Search

Background: Elective surgery in patients with insulin-treated type 2 diabetes mellitus (T2D) and the admission period in the hospital, comprise a distinctive and challenging situation for physicians, nurses, as well as for the patients themselves. There is a lack of widely accepted evidence-based and standardized approach of care in regard to perioperative management of patients with insulin-treated T2D. Methods: The main purpose of this proof-of-concept study was to investigate whether a standardized insulin and meal regimen on the day of surgery leads to a better management of diabetes in terms of blood glucose (BG) levels. Two different insulin and meal regimens—group A with half of insulin dose given with a standardized postoperative meal and group B with a custom preoperative breakfast and full insulin dose—were compared with Group C with routine care (no meal and no insulin injection on the day of surgery). Each group consisted of 12 to 15 patients. BG measurements were performed pre- and immediately postoperatively, before meals and at bedtime. Results: Both standardized and well-defined insulin and meal regimens resulted in better average BG levels in the perioperative period, especially in the morning after the surgery. Conclusions: In this study, we observed that a standardized perioperative insulin regimen efficiently lowered postoperative BG levels. Providing a custom breakfast and a full insulin dose resulted in lower postoperative BG levels. These approaches were not associated with an increase in hypoglycemic events. Physicians and nursing staff gave positive feedback to the structured and well-defined approaches.

PURPOSE Retinal vein occlusion (RVO) risk factors largely coincide with cardiovascular risk factors. Endothelin-1 (ET-1), the most potent vasoconstrictor with pro-inflammatory properties, is a known cardiovascular risk factor. In this study, we explore the role of serum ET-1 as a potential risk factor for RVO. METHODS ET-1 serum levels were measured in patients with RVO and control subjects. Samples were measured using the sandwich enzyme-linked immunosorbent assay (ELISA) for the quantitative determination of human big endothelin-1 (Biomedica Group, Austria). RESULTS The study consisted of 147 RVO patients and 150 control subjects. Median serum ET-1 was significantly higher in RVO patients (0.26 pmol/L, ranging 0.19-0.37) compared to controls (0.10 pmol/L, ranging 0.05-0.22) (p

Background and objectives: Benign skin tumors are the most common skin findings and contribute to the major reasons for consulting a dermatologist. However, the frequency of benign skin tumors concerning different body areas and their relationship with sun-related behavior have not been sufficiently characterized. We aimed to improve knowledge about the anatomic distribution of the most frequently occurring benign skin tumors among a healthy predominant elderly population. Furthermore, we investigated associations with sun-related habits. Methods: In total, 100 participants, 37 men, and 63 women (mean age: 67.2 years; range: 46-86 years) were enrolled in the Graz Study on Health & Aging (GSHA) cohort. Full body images were investigated for melanocytic nevi, seborrheic keratoses, hemangiomas, dermatofibromas, and lentigines. Information on the phenotypic trait, sun exposure, use of sun-protective measures, and history of sunburns was collected in a questionnaire. Results: Common melanocytic nevi were the most frequently encountered skin lesions. Male sex was associated with multiple common nevi on the abdomen and the presence of atypical nevi. High sun exposure in central European latitudes during adolescence was positively associated with multiple common nevi on the total body. Multiple common nevi and atypical nevi on the back correlated with frequent use of sunscreens with SPF during young adulthood and adolescence, respectively. Conclusion: Our study adds new knowledge about the most frequently occurring benign skin tumors, considering all visible body areas. This research may serve as a reference basis for following epidemiological studies.

Purpose To present a case of unilateral stellate nonhereditary idiopathic foveomacular retinoschisis in a patient with macular telangiectasia (MacTel) Type 2. Methods Single-patient case report. Results A 61-year-old female white patient was referred to our clinic with metamorphopsia and reduction of visual acuity over a period of 2 months on her right eye. Ocular findings in her right eye included reduced best-corrected visual acuity of 20/63 Snellen, foveomacular retinoschisis with extension to the lower middle periphery, central elevation of the neurosensory retina, and macular telangiectasia (MacTel) Type 2. Other causes of foveomacular retinoschisis, such as glaucoma, myopic degeneration, optic or scleral pit, X-linked juvenile retinoschisis, degenerative retinoschisis, and vitreomacular traction, were ruled out. The patient had no history of niacin or taxane medication, which may cause rather similar appearing cases of cystoid macular edema without leakage in fluorescein angiography. Because of the unilateral presentation, uneventful medical history, female sex, and the absence of known hereditary diseases or retinal pathologies in the patient's family history, hereditary predisposition appears to be highly unlikely. Conclusion To our knowledge, this is the first reported case of stellate nonhereditary idiopathic foveomacular retinoschisis in combination with MacTel Type 2. Whether or not MacTel Type 2 plays a role in the development of stellate nonhereditary idiopathic foveomacular retinoschisis or has an impact on its clinical course requires further investigation. Furthermore, we suggest a significant involvement of Henle fiber layer in the process of intraretinal expansion in optical coherence tomography, in accordance with the most recent published nomenclature.

