National survey of user-reported usability of electronic medical record software in ophthalmology in Germany.

PURPOSE: A nationwide, comparative survey of the physician-reported usability of electronic medical record (EMR) software used by ophthalmologists in Germany using the System Usability Scale (SUS) as a standardized metric. METHODS: A cross-sectional survey of members of the German Ophthalmological Society (DOG) and professional association of ophthalmologists (BVA) was conducted in May 2022. All 7788 physician members of both societies were invited to participate in an anonymous online-survey by individualized links. User-reported usability of the participants main software used for electronic medical recordkeeping was assessed using the SUS (range 0-100). RESULTS: A total of 881 participants with 51 different EMRs completed the entire questionnaire. Mean EMR-SUS score was 65.7 (SD ± 23.5). Significant differences in mean SUS of several EMR programs were observed with a range of 31.5 to 87.2 in programs with 10 or more responses. 31.8% of all main program SUS ratings were below 50 points. Female gender was associated with 4.02 higher SUS score (95% CI 0.46-7.59). Main program SUS was positively correlated with overall work-related satisfaction and work environment SUS but negatively correlated with the number of programs in the work environment. The SUS of the entire digital work environment including all programs used daily was closely correlated with the main EMR SUS, but not the number of programs used. CONCLUSION: Our survey revealed a fragmented pattern of EMR use by ophthalmologists in Germany with many competing software products and widely diverging mean System Usability Scale scores. A considerable share of ophthalmologists report EMR usability below what is commonly considered acceptable.

Influence of short-term face mask wear on semiautomatically measured tear film parameters in dry eye patients and healthy volunteers.

PURPOSE: The use of face masks has been proposed to cause or exacerbate the symptoms of dry eye disease (DED), which has been widely discussed under the term mask-associated dry eye (MADE). However, no studies have systematically investigated tear film parameters during the use of different face masks. Therefore, the objective of the present study was to investigate clinically relevant parameters of the tear film before and during the short-time use of face masks in dry and normal eyes. METHODS: In a prospective study, the tear film parameters of 42 DED patients and 42 healthy volunteers were examined while wearing different types of face masks in a randomized order. This included measurements of non-invasive tear break-up time (NIBUT), lipid layer thickness, tear meniscus height, and bulbar redness after 30 min of wearing no mask, a surgical face mask or an FFP2/K95 mask. The equivalence of the means was assessed using the two one-sided t-test (TOST) method. RESULTS: In healthy volunteers' lipid layer thickness, NIBUT and tear meniscus height were not significantly altered by 30 min of surgical or FFP2 mask wear (p > 0.016). The use of either type of mask was significantly associated with decreased bulbar redness (p < 0.001) in healthy eyes. In patients with DED, none of the tear film parameters or bulbar redness were significantly altered by 30 min of mask wear (p > 0.016). CONCLUSIONS: Based on these results, the short-term wearing of face masks, regardless of type, did not produce a significant difference in tear film parameters of lipid layer thickness, NIBUT, and tear meniscus in healthy or dry eyes, while bulbar redness was reduced after mask wear only in healthy volunteers.

Current Practice in the Treatment of Epithelial and Melanocytic Tumours with Interferon-α2b: A Survey of Tertiary Eye Centres in Germany.

