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Background: In medical studies digital learning is often achieved by the use of learning management platforms, such as Ilias. Lecture presentations and organizational documents are typical contents. Students use multiple, mostly external learning options for acquisition of knowledge and competences. We present our updated ophthalmology e‑learning environment for medical students and its evaluation., Objective: Evaluation of an ophthalmology e‑learning platform for medical students, which considers prevalent learning habits., Material and Methods: The platform should provide and link a selection of internal and external learning resources following anatomical structures of the eye. For every subject area the platform provides a text with essential matters, clinical cases, lecture presentations, multiple choice questions for practice, links to corresponding chapters of a textbook and the appropriate AMBOSS learning cards (Amboss GmbH, Berlin, Germany). At the end of the semester an evaluation of the platform was carried out. Different statements were rated by the students on ordinal scales and analyzed., Results: The platform was rated with 1.47 ± 0.54 (mean ± standard deviation; n = 107) on a German school grade scale (1 = best, 6 = worst). It was perceived as helpful for the individual learning with 1.62 ± 0.77 (1 = very helpful, 7 = not helpful at all). The structuring of the internal and external learning resources was rated as very good 1.44 ± 0.66 (1 = very good, 7 = very bad). The median for subjective amount of usage was 1-5 h (ordinal scale <1, 1-5, 6-10, 15-20, >20 h)., Conclusion: It appears to be meaningful to specifically link external learning resources corresponding to the own curricular structure in order to provide medical students with a modern basis for learning in ophthalmology., (© 2021. The Author(s).)

Background: Autonomous diagnosis and assessment of medical emergencies are important skills to acquire for medical students. Ophthalmology features certain specialty-specific "red flag" signs and symptoms, which pose a challenge for educators in ophthalmology. To support medical students in identifying those "red flags" we developed and implemented interactive cases for our e‑learning platform., Material and Methods: A total of seven interactive cases with key feature problems regarding potentially dangerous signs and symptoms, such as painless loss of vision or red eye were developed. Medical students were guided through a case and performed formative assessments. The interactive cases were created with e‑learning authoring software and were available on the learning management system presence of the department of ophthalmology. They were mandatory for medical students in the ophthalmology course. Students evaluated the cases after the course., Results: The interactive cases were rated on average at 1.51 ± 0.68 (mean ± standard deviation; n = 163) on a grade scale (1 = best, 6 = worst). On a Likert scale they were perceived as helpful for individual learning at 1.60 ± 0.81 (1 = very helpful, 7 = not helpful at all; n = 164). The information provided on the cases and selection of scenarios was positively evaluated., Conclusion: To support students in identifying and managing ophthalmic emergencies in the context of limited time in tightly packed curricula, interactive key feature cases can be part of corresponding e‑learning resources. An integration of such cases was evaluated as desirable., (© 2021. The Author(s).)

Background: Practical contents are gaining in importance in medical curricula in Germany. In times of a lack of applicants, practical courses provide an increased level of interest for students in the respective disciplines. A practical appeal of ophthalmology is microsurgical procedures. A microsurgical suture wet lab can be an introduction for medical students., Objective: Assessment of the increased interest in ophthalmology through evaluation of a suture wet lab course, including suturing under a microscope., Material and Methods: The data were obtained from the practical course in ophthalmology during the sixth semester for medical students at the university medical center in Mainz in April 2019. In a questionnaire developed in collaboration with the Center for Quality Assurance and Development various statements had to be answered and evaluated using ordinal scales., Results: A total of 64 evaluation questionnaires from 8 groups each with 8 medical students supervised by different tutors were analyzed. The wet lab was rated with 1.24 ± 0.5 (mean ± SD) on a German school grade scale (1 = best, 6 = worst). There was agreement (1 = total agreement, 7 = total disagreement) concerning the desire for further microscopic wet labs (1.86 ± 1.28) as well as learning more ophthalmological surgical techniques (2.02 ± 1.13). The interest in ophthalmology (1 = very high interest, 7 = very low interest) increased from 3.66 ± 1.55 before the course to 2.52 ± 1.00., Conclusion: Interest in ophthalmology can be increased through a microsurgical wet lab. The interest of students can therefore be awakened, which can have advantageous effects in job application situations and in research work. In this way experience and practical skills in ophthalmology can already be acquired during medical studies.

