Shift in bacterial etiology from the CAPNETZ cohort in patients with community-acquired pneumonia: data over more than a decade.

To determine the most relevant pathogens for CAP in Germany, patients with radiologically confirmed pulmonary infiltrates and at least one clinical sign of lung infection were prospectively recruited within the CAPNETZ cohort from 2004 until 2016. In 990 out of 4.672 patients (21%) receiving complete diagnostics the most prominent change of pathogens was a decrease of S. pneumoniae (58% in 2004 to 37.5% in 2016; p ≤ 0.001, ρ = - 0.148) and an increase of H. influenzae (12.2% to 20.8%; p = 0.001, ρ = 0.104).

[Clinical parameters of patients with neovascular age-related macular degeneration : Longterm treatment results of an outpatient clinic]. / Klinische Parameter von Patienten mit neovaskulärer altersbedingter Maculadegeneration : Langzeitbehandlungsergebnisse aus einem ambulanten Versorgungszentrum.

BACKGROUND: The clinical outcome of neovascular age-related macular degeneration (nAMD) depends on constant follow-up and consistent treatment. Data about the long-term course of intensive anti-vascular endothelial growth factor (VEGF) therapy from outpatient clinics are rare. OBJECTIVE: The aim of the study was to characterize a population of nAMD patients with long-term follow-up and intensive anti-VEGF therapy. PATIENTS AND METHODS: In a supra-regional outpatient clinic, we retrospectively identified patients who had received at least 30 intravitreal anti-VEGF injections and were followed for at least 4 years. All patients received an optical coherence tomography(OCT)-controlled Pro-Re-Nata (PRN) therapy regimen according to German guidelines. RESULTS: We identified 43 patients. Visual acuity at baseline was 0.44 ± 0.24 (1.0-0.1) logMAR. At the end of the follow-up period, visual acuity was 0.63 ± 3.6 (1.3-0.1) logMAR. Patients received a mean of 36.3 ± 8.0 (30-62) injections and were followed for a mean of 6.1 ± 1.8 (4-12) years. They received 6.12 ± 1.5 (3.1-9.9) injections per year. The number of injections in treatment-year one was with 3.67 ± 1.9 (1-8) significantly lower than the mean (p < 0.0001). CONCLUSION: Despite intensive PRN therapy, visual acuity slowly decreased over time. The mean number of injections was comparable to that of prospective studies. The low number of injections in treatment-year 1 may have been due to a lack of experience with the new treatment agents. The slow decrease in visual acuity in clinical routine as opposed to clinical studies may be attributed to a delay between occurrence of disease activity and treatment.

[10 years of Descemet membrane endothelial keratoplasty in Fuchs endothelial corneal dystrophy : What have we learned?] / Zehn Jahre "Descemet membrane endothelial keratoplasty" bei Fuchs-Dystrophie : Was haben wir gelernt?

BACKGROUND AND OBJECTIVE: Descemet membrane endothelial keratoplasty (DMEK) has increased in popularity since its introduction over 10 years ago. This article presents a summary of the experiences of the past years collected at the Department of Ophthalmology at the University of Cologne. METHODS: A literature review of DMEK studies primarily from the Department of Ophthalmology at the University of Cologne, Germany was carried out. Own experiences in the fields of donor selection and graft preparation, DMEK surgery, complication management and postoperative treatment are summarized. RESULTS: Since the introduction of DMEK experience has been gained and ongoing improvements have occurred ranging from donor-recipient allocation to postoperative follow-up. These led to a better reproducibility of the intervention for the surgeon, to a better postoperative result and to a reduction of the complication rate. DISCUSSION: The DMEK represents a safe and individualized procedure for endothelial transplantation for corneal endothelial dysfunction. Continuing development of the method leads to optimization and safer results.

[Merkel cell carcinoma of the eyelid. An often unrecognized tumor entity : Clinical aspects and treatment strategies]. / Merkel-Zell-Karzinom des Augenlids ­ eine häufig verkannte Diagnose : Klinische Aspekte und Behandlungsmethoden.

Merkel cell carcinoma of the eyelid is an aggressive, highly malignant tumor of the skin. Totaling approximately 0.5 % of all tumors of the eyelid, it constitutes a relatively small group of lid tumors. Nevertheless Merkel cell carcinoma is of significance to the ophthalmologist. Because of its clinical presentation it can be easily confused as a chalazion, a hordeolum or the lesser aggressive basal cell carcinoma. This often leads to delayed treatment. In this article we describe clinical aspects, which aim to help the ophthalmologist suspect Merkel cell carcinoma earlier. Additionally we outline a diagnostic and therapeutic workup taking into consideration the special anatomy of the eyelid.

[Rebound tonometry after vitreoretinal surgery]. / Reboundtonometrie nach vitreoretinaler Chirurgie.

PURPOSE: The aim of this study was to analyze the practicability and comparability of the Icare rebound tonometer (RT) versus the Schiötz indentation tonometer (SIT) and the Goldmann applanation tonometer (GAT) for measuring intraocular pressure (IOP) in patients after pars plana vitrectomy (PPV). METHODS: A total of 100 eyes from 100 patients who underwent vitreoretinal surgery in the Department of Ophthalmology, University of Cologne were included in this prospective analysis. The IOP was measured using RT preoperatively, on the day of surgery and 2 days after surgery, using SIT on the day of surgery and GAT preoperatively and 2 days after surgery. For the evaluation eyes were divided into subgroups with respect to the endotamponade selected and the IOP level. RESULTS: The mean preoperative IOP for all enrolled eyes was 15.4 ± 8.0 mmHg for RT and 16.1 ± 7.9 mmHg for GAT. Bland-Altman analysis revealed a bias between RT and GAT of - 0.6 mmHg. Bland-Altman analysis for the postoperative course of all eyes revealed a bias of 3.0 mmHg between RT and SIT on the day of surgery and no bias between RT and GAT in the further postoperative follow-up. CONCLUSION: Rebound tonometry seems to provide precise IOP values after vitreoretinal surgery. Divergence from SIT values on the day of surgery is presumably due to a general tendency of SIT to underestimate IOP values. Therefore, RT can be used in the clinical routine after vitreoretinal surgery as an alternative to GAT.