürich, Switzerland
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Said S, Blaser F, Link B, Gunzinger JM, Hanson J, Fasler K, Muth DR, Barthelmes D, Zweifel S. Hunter Syndrome and Bull's Eye Maculopathy. Klin Monbl Augenheilkd 2024; 241:463-467. [PMID: 38653277 DOI: 10.1055/a-2243-4636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, Switzerland
| | - Bianca Link
- Division of Metabolism, Connective Tissue Unit, University Children's Hospital Zurich, Switzerland
| | - Jeanne Martine Gunzinger
- Department of Ophthalmology, University Hospital Zurich, Switzerland
- Department of Ophthalmology, Hunter New England Health, New Lambton, Australia
| | - James Hanson
- Department of Ophthalmology, University Hospital Zurich, Switzerland
| | - Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, Switzerland
- Department of Clinical Neuro Science, Karolinska Institute, Stockholm, Sweden
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Switzerland
- Save Sight Institute, University of Sydney CAR, Glebe, Australia
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, Switzerland
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Schuknecht A, Wiest MRJ, Said S, Bajka A, Hamann T, Muth DR, Fasler K, Blaser F, Barthelmes D, Zweifel S. Ophthalmological Outcomes in Patients with Susac Syndrome. Klin Monbl Augenheilkd 2024; 241:477-481. [PMID: 38653298 DOI: 10.1055/a-2243-4913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND To report ophthalmological outcomes and treatment regimen in patients with Susac syndrome. METHODS This is a retrospective analysis of patients with Susac syndrome treated between November 2015 and March 2023. Multimodal imaging findings, ophthalmic examination data, information on neurological and sensorineural involvement, and therapeutic regimen were reviewed. Visual acuity was recorded as the logarithm of the minimum angle of resolution (logMAR). Ophthalmological manifestations and disease severity were assessed using the previously described clinical activity score (CAS). RESULTS Ten patients with Susac syndrome m : f = 5 : 5 were identified. The mean follow-up time was 31.2 ± 23.3 months (range 1 to 78 months). The mean age was 41.4 ± 13.8 years (range 21 to 59 years). At baseline, corrected distance visual acuity (CDVA) was 0.03 ± 0.08 logMAR. At the last follow-up, CDVA improved to 0.00 ± 0.03 logMAR (p = 0.029). Three of 20 eyes showed an improvement of 5 letters, while no loss of visual acuity was recorded during the follow-up time. Baseline CAS was 10.65 ± 12.69, and CAS at the last follow-up was 5.15 ± 5.49 (p = 0.068). Except for one patient, all were initially treated with intravenous (i. v.) steroids and subsequent oral tapering. Depending on the treatment response, cyclophosphamide (n = 4), i. v. immunoglobulins (IVIGs) (n = 4), anti-CD20 antibodies (n = 3), or plasmapheresis (n = 1) were applied. All patients under treatment for more than 1 month (n = 9) showed improvement in CAS and CDVA. CONCLUSION Susac syndrome is a rare autoimmune vascular endotheliopathy. Treatment of Susac syndrome appears to result in improving CAS and CDVA. The majority of patients, in addition to the systemic steroids, required systemic immunosuppressive agents. Interdisciplinary communication is crucial to reduce the time to diagnosis and initiation of therapy in patients with Susac syndrome.