The needs-based provision of medical services to the population represents a challenge for ophthalmology, not least as eye diseases become more frequent with age. Age-related macular degeneration, glaucoma, diabetic retinopathy and cataract occur particularly often. So far only few current population-based data have been available in Germany; however, this is currently changing with several ongoing population-based cohort studies, such as the Gutenberg Health Study, the National Cohort and the Rhineland Study. Preliminary data from the Gutenberg Health Study show that the expected increase in the prevalence of eye diseases with ageing has occurred and the development is comparable with international data from industrial countries. Over the last 15 years age-related eye diseases have increased by 15-34% due to demographic changes. The number of ophthalmologists increased during this period by 19%; however, as an ever increasing proportion do not work full time, the treatment time in ophthalmology only increased by 1%. Particularly in the working relationship of private practice employees, more ophthalmologists are now working than 15 years ago, the majority in part-time employment, whereas the number of self-employed ophthalmologists has declined. For ophthalmological care planning it is important to consider not only the age-related increase in patients but also the changes in treatment capacity, which cannot be solely derived from the absolute number of actively involved ophthalmologists.

Introduction: Eye diseases causing visual impairment increase with age. Thus, seeking eye care has a higher probability in older people. In this study, the rate of utilization of outpatient eye care services in Germany was analyzed. The analyses focused on older persons and persons in need of either home-based or facility-based long-term care., Methods: A descriptive secondary data analysis of health insurance data of the AOK Baden-Württemberg from 2016 was conducted. The study population comprised all insured persons on 1 January 2016. The cohort of older persons (60 years+) was further stratified by the type of care (home-based/facility-based) and the level of care (0-3). The utilization of outpatient eye care services was defined by the reimbursement for an ophthalmologist's provision of service., Results: While 39.3% of the study population 60+ years old sought eye care, the utilization rate was lower among people in need of home-based (33.0%) and facility-based care (19.3%). The utilization rates showed comparable age-dependent patterns, except for persons in need of facility-based care where rates were similar for all age groups. Utilization rates were negatively associated with increasing care levels. Only people with care level 0 showed lower utilization rates than people with care level 1., Discussion: Utilization rates of eye healthcare services among older persons are considerably influenced by the need of long-term care, by the form of care as well as by the level of care.

Introduction: Individual health services (ihs) have gained importance in the German health-care system. This article describes the economic impact and the daily practice of individual health services from the perspective of ophthalmologists., Methods: An online survey to examine the role of individual health services in ophthalmology was sent to the members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists in Germany (BVA). 1,361 ophthalmologists (one fifth of all ophthalmologists in Germany) responded to the poll., Results: 87.5 % of the ophthalmologists agree that the quality of ophthalmic care could suffer if the necessary individual health services were not performed. 78.9 % consider individual health services to be financially feasible for the patient. 65.6 % responded to be hardly able to survive economically without individual health services. For approximately half of the ophthalmologists, individual health services represent more than 10 % of their overall income. 57.5 % wish to abolish individual health services and to extend the service catalogue of the statutory health insurances., Discussion: In contrast to official reports about the benefit from individual health services, the ophthalmologists do see a medical need for individual health services. Obviously there is a discrepancy in the perspective between health insurers and ophthalmologists., (Georg Thieme Verlag KG Stuttgart · New York.)

This article describes the role of outcomes and health services research in the field of ophthalmology in Germany. First, the need for more information and data on the performance of ophthalmic care in Germany is explored. The concept, goals and methods of outcomes and health services research are explained and illustrated by examples of already existing research projects in ophthalmology. Future topics for research projects are highlighted. The article also describes how the field of outcomes and health services research can become a more important part within the scientific ophthalmological community in Germany.