Background/aimsThe purpose of this study was to investigate retinal structure in detail of subjects with autosomal-dominant (AD) and autosomal-recessive (AR)PROM1-associated retinal degeneration (PROM1-RD), study design: institutional, cross-sectional study.MethodsFour eyes from four subjects (three with AD and one with AR)PROM1-RD were investigated by ophthalmic examination including best-corrected visual acuity (BCVA) and multimodal retinal imaging: fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT) and adaptive optics scanning light ophthalmoscopy. Quantitative assessment of atrophic lesions determined by FAF, thickness of individual retinal layers and cone photoreceptor quantification was performed.ResultsBCVA ranged from 20/16 to 20/200. Initial pathological changes included the presence of hyperautofluorescent spots on FAF imaging, while later stages demonstrated discrete areas of atrophy. In all patients, thinning of the outer retinal layers on SD-OCT with varying degrees of atrophy could be detected depending on disease-causing variants and age. Cone density was quantified both in central and/or at different eccentricities from the fovea. Longitudinal assessments were possible in two patients.ConclusionsPROM1-RD comprises a wide range of clinical phenotypes. Depending on the stage of disease, the cone mosaic inPROM1-RD is relatively preserved and can potentially be targeted by cone-directed interventions.

Purpose To assess the rate of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in surgeons in training vs experienced surgeons and to analyze the rate of pCME according to surgeon’s sex. Methods Medical reports post phacoemulsification between 2010 and 2018 at the Department of Ophthalmology, Medical University of Graz, Austria, were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between surgeons in training and experienced surgeons. Outcome parameters were incidence of pCME, patient’s sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon’s sex. Results 25.422 surgeries on 18.266 patients were included. The majority was performed by experienced surgeons (23.139, 91.0%) vs 2.283 (9.0%) by surgeons in training (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by surgeons in training and in 152 eyes (0.7%) following surgery by experienced surgeons. Chance for pCME was 1.57 higher in training surgeries (95% CI 1.03–2.41, p = 0.034) and longer duration (OR = 1.04; 95% CI 1.02–1.07, p = 0.001). After excluding the first 100 surgeries for every surgeon in training similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (training and experienced surgeons). Conclusion In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for surgeons in training but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.

PurposeAccumulating evidence points towards a close relationship between cardiovascular, endocrine and metabolic diseases. The BioPersMed Study (Biomarkers of Personalised Medicine) is a single-centre prospective observational cohort study with repetitive examination of participants in 2-year intervals. The aim is to evaluate the predictive impact of various traditional and novel biomarkers of cardiovascular, endocrine and metabolic pathways in asymptomatic individuals at risk for cardiovascular and/or metabolic disease.ParticipantsBetween 2010 and 2016, we recruited 1022 regional individuals into the study. Subjects aged 45 years or older presenting with at least one traditional cardiovascular risk factor or manifest type 2 diabetes mellitus (T2DM) were enrolled. The mean age of the participants was 57±8 years, 55% were female, 18% had T2DM, 33% suffered from arterial hypertension, 15% were smokers, 42% had hyperlipidaemia, and only 26% were at low cardiovascular risk according to the Framingham ‘Systematic COronary Risk Evaluation’.Findings to dateStudy procedures during screening and follow-up visits included a physical examination and comprehensive cardiovascular, endocrine, metabolic, ocular and laboratory workup with biobanking of blood and urine samples. The variety of assessed biomarkers allows a full phenotyping of individuals at cardiovascular and metabolic risk. Preliminary data from the cohort and relevant biomarker analyses were already used as control population for genomic studies in local and international research cooperation.Future plansParticipants will undergo comprehensive cardiovascular, endocrine and metabolic examinations for the next decades and clinical outcomes will be adjudicated prospectively.

Zusammenfassung Fragestellung Kann sich ein Non-Profit-Unternehmen wie eine Universitäts-Augenklinik in Konkurrenz zu Profit-Unternehmen erfolgreich für einen Staatspreis des Bundesministeriums für Innovation und Wirtschaftsstandort in Österreich bewerben. Material und Methode Nach erfolgreichen Committed to Excellence (C2E) Assessments 2008/2010 wurde ein 70-seitiger Unternehmensbericht streng nach der EFQM(European Foundation for Quality Management)-Logik (bestehend aus Grundkonzepten, Kriterienmatrix und RADAR-Logik) erarbeitet. Im Assessment 2018 wurde besonderes Augenmerk auf die Entwicklung der Strategie der Universitäts-Augenklinik mit ihren beiden Anteilseignern (Shareholdern), der im Besitz des Landes Steiermark befindlichen Krankenanstalten Gesellschaft (KAGes) und der dem Bundesministerium zugehörigen Medizinischen Universität Graz, gelegt und diese mithilfe der X‑Matrix (nach Hoshin-Kanri) entwickelt und dargestellt. Ergebnisse Das Gesamt-Punktescore im Recognised for Excellence(R4E)-Assessment 2018 war 500 bis 550 Punkte, was die Jury zur Vergabe eines Jurypreises des Österreichischen Nationalpreises (Fokus: partizipative Führung) veranlasste. Verbesserungspotenziale waren die Ausrichtung der Kernprozesse auf die Hauptleistungsindikatoren der Universitäts-Augenklinik, die sich aus ihrer Mission, bestehend aus Patient*innen Versorgung, Forschung, Lehre, Ausbildung und Öffentlichkeitsarbeit, ergeben. Die Entwicklung der Strategie mit den Anteilseignern hat sich gegenüber dem R4E-Assessment von 2017 von einem Potenzial zu einer Stärke entwickelt. Diskussion Schriftliche und mündliche Rückmeldungen aus einem EFQM-Assessment sind der größte Mehrwert („value-added“) aus diversen Preisbewerbungen für eine Universitäts-Augenklinik sowie allgemein für Wirtschaftsunternehmen.

