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ZusammenfassungIn diesem Artikel sollen die Grundlagen zur Verwendung intraokularer Tamponaden in der Glaskörper-/Netzhautchirurgie bei Ablatio retinae und anderen Pathologien anhand zusätzlichen Videomaterials anschaulich dargestellt werden. Behandelt werden die verschiedenen Gase, Silikonöle und flüssigen Perfluorocarbone mit ihren Indikationen, ihrer Anwendung und insbesondere der intraoperativen Handhabung mit Fallstricken und Komplikationen. Charakteristische Animationen zeigen dabei nachvollziehbar die Prinzipien in der chirurgischen Handhabung. Seitens der beiden Erstautoren ist dieser Artikel ihrem Lehrer Herrn Prof. Dr. V.-P. Gabel gewidmet, der in den frühen 90er-Jahren die ersten Vitrektomiekurse für Augenärzte an der Universitäts-Augenklinik Regensburg erfolgreich im jährlichen Rhythmus etabliert hat und in denen viele heute noch netzhautchirurgisch tätige Kolleginnen und Kollegen ihre ersten Schritte in diesem Segment erlernt haben. Die weiteren Co-Autoren partizipierten unter seiner Leitung an jährlichen Vitrektomie-Wetlabs im Rahmen der Augenärztlichen Akademie Deutschlands.

Zusammenfassung Hintergrund Das Retina.net ROP-Register erhebt Daten von Kindern, die eine seltene behandlungsbedürftige Frühgeborenenretinopathie (Retinopathy of Prematurity, ROP) entwickeln. Ziel dieser Auswertung ist die Untersuchung der Daten zur behandlungsbedürftigen ROP, Epidemiologie, Therapie und deren Änderungen über einen Zeitraum von 15 Jahren an der Medizinischen Hochschule Hannover. Methoden Analyse der Daten der therapiebedürftigen Fälle der ROP eines Zentrums für die Geburtsjahre 2001 bis 2016 (Therapie in 2002 bis 2017) als Gesamtzeitraum und in 5 Abschnitten. Ergebnisse Es wurden 65 Kinder behandelt (23 weiblich), davon wurden 11 (16,9 %) extern auf ROP gescreent und zur ROP-Behandlung zugewiesen. Für den Zeitraum 2006 bis 2016 lag die Inzidenz der behandlungsbedürftigen ROP unter den gescreenten Kindern bei 4,1 %. Das mittlere Gestationsalter betrug 25,7 Schwangerschaftswochen (SSW) (Standardabweichung [SA] = 1,8), das Geburtsgewicht 763 g (SA = 235), das postmenstruelle Alter bei Behandlung 38,2 Wochen (SA = 3,2), das postnatale Alter 12,4 Wochen (SA = 3,2). Über die Zeit zeigte sich kein signifikanter Unterschied der demografischen Parameter. Am häufigsten (57 Augen bei 31 Kindern) wurde eine Zone II, 3+-Erkrankung behandelt; 58 Kinder erhielten eine Laserkoagulation (N = 114 Augen), 7 Kinder bilateral eine Anti-VEGF-Therapie (Bevacizumab) (N = 14 Augen), welche ab 2014 eingesetzt wurde. Eine Wiederbehandlung bei Wiederaufflammen der behandlungsbedürftigen ROP war in einem Fall nach initialer Laserbehandlung notwendig. Kinder mit behandlungsbedürftiger ROP zeigten häufig neonatologische Komorbiditäten, in mehr als 90 % Beatmung, bronchopulmonale Dysplasie und erhielten Transfusionen. Schlussfolgerung Dies ist die erste monozentrische Auswertung über 15 Jahre im Rahmen des Retina.net ROP-Registers. Ab 2014 sehen wir einen Wechsel von der Laserkoagulation zur Anti-VEGF-Therapie (Bevacizumab), während im betrachteten Kollektiv die demografischen Daten und Behandlungsparameter weitgehend konstant waren.

This article describes the development of decreased intraocular pressure (IOP) under general anesthesia with medetomidine, midazolam, and fentanyl in mice with normal and elevated IOP.IOP was measured using the iCare Tonolab rebound tonometer. Twelve 3-4 months-old male and female C57BL/6J mice were randomized to a control group with physiological IOP and a high IOP group with experimentally induced ocular hypertension using tarsal injections of dexamethasone-21-acetate. For anesthesia, medetomidine and midazolam were used, subgroups additionally received fentanyl. IOP was measured every 2.5 min for 30 min.Control group differed with 14.89 mmHg (SEM: 0.58) significantly (In mice, general anesthesia with medetomidine and midazolam leads to a declining IOP over time. Adding fentanyl to the anesthesia did not alter these effects. The decline is time-dependent and IOP-dependent.

Purpose Central serous chorioretinopathy (CSC) is a disease presenting with detachment of the neurosensory retina and characteristic focal leakage on fluorescein angiography. The spontaneous remission rate is 84% within 6 months. In this study, the efficacy of selective retina therapy (SRT) was examined in patients with therapy refractory persistent acute CSC defined by symptoms for at least 6 months and persistent subretinal fluid (SRF) despite eplerenone therapy. Material and methods This is a prospective, monocentric observational study in 17 eyes (16 patients, mean age 42 years, 2 female). SRT was performed with the approved R:GEN laser (Lutronic, South Korea), a micropulsed 527-nm Nd:YLF laser device, with a train of 30 pulses of 1.7 μs at 100-Hz repetition rate at the point of focal leakage determined by fluorescein angiography (FA) at baseline (BSL). Visits on BSL, week 4 (wk4), and week 12 (wk12) included best corrected visual acuity (BCVA, logMar), central retinal thickness (CRT) on spectral domain optical coherence tomography (SD-OCT), and FA. Statistical analysis was performed by pair-by-pair comparisons of multiple observations in each case with Bonferroni correction for multiple testing. (IBM SPSS Statistics 25®). Results Mean CRT at BSL was 387.69 ± 110.4 μm. CRT significantly decreased by 106.31 μm in wk4 (95%-KI: 21.42–191.2; p = 0.01), by 133.63 μm in wk12 (95%-KI: 50.22–217.03; p = 0.001) and by 133.81 μm (95%-KI: 48.88–218.75; p = 0.001) compared to BSL. Treatment success defined as complete resolution of SRF occurred at wk4 in 7/17 eyes (35.3%) and at wk12 in 10/17 eyes (58.8%). Re-SRT was performed in 7/17 eyes (41.2%) after an average of 107.14 ± 96.59 days. Treatment success after Re-SRT was observed in 4/6 eyes (66.6%, 12 weeks after Re-SRT). Mean BCVA did not change significantly from BSL to any later timepoint after adjusting for multiple testing. Notably, eyes with treatment success showed better BCVA at all timepoints and gained more letters compared to failures. Conclusion Single or repetitive SRT may be an effective and safe treatment in 2 of 3 patients suffering from acute persistent CSC after 6 months of symptoms or more. We observed complete resolution of SRF in around 60% of eyes 12 weeks after first SRT treatment and also 12 weeks after Re-SRT treatment in eyes with persistent or recurrent SRF. Results on the long-term course after SRT are still pending.

