1
|
Werkl P, Rademacher J, Pleyer U. HLA-B27-positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management, and treatment. Ophthalmologie 2024; 121:12-22. [PMID: 38085287 DOI: 10.1007/s00347-023-01960-z] [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] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/03/2024]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
Collapse
Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz-LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, 13355, Berlin, Germany.
| |
Collapse
|
2
|
Werkl P, Sommer M, Singer C, Tomasic H, Seidel G, Woltsche N. [Central retinal vein thrombosis in a 21-year-old man-What is the cause?]. Ophthalmologie 2023; 120:838-840. [PMID: 35947155 PMCID: PMC9364846 DOI: 10.1007/s00347-022-01703-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022]
Affiliation(s)
- P Werkl
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich.
| | - M Sommer
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - C Singer
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - H Tomasic
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - G Seidel
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - N Woltsche
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| |
Collapse
|
3
|
Werkl P, Rademacher J, Pleyer U. [HLA-B27 positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management and treatment]. Ophthalmologie 2023; 120:108-122. [PMID: 36633629 DOI: 10.1007/s00347-022-01793-2] [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] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
Collapse
Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz - LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Deutschland.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Uwe Pleyer
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, Berlin, Deutschland.
| |
Collapse
|
4
|
Werkl P, Woltsche N, Mueller A, Guschlbauer L, Horwath-Winter J, Steinwender G, Maertz J. [Acute keratoconjunctivitis in a breeder of highly poisonous exotic corals]. Ophthalmologie 2022; 119:1071-1073. [PMID: 35089413 DOI: 10.1007/s00347-022-01576-9] [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] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 01/26/2023]
Affiliation(s)
- P Werkl
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich. .,Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland.
| | - N Woltsche
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - A Mueller
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - L Guschlbauer
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - J Horwath-Winter
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - G Steinwender
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - J Maertz
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| |
Collapse
|
5
|
Werkl P, Woltsche N, Silbernagel B, Schließleder G, List W, Steinwender G, Boldin I, Horwath-Winter J. [New treatments present new challenges : Ocular side effects of belantamab mafodotin]. Ophthalmologie 2022; 119:730-732. [PMID: 33978807 DOI: 10.1007/s00347-021-01408-2] [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] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik, Medizinische Universität Graz, Graz, Österreich.
| | - Nora Woltsche
- Universitätsaugenklinik, Medizinische Universität Graz, Graz, Österreich
| | - Barbara Silbernagel
- Univ.-Klinik für Innere Medizin, Klinische Abteilung für Hämatologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Wolfgang List
- Universitätsaugenklinik, Medizinische Universität Graz, Graz, Österreich
| | - Gernot Steinwender
- Universitätsaugenklinik, Medizinische Universität Graz, Graz, Österreich
| | - Ingrid Boldin
- Universitätsaugenklinik, Medizinische Universität Graz, Graz, Österreich
| | | |
Collapse
|
6
|
Heidinger A, Falb T, Werkl P, List W, Hoeflechner L, Riedl R, Ivastinovic D, Hommer A, Lindner E. The Impact of Tape Sealing Face Masks on Visual Field Scores in the Era of COVID-19: A Randomized Cross-over Study. J Glaucoma 2021; 30:878-881. [PMID: 34387258 PMCID: PMC8483650 DOI: 10.1097/ijg.0000000000001922] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
PRECIS Tape sealing of the face mask can prevent fogging artifacts of visual field testing. Here, we demonstrate that tape sealing can improve visual field scores even when fogging artifacts are not obvious. PURPOSE The purpose of this study was to demonstrate that visual field scores improve when the face masks are taped to prevent fogging artifacts. METHODS A Single-center, randomized 2×2 cross-over study. Twenty-six visual fields of 13 patients of the glaucoma outpatient clinic were included. Patients were randomized in either sequence 1 (Octopus visual field examination without tape sealing, followed by examination with tape sealing) or sequence 2 (examination with, followed by without tape sealing). RESULTS The results for mean defect and square root of loss variance differ significantly in the examination with and without tape sealing [mean difference (without-with) 0.39 dB, 95% confidence interval: 0.07-0.70 dB, P=0.018 and 0.49 dB, 95% confidence interval: 0.19-0.79 dB, P=0.003, respectively]. There was no sequence effect (P=0.967) for mean defect nor the square root of loss variance (P=0.779). A significant effect for period (P=0.023) for mean defect was yielded. CONCLUSION Tape sealing of face masks during visual field testing prevented fogging artifacts and improved visual field scores even when fogging artifacts were not obvious and should be considered in clinical practice.
