Klinische Monatsblätter für Augenheilkunde
-
Klin Monbl Augenheilkd · Nov 2020
Review[Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis: Diagnosis and Treatment].
Optic neuritis (ON) is a frequent manifestation of aquaporin-4 (AQP4) antibody-mediated neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disorders, MOGAD). The past few years have seen major advances in the diagnosis and treatment of these two relatively new entities: international diagnostic criteria for NMOSD and MOG-EM have been proposed, improved antibody assays developed, and consensus recommendations on the indications and methodology of serological testing published. Very recently, the results of four phase III trials assessing new treatment options for NMOSD have been presented. ⋯ Especially MOG-ON has been found to be frequently associated with flare-ups, if steroids are not tapered, and to underlie many cases of "chronic relapsing inflammatory optic neuropathy" (CRION). Both NMOSD-ON and MOG-ON are often associated with simultaneous or consecutive attacks of myelitis and brainstem encephalitis; in contrast to earlier assumptions, supratentorial MRI brain lesions are a common finding and do not preclude the diagnosis. In this article, we review the current knowledge on the clinical presentation, epidemiology, diagnosis, and treatment of these two rare yet important differential diagnoses of both MS-associated ON und idiopathic autoimmune ON.
-
Klin Monbl Augenheilkd · Dec 2017
Review[Healthcare Research into Anti-VEGF Therapy: Selection and Methodological Precautions].
Health care research has emerged as an approach to assess and improve quality of care and patient outcomes in the real world. It also has the potential to reduce healthcare costs by providing evidence to guide healthcare decisions. Randomised controlled trials (RCTs) theoretically offer the ideal study design to support treatment decisions. ⋯ Observational studies and pragmatic trials can test new hypotheses and possible license extensions. The bearing of RCT findings on day-to-day practice can then be assessed. The data can be interpreted in a more meaningful manner by practicing clinicians if evidence is integrated from a variety of different study designs and methodologies.
-
Retrobulbar anaesthesia is a valuable alternative not only for polymorbid and haemodynamically compromised patients. Complications are rare but may be devastating. ⋯ Based on the recent literature, the present review compares techniques, describes possible complications and in the absence of evidence-based studies provides suggestions for the handling of patients under thrombocyte aggregation inhibitor and vitamin K antagonist therapy and anticoagulation.
-
Klin Monbl Augenheilkd · Dec 2014
Review[Ophthalmological imaging with ultrahigh field magnetic resonance tomography: technical innovations and frontier applications].
This review documents technical progress in ophthalmic magnetic resonance imaging (MRI) at ultrahigh fields (UHF, B(0) ≥ 7.0 T). The review surveys frontier applications of UHF-MRI tailored for high spatial resolution in vivo imaging of the eye, orbit and optic nerve. Early examples of clinical ophthalmic UHF-MRI including the assessment of melanoma of the choroid membrane and the characterisation of intraocular masses are demonstrated. A concluding section ventures a glance beyond the horizon and explores research promises along with future directions of ophthalmic UHF-MRI.
-
In Germany, a vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia (PHN) in adults aged 50 years and older has been available since October 2009. The efficacy of this attenuated high-dose live vaccine was evaluated in a double-blind randomised, placebo-controlled trial involving more than 38,000 immunocompetent adults aged >or= 60 years. Compared to placebo the vaccine reduced the frequency of herpes zoster by 51 % and the incidence of PHN by 67 %. ⋯ Zostavax has been well tolerated. It can be concomitantly administered with inactivated influenza vaccine at separate sites. Zoster and pneumococcal vaccines should not be given concomitantly.