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Affiliation(s)
| | | | - Sadiq Said
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | | | - Katrin Fasler
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
- Ophthalmology, The University of Sydney Save Sight Institute, Sydney, Australia
| | - Sandrine Zweifel
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
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Schütz S, Bajka A, Muth DR, Wiest MRJ, Meneau I, Blaser F, Toro MD, Rejdak M, Barthelmes D, Zweifel S. Imaging Assessment of Peripapillary Vessel Diameters in Postmortem Eyes. Klin Monbl Augenheilkd 2024; 241:562-570. [PMID: 38653313 DOI: 10.1055/a-2264-5559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Proof of concept of ex vivo retinal vessel diameter measurements in human postmortem eyes. METHODS En face near-infrared (IR) images and optical coherence tomography (OCT) of the optic nerve head (ONH) were captured ex vivo with a Heidelberg Engineering Spectralis (Spectralis, version 7.0.4, Image Capture Module, version 1.2.4, Heidelberg Heidelberg, Germany) device, using a custom-made eye chamber holding and positioning the eyes during the image process. Thirty-two formaldehyde-fixated eyes of 16 patients were imaged. In the IR images, two independent graders measured retinal vessel diameters at the intersection of a drawn circle centered on the ONH with diameters of 2.0 mm and 3.4 mm, respectively. The anatomically corresponding measurements between both graders were statistically analyzed using a Wilcoxon signed-rank test. RESULTS A total of 246 matched measurements of both graders were analyzed across all 32 imaged eyes. Statistically significant differences between the graders were found for arterioles at 2 mm from the ONH. The other measurements did not show statistically significant intergrader differences. The mean values for arteriole diameters were 72.2 µm at 2.0 mm and 61.5 µm at 3.4 mm for grader 1, and 66.4 µm at 2.0 mm and 63.2 µm at 3.4 mm for grader 2. The mean diameter for venules were 75.5 µm at 2.0 mm and 79.3 µm at 3.4 mm for grader 1, and 67.4 µm at 2 mm and 79.1 µm at 3.4 mm for grader 2. CONCLUSION To the best of our knowledge, this is the first study to present IR image-based retinal vessel diameters in ex vivo postmortem eyes. Retinal IR/OCT imaging is possible, and measurements are reproducible in formaldehyde-fixated human eyes. Fixation artefacts result in lower image quality, and this can impose challenges in correctly detecting, classifying, and measuring retinal vessels.
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Affiliation(s)
- Simona Schütz
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Isabelle Meneau
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
| | - Mario Damiano Toro
- Eye Clinic, Department of Public Health, University of Naples Federico II, Napoli, Italy
- Chair and Department of General and Paediatric Ophthalmology, Medical University of Lublin, Poland
| | - Magdalena Rejdak
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital of Zurich, Switzerland
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Blaser F, Muth DR, Kueper K, Zweifel S, Rejdak MB. Customised Corneal Endotamponade - A Sutureless Technique to Treat Sterile Perforating Corneal Ulcers. Klin Monbl Augenheilkd 2024; 241:409-411. [PMID: 38653270 DOI: 10.1055/a-2233-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Frank Blaser
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
- Department of Clinical Neuro Science, Karolinska Institute, Stockholm, Sweden
| | - Karin Kueper
- Department of Clinical Neuro Science, Karolinska Institute, Stockholm, Sweden
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
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Fasler K, Turgut F, Gunzinger JM, Sommer C, Muth DR, Kinzl S, Nilius H, Zweifel S, Somfai GM. Efficacy of Subthreshold Micropulse Laser for Central Serous Chorioretinopathy. Klin Monbl Augenheilkd 2024; 241:489-495. [PMID: 38653299 DOI: 10.1055/a-2229-2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE To evaluate the efficacy of a subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR). METHODS Retrospective clinical study conducted at the Departments of Ophthalmology at a university and a municipal hospital in Zurich, Switzerland. We enrolled acute and chronic CSCR patients with persistent subretinal fluid (SRF) treated with SML. Two treatment protocols (fluorescein/indocyanine green angiography or optical coherence tomography guided) were evaluated for efficacy after 3 and 6 months. The primary outcomes of the study were reduction and percentage of eyes with complete resolution of SRF 3 and 6 months after SML treatment. Secondary endpoints included changes in central subfield thickness (CST) and visual acuity (VA) after 3 and 6 months. RESULTS The study involved 37 eyes (35 patients, 48.6% chronic). A statistically significant reduction in SRF height and CST could be shown, irrespective of SRF duration, type of CSCR, or chosen guidance after 3 and 6 months: SRF - 40 µm (p < 0.01), CST - 52 µm (p < 0.01). Percentage of eyes with complete resolution of fluid at 3 and 6 months after SML were 24.3 and 21.6%, respectively. No statistically significant functional improvement (VA) could be shown. Multivariable regression and linear mixed regression analyses did not identify statistically significant differences in SRF reduction, CMT change, or VA improvement with respect to the type of CSCR or the treatment plan used (p > 0.05). CONCLUSION The effectiveness of SML in CSCR is under continuous debate. Our study findings demonstrate structural but only little functional changes with SML. In view of the shortage of verteporfin for photodynamic therapy, SML remains an important therapeutic option for CSCR patients.