Zusammenfassung Hintergrund Strabologische Operationen werden häufig in universitären Zentren durchgeführt. Ziel dieser Arbeit ist es, die Kosten dieser chirurgischen Leistung an einer Universitätsklinik zu ermitteln und die Kostenkompensation für den ambulanten Bereich zu überprüfen. Material und Methode Von allen Strabismusoperationen an der Medizinischen Hochschule Hannover wurden in den Jahren 2018 und 2019 relevante OP-Daten wie Alter des Patienten, Anzahl der operierten Muskeln, Schnitt-Naht-Zeit, Präsenzzeiten der Chirurgen und Anästhesisten sowie der entsprechenden Funktionsdienste auf Basis des klinikeigenen Informationssystems evaluiert. Im Rahmen einer Kostenträgerrechnung wurden dabei die Kosten für Personal, Material, Raummiete und Overhead kalkuliert. Ergebnisse Insgesamt wurden 302 Operationen (stationärer Anteil: 92,1 %) bis auf wenige Ausnahmen unter Vollnarkose durchgeführt. Das mittlere Alter der Patienten betrug 31 Jahre (Median: 26 Jahre), wobei 33 Patienten Kinder unter 6 Jahren waren. Im Mittel wurden 1,84 Muskeln pro Eingriff operiert. Die mittlere Schnitt-Naht-Zeit betrug 51,5 min, die mittlere Anästhesiezeit 85 min, die Präsenzzeit des Funktionsdienstes OP und auch die des Funktionsdienstes Anästhesie belief sich auf jeweils 104 min, die zusätzliche Aufwachraumzeit auf 66 min. Die am Gesamtprozess durchschnittlich entstandenen Personalkosten summierten sich auf 642,14 € zuzüglich durchschnittlich 109,23 € Material‑/Medikamentenkosten (Operation und Anästhesie) sowie Reinigung und Raumkosten (inklusive Infrastrukturkosten) von 178,71 €. Somit betrugen die Gesamtkosten einer durchschnittlichen strabologischen OP in unserem Kollektiv 930,08 € (Minimum: 491,01 €, Maximum: 1729,29 €). Kostenkalkulationen von Untergruppen ergaben aufgrund unterschiedlicher Behandlungszeiten (37 min für 1 Muskel bis 72 min für 3 und mehr Muskeln) respektive Anästhesiezeiten insbesondere bei Kindern 5 Jahren; Differenz 11 min [1 Muskel], 25 min [2 Muskeln] und 30 min [3 und mehr Muskeln]) deutlich höhere Kosten bei Kindernarkosen und einer höheren Anzahl operierter Muskeln. Das reine Kostenniveau einer Strabismusoperation an unserer Klinik erscheint durchschnittlich um den Faktor 2 höher als das Entgelt, welches für Strabismusoperationen über EBM (einheitlicher Bewertungsmaßstab) im ambulanten Bereich erlöst wird. Schlussfolgerungen Die rein betriebswirtschaftlich errechneten Kosten für strabologische Operationen an einer Universitätsklinik sind signifikant höher als die im ambulanten Bereich nach Paragraf 115b, Absatz 1, SGB V aktuell zu erzielenden Erlöse. Unter diesen Bedingungen können solche Operationen ambulant nicht kostendeckend erbracht werden.

Zusammenfassung Hintergrund Im Bereich des Pflegedienstes wurden und werden Mindestpersonalbemessungen gefordert und umgesetzt. Die Bundesärztekammer hat die Deutschen Fachgesellschaften im Dezember 2019 nach ihren Erfahrungen zu Personalvorgaben für Ärztinnen und Ärzte im Krankenhaus befragt. Da hierzu in der Augenheilkunde bislang keine strukturiert erhobenen Daten vorlagen, gründete die DOG im März 2020 einen Arbeitskreis zur Bearbeitung dieser Anfrage. Methode Im Rahmen mehrerer Abstimmungsrunden erstellte der „Arbeitskreis Personalvorgaben für Ärztinnen und Ärzte im Krankenhaus“ der DOG einen Fragebogen zu den bisherigen Erfahrungen in der Personalausstattung und -planung von Augenkliniken, der im Mai 2020 an die Chefärzte und Direktoren aller deutschen Universitätsaugenkliniken und Hauptabteilungen für Augenheilkunde verschickt wurde. Der Fragenbogen beinhaltete Einzelfragen mit vorgegebenen und freien Antwortmöglichkeiten zur Vorgehensweise und Ist-Situation bei der Personalausstattung sowie zum Aufgaben- und Organisationsspektrum des Ärztlichen Dienstes der Abteilungen. Ergebnisse Von 104 angeschriebenen Leitern von Hauptabteilungen antworteten 53 (51 %). Davon entfielen 25 Antworten auf universitäre Abteilungen (64 % Antwortquote), 23 auf Abteilungen von öffentlichen oder frei-gemeinnützigen Trägern (46 %) und 5 auf private Klinikträger (33 %); 49 % gaben an, dass es keine transparente Berechnungsgrundlage der Anzahl ärztlichen Stellen ihrer Klinik gibt. Nur bei 47 % der befragten Abteilungen werden die ambulanten Aufgaben, Leistungen und Erlöse im Stellenschlüssel berücksichtigt. Es zeigte sich ein statistisch signifikant höheres Verhältnis an Vollzeitkräften pro Bettenanzahl in den Universitätsaugenkliniken gegenüber den privaten und öffentlich/frei-gemeinnützig geführten Augenkliniken (p Schlussfolgerung Das Ergebnis zeigt, wie heterogen und intransparent die Personalbemessung in den deutschen Hauptabteilungen für Augenheilkunde festgelegt wird. Die universitären Abteilungen haben im Schnitt höhere Personalressourcen in Bezug auf die Bettenkapazität für die Bewältigung zusätzlicher Aufgaben in Forschung und Lehre. In der Personalberechnung werden vielfältige Aufgaben, darunter auch ambulante Aufgaben, die deutlich zum Erlös einer Augenklinik beitragen, oft nicht berücksichtigt. Eine transparente und einheitliche Berechnungsgrundlage für das ärztliche Personal der Abteilungen ist zukünftig wichtig, um eine ausreichende Personalausstattung für ein patienten- und mitarbeiterorientiertes Arbeitsumfeld zu gewährleisten.

Purpose To investigate the influence of treatment regularity with intravitreal aflibercept injections (IVT-AFL injections) on visual acuity (VA) outcomes in patients with neovascular age-related macular degeneration (nAMD) enrolled in the PERSEUS trial who received at least 7 IVT-AFL injections during the first year. Methods This was a post hoc analysis of the PERSEUS trial, a prospective, non-interventional, multicenter cohort study, and included 370 patients with nAMD who had received ≥ 7 IVT-AFL injections during year 1. In addition to the prespecified subgroups of treatment-naïve and previously treated patients, results were compared between patients with regular (n = 209) and irregular (n = 161) treatment. Regular treatment was defined as initial dosing with monthly IVT-AFL injections for 3 months, then bimonthly IVT-AFL injections until month 12. Irregular treatment was defined as any deviation from regular treatment (provided ≥ 7 injections were received). The outcome of primary interest was the mean change in VA from baseline after 12 months. Further outcomes of interest included VA gain or loss, proportion of patients achieving reading vision, and percentage of patients with fluid. Results At month 12, the mean (± standard deviation, SD) VA improvement from baseline was 6.1 ± 15.6 Early Treatment Diabetic Retinopathy Study letters in the regular cohort and 2.5 ± 16.7 letters in the irregular cohort with ≥ 7 IVT-AFL injections (P = 0.0514). Best results were obtained in the treatment-naïve regular sub-cohort with a mean ± SD VA improvement of 8.0 ± 17.7 letters, whereas treatment-naïve patients with irregular treatment experienced a considerably lower VA gain (2.8 ± 20.0 letters). Irregular treatment consistently correlated with inferior results in treatment-naïve patients. At month 12, the proportion of treatment-naïve patients who had experienced a worsening of ≥ 5 letters was 29.6% in the irregular sub-cohort versus 13.6% in the regular sub-cohort (P = 0.0049). However, among the treatment-naïve patients, the mean number of injections was significantly higher in the irregular than in the regular sub-cohort (8.0 ± 1.2 vs. 7.4 ± 0.6; P = 0.0001). Furthermore, compared with the treatment-naïve, regular sub-cohort, patients in the irregular sub-cohort had more visits (19.1 ± 8.6 vs. 16.1 ± 5.7), VA tests (14.2 ± 6.9 vs. 12.0 ± 4.6), and optical coherence tomography examinations (5.1 ± 3.7 vs. 3.4.0 ± 3.0). Conclusions Although irregularly treated patients received more injections and more monitoring visits during the first year of IVT-AFL treatment, they experienced worse VA outcomes than regularly treated patients.

