Search

Zusammenfassung Hintergrund Ziel dieser Studie war die Einführung einer Methode zum „Benchmarking“ von Intraokularlinsen beim Autofahren, insbesondere im Hinblick auf die Sehschärfe (visual acuity, VA) und die Kontrastempfindlichkeit (contrast sensitivity, CS). Dazu wurden Patienten mit IOL-Implantaten: ICB00 (Tecnis Eyhance, Johnson & Johnson, Santa Ana, CA, USA) vs. CNA0T0 (Clareon, Alcon Laboratories Inc., Fort Worth, TX, USA) klinisch und in einem Nachtfahrsimulator untersucht. Patienten und Methoden Klinische Tests zum Fernvisus bei hohem (high contrast visual acuity, HCVA) und niedrigem Kontrast (low contrast visual acuity, LCVA) sowie zur mesopischen CS wurden bei Probanden mindestens 2 Monate nach einer binokularen IOL-Operation durchgeführt (Einschlusskriterien: Visus > 20/25, ophthalmologisch normal, außer Kataraktoperation). Alle Patienten fuhren im Simulator eine gerade Strecke ab. Die VA, CS und Halogröße wurden binokular während des nächtlichen Autofahrens mit Landolt-Ringen in 4 verschiedenen (Fern- und Intermediärbereichs-)Positionen und Entfernungen gemessen. Ergebnisse Die Ergebnisse werden als Median/Interquartilsbereich angegeben: ICB00-Daten (CNA0T0-Daten): 5 (6) Probanden im Alter von 69,6/8,3 (71,1/13,0) Jahren wurden eingeschlossen. Klinische Tests: logMAR HCVA 0,11/0,39 (0,00/0,51), logMAR LCVA 0,78/0,52 (0,80/0,54); logCS ohne 0,50/0,31 (0,30/0,65), mit Blendung 0,20/0,15 (0,20/0,5). Fahrsimulator bei Nacht: Die logMAR-VA-Schwellenwerte für die rechte Straßenseite, das Armaturenbrett, den Navigationsbildschirm und den Innenrückspiegel betrugen 0,50/0,06 (0,57/0,22), 0,81/0,07 (0,91/0,14), 0,80/0,17 (0,92/0,27), 0,50/0,11 (0,63/0,26), logCS-Schwellenwerte 1,53/0,67 (1,00/0,81), 0,82/0,11 (0,61/0,19), 0,71/0,14 (0,50/0,15), 0,87/0,07 (0,81/0,11). Größe des Halos: 5,40°/0,89° (5,88°/2,00°). Schlussfolgerungen In einem Nachtfahrsimulator übertraf die ICB00-IOL die CNA0T0-IOL in Bezug auf logMAR (VA) und logCS um 0,1 log-Einheiten im Intermediärbereich. Klinische Tests für Ferne und Nähe ergaben keinen Unterschied. Dies könnte darauf hindeuten, dass Fahrsimulatorexperimente im Hinblick auf die Leistungsprüfung von IOLs – insbesondere auch im Intermediärbereich – sinnvolle Zusatzinformationen liefern können.

Purpose In this study, two intraocular lenses (spherical IOL SA60AT and aspherical IOL SN60WF) are examined in an eye model under conditions of misalignment (defocus, decentration and tilt). The lenses are rated using the contrast sensitivity function (CSF) based on Barten's physical model. The square root integral (SQRI) method is used as a quality criterion comparable to the subjective image quality assessment of the human eye. Methods The IOLs to be tested are decentered from 0 to 1mm and tilted from −5 to +5 degrees in the Navarro eye model (optimized for far-point 6m and pupil aperture 3mm). The defocus of the IOLs is ±0.1mm at the anterior chamber depth (ACD). The optical modulation transfer function (MTF) is simulated with a ray tracing program. The SQRI is calculated using this MTF and the Barten CSF model (for in-focus at aperture 3 and 4.5mm and for defocus at 3mm). Results With increasing decentration, the spherical IOL shows a significantly smaller loss of quality for both apertures compared to the aspherical lens. With an aperture of 4.5mm, the image quality of the aspherical IOL is better for small decentration and tilt. The loss of quality of the spherical IOL increases with increasing tilt in both directions. In contrast, the image quality of the aspherical IOL is reduced under decentration for certain tilt values. For ACD−0.1mm, both IOLs behave similarly to the in-focus situation. For ACD+0.1mm, the influence of tilt without decentration is small for both IOLs. With increasing decentration, the quality loss of the aspherical IOL is similar to that in-focus and greater than that of the spherical lens. Conclusion In general, under the same conditions the spherical SA60AT displays a lower tolerance in loss of quality of subjective vision with lens alignment errors, in comparison to the aspherical SN60WF, limited by certain combinations of decentration and tilt according to this study. This study shows a way to evaluate IOLs based on the subjective visual performance of the eye.

