Okuloplastische Chirurgie bei Expositionskeratopathie auf der Intensivstation

Abstract

Critically ill patients in the intensive care unit (ICU) may develop eye problems, due to impaired ocular protective mechanisms or direct involvement of the eye in severe systemic diseases. If eye infections or ocular surface disorders are not identified in time, endophthalmitis or corneal ulcer may develop and can cause permanent functional injuries of the eye. A retrospective analysis was performed and a total of 283 complete intensive care courses of treatment were evaluated, taking into account ophthalmic medical consultations for frequent cardinal symptoms. The most common cardinal symptoms were lagophthalmus (exposure keratopathy), chemosis, redness and periorbital haematoma. The following predisposing risk factors for the onset of ocular complications during intensive care treatment were detected: chemosis (p < 0.001), redness (p = 0.007), lagophthalmus (p = 0.001), ventilation (p < 0.001), use of muscle relaxants (p < 0.001), cardiovascular (p < 0.001), and neurological diseases (p < 0.001). In 71.7 % of ICU patients, additional treatment was prescribed during the eye consultation. This includes special eye care treatment (6.0 %) and/or drug therapy (64.0 %), as well as oculoplastic surgery in 4,3 % of critically ill patients. The most common oculoplastic-surgical procedure in the ICU was lid adhesion to achieve adequate protection of the corneal surface in patients with severe exposure keratopathy. Oculoplastic surgery is the method of choice for protecting the cornea in critically ill patients, when conservative options such as hypoallergenic adhesive tape or a moisture chamber are not sufficient to protect the ocular surface. The main challenges are to pay attention to the indication and performance in due time, and to avoid permanent loss of function through transparency reduction or irregular astigmatism in post-recovery patients.

Prevalence and risk factors of exposure keratopathy among critically ill patients: A systematic review and meta‐analysis

“…Included studies reported prevalence of EK between children ( n = 3 studies) (Hartford et al., 2019; Hernandez & Mannis, 1997; Narmawala & Jani, 2017) and adults ( n = 13 studies) (Aggarwal et al., 2022; Araujo et al., 2016; Casillas‐Chavarin et al., 2016; Gok et al., 2021; Hartford et al., 2019; Hernandez & Mannis, 1997; Jammal et al., 2012; Kuruvilla et al., 2015; Li et al., 2008; Mercieca et al., 1999; Narmawala & Jani, 2017; Siebert et al., 2017; Zhang et al., 2022), the main results of the meta‐analysis findings are summarized in Table 3. In individual studies, the prevalence of EK in intensive care patients ranged from 5.9% to 60.0%.…”

“…One study (Imanaka et al, 1997) included both a retrospective and prospective cohort study design, we extracted data from both study designs, so there were 24 sets of data. The frequency of cornel examination in 12 studies (Araujo et al, 2016;Germano et al, 2009;Hartford et al, 2019;Imanaka et al, 1997;Jammal et al, 2012;Kousha et al, 2018;Kuruvilla et al, 2015;Li, 2015;Li, Jin, et al, 2022;Oliveira et al, 2022;Silva et al, 2021;Werli-Alvarenga et al, 2011) is greater than or equal to five times and in the other 10 studies (Casillas-Chavarin et al, 2016;Gok et al, 2021;Hernandez & Mannis, 1997;Li et al, 2008;Martínez-García et al, 2020;Masoudi et al, 2013;Mercieca et al, 1999;Narmawala & Jani, 2017;Oliveira et al, 2022;Siebert et al, 2017) is less than five times during the studies period. Furthermore, the follow-up time in 12 studies (Araujo et al, 2016;Germano et al, 2009;Hartford et al, 2019;Imanaka et al, 1997;Kousha et al, 2018;Kuruvilla et al, 2015;Li, 2015;Li, Jin, et al, 2022;Mercieca et al, 1999;Oliveira et al, 2022;Silva et al, 2021;Werli-Alvarenga et al, 2011) is beyond 7 days and in another three studies (Jammal et al, 2012;…”