Purpose: To identify and describe the most relevant obstacles to carrying out ophthalmic research in Germany., Methods: Two research methods were used to assess current problems in ophthalmic research. First, 55 expert interviews were conducted with major stakeholders in ophthalmic research, and key problems were identified. An online questionnaire was then sent to 3,080 German ophthalmologists, of whom 927 responded by evaluating the current research situation within ophthalmology in Germany. We devised a score to rank areas of concern by multiplying the responders' rate, ranging between -3 ('I disagree completely') and +3 ('I fully agree'), with the percentage of response frequencies. The maximum possible score was 300., Results: The lack of opportunities to combine clinical work and research (score: 231.8) as well as unattractive career perspectives (175.7) were identified as the most relevant problems. Further barriers were difficulties in acquiring research funds (155.7), organizational problems at the local level (143.7) and a lack of support for women (24.1; among women: 122.3). Potential improvement was expected in particular from exemption from clinical work for scientific purposes; this was found to be more appealing than more prestigious awards for research achievements. A widely held position was that research projects should focus more closely on common eye diseases, and that vision research needs a more prominent profile among politicians and in the public arena., Conclusion: Our findings may help to initiate improvements in both research performance and outcomes.

Background: The main objectives of this analysis were to assess the treatment costs and to identify major cost drivers and factors predicting direct costs in German patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG)., Methods: This non-interventional cross-sectional study was conducted in two university hospitals and 13 ophthalmology practices in Germany regions (Bavaria, Rhineland-Palatinate, North Rhine-Westphalia, Hamburg and Mecklenburg-Western Pomerania) between May 2009 and January 2010 to assess resource utilisation in patients with OHT (ICD-10: 40.0) or POAG (ICD-10: 40.1) at early, moderate or advanced stages, according to the European Glaucoma Society classification Guidelines. Treatment patterns and direct costs were evaluated retrospectively for 5 years. Resource utilisation data (medication, hospitalisation, outpatient surgery, visits to ophthalmologists) were abstracted from the charts, and unit costs were applied to estimate direct costs per year (in Euros, 2009), calculated from the perspective of the statutory health insurance in Germany (Gesetzliche Krankenversicherung). Factors predicting costs were assessed in multivariate regression analysis., Results: One hundred and fifty-four patients (17.5% OHT, 27.9% early, 22.7% moderate, and 31.8% advanced POAG), on average 67 years old (SD 11) were included in the study. Average total annual direct costs per patient for OHT were 226 (SD 117), for early POAG 423 (SD 647), moderate 493 (SD 385) and advanced POAG 809 (SD 877). Glaucoma-related medications and hospitalisation represented the two major components of direct costs, increasing with the progression of glaucoma. In addition to treatment switches (p = 0.0001), factors predictive of an increase in total direct costs included the number of hospital interventions (p < 0.0001), disease-state changes since the start of treatment (p = 0.05), and current disease state (p = 0.05)., Conclusions: Direct costs of treatment are higher in glaucoma compared to OHT and further increase in more severe glaucoma states. Additional treatment changes are major contributing factors to the increased treatment costs of glaucoma. If intraocular pressure can be controlled over the long term, progression to moderate and advanced states avoided, and patients remain on initial treatments, treatment costs could decline due to reduced and less expensive healthcare resource utilisation.

Background and Purpose: Data on the epidemiology of glaucoma are sparse for Germany. Case registries from the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) can be used to estimate disease prevalence rates for different types of glaucoma and to illustrate the utilization of glaucoma healthcare., Methods: Analysis of healthcare data for suspected glaucoma cases and open angle, angle closure, secondary and other types of glaucoma was carried on the basis of case registries from the Association of Statutory Health Insurance Physicians in Rhineland-Palatine for the year 2010. Glaucoma cases were registered quarterly according to the ICD-10 classification for different glaucoma types (H40.0-H40.9). For the purpose of calculating the prevalence data were adjusted to the population size and compared in different age strata., Results: The estimated prevalence of suspected glaucoma, open angle, angle closure, secondary and other types of glaucoma were 0.55%, 0.97%, 0.06%, 0.10% and 0.64%, respectively, with a higher prevalence in older age groups and women. Most glaucoma cases were diagnosed in the age group between 70 and 79 years and up to 15% of the population within this age group sought glaucoma care. In more than 50% of the glaucoma cases unspecific types of glaucoma diagnosis (suspected glaucoma /other glaucoma) were used., Conclusions: The data from the Association of Statutory Health Insurance Physicians can provide information about the utilization of ophthalmic healthcare and allow estimation of the underlying glaucoma prevalence in the population. The data illustrate weaknesses in the practice of glaucoma diagnosis and indicate the lack of a widely accepted glaucoma definition.

