Search

ZusammenfassungDer demografische Wandel in Deutschland führt zu einer zunehmenden Zahl alter und pflegebedürftiger Personen, die stationär in Pflegeeinrichtungen betreut werden. Zusammen mit der Vergütungspraxis der Krankenkassen für Hausbesuche, auch von Fachärzten, sorgt dies für deutliche Defizite in der augenärztlichen Versorgung. Zur Entlastung des Systems wurde im Rahmen unserer Studie der ACTO-Sehtest getestet. Dieser kann nach einer kurzen Einführung auch von Laien durchgeführt werden. Für unsere Studie haben wir den Lesevisus von 218 Probanden in 4 Altenheimen in Deutschland beurteilt. Das Alter der Probanden lag bei mindestens 60 Jahren. Für die Studie wurden beide Augen einzeln untersucht, wobei eine eventuell vorhandene Lesebrille verwendet werden sollte. Das Pflegepersonal nutzte zur Bestimmung des Lesevisus den ACTO-Sehtest. Dieser stuft ab von 1 – 10, wobei 2 einem Dezimalvisus von 0,8 und 10 einem Dezimalvisus von 0,05 entspricht. Drei Wochen später ermittelte ein Augenarzt mithilfe der Birkhäuser-Lesetafeln ebenfalls den Lesevisus. Der Augenarzt erstellte eine allgemeine Anamnese und eine Anamnese der Augenerkrankungen, weiterhin erfolgte eine Untersuchung mittels Handspaltlampe und eine Funduskopie. Zwei Drittel der Heimbewohner gaben zu Beginn der Studie an, nicht unter Augenerkrankungen zu leiden. Die Untersuchung durch den Augenarzt zeigte jedoch, dass fast die Hälfte der Probanden dringend behandlungsbedürftig war. Der Vergleich der unterschiedlichen Sehtests zeigte, dass die Ergebnisse des ACTO-Lesetests mit den Werten der Birkhäuser-Lesetafel mit einem Korrelationskoeffizienten von r2 = 0,8443 korrelierten. Über den ACTO-Test wurde bei 40% der Probanden ein fehlender Lesevisus (> 7) ermittelt, über die Birkhäuser-Tafeln bei 35% (

The demographic change in Germany has led to an increasing number of elderly and dependent persons being cared for in nursing homes. Additionally, public health insurance has tried to save money on home visits made by general practitioners and specialists. This has led to significant deficits in ophthalmic care. To relieve the stress on the health care system, we tested the ACTO eye test as part of our study. This test can be performed after a short introduction; even by laypeople. For our study, we assessed the vision of 218 persons, aged 60 or above, in four nursing homes in Germany. Both eyes were examined individually, with reading glasses if required. The nursing staff applied the ACTO eye test for vision testing. The classification of the ACTO test ranges from 1 to 10, where 2 corresponds to a decimal visual acuity of 0.8 and 10 to a decimal visual acuity of 0.05. Three weeks later, an ophthalmologist visited the care homes and employed the Birkhäuser reading boards to determine the visual acuity. The ophthalmologist also did a general medical history and a history of ocular diseases. She also examined the eyes using a handheld slit lamp and did a fundoscopy in miosis. Two-thirds of the residents stated at the beginning of the study that they did not suffer from any eye disease. However, the ophthalmologist's examination showed that nearly half of the subjects needed urgent treatment. The comparison of the different eye tests showed that the results of the ACTO reading test correlated with the results from the Birkhäuser panels with a coefficient of rDer demografische Wandel in Deutschland führt zu einer zunehmenden Zahl alter und pflegebedürftiger Personen, die stationär in Pflegeeinrichtungen betreut werden. Zusammen mit der Vergütungspraxis der Krankenkassen für Hausbesuche, auch von Fachärzten, sorgt dies für deutliche Defizite in der augenärztlichen Versorgung. Zur Entlastung des Systems wurde im Rahmen unserer Studie der ACTO-Sehtest getestet. Dieser kann nach einer kurzen Einführung auch von Laien durchgeführt werden. Für unsere Studie haben wir den Lesevisus von 218 Probanden in 4 Altenheimen in Deutschland beurteilt. Das Alter der Probanden lag bei mindestens 60 Jahren. Für die Studie wurden beide Augen einzeln untersucht, wobei eine eventuell vorhandene Lesebrille verwendet werden sollte. Das Pflegepersonal nutzte zur Bestimmung des Lesevisus den ACTO-Sehtest. Dieser stuft ab von 1 – 10, wobei 2 einem Dezimalvisus von 0,8 und 10 einem Dezimalvisus von 0,05 entspricht. Drei Wochen später ermittelte ein Augenarzt mithilfe der Birkhäuser-Lesetafeln ebenfalls den Lesevisus. Der Augenarzt erstellte eine allgemeine Anamnese und eine Anamnese der Augenerkrankungen, weiterhin erfolgte eine Untersuchung mittels Handspaltlampe und eine Funduskopie. Zwei Drittel der Heimbewohner gaben zu Beginn der Studie an, nicht unter Augenerkrankungen zu leiden. Die Untersuchung durch den Augenarzt zeigte jedoch, dass fast die Hälfte der Probanden dringend behandlungsbedürftig war. Der Vergleich der unterschiedlichen Sehtests zeigte, dass die Ergebnisse des ACTO-Lesetests mit den Werten der Birkhäuser-Lesetafel mit einem Korrelationskoeffizienten von r