PURPOSE: To evaluate the standard of care, in particular the use of topical or subconjunctival interferon-α2b, in treating ocular surface squamous neoplasia or melanocytic tumours in tertiary eye centres in Germany. METHODS: A survey containing 14 questions was sent to 43 tertiary eye centres in Germany. The questions addressed the surgical and medical management of ocular surface squamous neoplasia and melanocytic tumours (primary acquired melanosis and malignant melanoma), as well as the clinical experiences and difficulties in prescribing off-label interferon-α2b eye drops and subconjunctival injections. RESULTS: Twenty-four tertiary eye centres responded to the survey. Eighty-three percent of centres had used interferon-α2b in their clinical practice and 25% prescribed it as the first-line cytostatic agent following surgical excision of ocular surface squamous neoplasia, while 10% would do so for melanocytic tumours. Correspondingly, the majority of respondents selected mitomycin C as their first-line agent. Side effects were uncommon with topical interferon-α2b eye drops but were more frequently reported after subconjunctival interferon-α2b injections. In total, eight centres had experience with interferon-α2b injections. The most significant obstacles perceived by ophthalmologists when prescribing interferon-α2b were its high cost and the reimbursement thereof. CONCLUSION: Off-label mitomycin C was the preferred adjuvant therapy for epithelial and melanocytic tumours, with interferon-α2b being the standard second-line option. Interferon-α2b has predominantly been used to treat ocular surface squamous neoplasia and, to a lesser extent, melanocytic tumours at German tertiary eye centres. Following its market withdrawal, supply shortages of interferon-α2b are likely to have a profound impact on patient care and their quality of life.

Impact of the COVID-19 pandemic's first wave on the care and treatment situation of intravitreal injections in a German metropolitan region.

PURPOSE: This study aims to evaluate the impact of the first coronavirus 2019 (COVID-19) wave in 2020 on patients scheduled for intravitreal injections (IVI) in a German metropolitan region. METHODS: We performed a multicentre prospective survey and retrospective analysis of the records of patients treated with intravitreal injections during the 20-week period from March to July 2020 in all four hospital eye departments in the city of Hamburg using a questionnaire (on treatment adherence, SarsCoV2-related personal, familial and social data) and treatment data. RESULTS: A total of 1038 patients (2472 IVI, 1231 eyes) and 818 questionnaires were evaluated. Longer duration of therapy, lower visual acuity (VA) of the treated and higher VA of the fellow untreated eye was were associated with a higher probability of visit cancellation. Every additional year of life posed a 2.6% lower risk of noncompliance. A COVID-19 infection in the family environment displayed a 5.5-fold chance of visit cancellation. Patients treated for neovascular age-related macular degeneration (nAMD) had a 36% reduced risk of visit cancellation compared to patients with diabetic macular oedema (DME). CONCLUSION: A long preceding treatment period, low VA of the treated eye, high VA of the untreated eye, COVID-19 in the family and DME were identified as risk factors for IVI visit cancellations during the COVID-19 pandemic. Compliance to treatment might be improved in the future by taking these risk factors into account when scheduling patients for IVI during the exceptional circumstances of a pandemic.

Primary Vitreoretinal Lymphoma Therapy Monitoring: Significant Vitreous Haze Reduction After Intravitreal Rituximab.

BACKGROUND/AIMS: Intravitreal rituximab is an off-label treatment option for primary vitreoretinal lymphoma (PVRL). The objective of this study was to monitor the therapeutic response and safety profile of intravitreal rituximab in a cohort of PVRL patients. METHODS: In this retrospective, uncontrolled, open label, multicentre study, 20 eyes from 15 consecutive patients diagnosed with PRVL received at least one intravitreal injection of 1mg in 0.1ml rituximab. Biodata of the PVRL patients was recorded as well as visual acuity and vitreous haze score immediately before rituximab intravitreal injection and at follow-up examinations. Intravitreal rituximab safety data was also recorded. Additional rituximab injections were made during control visits on a pro re nata (PRN) regime using increased vitreous haze to indicate recurrence. RESULTS: There was significant vitreous haze reduction (p=0.0002) followed by significant improvement of visual acuity (mean best visual acuity before therapy 0.57 logMAR, after therapy 0.20 logMAR (p=0.0228) during the follow-up time up to 4 years. Only mild ocular side effects were reported. Median follow-up time was 565 days (range, 7-1253 days). CONCLUSION: Intravitreal rituximab therapy shows promising PVRL regression without any severe side effects. Although our clinical data support rituximab as intravitreal therapy in PVRL disease, further study is warranted.

