Search

ZusammenfassungBei chronisch progredienten und therapierbaren Erkrankungen ist die Adhärenz der Patienten ausschlaggebend für den Krankheitsverlauf und entscheidet maßgeblich über den Therapieerfolg. Dabei ist nicht nur eine geringe Adhärenz bei der Medikamenteneinnahme problematisch, sondern auch beim Einhalten der empfohlenen Nachuntersuchungen. Eine akkurate Einschätzung der Adhärenz ist insbesondere bei Glaukompatienten nur schwer möglich aufgrund der Darreichungsform als Augentropfen bei den meisten drucksenkenden Medikamenten. In der Literatur lässt sich eine große Variabilität an Angaben für die Adhärenz von Glaukompatienten finden. Die meisten Studien berichten eine durchschnittliche Arzneimitteladhärenz von ungefähr 70% mit einem Patientenanteil von um die 50% mit einer guten Adhärenz (mindestens 80% der Medikation wird wie geplant appliziert). Des Weiteren landen 6,8 – 31,4% der Augentropfen nicht im Auge, wodurch noch weniger Wirkstoff einen therapeutischen Effekt erzielen kann. Auch weisen Glaukompatienten eine geringe Persistenz und Adhärenz in puncto Kontrolluntersuchungen auf. Da ein bestehender Diabetes das Risiko für ein POAG und sekundäre Glaukomformen steigert und Diabetiker eine besonders niedrige Adhärenz aufweisen, stellte sich die Frage, ob eine Diabetesdiagnose mit einer erniedrigten Adhärenz bei Glaukompatienten assoziiert ist. Bisherige Studien fanden keine signifikante Assoziation zwischen einer Diabeteskomorbidität und einer erniedrigten Adhärenz bei Glaukompatienten, allerdings wurde ein signifikanter Einfluss von einem erhöhten HbA1c-Wert auf die Adhärenz bei Glaukompatienten in einer Studie festgestellt. Dieser Zusammenhang muss allerdings noch in Studien mit größeren Stichproben genauer untersucht werden.

Background/AimsThe current study evaluates the efficacy and safety of the stand-alone implantation of the MINIject (iSTAR Medical, Wavre, Belgium) supraciliary, microinvasive glaucoma drainage device in patients with medically uncontrolled open-angle glaucoma.MethodsThis prospective, multicentre, first-in-human, single-arm interventional study evaluated stand-alone, ab interno implantation in 25 patients of a 5 mm long uveoscleral device made of STAR biocompatible material, which is a soft, microporous, flexible silicone. The primary outcome was the reduction of intraocular pressure (IOP) at 6 months compared with baseline, and follow-up continued until 2 years for 21 patients. Secondary outcomes included success defined as diurnal IOP of ≤21 mmHg and >5 mmHg with an IOP reduction of 20% without (complete) or with/without (qualified) glaucoma medication.ResultsMean baseline IOP was 23.2±2.9 mmHg on 2.0±1.1 glaucoma medication ingredients and decreased to 13.8±3.5 mmHg (−40.7% reduction) on 1.0±1.3 medications 2 years after implantation. Complete success was achieved in 47.6% of patients (10/21) and qualified success in 100% of patients (21/21) at the 2-year follow-up. All patients achieved a 20% IOP reduction with 48% of patients medication-free. No serious ocular adverse events or additional glaucoma surgery were reported. Mean central endothelial cell density (ECD) mildly decreased from 2411 cells/mm2 (n=26) to 2341 cells/mm2 (n=21) at 24 months, which represents a 5% decrease for matched eyes. No patient had a ≥30% decrease in central ECD.ConclusionThis first-in-human study on the stand-alone implantation of the MINIject supraciliary drainage system shows promising IOP-lowering results and medication reduction over 24 months with few adverse events.Trial registration numberNCT03193736.

Susanna Friederike Koenig,1 Christoph Wolfgang Hirneiss2 1Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK; 2Ludwig-Maximilians University, Eye Clinic, Campus Innenstadt, Munich, D-80336, GermanyCorrespondence: Susanna Friederike KoenigMoorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD Email susanna.koenig@nhs.netPurpose: Lowering the intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) with filtration surgery can induce morphological changes to the bulbus and structures of the retina. In this study, we have evaluated changes of Bruch’s membrane-based parameters and retinal nerve fiber layer (RNFL) derived by spectral-domain optical coherence tomography (SD-OCT) in eyes that have undergone glaucoma filtration surgery.Patients and Methods: SD-OCT imaging of the optic nerve head (ONH) and of the RNFL was performed in 54 eyes of 54 patients with medically uncontrolled POAG before and after IOP-lowering surgery (trabeculectomy or deep sclerectomy). The ONH parameter minimum rim width (MRW) and the size of the Bruch’s membrane opening (BMO-Area) were derived from 24 radial B-scans centered on the ONH.Results: The average preoperative IOP was 23.1 ± 7.5 mmHg. One month postoperatively, the average IOP decreased to 12.1 ± 4.6 mmHg (p < 0.01), which caused a significant increase in the thickness of neuroretinal rim. There was no significant change in the automatically detected BMO-Area (p = 0.32). The pressure-related increase in MRW correlated well with the postoperative IOP and cup-to-disc ratio (CDR). In regression analysis, the alteration in thickness of the neuroretinal rim could be well predicted in a model including CDR, change of IOP and mean deviation (MD) (R2 = 0.414, p < 0.001). RNFL showed a significant increase as well.Conclusion: IOP-lowering surgery in patients with medically uncontrolled POAG causes an increased thickness of the SD-OCT derived ONH parameters. The changes of the RNFL after surgery showed no significant correlations with IOP changes. In contrast to this, highly significant correlations of MRW values with the IOP could be observed. The BMO-Area remained completely stable A preferred use of RNFL for follow-up should be discussed.Keywords: glaucoma, optic nerve head, ONH, OCT, retinal nerve fiber layer, RNFL, Bruch’s membrane opening, BMO

To describe the safety and efficacy of a novel, supraciliary, microinvasive glaucoma surgery drainage system, MINIject (iSTAR Medical, Wavre, Belgium), in the study.Prospective, multicenter, interventional, single-arm trial.Twenty-six patients with primary open-angle glaucoma uncontrolled with 1 or more intraocular pressure (IOP)-lowering medications.Using an ab interno approach, 25 eyes were implanted successfully in a stand-alone procedure with a 5-mm long device made of biocompatible STAR material, which is soft and flexible silicone in a microporous, network design. Intraocular pressure, medication use, and other ocular parameters were evaluated before surgery, 1 day, 1 and 2 weeks, and 1, 3, and 6 months after surgery.Intraocular pressure reduction at 6 months compared with baseline analyzed using a paired t test. Safety evaluation entailed tabulation of the nature and frequency of adverse events.Mean baseline diurnal IOP was 23.2 mmHg (standard error, 0.6 mmHg) using a mean ± standard deviation of 2.0±1.1 IOP-lowering medication classes. During the 6-month follow-up period, mean IOP ranged from 10.0-16.3 mmHg (mean reductions, 6.9-13.2 mmHg or 31.0%-56.8%). Six months after surgery, mean diurnal IOP was 14.2 mmHg (standard error, 0.9 mmHg), equivalent to a reduction of 9.0 mmHg or 39.1% (P0.0001). The mean ± standard deviation number of IOP-lowering medications was 0.3±0.7. Of 24 patients seen at 6-month follow-up, 21 (87.5%) were medication-free and 23 (95.8%) achieved a minimum 20% IOP reduction from baseline. There were no serious adverse events related to the device or procedure, and no additional glaucoma surgery was required. Frequently reported events included anterior chamber inflammation (n = 8), IOP elevation (n = 6), of which 1 event was an IOP spike per protocol, visual acuity reduction (n = 3), and hyphema (n = 3), all of which resolved. There was no change to mean central or peripheral corneal endothelial cell density. No device-related adverse events were reported.The MINIject glaucoma drainage system significantly lowered IOP and eliminated the need for medication in most patients 6 months after surgery when implanted in a standalone procedure. There were no serious ocular adverse events.