Ascorbic acid is present at high concentrations in the vitreous and plays a central role in vitreous redox chemistry. Albumin is the main protein in the vitreous with antioxidant properties and occurs in different oxidation states, which can be used as redox indicators, but have not been studied in the vitreous. This study, therefore, addressed the vitreous redox state of cysteine-34 of albumin in relation to the ascorbic acid content, which has been suggested to exert a main function in detoxifying reactive oxygen in the vitreous. A total of 58 vitreous samples obtained from patients undergoing vitrectomy were analyzed for (i) human mercaptalbumin (HMA), the reduced thiol form; (ii) human non-mercaptalbumin1 (HNA1), a reversible oxidative modification with a disulfide at cysteine-34; and (iii) human non-mercaptalbumin2 (HNA2), a non-reversibly (highly) oxidized form of albumin; as well as (iv) ascorbic acid concentrations, to study possible relations. In addition, blood samples were taken to compare albumin redox state between plasma and the vitreous. Vitreous albumin showed greater variability in the redox state of cysteine-34 and a shift to the oxidized fractions compared to plasma albumin (P 0.001). A strong positive relation was observed between the vitreous ascorbic acid concentrations and the reversibly oxidized form, HNA1 (P 0.001), and a negative relation with the reduced form, HMA. Positive relations between ascorbic acid and HNA1 in the vitreous were stronger in men than in women. In contrast to HMA and HNA1, there was a distinct gender difference noted for the irreversibly oxidized form, HNA2. While males showed a positive relation between the vitreous ascorbic acid concentrations and HNA2, there was no correlation found with HNA2 in females. Our results support the view that ascorbic acid, by decreasing either directly or indirectly the concentrations of molecular oxygen, generates hydrogen peroxide, and that thiols, including HMA, are acting as antioxidants. This study for the first time provides evidence that vitreous albumin can be used as a marker molecule for the appearance of reactive oxygen species in the vitreous of patients undergoing vitrectomy. Moreover, it can be shown that there are gender differences in vitreous ascorbic acid and albumin concentrations as well as in oxidation state of vitreous albumin.

Purpose To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. Methods Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent). Results Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 μm preoperatively and 327 ± 66.1 μm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 μm; ELM disruption: 334 ± 75.2, p = 0.31). Conclusions PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow-up depending on stage of diabetic eye disease are summarized.

Tobacco smoking is a risk factor for many ocular diseases. Of the multiple tobacco smoke compounds nicotine and its main metabolite cotinine are likely agents in disease modulation. The interaction of these compounds with exposed tissue is complex and ranges from proinflammatory to potentially neuroprotective properties. We aimed to determine cotinine and cytokines in the vitreous in smokers and non-smokers in this prospective, cross-sectional study at the Department of Ophthalmology, Medical University Graz, Austria. We included 10 smokers and 10 non-smokers. Vitreous and serum samples were analyzed for cotinine and cytokines. The cytokine analysis was performed with multiplex assay and cotinine was quantified with enzyme-linked immunosorbent assay. Cotinine was detectable in smokers only with a mean of 154.0 ng/ml ± 107.3 ng/ml in the vitreous and of 194.1 ng/ml ± 121.3 ng/ml in the serum. The difference between intraocular and systemic levels was statistically significant. There were no statistically significant differences between the cytokine levels of smokers and non-smokers. However, intravitreal VEGF-A was by trend elevated in smokers and correlated positively with intravitreal cotinine (r = 0.59, p = 0.073). In conclusion cotinine is detectable in the vitreous of smokers and is lower than the serum. There is a trend towards elevation of VEGF-A in the vitreous of smokers.

Purpose To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB). Materials and methods We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional-hazard regression model was used to analyse risk factors for PRD and PRB. Results Sixty-five thousand six hundred and sixty-two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow-up (median 7.1 years, range 0-21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age 75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy. Conclusions Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery.

To report on Acanthamoeba keratitis cases in a tertiary university eye-hospital in Graz, Austria, over a 21-year period. Retrospective study. Parameters included demographics, diagnostics, clinical courses, medical therapies, surgical interventions, secondary complications, and best spectacle-corrected visual acuity (BSCVA). Patient records for 44 eyes of 42 patients were analysed; 2 bilateral infections. Mean age at presentation was 31 ± 13 (16–65) years; contact lenses were used in 41 of 44 eyes (93.2%). Symptoms at initial presentation were mainly pain (41/43, 95.3%) and photophobia (16/43, 37.2%). Most frequent morphological findings were stromal infiltrates (30/44, 68.2%). Diagnosis was mainly confirmed by smears (40/42, 95.2%) and polymerase chain reaction (8/42, 19%). Antiamoebic treatment comprised biguanides and diamidines. Penetrating keratoplasty was performed in 10/44 (22.7%) eyes. Median time from symptom onset to initial visit was 2 (0–26) weeks; median follow-up was 30 (2–1008) weeks. BSCVA improved in 23/36 (63.9%) eyes, remained unchanged in 6/36 (16.7%) eyes and deteriorated in 7/36 (19.4%) eyes. Acanthamoeba keratitis predominantly occurs in young contact lens wearers. Diagnosis should be considered in patients with pain and stromal infiltrates. In the majority of cases, BSCVA can be improved. Early diagnosis and adequate treatment should be implemented to prevent complications.