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Affiliation(s)
- Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Ferhat Turgut
- Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
- Ophthalmology, Gutblick Research, Pfäffikon, Switzerland
- Spross Research Institute, Zürich, Switzerland
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Jeanne Martine Gunzinger
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
- Hunter New England Health, New South Wales, Australia
| | - Chiara Sommer
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
- Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
- Spross Research Institute, Zürich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Kinzl
- Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
- Spross Research Institute, Zürich, Switzerland
| | - Henning Nilius
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Gabor Mark Somfai
- Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
- Spross Research Institute, Zürich, Switzerland
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Wiest MRJ, Gunzinger JM, Hamann T, Fasler K, Said S, Bajka A, Muth DR, Barthelmes D, Blaser F, Zweifel SA. Natural Course of Solar and Laser-Associated Retinal and Macular Injuries at a Primary Care Hospital in Switzerland. Klin Monbl Augenheilkd 2023; 240:516-521. [PMID: 37164408 DOI: 10.1055/a-2021-7724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Solar and laser-associated retinopathies are rare occurrences. The two retinopathies are both photo-induced but differ in the involved intensity and duration of exposure. The purpose of this study was to evaluate the clinical features and natural course of these two entities, with a focus on the changes in the outer retina over time. PATIENTS AND METHODS This retrospective analysis assessed patients with solar or laser maculopathy seen at the Department of Ophthalmology of the University Hospital Zurich in Switzerland over the last 10 years. Visual acuity (VA; Snellen) and optical coherence tomography (OCT) findings were reviewed and analyzed at baseline and last follow-up visit. Areas of damaged outer retina, identified on en face OCT images as hyporeflective areas, were tagged and compared between visits. Descriptive analysis was performed by calculating mean values ± standard deviation (SD). Statistical evaluation was done using the Wilcoxon signed rank test. A p value < 0.05 was considered statistically significant. RESULTS Five patients with solar retinopathy and six patients with laser-associated retinopathy were identified. In the solar retinopathy group, mean VA at baseline was 0.80 (SD ± 0.37) and improved to 0.90 (SD ± 0.36). This was not statistically significant (p = 0.066). In the laser-associated retinopathy group, mean VA at baseline was 0.89 (SD ± 0.18) and improved to 1.03 (SD ± 0.09), which was not statistically significant either (p = 0.063). At baseline, in OCT cross-sections, initial changes were observed in the interdigitation, myoid, and ellipsoid zone, as well as the outer nuclear layer and the Henle fiber layer. At follow-up, most cases presented an alteration in the residual ellipsoid zone, with the degree of the aforementioned alterations depending on the size of the initial defect. A decrease of the hyporeflective alterations measured in en face OCT scans was observed in both groups but was only statistically significant in the laser-associated retinopathy group (p = 0.018 versus p = 0.172). CONCLUSIONS OCT can help to detect and monitor solar and laser-associated retinal injuries. Most injuries are minor, with good functional restitution. Minor changes in the ellipsoid zone often persist, even in cases with full visual recovery.
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Affiliation(s)
| | | | - Timothy Hamann
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Katrin Fasler
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Sadiq Said
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Anahita Bajka
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | | | | | - Frank Blaser
- Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
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Blaser F, Zweifel S, Wiest MRJ, Bajka A, Said S, Barthelmes D, Muth DR. Severe Complications after Corneal Collagen Cross-Linking (CXL). Klin Monbl Augenheilkd 2023; 240:369-378. [PMID: 37164391 PMCID: PMC10129411 DOI: 10.1055/a-2040-4290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/22/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients. METHODS Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland. RESULTS We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to Streptococcus pneumoniae and the other due to Staphylococcus hominis, Micrococcus luteus, and Streptococcus epidermidis. The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved ad integrum, the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant. CONCLUSION Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction.