Our study presents a digitised tangent screen test for ocular motility analysis according to the Harms and Hess tests (measurement of the squint angle in all fields of vision). This test uses an image beamer to display the tangent screen, a position sensor to measure the patient's head orientation, and a distance sensor to measure the fixation distance. Digital measurement of head orientation allows for a test procedure that eliminates the conventional requirement for a light pointer in the patient's hand. Thus, the digital screen test is presented, and the uncertainty of the measurement system is evaluated.A mathematical relationship was given between the measured squint angles, as well as the angle of diagnostic gaze direction, and the influence quantities on their measurement uncertainty. The individual uncertainties resulted from deviations in the measured values by the position and distance sensors, the calibration of the projection image of the beamer in length units, and the finite image resolution of the beamer. The individual standard uncertainties of the influence quantities were determined. The combined standard measurement uncertainties of the squint and gaze direction angles were given based on the model equation of the error propagation law at the tangent table according to Harms at a test distance of 2.5 m. The patient's uncertainty contribution to the mobility analysis was not considered.The combined standard uncertainty of the measurement system (coverage factor k = 2 for 95% confidence level) for the squint angle is ≤ 0.43° for the angle of diagnostic gaze direction ≤ 3.13° at the test distance of 2.5 m. The individual standard uncertainties of the influence quantities on the angles are (k = 1): 1.55°/1.01° (horizontal/vertical angle of the position sensor), 0.19° (distance sensor), 0.06° (calibration of the projection image of the beamer), and 0.02° (image resolution of the beamer). The maximum valid test distance of the digital screen test is 3.8 m.The digital screen test is compact and can be used at different locations. Compared to the traditional test, the time required for examination via the digitised test is less; additionally, its documentation is simplified. The measurement uncertainty of the diagnostic gaze direction angle is dominated by the sensor drift of the position sensor in the horizontal direction (yaw angle) and is due to the sensor technology. However, this drift error does not affect the squint angle measurement result nor its measurement uncertainty because the measurement principle used here is based on the congruence between the position cross and the fixation object and the confusion principle and compensates for the drift error. The measurement uncertainties of the determined measurement system are the lower limits of the uncertainties in the clinical use of the digital screen test if there are no effects due to significant patient deviations.

AimsTo determine long-term safety and efficacy outcomes of a subretinal gene therapy for CNGA3-associated achromatopsia. We present data from an open-label, nonrandomised controlled trial (NCT02610582).MethodsDetails of the study design have been previously described. Briefly, nine patients were treated in three escalating dose groups with subretinal AAV8.CNGA3 gene therapy between November 2015 and October 2016. After the first year, patients were seen on a yearly basis. Safety assessment constituted the primary endpoint. On a secondary level, multiple functional tests were carried out to determine efficacy of the therapy.ResultsNo adverse or serious adverse events deemed related to the study drug occurred after year 1. Safety of the therapy, as the primary endpoint of this trial, can, therefore, be confirmed. The functional benefits that were noted in the treated eye at year 1 were persistent throughout the following visits at years 2 and 3. While functional improvement in the treated eye reached statistical significance for some secondary endpoints, for most endpoints, this was not the case when the treated eye was compared with the untreated fellow eye.ConclusionThe results demonstrate a very good safety profile of the therapy even at the highest dose administered. The small sample size limits the statistical power of efficacy analyses. However, trial results inform on the most promising design and endpoints for future clinical trials. Such trials have to determine whether treatment of younger patients results in greater functional gains by avoiding amblyopia as a potential limiting factor.

