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1.
Ophthalmologe ; 117(12): 1218-1224, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-32303832

RESUMO

BACKGROUND: The aim of the study was to analyze the importance of e­learning in the learning and training behavior of ophthalmologists in Germany and to evaluate the acceptance of a new e­learning user software (app). MATERIAL AND METHODS: Ophthalmological residents and specialists were asked about continuing education activities by means of a questionnaire during continuing education events. Furthermore, a structured evaluation was carried out after the presentation and application of an e­learning app. RESULTS: A total of 149 ophthalmologists took part in the survey. While the majority of colleagues (74.3%) used specialist journals weekly or monthly for further education, 45.9% of ophthalmologists used digital print media (books, journals, articles) and 46.5% used specialist books in printed form. Only 35% of the interviewees used online training platforms, e.g. digital courses (CME courses) or portals for retrieving recorded lectures. The use of the offered e­learning app was generally accompanied by a positive acceptance. Of the interviewed colleagues 91.7% would recommend this form of interactive learning. DISCUSSION: Despite a progressive digitalization in all areas of life, e­learning continues to play a minor role as a learning medium in ophthalmological advanced training. Interestingly, the evaluation of app users showed a high level of acceptance, regardless of age or field of work.


Assuntos
Instrução por Computador , Oftalmologia , Currículo , Alemanha , Aprendizagem , Oftalmologia/educação
2.
Graefes Arch Clin Exp Ophthalmol ; 258(7): 1411-1417, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32306096

RESUMO

PURPOSE: The aim of this study was to investigate the outcomes of a fixed intravitreal aflibercept regimen in patients with vascular pigment epithelium detachment (vPED) secondary to age-related macular degeneration with refractory subretinal fluid. METHODS: A prospective, interventional case series involved 20 eyes of 20 patients with refractory subretinal fluid and vPED treated with at least three injections of intravitreal anti-VEGF prior to study inclusion. After study inclusion, patients were treated with three injections of intravitreal aflibercept 2 mg/0.05 mL monthly followed by injections every 8 weeks. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated at all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and quarterly. Primary outcomes were effectivity of a fixed treatment as measured in change in BCVA, PED greatest linear diameter (GLD), and PED height from baseline to month 12. In an additional post hoc analysis, vPED patients were differentiated into two groups: (1) vPED lesions that showed persistence of subretinal fluid throughout 1 year of treatment and (2) vPED lesions that showed complete resolution of subretinal fluid at least at one of the monthly performed OCT volume scans. Reflectivity values were determined in the subretinal pigment epithelium (RPE) compartment in OCT scans at baseline, month 6 and 12. RESULTS: A total of 18 patients completed the study protocol. The mean age was 74.8 ± 10.6 years, and six patients were female. The median BCVA of all patients was 72.0 ± 8.0 EDTRS letters at baseline and 72.5 ± 9.5 EDTRS letters at 12-month follow-up (p = 0.7420). The median PED height in all patients as measured in the OCT images significantly decreased from 372.0 ± 140.0 µm to 149.0 ± 142.0 µm after 12 months of treatment (p = 0.0020). Persistent subretinal fluid was present at every OCT control in six patients (group 1). Twelve patients showed resolution of subretinal fluid at least at one OCT control (group 2). Reflectivity values in the sub-RPE compartment in OCT scans were 41.48 ± 4.48 (group 1) and 42.62 ± 12.34 (group 2) at baseline (p = 0.854) and 65.88 ± 6.74 and 50.87 ± 14.11 at month 12 (p = 0.038). CONCLUSIONS: Intravitreal aflibercept in refractory vPED leads to a significant reduction in PED height and disease activity as well as preservation of BCVA over 1 year. Persistent subretinal fluid was present in PED lesions with high values of reflectivity under the RPE, suggesting both a diffusion barrier and an increasing fibrovascular maturization of the choroidal neovascularization. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03370380.