[Clinical Decision Making for Treatment of Diabetic Macular Oedema with DEX Implant: a Consensus Paper]. / Klinische Entscheidungsfindung bei der Behandlung des diabetischen Makulaödems mit DEX-Implantat: ein Konsenspapier.

BACKGROUND: Currently two intravitreally applied corticosteroids (dexamethasone and fluocinolone) are licensed in Germany for treatment of diabetic macular oedema (DME). The use of DEX implant for DME in daily clinical practice has not been defined in detail. Following a Delphi panel survey, a group of retina experts set out to come up with a consensus for use of the DEX implant in DME. MATERIAL AND METHODS: International and national treatment recommendations were identified from the literature. A steering group generated a catalogue of 72 statements on the aetiology and pathogenesis of DME, therapy with DEX implant, use of DEX implant in patients previously treated with VEGF-inhibitors, use of DEX implant in combination therapy, safety of DME therapies as well as patients' burden of treatment. Twenty-two ophthalmologists from private practice and 6 hospital ophthalmologists participated in the Delphi panel via Survey Monkey. Consensus was reached if at least 75% of participants agreed or disagreed with a statement. Statements for which consensus was not reached were discussed once more during the expert consensus meeting and a vote was taken. Based on these results a treatment algorithm for foveal DME was proposed. RESULTS: If a patient does not show sufficient response after 3 - 6 months of anti-VEGF treatment (visual acuity gain of < 5 ETDRS letters or reduction of central retinal thickness ≤ 20%), a switch to DEX implant should take place. DEX implant is also suitable in eyes with longer presentation of DME, showing e.g. massive lipid exudates. DEX implant is suitable as first-line therapy especially in pseudophakic patients, patients unwilling or able to comply with tight anti-VEGF injection intervals or patients with known vascular diseases. With fixed control visits every 4 - 8 weeks, use of DEX implant is flexible and individual. Decision parameters for repeated use should be visual acuity, retinal thickness and intraocular pressure. Treatment of both eyes on the same day should not take place. CONCLUSION: The algorithm presented reflects survey as well as expert discussion results and may differ from recommendations issued by the German professional society. The consensus recommendations for the treatment of DME generated during the survey and meeting of retina experts are intended to guide use of DEX implant in daily practice.

Outcome of a single XEN microstent implant for glaucoma patients with different types of glaucoma.

BACKGROUND: The aim of this retrospective study was to compare the efficacy and safety profile of a single XEN-microstent in different types of primary and secondary open angle glaucoma. METHODS: A single XEN microstent was implanted in patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pseudoexfoliation glaucoma (PEX) and secondary glaucoma (Sec.Gl). The intraocular pressure (IOP), the active substances of the applied IOP-lowering drugs, the best corrected visual acuity (BCVA) and the mean deviation (MD) of the perimetry were measured at baseline and at regular follow-ups, scheduled at 2 days and 1, 3, 6 and 12 months after surgery. RESULTS: 153 eyes were included in this analysis. 113 eyes were affected by POAG (74%), 5 eyes by NTG (3%), 22 eyes by PEX (14%) and 13 eyes by Sec. Gl (9%). Mean IOP decreased in all treatment groups during the 12 months of follow-up (complete group: 23.9 ± 7.4 to 15.4 ± 5.1 mmHg (p < 0.01); POAG: 22.8 ± 6.5 to 15.1 ± 4.6 mmHg (p < 0.01); NTG: 16.6 ± 3.4 to 11.6 ± 2.2 mmHg (p < 0.05); PEX: 28.0 ± 7.9 to 17.1 ± 6.6 mmHg (p < 0.01); Sec.Gl: 28.9 ± 13.9 to 15.5 ± 6.9 mmHg (p < 0.05)). In the 153 eyes the average number of IOP-lowering drugs applied decreased from 2.6 ± 1.2 to 0.8 ± 1.3 12 months after surgery (p < 0.01). BCVA and mean deviation of automated standard perimetry remained stable in all groups during follow-up. CONCLUSION: As in eyes suffering from POAG, IOP and number of IOP-lowering drugs applied can be effectively reduced by XEN implantation in eyes suffering from NTG, PEX and secondary glaucoma while leaving BCVA and visual field unchanged. TRIAL REGISTRATION: Trial was registered at DRKS (registration number: DRKS00020800 , Registered 25.February 2020 - Retrospectively registered).