Collapse
Affiliation(s)
| | | | | | | | | | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz
| | | | - Anton Hommer
- Department of Ophthalmology, Sanatorium Hera, Vienna, Austria
| | | |
Collapse
|
7
|
Werkl P, Hoeflechner L, List W, Lindner E. The impact of social distancing on conjunctivitis cases-a retrospective single-center observation report. Graefes Arch Clin Exp Ophthalmol 2021; 260:689-691. [PMID: 34453608 PMCID: PMC8401350 DOI: 10.1007/s00417-021-05392-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 10/24/2022] Open
Affiliation(s)
- Peter Werkl
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Lukas Hoeflechner
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Wolfgang List
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Ewald Lindner
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
| |
Collapse
|
8
|
Gasteiger S, Primavesi F, Werkl P, Dostal L, Gehwolf P, Braunwarth E, Maglione M, Sopper S, Öfner D, Stättner S. The prognostic value of Presepsin for postoperative complications following pancreatic resection: A prospective study. PLoS One 2020; 15:e0243510. [PMID: 33296435 PMCID: PMC7725319 DOI: 10.1371/journal.pone.0243510] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Presepsin is involved in binding lipopolysaccharides and previous studies have confirmed its value as a marker for early diagnosis and prediction of severity in sepsis. Comparable studies assessing the predictive potential regarding postoperative complications and mortality following pancreatic resection are lacking. Methods This prospective study included 70 patients undergoing pancreatic resection from December 2017 until May 2019. Presepsin was measured preoperatively, on postoperative day 1, 3 and 8 (POD1/3/8) and correlated with the clinical course and mortality. Results Severe complications (Clavien-Dindo ≥3a) occurred in 28 patients (40%), postoperative pancreatic fistula (POPF) grade B/C occurred in 20 patients (28.6%), infectious complications in 28 (40%), and four patients (5.7%) died during hospital stay. Presepsin levels at any timepoint did not correlate with further development of postoperative complications or in-hospital mortality whereas CRP levels on postoperative day (POD) 3 were significantly associated with clinically relevant POPF (AUC 0.664, 95%CI 0.528–0.800; p = 0.033). Preoperative Presepsin levels as well as Presepsin on POD1 were significantly elevated in patients with malignant compared to benign underlying disease (299pg/ml vs. 174pg/ml and 693.5pg/ml vs. 294pg/ml; p = 0.009 and 0.013, respectively). Conclusion In our cohort, Presepsin was not eligible to predict the postoperative course following pancreatic resection. However, Presepsin levels were significantly elevated in patients with malignant disease, this finding warrants further investigation.
Collapse
Affiliation(s)
- Silvia Gasteiger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Peter Werkl
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Lucie Dostal
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Gehwolf
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sieghart Sopper
- Department of Haematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria
- * E-mail:
| |
Collapse
|
9
|
Woltsche N, Werkl P, Posch-Pertl L, Ardjomand N, Frings A. Astigmatismus. Spektrum Augenheilkd 2019. [DOI: 10.1007/s00717-019-00440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Der Astigmatismus ist der weltweit häufigste Refraktionsfehler vor Hypermetropie und Myopie. Man unterscheidet den äußeren vom inneren Astigmatismus. Der äußere Astigmatismus kann weiter in „mit der Regel“, „gegen die Regel“ und „schräg“ unterteilt werden. Die Summierung des äußeren und inneren Astigmatismus ergibt den refraktiven Zylinder. Astigmatismus wurde lange als zweidimensionales Phänomen gesehen, doch erst die dreidimensionale Betrachtung hat den Blick auf bestehende Analyseverfahren (Topo- und Tomographie) erweitert. Die Vektoranalyse nach Alpins ist hierbei eine bekannte Methode zur Therapieplanung. Zur Therapie des Astigmatismus stehen konservative Optionen wie Brille oder torische Kontaktlinse sowie unterschiedlichste chirurgische Verfahren wie photorefraktive Keratektomie, Femtosekundenlaser-assistierte Keratotomie, Laser-in-situ-Keratomileusis, „small-incision lenticule extraction“ und die Implantation torischer Intraokularlinsen zur Verfügung.
Collapse
|
10
|
Abstract
Astigmatism is the most frequent refractive error worldwide followed by hyperopia and myopia. Internal astigmatism has to be differentiated from external astigmatism. Furthermore, external astigmatism can be divided into "with the rule", "against the rule" and "oblique". The summation of internal and external astigmatism results in the refractive cylinder. Astigmatism has for a long time been regarded as a two-dimensional phenomenon; however, only a three-dimensional consideration expanded the view on existing analytical methods (topography and tomography). Alpins' vector analysis is a commonly used method for treatment planning. Multiple options exist for treatment of astigmatism with conservative approaches, such as eyeglasses or toric contact lenses as well as various surgical procedures, such as photorefractive keratectomy, femtosecond laser-assisted keratotomy, laser in-situ keratomileusis, small incision lenticule extraction and toric intraocular lens implantation.
Collapse
Affiliation(s)
- N Woltsche
- Univ.-Augenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich.
| | - P Werkl
- Univ.-Augenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - L Posch-Pertl
- Univ.-Augenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - N Ardjomand
- Sehzentrum für Augenlaser & Augenchirurgie, Leechgasse 58, 8010, Graz, Österreich
| | - A Frings
- Univ.-Augenklinik Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.,UCL Institute of Ophthalmology, 11-43 Bath St, EC1V 9EL, London, Großbritannien.,Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, EC1V 2PD, London, Großbritannien
| |
Collapse
|