Assuntos
Degeneração Macular/complicações , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Descolamento Retiniano/tratamento farmacológico , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Masculino , Estudos Prospectivos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
3.
Graefes Arch Clin Exp Ophthalmol ; 257(12): 2623-2629, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31630231

RESUMO

PURPOSE: Multiple image averaging (MIA) is a new approach to improve OCT angiography (OCTA) imaging. The aim of this work was to analyze the impact of MIA on image quality and quantitative OCTA parameters. METHODS: Twenty eyes from 20 healthy volunteers (55.65 ± 14.8 years) were prospectively enrolled. Imaging was performed using two commercially available OCTA devices (Canon OCT HS-100, Optovue AngioVue) using a uniform imaging protocol. Each participant had two single scans of the macula (3 × 3mm, Canon and Optovue) as well as five continuous single scan imaging procedures (3 × 3mm each) using the Canon device. Three out of five of these images with highest quality were manually chosen and then automatically processed by the Canon device using MIA. The superficial retinal plexus of the single scans and of MIA images was analyzed with regard to the device' own image quality scores (IQS), peak signal-to-noise ratio (PSNR), the size of the foveolar avascular zone (FAZ), and vessel density (VD). Image acquisition times were recorded. Parameters were compared between the devices and the different imaging protocols. RESULTS: Average acquisition time was significantly higher for the MIA compared with the single measurements (29.09 ± 10.19 seconds (s) (MIA) vs. 5.56 ± 2.17 s (Canon single scan) vs. 20.28 ± 6.81 s (Optovue) (p < 0.001)). IQS showed no significant differences between the devices and between the recording protocols. PSNR was 12.38 ± 0.20 (Canon single scan), 13.01 ± 0.36 (Canon MIA), and 14.34 ± 0.60 (Optovue) (p < 0.001 between the groups). Mean FAZ area in Canon single scans was 0.29 ± 0.06 mm2, 0.27 ± 0.07 mm2 using MIA, and 0.27 ± 0.08 mm2 using the Optovue device. There was no significant difference between mean FAZ measurements before and after averaging (Canon single scan vs. MIA, p = 0.168). VD of the parafoveal area using MIA was significantly lower compared with both single scans (p < 0.001). CONCLUSIONS: MIA can improve PSNR, but it also reduces imaging speed and significantly affects VD measurements. Therefore, when comparing OCTA data, the use of uniform imaging protocols is required.


Assuntos
Algoritmos , Angiofluoresceinografia/métodos , Macula Lutea/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Feminino , Seguimentos , Fundo de Olho , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
4.
Graefes Arch Clin Exp Ophthalmol ; 257(8): 1641-1648, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31119426

RESUMO

PURPOSE: To expedite and to standardize the process of image quality assessment in optical coherence tomography angiography (OCTA) using a specialized deep learning algorithm (DLA). METHODS: Two hundred randomly chosen en-face macular OCTA images of the central 3 × 3 mm2 superficial vascular plexus were evaluated retrospectively by an OCTA experienced reader. Images were defined either as sufficient (group 1, n = 100) or insufficient image quality (group 2, n = 100) based on Motion Artifact Score (MAS) and Segmentation Accuracy Score (SAS). Subsequently, a pre-trained multi-layer deep convolutional neural network (DCNN) was trained and validated with 160 of these en-face OCTA scans (group 1: 80; group 2: 80). Training accuracy, validation accuracy, and cross-entropy were computed. The DLA was tested in detecting 40 untrained OCTA images (group 1: 20; group 2: 20). An insufficient image quality probability score (IPS) and a sufficient image quality probability score (SPS) were calculated. RESULTS: Training accuracy was 97%, validation accuracy 100%, and cross entropy 0.12. A total of 90% (18/20) of the OCTA images with insufficient image quality and 90% (18/20) with sufficient image quality were correctly classified by the DLA. Mean IPS was 0.88 ± 0.21, and mean SPS was 0.84 ± 0.19. Discrimination between both groups was highly significant (p < 0.001). Sensitivity of the DLA was 90.0%, specificity 90.0%, and accuracy 90.0%. Coefficients of variation were 0.96 ± 1.9% (insufficient quality) and 1.14 ± 1.6% (sufficient quality). CONCLUSIONS: Deep learning (DL) appears to be a potential approach to automatically distinguish between sufficient and insufficient OCTA image quality. DL may contribute to establish image quality standards in this recent imaging modality.