An essential aspect in the cooperation of clinic and biometry consists in designing of studies, e.g. during the preparation of grant applications or for review by official drug surveillance institutions. A central aspect in study planning is the design-adequate and well-documented prediction of sample size, which should be recommended for any intended study. Based on several examples for sample size planning in study designs, which are of common relevance for ophthalmology, guidelines are derived to enable clinical researchers to perform sample size planning on their own. The latter can be based on the various available software packages for sample size prediction.

The Internet has become a powerful, international source for information, and it has shown an exponential growth because of the ease of access and the immediate availability of information. We introduced a new ophthalmological atlas including ICD coding on the World Wide Web. So far, more than 500 lantern slides of typical and interesting ophthalmological findings have been selected and digitized. These pictures were integrated in a data base, which was arranged for ease and speed of search and retrieval. In its background, the data base contains a list of over 4700 ICD-encoded diagnoses to which the picture-documented findings are linked. Comments on pictures can be added by the author or by users. The data base contains several lists, such as a list of ICD codes and diagnoses, a list of all pictures with corresponding diagnoses, a list of all diagnoses and number of pictures, a list of those diagnoses for which the corresponding picture is available, as well as a list of comments on each picture. Special program scripts handle the user's search key words for diagnoses and extract the required information out of the data base, using Windows NT. Search results are presented on an automatically built-up webpage. To provide fast speed of search all pictures initially are shown in a small format (thumbnails) with little amount of data. The related full-size picture is retrieved by a single mouse click. Moreover, the name and institution of the author, diagnostical hints and comments on pictures by the author or by users are offered for each diagnosis available. The Giessen Ophthalmological Picture Atlas can be reached under www.med.unigiessen.de in the Internet. It allows a fast search free of charge from all over the world and, therefore, offers an additional option to obtain specific ophthalmological information for various purposes.

Achim Fieß,1,&ast; Sandra Gißler,1,&ast; Philipp S Wild,2– 4 Karl J Lackner,5 Thomas Münzel,6 Matthias Michal,7 Michael S Urschitz,8 Norbert Pfeiffer,1 Alexander K Schuster1 1Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 2Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 3Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 4German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; 5Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 6Center for Cardiology – Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 7Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 8Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany&ast;These authors contributed equally to this workCorrespondence: Achim Fieß, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany, Tel +49-6131-17-5150, Fax +49-6131-17-8495, Email Achim.fiess@gmail.comAbstract: This study investigates the association between self-reported birth weight (BW) and the prevalence of hypertensive retinopathy (HR) in a large population-based cohort in Germany, as part of the Gutenberg Health Study (GHS). The study involved analyzing fundus photographs of 6855 participants, aged 35 to 74, to assess signs of HR, classified according to the Mitchell-Wong Classification. The research aimed to explore the correlation between fetal growth restriction indicated by BW and the frequency of HR. The results showed that the frequency of HR did not significantly differ among groups with different BW ranges. In the univariable analysis, HR was initially associated with high BW, but this association disappeared after adjusting for age, sex, and cardiovascular risk factors. No association was found between low BW and HR. The study reveals novel insights as there are no prior population-based studies specifically exploring this association.Keywords: birth weight, hypertensive retinopathy, epidemiology, population-based study