Background To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. Patients and methods Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. Results After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. Conclusion Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling

Introduction In some diseases of the cornea, histopathological or microbiological evaluation of a stromal sample is essential. On the other hand one of the main aims in therapy is to keep the cornea clear and without scars. Until now bioptic techniques were not suitable for both aims, getting a sample with minimal damage of the cornea. There was a lack of a method for corneal biopsy which is clinically easily applicable. Material We developed a new instrument for taking corneal biopsies. It is a microtrephine with 160 μm diameter rotating with 30 000 Rpm. It takes biopsies of corneal epithelium and stroma as solid cylinders. The biopsy is non traumatic, safe and repeatable. Biopsies were taken until now on 32 alkali burnt rabbit corneas, 8 enucleated human corneas and 5 patients. Results 157 biopsies were taken until now. In 75% a sample could be gained. The perforation rate was 0.63% in rabbits. No perforation occurred until now in human corneas. Preparations of light-, scanning- and transmission electron microscopy are presented in this paper for demonstrating examples of application. Microbiological preparations of corneal infiltrates were sterile up to now, representing sterile technique with this new instrument. Herpes simplex PCR was positive in one out of six stromal biopsies from one cornea in supposed herpes keratitis. Conclusion With the microtrephine samples of the corneal stroma can be taken with high precision. A wide variety of routine diagnostics including repeated measurements on stromal samples of a single cornea are possible now. Early bioptic diagnostics of corneal diseases can be achieved now.

BACKGROUND: Until now there were no statistical data on the incidence and the prevalence of eye burns. Therefore we studied all patients coming to our hospital from the area of Aachen with eye burns during the time from September 1990 until August 1991. PATIENTS AND METHODS: All patients underwent a standardized examination including special history of the burning agent, industrial medical aspects and the employers liability insurance association. The documentation of the anterior eye segment pathology was scored separately for each eye encoded by location and special items. This documentation was worked up by the aid of a database (Filemaker II). 171 patients with eye burns were documented during one year. 65 patients had both eyes burned resulting in 236 documented records. RESULTS: The 171 accidents can be divided in 104 (61%) industrial accidents and 64 (37%) housework accidents. 3 accidents were of unknown origin. Classification of burns was scored according to Reim 1991. 208 (88%) eyes showed score I burns, 27 (11.5%) score II and only one patient showed a score III eye burn. We saw 121 (70%) male patients, 39 (23%) female patients and 11 children (7%). The main age group ranged from 16-45 years. 28% (n = 30) of all accidents happened in machine factories, which have thereby in our study the highest incidence of industrial accidents. CONCLUSION: By means of a one-year statistic we found that over 60% of all eye burns were industrial accidents, 28 in machine factories and 20% in service industries. 37% houseworks accidents are very difficult to prevent because of a deficit of safety rules. Language: de

BACKGROUND: Persistent epithelial defects of the cornea are difficult to treat and can lead to severe complications such as melting processes. Therefore the application of a glued-on hard contact lens as an artificial epithelium has been recommended for many years, to protect the denuded corneal stroma. MATERIALS AND METHODS: This paper presents a 7-year retrospective study on the application of a hard contact lens as an artificial epithelium. 46 patients with 50 eyes were treated with this method from january 1985 to march 1992. The majority of the patients suffered from most severe burns of the whole anterior eye segment (group I: n = 29 eyes) or of the cornea alone (group II: n = 13 eyes). A smaller number of patients (group III: n = 8 eyes) presented corneal melting processes associated with other diseases. RESULTS: The patients of group II and III showed the best outcome concerning spontaneous epithelialization and prognosis for a penetrating keratoplasty. The treatment with a glued-on hard contact lens was limited by the high rate of complications (92%) in group I and II. In one third of the cases of group I these complications led to further surgical interventions (e.g. conjunctivoplasty of the globe). The results also show, that the application of a glued-on hard contact lens in patients with most severe eye burns is a long-term treatment (> one year). CONCLUSION: The poor prognosis of corneas with severe healing problems of the epithelium can be improved by the application of a glued-on hard contact lens as an artificial epithelium. In severe burns of the whole anterior eye segment however, the treatment with an early keratoplasty should be considered.

Following Crede's prophylaxis with silver-nitrate, the cornea of a newborn presented greyish-brown, lime-like plaques on the nasal part of the right eye. A paracentral ulcerating stromal opacification undermined these appositions, when the patient was admitted to the eye-clinic at Aachen. In the material taken in a lamellar keratectomy scanning electron microscopical examination was able to prove the existence of granules, previously described in light-microscopy. These granules measured 100 to 300 nm in diameter and were placed up to 110 microns deep into the corneal stroma of the specimen. An earlier chemical analysis of necrotic material showed no silver specific reaction. By means of EDX-Analysis these granules could be identified as silver-containing. This was once reassured by a newly developed modification of van-Kossa's-staining-method. The fact that the granular deposits contained mainly silver proves that the onset of a sodium-chloride-irrigation did not promote an intended therapeutic silver-chloride-precipitation and therefore had no effects on the silver-nitrate's penetration abilities. Injuries by silver-nitrate-solutions used for Crede's prophylaxis are seldom but still reported. The mechanism of injury in this case of a child, born by sectio remains unknown. Neither the use of an unusual silvernitrate solution, that was taken from a disposable ampoule (Mova-Nitrat) was reported, nor any corneal injury during sectio mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)

To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery.Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients.After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed.Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling