A Viestenz

Universität des Saarlandes, Homburg, Saarland, Germany

Are you A Viestenz?

Claim your profile

Publications (137)117.25 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital glaucoma is a disease potentially leading to blindness in children. It poses a diagnostic and therapeutic challenge even though new knowledge has been acquired and a sufficient understanding of the pathogenesis has been gained. New discoveries, such as the exact time when Schlemm's canal develops could lead to a prenatal diagnosis and therefore surgical intervention so that other complications including blindness can be avoided. This case report demonstrates that an early prenatal eye screening with ultrasound (after approximately 30 weeks of pregnancy) would be desirable in order to diagnose buphthalmus early and to plan postnatal surgery.
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: In cases of contact lens intolerance and/or central corneal scars, corneal transplantation is indicated for advanced keratoconus. This can be performed as deep anterior lamellar keratoplasty (DALK) or as penetrating keratoplasty (PKP). The German keratoplasty registry shows that the proportion of anterior lamellar grafts in Germany has remained stable at approximately 5 % in recent years. Up to now DALK has not been technically standardized but can result in a good visual acuity using the big bubble technique if Descemet's membrane is laid bare intraoperatively. In 10-20 % a conversion to PKP is required if perforation of Descemet's membrane occurs. In cases of advanced keratoconus PKP is still the method of first choice especially after corneal hydrops due to rupture of Descemet's membrane. Non-contact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and those with repeat grafts in cases of keratoconus recurrence due to the graft being too small. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved by a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually depending on corneal size (as large as possible and as small as necessary). Limbal centration is given priority intraoperatively due to optical displacement of the pupil. Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces vertical tilt and horizontal torsion of the graft in the recipient bed, thus resulting in significantly less all-sutures-out keratometric astigmatism (2.8 D versus 5.7 D), higher regularity of the topography (SRI 0.80 vs. 0.98) and better visual acuity (0.80 vs. 0.63) in contrast to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. In cases with optimal course DALK achieves the same visual outcome as mechanical PKP but the healthy endothelium can be preserved and endothelial immune reactions are prevented in keratoconus. In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination.
    Der Ophthalmologe 09/2013; 110(9):839-48. · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bei Kontaktlinsenintoleranz und/oder zentralen Hornhautnarben ist beim fortgeschrittenen Keratokonus die Korneatransplantation angezeigt. Diese kann prinzipiell als anteriore lamelläre Keratoplastik (bevorzugt als ,,deep anterior lamellar keratoplasty“, DALK) oder als perforierende Keratoplastik (PKP) durchgeführt werden. Das Deutsche Keratoplastikregister weist für die letzten Jahre stabil einen Anteil von etwa 5 % an anterioren lamellären Keratoplastiken aus.Die DALK ist bis heute technisch nicht standardisiert, kann aber mittels Big-Bubble-Technik zu guten Visusergebnissen führen, wenn intraoperativ die Descemet-Membran freigelegt wurde. In 10–20 % der Eingriffe ist bei Perforation der Descemet-Membran die Konversion zur PKP nötig. Bei fortgeschrittenem Keratokonus – besonders bei Zustand nach akutem Keratokonus mit Descemet-Ruptur – wird die PKP nach wie vor für die Methode der Wahl gehalten. Die kontaktfreie nichtmechanische Excimerlasertrepanation bietet sich in besonderem Maße auch für die iatrogene Keratektasie nach Laser-in-situ-Keratomileusis (LASIK) und die Rekeratoplastik bei sog. ,,Keratokonusrezidiv“ wegen zu kleinem Transplantat an. Für die Spendertrepanation von epithelial wird eine künstliche Vorderkammer eingesetzt, der wasserdichte Wundverschluss erfolgt mittels doppelt fortlaufender Naht nach Hoffmann. Die Transplantatgröße wird individuell an die Hornhautgröße angepasst (,,so groß wie möglich, so klein wie nötig“). Der Limbuszentrierung wird wegen der optischen Verlagerung der Pupille intraoperativ der Vorzug gegeben.Publizierte klinische Studien haben gezeigt, dass die Technik der Non-contact-Excimerlasertrepanation die Spender- und Empfängerzentrierung, die ,,vertikale Verkippung“ sowie die ,,horizontale Torsion“ des Transplantates im Empfängerbett verbessert. Daraus resultieren nach Fadenentfernung ein signifikant geringerer Astigmatismus (2,8 vs. 5,7 dpt), eine höhere Regularität der Topografie [Surface Regularity Index (SRI) 0,80 vs. 0,98] und vor allem ein besserer Visus (0,80 vs. 0,63) im Vergleich zum Motortrepan. Die funktionellen Ergebnisse nach Excimerlaser-PKP sind bei Operation im fortgeschrittenen Stadium nicht schlechter als bei Operation in früheren Stadien des Keratokonus.Bei optimalem Verlauf kann die DALK bei Erhalt des eigenen gesunden Endothels zu Visusergebnissen analog denen der PKP führen und endotheliale Immunreaktionen komplett vermeiden. Den unbestrittenen klinischen Vorteilen der Excimerlasertrepanation für die PKP bei Keratokonus steht bei der Femtosekundenlasertrepanation die Notwendigkeit der Ansaugung und Applanation des Konus als gravierender Nachteil gegenüber.