Comparable effects on tear film parameters after femtosecond laser-assisted and conventional cataract surgery.

PURPOSE: Dry eye symptoms after conventional cataract surgery are a very common problem. Until now, only few data are available on objective tear film parameters in regard to femtosecond laser-assisted cataract surgery (LCS). Aim of this study was therefore to analyze and compare tear film parameter changes between LCS and conventional cataract surgery. METHODS: A consecutive group of 34 patients, scheduled for cataract surgery, were randomly selected for either LCS or conventional cataract surgery (17 patients/group). Tear film assessments including tear film osmolarity, Schirmer test, MMP-9 analysis via quantitative ELISA, corneal sensitivity, corneal fluorescein staining, and conjunctival fluorescein staining were sequentially evaluated pre- as well as 1 and 3 months postoperatively. RESULTS: Both groups showed no significant difference in baseline characteristics. All surgeries were performed without any complications. After 1 and 3 months, there was no statistically significant difference in regard to tear film osmolarity (1 month: p = 0.81, 3 months: p = 1.0), Schirmer test (1 month: p = 0.35, 3 month: p = 0.08), and MMP-9 concentration (1 month: p = 0.36, 3 month: p = 0.28) between the two groups. CONCLUSIONS: Neither LCS nor conventional cataract surgery affected objective tear film parameters significantly during our 3-month postoperative observation period. Hence, both surgical techniques can be equally used to treat patients without prior dry eye symptoms.

[The 100 Most Often Articles on Glaucoma Research: a Bibliometric Analysis]. / Die 100 meistzitierten Studien der Glaukomforschung: eine bibliometrische Analyse.

BACKGROUND: Bibliometric science employs statistical and quantitative analyses to analyse the scholarly impact and characteristics of publications within a research field. The present study was initiated to analyse and quantify the 100 most often cited papers in glaucoma research. MATERIALS AND METHODS: The databases of the Institute for Scientific Information were utilised for the identification of articles published from 1900 to December 2016. All glaucoma articles were identified that had been published in 109 relevant journals and which had been cited at least 200 times. The top 100 articles were selected for further analysis of authorship, source journal, number of citations, citation rate, geographic origin, article type, and level of evidence. RESULTS: The publication dates of the 100 most often cited articles ranged from 1966 to 2011, with the greatest number of articles published in the 1990s. Citations per article ranged from 258 to 1908. All articles were published in 18 of the 109 journals. The leading countries of origin were the U. S. A., followed by the U. K. The study focussed on two main clinical articles (diagnostics; epidemiology) and basic research articles. The number of citations per article was greatest for articles published in the 2000s. Most articles provided level III evidence, followed by levels I and II. CONCLUSION: The majority of the most cited articles were published in three of the top-ranked journals. Most clinical articles dealt with epidemiology and diagnostics. Individuals who authored multiple articles in the list often focussed on one of these two areas. Most studies were conducted in the U. S. A. and presented level III clinical outcomes. This indicates that even studies with small case series or cohort studies can attract attention.

CONTAMINATION OF ANTI-VEGF DRUGS FOR INTRAVITREAL INJECTION: How Do Repackaging and Newly Developed Syringes Affect the Amount of Silicone Oil Droplets and Protein Aggregates?

