Five-Year Risk and Safety Profile of Autologous Serum Eye Drop Therapy.

PURPOSE: To evaluate the risk and safety profile of autologous serum eye drop therapy in clinical routine over a period of 5 years. METHODS: This retrospective study involved all patients treated with autologous serum between July 2014 and December 2019 at a tertiary ophthalmic referral center. The electronic patient record system was searched for all patients with autologous serum eye drop therapy at any time point. These records were subsequently searched for keywords such as infectious keratitis, corneal ulcer, conjunctivitis, or endophthalmitis at any recorded contact. The probability of an association between the therapy with autologous serum eye drops and infectious complications was investigated independently by three corneal specialists and rated as likely, potential, or unlikely. RESULTS: In total, 752 patients were treated with autologous serum eye drops between July 2014 and December 2019. There were 5 384 batches with a total of 107 680 bottles of serum eye drops that had been produced and dispensed for these patients during this period. The records of 291 patient showed a combination of autologous serum therapy and at least one keyword for infectious diseases. In 288 patients, individual case analyses revealed an unlikely association between the therapy and infection, as their infectious episodes occurred either before the start of the therapy, more than 1 month after the therapy ceased, or in the contralateral untreated eye in the case of unilateral therapy. Three cases of infectious keratitis were classified as potentially associated with autologous serum therapy. However, all three patients suffered from chronic anterior eye diseases with a high risk of spontaneous infectious complications independent of therapy with autologous eye drops. None of the infectious events was rated as being likely due to the serum eye drops. CONCLUSIONS: Serum eye drops are often used in patients with severe or chronic anterior eye diseases with an intrinsic risk of infectious diseases. Despite these preexisting risk factors, autologous serum eye drops can be considered safe, even in patients with a compromised ocular surface.

Patient-Reported Outcome Measures (PROMs) with Refractive and Diffractive Extended Depth of Focus (EDOF) Intraocular Lenses.

BACKGROUND: Extended depth of focus intraocular lenses (EDOF-IOLs) provide unaided far- and mid-range vision. Refractive IOLs, in contrast to diffractive designs, are associated with a lower depth of focus and absence of dysphotopsia. The aim of this study was to assess spectacle independence for far-range, mid-range, and near-vision activities in patients after implantation of refractive or diffractive EDOF-IOLs using patient-reported outcome measures (PROMs) in a real-world setting. PATIENTS AND METHODS: In 2021 and 2022, all patients in a single center referred for bilateral cataract surgery were assigned to 7 experienced cataract surgeons who either bilaterally implanted only a diffractive EDOF-IOL (Carl Zeiss Meditec AG, AT LARA Jena, Germany, three surgeons) or refractive EDOF-IOL (Johnson & Johnson Vision Inc., Tecnis Eyhance Irvine, California, USA, four surgeons) at the surgeon's discretion, with the aim of bilateral emmetropia. Six months after both cataract surgeries, all patients were contacted by telephone and asked to report their outcomes using a structured questionnaire investigating their spectacle usage for various daily activities and their experience with night glare or halos. Inclusion criteria were a normal postoperative visual potential based on the preoperative examination and completion of the questionnaire regarding postoperative visual experience. RESULTS: Of the patients, 514 underwent bilateral cataract surgery aiming for bilateral emmetropia with the implantation of EDOF-IOLs (422 with Tecnis Eyhance and 92 with AT LARA). A complete questionnaire was obtained from 472 (92%) patients, who were included in the study (393 vs. 79). Comparing Tecnis Eyhance with AT LARA IOL, 54 vs. 57% patients were able to perform most of their daily activities without spectacles, 9 vs. 19% reported not being dependent on spectacles at all, 25 vs. 29% reported using their smartphones without spectacles, 15 vs. 49% patients reported experiencing glares or halos at night, and 1 vs.15% with driving disturbance. Overall, 95 vs. 93% patients described themselves as "satisfied" or "highly satisfied" with their IOL. CONCLUSIONS: With both types of EDOF-IOLs, the majority of patients could perform most of their daily activities without spectacles, except reading, and were highly satisfied with their IOLs. Patients with diffractive Zeiss AT LARA EDOF-IOLs were more likely to accomplish unaided near-range visual tasks; however, they were also at a higher risk of experiencing glares or halos at night.

Use of Spectacles after Cataract Surgery.