Hintergrund Das STARflo-Glaukomdrainageimplantat (Fa. iSTAR Medical, Wavre, Belgien) ermoglicht die Senkung des intraokularen Drucks durch Kammerwasserabfluss in den suprachoroidalen Raum ohne die Ausbildung eines Sickerkissens.

Zusammenfassung Hintergrund Die Bedeutung der Analyse von Untersuchungsdaten aus der Behandlungsrealität nimmt stetig zu. Gründe hierfür sind u. a. verbesserte Auswertungsmöglichkeiten durch leistungsfähigere Informatiksysteme. Zudem stehen mehr und mehr Daten digital zur Verfügung. Vor einem Projektstart zur Auswertung von Routinedaten, sind technische, personelle, aber vor allem auch (daten-)schutzrechtliche Aspekte zu beachten. In diesem Manuskript werden diese Aspekte anhand eines Beispiels aus der Augenklinik München erarbeitet. Material und Methoden Es werden die rechtlichen Rahmenbedingungen anhand der verschiedenen Gesetze sowie Richtlinien zur Dokumentation und zum Datenschutz beleuchtet. Auch die technischen Anforderungen an eine Infrastruktur sowie Software werden definiert. Im Rahmen einer Umfrage der Deutschen Ophthalmologischen Gesellschaft (Arbeitsgruppe IT) wurde der Stand der Digitalisierung an deutschen Augenkliniken erhoben. Abschließend erfolgt eine Definition des Personalbedarfs. Ergebnisse Es konnte eine Datenbank mit den Behandlungsergebnissen von 330 801 Patienten aufgebaut werden. Darin enthalten sind alle Diagnosen, Prozeduren an der Klinik, klinischen Befunde sowie Ergebnisse aus Messuntersuchungen. Diese Datenbank wurde vom lokalen behördlichen Datenschutzbeauftragten freigegeben. An weniger als der Hälfte der deutschen Augenkliniken, die an der Umfrage teilnahmen (n = 54) findet eine komplette elektronische Datenerfassung statt. 14 Kliniken gaben an, noch komplett papierbasiert zu arbeiten. Schlussfolgerung Im Rahmen dieser Arbeit konnte exemplarisch gezeigt werden, welche verschiedenen Rahmenbedingungen eingehalten werden müssen, um eine umfassende Datenbank mit Routineuntersuchungsdaten auszubauen. Dies wird in Zukunft immer wichtiger werden, da mehr und mehr Innovation im Bereich der entscheidungsunterstützenden Software im Bereich der Augenheilkunde zu erwarten ist. Hierfür ist eine gute Datenbasis unerlässlich.

Purpose To develop a near-real-time data warehouse (DW) in an academic ophthalmologic center to gain scientific use of increasing digital data from electronic medical records (EMR) and diagnostic devices. Design Database development. Methods Specific macular clinic user interfaces within the institutional hospital information system were created. Orders for imaging modalities were sent by an EMR-linked picture-archiving and communications system to the respective devices. All data of 325 767 patients since 2002 were gathered in a DW running on an SQL database. A data discovery tool was developed. An exemplary search for patients with age-related macular degeneration, performed cataract surgery, and at least 10 intravitreal (excluding bevacizumab) injections was conducted. Results Data related to those patients (3 142 204 diagnoses [including diagnoses from other fields of medicine], 720 721 procedures [eg, surgery], and 45 416 intravitreal injections) were stored, including 81 274 optical coherence tomography measurements. A web-based browsing tool was successfully developed for data visualization and filtering data by several linked criteria, for example, minimum number of intravitreal injections of a specific drug and visual acuity interval. The exemplary search identified 450 patients with 516 eyes meeting all criteria. Conclusions A DW was successfully implemented in an ophthalmologic academic environment to support and facilitate research by using increasing EMR and measurement data. The identification of eligible patients for studies was simplified. In future, software for decision support can be developed based on the DW and its structured data. The improved classification of diseases and semiautomatic validation of data via machine learning are warranted.

Unter Smart Data versteht man die intelligente Sammelplanung, Umsetzung und Evaluation groser Datenmengen. Dies trifft auch auf die Augenheilkunde zu, da mehr und mehr Daten digital anfallen. Einen zusatzlichen Erkenntnisgewinn sowie Moglichkeiten der personalisierten Therapie erwartet man sich aus der Kombination der Messdaten mit klinischen Werten aus einer digitalen Akte. Im Rahmen dieser Arbeit soll gezeigt werden, wie man die Daten aus Messgeraten sowie einer digitalen Akte in einem „Data Warehouse“ (DW) zusammenfuhren kann. Es wurde eine Erweiterung des klinischen Informationssystems (Krankenhausinformationssystem [KIS]) um Eingabemasken fur die Augenheilkunde durchgefuhrt, sowie Arztbriefe wurden exportiert. Diese Daten werden nachtlich in ein DW importiert. Die Anbindung von Diagnostikgerat an das KIS per HL7-Schnittstelle erfolgte uber ein Bildarchivsystem. Der Export von Messdaten in das DW geschah uber selbst entwickelte Programme. Zur Datenanalyse wurde eine Software fur augenarztliche Bedurfnisse modifiziert. Es wurden 12 Eingabemasken innerhalb des KIS geschaffen sowie der Inhalt von 32.234 Arztbriefen importiert. Es konnten 23 Diagnostikgerate an das Bildverwaltungssystem angeschlossen werden und 85.114 OCT (optische Koharenztomographie)-Datensatze, 19.098 IOLMaster-Datensatze sowie 5425 Pentacam-Datensatze in das DW mit uber 300.000 Patienten importiert werden. Zur Datenanalyse wurde eine Auswertungssoftware entwickelt, die Filtermoglichkeiten bietet. Durch den Aufbau eines DW steht eine Grundlage fur klinische und epidemiologische Auswertungen zur Verfugung. In Zukunft kann der Datenbestand genutzt werden, um Entscheidungsfindungssysteme sowie Anwendungen fur personalisierte Medizin zu entwickeln.

Objectives To report the prevalence and severity of metamorphopsia, estimate its impact on vision-related quality of life (VRQoL) and evaluate predictors of VRQoL in patients with vitreomacular traction (VMT). Patients and methods A prospective, cross-sectional multi-centre study in the United Kingdom of 185 patients with VMT, with or without a full thickness macular hole (FTMH). Self-reported metamorphopsia was determined using the metamorphopsia questionnaire. VRQoL was assessed using the Visual Function Questionnaire (VFQ-25). Physicians recorded clinical and ocular characteristics in both eyes including a physician assessment of metamorphopsia. ANOVA and predicted least-squares means were used to estimate the impact of metamorphopsia on VRQoL. Predictors of VRQoL were assessed using ordinary-least-squares regression adjusting for clinically important variables. Results The prevalence of self-reported metamorphopsia was 69.7% (95% CI 62.6–76.3%) and was higher in eyes with a concomitant FTMH vs. without FTMH (85.4% vs. 64.2%). Physician assessment of metamorphopsia was 53.0% (95% CI: 45.5–60.3%). Comparing eyes with metamorphopsia vs. without metamorphopsia, the VFQ-25 composite score was lower (82.3 vs. 91.4), and mean VA (LogMAR) was worse (0.44 vs. 0.33). The largest difference in VFQ-25 scores was observed for near activities (metamorphopsia: 75.3, No metamorphopsia: 90.2). The adjusted model showed that metamorphopsia severity and age were significantly associated with lower VFQ-25 scores. Conclusion Metamorphopsia was highly prevalent in patients with VMT and associated with significantly lower VRQoL. Physician assessment of symptoms underestimated the self-reported presence of metamorphopsia. Metamorphopsia severity acts as a predictor of impaired VRQoL, over and above decrements due to reduced vision.