Assuntos
Algoritmos , Aprendizado Profundo , Angiofluoresceinografia/métodos , Redes Neurais de Computação , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Artefatos , Fundo de Olho , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
Ophthalmologe ; 115(9): 754-760, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-29058071

RESUMO

BACKGROUND: The ratio of choroidal neovascularization (CNV) and pigment epithelium detachment (PED) represents an important parameter regarding the risk of developing a tear of the retinal pigment epithelium (RPE) in patients with vascularized PED due to age-related macular degeneration (AMD). METHODS: Within the framework of the RECOVER study a total of 29 treatment-naive patients with vascularized PED underwent fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) volume scans. The CNV-PED ratio was evaluated retrospectively by two independent graders in three ways: 1) manually based on the en face image of the FA late phase and 2) manually based on the en face image of the ICGA late phase. 3) In every OCT scan encompassing the PED, the area between the RPE and Bruch's membrane and the CNV area was measured and multiplied by the distance between OCT scans in order to determine volumetric data of CNV, PED and the serous cavity. RESULTS: The FA and ICGA showed a mean serous area of 6.14 ± 4.21 mm2 (ICGA 5.94 ± 4.13 mm2), a mean CNV area of 3.25 ± 1.79 mm2 (ICGA 2.84 ± 1.68 mm2) and a mean PED area of 9.39 ± 4.27 mm2 (ICGA 8.79 ± 4.23 mm2) resulting in a mean two-dimensional morphological ratio of 0.35 ± 0.21 (ICGA 0.32 ± 0.22). The volumetric measurement revealed a mean CNV volume of 0.63 ± 0.67 mm3, a mean serous volume of 3.61 ± 3.83 mm3 and a mean total PED volume of 4.25 ± 3.68 mm3. The mean three-dimensional morphological ratio was 0.15 ± 0.29. The difference between the two-dimensional ratios of FA (p < 0.0001) and ICGA (p = 0.0004) was significant compared to the three-dimensional OCT ratio. CONCLUSION: Assessment of the CNV-PED ratio using volumetric OCT measurements is an additional tool to the en face modalities FA and ICGA. This seems to be clinically relevant regarding the risk stratification of RPE tear development in PED patients and for the planning of the treatment regimen.


Assuntos
Neovascularização de Coroide , Degeneração Macular , Descolamento Retiniano , Angiofluoresceinografia , Humanos , Verde de Indocianina , Epitélio Pigmentado da Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica
6.
Ophthalmologe ; 115(4): 322-325, 2018 04.
Artigo em Alemão | MEDLINE | ID: mdl-28508379

RESUMO

We present a case of a 57-year-old woman who reported bilateral visual impairment since 2 weeks. She had a medical history of congenital, cyanotic heart failure. Funduscopic examination revealed serous retinal detachment on the left side, central subneurosensory detachment on the right side, retinal vessel tortuosity and multiple retinal haemorrhages in the periphery. As blood analysis showed a distinct increase in haemoglobin and haematocrit, hyperviscosity syndrome was suspected to have caused bilateral serous retinal detachment. Isovolemic haemodilution was performed in close cooperation with the cardiology department with repeated phlebotomy, which resulted in a significant reduction of subretinal fluid and, concurrently, an increase in visual acuity.