PURPOSE: The particle counts and the nature of particles of three different antivascular endothelial growth factor agents (VEGF) in different containers in a laboratory setting were compared. METHODS: Original prefilled ranibizumab glass syringes, original vials with aflibercept, and repacked ready-to-use plastic syringes with bevacizumab from a compounding pharmacy and a compounding company (CC) were analyzed. Particle counts and size distributions were quantified by different particle characterization methods (nephelometry, light obscuration, Micro-Flow Imaging, nanotracking analysis, resonant mass measurement). Using high-performance size-exclusion chromatography (HP-SEC), levels of protein drug monomer and soluble aggregates were determined. RESULTS: Nearly all samples showed similar product quality. Light obscuration and Micro-Flow Imaging showed a 4-fold to 9-fold higher total particle count in compounding company bevacizumab (other samples up to 42,000 particles/mL). Nanotracking analysis revealed highest values for compounding company bevacizumab (6,375 million particles/mL). All containers showed similar amounts of silicone oil microdroplets. Ranibizumab showed lowest particle count of all tested agents with only one monomer peak in HP-SEC. Repackaged bevacizumab from different suppliers showed varying product quality. CONCLUSION: All three tested agents are available in similar quality regarding particulate purity and silicone oil microdroplet count. Repackaging can have a major impact on the quality.

Design and Baseline Characteristics of the HELP Study: An Extended and Long-Term Observation of Pathological Myopia in Caucasians.

PURPOSE: To assess the natural disease progression of high myopia in Caucasians considered at risk for the development of myopic choroidal neovascularization (mCNV). METHODS: Subjects were recruited in 25 clinical sites between June 2014 and June 2016. Main inclusion criteria included axial length of ≥26 mm, best-corrected visual acuity ≥0.05 decimal equivalent and presence of at least one out of five predefined morphological disease risk criteria. These were (1) subfoveal choroidal thinning < 50 µm, (2) enhanced choroidal curvature length > 6,300 µm, (3) lacquer cracks, (4) patchy atrophy > 5 mm2 and (5) preexisting mCNV in the fellow eye (German Clinical Trial Register DRKS00007761). RESULTS: A total of 150 participants (66% females) with a mean age of 57.2 (±12.7) years (range 21.9-86.2 years) were included. The disease criteria most frequently encountered were choroidal thinning (33.3%) and lacquer cracks (32.7%). Enhanced choroidal curvature length was detected in only 8 subjects and always occurred in combination with other disease criteria. Presence of patchy atrophy was found to be more common in older subjects (p = 0.0012) and also associated with a more severe disease manifestation. CONCLUSION: The baseline data of this study indicate that enhanced choroidal curvature might be less common in Caucasians than in Asian populations. Further, disease severity in patients with high myopia is relatively high in the presence of patchy atrophy.

Intravitreal Dexamethasone Implant for the Treatment of Postoperative Macular Edema.

INTRODUCTION: Macular edema after cataract surgery (Irvine-Gass syndrome) or pars plana vitrectomy is a postoperative complication which can lead to permanent visual loss. Increased inflammatory substances, such as prostaglandins and cytokines, are discussed to be causative. Currently, there are no evidence-based guidelines for the treatment of postoperative macular edema. Intravitreal dexamethasone (DEX) could be effective by its anti-inflammatory effect. We examined the functional and morphological results of treatment with 0.7 mg intravitreal DEX implant (Ozurdex®). METHODS: In an observational study, we analyzed visual acuity (logMAR), intraocular pressure (IOP), clinical findings, and the central macular thickness (CMT, optical coherence tomography [OCT] Spectralis®, Heidelberg Engineering, 30° macular scan, 19 scans) of 12 eyes before and 1 month after the last DEX implantation (off-label use, Ozurdex®, Allergan, Inc., Irvine, CA, USA) for macular edema after cataract surgery or vitrectomy. Re-implantation was performed when OCT showed new intraretinal fluid along with a decrease in the patient's visual acuity. The mean follow-up was 14.4 ± 10.6 months. RESULTS: Twelve eyes of 12 patients (4 female, 8 male) with a mean age of 62.6 ± 11.9 years were treated with a mean of 2.5 ± 1.6 intravitreal DEX implant injections. Prior to injection, the visual acuity was 0.74 ± 0.34 logMAR and the CMT was 608 ± 129 µm. One month after the last injection (after a mean of 437 ± 322 days), the CMT normalized (300 ± 90 µm, p < 0.01) in all cases with a visual acuity of 0.49 ± 0.43 logMAR (p < 0.01). After 8.1 ± 5.3 months, recurring macular edema could be completely reduced by re-injection in 66% (8 patients). Four patients had no recurrence. Postinjection, the mean IOP was 17.4 ± 6.8 mm Hg. Postinjection, 7 patients required topical antiglaucomatous therapy. CONCLUSIONS: Treatment with an intravitreal DEX implant is an effective therapy for postoperative macular edema. Each injection leads to a complete resorption of the edema with a significant increase in visual acuity.