    Der Ophthalmologe 01/2013; 110(9). · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was an assessment of refraction error after implantation of two types of hydrophobic acrylic intraocular lenses and derivation of customized IOL constants for the SRK II, SRK/T, Hoffer Q, Holladay 1 and Haigis formula. The purpose of the present study was to analyze the refractive outcome of two hydrophobic acrylic intraocular lenses and to present a computerized calculation scheme for customization of lens-specific parameters provided by the lens manufacturers based on the refractive results of a surgeon or study center. In this prospective monocentric study 100 consecutive cataract eyes were treated at the Eye Hospital of the Barmherzige Brüder (Compassionate Brothers) in Linz/Austria with a hydrophobic acrylic aspherical intraocular lens (Polytech Y10AS, n = 50) or a hydrophobic acrylic spherical intraocular lens (Hoya PC-60R, n = 50). The biometrical data were assessed preoperatively together with the refractive outcome 8-10 weeks after treatment in order to analyze the deviation of postoperative refraction (spherical equivalent) from target refraction (ΔREF) and to customize the lens constants for the SRK II, SRK/T, Hoffer Q, Holladay 1 and Haigis formula. Based on this data set it could be demonstrated that using the lens constant provided by the manufacturer (ΔREF) the Polytech lens showed a systematic trend to myopia in contrast to the Hoya lens which ranged around zero. This trend could be compensated by selecting appropriate lens specific constants. For the Polytech/Hoya lens median lens constants of: A = 118.0/118.6 (SRK II), A = 117.9/118.6 (SRK/T), pACD = 4.8/5.1 (Hoffer Q), SF = 1.1/1.5 (Holladay I) and d = 4.2/4.6 (Haigis) were extracted and using linear regression a lens constant triplet for the Haigis formula of a(0) = 4.39, a(1) = 0.29, a(2) = 0.11/a0 = 4.73, a(1) = 0.30, a(2) = -0.01 could be derived. Ophthalmic surgeons or surgical centers are encouraged to check (refractive) outcomes after cataract surgery permanently in terms of quality control. If a systematic trend in ΔREF could be extracted from the data set a customization of the lens-specific constants is recommended to eliminate systematic errors. Such customization is only valid for a dedicated environment (e.g. for one surgical center with standardized surgical techniques and measurement equipment) and cannot be generalized.