Purpose To evaluate the relationship between macular pigment optical density (MPOD) and glaucoma. Methods Forty-three patients with an established glaucoma diagnosis (25 females, 18 males, mean age 70 (range 34-84)) and 43 healthy controls (28 females, 15 males, mean age 62 (range 30-87)) were included in this prospective diagnostic case-control study. All subjects underwent detailed eye examination including ophthalmoscopy, best-corrected visual acuity, biomicroscopy, measurement of the axial length of the eye, objective refraction, lens status, central foveal thickness on spectral-domain optical coherence tomography (SD-OCT). In all glaucoma patients, a visual field assessment and a measurement of the retinal nerve fibre layer (RNFL) on SD-OCT were done. MPOD was determined using the macula pigment module of the Spectralis HRA+OCT (Heidelberg Engineering GmbH, Heidelberg, Germany) at 0.51°, 1.02° and 1.99° retinal eccentricity using two-wavelength autofluorescence imaging. Results In the glaucoma group, the median of the visual field mean defect was 5.1 db (quartiles 3.0 and 13.5) and the mean RNFL-thickness global was 65.9 µm (SD ± 16.1). Median MPOD measured at 0.51°, 1.02° and 1.99° retinal eccentricity in the glaucoma group was 0.42 DU, 0.34 DU and 0.13 DU, in the control group 0.40 DU, 0.35 DU and 0.12 DU respectively. There was no statistically significant difference of median MPOD between glaucomatous and control eyes (p=0.510, 0.735, 0.481). No significant relation between MPOD at 1.02 retinal eccentricity and the presence of glare symptoms was found (p=0.948). However, age seems to correlate with median MPOD measured at 1.02 retinal eccentricity (p=0.017). Conclusion There was no evidence for lower MPOD levels in our glaucoma patients; lower MPOD was not related to the presence of glare symptoms. However there seems to be a positive correlation between age and MPOD at 1.02° retinal eccentricity. To further investigate the relation between glare reported by glaucoma patients and glare disability linked to lower MPOD levels, additional studies are necessary that include both detailed inquiry of the quality of glare and a glare quantification and precise analysis of MPOD levels in glaucoma patients.

Zusammenfassung Hintergrund Die Medien berichten über die erhöhte Gewaltbereitschaft von Patienten sowie Angehörigen gegenüber medizinischem Personal. Bislang wurden wenige Untersuchungen zu diesem Thema durchgeführt, entsprechend schwach ist die Datenlage. Gerade Augenärzte haben an der Spaltlampe engen Kontakt zum Patienten und sind oft mit Patienten allein. Methodik Auf Grundlage der Aggressions-Wahrnehmungsskala (POPAS Fragebogen, Oud 2000) sowie der Umfrage zu Aggressionen und Gewalt unter Allgemeinmedizinern (Vorderwülbecke et al. 2015) wurde ein Fragebogen entwickelt. Im Herbst 2018 erhielten alle Mitglieder der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbandes der Augenärzte (BVA) per Mail eine Einladung, um den Fragebogen online auszufüllen. Ergebnisse Von 9411 angeschriebenen Augenärzten nahmen insgesamt 1508 (Alter: 49 ± 12 Jahre) an der Befragung teil (16 %). 806 (53,7 %) Befragte waren weiblich. 1139 (75,5 %) Teilnehmer arbeiteten in Praxen. Insgesamt 1264 (83,3 %) der Augenärzte hatten Aggressionen/Gewalt in ihrer Tätigkeit erfahren. 986 (65 %) Befragte hatten verbale Übergriffe ohne Drohung erlebt. Von bedrohlich körperlichen Gewalterfahrungen berichteten 363 (24,1 %) Ärzte. 30 (2 %) Teilnehmer erhielten aufgrund schwerer körperlicher Gewalt eine ärztliche Behandlung. Sexuelle Einschüchterung/Belästigung bejahten 322 (21,4 %) der Befragten, von diesen waren 243 (75,5 %) weiblich. 533 (47,9 %) Ärzte empfanden, dass aggressive/gewalttätige Verhaltensweisen in den letzten 5 Jahren zugenommen haben. Schlussfolgerung Die hohe Teilnehmeranzahl weist auf die hohe Relevanz des Themas hin. Die Umfrage hat erstaunliche Ergebnisse geliefert, die weitere Diskussionen und Handlungen zur Folge haben sollten, um die Sicherheit der Mitarbeiter zu verbessern.

Even in the era of intravitreal injection therapy (intravitreal operative injection of medication, IVOM) for the treatment of macular and retinal diseases, such as age-related macular degeneration (AMD), proliferative diabetic retinopathy (DR) and diabetic macular edema (DME) as well as proliferative stages and/or macular edema due to retinal vein occlusion (RVO), conventional retinal laser treatment is still of importance. It can be focally performed on an on-label basis for DME and macular edema due to branch RVO (BRVO) and its use as panretinal treatment for proliferative stages in retinal diseases as well as for the treatment of retinal holes is undisputed. The spectrum is extended by the treatment of less common diseases, such as retinal hemangioblastoma, macroaneurysms and subhyaloid macular hemorrhage. There is cause for concern that knowledge about the correct performance of retinal laser application might be shifted into the background due to an increase of IVOM treatment, which could lead to an increase in unnecessary errors. The aim of this manuscript is to increase awareness for the correct indications and execution of retinal laser treatment based on case examples of flawed or insufficient treatment.

Purpose To evaluate the effect of corneal density and thickness on the accuracy of tonometry readings obtained via three most used techniques. Method Intraocular pressures of 45 patients’ right eyes were measured using Goldmann Applanation, iCare, and non-contact tonometry methods. Corneal parameters were obtained using the Pentacam Camera System. Data obtained were analyzed using Paired t Test, Pearson’s correlation coefficient, multiple linear regression analysis, and Bland–Altman plots. Results The mean corneal thickness was 545.4 ± 3.93 μm. The mean corneal density of total, stromal, 0–2 mm, and 2–6 mm zones were 27.85 ± 6.23 GSU, 24.61 ± 6.05 GSU, 20.76 ± 2.96 GSU, and 20.81 ± 3.51 GSU respectively. IOP readings had a statistically significant correlation with corneal stromal thickness, as well as with total and stromal density. The stromal density, however, showed higher correlation with the three tonometry methods than did the total density (iCare: − .482 (0.001) stromal density versus− .464 (0.001) total density, NCT: − .376 (0.011) versus − .353 (0.017), GAT: − .306 (0.041) versus − .296 (0.048)). Statistical differences were found in comparing the iCare readings with GAT (P P P > 0.05). Conclusion This study shows that both central corneal thickness and stromal density are significant influential factors of reliable IOP readings. It is necessary to consider more corneal biomechanical properties, as well as exercise a high degree of caution in any new attempts towards adjusting an IOP-correction equation.