The purpose of this research is to study the intraocular occurrence of SARS-CoV-2. In postmortem examinations, aqueous humor and the vitreous samples were collected. All individuals were previously positive in nasopharyngeal swabbing and cause of death was respiratory failure due to SARS-CoV-2 infection. Testing was done using quantitative RT-PCR. We included 16 aqueous humor and 16 vitreous samples for PCR testing. None of the results was positive for SARS-CoV-2. Human GAPDH genes to verify the presence of RNA was present in all aqueous humor samples (16/16, 100%) and 15/16 (93.8%) vitreous samples. In conclusion, this case series found no evidence of SARS-CoV-2 in the intraocular milieu., Highlights • Manifestation of SARS-CoV-2 in the intraocular milieu. • Manifestation of SARS-CoV-2 in the vitreous. • Manifestation of SARS-CoV-2 in the aqueous humor.

Purpose Oxidative stress and inflammation have been implicated in the development of retinal vein occlusion (RVO). Oxidation-specific epitopes (OSEs) represent products of oxidative stress that can trigger vascular inflammation and thrombosis. Natural occurring antibodies have been shown to bind oxidation-specific epitopes thereby inhibiting their inflammatory potential and promoting their removal. Methods This prospective cross-sectional study included 270 patients with RVO and 81 in-hospital control patients. We measured three types of serum levels of oxidation-specific epitope-specific immunoglobulin M and immunoglobulin G antibodies (anti-copper-oxidized LDL [CuOx-LDL], antiphosphocholine [PC], anti-malondialdehyde-modified LDL [MDA-LDL]). History of arterial hypertension, hyperlipidemia, myocardial infarction, diabetes mellitus, stroke, smoking status, and several laboratory parameters were determined to control for potential confounders. Results Compared with controls, patients with RVO had significantly lower levels of immunoglobulin M and immunoglobulin G antibodies against CuOx-LDL and PC, and significantly lower levels of immunoglobulin G but not immunoglobulin M antibodies against MDA-LDL. The association between RVO patients and lower levels of these antibodies prevailed upon multivariable adjustment. Conclusion These prospective data show that antibodies against oxidation-specific epitope are lower in patients with RVO compared with control patients and support the concept that oxidative stress and inflammation play key roles in the development and subsequent complications in RVO.

BackgroundTo assess the influence of intraocular lens (IOL) characteristics on IOL dislocations after cataract surgery.MethodsPatients who underwent cataract surgery at the Department of Ophthalmology Graz, Austria, between 1996 and 2017 were included and medical records were reviewed. Cox proportional-hazard regression models were used to assess the influence of IOL characteristics on IOL dislocation.ResultsFrom 68 199 eyes out of 46 632 patients (60.2% women, mean age: 73.71 SD±10.82 years), 111 (0.16%) had an in-the-bag (ITB) disloaction and 35 (0.05%) had an out-of-the-bag (OTB) dislocation. The HRs adjusted for predisposing factors significantly associated with a higher risk for an ITB dislocation were 2.35 (95% CI, 1.45 to 3.8) for hydrophilic IOLs, 2.01 for quadripode IOLs (95% CI, 1.04 to 3.86) and 1.61 (95% CI, 1.04 to 2.48) for haptic angulation. A lower risk was observed for three-piece IOLs (HR=0.58, 95% CI, 0.34 to 0.98) and larger overall IOL diameter (HR=0.79, 95% CI, 0.66 to 0.95). For an OTB dislocation, the HR associated with a higher risk was 18.81 (95% CI, 5.84 to 60.58) for silicone IOLs and 2.12 (95% CI, 0.62 to 7.29) for hydrophilic IOLs. Larger overall IOL diameter (HR 0.40, 95% CI; 0.25 to 0.63) showed a lower risk.ConclusionHydrophilic IOLs, quadripode IOLs and haptic angulation were associated with a higher risk for an ITB dislocation, whereas three-piece IOLs and a larger overall diameter were associated with a lower risk. Risk factors for OTB dislocation were silicone IOLs, hydrophilic IOLs and a smaller overall IOL diameter.

Purpose Intraocular pressure is the main risk factor for glaucoma; however, additional risk factors may also matter. This systematic review and meta-analysis were conducted to summarize the evidence regarding the association of cholesterol parameters (total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels) and glaucoma. Methods Four electronic databases were searched for all publications containing 'glaucoma' and one of various forms of 'cholesterol' or 'lipoprotein'. Two independent reviewers screened abstracts and potentially full texts of identified articles for eligibility. Risk of bias was assessed with the Newcastle-Ottawa Scale. A random-effects meta-analysis was used to investigate the differences in total cholesterol, LDL and HDL levels between patients with and without glaucoma. Results Overall, 29 observational studies were included in the systematic review and 26 reported quantitative information to investigate differences in cholesterol parameters between patients with glaucoma (N = 7196) and patients without glaucoma (N = 350 441). Patients with glaucoma had significantly higher total cholesterol levels than patients without glaucoma (Mean Difference (MD) 7.9 mg/dl, 95% CI 3.3 to 12.5, p = 0.001) and lower mean HDL levels (MD -2.0 mg/dl, 95% CI: -3.1 to -0.9, p = 0.001). Patients with glaucoma had higher mean LDL levels than patients without glaucoma, albeit not statistically significant (MD 6.1 mg/dl, 95% CI: -4.3 to 16.4, p = 0.251). Conclusion This systematic review and meta-analysis of observational studies found an association of glaucoma and high total cholesterol and low HDL levels, respectively. Although this supports the hypothesis that lipid levels pose an additional risk for glaucoma development, heterogeneity was substantial and causality cannot be presumed from identified observational studies.