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Affiliation(s)
- Frank Blaser
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandrine Zweifel
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Anahita Bajka
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sadiq Said
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Rudolf Muth
- Ophthalmology and Eye Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Said S, Muth DR, Barthelmes D, Hamann T, Bajka A, Wiest MRJ, Zweifel S, Blaser F. Microsporidial Stromal Keratitis: A Rare Entity in Central Europe. Klin Monbl Augenheilkd 2023; 240:387-390. [PMID: 37164415 DOI: 10.1055/a-2013-2600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
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Said S, Muth DR, Barthelmes D, Hamann T, Bajka A, Wiest MRJ, Blaser F. No Pain, No Gain - Topical Anesthesia-Induced Keratopathy. Klin Monbl Augenheilkd 2023; 240:456-458. [PMID: 37164421 DOI: 10.1055/a-2013-2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
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Bajka A, Muth DR, Wiest MRJ, Said S, Rejdak M, Sidhu S, Foa N, Blaser F, Barthelmes D, Toro MD, Souied EH, Deuel JW, Schlagenhauf P, Zweifel SA. Analysis of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) Parameters in Young Adults after SARS-CoV-2 Infection (COVID-19) Compared with Healthy Young Controls. Diagnostics (Basel) 2023; 13:diagnostics13071283. [PMID: 37046498 PMCID: PMC10093659 DOI: 10.3390/diagnostics13071283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose: To compare retinal changes in young adults with previous SARS-CoV-2 infection with healthy young controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: This prospective single-center study was conducted at the University Hospital of Zurich, Zurich, Switzerland. Participants were imaged from May to November 2021 using the SOLIX device (Visionix International SAS, Pont-de-l’Arche, France). We performed 12 mm × 12 mm, 6.4 mm × 6.4 mm, 6 mm × 6 mm and 3 mm × 3 mm OCT and OCTA scans, as well as fundus photography of each participant’s eyes. Results: In total, 466 participants were imaged. Of these, 233 were healthy controls with negative RT-PCR tests for SARS-CoV-2, 168 were young adults who had a SARS-CoV-2 infection at least 180 days previously, 19 were participants who had a SARS-CoV-2 infection < 180 days previously, and 46 were participants with asymptomatic SARS-CoV-2 infection (i.e., serologically positive but with no symptoms). Compared with healthy controls, statistically significant differences were found for OCTA recordings of the optic disc for the whole image (WI) and WI capillary vessel density, with both being higher in the SARS-CoV-2 group. Conclusion: Statistically significant results were only observed for selected variables, and in parts, only unilaterally, with relatively large p values (p = 0.02–0.03). Thus, we did not interpret these as clinically significant, leading to the conclusion that young and otherwise healthy individuals (mainly men) seem to recover from mild COVID-19 infections with no ophthalmological residues.