Since 2019, corneal collagen crosslinking (CXL) is included in the catalog of procedures covered by statutory health insurance in Germany. CXL is an established ophthalmological procedure for the last 20 years. The aim of this investigation was the measurement of progression before and after CXL.65 consecutive eyes with progressive keratoconus from 53 patients were included in the retrospective study, which were observed at the University Eye Hospital Tübingen at least two years before and at least two years after CXL. The time of observation took place from October 2009 until March 2018. Parameters of interest had been the best corrected visual acuity (BCVA) and the keratometric values from the elevation maps measured by a Scheimpflug camera.65 eyes of 53 patients had been documented. The study population included 46 (86.8%) male and 7 (13.2%) female subjects. The mean age was 24 ± 8 years. The averaged observation time between the primary consultation and CXL showed 25 ± 15 months. Preoperatively the mean BCVA pointed out in a significant increase (0.13 ± 0.17 [first visit] vs. 0.23 ± 0.22 [preOP], p 0.0001) while the mean Kmax resulted in a statistically significant increase (46.34 ± 3.33 dpt [first visit] vs. 48.78 ± 4.17 dpt [preOP], p 0.0001). The mean thinnest point of the cornea showed a significant decrease (490.48 ± 34.23 µm [first visit] vs. 468.62 ± 29.84 µm [preop], p 0.0001). Postoperatively the mean BCVA resulted in a significant improvement at the 12th postoperative month in comparison to the preoperative measurement (0.23 ± 0.22 [preOP] vs. 0.16 ± 0.14 [12 months], p = 0.04 respectively 0.17 ± 0.17 [24 months], p = 0.0006). The mean Kmax demonstrated in the 12th postoperative month a significant reduction (48.78 ± 4.17 dpt [preOP] vs. 47.91 ± 3.41 dpt [12 months], p = 0.0009 respectively 48 ± 4.56 dpt [24 months], p = 0.0051). The mean thinnest point of the cornea indicated a decrease at the 12th postoperative month (468.62 ± 29.84 µm [preOP] vs. 459.82 ± 35.88 µm [12 months], p = 0.0078 respectively 453.47 ± 43.39 µm [24 months], p = 0.0227).CXL is a successful procedure for the therapy of progressive keratoconus.Seit 2019 ist bei progredientem Keratokonus (KK) das korneale Crosslinking (CXL) in Deutschland als Kassenleistung anerkannt. Das Verfahren ist seit 20 Jahren etabliert. Ziel dieser Studie war es, die Progression vor und nach erfolgtem CXL zu analysieren.In dieser retrospektiven Studie wurden 65 konsekutive Augen mit progredientem Keratokonus (KK) von 53 Patienten von Oktober 2009 bis März 2018 eingeschlossen, die an der Universitäts-Augenklinik Tübingen mindestens sowohl 2 Jahre vor als auch mindestens 2 Jahre nach dem Crosslinking kontrolliert wurden. Analysiert wurden die bestkorrigierte Sehschärfe (BCVA) und die Keratometerwerte der Hornhaut, die mittels Scheimpflug-Kamera vermessen wurden.Von 53 Studienpatienten waren 46 männlich (86,8%) und 7 weiblich (13,2%). Das Durchschnittsalter der Patienten lag bei 24 ± 8 Jahren. Die mittlere Zeitspanne zwischen Erstvorstellung und CXL betrug 25 ± 15 Monate. Präoperativ konnte eine deutliche Progression der Parameter von der Erstvorstellung bis hin zur Operationsindikation gesehen werden. So stieg die mittlere BCVA statistisch signifikant an (0,13 ± 0,17 logMAR vs. 0,23 ± 0,22 logMAR, [p 0,0001]). Auch der mittlere Kmax-Wert zeigte eine statistisch signifikante Steigerung (46,34 ± 3,33 dpt vs. 48,78 ± 4,17 dpt, [p 0,0001]). Und die mittlere dünnste Hornhautdicke nahm statistisch signifikant ab (490,48 ± 34,23 µm vs. 468,62 ± 29,84 µm, [p 0,0001]). Postoperativ zeigte sich eine Verbesserung der Parameter wie folgt: Die mittlere BCVA verbesserte sich ab dem 12. Monat (0,23 ± 0,22 logMAR [präOP] vs. 0,16 ± 0,14 logMAR [12 Monate postOP], p = 0,04 bzw. 0,17 ± 0,17 logMAR [24 Monate postOP], p = 0,0006). Auch der mittlere Kmax zeigte ab dem 12. Monat eine statistisch signifikante Reduktion im Vergleich zum Ausgangswert (48,78 ± 4,17 dpt [präOP] vs. 47,91 ± 3,41 dpt [12 Monate postOP], p = 0,0009 bzw. 48 ± 4,56 dpt [24 Monate postOP], p = 0,0051]). Und die durchschnittliche dünnste Hornhautdicke nahm ab dem 12. Monat statistisch signifikant ab (468,62 ± 29,84 µm [präOP] vs. 459,82 ± 35,88 µm [12 Monate postOP], p = 0,0078 bzw. 453,47 ± 43,39 µm [24 Monate postOP], p = 0,0227).CXL ist ein erfolgreiches Verfahren für die Therapie des progressiven Keratokonus.