Purpose Hazelnut and birch pollen are known to destroy tear film components and attack ocular surface cells. We investigated further pollen species from different plant families, whether they show similar effects on human tear fluid and an epithelial cell line in vitro, to provide a broad basis for further research on pollen reactions affecting the tear film and ocular surface. Materials and methods Regional pollen species from different plant families (Adoxaceae, Betulaceae, Fagaceae, Juglandaceae, Malvaceae, Oleaceae, Pinaceae, Plantaginaceae, Poaceae, Salicaceae, Sapindaceae) were collected. Their proteolytic activity was evaluated by Zymography. Human tear fluid and cells of an epithelial cell line were incubated with pollen extracts. Tear fluid was analyzed by Polyacrylamide gel electrophoresis (PAGE). Cytomorphology was assessed microscopically and cell viability by proliferation (MTS), water-soluble tetrazolium (WST-1) assay and the impedance-based xCELLigence real-time analysis (RTCA). Results Zymography revealed significant protease activity and PAGE showed the degradation of tear proteins by different pollen species. Cells incubated with pollen extracts presented dose- and time-dependent cytomorphological changes. MTS, WST-1, and RTCA revealed cytostatic as well as cytotoxic effects of pollen extracts. Conclusions Pollen species from different plant families exert proteolytic activity and degrade human tear fluid as well as epithelial cells, which may play a crucial role in the pathogenesis of allergic and non-allergic reactions affecting the ocular surface.

Qualitatsmanagement (QM) wurde 2006 verpflichtend an der Universitats-Augenklinik Graz eingefuhrt. Das European Foundation for Quality Management (EFQM) Modell wurde von der Universitats-Augenklinik als bisher anspruchsvollstes Modell (heute als Business Excellence Model bezeichnet) zusammen mit der Anstaltsleitung des LKH Universitats-Klinikums Graz ausgewahlt. Aufbauend auf zwei Committed to Excellence (C2E) Auszeichnungen 2008 und 2010 hat die Universitats-Augenklinik Graz im Februar 2017 die Recognised for Excellence (R4E) Anerkennung erlangt. Wahrend bei der Committed to Excellence (C2E) Validierung das Prozess- und Projektmanagement der 3 wichtigsten Handlungsfelder der Klinik basierend auf einer Selbstbewertung bearbeitet und beurteilt wurden, muss fur das R4E Assessment eine Einreich-Broschure uber die Gesamtklinik in Hinblick auf die Kriterienmatrix mit 9 Haupt- und 32 Subkriterien des EFQM Modells auf Basis der RADAR-Logik („Results-Approach-Deployment-Assessment-Refinement“) erarbeitet und beschrieben werden. Zu diesen Kriterien zahlen zum Beispiel u.a. die Fuhrung und die strategische Ausrichtung, Prozesse und Ablaufe, Mitarbeitenden-Orientierung sowie Ergebnisse (wie beispielsweise Anzahl der Publikationen, Anzahl an Kataraktoperationen) der letzten Jahre. Die Kriterienmatrix des Modells sieht vor, dass die Klinikleitung unter Beachtung der Fuhrung und Strategie mit ihren MitarbeiterInnen und den zur Verfugung stehenden Ressourcen mittels strukturierter Prozesse Ergebnisse generiert. Diese Ergebnisse werden unterteilt in mitarbeiterInnenbezogene Ergebnisse (z. B. Zufriedenheitsergebnisse aus der MitarbeiterInnenbefragung), kunden- bzw. patientInnenbezogene Ergebnisse (z. B. Zufriedenheitsergebnisse aus der PatientInnenbefragung) und gesellschaftsbezogene Ergebnisse (z. B. Ausmas der Public Relation Aktivitat der Klinik). In den Schlusselergebnissen, dem letzten und 9. Kriterium des EFQM Modells, finden sich u. a. jene (Schlussel‑) Ergebnisse, die fur die Strategieumsetzung und operative Fuhrung der Klinik wesentlich sind (z. B. Anzahl an Operationen mit Qualitatskennzahlen, Anzahl der Impact Faktoren, Anzahl der betreuten Dissertationen/ Diplomarbeiten). Nach einer SWOT-Analyse der Klinik wurden zu den einzelnen Kriterien interdisziplinare Teams zur Erarbeitung der Themen gebildet. Die Ergebnisse dieser Kriterienteams wurden von einem Redaktionsteam – bestehend aus Klinikleitung und Pflegeleitung sowie den Qualitatsbeauftragten und Risikomanagern – abstimmend formuliert, zusammengefasst, erganzt und in die vorgegebene Struktur der EFQM Broschure Kriterium fur Kriterium eingearbeitet. Auffallende Lucken in der Darstellung – zum Beispiel fehlende Prozesslandkarte – wurden in eigenen kleinen Projekten erarbeitet und in die bestehende Beschreibung integriert. Nach Prufung der Gesamtbroschure auf Konsistenz wurde diese bei der Quality Austria zum Assessment eingereicht. In einem, aufgrund der Klinikgrose eintagigen Assessment, durchgefuhrt von einem Leadassessor und 2 weiteren Assessoren der Quality Austria im Februar 2017, erfolgte die Bewertung der Klinik. Die Assessoren attestierten der Universitats-Augenklinik mit 400–450 Punkten die fur „Recognised for Excellence“ (R4E****) benotigte Zahl von mindestens 300 Punkten. Als Starken der Klinik wurden die hohe PatientInnenzufriedenheit (die Klinik ist an der Spitze innerhalb des Klinikums platziert) sowie den mitarbeiterInnen-zentrierte Fuhrungsansatz der Klinikleitung. Das 1. Kriterium im EFQM Modell, die Fuhrung resp. Klinikleitung, erhielt die hochste Punkteanzahl (50–60 Punkte ) mit den Subkriterien Fuhren nach einem definierten Leitbild (das Leitbild wurde bereits im 2. C2E 2010 unter der Leitung des Vorstands der Klinik entwickelt), Einfuhrung und Weiterentwicklung eines QM Systems, exzellentes Unternehmensklima zusammen mit den MitarbeiterInnen sowie grose Flexibilitat bei extern induzierten Veranderungen. Potenziale, die fur eine Weiterentwicklung in Richtung hoherer Punktescores bearbeitet werden mussen, sind u.a. die detaillierte Entwicklung einer Strategie, ausgerichtet auf die Schlusselkennzahlen, die Abstimmung dieser Strategie auf die Leitbilder der Medizinischen Universitat Graz (MUG) und der Krankenanstalten Gesellschaft (KAGES) und das Thema Offentlichkeitsarbeit – insgesamt Themen, die teilweise nur beschrankt innerhalb eines Krankenanstalten-Verbundes masgeblich beeinflussbar sind und daher eine besondere Herausforderung fur eine Klinik mit den beiden Tragern MUG und KAGes darstellen. Das EFQM Modell, ursprunglich vor allem fur Organisationseinheiten konzipiert, die in der Privatwirtschaft tatig sind, kann auch in operativ tatigen Organisationseinheiten im Gesundheitsbereich – auch in Konkurrenz mit privatwirtschaftlichen Unternehmen – erfolgreich implementiert werden. Inwieweit eine weitere Maximierung der in der Fremdbeurteilung erreichten Punkte mit den durch die Trager KAGes und MUG vorgegebenen Rahmenbedingungen und dadurch eingeschrankter Selbstbestimmung/-gestaltung erzielt werden kann, bleibt Gegenstand weiterer Organisationsentwicklungsschritte und nachfolgender Bewerbungen. Entscheidend ist die kontinuierliche Weiterentwicklung der Struktur-, Prozess- und Ergebnisqualitat,wobei diese kontinuierliche Weiterentwicklung durch konsequente Anwendung von geschlossenen RADAR-Kreisen in allen relevanten Bereichen die Starke des EFQM Modells darstellt.