Zusammenfassung Hintergrund Die Coronaviruserkrankung COVID-19 hat im Frühjahr 2020 zu einer deutlichen Minderleistung der elektiven Medizin in den Krankenhäusern geführt, wobei es für universitäre Polikliniken bisher keine entsprechenden Daten über das Ausmaß dieser Reduktion und die damit verbundenen Erlösminderungen gibt. Material und Methode Mithilfe der Daten des aus dem Krankenhausinformationssystems (IS-H/i.s.h.med unter SAP, Cerner Corporation, North Kansas City, MO, Vereinigte Staaten von Amerika und SAP SE, Walldorf, Deutschland) und der an unserer Klinik mitentwickelten Zeiterfassungs- und Managementsoftware TimeElement (Medizinische Hochschule Hannover, Hannover, Deutschland) wurden alle Patientenkontakte des COVID-19-Shutdowns über ca. 7 Wochen vom 18.03.2020 bis zum 08.05.2020 evaluiert und mit dem Vorjahreszeitraum 2019 verglichen. Zudem wurden die Fallzahlen für das erste und zweite Quartal 2019 und 2020 in Relation gesetzt. Ergebnisse Im COVID-19-Zeitraum reduzierte sich die Gesamtzahl der Patientenkontakte um 59,5 % gegenüber dem Vorjahr. Die Anzahl der abrechenbaren Fälle reduzierte sich um 74,8 %. Insbesondere der Hochschulambulanz‑/Selbstzahlerbereich verzeichnete mit einer Reduktion der Patientenkontakte auf 17,2 % des Ausgangswertes von 2019 den größten Patientenwegfall. Aus der reduzierten Arbeitsleistung resultierte ein Erlösverlust von mindestens 218.000 €. Über TimeElement ergab sich ein Rückgang aller diagnostischen Spezialleistungen von 69,4 %, wobei gerade auch Gesichtsfelduntersuchungen um ca. 75,3 % reduziert waren. OCT-Messungen verzeichneten einen Rückgang um 60,3 %. Das Patiententracking ergab allerdings auch eine Reduktion der durchschnittlichen Anwesenheitszeiten der Patienten um ca. 23 % (COVID-19: 145,8 ± 88,8 min vs. 2019: 189,6 ± 97,2 min). Diskussion Der COVID-19-Shutdown ließ die Arbeitsleistung unserer Poliklinik auf nur noch ca. 40 % der Patientenkontakte und die der funktionsdiagnostischen Untersuchungen auf nur noch ca. 30 %, verglichen zur Leistung aus dem Jahr 2019, einbrechen. Die Reduktion der Patientenzahl führte allerdings auch dazu, dass die Anwesenheitszeiten der Patienten deutlich geringer als bei regulärer Auslastung ausfielen. Die damit verbundenen finanziellen Verluste sind durchaus erheblich und offensichtlich nicht über gesetzlich geregelte Ausgleichszahlungen wie im stationären Bereich kompensiert.

Autosomal recessive bestrophinopathy (ARB) has been reported as clinically heterogeneous. Eighteen patients (mean age: 22.5 years, 15 unrelated families) underwent ophthalmological examination, fundus photography, fundus autofluorescence, and optical coherence tomography (OCT). Molecular genetic testing of the BEST1 gene was conducted by the chain-terminating dideoxynucleotide Sanger methodology. Onset of symptoms (3 to 50 years of age) and best-corrected visual acuity (0.02&ndash, 1.0) were highly variable. Ophthalmoscopic and retinal imaging defined five phenotypes. Phenotype I presented with single or confluent yellow lesions at the posterior pole and midperiphery, serous retinal detachment, and intraretinal cystoid spaces. In phenotype II fleck-like lesions were smaller and extended to the far periphery. Phenotype III showed a widespread continuous lesion with sharp peripheral demarcation. Single (phenotype IV) or multifocal (phenotype V) vitelliform macular dystrophy-like lesions were observed as well. Phenotypes varied within families and in two eyes of one patient. In addition, OCT detected hyperreflective foci (13/36 eyes) and choroidal excavation (11/36). Biallelic mutations were identified in each patient, six of which have not been reported so far [c.454C&gt, T/p.(Pro152Ser), c.620T&gt, A/p.(Leu207His), c.287_298del/p.(Gln96_Asn99del), c.199_200del/p.(Leu67Valfs*164), c.524del/p.(Ser175Thrfs*19), c.590_615del/p.(Leu197Profs*26)]. BEST1-associated ARB presents with a variable age of onset and clinical findings, that can be categorized in 5 clinical phenotypes. Hyperreflective foci and choroidal excavation frequently develop as secondary manifestations.

The treatment of macular edema with intravitreal injections has revolutionized the treatment of associated diseases in ophthalmology. However, with a few exceptions, this is a chronic treatment where patients require many injections and usually need to stay in treatment for years. Patient adherence and control of patient flow are critical to treatment success. In this manuscript, we describe the development of a patient-oriented organization management for intravitreal injections in a university hospital.In 2015, the intravitreal treatment in our clinic was switched to the treat-and-extend regime. At the same time, the optimization of the previous organizational processes in perioperative management was evaluated. For the period 2015 to 2018, we analyzed and gradually optimized the procedures of our intravitreal injection therapy in a survey with a specialized service provider.Through the analysis of the original processes, the patient appointment was optimized, work processes were summarized, spatially reorganized and there was only a slight increase in the number of staff involved compared with the significant increase in the number of injections. Through these measures, the total in-hospital-time of the patients could be drastically reduced and at the same time the number of patients on one operation day could be multiplied.In the context of chronic treatment with intravitreal injections, the care of an increased number of patients is a logistical challenge. By optimizing processes, existing resources can be better used to meet the increased demands. An optimized system offers the patient greater adherence and a better visual outcome largely independent of the medication used.Die Behandlung eines Makulaödems mittels intravitrealer Injektionen hat die Behandlung der assoziierten Krankheitsbilder in der Augenheilkunde revolutioniert. Abgesehen von einigen wenigen Ausnahmen handelt es sich jedoch um eine chronische Behandlung, bei der die Patienten viele Injektionen benötigen und i. d. R. über Jahre in Behandlung bleiben müssen. Die Adhärenz der Patienten und die Steuerung des Patientenflusses ist mit entscheidend für den Behandlungserfolg. In diesem Manuskript beschreiben wir die Entwicklung eines patientennahen Organisationsmanagements für intravitreale Injektionen in einer Universitätsklinik.Im Jahr 2015 wurde in unserer Klinik die intravitreale Behandlung auf das Treat-and-Extend-Regime umgestellt. Zugleich erfolgte die Evaluation der Optimierung der bisherigen Organisationsabläufe im perioperativen Management. Für den Zeitraum 2015 bis 2018 haben wir im Rahmen einer Erhebung mit einem spezialisierten Dienstleister die Abläufe unserer intravitrealen Injektionstherapie analysiert und schrittweise optimiert.Durch die Analyse der ursprünglichen Abläufe wurde die Patienteneinbestellung optimiert, Arbeitsabläufe wurden zusammengefasst sowie räumlich neu geordnet und es fand eine verglichen mit der deutlichen Erhöhung der Injektionszahlen nur geringfügige Erhöhung der beteiligten Mitarbeiterzahl statt. Durch diese Maßnahmen konnte sowohl die Gesamtaufenthaltszeit der Patienten deutlich reduziert werden als auch zugleich die Patientenzahl bei guter Adhärenz und guten Visusergebnissen an einem Operationstag vervielfacht werden.Im Rahmen der chronischen Behandlung mittels intravitrealer Injektionen ist die Versorgung einer gestiegenen Anzahl an Patienten eine logistische Herausforderung. Durch Optimierung von Abläufen können vorhandene Ressourcen besser genutzt werden, um den gestiegenen Anforderungen gerecht zu werden. Ein optimiertes System bietet für den Patienten eine höhere Adhärenz und ein besseres Visusergebnis weitgehend unabhängig von dem verwendeten Medikament.