Femtosecond laser-assisted cataract surgery without OVD: a prospective intraindividual comparison.

PURPOSE: To compare femtosecond laser-assisted cataract surgery without the use of ophthalmic viscosurgical device (OVD) with standard phacoemulsification using OVD. METHODS: This was a prospective, randomized, single-center trial of 37 patients (74 eyes) diagnosed as having significant cataract in both eyes. Randomly, one eye underwent standard phacoemulsification with OVD (the OVD group); this group acted as controls. The other eye was treated with the femtosecond laser; the subsequent manual part of the procedure was performed without OVD (non-OVD group). Time of surgery, amount of fluid used during phacoemulsification, central corneal thickness, intraocular pressure, endothelial cell count, and visual acuity were documented over the 6-month follow-up. RESULTS: There were no major complications and no significant difference in overall surgery time (non-OVD: 375 ± 81 seconds; OVD: 362 ± 43 seconds; P = .713) and in the quantity of fluid passing through the eye (non-OVD: 187 ± 35 mL; OVD: 186 ± 27 mL; P = .952) between groups. Endothelial cell loss after 6 months was not significantly different between groups (non-OVD: -2.4%; OVD: -2.7%; P = .880). Central corneal thickness was not different at 1 week postoperatively between groups (non-OVD: 575 ± 45 µm; OVD: 573 ± 46 µm; P = .820). Three patients in the OVD group and one patient in the non-OVD group experienced intraocular pressure greater than 25 mm Hg at 1 day postoperatively. There were no significant differences in corrected distance visual acuity between groups (logMAR non-OVD: 0.024; OVD: 0.038; P = .461). CONCLUSIONS: Femtosecond laser-assisted treatment allows the cataract surgeon to perform phacoemulsification and intraocular lens implantation without the use of OVD at no additional risk to the corneal endothelium. Furthermore, there was a tendency toward fewer increases in intraocular pressure in patients treated with the femtosecond laser.

Long-term course in type 2 idiopathic macular telangiectasia.

INTRODUCTION: To study the long-term course in patients with idiopathic macular telangiectasia and report the effect of anti VEGF and laser treatment. METHODS: A retrospective case series of 19 patients/38 eyes with symptomatic type 2 idiopathic macular telangiectasia was performed. Six eyes received intravitreal injections of bevacizumab (1-3 injections), four eyes received focal laser treatment. Follow up examinations comprised visual acuity, biomicroscopy, fluorescein angiography and assessment of macular morphology and thickness by time and spectral-domain optical coherence tomography (OCT). RESULTS: Mean follow-up time was 81 months (range 15-188 months) - the median added up to 80 months. Visual outcome at final visit varied substantially (20/200-20/20). On average visual acuity decreased 1,2 lines (range -0,5 to 6) by 3 years, 2 lines (range -0,5 to 7) by 5 years and 4,1 lines (range 0 to 12) by 10 years. Development of choroidal neovascularisation was observed in only one eye. There was no significant difference in visual acuity between eyes receiving no treatment, intravitreal bevacizumab or laser treatment after 3 and 5 years. Morphological studies by OCT revealed typical changes with retinal atrophy and intraretinal cysts. Visual acuity correlated with the eccentricity of the main manifestation-visual preservation was associated with mainly extrafoveal disease manifestation. DISCUSSION: Type 2 idiopathic macular telangiectasia is a chronic, often slowly progressing macular disease leading to retinal atrophy and visual impairment over decades. Thorough knowledge about the long term course of this disease is necessary to evaluate possible therapeutic options in the long run.