To evaluate if repeated flicker-defined form (FDF) perimetry can detect visual field (VF) defects in glaucoma suspects with normal findings in achromatic standard automated perimetry (SAP).Patients with optic nerve heads (ONHs) or retinal nerve fiber layer (RNFL) findings clinically suspicious for glaucoma and normal SAP were enrolled. Patients underwent VF testing with FDF perimetry (Heidelberg Edge Perimetry, HEP) at two consecutive visits (HEP I and HEP II) and confocal scanning laser ophthalmoscopy with the Heidelberg Retina Tomograph (HRT). Abnormal HEP was defined by cluster-point analysis (CPA) and by the HEP specific glaucoma hemi-field test (GHT). Results were compared with an age-matched control group of healthy individuals.In 65 eyes of 36 glaucoma suspects, the mean deviation (MD) in SAP was -0.9 ± 1.3 dB. In HEP I and HEP II, mean MD was -3.6 ± 3.0 and -3.3 ± 3.7 dB, respectively (p = 0.276). The HRT assessed CDR was significantly correlated with the MD in HEP II (r = -0.281, p = 0.04). In HEP I, VF defects on CPA testing were found in 38 study eyes (58.5%). In HEP II, 34 eyes (51.8%) had VF defects on CPA testing. In 46 eyes of 46 age-matched healthy individuals in the control group, the mean MD was -0.2 ± 1.1 and -1.6 ± 2.3 dB in SAP and HEP testing, respectively. The FDF was abnormal in 21.7% in the control group compared to 58.5% in the glaucoma suspect group in HEP I.In more than half of the patients with ONHs or RNFLs clinically suspicious for glaucoma and normal SAP second FDF perimetry depicts VF defects.

Purpose Patients with eye diseases often have a better-seeing eye (BSE) and a worse-seeing eye (WSE). This review will carve out the current knowledge in which the relationship to BSEs and WSEs contributes to overall visual functioning and vision-related quality of life (VRQoL). Methods Searches were from database inception to the current date. Terms used for the search were “better eye”, “worse eye”, “utility”, “life quality”, “quality of life”, “VFQ-25”, and “visual acuity”. Results There is a lack of a clear definition for BSE and WSE, and the used definitions are regularly dependent on the underlying eye disease. “BSE” and “WSE” can interact in terms of binocular inhibition or summation. Measured influences of the BSE and WSE on VRQoL are dependent on the underlying instrument used for the measurement. Several studies show impaired VRQoL if only one eye is affected from disease, with unimpaired vision of the BSE. VRQoL can improve significantly when treating the BSE and the WSE. In eye diseases with impairment of the central vision, there is a better correlation between the BSE and VRQoL. However, in eye diseases with peripheral vision impairment, eg, glaucoma, functional parameters of the WSE are better predictors for VRQoL. Conclusion The WSE appears to have a stronger influence on VRQoL than is generally assumed. This is especially the case if the underlying eye disease does not affect central vision but peripheral vision.

Wichtige fur Volkswirtschaft und Gesellschaft relevante Augenkrankheiten umfassen insbesondere die Katarakt, die diabetische Retinopathie, die altersbedingte Makuladegeneration, das Glaukom und Refraktionsfehler. Ziel der Darstellung in dieser Arbeit ist es, auf der Basis bestehender Daten ein moglichst vollstandiges Bild der gesamten durch die jeweilige Augenerkrankung entstehenden volkswirtschaftlichen Kosten fur Deutschland zu geben. Diese Arbeit basiert auf einer semistrukturierten Literaturrecherche in den Datenbanken Medline und Embase sowie der Suchmaschine Google zu relevanten Originalarbeiten und Ubersichten zu den Kosten von Augenerkrankungen mit Relevanz fur oder Ubertragbarkeit auf Deutschland (letzte Nachrecherche 10/2013). Es erfolgte weiterhin eine Freihandsuche in wichtigen nationalen Datenbanken und Informationsquellen wie dem statistischen Bundesamt und Veroffentlichungen der Fachgesellschaften. Die direkten Kosten fur die genannten wichtigen Augenerkrankungen belaufen sich pro Jahr fur die Bundesrepublik Deutschland auf etwa 2,6 Mrd. EUR, inklusive Zuzahlungen durch die Patienten, aber ohne optische Hilfsmittel. Allerdings fallen neben direkten Kosten auch indirekte Kosten an, deren Hohe schwer genau erfasst werden kann, beispielsweise verursacht durch Erwerbsunfahigkeit oder Produktivitatsverlust, aber auch durch Verlust an Lebensqualitat. Berucksichtigt man diese indirekten Kosten, so ergeben sich volkswirtschaftliche Gesamtkosten zwischen 4 und 12 Mrd. EUR pro Jahr durch die genannten Augenerkrankungen. Die fur die Kosten besonders relevanten Krankheiten in der Augenheilkunde – Refraktionsfehler, Glaukom, Katarakt und Erkrankungen der Netzhaut – erreichen eine volkswirtschaftlich relevante Dimension. Aufgrund der demografischen Entwicklung ist in Zukunft mit einem Anstieg der Pravalenz und damit einem Anstieg der Kosten fur Augenerkrankungen zu rechnen.

Hintergrund Die Goldmann-Applanationstonometrie (GAT) gilt als der Goldstandard zur Augendruckmessung. Ublicherweise wird hierbei zusatzlich zur topischen Anasthesie der Tranenfilm mittels Fluoreszein-Augentropfen angefarbt, um eine bestmogliche Visualisierung des Ergebnisses zu erhalten. Die vorliegende Studie evaluiert die Unterschiede in den Messergebnissen der GAT wenn bei der Messung auf Fluoreszein verzichtet wird.

Purpose: Oxidative stress plays an important role in the pathogenesis of several neurodegenerative diseases including glaucoma. Astrocytes are supposed to play a role in glaucoma pathogenesis. This study investigates the antiapoptotic and cytoprotective effects of idebenone on optic nerve head astrocytes (ONHA) under oxidative stress. Methods: ONHA were treated with 1 to 150mM idebenone. Cell viability (MTT assay and live-dead assay), induction of intracellular reactive oxygen species, senescence-associated b-galactosidase activity were investigated. In addition, apoptosis (detection of histone-associated DNA fragmentation), and expression of BAX and Bcl-2, and their mRNA were determined after 48 hours and after hydrogen peroxide (H2O2) treatment. Results: Idebenone concentrations from 1 to 50mM showed no effects on ONHA viability. Pretreatment with 10mM idebenone led to an increase in viability of ONHA after H2O2 treatment. In addition, idebenone pretreatment significantly attenuated the increase of histone-associated DNA fragmentation, induction of senescence-associated b-galactosidase, and intracellular reactive oxygen species after treatment with H2O2. When ONHA cells were treated with idebenone and H2O2, real-time polymerase chain reaction and Western blot analysis yielded an increased expression of Bcl-2 and a decrease of BAX compared with those cells that were treated with H2O2 only. Conclusions: Idebenone reduced senescence, oxidative stress, and apoptotic cell death in cultured ONHA in vitro. Our results suggest that idebenone may help to protect ONHA in vivo, and therefore might be helpful in preventing the progression of glaucomatous degeneration.