Achim Fieß,1 Marilena Brandt,1 Eva Mildenberger,2 Michael Siegfried Urschitz,3 Felix Mathias Wagner,1 Stephanie Desiree Grabitz,1 Esther Maria Hoffmann,1 Norbert Pfeiffer,1 Alexander Konrad Schuster1 1Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 2Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; 3Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyCorrespondence: Achim Fieß, Department of Ophthalmology, Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany, Tel +49-6131-17-5150, Fax +49-6131-17-8495, Email Achim.fiess@gmail.comPurpose: Prenatal growth restriction is associated with impaired neurodevelopment in childhood. This study investigated the effects of being born small for gestational age (SGA) on peripapillary retinal nerve fiber layer (pRNFL) thickness in adults born at term.Methods: A retrospective cohort study was conducted with a prospective ophthalmologic examination of participants born at full-term (gestational age ≥ 37 weeks) between 1969 and 2002. All participants were examined with spectral-domain optical coherence tomography and grouped according to their birth weight in correlation to gestational age as former moderate (birth weight (BW) percentile 3rd to < 10th) and severe SGA (< 3rd percentile), normal (10th-90th percentile, AGA), and moderately (> 90th to 97th percentile) and severely (> 97th percentile) large for gestational age (LGA) adults (18 to 52 years).Results: Overall, 547 eyes of 285 individuals (age 29.9± 9.4 years, 151 females) born at term were included. Multivariable regression analyses revealed a strong association between a lower global pRNFL thickness in the severe SGA (B=− 8.99 [95%-CI: − 12.68; − 5.30] μm; p< 0.001) and in the moderate SGA groups (B=− 6.40 [95%-CI: − 10.29; − 2.50] μm; p=0.001) compared to the reference AGA group.Conclusion: Our results indicate that restricted fetal growth affects neurologic tissue development of the optic nerve head, particularly in individuals born severely SGA at term. This indicates that fetal growth restriction may exert disturbances in the development of neurologic tissue, which persists in adulthood.Keywords: birth weight, small for gestational age, large for gestational age, peripapillary retinal nerve fiber layer, optic nerve head, epidemiology

Juliane Matlach,1 Sandra Bender,2 Jochem König,2 Harald Binder,2,3 Norbert Pfeiffer,1 Esther M Hoffmann1 1Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany; 2Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany; 3Institute of Medical Biometry and Statistics, Medical Center – University of Freiburg, Freiburg, Germany Purpose: Since the role of short- and long-term intraocular pressure (IOP) fluctuation as a predictor of glaucoma progression is still controversial, the purpose of this study was to investigate the role of IOP fluctuation in a non-selected patient cohort. Materials and methods: Two-hundred and forty eyes of 120 glaucoma patients (51% female) with a mean age of 64.5 years were included. Inclusion criteria were at least a visual field (VF) and a 48-hour diurnal phasing of IOP including nocturnal measurement. Glaucoma progression was defined as – if available – confirmed progression of reproducible VF defects in at least three VF examinations or increase of cup area on optic nerve imaging (Heidelberg Retina Tomograph [HRT]) with at least two images after baseline. If results were stable or less than previously mentioned VF or HRT examinations were available, it was classified as “no progression”. Results: Glaucoma progression was seen in seven of 240 eyes in the VF analysis and ten of 240 eyes on HRT. Of all 240 eyes, 92 and 41 eyes fulfilled the criteria to be included for progression evaluation on VF and HRT analysis, respectively. Mean time to progression ± standard error was 3.6±0.2 years on VF and 4.5±0.3 years on HRT. Univariate and multivariate Cox regression analyses revealed short-term IOP fluctuation (P

Lutz E Pillunat,1 Carl Erb,2 Auli Ropo,3 Friedemann Kimmich,4 Norbert Pfeiffer5 1Department of Ophthalmology, University Hospital Carl Gustav Carus, Dresden, 2Augenklinik am Wittenbergplatz, Berlin, Germany; 3Santen Europe, Helsinki, Finland; 4eyecons, Pfinztal, 5Department of Ophthalmology, Mainz University Medical Center, Mainz, Germany Background: Efficacy, tolerability and safety of the novel preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% (Taptiqom®) were investigated in an observational study in Germany.Objective: To assess efficacy, tolerability and safety of the preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% in a real-life setting.Methods: Intraocular pressure (IOP) was recorded for each eye at baseline (any previous therapy or untreated) and 4–16 weeks after changing medical treatment to or initiating treatment with the preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5%. Change in IOP was evaluated over the study period for all patients and for specific pretreatment subgroups. Clinical signs such as conjunctival hyperemia and lid-parallel conjunctival folds (LIPCOF) were recorded using standardized comparative photographs. Corneal staining, subjective symptoms and local comfort were measured using a four-step scale. All adverse events were recorded.Results: Among 1,157 patients enrolled, 1,075 patients were treated with the preservative-free fixed combination as the only medication at the final visit. Medical treatment was initiated in 741 patients because of an insufficient IOP-lowering effect of the prior medication. In 343 patients, medication was changed because of tolerability issues. The preservative-free fixed combination lowered IOP significantly in the subgroup of naïve patients, all subgroups with prior monotherapy and patients with prior fixed combinations: naïve patients: −8.9 mmHg, alpha-2-agonists: −6.4 mmHg, beta-blockers: −5.7 mmHg, carbonic anhydrase inhibitors: −5.2 mmHg, prostaglandins: −4.7 mmHg, fixed-combination prostaglandins/timolol: −2.4 mmHg. At the final visit, clinical signs and subjective symptoms were improved in patients with prior medical therapy. Local comfort was rated as “very good” or “good” by 89.1% of patients at the final visit. Only few adverse events occurred during the treatment period.Conclusion: The preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% was effective, well tolerated and showed a good safety profile. Keywords: fixed combination, tafluprost, timolol, glaucoma, preservative-free medication, preservatives