To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling.Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent).Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 μm preoperatively and 327 ± 66.1 μm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 μm; ELM disruption: 334 ± 75.2, p = 0.31).PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.

Contact with pollen is the major reason for the development of allergic symptoms on the ocular surface leading to a significant increase of allergic diseases worldwide. Environmental changes such as increased ultraviolet (UV) radiation and air pollution are discussed as contributory causes for this increase.We investigated the effect of UV light on the histamine content of pollen and examined if an irradiation of pollen affects the viability and proliferation of conjunctival cells.Alder (Alnus glutinosa) and hazel (Corylus avellana) pollen were irradiated for different time periods with sunlight, UV-A or UV-B light and the histamine content was analysed and compared with non-irradiated pollen. Conjunctival epithelial cells (CHANG cells) were exposed to irradiated and non-irradiated pollen followed by an assessment of cell viability with the colorimetric MTS test and the impedance-based measurement of cell proliferation using the xCELLigence real-time analysis system.UV light irradiation increased the histamine level of alder and hazel pollen in a dose-dependent manner. CHANG cells treated with irradiated pollen induced a statistically significant higher decrease of cell viability than treatment with non-irradiated pollen.Our results indicate that UV light is able to alter pollen thus making them more harmful for conjunctival cells.

Although intraocular pressure is the main the risk factor for the development of glaucoma, other risk factors such as vascular dysfunction might play an additional pathogenic role. Hypertriglyceridemia, which may lead to vascular dysfunction, has been implicated in the development of glaucoma. The objective of this meta-analysis was to investigate the association of triglyceride levels with the risk of glaucoma in case-control studies. Seventeen case-control studies were included investigating the difference in triglyceride levels in patients with glaucoma (N = 1 391) compared to subjects without glaucoma (N = 25 575). In random effects meta-analysis, the pooled mean triglyceride level across all studies and patients with and without glaucoma was 132.9 mg/dL (95%CI: 124.0–141.7). Patients with glaucoma had significantly higher mean triglyceride levels than patients without glaucoma (absolute difference = 14.2 mg/dL, 95%CI: 5.8–22.5, p 2 = 66.2%, heterogeneity χ2 = 47.4 on 16 degrees of freedom, p