PURPOSE. The autoimmune blistering skin disease pemphigus vulgaris (PV) is caused by autoantibodies against desmosomal adhesion molecules. Patients may suffer conjunctival involvement, yet the underlying mechanisms are largely unclear. We characterized human and murine conjunctiva with respect to the PV autoantigens, and evaluated the effects and mechanisms of PV autoantibodies applied to human conjunctiva ex vivo. METHODS. We obtained human conjunctiva specimens from surgical explants and established a short-term culture model to study the alterations induced by antibody fractions of PV patients (PV-IgG). Furthermore, we applied a mouse model depleted of the desmosomal cadherin desmoglein 3 (Dsg3), the primary autoantigen in PV. Murine and human conjunctiva also was used to analyze the expression pattern of desmosomal proteins by immunostaining and Western blotting. RESULTS. Human and murine conjunctiva samples expressed the majority of desmosomal molecules with an expression pattern similar to the epidermis. Interestingly, Dsg3 knock out animals frequently suffer eye lesions, histologically evident as microblisters in the eyelid epidermis and conjunctiva. Incubation of human specimens with PV-IgG for 12 hours caused blistering in the suprabasal layers of the conjunctiva as well as reduction of Dsg1 and Dsg3 protein levels. Furthermore, PV-IgG prompted activation of p38MAPK in the conjunctiva, which is a central pathomechanism leading to blistering in the epidermis. CONCLUSIONS. PV-IgG leads to blister formation and p38MAPK activation in the conjunctiva and, thus, resembles the effects found in the epidermis. Our data indicate that the ocular involvement observed in PV patients is mainly based on conjunctival blistering.

To evaluate the relationship between functional parameters of repeated flicker-defined form perimetry (FDF) and structural parameters of spectral-domain optical coherence tomography (SD-OCT) in glaucoma suspects with normal findings in achromatic standard automated perimetry (SAP).Patients with optic nerve heads (ONH) clinically suspicious for glaucoma and normal SAP findings were enrolled in this prospective study. Each participant underwent visual field (VF) testing with FDF perimetry, using the Heidelberg Edge Perimeter (HEP, Heidelberg Engineering, Heidelberg, Germany) at two consecutive visits. Peripapillary RNFL thickness was obtained by SD-OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany). Correlations and regression analyses of global and sectoral peripapillary RNFL thickness with corresponding global and regional VF sensitivities were investigated.A consecutive series of 65 study eyes of 36 patients were prospectively included. The second FDF test (HEP II) was used for analysis. Cluster-point based suspicious VF defects were found in 34 eyes (52%). Significant correlations were observed between mean global MD (PSD) of HEP II and SD-OCT-based global peripapillary RNFL thickness (r = 0.380, p = 0.003 for MD and r = -0.516, p0.001 for PSD) and RNFL classification scores (RIn glaucoma suspects with normal SAP, global and sectoral peripapillary RNFL thickness is correlated with sensitivity and VF defects in FDF perimetry.

OBJECTIVE To compare the diagnostic properties of a nonmydriatic 200° ultra-widefield scanning laser ophthalmoscope (SLO) versus mydriatic Early Treatment of Diabetic Retinopathy Study (ETDRS) 7-field photography for diabetic retinopathy (DR) screening. RESEARCH DESIGN AND METHODS A consecutive series of 212 eyes of 141 patients with different levels of DR were examined. Grading of DR and clinically significant macular edema (CSME) from mydriatic ETDRS 7-field stereo photography was compared with grading obtained by Optomap Panoramic 200 SLO images. All SLO scans were performed through an undilated pupil, and no additional clinical information was used for evaluation of all images by the two independent, masked, expert graders. RESULTS Twenty-two eyes from ETDRS 7-field photography and 12 eyes from Optomap were not gradable by at least one grader because of poor image quality. A total of 144 eyes were analyzed regarding DR level and 155 eyes regarding CSME. For ETDRS 7-field photography, 22 eyes (18 for grader 2) had no or mild DR (ETDRS levels ≤ 20) and 117 eyes (111 for grader 2) had no CSME. A highly substantial agreement between both Optomap DR and CSME grading and ETDRS 7-field photography existed with κ = 0.79 for DR and 0.73 for CSME for grader 1, and κ = 0.77 (DR) and 0.77 (CSME) for grader 2. CONCLUSIONS Determination of CSME and grading of DR level from Optomap Panoramic 200 nonmydriatic images show a positive correlation with mydriatic ETDRS 7-field stereo photography. Both techniques are of sufficient quality to assess DR and CSME. Optomap Panoramic 200 images cover a larger retinal area and therefore may offer additional diagnostic properties.

Hintergrund Es erfolgte eine Evaluation der Zielgenauigkeit von navigierter Lasertherapie mit dem NAVILAS®-System bei diabetischem Makulaodem (DMO).

Purpose To assess the effect of ranibizumab treatment for neovascular age-related macular degeneration (nvAMD) on patients9 preferences and vision-related quality of life (VRQoL) in a routine clinical setting. Methods 55 treatment naive patients were examined before and after the initial upload of three monthly injections of 0.5 mg ranibizumab. VRQoL was assessed using a Rasch-adjusted NEI-VFQ-25. Time trade-off (TTO), standard gamble, a visual analogue scale and the European Quality of Life Questionnaire (EQ-5D) were used to calculate utilities, and multiple logistic regression models were conducted to determine independent factors associated with utilities. Results Mean±SD age was 75±7 years, and 40 patients (73%) were female. Mean±SD best-corrected visual acuity of the treated eye increased from 20/80 at baseline (logMAR 0.60±0.35) to 20/63 (logMAR 0.52±0.36; p=0.020) at follow-up after three injections. Utility score increases ranged from 2 utils (standard gamble anchored for death) up to 6.6 utils (EQ-5D German TTO, p=0.023) and visual functioning improved (Rasch adjusted composite NEI-VFQ score 50±21 to 54±21, p=0.042). Whether the worse or better eye was treated was not significantly associated with improvements in utility or VRQoL, whereas VA improvement in the treated eye was associated with an increase in utility (TTO, p=0.020). Conclusions TTO performed best in this sample of elderly nvAMD patients undergoing anti-VEGF therapy. Better or worse eye treatment was not associated with a change in reported utilities or visual functioning in patients with newly diagnosed nvAMD. Directly elicited, vision-specific utilities gained with TTO seem to be sensitive to a change in vision status.

Background: Cumulative light exposure is significantly associated with ageing and the progression of age-related macular degeneration. To prevent the retina from blue-light damage in pseudophakia, blue light-absorbing intraocular lenses have been developed. This study compares the possible protective effects of a blue light-absorbing intraocular lens to an untinted ultraviolet-absorbing intraocular lens with regard to light-induced oxidative stress and senescence of human retinal pigment epithelium. Methods: As primary human retinal pigment epithelium cells were exposed to white light, either an ultraviolet- and blue light-absorbing intraocular lens or ultraviolet-absorbing intraocular lens was placed in the light beam. After 60 min of irradiation, cells were investigated by electron microscopy for viability, induction of intracellular reactive oxygen species, and senescence-associated β-galactosidase activity. Expression and secretion of matrix metalloproteinases 1 and 3 and their mRNA were determined by real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay. Results: Light exposure induced structural damage, decreased retinal pigment epithelium cell viability, and increased reactive oxygen species, senescence-associated β-galactosidase activity and matrix metalloproteinases 1 and 3 expression and secretion. Although both types of intraocular lens significantly reduced these effects, the protective effects of the ultraviolet- and blue light-absorbing intraocular lens were significantly stronger than those of the ultraviolet-absorbing intraocular lens. Conclusions: The ultraviolet- and blue light-absorbing intraocular lens demonstrated significantly better protection against light-induced oxidative stress, senescence and structural damage than the ultraviolet-absorbing intraocular lens. These in vitro findings support the hypothesis that the ultraviolet- and blue light-absorbing intraocular lens may prevent retinal damage in clinical use.