    Der Ophthalmologe 05/2012; 109(5):468-73. · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To validate changes in intraocular pressure (IOP) after phacoemulsification with intraocular lens (IOL) implantation without pressure-lowering surgery in previously unoperated eyes of normal and glaucoma patients. University Eye Clinic, Otto-von-Guericke-University, Magdeburg, Germany. Cohort study. The IOP in both eyes of patients was determined by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) 1 to 2 days before and after uneventful unilateral surgery. Central corneal thickness was used to correct raw GAT readings. Of the 50 patients having unilateral phacoemulsification, 29 had had cataract extraction in the contralateral eye. The mean baseline IOP was 17.4 ± 4.4 mm Hg (GAT) and 16.6 ± 2.9 mm Hg (DCT). Postoperatively, the GAT IOP decreased to 16.4 ± 6.5 mm Hg and the DCT IOP increased slightly to 17.1 ± 4.1 mm Hg. The mean tonometer difference (ΔIOP = GAT - DCT) amounted to ΔIOP(pre) = +0.75 ± 2.69 mm Hg in phakic eyes and ΔIOP(post) = -0.70 ± 3.76 mm Hg in pseudophakic eyes (P=.0011). Consistent results were found in pairs of phakic eyes and pseudophakic eyes (mean IOP 18.0 ± 4.8 mm Hg [GAT] and 17.0 ± 3.3 mm Hg [DCT]). In fellow eyes, the mean GAT reading was 13.4 ± 4.4 mm Hg and the mean DCT value, 14.8 ± 2.4 mm Hg. ΔIOP(phakic) was +1.04 ± 2.75 mm Hg and ΔIOP(pseudophakic) was -1.48 ± 2.78 mm Hg (P=.00000021). The GAT IOP readings in pseudophakic eyes seemed to be falsely low. Hence, special attention in the screening, diagnosis, and management of glaucoma is necessary.
    Journal of Cataract and Refractive Surgery 02/2012; 38(4):683-9. · 2.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To perform an objective functional assessment of the impact of blue-light filters on cortical processing to evaluate the potential side effects of the filters on higher tier visual function at the neural level. Department of Ophthalmology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany. Cohort study. Multifocal pattern-reversal visual-evoked potentials (multifocal VEPs) were recorded monocularly in pseudophakic patients with a clear intraocular lens (IOL) under 2 conditions: (1) stimulus perception through a yellow filter with the filter characteristics of an AF-1 YA-60BB IOL (blue filtering); (2) stimulus perception through a neutral filter that homogeneously attenuates the effective stimulus intensity as under the blue-light filtering condition but independent of the wavelength (neutral filtering). Second-order kernel multifocal VEPs were extracted for 60 visual field locations, and amplitude and latency effects were determined for 6 stimulus eccentricities. The study evaluated 20 patients. Typical multifocal VEPs were obtained for the blue-light and neutral filtering conditions at all eccentricities. No significant effects on amplitudes were obtained, and a subtle latency effect (<0.5 millisecond delay for neutral filtering; P<.02) did not reach significance in an eccentricity-specific analysis. The induced short-term change in the spectral composition of the visual stimulus left neural activity at the level of the primary visual cortex largely unaffected, providing an objective account of the integrity of visual processing under this condition.
    Journal of Cataract and Refractive Surgery 01/2012; 38(1):85-91. · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: For the contactless diagnosis of the human cornea and anterior chamber in clinical routine, two systems have been established besides the slit lamp: the Scheimpflug camera and optical coherence tomography (OCT). A short introduction into these imaging methods is provided along with a comparison with respect to imaging quality and the visibility of relevant ocular structures. We present different examples from special clinical diagnostics such as keratoconus, condition after keratoplasty or tumours in ocular tissue.
    Klinische Monatsblätter für Augenheilkunde 12/2011; 228(12):1052-9. · 0.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A high corneal astigmatism is a major limitation for the attainable visual acuity with spectacle or contact lens correction. In addition, people with higher ametropia may feel discomfort while wearing contact lenses or spectacles which leads to the desire for a permanent correction. Phakic intraocular lenses provide correction possibilities of higher spherocylindrical ametropies beyond those of corneal refractive surgery. For the calculation of toric phakic lenses the matrix formalism for calculation of toric pseudophakic implants is applied. The methods are presented and explained using clinically relevant data examples. A Java-based program JPhakicIOL was used for calculation of the examples and is provided online for teaching and experimental purposes. Phakic IOLs can be calculated using a matrix scheme similar to the one used for toric pseudophakic implants. With the Java programme JPhakicIOL we provide a software tool to assist ophthalmologists in understanding and performing the phakic IOL calculation.