Purpose To evaluate the real-world effectiveness of intravitreal aflibercept injections in Germany in patients with neovascular age-related macular degeneration over 24 months. Methods PERSEUS was a prospective, non-interventional cohort study. The primary endpoint was the mean change in visual acuity (VA) from baseline. Secondary endpoints included the proportion of patients with a VA gain or loss of ≥ 15 letters and the frequency of injections and examinations. Patients with regular (bimonthly after 3 monthly injections during year 1 and ≥ 4 injections in year 2) and irregular (any other) treatment were analyzed. The last observation carried forward (LOCF) and the observed cases (OC) approach was applied for primary endpoint analysis to account for missing data. Results 803 patients were considered for effectivity analysis. At month 24, only 38% of the patients were still under observation. The LOCF population included 727, the OC population 279 patients. Treatment-naïve patients improved by 6.3 (LOCF)/8.1 (OC) letters with regular treatment over 24 months but only by 3.3 (LOCF)/3.1 (OC) letters with irregular treatment. The proportion of treatment-naïve patients achieving a VA improvement of ≥ 15 letters was similar between regularly and irregularly treated cohorts. However, considerably more patients in the irregular cohorts experienced a VA worsening of ≥ 15 letters than in the regular cohorts (LOCF: 18.7% vs. 7.4%). Conclusions Regular IVT-AFL treatment resulted in better VA outcomes than irregular treatment at month 24. However, only a minority of patients received regular treatment over a 2-year period.

Introduction: The evaluation of retinal vessels and the retinal blood flow is important for ocular diseases. We introduce a spectral domain optical coherence tomography (SD-OCT) based method for facilitating a retinal blood vessel analysis using the scattering properties of retinal vessels. The intensity of the distal shadow of vessels caused by the scattered signal is measured, correlated with the pulsatile ocular blood flow (POBF), and its repeatability is analyzed.Methods: About 20 eyes of 20 healthy, young participants (mean age 23.15 years, standard deviation 2.3 years) were included in the analysis. Participants underwent ophthalmic diagnostics including three repeated SD-OCT examinations and measurement of POBF. The vessel shadow intensity analysis is based on peripapillary SD-OCT scans and automatically analyses the intensity of the distal vessel shadow compared to its surroundings.Results: The distal shadow of arteries in SD-OCT scans correlated with the POBF (r = 0.647, p = 0.002). Furth...

Purpose To explore real-world effectiveness of intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration (nAMD) in Germany. Design A 24-month, prospective, noninterventional, noncontrolled, multicenter observational cohort study. Participants Patients (n = 848) with nAMD treated with IAI. Methods Patients (n = 988) were screened at 67 study sites. Therapeutic decisions were made by the treating physician. Primary end point analysis was performed after 12 months for the entire study cohort and for predetermined subgroups of treatment-naive and previously treated patients. Additionally, outcomes with regular injection intervals (bimonthly after 3 monthly injections) were compared with those of patients with irregularities in their treatment regimen. Main Outcome Measures The primary end point was the mean change in visual acuity (VA) from baseline after 12 months. Other key end points included the proportions of patients gaining 15 letters or more and patients with reading vision (≥70 letters). Furthermore, the number of injections, anatomic measurements, and safety data were recorded. Results Mean ± standard deviation VA improvement was 5.3±17.4 letters in treatment-naive patients and −0.1±15.6 letters in previously treated patients (P ≤ 0.0001), and that of the total study group was 2.9±16.8 letters. Baseline VA was 53.4±17.9 letters for treatment-naive patients, 52.9±18.4 letters for previously treated patients, and 53.2±18.1 letters for the total patient population. Treatment pattern was associated with VA outcome: best outcomes—an average VA gain of 8.0±17.7 letters—were seen in treatment-naive patients in the regularly treated population, whereas irregularly treated, treatment-naive patients achieved a mean VA gain of only 4.0±17.1 letters. Among previously treated patients, regular treatment also was associated with better outcomes (+3.1±10.7 vs. −1.1±16.8 letters). For the total study group, the mean VA gain was the following: regularly treated population, 6.1±15.6 letters; irregularly treated population, 1.5±17.1 letters (P = 0.008). No cases of endophthalmitis were observed during the first 12 months of the study. Adverse events were in line with the known safety profile of IAI. Conclusions After 12 months of treatment with IAI, treatment-naive patients showed substantial functional benefit, whereas previously treated patients maintained their VA. With regular IAI treatment, it seems that similar results as those in pivotal IAI studies can be achieved in routine clinical practice.

Zusammenfassung Hintergrund Die hochauflösende optische Kohärenztomografie (OCT) ermöglicht eine kontrastreiche Bildgebung von Mikrostrukturen, die mit konventioneller Bildgebung nicht so detailliert darstellbar waren. Wir berichten über unsere Erfahrungen beim Einsatz der intraoperativen OCT (iOCT) in der vitreoretinalen Chirurgie. Methoden 110 Patienten mit vitreoretinalen Erkrankungen (Makulaforamen, epiretinale Membranen, vitreomakulärem Traktionssyndrom, Ablatio und Glaskörperblutung) wurden unter Visualisierung mit dem im Mikroskop integrierten iOCT-Gerät operiert. Ergebnisse Das iOCT liefert durch die Integration von Mikroskop und SD-OCT eine sofortige Visualisierung der „Region of Interest“ (ROI). Der Operateur erhält neben dem Mikroskopbild die intraoperative Darstellung aller Netzhautschichten, des Glaskörpers sowie der Instrument-Gewebe-Interaktion in Echtzeit und kann diese intraoperativ sofort verfügbare Information für die chirurgische Strategie nutzen. Schlussfolgerung Bisher ist das iOCT nur als Standmikroskop erhältlich, es besitzt keine Messfunktion, keine Tracking-Funktion, und die Metallinstrumente verdecken den Scan. Künftig könnten transparente Instrumente, Tracking-Funktionen, ein Autofokus sowie eine noch bessere Auflösung eine optimierte, lückenlose, hochauflösende intraoperative OCT-Diagnostik in Echtzeit erlauben.