Zusammenfassung Einleitung Der Beginn der organerhaltenden Therapie an der Univ.-Augenklinik datiert auf das Jahr 1985 mit der Einführung der Ruthenium 106 Applikatoren (Lommatzsch, Vormun) zurück. Der Autor skizziert in zeitlicher Abfolge die Einführung und gemeinsame Entwicklung verschiedener Arten von organerhaltender Therapien und endet mit neuen Therapieansätzen des Retinoblastoms und des metastasierenden Aderhautmelanoms. Methodik Die Vorstände der Univ.-Augenklinik beginnend mit Hofmann (1964–1987) unterstützten den Paradigmenwechsel von einem radikalchirurgischen Konzept (Enukleation) bei intraokularen Tumoren zu einem organerhaltenden Konzept trotz Fehlens von großen Studien mit hoher Evidenz. Zuweisende FachärztInnen waren zu Recht im Zweifel über die Sinnhaftigkeit dieser neuen Therapiekonzepte, unterstützen jedoch mit ihren PatientInnen Zuweisungen den neuen Arbeitsschwerpunkt bzw. den organerhaltenden Therapieansatz bis zum heutigen Tag. Ergebnisse Aderhautmelanom: 1985 wurde die organerhaltende Therapie mittels Ruthenium 106 Applikatoren in Graz für kleine und mittelgroße Aderhautmelanome mit aequatorialler und anteriorer Lokalisation eingeführt, ab 1992 war die Gamma Knife Radiochirurgie alternativ zur Protonen- und Photonentherapie an der Univ. Klinik für Neurochirurgie in Graz verfügbar und wurde mit Beiträgen anderer Tumorzentren für die Behandlung von großen Aderhautmelanomen oder solchen mit posteriorer Lokalisation entwickelt. Die transpupillare Thermotherapie (TTT) wurde 1995 in Leiden von Osterhuis und Journée-de Korver für die Behandlung von flachen posterior lokalisierten Melanomen im Tiermodell entwickelt. Die Therapie geriet auf Grund einer erhöhten Rate von Rezidiven in einzelnen Tumorzentren in Mißkredit und Vergessenheit, sollte jedoch auf Grund guter eigener Erfahrungen und der Einführung der TTT bei der Behandlung von Retinoblastomen in Hinblick auf Technik und Indikationen neuerlich evaluiert werden. Endoresektion: Aderhautmelanome werden nach Vorbestrahlung wegen des großen Tumorvolumens bzw. einer persistierenden Amotio mittels Vitrektomie Techniken reserziert, als Bestrahlungstechnik wurde in Graz und in Essen das Gamma Knife verwendet. Biopsien werden seit einigen Jahren für genetische und mikrobiologische Untersuchungen durchgeführt, neue mikrobiologische Erkenntnisse werden zur Entwicklung neuer systemischer Therapiekonzepte führen. Retinoblastom: Im Gegensatz zum Aderhautmelanom erwies sich die adjuvante Chemotherapie beim Retinoblastom als hoch wirksam v. a. in der Volumsreduktion der Tumoren. Die Brachytherapie mit Ruthenium 106 Schalen, die 3‑fach Kryotherapie bzw. die Lasertherapie werden bereits seit Jahrzehnten an der Univ.-Augenklinik als organerhaltende Lokaltherapien durchgeführt, seit kurzem komplettiert die TTT (mit oder ohne simultane Chemotherapie) das Spektrum der fokalen Therapien. Neue Therapiekonzepte wie die intrabulbäre Chemotherapie (bereits in Anwendung) sowie die intraarterielle Chemotherapie (steht kurz vor der Implementierung) sind bereits in Routine. Seit 2003 werden erstmals Retinoblastome in einer Therapie Optimierungsstudie RBA2003 (die das Department für Hämato‑/Onkologie der Univ. Kinderklinik Graz zusammen mit der Univ.-Augenklinik entwickelt hat) in Graz behandelt. Das Univ. Klinikum Graz etabliert sich als Referenzzentrum für Retinoblastome und Pseudoretinoblastome in Österreich und dem umgebenden Ausland und erhielt Anfragen und PatientInnen Zuweisungen aus den Alpe Adria Ländern sowie Schweiz, Bulgarien, Tschechien, Rumänien, Ukraine und Rußland. Wedrich, derzeitiger Vorstand der Univ.-Augenklinik Graz, förderte die Entwicklung des Retinoblastom Kompetenz Zentrums in personeller, instrumenteller und logistischer Hinsicht. 2015 entwickelte das Klinikum Essen ein auf das Protokoll RBA2003 aufbauendes, erweitertes internationales Protokoll, nach dem nun PatientInnen aus Essen und Graz gemeinsam behandelt, evaluiert und nachkontrolliert werden. Dieses wiederum wird in einem EU-Antrag, initiert von Chandada (Buenos Aires, Barcelona) für eine einheitliche Behandlung des Retinoblastoms in Europa berücksichtigt. 2005 engagierte sich die Arbeitsgruppe erstmals in Mosambique, Afrika folgend einer Bitte der NGO, Licht für die Welt, die Rahmenbedingungen für die Etablierung eines Retinoblastomzentrums zu prüfen. 2008 wurde am LKH Univ. Klinikum Graz ein Forschungsfeld Onkologie etabliert, in weiterer Folge das Comprehensive Cancer Center (CCC) der MUG gegründet, in das die Ophthalmoonkologie thematisch eingegliedert ist. Schlussfolgerung Das vor 32 Jahren am LKH Univ.-Klinikum Graz etablierte Konzept der organerhaltenden Therapie erfuhr 13 Jahre später die Bestätigung durch die bislang größte multizentrische Studie (COMS Studie) in den USA, wonach kein Unterschied in Hinblick auf Überleben zwischen Enukleation und bulbuserhaltender Therapie mit Jod 125 Schalen bei kleinen und mittelgroßen Aderhautmelanomen gefunden wurde. Die seit über 30 Jahren unveränderte (z. T. sehr schlechte) Prognose kann möglicherweise in absehbarer Zeit durch neue Medika verbessert werden. Basis für diese erfreulichen Entwicklungen sind neue bahnbrechende Erkenntnisse aus der zytogenetischen und molekularbiologischen Forschung.