Katrin Lorenz1, Klaus Rosbach2, Andreas Matt3, Norbert Pfeiffer11University Medical Center, Johannes Gutenberg-Universität Mainz, Mainz, Germany; 2Private practice, Mainz, Germany; 3Private practice, Köln-Hohenhaus, GermanyBackground: This study was conducted to evaluate the safety and efficacy of adding a fixed combination of brinzolamide 1%/timolol 0.5% to prostaglandin analog (PGA) monotherapy in patients with primary open-angle glaucoma, pigment dispersion glaucoma, or ocular hypertension who require additional intraocular pressure (IOP) reduction.Methods: This was a prospective, multicenter (n = 5), open-label, single-arm, Phase IV clinical trial in which patients currently being treated with a PGA but requiring additional IOP reduction were administered brinzolamide 1%/timolol 0.5% twice daily as adjunctive therapy to their current PGA monotherapy regimen. The primary objective was to examine the IOP-lowering efficacy of brinzolamide-timolol when used as adjunctive therapy.Results: Forty-seven patients enrolled in and completed the study. After 12 weeks of adjunctive brinzolamide-timolol therapy, the mean IOP of the total patient population decreased from 22.1 mmHg at baseline to 16.7 mmHg. The mean IOP reduction of 5.4 mmHg (24.4%) was both clinically and statistically significant (P < 0.001). This significant decrease in mean IOP at week 12 was maintained across all PGA groups (P < 0.05). No significant differences were observed in symptom frequency between baseline and week 12 for any of the six solicited symptoms. A total of 17 adverse events from six patients was reported, of which ten were drug-related. Most (n = 7) of the drug-related adverse events were mild or moderate in intensity. None of the adverse events required any treatment or resulted in treatment interruption or discontinuation. Of the 90 eligible eyes, 85.6% had a decrease in IOP of at least 3 mmHg from baseline and 98% of patients had a decrease in IOP of ≥1 mmHg.Conclusion: This study suggests that a fixed combination of brinzolamide 1%/timolol 0.5% can provide additional IOP reduction effectively and safely when used as adjunctive therapy for patients receiving insufficient IOP reduction from PGA monotherapy.Keywords: adjunctive therapy, brinzolamide, carbonic anhydrase inhibitor, fixed combination, glaucoma, intraocular pressure

Abstract Background Previous studies have shown a significant increase in tear protein peaks in the tears of diabetic patients suffering from dry eye. The aim of this study was to analyze the tear protein patterns from patients with diabetes mellitus who do not suffer from ocular surface diseases (DIA). Methods A total of 515 patients were examined in this study (255 healthy subjects (controls) and 260 patients suffering from diabetes mellitus). Tear proteins were separated by sodium-dodecyl-sulfate polyacrylamide gel electrophoresis. After digital image analysis densitometric data files were created and subsequently used for multivariate statistical procedures. Results A significant increase in the number of peaks was detected in diabetic patients compared to controls (P < 0.0003). The analysis of discriminance revealed a highly significant discrimination between diabetic patients and controls (Wilks lambda: 0.27; P < 0.000001). Furthermore, a significant difference in the protein pattern of diabetic patients could be detected between those suffering from dry eye or not (P < 0.002). The changes in protein patterns of diabetic patients increased with the duration of the diabetic disease. In diabetic patients with a disease duration longer than 10 years the changes were significantly more expressed than in patients with a shorter diabetic history (P < 0.003) and in healthy subjects (P < 0.0001). Conclusions The tear protein patterns of diabetic patients are very different in the number and intensity of spots from those of healthy subjects. Furthermore, it could be demonstrated that the differences found in the tear patterns of diabetic patients are not equal to those found in previous studies in patients suffering from dry-eye disease. The alterations in the diabetic tears were correlated with the duration of the diabetic disease. With longer disease, history changes in the tear protein patterns increased. With the course of the disease some protein peaks appeared that are not present in healthy persons. Our study shows that the analysis of electrophoretic tear protein patterns is a new non-invasive approach in the early diagnosis and analysis of the pathogenesis of diabetes induced ocular surface disease.