Einleitung Das Glaukom zahlt zu den haufigsten Ursachen irreversibler Erblindung weltweit und kann die Lebensqualitat und Funktionsfahigkeit betroffener Patienten signifikant beeintrachtigen. Mit dem englischsprachigen „Glaucoma Quality of Life-15“ (GQL-15) steht seit geraumer Zeit ein spezialisiertes Instrument zur Quantifizierung der funktionellen Beeintrachtigung von Glaukompatienten zur Verfugung. Diese Studie evaluiert eine deutschsprachige Version des GQL-15 und stellt Korrelationen zu Gesichtsfeldparametern her.

BACKGROUND Light-induced oxidative stress is an suggested reason for retinal pigment epithelium (RPE) degeneration in age-related macular degeneration (AMD). This study investigates the influence of light on intracellular reactive oxygen species (ROS) and apoptosis in the human RPE and potential cytoprotective effects of the tetracycline antibiotic minocycline. METHODS Primary human RPE cells were either pre- or post-incubated with minocycline and then exposed to white light or oxidative stress (600 µM, H(2)O(2)). Then viability, induction of intracellular reactive oxygen species (ROS), apoptosis and cell death was determined. Expression of apoptotic BAX and anti-apoptotic Bcl-2 protein and their mRNA were determined by RT-PCR and Western blot analysis. RESULTS Both light exposure and oxidative stress decreased RPE cell viability and Bcl-2 expression and increased intracellular ROS, apoptotic cell death, and BAX expression. Minocycline reduced these effects under certain conditions. CONCLUSIONS This study demonstrates that minocycline effectively protects human RPE cells against oxidative damage. However, in the light of minocycline's photosensitising properties its potential role in AMD treatment needs further evaluation.

Kumulative Lichtexposition wird fur die Entstehung der altersabhangigen Makuladegeneration (AMD) mitverantwortlich gemacht. Die Hemmung des „vascular endothelial growth factor A“ (VEGF) ist das wichtigste Ziel der aktuellen antiangiogenen Behandlungsstrategien bei AMD. In Fallberichten konnte die Wirksamkeit des Multikinaseinhibitors Sorafenib bei Patienten mit exsudativer AMD gezeigt werden. Diese Studie untersucht die Wirkung von Sorafenib auf die Expression der VEGF-Rezeptoren 1 und 2 (VEGFR-1/2) und die lichtinduzierte Expressionszunahme von VEGF in humanen retinalen Pigmentepithelzellen (RPE-Zellen). Der Effekt von Sorafenib auf die Expression von VEGFR-1 und -2 in primaren humanen RPE-Zellen wurde auf zellularer Ebene mittels RT-CR, Immunhistochemie und Westernblot untersucht. Zusatzlich wurden die RPE-Zellen mit rein weisem Licht bestrahlt und mit Sorafenib behandelt. Dann wurden die Vitalitat der RPE-Zellen und die Expression von VEGF auf zellularer Ebene bestimmt (Real-Time-PCR, Westernblot, Immunhistochemie, ELISA). Sorafenib reduziert die VEGFR-1/2-Expression von humanen RPE-Zellen. Die Bestrahlung der RPE-Zellen mit weisem Licht fuhrt zu einer Abnahme der Vitalitat und zur Induktion von VEGF. Diese lichtinduzierten Effekte werden signifikant reduziert, wenn Zellen mit Sorafenib (1 µg/ml) behandelt werden. Die Ergebnisse dieser Studie zeigen, dass der Multikinaseinhibitor Sorafenib vielversprechende Eigenschaften fur eine mogliche Anwendung bei exudativer AMD aufweist.

OBJECTIVE: The aim of the study was to compare the diagnostic properties of a non-mydriatic 200A‚° ultra-widefield scanning laser ophthalmoscope (SLO) with mydriatic ETDRS 7-field fundus photography for diabetic retinopathy screening. METHODS: A consecutive series of 66 eyes from 34 patients with different levels of diabetic retinopathy (DR) were examined. Grading of DR and macular edema (ME) obtained from mydriatic ETDRS 7-field fundus photography were compared with grading obtained from Optomap Panoramic 200MA SLO images. All SLOs were performed with an undilated pupil and no additional clinical information was used for evaluation of images by two independent, masked experts. RESULTS: A total of 14 eyes from ETDRS 7-field fundus photography and 11 eyes from Optomap could not be graded by at least one grader due to poor image quality, yielding 48 eyes for comparison purposes. Of the 48 ETDRS 7-field fundus photographs, 9 (11 for grader 2) eyes had no or mild DR (ETDRS levels A¢Â‰Â¤20) and 17 (23 for grader 2) eyes had no ME. Agreement of Optomap retinopathy grading with ETDRS 7-field fundus photography was good, kappa 0.70 for grader 1 and kappa 0.66 for grader 2. There was good agreement between both techniques for ME, grader 1 kappa 0.68 and grader 2 kappa 0.74. CONCLUSIONS: Grading of DR levels from Optomap Panoramic 200MA non-mydriatic images showed a good correlation with mydriatic ETDRS 7-field fundus photography. Both techniques are of sufficient quality for a valid assessment of DR. Optomap Panoramic 200MA images cover a larger retinal area and might therefore offer additional diagnostic properties.

Purpose: Indocyanine green (ICG) is a commonly used vital dye for macular surgery. Recent reports implicate that its use might be associated with less favourable results regarding postoperative visual outcome and damage of retinal cells, and atrophic degeneration of the retinal pigment epithelium (RPE) has been described. This study investigates the effects of ICG on light-induced senescence of RPE cells. Methods: Primary human RPE cells were either pre-incubated with ICG in concentrations of 0.005% and 0.05% or not and then exposed to white light. After 10 min of irradiation viability, induction of intracellular reactive oxygen species (ROS) and senescence-associated β-galactosidase activity (SA β-Gal) were determined. Expression and secretion of matrix metalloproteinases (MMPs) 1 and 3 and their mRNA were determined by RT-PCR and ELISA. Results: Light exposure decreased RPE cell viability by 46%. Treatment with 0.005% and 0.05% ICG alone decreased RPE cell viability by 7% and 21%. In addition, expression of ROS, SA β-Gal, and MMP-1 and 3 was significantly increased. When 0.005% and 0.05% ICG treatments were combined with light exposure, viability decreased by 69% and 82% compared to the untreated control. Effects on the expression of ROS, SA β-Gal, and MMP-1 and 3 were, depending on the ICG dose, significantly increased when cells were pre-incubated with ICG and then illuminated. Conclusion: In this study, pretreatment with ICG significantly increased light-induced oxidative stress and senescence. This might indicate a potential, supplementary mechanism that could explain RPE alterations and reduced functional results after ICG-assisted internal limiting membrane peeling.

Loss of corneal endothelial cells (CECs) is one major factor limiting transplant clarity and survival after keratoplasty. Amongst other factors, apoptosis due to cellular stress is responsible for these problems. This study investigates the possible anti-apoptotic and cytoprotective effects of minocycline on a human corneal endothelial cell line (HCEC-SV40) cultured under oxidative stress and with transforming growth factor beta (TGF-beta).CECs were treated with 1-150 microM minocycline. Cell viability and the median inhibitory concentration (IC(50)) were evaluated after 48 h and after H(2)O(2) treatment (tetrazolium dye reduction assay and live-dead assay). Expression of B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP) and their mRNA were assessed by reverse transcriptase (RT)-PCR and western blot analysis after treatment with minocycline alone and consecutive incubation with 200 microM H(2)O(2) and TGF-beta2. A quantitative detection of histone-associated DNA fragmentation by ELISA was performed.Minocycline concentrations from 1-50 microM showed no toxic effects on CECs. Pre-treatment with 10-40 microM minocycline led to an increase in viability after H(2)O(2) treatment. In addition, minocycline pre-treatment attenuated the increase of histone-associated DNA fragmentation after treatment with H(2)O(2) and TGF-beta2 significantly. When CECs were treated with minocycline and then consecutively with H(2)O(2) or TGF-beta2, RT-PCR and western blot analysis yielded an overexpression of Bcl-2 and XIAP.In this study minocycline prevented apoptotic cell death in cultured CECs in vitro. Our results suggest that minocycline might offer cytoprotective properties that might help to prevent loss of corneal endothelial cells in vivo.