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Affiliation(s)
- Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | | | - Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Magdalena Rejdak
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sophia Sidhu
- Faculty of Medicine, University of California, San Diego, CA 92093, USA
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80138 Naples, Italy
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris Est Creteil, 94000 Creteil, France
| | - Jeremy Werner Deuel
- Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- Division of Medical Oncology and Haematology, University Hospital of Zurich, 8006 Zurich, Switzerland
| | - Patricia Schlagenhauf
- Department of Global and Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- MilMedBiol—Centre of Competence for Military Medicine Biology, University of Zurich, 8006 Zurich, Switzerland
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-255-87-94
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Muth DR, Blaser F, Foa N, Scherm P, Mayer WJ, Barthelmes D, Zweifel SA. Smartphone Slit Lamp Imaging-Usability and Quality Assessment. Diagnostics (Basel) 2023; 13:diagnostics13030423. [PMID: 36766528 PMCID: PMC9913954 DOI: 10.3390/diagnostics13030423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To assess the usability and image quality of a smartphone adapter for direct slit lamp imaging. METHODS A single-center, prospective, clinical study conducted in the Department of Ophthalmology at the University Hospital Zurich, Switzerland. The smartphone group consisted of 26 medical staff (consultants, residents, and students). The control group consisted of one ophthalmic photographer. Both groups took images of the anterior and the posterior eye segment of the same proband. The control group used professional photography equipment. The participant group used an Apple iPhone 11 mounted on a slit lamp via a removable SlitREC smartphone adapter (Custom Surgical GmbH, Munich, Germany). The image quality was graded independently by two blinded ophthalmologists on a scale from 0 (low) to 10 (high quality). Images with a score ≥ 7.0/10 were considered as good as the reference images. The acquisition time was measured. A questionnaire on usability and experience in smartphone and slit lamp use was taken by all of the participants. RESULTS Each participant had three attempts at the same task. The overall smartphone quality was 7.2/10 for the anterior and 6.4/10 for the posterior segment. The subjectively perceived difficulty decreased significantly over the course of three attempts (Kendall's W). Image quality increased as well but did not improve significantly from take 1 to take 3. However, the image quality of the posterior segment was significantly, positively correlated (Spearman's Rho) with work experience. The mean acquisition time for anterior segment imaging was faster in the smartphone group compared to the control group (156 vs. 206 s). It was vice versa for the posterior segment (180 vs. 151 s). CONCLUSION Slit lamp imaging with the presented smartphone adapter provides high-quality imaging of the anterior segment. Posterior segment imaging remains challenging in terms of image quality. The adapter constitutes a cost-effective, portable, easy-to-use solution for recording ophthalmic photos and videos. It can facilitate clinical documentation and communication among colleagues and with the patient especially outside normal consultation hours. Direct slit lamp imaging allows for time to be saved and increases the independence of ophthalmologists in terms of patient mobility and the availability of photographic staff.
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Affiliation(s)
- Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-255-87-94; Fax: +41-44-255-44-72
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Pauline Scherm
- Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Wolfgang Johann Mayer
- Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
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Muth DR, Toro MD, Bajka A, Jonak K, Rieder R, Kohler MM, Gunzinger JM, Souied EH, Engelbert M, Freund KB, Zweifel SA. Correlation between Macular Neovascularization (MNV) Type and Druse Type in Neovascular Age-Related Macular Degeneration (AMD) Based on the CONAN Classification. Biomedicines 2022; 10:biomedicines10102370. [PMID: 36289632 PMCID: PMC9598373 DOI: 10.3390/biomedicines10102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
To investigate associations and predictive factors between macular neovascularization (MNV) lesion variants and drusen types in patients with treatment-naïve neovascular age-related macular degeneration (AMD). Methods: Multimodal imaging was retrospectively reviewed for druse type (soft drusen, subretinal drusenoid deposits (SDDs) or mixed) and MNV type (MNV 1, MNV 2, MNV 1/2 or MNV 3). The Consensus on Neovascular AMD Nomenclature (CONAN) classification was used for characterizing MNV at baseline. Results: One eye of each eligible patient was included (n = 191). Patients with predominant SDDs had an increased adjusted odds ratio (aOR) for MNV 2 (23.4453, p = 0.0025) and any type of MNV 3 (8.7374, p < 0.0001). Patients with MNV 1/2 had an aOR for predominant SDDs (0.3284, p = 0.0084). Patients with MNV1 showed an aOR for SDDs (0.0357, p < 0.0001). Eyes with SDDs only without other drusen types showed an aOR for MNV 2 (9.2945, p < 0.0001). Conclusions: SDDs represent a common phenotypic characteristic in AMD eyes with treatment-naïve MNV. The aOR for eyes with predominant SDDs to develop MNV 2 and MNV 3 was much higher, possibly due to their location in the subretinal space. The predominant druse type may help to predict which type of MNV will develop during the course of AMD.
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Affiliation(s)
- Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
- University of Zurich (UZH), 8006 Zurich, Switzerland
- Correspondence: (D.R.M.); (S.A.Z.); Tel.: +41-44-255-87-94 (D.R.M. & S.A.Z.); Fax: +41-44-255-44-72 (D.R.M. & S.A.Z.)