    Klinische Monatsblätter für Augenheilkunde 08/2011; 228(8):690-7. · 0.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A high corneal astigmatism limits the attainable visual acuity and the ability of correction with spectacles or contact lenses. The astigmatism can also be an impairment for visual rehabilitation, especially after penetrating keratoplasty. A pseudohakic toric intraocular lens (T-IOL) can correct high corneal astigmatism during cataract surgery. For the calculation of the correct power for the T-IOL several additional factors need to be considered, which are less relevant for spherical IOL calculation. With the matrix-based vergence transformation an elegant paraxial calculation scheme is available for calculating the optical system "pseudophakic eye" as a closed system. The basic elements of this method are explained in detail along with some clinical examples. The Java-based software JToricIOL is provided online to support comprehension of the examples and to enable readers to make their own calculations for teaching and experimental purposes. The examples mentioned in this article have been calculated with JToricIOL. Toric intraocular lenses are an essential tool for correcting high corneal astigmatism if cataract surgery is needed. For preoperative calculation of the lens power and axis, the matrix method provides a qualified tool for precise calculations. The software JToricIOL enables surgeons and students to reproduce the examples in this paper and to experiment with their own calculations.
    Klinische Monatsblätter für Augenheilkunde 04/2011; 228(8):681-9. · 0.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In concomitant cataract surgery and penetrating keratoplasty (PKP), the sequential procedure is supposed to have a higher accuracy in calculation of the intraocular lens (IOL) power compared to the triple procedure. The purpose of this study was to evaluate the refractive results of cataract surgery in patients after PKP. Our retrospective study included 72 operations on 65 patients. In 35 eyes (group 1, G 1), all corneal sutures had been removed before cataract surgery (median time interval after PKP 3.1 years), while in 37 eyes (group 2, G 2) corneal sutures were in place but removed intra- or postoperatively (median time interval after PKP 1.5 years). Mean age of the patients (65 / 67 years), mean target refraction (-1.8 diopters, D), and mean follow-up interval (2.9 / 3.4 years) were comparable in G1 / G2. Pre- and postoperatively refraction, keratometry, and best corrected visual acuity were recorded. Main outcome measures included the deviation of the spherical equivalent of the real refraction from the target refraction after cataract surgery. In G1 / G2 median visual acuity increased from preoperatively 0.2 / 0.15 to 0.6 / 0.5 after a follow-up period of 3 years on average. Mean deviation from target refraction was -0.3 ± 2.2 (-4.95 to + 3.15) D in G 1 and -0.4 ± 3.0 (-7.3 to + 7.25) D in G 2. After cataract surgery, the steepening of the cornea on average was significantly less in G 1 (0.5 ± 1.6 D) than it was in G 2 (3.3 ± 2.1 D; p = 0.003). Although the mean deviation from target refraction is minimal after cataract surgery following PKP, our results indicate a high level of variability. If corneal sutures have been completely removed before biometry, the accuracy of the IOL power calculation seems to be better.
    Klinische Monatsblätter für Augenheilkunde 11/2010; 228(8):698-703. · 0.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the impact of blue-light filtering on retinal processing to evaluate potential side effects of these filters on visual function at the neural level. Department of Ophthalmology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany. Cohort study. Multifocal electroretinograms (ERGs) were recorded monocularly after pupil dilation in pseudophakic patients with a colorless intraocular lens (IOL) under 2 conditions: (1) stimulus perception through a yellow-tinted filter with the filter characteristics of the AF-1 YA-60BB IOL (blue-light filter) and (2) stimulus perception through a neutral filter that homogeneously attenuates the effective stimulus intensity like the blue-light filter independent of the wavelength. First-order kernel multifocal ERGs were extracted at 61 visual field locations and averaged for 5 stimulus eccentricities. Amplitudes and implicit times were determined for the multifocal ERG components N1 (first negative deflection), N2 (second negative deflection), and P1 (first positive deflection). The study evaluated 20 patients. Typical multifocal ERGs were obtained for both conditions at all eccentricities. There were no significant differences in amplitudes or implicit times between the 2 conditions except for a slight P1 amplitude enhancement (6.9%) with the blue-light filter at an intermediate eccentricity (P = .003). The bipolar cell-dominated multifocal ERG was largely unaffected by short-term effects of blue-light filtering. The induced change in the spectral composition of the stimulus did not significantly alter the activity at the input stage of the visual system, specifically the retinal network comprising photoreceptors, horizontal cells, and bipolar cells.