Background: Cataract is one of the most prevalent eye disease and a major cause for legal blindness in the world. Beside others, cumulative light-exposure and apoptotic cell death are significantly associated with cataract development. In contrast, supplementation with antioxidants has been suggested to prevent premature cataractogenesis. This study investigates possible protective effects of Coenzyme Q10 (CoQ10) regarding light-induced stress and apoptotic cell death in human lens epithelial cells (LEC). Methods: Human LEC were either pre-incubated with CoQ10 or not and then exposed to white light. After 10–40 min of irradiation viability, induction of intracellular reactive oxygen species (ROS), apoptosis and cell death was determined. Expression of apoptotic BAX and anti-apoptotic Bcl-2 protein and their mRNA were determined by RT-PCR and Western blot analysis. Results: Light exposure decreased LEC viability and Bcl-2 expression and increased intracellular ROS, apoptotic cell death, and BAX expression in a time-of-irradiation-dependent manner. Phototoxic cell death and apoptosis, as well as decrease of Bcl-2 and increase in BAX expression was significantly reduced, when cells were pre-incubated with CoQ10. Conclusions: In this study, CoQ10 significantly reduced light-induced LECdamage and attenuated phototoxic effects on BAX and Bcl-2 expression. Therefore, CoQ10 supplementation might also be useful in preventing LEC death and consecutive cataract formation in vivo.

Modeling plays an important role in value-based medicine (VBM). It allows decision support by predicting potential clinical and economic consequences, frequently combining different sources of evidence. Based on relevant publications and examples focusing on ophthalmology the key economic modeling methods are explained and definitions are given. The most frequently applied model types are decision trees, Markov models, and discrete event simulation (DES) models. Model validation includes besides verifying internal validity comparison with other models (external validity) and ideally validation of its predictive properties. The existing uncertainty with any modeling should be clearly stated. This is true for economic modeling in VBM as well as when using disease risk models to support clinical decisions. In economic modeling uni- and multivariate sensitivity analyses are usually applied; the key concepts here are tornado plots and cost-effectiveness acceptability curves. Given the existing uncertainty, modeling helps to make better informed decisions than without this additional information.

The application of value-based medicine (VBM) tenets in the area of glaucoma research requires valid and reliable data concerning the quality of life with glaucoma. A multitude of instruments for measuring quality of life of patients with glaucoma have been employed in the past. Any instrument used would need to capture peripheral vision loss and its influence on patient-reported quality of life as this is one of the hallmarks of this disease. Cost-utility analyses can then be based on the reported quality of life and the cost of glaucoma therapy. Several cost-utility analyses have been applied in the field of glaucoma screening as well as treating ocular hypertension and based on this a recommendation regarding population subgroups which can be treated cost efficiently can be made.

Loss of an eye can be supposed to lead to reduced health-related quality of life. This can be due to monophthalmia in acquired anophthalmus and/or because of cosmetic impairment. Meanwhile several methods exist to evaluate the quality of life and the impairment in utility values in patients with ophthalmological diseases.Twenty-three patients who underwent enucleation of one eye with good visual acuity of the fellow eye (20/30) were included. All patients were asked to complete a standardized time trade-off (TTO) utility assessment form as well as the self-administered National Eye Institute Visual Function Questionnaire 25 (VFQ 25). TTO was assessed for restoring vision (TTO-A) and for restoring cosmetic appearance (TTO-B).The mean TTO value for visual function (TTO-A) was 0.87, the mean TTO value for cosmetic restoration (TTO-B) was 0.90 with a significant correlation. These values are surprisingly high compared to current TTO data. Visual acuity of the last eye and utility values were not correlated. TTO was not influenced by the underlying diagnosis. Patients older than 50 years were willing to trade off relatively more years than younger patients. TTO values were independent from the duration of the acquired anophthalmus. The mean VFQ-25 composite score was 81.0 and significantly lower than in the normal population. There was no significant correlation between TTO and the VFQ-25 composite score or any of the 12 subscales of the VFQ-25.Utility of patients with acquired anophthalmus and good vision of the last eye is very similar to patients with two eyes of which one is worse and good binocular vision. The VFQ-25 is no predictor for time trade-off.

BackgroundMoxifloxacin (Vigamox®), a 4th-generation fluoroquinolone, covers most isolates causing endophthalmitis. It is safe and effective for systemic and topical use; however, only very limited data are available on prophylactic intracameral administration to prevent endophthalmitis. This study investigated the safety of Vigamox® for intracameral application in a cell-culture model.MethodsThe endothelial toxicity of moxifloxacin (Vigamox®) was evaluated in cultured human corneas. Primary human retinal pigment epithelium cells (RPEs), trabecular meshwork cells (TMCs), lens epithelium cells (LECs), and corneal endothelial cells (CECs) were treated with concentrations of Vigamox. Toxic effects were evaluated after 24 h (MTT assay and live-dead assay). By treating TMC, CEC, and RPE cells either with oxidative stress or tumor necrosis factor-alpha (TNF-a), lipopolysaccharide (LPS), and interleukin-6 (IL-6), the effects of moxifloxacin on cellular viability under conditions of inflammation were investigated.ResultsNo corneal endothelial toxicity could be detected after 30 days of treatment with moxifloxacin 500 μg/ml. Primary RPEs, TMCs, LECs, and CECs showed adverse effects on proliferation and viability only at concentrations higher than 150 μg/ml moxifloxacin. After preincubation with TNF-a, LPS, and IL-6 for 24 h and subsequent treatment with moxifloxacin at concentrations of 10-150 μg/ml for 24 h, no significant decrease in proliferation or viability was observed. H 2 O 2 exposure did not increase cellular toxicityConclusionVigamox® did not show significant toxicity on primary RPEs, TMCs, LECs, CECs, or human corneal endothelium at concentrations up to 150 μg/ml. The MIC90 of moxifloxacin for pathogens commonly encountered in endophthalmitis is known to be in the range of 0.25-2.5 μg/ml. Therefore, intracameral use of Vigamox® at concentrations up to 150 μg/ml may be safe and effective for preventing endophthalmitis after intraocular surgery.

To apply the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) to a large group of working people and assess the prevalence of eye disease. In this cross-sectional study, 619 employees of two large enterprises in Munich, Germany, underwent complete ophthalmological examination and assessment of the vision-related quality of life by the Visual Function Questionnaire (VFQ-25, German translation). Statistical analysis including binary logistic regression to investigate predictive factors of eye disease was performed. The age of the participants was mean 42 years. In 108 patients (17.4%) an ophthalmological disease was present. The mean VFQ-25 composite score was 91.1, and was not significantly different between the group with (88.8) or without (91.6) eye disease. A clear age dependency of VFQ-25 scores was seen. Most reduced subscales in eye disease were ocular pain and role difficulties. Patients with amblyopia did not show any reduction in visual quality of life (composite score 93.4). In the binary regression model, considering the clinical parameters intraocular pressure (IOP), cup/disc ratio (CDR), and spherical equivalent, as well as some of the VFQ-25 subscales, the presence of eye disease could be predicted with a high specificity of 98.7% but a low sensitivity of 12.2%. Normal values of the VFQ-25 performance in a large number of working people in Germany are given with a clear age dependency. A combination of refraction, IOP, CDR and some VFQ subscales could reasonably well exclude any prevalent eye disease. For screening purposes, neither variable nor combination was sufficiently sensitive and specific.