Dry eye is a multifactorial disease that affects the ocular surface and tear fluid. Current treatment options include lubricant eye drop application several times a day. However, these eye drops often cause local side effects like ocular allergies or blurred vision after the application. To test new treatment options, a robust dry eye model is needed. Here, a porcine ex vivo model was established by means of incubation of porcine corneas in low humidity (LH) and characterized by histological damage evaluation, epithelial thickness and by relevant dry eye markers, such as interleukin 1 beta (IL-1β), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), occludin and galectin-3. In the dry eye model proposed, an increased secretion of IL-1β was observed, as well as an upregulation of NF-κB, occludin and galectin-3 mRNA expression. Moreover, the model presented a higher rate of cell death in comparison to the controls. These effects could be reversed with successful treatment of dexamethasone (dexa) and partially reversed with hyaluronic acid (HA) containing eye drops. Furthermore, medium-molecular-weight HA stimulated an increase in IL-1β in the model proposed. In conclusion, this dry eye model mimics the in vivo condition and hence allows for animal-free testing of novel dry eye treatments.

The purpose of this study is to introduce a method for benchmarking intraocular lenses during driving activities under highly standardized conditions, specifically with regard to visual acuity (VA) and contrast sensitivity (CS). Therefore, patients with intraocular lens (IOL) implants ICB00 (Tecnis Eyhance, JohnsonJohnson, Santa Ana, CA, USA) vs. CNA0T0 (Clareon, Alcon Laboratories Inc., Fort Worth, TX, USA) were examined clinically and in a nighttime driving simulator.Clinical tests for high (HCVA), low contrast (LCVA) distant VA, and mesopic CS were conducted in subjects at least 2 months after binocular IOL surgery (inclusion criteria: VA 20/25, ophthalmologically normal, except cataract surgery). All patients completed a straight driving simulator route. VA, CS, and halo size were assessed binocularly during nighttime driving using eight-position Landolt Cs in four different locations and two (far and intermediate) distances.Results are presented as median/interquartile range: ICB00 data (corresponding CNA0T0 data are shown in brackets): 5 (6) subjects, aged 69.6/8.3 (71.1/13.0) years were enrolled. Clinical tests: logMAR HCVA 0.11/0.39 (0.00/0.51), logMAR LCVA 0.78/0.52 (0.80/0.54); logCS without glare 0.50/0.31 (0.30/0.65), logCS with glare 0.20/0.15 (0.20/0.5). Nighttime driving simulator: logMAR VA thresholds for right roadside, dashboard, navigation screen, and interior rear-view mirror were 0.50/0.06 (0.57/0.22), 0.81/0.07 (0.91/0.14), 0.80/0.17 (0.92/0.27), 0.50/0.11 (0.63/0.26); logCS thresholds were1.53/0.67 (1.00/0.81), 0.82/0.11 (0.61/0.19), 0.71/0.14 (0.50/0.15), 0.87/0.07 (0.81/0.11). Halo size: 5.40°/0.89° (5.88°/2.00°).Within a nighttime driving simulator environment, ICB00 exceeded CNA0T0 in median logMAR (VA) and logCS by 0.1 log unit at intermediate distances (dashboard, navigation screen). The clinical test for far and remote distances did not show a difference. These results confirm benefits of monofocal IOLs with enhanced optical properties for intermediate distances compared to conventional monofocal lenses within the target medium distance ranges.Ziel dieser Studie war die Einführung einer Methode zum „Benchmarking“ von Intraokularlinsen beim Autofahren, insbesondere im Hinblick auf die Sehschärfe (visual acuity, VA) und die Kontrastempfindlichkeit (contrast sensitivity, CS). Dazu wurden Patienten mit IOL-Implantaten: ICB00 (Tecnis Eyhance, JohnsonJohnson, Santa Ana, CA, USA) vs. CNA0T0 (Clareon, Alcon Laboratories Inc., Fort Worth, TX, USA) klinisch und in einem Nachtfahrsimulator untersucht.Klinische Tests zum Fernvisus bei hohem (high contrast visual acuity, HCVA) und niedrigem Kontrast (low contrast visual acuity, LCVA) sowie zur mesopischen CS wurden bei Probanden mindestens 2 Monate nach einer binokularen IOL-Operation durchgeführt (Einschlusskriterien: Visus 20/25, ophthalmologisch normal, außer Kataraktoperation). Alle Patienten fuhren im Simulator eine gerade Strecke ab. Die VA, CS und Halogröße wurden binokular während des nächtlichen Autofahrens mit Landolt-Ringen in 4 verschiedenen (Fern- und Intermediärbereichs-)Positionen und Entfernungen gemessen.Die Ergebnisse werden als Median/Interquartilsbereich angegeben: ICB00-Daten (CNA0T0-Daten): 5 (6) Probanden im Alter von 69,6/8,3 (71,1/13,0) Jahren wurden eingeschlossen. Klinische Tests: logMAR HCVA 0,11/0,39 (0,00/0,51), logMAR LCVA 0,78/0,52 (0,80/0,54); logCS ohne 0,50/0,31 (0,30/0,65), mit Blendung 0,20/0,15 (0,20/0,5). Fahrsimulator bei Nacht: Die logMAR-VA-Schwellenwerte für die rechte Straßenseite, das Armaturenbrett, den Navigationsbildschirm und den Innenrückspiegel betrugen 0,50/0,06 (0,57/0,22), 0,81/0,07 (0,91/0,14), 0,80/0,17 (0,92/0,27), 0,50/0,11 (0,63/0,26), logCS-Schwellenwerte 1,53/0,67 (1,00/0,81), 0,82/0,11 (0,61/0,19), 0,71/0,14 (0,50/0,15), 0,87/0,07 (0,81/0,11). Größe des Halos: 5,40°/0,89° (5,88°/2,00°).In einem Nachtfahrsimulator übertraf die ICB00-IOL die CNA0T0-IOL in Bezug auf logMAR (VA) und logCS um 0,1 log-Einheiten im Intermediärbereich. Klinische Tests für Ferne und Nähe ergaben keinen Unterschied. Dies könnte darauf hindeuten, dass Fahrsimulatorexperimente im Hinblick auf die Leistungsprüfung von IOLs – insbesondere auch im Intermediärbereich – sinnvolle Zusatzinformationen liefern können.