We aimed to evaluate the neuroprotective efficacy of rasagiline in pseudophakic patients who had surgery for macula-off rhegmatogenous retinal detachment (RRD). This was a 6-month, prospective, randomized, double-blind, placebo-controlled pilot study. Patients presenting with acute macula-off RRD were recruited and randomized 1:1 to receive rasagiline 1 mg/day or placebo for 7 days. Best-corrected visual acuity (BCVA) and optical coherence tomography were acquired 1 day before as well as 2 days, 3 weeks, 3 months and 6 months after surgery. We screened 26 patients with RRD whereof 23 were eventually included and randomized. The primary outcome was final BCVA. Secondary outcomes included central retinal thickness (CRT) and adverse events (AE). We evaluated photoreceptor cells (prc) recovery through morphological measurements. The baseline characteristics were comparable between groups. BCVA significantly improved in both groups (letters gained: rasagiline 61.5 ± 18.1 vs placebo 55.3 ± 29.2, p = 0.56), but no significant inter-group difference was found at any visit. CRT was stable 3 weeks after surgery onwards, with no inter-group difference. No treatment-emergent AE occurred. Significant prc restoration was observed from 3 weeks to 6 months after surgery, without inter-group difference at either visit. Ellipsoid zone integrity (β = 0.517, p = 0.008) and foveal bulge (β = 0.387, p = 0.038) were significant predictors of good final BCVA. In conclusion, perioperative oral treatment with rasagiline 1 mg/day for 7 days did not show significant benefits on visual or anatomical outcomes in macula-off RRD patients.

Background Intravitreal injections are a mandatory treatment for macular edema due to nAMD, DME and RVO. These chronic diseases usually need chronic treatment using intravitreal injections with anti-VEGF agents. Thus, many trials were performed to define the best treatment interval using pro re nata regimes (PRN), fixed regimes or treat-and-extend regimes (TE). However, real-world studies reveal a high rate of losing patients within a 2-year interval of treatment observation causing worse results. In this study we analyzed retrospectively 2 years of real-world experience with an individualized treat-and-extend injection scheme. Methods Since 2015 our treatment scheme for intravitreal injections has been switched from PRN to TE. Out of 102 patients 59 completed a follow up time of 2 years. Every patient received visual acuity testing, SD-OCT and slit lamp examination prior to every injection. At each visit an injection was performed and the treatment interval was adjusted mainly on SD-OCT based morphologic changes by increasing or reducing in 2-week steps. Individual changes of the treatment protocol by face-to-face communication between physician and patient were possible. Results After 1 year of treatment visual acuity gain in nAMD was 7.4 ± 2.2 ETDRS letters (n = 34; injection frequency: 7.4 ± 0.4) respectively 6.1 ± 4.7 in DME (n = 9; injection frequency: 8.4 ± 1.1) and 9.7 ± 4.5 in RVO (n = 16; injection frequency: 7.6 ± 0.5). After 2 years of treatment results were as following: nAMD: visual acuity gain 6.9 ± 2.1 (injection frequency: 12.6 ± 0.7); DME: 11.1 ± 5.1 (injection frequency: 14.0 ± 1.0); RVO: 7.5 ± 5.0 (injection frequency: 11.2 ± 0.9). Planned treatment exit after 2 year was achieved in 29.4% of patients in nAMD (0% after 1 year); 0% in DME (0% after 1 year); and 31.3% in RVO (0% after 1 year). Patients’ persistence was 94.1% during the follow-up. Conclusion Using a consequent and individualized TE regime in daily practice may lead to a high patients’ persistence and visual acuity gains nearly comparable to those of large prospective clinical trials. Crucial factors are face-to-face communication with the patient as well as a stringent management regime. At this time TE may be the only instrument for proactive therapy which should therefore be regarded as a first-line tool in daily practice.

ZusammenfassungDas Ziel dieses Artikels ist es, einen Überblick zu geben über verschiedene Strategien zur Verwendung von PRN- und T&E-Therapieschemata (PRN: pro re nata; T&E: treat and extend) mit intravitrealen Anti-VEGF-Medikamenten (Bevacizumab, Ranibizumab oder Aflibercept) bei Patienten mit Netzhauterkrankungen wie neovaskulärer AMD, diabetischem Makulaödem und Makulaödem aufgrund von retinalen Venenverschlüssen. Der Schwerpunkt liegt dabei darauf, die Wirksamkeit und die Visusergebnisse des PRN- und des T&E-Regimes in Korrelation mit den wichtigsten Zulassungsstudien und Studien basierend auf den derzeit verfügbaren Daten vorzulegen. Wir diskutieren auch die Vor- und Nachteile der beiden Therapieregimes sowie die Überwachung und Behandlung der Krankheitsaktivität einschließlich der Behandlungsintervalle und Injektionsfrequenz. Derzeit gibt es ein zunehmendes Interesse, ein Regime zu etablieren, das die besten Visusergebnisse bei reduzierter Injektionsfrequenz und konsekutiv geringerer Belastung der Patienten durch individualisierte Behandlungsintervalle mit Minimierung der Anzahl der Klinikbesuche und der entstehenden Kosten bietet. Studien haben gezeigt, dass das PRN-Regime im realen Klinikalltag keine optimalen Visusergebnisse liefert. PRN erfordert häufige Arztbesuche, um den Krankheitsstatus zu kontrollieren und intravitreale Behandlung bei Bedarf reaktiv zu indizieren. Individualisierte T&E-Regimes können das Visusergebnis mit signifikant weniger Kontrolluntersuchungen verbessern im Gegensatz zu Therapieschemata mit einer monatlichen Applikation oder einem PRN-Regime.

Vorgestellt wird eine Methode zur Messung und Visualisierung des Patientenflows komplex strukturierter Augenambulanzen. Zugrunde liegt eine hierfur programmierte netzwerkbasierte Software mit den Zielen der Prozessoptimierung und der zeitlich strukturellen Abstimmung der Prozesse aufeinander. Jede Untersuchungseinheit erhielt eine separate Warteliste, in der zu jedem Patienten der Patientenflow auf einer Timeline aufgezeichnet wurde. Von der Warteliste ausgehend, wurden Zeitraume und Zeitpunkte per Mausklick aufgezeichnet und Auftrage zur Diagnostik erteilt. Auserdem wurde uber ein Signal mitgeteilt, wann eine Oberarztabnahme gewunscht war. Hierbei wurden Feedbackschleifen verwendet, die zu jeder Zeit fur alle involvierten Instanzen innerhalb der Ambulanz den aktuellen Progress der Patienten sichtbar machten. Die praktische Anwendbarkeit wird bereits seit wenigen Monaten erfolgreich getestet. So konnte z. B. bei Aufzeichnungen des Patientenflows von 250 Vorstellungen zu intravitrealen Injektionen eine durchschnittliche Anwesenheitszeit von 169,71 min gezeigt werden, wobei auch automatisch eine zeitliche Erfassung von Teilschritten erfolgte. Langfristig bilden die Aufzeichnungen der Daten zum Patientenflow eine Basis, um Patienten zeitgerecht durch die vielschichtigen Untersuchungen einer Universitats-Augenpoliklinik zu fuhren und Wartezeiten zu reduzieren sowie den Einfluss einzelner Umstrukturierungen innerhalb einer Ambulanz zu untersuchen. Da die Einfuhrung der Software selbst mit einem Strukturwandel einhergeht, ist auch ein Fragebogen fur die involvierten Mitarbeiter geplant.