Assuntos
Descolamento Retiniano , Feminino , Angiofluoresceinografia , Humanos , Pessoa de Meia-Idade , Síndrome , Acuidade Visual
7.
Graefes Arch Clin Exp Ophthalmol ; 255(12): 2347-2355, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28983695

RESUMO

PURPOSE: To analyze signal reduction in choriocapillaris (CC) and segmentation errors in spectral domain optical coherence tomography angiography (OCT-A) caused by soft drusen due to age-related macular degeneration (AMD). METHODS: Twenty-four eyes of 24 patients underwent multimodal retinal imaging including central 3 × 3mm2 OCT-A (AngioVue, Optovue). Three drusen per study eye were randomly chosen and evaluated regarding drusen height, diameter, and accuracy of OCT-A layer segmentation in lesion proximity. Structural en-face OCT CC images were graded qualitatively and quantitatively regarding signal loss underneath the individual drusen area. Those drusen that showed no distinct signal loss in structural en-face OCT CC images were further evaluated in OCT-A. CC decorrelation signal index was measured within a 30-µm OCT-A CC slab in the exact area of drusen affection. Data were compared to healthy age-matched control subjects. Accuracy of layer segmentation, OCT CC data, and OCT-A CC data were correlated to morphological drusen parameters. RESULTS: Mean drusen height and diameter were 91.57 ± 19.5µm and 315.17 ± 116.7µm. OCT-A layer segmentation of the inner plexiform layer (IPL) was disturbed by more than 50 µm in proximity to 26 drusen (36.1%). In these patients, drusen height was significantly higher compared to those with accurate IPL segmentation (p = 0.0126). Sixty-six out of 72 drusen (91.7%) caused a distinct signal loss in the structural en-face OCT CC image. Drusen height and drusen diameter were significantly higher in this group compared to the six drusen with a sufficient signal (p = 0.0276, p = 0.0025). CC decorrelation signal index measured in the area of these six drusen without OCT signal loss (8.3%) was reduced compared to age-matched healthy controls (73.6 vs. 100.1; p = 0.001). CONCLUSIONS: Signal attenuation in CC slabs and segmentation errors of the IPL depend on drusen morphology. Both are frequent artifacts in OCT-A imaging in patients with soft drusen and must be considered during image analysis.


Assuntos
Capilares/patologia , Corioide/irrigação sanguínea , Angiofluoresceinografia/métodos , Drusas Retinianas/diagnóstico , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/complicações , Idoso , Idoso de 80 Anos ou mais , Artefatos , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Drusas Retinianas/etiologia , Degeneração Macular Exsudativa/diagnóstico
8.
Ophthalmologe ; 114(9): 818-827, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28831559

RESUMO

BACKGROUND: Due to demographic change and societal transformation the number of elderly persons living in retirement homes is growing in Germany. Access to health care is more complicated in the setting of nursing homes. Different regional studies suggest unmet ophthalmological health care needs in institutionalized elderly people. This study assessed the current ophthalmological health care structure and supply status in nursing homes in Germany. METHODS: This prospective, multicenter cross-sectional study was conducted by 14 study centers in Germany. Elderly people living in 32 nursing homes were included after approval by the local institutional review boards. A standardized examination was performed which included a detailed medical and ocular history, refraction, visual acuity testing, tonometry, biomicroscopy and dilated funduscopy. Unmet ophthalmological health care needs were documented and the data were analyzed descriptively and via logistic regression modelling. RESULTS: A total of 600 participants (434 women and 166 men) aged 50-104 years were examined of which 368 (61%) had ophthalmological conditions requiring treatment. The most prevalent findings were cataracts (315; 53%), disorders of the eyelids (127; 21%), dry eye disease (57; 10%) and posterior capsule opacification (43; 7%). In 63 (11%) of the participants glaucoma was suspected and 55 (9%) of the examined population had a known diagnosis of glaucoma, of whom one third was not on any or on insufficient anti-glaucomatous therapy. 236 (39%) showed signs of age-related macular degeneration (AMD). Only 52% of the examined cohort had been examined by an ophthalmologist within the last 5 years and 39% stated that they would currently not be able to consult an ophthalmologist. Reported barriers were mainly transport and lack of support. CONCLUSION: This study demonstrates considerable unmet ophthalmological health care needs of the institutionalized elderly in Germany. Novel and reformed models of specialist care provision have to be developed.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Oftalmopatias/epidemiologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade
9.
Graefes Arch Clin Exp Ophthalmol ; 255(8): 1535-1542, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28474129