Complicated retinal re-detachment with inferior proliferative vitreoretinopathy (PVR) remains a challenge. This study’s aim was to compare vitrectomy with conventional silicon oil (CSO) combined with an encircling band (EB) and vitrectomy with heavy silicon oil (HSO) alone to treat retinal re-detachment through inferior PVR, where standard procedures have already failed. A retrospective analysis was done on patients with inferior complex re-detachment with secondary PVR after primary surgery, who received pars plana vitrectomy (PPV) with CSO combined with EB (group 1) or PPV alone with HSO (group 2) between December 2006 and August 2017. The primary endpoint was retinal reattachment, and the secondary endpoint was visual acuity (VA) change and complications in both groups. This study included 119 eyes. Total single surgery anatomical success (SSAS) was 64%, with 80% (52/65) achieved in group 1 and 44.5% (24/54) in group 2 (p < 0.0001). The total final anatomical success (FAS) rate was 79% (94/119). In group 1, FAS was 91% (59/65) compared with 65% (35/54) in group 2 (p = 0.003). The pretreatment VA of group 1 had a median of 1.4 logMAR (95% CI 0.3–1.8), and group 2 showed a median of 1.4 logMAR (95% CI 0.2–1.8). The post-treatment decrease in group 1 was a median equal to − 0.6 versus − 0.1 for group 2 (p = 0.0001). Serious complications were similar in both groups. For complicated retinal re-detachment through inferior PVR, the combination of PPV with EB may lead to better anatomical (SSAS, FAS) and functional success compared with PPV alone with HSO.

SARS-CoV‑2 verursacht ein Krankheitsspektrum, das auch asymptomatische und wenig symptomatische Infektionen mit subklinischen Manifestationen einschließt, die aber dennoch potenziell ansteckend sein können. Hinweise von SARS-CoV-2-infizierten Makaken und aus Studien mit saisonalen Coronaviren deuten darauf hin, dass die Infektion wahrscheinlich eine Immunität erzeugt, die für eine gewisse Zeit protektiv ist. Verfügbare Testmethoden ermöglichen ein hohes Maß an Zuverlässigkeit, falls qualitativ hochwertige serologische Methoden kombiniert werden. Obwohl individuelle Testergebnisse vorsichtig interpretiert werden, kann Sero-Surveillance in einer Klinik der Maximalversorgung und einem Forschungsinstitut Ängste abbauen und Klarheit in Bezug auf die tatsächliche Durchseuchung mit SARS-CoV‑2 schaffen.