Ein Glaukomscreening, das derzeit nicht zum Leistungsumfang der gesetzlichen Krankenkassen gehort, kann bislang nicht diagnostizierte Glaukompatienten detektieren und einer Behandlung zufuhren, um die Sehfunktion und Lebensqualitat der Patienten zu erhalten. In dieser Arbeit soll der gesundheitsokonomische Aspekt der Kosteneffizienz eines Glaukomscreenings herausgearbeitet werden. Relevante medizinische Datenbanken (CDSR, HTA, MEDLINE, EMBASE) wurden nach den Inhalten Glaukomscreening, geeigneten Testverfahren fur ein Glaukomscreening und nach gesundheitsokonomischen Analysen fur Glaukomscreening durchsucht. Die wesentlichen Arbeiten und Ubersichten werden dargestellt und zusammen mit epidemiologischen Daten erlautert und verglichen. Ein Screening auf Glaukom erfullt wesentliche Screeningkriterien. Das derzeit beste Einzeltestverfahren fur ein Glaukomscreening ist die frequenzverdoppelte Perimetrie (FDT). Die Kosteneffizienz des Glaukomscreenings wird von folgenden Parametern bedingt: Pravalenz der Erkrankung, Spezifitat des Testverfahrens, Kosten fur Screening und Krankheit und die Beeintrachtigung der Lebensqualitat durch das Glaukom. Aktuelle Kosten-Nutzwert-Analysen kommen zum Ergebnis, dass ein flachendeckendes Screening der Gesamtbevolkerung nicht kosteneffizient ist. Ein Screening von Risikogruppen kann aber durchaus kosteneffizient sein. Nach bisheriger Datenlage ist ein flachendeckendes Screening auf Glaukom nicht kosteneffizient, obgleich fur Deutschland noch keine Analyse berechnet wurde. Gesundheitsokonomische Analysen konnen die Frage klaren, bei welchen Risikogruppen und ab welcher Schwelle Kosteneffizienz besteht. Analysen dieser Art sind wichtige Kriterien fur Entscheidungstrager im Gesundheitswesen.

Kumulative Lichtexposition wird fur die Entstehung der altersabhangige Makuladegeneration (AMD) mitverantwortlich gemacht. Um die Netzhaut vor den schadlichen Einflussen des blauen Lichts zu schutzen, werden seit geraumer Zeit Blaulicht absorbierende Intraokularlinsen (IOLs) eingesetzt. Diese Studie vergleicht mogliche zytoprotektive Effekte der Blaulicht absorbierenden SN60AT IOL (ALCON) mit der ungefarbten, UV-Licht absorbierenden SA60AT IOL (ALCON) auf das humane retinale Pigmentepithel (RPE). Kulturen primarer humaner RPE Zellen wurden mit weisem Licht bestrahlt, das entweder durch eine SN60AT IOL oder eine SA60AT IOL gefiltert wurde. Nach einer Bestrahlungszeit von 15–60 min wurden Vitalitat, Induktion von Apoptose und die Expression des „vascular endothelial growth factor A“ (VEGF-A) sowie des antiapoptotisch wirksamen Proteins XIAP auf zellularer Ebene bestimmt (RT-PCR/Western Blot/ELISA) Die ungefilterte Bestrahlung der RPE-Zellen mit weisem Licht fuhrte zu einer bestrahlungszeitabhangigen Abnahme der Vitalitat und der Expression von XIAP sowie zu einer Induktion von Apoptose und Bildung von VEGF-A. Diese phototoxische Zellschadigung wurde durch beide untersuchten IOLs signifikant reduziert. Die Zellschadigung durch Bestrahlung mit Licht nach Blaulichtfilterung mit der SN60AT IOL war signifikant geringer als mit der SA60AT IOL. Sowohl UV-filternde als auch Blaulicht absorbierende IOLs reduzieren phototoxische RPE-Schadigung. Die Blaulicht absorbierende SN60AT IOL fuhrte in unseren Versuchen zu einer zusatzlichen Reduktion der Zellschadigung. Die Ergebnisse deuten darauf hin, dass Blaulicht absorbierende IOLs auch im klinischen Gebrauch eine photoprotektive Wirksamkeit auf Netzhautebene besitzen.

OBJECTIVE: The aim of this study is to provide the best available evidence on how to disinfect contact Goldman tonometers. METHODS: A systematic review of all articles on disinfection of contact tonometers was conducted. Articles published up to July 2008 were identified in Medline, Embase and references from included articles. Two observers participated in the data retrieval and assessment of the studies identified. RESULTS: A total of 89 articles was retrieved, of which 58 could be included. Of those, 18 were clinical studies, 17 experimental microbiological studies, 8 expert assessments or guidelines and 15 reviews, surveys, descriptions of new methods. The clinical studies illustrate the importance of the problem, possible side effects of some disinfection methods but yield inconclusive results regarding efficacy. Experimental studies investigated a variety of bacterial and virological questions as well as material damage by disinfection. Both chlorine-based and hydrogen peroxide-based liquid disinfection were shown to be effective if applied for 5 min. Inconsistent results exist for alcohol wipes and UV disinfection - material damage has been described for both. The US guidelines and most expert recommendations are supported by evidence of the existing data. CONCLUSIONS: Chlorine-based and hydrogen peroxide-based liquid disinfections for 5 minutes are effective and relatively safe for disinfecting contact tonometers.

PURPOSE: Ranibizumab (Lucentis) stabilizes or improves visual acuity in a high percentage of patients with age-related macular degeneration (AMD). As this therapy is associated with significant costs, the aim of this study was to provide a cost-utility analysis, which considers both costs and utility of a therapy with ranibizumab in an economic model. METHODS: The incremental utility for the patient was modelled based on visual acuity data of the MARINA and ANCHOR study. The utility data used assume that the better seeing eye is affected. The study groups used for comparison consisted of patients who only received best supportive care, e. g., low-vision aids. The baseline scenario of the model assumes 6 treatments per year over a 2 year time period - based on the assessment of an expert panel. Treatment costs were based on German pharmacy prices and recommendations for reimbursement of the intravitreal injections. In a univariate sensitivity analysis all important parameters were varied to assess the stability of the results. RESULTS: The baseline scenario yields for predominantly classic lesions 16 882 €/QALY (quality adjusted life year), for minimally classic CNV 24 766 €/QALY and for occult CNV 26 170 €/QALY. If a distribution of the CNV types with 18 - 25 - 57 % is assumed, the mean cost of therapy with ranibizumab amounts to 24 147 €/QALY. Sensitivity analysis showed that all reasonable variations yielded results which are considered cost-effective (≤ 50.000 US $/QALY). This is especially true for high and low patient age, for groups with low (0.05 - 0.1) and high ( > 0.4) visual acuity, for a variation of costs per treatment of ± 20 %, and a prolonged treatment duration of 3 years. CONCLUSIONS: In the investigated szenario a therapy of neovascular AMD with ranibizumab is cost-effective for all angiographic subtypes as well as in the sensitivity analysis.

Several automated systems have become available to determine endothelial cell density (ECD) of donor corneas. The purpose of this study was the comparison of 2 systems, the Endothelial Analysis System EAT V1.4 (Rhinetec, Duesseldorf, Germany) and the NAVIS Cell Count Version 3.4.1 (Nidek Technologies, Erlangen, Germany), against manual ECD counts.During organ culture, the endothelium of 50 human corneas was photographed on both conventional film and digitally. Manual fixed-frame counting was performed on 2 photographs by 3 experienced ophthalmologists. Three digital pictures of each cornea were analyzed semiautomatically on the Rhinetec EAT system V1.4. Images were imported and analyzed by the fully automatic mode of the NAVIS system V3.4.1 (which also offers a semiautomatic counting mode). In an additional experiment on 11 corneas, the NAVIS counts on the microscopy system previously used only for manual cell counts were directly compared with manual counts.Mean endothelial cell density obtained by manual counting of all observers was 2679 +/- 313 (SD) cells/mm. Values obtained by digital analysis with EAT were a mean of 1.3% higher (2713 +/- 286 cells/mm), which is not a significant difference. In contrast, analysis of the digital pictures with the fully automated NAVIS software mode showed a mean of 7.0% higher measurements (2867 +/- 111 cells/ mm), a significant difference (P = 0.0001). Altman-Bland analysis revealed that the fully automated NAVIS counts gave too low results for high ECDs and too high results for low ECDs. This result was confirmed by the direct comparison with manual counting.Fully automated analysis of ECD remains problematic. Validation of any computer-assisted system against manual counting is of importance.