BACKGROUND Central serous chorioretinopathy (CSC) is a common chorioretinal disease, characterized by choroidal hyperpermeability leading to neurosensory and/or retinal pigment epithelial detachments. Hypofibrinolysis due to higher plasma concentrations of plasminogen activator type 1 (PAI-1) or lower activity of tissue-type plasminogen activator (t-PA) has been implicated in the pathogenesis of CSC. Functional polymorphisms in the PAI-1 (SERPINE1) and t-Pa (PLAT) are thus potential risk factors for CSC. The aim of the present study was therefore to investigate a hypothesized association between the PAI-1 4G/5G and the t-PA -7351C > T gene variants and the presence of CSC. METHODS The present study comprised 172 CSC patients and 313 control subjects. Genotypes of the PAI-1 4G/5G and the t-PA -7351C > T polymorphisms were determined by TaqManTM fluorogenic 5'-exonuclease assays. RESULTS Allelic frequencies or genotype distributions of neither the PAI-1 4G/5G nor the t-PA -7531C > T polymorphisms were significantly different between patients with CSC and control subjects (PAI-1 4G/4G: 24.4% vs. 20.4, p = 0.36; t-PA -7351CC: 42.4% vs. 46.0%, p = 0.50). After adjusting for age and gender presence of the PAI-1 4G/4G genotype was associated with a non-significant odds ratio (OR) of 1.21 (95% confidence interval [95% CI]: 0.77-1.92, p = 0.41), while homozygosity for the t-PA -7351C allele yielded a non-significant OR of 0.91 (95% CI: 0.62-1.33, p = 0.62) for CSC. CONCLUSION The present study suggests that both the t-PA -7351C > T and the PAI-1 4G/5G gene variants are unlikely major risk factors for CSC.

Purpose Numerous studies suggest that reactive oxygen species play a crucial role in the development of glaucoma. Since glaucoma patients exhibit posterior vitreous detachment earlier than controls, it has been suggested that reactive oxygen species—increased in glaucoma—also affect the vitreous. In the present study we evaluated the influence of open-angle glaucoma oxidative stress on the redox state of vitreous albumin. Methods Albumin redox states of the vitreous and plasma were evaluated in 22 subjects—11 open-angle glaucoma patients and 11 controls—matched for age, gender, and vitreous state. According to the redox state of cysteine-34, albumin can be separated into: human mercaptalbumin (the thiol form), human nonmercaptalbumin1 (a reversible modification due to mild oxidation), and human nonmercaptalbumin2 (an irreversible modification due to severe oxidation). Results Albumin of both, the open-angle glaucoma group and the control group, was more oxidized in the vitreous compared to plasma. Furthermore, significantly higher human nonmercaptalbumin1 fractions were found in the vitreous of open-angle glaucoma patients compared to controls. No significant differences were found in the plasma albumin fractions between the groups. Conclusion Our results support the hypothesis that oxidative stress plays a crucial role in open-angle glaucoma and that reactive oxygen species in glaucomatous eyes may also affect the vitreous.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow-up depending on stage of diabetic eye disease are summarized.

Purpose To evaluate the impact of oxidative stress – present in glaucoma – on the vitreous. We therefore compare the presence of early and late stages of posterior vitreous detachment (PVD) between patients with glaucoma and controls. Methods The vitreous state was evaluated by the combination of optical coherence tomography and ultrasound. The main outcome was the vitreous state classified into ‘no PVD’, ‘initial PVD’ and ‘advanced PVD’. Results We evaluated the vitreous state in 48 patients with glaucoma (age: mean 66.5 ± 11.9 years; visual field deviation: mean 10.4 ± 6.8 dB) and compared the results with 101 previously investigated controls (age: mean 73.6 ± 9.3 years). After one-to-one matching on age and sex, ordinal logistic regression revealed that patients with glaucoma were significantly more likely to exhibit advanced PVD stages compared to non-glaucoma patients (OR 2.60, 95% confidence interval: 1.06–6.36, p = 0.037). Conclusion Our results suggest that the presence or absence of PVD might be a valuable hint for diagnosing glaucoma – however, further research is needed to determine whether PVD can be used to supplement current glaucoma screening guidelines.

Hintergrund Ziel der vorliegenden Studie war die Erfassung des Ausmases und Verteilungsmusters von kornealem Astigmatismus bei Patienten vor Kataraktchirurgie in einem mitteleuropaischen Tertiarzentrum, um den Bedarf an chirurgischer Astigmatismuskorrektur in diesem Patientengut zu ermitteln.

Das Trockene Auge ist eine sehr komplexe Erkrankung der Augenoberflache. Zur Behandlung bieten sich eine Vielzahl von Tranenersatzmitteln mit unterschiedlichen Inhaltsstoffen an sowie diverse Methoden. Diese Arbeit entwickelt ein Schema zur Anwendung der in Osterreich erhaltlichen Produkte. Aus der Literatur werden verschiedene diagnostische Verfahren, atiologische/pathogenetische Mechanismen sowie Beschreibungen der Schweregrade den therapeutischen Moglichkeiten fur das Trockene Auge gegenubergestellt. Daraus entsteht eine Arbeitstabelle, welche als Grundlage zur erleichterten Behandlung dieser Erkrankung dienen soll. Es werden 149 Tranenersatzmittel/Therapeutika fur das Trockene Auge in der Arbeitstabelle erfasst, welche je nach Diagnose und dem Schweregrad zu den Therapiemoglichkeiten in 9 Untergruppen zugeordnet werden. Der Arbeitsablauf zur Behandlung dieser Erkrankung beinhaltet die Schritte von der Symptomatik, Diagnostik und Einordnung der subjektiven und objektiven Parameter bis zur optimierten Therapie mit den in Osterreich erhaltlichen Produkten.