Das Auftreten des neuartigen „schweres akutes respiratorisches Syndrom-Coronavirus-2“ (SARS-CoV‑2) stellt in der Ophthalmologie insbesondere auch die Hornhautbanken vor Herausforderungen, da eine valide Risikoabschätzung für die Entnahme und Prozessierung von Spenderhornhäuten aufgrund weniger Daten schwierig ist. Eine Gefährdung von Transplantatempfängern durch SARS-CoV‑2 erscheint auch aufgrund der Erfahrungen mit dem „schweres akutes respiratorisches Syndrom-Coronavirus(‑1)“ (SARS-CoV(‑1)) und dem „Nahost-Atemwegssyndrom-Coronavirus“ (MERS-CoV) nach wie vor als sehr unwahrscheinlich. Allerdings kann aufgrund des Vorkommens von Angiotensin-konvertierendes Enzym 2 (ACE2)-Rezeptoren in der Hornhaut eine Infektion dieses Gewebes mit SARS-CoV‑2 nicht ganz ausgeschlossen werden. Daher muss diskutiert werden, ob in der Zeit der Coronavirus-Krankheit-2019(COVID‑19)-Pandemie das Organkulturmedium von Spenderhornhäuten vor Transplantation routinemäßig auf SARS-CoV‑2 getestet werden sollte.

Purpose The study aimed to construct a new retinal tack design with high retention forces to prevent spontaneous disentanglement in cases of complicated retinal surgery. Methods Six new forms for the peak of a retinal tack were developed using computer-aided design (CAD); then a prototype was produced for each model. Finally, standardised design testing was conducted using human (ex vivo) sclera by logging 15 consecutive measurements for each model. Results Seven different models underwent pull-out testing (six new models and the original tack model), but two tack models (Model 4, Model 5) failed to penetrate the human tissue. The highest pull-out forces (median) were measured for Model 3, followed by Model 6, Model 2 and Model 1. The original Heimann tack (Model H) was found to have the lowest retention forces. Conclusion The different tack designs altered the penetration and holding forces. The retention forces of the proposed peak design led to a significant increase in the retention forces that were more than twice as high as those in the original Heimann Model.

ZusammenfassungWährend zwischen 2005 und 2016 mehr als 30 000 Cochleaimplantate in Deutschland implantiert wurden, wurden nur weniger als 1% vergleichbarer Eingriffe an der Retina durchgeführt. Die beiden für den Markt zugelassenen Implantattypen haben wirtschaftlich nicht überleben können. Die vorliegende Arbeit diskutiert die Bedeutung und die Zukunft elektronischer Retinaimplantate für die Augenheilkunde.

Purpose: The aim of this study was to analyze the impact of OCT characteristics on the natural course of optic disc pit maculopathy (ODP-M). Methods: This was a single-center, retrospective, observational case series. Patients with ODP-M were included in the study. Baseline demographic characteristics, central macular thickness (CMT), IPP, subretinal fluid (SRF), subretinal precipitations, outer retinal fluid (ORF), and outer retinal layer hole were evaluated. The changes in the OCT characteristics were analyzed with respect to the best-corrected visual acuity (BCVA) from baseline to the last visit. Results: Twenty-two eyes of 22 patients were evaluated with a mean follow-up time of 37.6 (median 22) months. The mean BCVA was 0.31 logMAR at baseline and 0.28 logMAR at the final visit (p = 0.521). Baseline BCVA was significantly related to CMT (β coefficient 0.001, p = 0.002). Mean BCVA increased in 7 patients (group 1), remained stable in nine (group 2), and decreased (group 3) in 6 patients. No significant difference was found between the groups regarding the baseline BCVA, CMT, and extent of retinal fluid. In patients with subretinal deposits, BCVA remained stable in 3 patients and worsened in one. ORF was recorded in all patients. In patients with SRF, the mean change of BCVA during follow-up differed significantly, depending on the presence (0.07 logMAR) or absence (−0.125 logMAR) of SRF (p = 0.019). Conclusion: Among the OCT characteristics, SRF was a negative prognostic factor in ODP-M. Most ODP-M patients showed improved or stable vision over 3 years of follow-up. Therefore, observation may be considered in patients with reasonable vision and without SRF even when they present with remarkable OCT findings.