    Journal of Cataract and Refractive Surgery 10/2010; 36(10):1692-9. · 2.75 Impact Factor
  • A Viestenz, R Laemmer, C Y Mardin
    Klinische Monatsblätter für Augenheilkunde 09/2010; 227(9):739-40. · 0.70 Impact Factor
  • C Raum, A Viestenz, C Y Mardin
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to investigate whether digital planimetry is appropriate for quantification of neuroretinal rim loss in patients with glaucoma, with and without progression. The optic discs of 44 patients, whose illness had been well documented with photographs over a period of at least eight years were divided in a progression group and an unchanged group with regard to glaucoma. After this evaluation we measured each disc by digital planimetry and correlated the results. The researcher conducting the measurements was unaware of the patients' date of examination and the diagnosis. While the neuroretinal rim decreased by only 0.06 A+/- 0.15 mm(2) on average in the group of patients without glaucoma, the average decrease was 0.30 A+/- 0.27 mm(2) in the group with progression. This corresponds to a yearly decrease on average of merely 0.0043 A+/- 0.011 mm(2) (0.25%/a) in the group without progression and one of 0.0228 A+/- 0.025 mm(2) (1.9%/a) in the group with progression. Mean neuroretinal rim loss was 0.25% per year in the group without progression of glaucoma, and 1.9% per year in the group with progression. This annual difference is significant. (p = 0.003). The average observation time in the morphologically better group was on average significantly shorter (12.3 years compared to 14.5 years). Digital planimetry was able to determine if a morphological progression was found in a clinical examination or if a glaucoma showed no signs of worsening. So we can use this method of digital planimetry of optic discs to examine and re-examine older and more recent photographs to always get the best results of a possible progression of glaucoma.
    Klinische Monatsblätter für Augenheilkunde 03/2010; 227(3):215-20. · 0.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the last decades, the implantation of pseudophakic and phakic toric lenses has become widespread for correcting corneal astigmatism: in cataract surgery cases with implantation of a posterior chamber lens and in refractive surgery cases with implantation of phakic lenses. The purpose of this educational and training article is to familiarize the reader with the application of pseudophakic and phakic toric lenses, to show which parameters are necessary for calculating toric lenses, to present a matrix-based calculation scheme for pseudophakic and phakic toric lenses, to explicitly demonstrate the step-by-step calculations with clinical examples, and to show the impact of lens dislocation (especially rotation) on refractive outcome.
    Der Ophthalmologe 02/2010; 107(2):189-201. · 0.53 Impact Factor
  • C. Raum, A. Viestenz, C. Mardin
    Klinische Monatsblatter Fur Augenheilkunde - KLIN MONATSBL AUGENHEILK. 01/2010; 227(03):215-220.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Implantation von pseudophaken und phaken torischen Kunstlinsen entwickelte sich in den vergangenen Jahren zunehmend zum Mittel der Wahl, einen hohen Hornhautastigmatismus im Rahmen einer Kataraktextraktion bzw. eines refraktiven Eingriffs auszugleichen. Im vorliegenden Beitrag werden das Einsatzgebiet pseudophaker und phaker torischer Kunstlinsen vorgestellt, die Ermittlung notwendiger Messgrößen erläutert, ein matrixbasiertes Schema für die Berechnung pseudophaker und phaker torischer Kunstlinsen aufgezeigt und anhand von Beispielen Schritt für Schritt erläutert. Zudem wird auf die intraoperative Positionierung der Linse sowie die Auswirkungen einer Dislokation (speziell Rotation) eingegangen. In the last decades, the implantation of pseudophakic and phakic toric lenses has become widespread for correcting corneal astigmatism: in cataract surgery cases with implantation of a posterior chamber lens and in refractive surgery cases with implantation of phakic lenses. The purpose of this educational and training article is to familiarize the reader with the application of pseudophakic and phakic toric lenses, to show which parameters are necessary for calculating toric lenses, to present a matrix-based calculation scheme for pseudophakic and phakic toric lenses, to explicitly demonstrate the step-by-step calculations with clinical examples, and to show the impact of lens dislocation (especially rotation) on refractive outcome.