In vitro characterization and ex vivo surgical evaluation of human hair keratin films in ocular surface reconstruction after sterilization processing.

The disadvantages of human amniotic membrane (hAM), used for ocular surface reconstruction, necessitate the development of standardized alternatives. Keratin-derived-films (KF) have been indicated as transferable substrate for cell cultivation and tissue engineering. The impact of different sterilization procedures on KF and surgical feasibility were investigated. Human hair KF were prepared and sterilized; optical, biomechanical properties, in vitro cell seeding efficiency and proliferation of human corneal epithelial cells were studied and compared with hAM. Surgical feasibility was tested on enucleated porcine eye. Sterilized KF showed higher light transmission and significantly higher E-modulus than hAM; cell-seeding-efficiency and proliferation rate were not affected. Although KF could be surgically handled, suture placement was more difficult compared to hAM. Plasma treatment seems the best sterilization method for KF; it does not affect cell biology or optical and biomechanical properties. However material modifications are requested before KF may represent a feasible alternative for ocular surface reconstruction.

[oregis-The German ophthalmological registry]. / oregis ­ Das deutsche ophthalmologische Register.

BACKGROUND: Medical registries have shown their potential for medical research in different areas of healthcare in the past. The United States of America uses the well-known national ophthalmology registry Intelligent Research in Sight (IRIS®), on the basis of which insights into the ophthalmological care situation in the USA can be gained. Comparable projects do not currently exist in Germany. The oregis is the first disease-independent registry to collect comprehensive data in the field of ophthalmology in Germany for the purpose of healthcare research. METHODS: The oregis collects anonymized clinical patient information from all subfields of ophthalmology and makes it available for research purposes. Participating centers read their data into the registry free of charge and preferably in an automated fashion. Currently, the oregis parameter list contains about 600 parameters, of which about 100 are used in the current pilot phase. RESULTS: Since its initiation, the German ophthalmological registry oregis has compiled data on more than 1.75 million physician visits for more than 400,000 patients from German ophthalmologic centers. As of late 2022, more than 2.8 million visual acuity measurements and an equal number of intraocular pressure measurements have been recorded. DISCUSSION: The aim of the oregis project is to establish a nationwide ophthalmology databank that forms the basis for a learning healthcare system in the field of ophthalmology. With the help of continuous updating, oregis can also illustrate short-term innovations in ophthalmological care.

Investigation of Inter- and Intra-Day Variability of Tear Fluid Regarding Flow Rate, Protein Concentration as well as Protein Composition.