RESUMO

OBJECTIVE: To evaluate the impact of eye-tracking (ET) technology on optical coherence tomography angiography (OCT-A) image quality and manifestation of motion artifacts in patients with age-related macular degeneration (AMD). METHODS: In a prospective trial, multimodal retinal imaging including OCT-A was performed in 30 patients (78.97 ± 9.7 years) affected by different stages of AMD. Central 3 × 3 mm2 OCT-A imaging was performed four times consecutively in each patient, twice with active, and twice with inactive ET. Parameters for image evaluation were signal strength index (SSI), variability of foveal vessel density (VD), acquisition time, presence of motion artifacts caused by eye movement (blink lines, displacement) and by software correction of eye movement (quilting, stretch artifacts, vessel doubling). Images were evaluated by two independent readers with subsequent senior reader arbitration for presence of artifacts, and an OCT-A motion artifact score (MAS) was calculated. RESULTS: Eight patients had early and eight patients had intermediate stages of AMD. Four patients had an atrophic late stage and ten patients an exudative stage of the disease. SSI was 53.55 with inactive and 57.18 with active ET (p = 0.0005). Coefficients of variability of VD between the first and second measurement were 8.9% with inactive and 5.7% with active ET. Mean image acquisition time was 15.97 s (active ET: 22.88 s, p < 0.001). Presence of motion artifacts was significantly higher with inactive ET (mean MAS 3.27 vs. 1.93; p < 0.0001). MAS correlated with AMD disease stage [p = 0.0031 (inactive ET) and p < 0.0001 (active ET)] and with SSI (p = 0.0072 and p = 0.0006). CONCLUSIONS: In patients with AMD, active ET technology offers an improved image quality in OCT-A imaging regarding presence of motion artifacts at the expense of higher acquisition time.


Assuntos
Artefatos , Angiofluoresceinografia/métodos , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/diagnóstico , Idoso , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
10.
Graefes Arch Clin Exp Ophthalmol ; 255(7): 1319-1324, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28353013

RESUMO

PURPOSE: To quantify the extent and depth of distortion of the foveal capillary architecture due to traction of an idiopathic epiretinal membrane (ERM) using optical coherence tomography angiography (OCT-A). METHODS: Multimodal imaging including OCT-A (Angiovue, Optovue) was performed in 42 eyes with idiopathic ERM (72.4 years ±6.8). Best corrected visual acuity (BCVA), OCT-A vessel density of the foveal (VDfo) and parafoveal (VDp) region were assessed. Based on 6 × 6-mm2 OCT-A images, a macular vessel density ratio (MVR = VDfo/VDp) was calculated for the superficial (s), deep (d) and full-thickness (f) slabs to assess a depth-resolved, non-invasive evaluation of foveal distortion. The acquired data were subdivided in a patient group with mild and significant BCVA reduction due to ERM. Data was compared to age-matched healthy controls. RESULTS: In all three slabs, MVR was significantly smaller in the control group in comparison with the ERM group: MVRs: 0.63 ± 0.1 vs 0.83 ± 0.1 (p > 0.001); MVRd: 0.60 ± 0.1 vs 0.73 ± 0.1 (p < 0.001); MVRf: 0.68 ± 0.1 vs 0.82 ± 0.1 (p < 0.001). Group 1 (BCVA <0.4 LogMar) showed a significantly higher MVR in comparison with the control group in the superficial plexus only: MVRs: 0.64 ± 0.1 vs 0.78 ± 0.1 (p < 0.001); MVRd: 0.60 ± 0.1 vs 0.65 ± 0.2 (p = 0.3); MVRf: 0.68 ± 0.1 vs 0.77 ± 0.1 (p = 0.01). However, group 2 (BCVA > = 0.4 LogMar) showed a significantly higher MVR in all three slabs: MVRs: 0.64 ± 0.1 vs 0.86 ± 0.1 (p < 0.001); MVRd: 0.60 ± 0.1 vs 0.77 ± 0.2 (p < 0.001); MVRf: 0.68 ± 0.1 vs 0.85 ± 0.1 (p < 0.001). CONCLUSION: Assessing MVR using OCT-A may serve as a tool to quantify the extent and depth of distortion of the foveal capillary architecture due to traction of ERM. BCVA reduction appears to be associated with extent and depth of distortion.