    Der Ophthalmologe 01/2010; 107(2):189-201. · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe 1) how to determine toric (posterior chamber) intraocular lenses (IOLs) with standard formulas, 2) a matrix-based calculation scheme for determining toric IOLs using 4x4 matrices, 3) a method to determine residual refraction after implantation of an arbitrary toric lens, and 4) to address clinical aspects. Formulas and metrics are reviewed for determining IOL power and residual refraction after toric IOL implantation. From 4x4 refraction and translation matrices characterizing refractive surfaces and interspaces between refractive surfaces, a system matrix is determined characterizing the entire optical system paraxially. Toric posterior chamber IOLs are determined by solving a linear equation system. In a second step, the same methodology is used for estimation of the residual refraction at the spectacle plane after implantation of an arbitrary toric lens. The methodology is applied to working examples, and the calculation procedure is described in a step-by-step approach. A straight-forward en bloc concept is demonstrated for determination of toric IOLs and estimation of the residual refraction. The applicability is shown in working examples, and clinical aspects such as rotation of the lens implant are addressed.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 08/2009; 25(7):611-22. · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: An 83-year old female was given an intravitreal injection of 0.4 ml of triamcinolone acetonide (TA) by her local ophthalmologist for age-related maculopathy with a large choroidal neovascularisation in the left eye. During the injection, globe explosion occurred with nasal limbal rupture and extrusion of intraocular contents. Emergency primary wound repair was performed at the Eye Surgery Centre Erlangen-Mitte. During surgery, a 9 mm limbal rupture with prolapse of half of the iris and subconjunctival extrusion of the complete natural lens was discovered. After lens removal, anterior vitrectomy and iris repositioning, the wound was closed and the eye left aphakic. The further postoperative course was unremarkable and the patient retained her preoperative visual acuity of counting fingers. In this case, several factors may have contributed to the dramatic events: relative nanophthalmus (preoperative refraction + 5.0dpt), scleral weakness secondary to chemotherapy for leukemia, older age, and a relatively large volume of injected TA. The intravitreal injection of drugs may cause serious complications. Paracentesis or limited pars plana vitrectomy should be considered prior to intravitreal injection in high-risk cases to prevent such disastrous complications.
    Klinische Monatsblätter für Augenheilkunde 01/2009; 225(12):1087-90. · 0.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360 degrees peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.
    Der Ophthalmologe 12/2008; 105(12):1163-74; quiz 1175. · 0.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-traumatic endophthalmitis is one of the most severe complications occurring in 2-17% after open globe injuries. Early intravenous antibiotics may minimise the risk of post-traumatic endophthalmitis. The design of a new study to evaluate the role of an additional intravitreal antibiotic injection in the prevention of post-traumatic endophthalmitis is presented in this paper. A prospective, multicentre, randomised controlled study was designed. Patients with penetrating or perforating eye injuries will be included up to the year 2010. The wound closure and IOFB (intraocular foreign body) removal must be performed within 24 hours after the trauma. After grouping into low risk (e. g., metallic IOFB) or high risk patients (e. g., agricultural trauma, organic IOFB) each patient will be randomised for 1) intravenous moxifloxacin only or 2) intravenous moxifloxacin plus intravitreal 1 mg Vancomycin plus 2.25 mg [DOSAGE ERROR CORRECTED] Ceftazidim. 17 European Departments of Ophthalmology have agreed to participate. The rate of post-traumatic endophthalmitis in each group will be statistically compared. The follow-up period of this study will last 6 months. Other Departments of Ophthalmology are invited to join the TEPT.
    Klinische Monatsblätter für Augenheilkunde 12/2008; 225(11):941-6. · 0.70 Impact Factor

Publication Stats

692 Citations
117.25 Total Impact Points

Institutions

  • 2010–2012
    • Universität des Saarlandes
      • • Experimentelle Pneumologie
      • • Stiftungsprofessur für Experimentelle Ophthalmologie
      Homburg, Saarland, Germany
    • University Hospital Regensburg
      • Klinik für Augenheilkunde
      Regensburg, Bavaria, Germany
  • 2006–2012
    • Otto-von-Guericke-Universität Magdeburg
      • Clinic for Ophthamology
      Magdeburg, Saxony-Anhalt, Germany
  • 2000–2010
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • • Department of Ophthalmology
      • • Institute of Physics
      Erlangen, Bavaria, Germany
  • 2007
    • Konventhospital Barmherzige Brüder Linz
      Linz, Upper Austria, Austria
  • 2002
    • Universität zu Lübeck
      • Department of Ophthalmology
      Lübeck Hansestadt, Schleswig-Holstein, Germany