Purpose To investigate whether compulsory face masking in public life changes the incidence or pattern of post-injection endophthalmitis (PIE). Patients and methods All injections of bevacizumab, ranibizumab, aflibercept, dexamethasone or triamcinolone between 01/01/2015 and 12/31/2021 at the University Eye Clinic of Tuebingen were included in this retrospective analysis. The injection procedure itself was unchanged since 2015 and included the use of a sterile drape covering the head up to the shoulders which prevents airflow toward the eye. Furthermore, all staff wore a face mask and gloves at all times. The two study periods were defined by the introduction of a compulsory face masking rule in public life (01/01/2015 until 04/27/2020 vs. 04/28/2020 until 12/31/2021). Results A total of 83,543 injections were performed in the tertiary eye clinic, associated with a total of 20 PIE (0.024%, 1/4177 injections). Of these, thirteen PIE were documented during the pre-pandemic period (0.021%, 1/4773 injections) and seven PIE during the pandemic period (0.033%, 1/3071 injections). No significant difference in PIE risk was observed (p = 0.49), and there was no case of oral flora associated PIE. Conclusion Although some potential confounders (wearing time, skin flora) could not be considered, there was no clear signal that the introduction of compulsory face masking in public life did alter the risk for PIE in our patient population. Three and six months after PIE, no difference in visual acuity was detectable between the two study periods.

Dry eye is a multifactorial disease that affects the ocular surface and tear fluid. Current treatment options include lubricant eye drop application several times a day. However, these eye drops often cause local side effects like ocular allergies or blurred vision after the application. To test new treatment options, a robust dry eye model is needed. Here, a porcine ex vivo model was established by means of incubation of porcine corneas in low humidity (LH) and characterized by histological damage evaluation, epithelial thickness and by relevant dry eye markers, such as interleukin 1 beta (IL-1β), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), occludin and galectin-3. In the dry eye model proposed, an increased secretion of IL-1β was observed, as well as an upregulation of

Background: This study aimed to analyze if the outcome after corneal crosslinking (CXL) in progressive keratoconus patients depends on the stage in which the procedure is performed. This knowledge would help to improve success of CXL and facilitate defining surgery indications in those patients.Methods: In this retrospective study, 124 consecutive eyes of 100 patients with progressive keratoconus undergoing corneal CXL at the University Eye Hospital Tübingen were included. The eyes were graded according to modified Krumeich stages depending on induced myopia or astigmatism, corneal radii, minimum corneal thickness, and morphological changes. The observation period took place from November 2008 to September 2018. Preoperatively, 12 and 24 months after CXL, the best corrected visual acuity (BCVA) was determined and astigmatism as well as keratometric parameters (Kmax, Kmin, central corneal thickness (CCT), minimum corneal thickness (MCT)) were measured by means of a Scheimpflug camera system.Results: BCVA results showed significant differences between the modified Krumeich stages 12 months (p=0.014) and 24 months postoperatively (p=0.032). Also, astigmatism differed significantly among the stages 24 months after CXL (p=0.023); however, after 12 months, no significant differences between the groups were detectable. In terms of Kmax, Kmin, CCT, and MCT, no significant differences between the Krumeich stages were observed.Conclusions: BCVA showed a significantly higher improvement after CXL in the early stage of keratoconus compared to a higher stage. However, the postinterventional keratometric values did not differ significantly between the different modified Krumeich stages. The significantly higher improvement in BCVA after CXL in the early stage might indicate that earlier intervention provides a higher subjective benefit to the individual. Further studies with larger sample sizes are needed to confirm these findings.

PurposeTo determine differences in postoperative pupil diameter in eyes that undergo pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with endolaser retinopexy (ELR), comparing 360° vs focal ELR.MethodsPatients with uncomplicated RRD who underwent PPV were prospectively analysed regarding the postoperative pupil diameter difference (PDD) between the affected eye and the partner eye. Group 1 underwent 360° ELR and group 2 received focal ELR. Postoperative vision and complications, including redetachment rate, macular oedema and epiretinal membrane formation, were also compared.ResultsA total of 72 patients, 42 in group 1 and 30 in group 2, were analysed. PDD, as observed at 6 weeks, was significantly greater than the preoperative values in both groups 1 and 2. It increased by a mean of 1±1.11 mm in group 1 and by 0.5±0.78 in group 2. This initial increase in PDD receded over time, but remained statistically significant in both groups, even at 6 months. The top 20% of patients with the largest PDD change comprised 13 out of 15 eyes from group 1, which was a statistically significant overrepresentation (p=0.0435).ConclusionsModerate pupillotonia was induced post-ELR in vitrectomy and correlated to the extent of ELR. The pupillotonia effect of ELR was significantly less marked in pseudophakic eyes.