Assuntos
Membrana Epirretiniana/diagnóstico , Angiofluoresceinografia/métodos , Fóvea Central/irrigação sanguínea , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Idoso , Capilares/patologia , Membrana Epirretiniana/fisiopatologia , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Estudos Prospectivos , Acuidade Visual
13.
Br J Ophthalmol ; 99(6): 717-22, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25232026

RESUMO

Drusen are focal deposits of extracellular material located between the retinal pigment epithelium (RPE) and Bruch's membrane and represent the major phenotypic characteristic of age-related macular degeneration (AMD). Due to evolving imaging techniques and recent histological studies, reticular pseudodrusen (RPD) have received increasing attention and have been recently identified as an additional phenotypic entity in AMD. In contrast to conventional drusen, RPD proved to be located internal to the RPE. In the past few years, numerous studies collected new findings on RPD related to their pathogenesis, imaging properties and impact on retinal function. While most former natural history studies as well as interventional studies in early AMD did not include imaging RPD beyond colour fundus photography, this phenotype must be included in every future large-scale study on AMD. This review summarises the current knowledge on RPD.


Assuntos
Degeneração Macular/complicações , Drusas Retinianas/complicações , Lâmina Basilar da Corioide/patologia , Humanos , Degeneração Macular/diagnóstico , Drusas Retinianas/diagnóstico , Epitélio Pigmentado da Retina/patologia
15.
Ophthalmologe ; 112(4): 337-45, 2015 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-25501930

RESUMO

BACKGROUND: Although electronic health records (EHR) were introduced into ophthalmology practices many years ago, paper-based medical records are still common in most tertiary care eye hospitals. MATERIAL AND METHODS: We report on the implementation of an EHR system at the university eye hospital in Münster in the time period between January and December 2013. RESULTS: Advantages of an EHR system in the setting of a university eye hospital include ubiquitous access to patient data, structurability as well as scientific interpretability. Data safety, personnel and financial investment and integration into existing hospital software systems represent the main challenges. CONCLUSION: The EHR system will replace paper-based records in the future. In view of the high need for visualization and recording of medical findings, EHR software solutions seem promising particularly in ophthalmology.


Assuntos
Registros Eletrônicos de Saúde , Hospitais Especializados/organização & administração , Oftalmologia , Centros de Atenção Terciária/organização & administração , Registros Eletrônicos de Saúde/tendências , Alemanha , Humanos
16.
Ophthalmologe ; 111(1): 37-43, 2014 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-23681179

RESUMO

BACKGROUND: Previous studies have proven that long-lasting success in the therapy of neovascular age-related macular degeneration (AMD) and other neovascular retinal diseases depends on monthly follow-up examinations to assess visual acuity and retinal morphology. MATERIALS AND METHODS: The interactive database Bonn ophthalmology online network (BOON) offers a platform for patient monitoring, increasing control reliability and providing a tool for permanent communication between treating centers and referring ophthalmologists. The BOON data-based project started in 2009 at the department of ophthalmology at Bonn University and ten referring ophthalmology practices. It was programmed to communicate diagnostic findings, images and patient appointments online. In order to react promptly the system gave immediate notice if patients had missed a follow-up appointment or the condition had worsened. Patients were recruited in 2009 and 2010 and were followed for 1 year. Each patient had an electronic master file with several registers in which, besides personal data, precise diagnostic findings, imaging and reports were quickly and easily entered by means of detailed check box and drop-down menus. Each follow-up was registered and an alert email was sent to the referring physician in cases of missed appointments or disease progression. RESULTS AND CONCLUSIONS: The BOON database supports the requirements for a fast and detailed communication between treating and referring physicians in the treatment of patients with AMD as well as other retinal diseases. It was programmed to support data exchange and monthly control visits and thus a better patient management. Results will show whether this helps to enhance long-term treatment success in neovascular diseases.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bases de Dados Factuais , Disseminação de Informação/métodos , Degeneração Macular/terapia , Monitorização Fisiológica/métodos , Oftalmologia/organização & administração , Neovascularização Retiniana/terapia , Mineração de Dados/métodos , Alemanha , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Registro Médico Coordenado/métodos , Sistemas On-Line , Neovascularização Retiniana/diagnóstico , Integração de Sistemas
17.
Graefes Arch Clin Exp Ophthalmol ; 252(5): 715-21, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24276561