Purpose: The purpose of this study was to present the determination of inter- and intra-day variations in tear flow rate, and tear fluid protein concentration, as well as protein composition regarding their impact for future biomarker studies. Methods: Tear fluid was collected noninvasively from 18 healthy subjects by performing Schirmer tests at 4 different time points repetitive in a period of 2 days. The tear flow rate on the Schirmer test strips was measured. Proteins were extracted from strips and quantified using amino acid analysis. Protein composition was analyzed by the strips data-independent (DIA) based mass spectrometry. To exclude any impairments to health, volunteers underwent a detailed neurological as well as an ophthalmological examination. Results: Whether tear fluid was collected from oculus sinister or oculus dexter did not affect the tear flow rate (P ≈ 0.63) or protein concentration (P ≈ 0.97) of individual subjects. Moreover, protein concentration was independent from the tear volume, so that a change in volume may only influence the total protein amount. When the examination days were compared, investigation of tear flow rate (P ≈ 0.001) and protein concentration (P ≈ 0.0003) indicated significant differences. Further, mass spectrometric analysis of tear fluid revealed 11 differentially regulated proteins when comparing both examination days. Conclusions: Our findings provide evidence of inter-day variation in tear flow rate, tear proteome concentration, and composition in healthy subjects, suggesting that inter-day variation needs to be taken into consideration in biomarker research of tear fluid. Identified proteins were assigned to functions in the immune response, oxidative and reducing processes, as well as mannose metabolism.

[CyPass microstent trimming with special cutting forceps : Video article]. / CyPass-Mikrostent-Kürzung mittels spezieller Schneidezange : Videobeitrag.

OBJECTIVE OF SURGERY: A CyPass®-microstent (Alcon, Fort Worth, TX, USA) extending too far into the anterior chamber should be trimmed as close as possible to the scleral spur to avoid progression of endothelial cell reduction. INDICATIONS: After CyPass implantation, if there is a significant loss of corneal endothelial cells due to the Cypass microstent extending too far into the anterior chamber, trimming or removal of the CyPass stent is necessary. CONTRAINDICATIONS: There are no contraindications. SURGICAL TECHNIQUE: As shown in our video, which is available online, a special cutter (19 Gauge Ahmed Micro Stent Cutter, MicroSurgical Technology Inc, Redmond, WA, USA) is inserted into the anterior chamber via a 1.5-mm wide corneal paracentesis made directly opposite to the CyPass stent. It is then possible to trim the anterior part of the stent. The severed fragment is removed using the head of the forceps. Finally, the previously inserted viscoelastic agent can be aspirated and the paracentesis can be hydrated. POSTOPERATIVE TREATMENT: After the surgery vision testing as well as control of intraocular pressure and location of the stent are carried out. Antibiotic eye drops and ointment are postoperatively applied. EVIDENCE: There is still no standardized protocol for the procedure to trim the CyPass stent. Performing the trimming in our clinic using the procedure described here has so far not led to any complications. Long-term data about the development of the endothelial cell measurement after CyPass trimming are not yet available.

[The Hamburg register for intravitreal injection therapies (QIVOM)]. / Das Hamburger Register für intravitreale Injektionstherapien (QIVOM).

BACKGROUND: Intravitreal drug delivery belongs to the most common medical procedures, with approximately 1.5 million treatments per year in Germany. However, for this enormous challenge to provision of proper care, there is a lack of empirical data regarding the treatment process and its clinical and subjective effect. MATERIALS AND METHODS: This publication presents the development and structure of the Hamburg register for intravitreal therapies (QIVOM). Patients undergoing intravitreal injection therapy were invited to join the register study. Patients were recruited from the Hamburg eye clinics in Heidberg-Nord and Barmbek as well as from the University Medical Center Hamburg-Eppendorf (UKE). Both subjective patient-reported information about the perception of their eye disease and its treatment as well as medical parameters were stored in a central electronic database. RESULTS: Of the first 162 study patients (aged 41-95 years), 64% suffered from wet age-related macular degeneration (AMD), 22% had a retinal vein occlusion, and 11% a diabetic macula edema. Disease severity and subjective impairment were heterogenous. Among these patients, 31.8% had a visual acuity above 10/20 on the treated eye compared to 79.1% on the other eye. The reduced ability to read was the most relevant limitation for more than one third of patients. However, 62% were able to drive a vehicle. An improvement of vision through intravitreal therapy was experienced by 45%. CONCLUSION: Collection of patient-reported as well as treatment-related data comprises the advantage of the newly created register. This extension of the data basis should deliver new findings in the future and contribute to quality assurance in intravitreal care.