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80138 Naples, Italy
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Kamil Jonak
- Department of Biomedical Engineering, Lublin University of Technology, 20-618 Lublin, Poland
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-093 Lublin, Poland
| | - Roman Rieder
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Myrtha Magdalena Kohler
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Jeanne Martine Gunzinger
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris Est Creteil, 94000 Creteil, France
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
- Correspondence: (D.R.M.); (S.A.Z.); Tel.: +41-44-255-87-94 (D.R.M. & S.A.Z.); Fax: +41-44-255-44-72 (D.R.M. & S.A.Z.)
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Muth DR, Wolf A, Kreutzer T, Shajari M, Vounotrypidis E, Priglinger S, Mayer WJ. Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview. Klin Monbl Augenheilkd 2021; 238:868-874. [PMID: 33853190 DOI: 10.1055/a-1333-3199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique. MATERIAL AND METHODS Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z). RESULTS Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up. CONCLUSION The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.
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Affiliation(s)
- Daniel Rudolf Muth
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Armin Wolf
- Augenklinik des Universitätsklinikums Ulm, Deutschland
| | - Thomas Kreutzer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Mehdi Shajari
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | | | - Siegfried Priglinger
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
| | - Wolfgang J Mayer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Deutschland
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Mackert M, Muth DR, Vounotrypidis E, Deger C, Goldblum D, Shajari M, Hasler PW, Priglinger S, Wolf A. Analysis of opacification patterns in intraocular lenses (IOL). BMJ Open Ophthalmol 2021; 6:e000589. [PMID: 33634210 PMCID: PMC7880112 DOI: 10.1136/bmjophth-2020-000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022] Open
Abstract
Objective Intraocular lens (IOL) opacification may cause severe visual impairment. The pathogenesis remains unclear. The aim of this study was to analyse opacification patterns in different IOLs. Therefore, this multicentre, retrospective, observational study was conducted at Ludwig-Maximilians-University, Munich, Germany and University-Hospital Basel, Switzerland. Methods and analysis In this study, 75 opacified IOLs were identified and classified after extraction. Macroscopical photo documentation, light and electron microscopic analysis were done. Results 68 acrylic-hydrophilic single-piece-IOLs, 1 acrylic-hydrophilic 3-piece-IOL, 6 acrylic-hydrophobic 3-piece-IOLs were extracted. The dataset comprised IOLs known for opacification and IOLs not having been reported yet. 67 IOLs showed a fine-granular and 8 IOLs a crust-like opacification pattern. According to literature, 62 of the fine-granular opacified IOLs were graded into type 1 (processing/packaging-induced primary opacification) and 13 into type 2 (secondary opacification of unknown aetiology). The anterior surface of the IOLs was affected in all 75 IOLs, the posterior surface only in 23 cases. Of all 67 fine-granular IOLs, 43 had a central defect and 21 had a zone without opacification (clear islet). Conclusion In our series, the morphology of IOL opacification did not follow the existing pathogenetic classification that strictly discriminates between primary and secondary causes. Fine-granular IOL opacification occurs with similar patterns in both type 1 and type 2 IOL opacification, while a crust-like pattern was only detected in type 2 IOL opacifications. Consequently, susceptibility of an IOL to opacification is caused by a multifactorial combination of material and processing properties as well as individual (pathological) conditions of the patient.
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Affiliation(s)
- Marc Mackert
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Daniel Rudolf Muth
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | | | - Constanze Deger
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - David Goldblum
- Department of Ophthalmology, University Hospital Basel, Universitatsspital Basel Augenklinik, Basel, Switzerland
| | - Mehdi Shajari
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Pascal Willy Hasler
- Department of Ophthalmology, University Hospital Basel, Universitatsspital Basel Augenklinik, Basel, Switzerland
| | - Siegfried Priglinger
- Department of Ophthalmology, University of Munich, Ludwig-Maximilians-Universitat Munchen Medizinische Fakultat, Munchen, Bayern, Germany
| | - Armin Wolf
- Ophthalmology, Universitätsklinikum Ulm, Ulm, Baden-Württemberg, Germany
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