RESUMO

BACKGROUND: To analyse reticular pseudodrusen (RPD) in patients with age-related macular degeneration (AMD) using multi-spectral (MS), confocal scanning laser ophthalmoscopy (cSLO). METHODS: cSLO images (blue fundus autofluorescence [FAF; exc., λ = 488; em., λ = 500-700 nm], near-infrared reflectance [IR; λ = 820 nm], MS [blue reflectance (BR) λ = 488 nm, green reflectance (GR) λ = 515 nm, IR λ = 820 nm], as well as colour fundus photographs (CFP) were taken of 200 eyes from 100 AMD patients suspected to show RPD on the basis of funduscopy or previous fundus imaging. FAF and IR images were graded by two independent readers. If both readers concordantly confirmed the presence of RPD in both modalities, eyes were subsequently also graded for RPD in MS, BR, GR, green-blue enhanced mode (GBE), and CFP. Besides, FAF, IR, and MS images were evaluated for the presence of a target aspect, which represents a common feature of RPD lesions. RESULTS: The presence of RPD was confirmed using FAF and IR images by both readers in 130 eyes of 76 patients. In those eyes, both readers concordantly diagnosed RPD in MS images in 124 (95.4%) eyes (BR: 52 [40.0%], GR: 63 [48.5%], GBE: 101 [77.7%], CF: 27 [20.8%]). Cohen kappa statistics revealed excellent inter-observer agreement for MS (0.95) and GBE (0.85), substantial agreement for BR (0.75), GR (0.78), and moderate agreement for CFP (0.59). A target aspect within RPD lesions was detected in 45 of 130 (35.0%) included eyes using FAF and IR. The presence of a target aspect improved the recognition of RPD lesions in all modalities. If a target aspect was present, RPD were diagnosed in 45 eyes (100%) using MS (GBE: 42 eyes [93.3%], BR: 30 eyes [66.7%], GR: 37 eyes [82.2%], CFP: 17 eyes [37.8%]). Using MS cSLO, a target aspect could be identified in 75 of 130 (57.7%) included eyes. CONCLUSIONS: MS cSLO imaging is equivalent to FAF and IR in identifying RPD in AMD patients. Higher identification rates in BR and GR of those RPD lesions featuring a target aspect confirm the current hypothesis of RPD localisation and its progression further into the photoreceptor layers. MS seems to be more sensitive in identifying a central target aspect in RPD lesions compared to blue FAF and IR.


Assuntos
Atrofia Geográfica/diagnóstico , Imagem Multimodal , Drusas Retinianas/diagnóstico , Degeneração Macular Exsudativa/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Angiofluoresceinografia , Humanos , Raios Infravermelhos , Masculino , Microscopia Confocal , Variações Dependentes do Observador , Oftalmoscopia , Sensibilidade e Especificidade
18.
HNO ; 59(5): 511-3, 2011 May.
Artigo em Alemão | MEDLINE | ID: mdl-21181393

RESUMO

Endogenous and exogenous glucocorticoids are suspected to play a key role in the development of central serous chorioretinopathy (CSC), which is characterized by a serous detachment of the neurosensory retina caused by the accumulation of fluid between the retinal pigment epithelium and the photoreceptor layer. We report the case of a patient with pansinusitis who was treated with high-dose corticosteroids and developed CSC. Patients under systemic corticosteroid therapy should be informed about the associated risk and symptoms of CSC.


Assuntos
Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Cegueira/induzido quimicamente , Cegueira/diagnóstico , Sinusite/tratamento farmacológico , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade
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