IntroductionThe actual prevalence of a SARS-CoV-2 infection and the individual assessment of being or having been infected may differ. Facing the great uncertainty—especially at the beginning of the pandemic—and the possibility of asymptomatic or mildly symptomatic, subclinical infections, we evaluate the experience of SARS-CoV-2 antibody screening at a tertiary clinical setting.Methods and analysisAll employees of a tertiary eye centre and a research institute of ophthalmology were offered antibody testing in May 2020, using a sequential combination of different validated assays/antigens and point-of-care (POC) testing for a subset (NCT04446338). Before taking blood, a systematic inquiry into past symptoms, known contacts and a subjective self-assessment was documented. The correlations between serostatus, patient contacts and demographic characteristics were analysed. Different tests were compared by Kappa statistics.ResultsAmong 318 participants, SARS-CoV-2 antibodies were detected in 9 employees. Chemiluminescence assays (chemiluminescence immunoassay and electrochemiluminescence) showed superior specificity and high reproducibility, compared with ELISA and POC results.In contrast to the low seropositivity (2.8%) of healthcare workers, higher than that of the other departments of the hospital, a large proportion mistakenly assumed that they might have already been infected. Antiviral antibody titres increased and remained on a plateau for at least 3 months.ConclusionsThe great demand and acceptance confirmed the benefit of highly sensitive testing methods in the early phase of the pandemic. The coincidence of low seroprevalence and anxious employees may have contributed to internalising the need of hygiene measures.

Preliminary investigations of human corneal tissues from coronavirus disease 2019 (COVID-19) cadaveric donors indicated that no severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is present. Current eye banking guidelines do not recommend any type of routine testing for SARS-CoV‑2 RNA in post-mortem donor tissue. This is partly based on factors that can influence the test results of the reverse transcription polymerase chain reaction (RT-PCR).Die ersten Untersuchungen von humanen Hornhäuten von COVID‑19(Coronavirus Disease 2019/Coronaviruserkrankung 2019)-Spendern legen nahe, dass keine SARS-CoV-2(„severe acute respiratory syndrome-coronavirus-2“/schweres akutes respiratorisches Syndrom-Coronavirus-2)-RNA vorhanden ist. Derzeit wird nicht empfohlen, eine routinemäßige Testung von postmortalen Spendergeweben auf SARS-CoV-2-RNA durchzuführen. Dies begründet sich u. a. in den Faktoren, die das RT-PCR („reverse transcription polymerase chain reaction“/Reverse-Transkriptase-Polymerasekettenreaktion) Testergebnis beeinflussen können.

Die ersten Untersuchungen von humanen Hornhäuten von COVID‑19(Coronavirus Disease 2019/Coronaviruserkrankung 2019)-Spendern legen nahe, dass keine SARS-CoV-2(„severe acute respiratory syndrome-coronavirus-2“/schweres akutes respiratorisches Syndrom-Coronavirus-2)-RNA vorhanden ist. Derzeit wird nicht empfohlen, eine routinemäßige Testung von postmortalen Spendergeweben auf SARS-CoV-2-RNA durchzuführen. Dies begründet sich u. a. in den Faktoren, die das RT-PCR („reverse transcription polymerase chain reaction“/Reverse-Transkriptase-Polymerasekettenreaktion) Testergebnis beeinflussen können.

BACKGROUND This study aimed to investigate the effectiveness of conjunctival autograft compared with primary closure and amniotic membrane transplantation for primary pterygium excision. MATERIAL AND METHODS Data were retrospectively studied from all primary pterygium excisions from January 2002 to December 2017 from the electronic database at the University Eye Hospital, Tubingen. RESULTS From 521 primary pterygium excisions, 284 (54.5%) were primary closures, 203 (39.0%) were conjunctival autografts, and 34 (6.5%) were amniotic membrane transplants. The mean number of primary pterygium excisions was 33 per year (range, 14-56 per year). The mean patient age was 58±15 years. Younger age was associated with a significantly increased recurrence rate (P=0.002). The mean pterygium recurrence rate in the three study groups at 12 months after surgery was 11.3% (range, 6.4-14.7%). Recurrence occurred 13 patients (6.4%) in the conjunctival autograft group, 41 patients (14.4%) in the primary closure group, and five patients (14.7%) in the amniotic membrane transplantation group. Conjunctival autograft was associated with a significantly lower recurrence rate (P=0.005). CONCLUSIONS A retrospective study at a single center to compare conjunctival autograft with primary closure and amniotic membrane transplantation for primary pterygium excision showed a significantly lower recurrence rate after surgery using a conjunctival autograft.

Background: This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). Methods: A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher's exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. Results: Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). Conclusions: The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.