PURPOSE: The goal of this study was to investigate the use of spectacles in everyday life after bilateral cataract surgery with a preoperative refractive target of emmetropia in both eyes. In addition, we analyzed the total cost of spectacles and the patient's visual satisfaction at least 6 months after surgery. METHODS: Patients after bilateral cataract surgery with implantation of an aspheric monofocal IOL (Tecnis 1, Johnson & Johnson) with a preoperative refractive target of emmetropia in both eyes and a documented refractive outcome were included in this prospective observational study. In a phone interview ≥ 6 months after surgery, the following items were assessed: type of spectacles purchased and overall cost, type of activity with and duration of spectacle wear, and satisfaction with the visual situation. RESULTS: Seventy patients were included in this study. Depending on their postoperative refraction, patients were divided into group A (n = 27) with perfect emmetropia in both eyes (i.e., spherical equivalent [SE] of ≥ - 0.25 D to ≤ + 0.25 D), group B (n = 21) with achieved emmetropia in one eye (i.e., SE of ≥ - 0.25 D to ≤ + 0.25 D) and a myopic refraction in the other eye (< - 0.25 D), and group C (n = 22) with bilateral myopic results (SE of < - 0.25 D). Overall, 84% of patients had purchased new spectacles, mostly varifocals (59%) or reading glasses (24%) at the median cost of 980 Swiss Francs (mean: CHF 912 ± 746). Despite patients' initial reasoning for their lens choice to require reading glasses only, varifocal glasses were worn for more than 50% or all of awake time by 48% of patients in group A, 43% in group B, and 68% in group C. Despite their regular spectacles use, patients' visual satisfaction was very high in all three groups. CONCLUSIONS: Most patients who achieve perfect bilateral emmetropia after implantation of monofocal aspheric lenses buy varifocal spectacles within 6 months, and more than half of all patients use their varifocal spectacles for more than 50% of their awakening time. The costs for such spectacles are high.

Distribution of preoperative angle alpha and angle kappa values in patients undergoing multifocal refractive lens surgery based on a positive contact lens test.

PURPOSE: To assess the preoperative objective angle alpha and angle kappa measurements of patients deciding to undergo multifocal refractive lens surgery based on a subjective positive multifocal contact lens test (MCLT). METHODS: Retrospective, consecutive case series. Alpha and kappa angles were measured using the iTrace aberrometer. All patients also performed a 1-week MCLT. Only patients with a positive MCLT underwent surgery. Visual outcome (UCVA) was obtained in the 1-year follow-up. We assessed the preoperative distribution of angle values within MCLT positive and negative patient groups. RESULTS: Two hundred seventeen eyes (111 patients) were included. Mean age was 56.4 years (SD 5.6) and 46.9% were female. In 71 eyes (38 patients), MCLT was positive. Of them, 12 eyes (17%) had an angle alpha and angle kappa ≥ 0.5mm. Of 146 eyes (73 patients) who refrained from surgery due to a negative MCLT, 71 eyes (48.6%) had both angles small (<0.5mm). In the 1-year follow-up, UCVA improved by 0.68 logMAR (SD 0.51; p<0.001) from baseline. Eyes with both small angle alpha and kappa sizes improved by 0.78 logMAR (SD 0.56), as did eyes with high (≥0.5mm) angle sizes (0.82 logMAR (SD 0.53). UCVA of eyes (n=24) with high alpha but low kappa sizes improved less (-0.31 logMAR (SD 0.13; p=0.019)). CONCLUSION: Four out of five patients with a positive MCLT also had correspondingly small angle values. One-half of patients with low preoperative angle values refrained from surgery due to a negative MCLT result. One-year visual acuity improvement was substantial and independent from angle sizes.

Bilateral blindness after uneventful brolucizumab injection for macular degeneration.

BACKGROUND: We report a very severe case of bilateral panuveitis and ischemic vasculitis with possible perineural inflammation, which followed bilateral intravitreal brolucizumab administration in a patient with neovascular age-related macular degeneration (nAMD). CASE PRESENTATION: On December 11, 2020, a 81-year-old woman presented with severe bilateral loss of vision. Eight days earlier, she had received uneventful bilateral injection of brolucizumab, a novel anti-vascular endothelial growth factor (VEGF) single-chain variable region (scFv) recombinant protein drug, for treatment of neovascular age-related macular degeneration (nAMD). Slit-lamp examination revealed signs of a bilateral panocular vasculitis with ischemia. Scanning laser ophthalmoscopy of her left eye revealed marked vascular sheathing. T1 fat-saturated post-contrast images of the orbit revealed a higher-than-normal signal of the choroid, with localized choroidal detachment. Additionally, pathologic enhancement was visible around the optic nerve in the orbit, which was interpreted as vasculitis. Due to the severe bilateral panuveitis with vasculitis, an additional vitreous tap was obtained, which revealed elevated levels of interleukin six and interleukin ten. CONCLUSIONS: To our knowledge, this is the first documented case showing both panuveitis and ischemic vasculitis with possible perineural inflammation. We do not recommend performing bilateral brolucizumab injections until more data is available regarding the mechanism of brolucizumab-induced vasculitis. From a clinical point of view, we find it difficult to justify the use of brolucizumab when there are other well-known agents, such as ranibizumab and aflibercept, which have better safety profiles and comparable efficacy.

Estimation of Aboveground Biomass in Agroforestry Systems over Three Climatic Regions in West Africa Using Sentinel-1, Sentinel-2, ALOS, and GEDI Data.