Hintergrund Wahrend die intraoperative optische Koharenztomographie (iOCT) im Bereich der Makulachirurgie oder der lamellierenden Keratoplastiken einen sichtbaren Vorteil bringen kann, ist ihr Einsatz bei der Ablatiochirurgie bisher mit unklarem Nutzen verknupft.

Spectral domain optical coherence tomography (SD-OCT) has become a standard diagnostic tool in the surgical management of vitreomacular interface disorders. The high-resolution cross-sectional information obtained from SD-OCT is a perfect complement to vitreoretinal surgery. It provides detailed intraoperative anatomical views that are not possible with a microscope.To investigate the value of intraoperative real-time OCT with respect to improvement of surgical techniques in the management of vitreomacular disorders.A review of the current literature was conducted and an analysis of own systematically evaluated data was included to provide a comprehensive overview of potential applications for the clinical use of intraoperative real-time OCT in macular surgery.Intraoperative real-time OCT can provide detailed visualization of epiretinal membranes and help to identify whether complete membrane removal has been achieved following surgery. In addition, it can provide qualitative and quantitative information that has previously not been available and assist in surgical decision-making. Intraoperative real-time OCT allows membrane peeling to be performed in selected cases without using retinal dyes, whereas it is not ideal for accurately guiding the surgeon while performing maneuvers.Intraoperative real-time OCT provides high-resolution visualization of the effects of surgical maneuvers on the microarchitecture of the retina and surrounding tissues and will fill a gap in the understanding of the pathophysiology and prognostic factors of vitreomacular disorders; however, with currently available systems, accurate intraoperative real-time guidance of surgical maneuvers is hindered by several limiting factors.

Bacterial orbital cellulitis is a life-threatening infection of the postseptal orbital tissue. It can occur in the context of sinusitis, particularly in children and adolescents. Ocular complications include exposure keratopathy, increased intraocular pressure, occlusion of the central retinal artery or vein and optic neuropathy. Rarely, a subperiosteal abscess can occur, and osteomyelitis can lead to spread of the infection to the cerebrum. A rapid diagnosis and targeted therapy are essential for saving the eye as well as the life of the patient.

Purpose To investigate 12-month outcomes of conversion to aflibercept in patients with neovascular age-related macular degeneration resistant to ranibizumab. Methods Twenty-two eyes of 19 consecutive patients received 3 monthly aflibercept injections followed by a pro re nata protocol. Spectral-domain optical coherence tomography (OCT) images were obtained before each injection. All 49 cross-sectional OCT B-scans obtained in each examination were investigated and the largest choroidal neovascularization (CNV) size was chosen. The same cross-sectional B-scan sections containing the maximum CNV size were used during the follow-up. Results After 12 months, best-corrected visual acuity increased from 45.68 ± 20.25 to 59.09 ± 17.50 Early Treatment Diabetic Retinopathy Study letters (p2 (p = 0.003), and macular volume improved from 9.64 ± 1.75 to 8.45 ± 0.98 mm3 (pConclusions Visual and anatomic improvement were obtained after conversion to aflibercept.

Background and Objectives To evaluate the changes in the size of choroidal neovascularization (CNV) lesion using spectral domain-optical coherence tomography (SD-OCT) in patients with treatment-resistant neovascular age-related macular degeneration (AMD) who were switched from ranibizumab to aflibercept. Materials and Methods In this prospective case-series, 33 eyes of 30 patients with treatment-resistant neovascular AMD were included. Treatment-resistant neovascular AMD was defined as choriodal neovascularization secondary to AMD determined by subretinal fluid and/or intraretinal fluid/cysts after more than 6 months of monthly ranibizumab therapy. Enrolled eyes were received intravitreal aflibercept injections at weeks 0, 4, and 8. Maximum area of CNV lesion in the cross-sectional area in the B-scan was measured using Heidelberg Eye Explorer software. The same cross-sectional sections containing maximum area of CNV lesion were used during the follow-up. CNV subtypes were determined based on fluorescein angiography images prior to ranibizumab therapy. Main outcome measures were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), and area of CNV lesion. Results There were five classic (15%), seven minimally classic (21%), and 21 occult subtypes of CNV (64%). Four weeks after the third injection, BCVA improvement and reduction of the retinal thickness in nine standard ETDRS subfields were significant (both P

The transforming growth factor-beta (TGFB) plays an essential role in the pathogenesis of some ophthalmologic diseases, including neovascular age-related macular degeneration (nAMD) and proliferative vitreoretinopathy (PVR). TGFB activates the transcription factors SMAD2 and SMAD3 via the TGFB receptor, which together activate several genes, including VEGFA. TGFB treated ARPE-19 cells show an increased proliferation rate and undergo epithelial to mesenchymal transition (EMT). Since microRNAs (miRNAs) are capable of inhibiting the translation of multiple genes, we screened for miRNAs that regulate the TGFB signalling pathways at multiple levels. In this study, we focused on two miRNAs, miR-302d and miR-93, which inhibit TGFB signalling pathway and therefore TGFB-induced EMT transition as well as VEGFA secretion from ARPE-19 cells. Furthermore, we could show that both miRNAs can retransform TGFB-stimulated mesenchymal ARPE-19 cells towards the morphological epithelial-like state. Taken together, transient overexpression of these miRNAs in RPE cells might be a promising approach for further translational strategies.

Bernd Junker,1 Jens F Jordan,2 Carsten Framme,1 Amelie Pielen1 1University Eye Hospital, Medical School Hannover, Hannover, 2Eye Center, Medical Center, University of Freiburg, Freiburg, Germany Importance: This study is the first description of the use of the intraoperative optical coherence tomography (iOCT) for trabecular meshwork surgery with the Trabectome in a regular clinical setting.Background: The aim of this study is to evaluate intraoperatively the immediate success of ab interno trabeculotomy with the Trabectome defined as a removal of the trabecular meshwork.Design: This is a retrospective clinical study performed in the University Eye Hospital, Medical School Hannover.Participants: A total of nine consecutive Caucasian patients suffering from primary open angle glaucoma, pigment dispersion glaucoma, or pseudoexfoliation glaucoma took part in the study.Methods: All patients underwent ab interno trabeculotomy surgery with the Trabectome using a commercially available iOCT to visualize the anterior chamber angle (ACA) before and after the procedure. The visualization was done using a modified Swan-Jacobs lens (all nine patients) or without lens (view from above, five patients).Main outcome measures: The main outcome of this study is the success of visualization of the ACA on iOCT, especially the postprocedural visualization of the wound gap after removal of the trabecular meshwork.Results: Using the view from above, the ACA could be visualized before and after the procedure in only two of the five cases. Using the modified Swan-Jacobs lens, the ACA could be visualized before the procedure and the trabecular meshwork opening after the procedure in all nine patients.Conclusion: The iOCT can be used to objectify the immediate success of the surgical procedure, ie, the removal of the trabecular meshwork, of ab interno trabeculotomy with the Trabectome. The procedure itself cannot be captured sufficiently via iOCT. Keywords: glaucoma, imaging, iOCT, trabecular meshwork surgery

PURPOSE Modifications in ocular blood flow may play a significant role in glaucoma development. Optical coherence tomography angiography (OCT-A) is based on the detection and analysis of the reflection behaviour of motion in a static environment and therefore is able to quantify the retinal flow density. We used this new technology to examine the density of the active flow vasculature in the macular area in glaucoma patients compared to healthy patients. METHODS Thirty patients with primary open-angle glaucoma (mean age: 72.6 ± 7.1 years) and 21 healthy patients (mean age: 70.3 ± 8.6 years) were recruited. Patients received perimetry and OCT measurements of the peripapillary retinal nerve fibre layer thickness (RNFLT) and macular retinal thickness and OCT-A of the macular area in the superficial and deep retinal (DR) plexus. Flow density of the OCT-A scan was calculated by binarisation and quantification of the pixel density. RESULTS Macular flow density was globally and nasally reduced in glaucoma patients in the superficial (globally: p = 0.0203; nasally: p = 0.0003) and DR plexus (globally: p = 0.0113, nasally: p

Presentation of a patient with two foreign bodies each 21 cm long in left nasal orbit and penetrating as far as the sinciput. The patient had been knitting at the time of the accident and had probably autonomously thrust the two knitting needles into the left orbit, as assessed by questioning of other parties. The patient had a known history of paranoid schizophrenia and dementia. Central imaging revealed the position of the knitting needles with respect to the intracranial vessels to be threatening. The surgical removal of the knitting needles was carried out without any serious complications, such as intracranial hemorrhage.