Purpose: To compare two surgical approaches for treating encapsulated blebs after trabeculectomy with mitomycin C, in terms of the development of intraocular pressure and progression of glaucoma in a long-term follow up: 1. bleb needling alone vs. 2. a combined approach of needling with additional transconjunctival scleral flap sutures, to prevent early ocular hypotony. Methods: Forty-six patients with failing blebs after trabeculectomy with mitomycin C were enrolled in this study. Patients received either needling revision alone (group 1; n = 23) or a combined needling with additional transconjuctival flap sutures, if intraoperatively the intraocular pressure was estimated to be low (group 2; n = 23). Intraocular pressure (IOP), visual acuity, visual fields, and optic nerve head configuration by means of Heidelberg Retina Tomograph (HRT®) were analysed over time. Results from both groups were compared using Mann-Whitney U-test for single timepoints. Results: IOP did not differ significantly between the two groups during follow-up at three months (P = 0.13), six months (P = 0.12), one year (P = 0.92) and two years (P = 0.57) after surgery. Furthermore, there was no significant difference in the course of glaucoma concerning the optic nerve anatomy between the two groups (Rim Area Change in the Moorfields Regression Analysis of HRT®) till two years after surgery (P = 0.289). No functional impairment in visual acuity and visual fields was found in the groups of the study. Conclusions: Single needling procedure is a standard successful method for restoring the function of encapsulated blebs. Postoperative hypotony represents a possible hazard, which can be minimized by additional transconjunctival flap sutures. Long-term results suggest that this modification is equally effective in lowering the IOP and preventing the progression of glaucoma as the standard needling procedure. To our knowledge this is the first study to investigate the long-term effect of tranconjunctival sutures for the prevention of hypotony. [ABSTRACT FROM AUTHOR]

Purpose: The TonoPen applanation tonometry is an established method for intraocular pressure (IOP) measurement. The IOP is one of the main variables affecting retinal ganglion cell (RGC) loss in experimental animal models in ophthalmology and the main risk factor for human glaucoma. In this study, we examined if IOP measurements with the TonoPen itself lead to retinal ganglion cell loss or any other possible retina damages, such as intraocular bleedings or ablation, in Lewis rats. Methods: Three groups of rats ( n = 5 each) were formed. IOP monitoring, using a TonoPen XL, was performed on groups 1 and 3. Animals in groups 1 and 2 received funduscopies before and after one and two weeks of the study, in order to detect possible abnormalities. After two weeks, retinal flatmounts were stained to detect ganglion cells. RGCs were manually counted in eight predefined areas to compare mean RGC densities between groups 1 and 2 (IOP readings vs. no readings), using student t-test. Results: No significant difference in RGC density between animals that underwent IOP readings and controls could be observed ( p = 0.8). As expected, no IOP alterations were monitored in groups 1 and 3 throughout the study. No retinal abnormalities, such as bleeding or retina ablation, were detectable. Conclusion: We could detect no effects on retinal ganglion cell survival in Lewis rats or any other damages to the retina caused by IOP measurements using a TonoPen XL. This study proposes that repeated applanation tonometry does not affect RGC numbers, one of the main monitored variables in most glaucoma model studies. Therefore, the use of a TonoPen XL for repeated IOP monitoring in Lewis rats can be considered harmless. [ABSTRACT FROM AUTHOR]