Background A specific Electronic Health Record (EHR) for ophthalmology was introduced in an academic center in Germany. As diagnoses coding corresponding to the International Classification of Diseases Version 10 (ICD-10) is mandatory for billing reasons in Germany, we analyzed whether a change occurred in the diversity and number of diagnoses after the EHR introduction. The number of patients was also analyzed. Proper diagnoses coding is of the utmost importance for further data analysis or billing. Methods Graphical User Interfaces (GUIs) were created by using Advanced Business Application Programming language in EHR “i.s.h.med.” Development of an EHR was conducted in close collaboration between physicians and software engineers. ICD-10 coding was implemented by using a “hit list” and a search engine for diagnoses. An observational analysis of a 6-month period prior to and after the introduction of an ophthalmological specific EHR was conducted by investigating the diversity and number of diagnoses in various ophthalmological disease categories and the number of patient consultations. Results During the introduction of a specific ophthalmological EHR, we observed a significant increase in the emergency department cases (323.9 vs. 359.9 cases per week), possibly related to documentation requirements. The number of scheduled outpatients didn’t change significantly (355.12 vs. 360.24 cases per week). The variety of diagnoses also changed: on average, 156.2 different diagnoses were made per week throughout our hospital before the EHR launch, compared to 186.8 different diagnoses per week thereafter (p

PURPOSE This study was performed to evaluate the structure-function relationship between Bruch's membrane opening (BMO) parameters of the optic nerve head (ONH) and visual field (VF) sensitivity. METHODS Forty-six right eyes of 46 patients with open-angle glaucoma (OAG) in the patient group and 12 right eyes in the control group were included. Standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SD-OCT) were assessed. Three BMO-based distances and two areas of the neuroretinal rim were used for correlation: the minimum rim width (MRW), the perpendicular rim width (PRW), the horizontal rim width (HRW), the minimum rim area (MRA) within the neuroretinal tissue defined by the MRW, and the perpendicular rim area (PRA) within the neuroretinal tissue defined by the PRW. These parameters were correlated with global and sectoral VF sensitivities. Spearman's correlation coefficients between BMO parameters and global and sectoral VF sensitivities were obtained. RESULTS Within the patient group, significant correlations could be observed between global and sectoral VF sensitivities and BMO parameters, with PRW and PRA showing the highest values. In the sectoral analysis the highest correlations were found for the temporal-inferior VF sector (MD-TI): PRW-TI (ρ = 0.72394; P < 0.00001) and PRA-TI (ρ = 0.77205; P < 0.00001). Minimum rim width and MRA performed more weakly than PRW and PRA. CONCLUSIONS The BMO-based parameters PRW and PRA presented with a very good structure-function relationship in glaucoma patients, statistically at least equal to MRW and MRA. Using new BMO-based parameters might allow early objective assessments of functional glaucomatous impairments.

Purpose Cost-utility and cost-effectiveness analyses are of increasing importance to clinicians and health policy experts. This study determines the costs in Germany and other countries in relation to gain of utility for patients with bilateral poor vision owing to corneal disease undergoing penetrating keratoplasty (PK) in 1 eye. Design A cost-utility analysis was performed using retrospective clinical data and high-level evidence-based data. Participants Sixty patients (mean age, 46.3 years) with bilateral poor vision who underwent PK for corneal disease. Methods Visual acuity and utility values were obtained before and 1 year after PK and after suture removal. A 10-year graft survival rate of 80% was assumed. Expenses included costs for the corneal transplant and surgery, medication, and optical rehabilitation. A discount rate of 5% was applied for costs and quality-adjusted life years (QALYs). Cost-utility analysis encompassed a 10-year period after surgery. Main Outcome Measures The number of QALYs was calculated for the study group undergoing PK. This was divided into the cost of the procedure to get the number of euros spent per QALY gained. Results Median binocular preoperative visual acuity was −log mean angle of resolution (−logMAR) 0.91±0.53 (Snellen equivalent 20/160) yielding a utility value of 0.67. After suture removal and optical rehabilitation, binocular visual acuity increased to median −logMAR 0.36±0.36 (20/46) with a utility value of 0.79. Over the 10 years after surgery and considering graft survival and discounting, a cost utility of €9551 per QALY was gained (equivalent to US$11 557). One-way sensitivity analysis yielded a range from €7706 to €12874 per QALY, highlighting the robustness of the model. Conclusions Although an expensive procedure, PK is cost effective in patients with bilateral poor vision.

In the present study we evaluated the functional success after macular hole surgery in correlation to visual quality of life and looked for predictive factors determining surgical success.Fifty-nine patients that underwent pars plana vitrectomy for idiopathic macular hole were included. Follow-up visits were performed in regular intervals after surgery and included a clinical examination, optical coherence tomography (OCT) and measurement of visual acuity. To assess the visual quality of life patients filled out the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) before and three months and one year after surgery.Macular hole closure was achieved in 57 of 59 patients (97%). Mean visual acuity increased from 20/100 preoperatively to 20/34 one year after surgery (p = 0.02). Despite good visual acuity (20/27) in the fellow eye, visual quality of life (VFQ composite score) rose from 75.9 +/- 14.4 (SD) to 81.5 +/- 14.2 one year after surgery (p0.001). Although there was no correlation between the increase in visual quality of life and visual acuity, the increase in VFQ-25 could be well predicted: low visual acuity and significant impairment on VFQ-25 testing preoperatively made patients most likely to benefit from macular hole surgery. A relatively high retinal thickness measurement at the hole border measured on OCT further increases the predictive value.Macular hole surgery is associated with an increase in visual quality of life despite good visual acuity of the fellow eye. Preoperative visual acuity, VFQ-25 value and partly OCT may help to predict the increase in patients' vision related quality of life after surgery.

Hintergrund Die „value-based medicine“ (VBM) nimmt eine Bewertung der Aufwendungen (Kosten) fur medizinisches Handeln mit dem resultierenden Nutzen fur den Patienten vor. Das ermoglicht eine quantitative Analyse von Diagnostik- und Therapieoptionen mit zunehmender Bedeutung auch in der Augenheilkunde.

Da mit dem Anstieg der Sehscharfe sowie mit anatomisch-morphologischen Ergebnissen bildgebender Verfahren die Beeintrachtigung des Patienten nach vitreomakularer Chirurgie nur teilweise beschrieben wird, ist es Ziel dieser prospektiven Studie, die Entwicklung der visuellen Lebensqualitat nach operativer Therapie bei epiretinalen Membranen darzustellen. Bei 20 Patienten mit einseitiger epiretinaler Membran wurde praoperativ und 3 Monate nach Vitrektomie mit Peeling die bestkorrigierte Sehscharfe sowie die visuelle Lebensqualitat mit Hilfe des „Visual-Functioning-14-“ (VF-14-)Tests bestimmt. Im Beobachtungszeitraum kam es zu einem Anstieg der medianen bestkorrigierten Sehscharfe von praoperativ 0,28 auf postoperativ 0,4. Die visuelle Lebensqualitat (VF-14-Werte) stieg von 72,8±4,7 (SEM) praoperativ auf 83,3±2,9 postoperativ (p