PURPOSE To evaluate 3-year follow-up treatment outcomes with ranibizumab (Lucentis(®)) 0.5 mg administered either monthly or quarterly on a pro re nata (PRN) basis according to a disease activity-guided monitoring and treatment algorithm. METHODS A total of 316 treatment-naive eyes of 316 patients with exudative age-related macular degeneration met the criteria for inclusion in this retrospective, interventional case series. Patients were treated with ranibizumab 0.5 mg according to a disease activity-guided algorithm with monthly monitoring. Optical coherence tomography and fluorescein angiography were routinely used to assess disease activity: active lesions were treated with a series of three monthly injections, whereas inactive lesions were treated with quarterly injections. RESULTS Mean Early Treatment Diabetic Retinopathy Study best-corrected visual acuity improved from 52 letters at baseline to 59 letters at 12 months, achieved with a mean of 7.1 injections, 61 letters at 24 months with a mean of 5.0 injections administered in the second year and 60 letters at 36 months with a mean number of 5.2 injections. CONCLUSIONS Monthly visits and a morphology-driven PRN regimen with 3 injections in case of recurrence plus quarterly injections in case of inactive CNV resulted in an average VA gain of 7-9 letters that could be maintained over 3 years.

Visual results in treating neovascular age-related macular degeneration (AMD) using intravitreal injected anti-VEGF (IVT) clearly depend on injection frequency. Regarding to the European approval Ranibizumab has to be used only in cases of recurrent visual loss after the loading phase. In contrast monthly treatment--as also provided in the ANCHOR and MARINA studies--is generally allowed in Switzerland. However, it is commonly tried to reduce the injection frequency because of the particular cost situation in all health systems and of cause also due to the necessary strict monitoring and reinjection regimes, which raise management problems with increasing patient numbers. In this article the special treatment regimes of our University Eye Hospital is presented, in which a reduced injection frequency basically leads to the same increased and stable visual results as in ANCHOR and MARINA; however, needing significantly more injections as generally provided in other countries of Europe. The main focus for achieving this in a large number of patients is placed on re-structuring our outpatient flow for IVT patients with particular emphasis on patient separation and standardisation of treatment steps leading to significantly reduced time consumption per patient. Measurements of timing and patient satisfaction before and after restructuring underline its importance in order to be able to treat more patients at a high quality even in the future. The exceptional importance of spectral domain OCT measurements as the most important criterium for indicating re-treatment is illustrated.

To observe the excursions of short-term intraocular pressure (IOP) after 20-G pars-plana vitrectomy (ppV).In a prospective study, 851 patients (age: mean 63 ± 15 years) underwent unilateral ppV for various vitreoretinal diseases using different endotamponades [Balanced Salt Solution (BSS) 33.1%, Air 7.2%, SF(6) 33.6%, silicon oil 5000 cst 26.1%]. Intraocular pressure was measured in all patients before and at 3, 6, 24 and 48 hr after surgery. Survival analysis was performed to determine the cumulative hazard of IOP changes depending on endotamponade and time point after ppV (Log-Rang - Mantel Cox; p0.0001). At baseline, IOP ranged from 0 to 50 mmHg (mean IOP: 15.3 ± 5.3 mmHg). Mean IOP after surgery revealed a slight elevation (3 hr: 16.5 ± 11.0 mmHg; 6 hr 16.9 ± 9.8 mmHg; 24 hr 19.7 ± 8.0 mmHg; 48 hr 17.3 ± 6.2 mmHg; range: 0-64 mmHg). Silicon oil filling revealed highest mean values at already 3 hr after surgery (21.8 mmHg). Also, BSS filling showed a peak after 3 hr; however, mean values were lower. Equivalent high IOP values as for silicon oil tamponade were found for gas filling; however, maximal peak was reached after 24 hr but not after 3 hr post-treatment. The cumulative hazard in all patients to reach IOP ≥ 30 mmHg after 24 hr was 23.9%; (IOP ≥ 40 mmHg = 8.2%). Herein, oil filling revealed highest risk at all time points after surgery. The risk of suffering from IOP5 mmHg lasting longer than 6 hr was only 1.2% after 20 G vitrectomy.Intraocular pressure measurements after ppV are important to prevent unintentional high IOP, especially within the early phase (3 hr post-treatment) in eyes with silicon oil filling. Gas filling leads to prolonged IOP increase (24 hr post-treatment). Long-lasting hypotony (≥ 6 hr) is very rare after 20G vitrectomy.

Purpose: To assess the interobserver variability (IOV) in indicating retreatment for neovascular Age-related macular degeneration 4 weeks after three Ranibizumab loading doses using spectral domain OCT (SD-OCT) as the primary objective diagnostic tool. Material and methods: Four observers decided for or against 4th Ranibizumab injection in 108 patients by six different rating rounds (RR) based on the SD-OCT findings after the loading doses. Postoperative OCT images were supplemented consecutively with information from a chart review as the ‘patients subjective estimation of vision (SE)’, the course of best-corrected visual acuity (BCVA) and the preoperative OCT as well as all information collectively. Agreement rates (AR) and Kappa statistics were calculated. Results: Based on post-treatment OCT findings only (RR1), mean reinjection rate of all observers was 37.5%. Adding supplementary information, mean reinjection rate decreased to 20% when all information was available reflecting the ‘real’ situation (RR 6). Interobserver agreement rates varied from 66.7% to 90.7% depending on rating rounds and interobserver pairs. Mean AR and Kappa values (KV) were as following: AR 81.6%, KV 0.61 (RR1: ‘only post-OP OCT’); AR 76.7%, KV 0.33 (RR2: post-OP OCT + SE); AR 80.3%, KV 0.45 (RR3: post-OP OCT + BCVA); AR 80.7%, KV 0.46 (RR4: pre- and post-OP OCT); AR 82.2%, KV 0.49 (RR5: post-OP OCT + SE + BCVA); and finally AR 83.6%, KV 0.47 (RR6: pre- and post-OP OCT + SE + BCVA). The overall mean agreement rate was 80.9% with a Kappa of 0.47. Conclusion: IOV for indicating retreatment after three Ranibizumab loading doses reveals only moderate agreement in Kappa statistics, which seems to be too low considering the high costs for retreatments. More concise guidelines based on the post-treatment OCT scans as the presumably most sensitive and noninvasive objective tool to follow choroidal neovascularization activity by judging the course of sub- and intraretinal fluid are necessary.