Agroforestry systems (AFS) offer viable solutions for climate change because of the aboveground biomass (AGB) that is maintained by the tree component. Therefore, spatially explicit estimation of their AGB is crucial for reporting emission reduction efforts, which can be enabled using remote sensing (RS) data and methods. However, multiple factors including the spatial distributions within the AFS, their structure, their composition, and their variable extents hinder an accurate RS-assisted estimation of the AGB across AFS. The aim of this study is to (i) evaluate the potential of spaceborne optical, SAR and LiDAR data for AGB estimations in AFS and (ii) estimate the AGB of different AFS in various climatic regions. The study was carried out in three climatic regions covering Côte d'Ivoire and Burkina Faso. Two AGB reference data sources were assessed: (i) AGB estimations derived from field measurements using allometric equations and (ii) AGB predictions from the GEDI level 4A (L4A) product. Vegetation indices and texture parameters were generated from optical (Sentinel-2) and SAR data (Sentinel-1 and ALOS-2) respectively and were used as predictors. Machine learning regression models were trained and evaluated by means of the coefficient of determination (R2) and the RMSE. It was found that the prediction error was reduced by 31.2% after the stratification based on the climatic conditions. For the AGB prediction, the combination of random forest algorithm and Sentinel-1 and -2 data returned the best score. The GEDI L4A product was applicable only in the Guineo-Congolian region, but the prediction error was approx. nine times higher than the ground truth. Moreover, the AGB level varied across AFS including cocoa (7.51 ± 0.6 Mg ha-1) and rubber (7.33 ± 0.33 Mg ha-1) in the Guineo-Congolian region, cashew (13.78 ± 0.98 Mg ha-1) and mango (12.82 ± 0.65 Mg ha-1) in the Guinean region. The AFS farms in the Sudanian region showed the highest AGB level (6.59 to 82.11 Mg ha-1). AGB in an AFS was mainly determined by the diameter (R2 = 0.45), the height (R2 = 0.13) and the tree density (R2 = 0.10). Nevertheless, RS-based estimation of AGB remain challenging because of the spectral similarities between AFS. Therefore, spatial assessment of the prediction uncertainties should complement AGB maps in AFS.

Efficacy of Diclofenac in Pain Reduction after Topography-Guided Transepithelial Surface Ablation.

PURPOSE: To report the efficacy of postoperative diclofenac eye drops for pain reduction in patients undergoing topography-guided transepithelial surface ablation. METHODS: Retrospective consecutive case series of patients undergoing topography-guided transepithelial surface ablation for refractive myopia treatment using a 1 KHz excimer laser. Patients were divided into three groups. Group 1 did not receive any diclofenac drops, group 2 received one diclofenac drop postoperatively (day 1), and group 3 received one drop of diclofenac postoperatively (day 1) and on the day after treatment (day 2). Postoperative pain was self-assessed by patients per eye daily for the first 4 consecutive days (days 1 to 4) after the treatment using the visual analogue scale (VAS). We compared VAS with respect to the use of additional oral or topical treatment as well as VAS with regards to the total amount of ablated tissue (< 50 µm, 50 - 100 µm, ≥ 100 µm) among the groups. RESULTS: We enrolled 163 eyes of 163 patients (55.0% female), with a mean age of 31.3 years (SD ± 6.6; range 21 - 68). We excluded 16 patients who applied other additional analgesics. Group 1 comprised 35 eyes (21%), group 2 had 21 eyes (13%), and group 3 consisted of 107 eyes (66%). Median pain score (VAS) was 5 (range 0, 10) in group 1, which was higher than in groups 2 (median 1, range 0 to 7) and 3 (median 1.5, range 0 to 7) on the day of surgery (p < 0.0001). Percentage of patients using an additional oral NSAID on days 1 and 2 was significantly higher in group 1 (69/83%) when compared to groups 2 (24/43%) or 3 (31/49%) (p < 0.001 day 1, p = 0.001 day 2). No correlation was found between pain sensation and maximum ablation depth (Spearman correlation p > 0.05). CONCLUSION: The instillation of one drop of diclofenac after topography-guided transepithelial surface ablation reduced subjective pain sensation according to VAS and decreased the need for additional topical anesthetic drops or oral NSAID.

VEGF-A in Serum and Plasma Rich in Growth Factors (PRGF) Eye Drops.

BACKGROUND: Vascular endothelial growth factor (VEGF)-A, the most abundant subtype of the VEGF family in the eye, plays an important role in corneal homeostasis due to its ability to mediate corneal nerve repair. Repeated intravitreal anti-VEGF injections were shown to significantly reduce corneal nerve density, which might negatively affect corneal homeostasis and lead to a neuropathic dry eye disease. Currently, there are two effective modalities to treat dry eye while supplying VEGF to the ocular surface: serum eye drops (SED) and eye drops manufactured from plasma rich in growth factors (PRGF). The purpose of this study was to measure the VEGF-A concentration in SED and PRGF eye drops. MATERIAL AND METHODS: Ten healthy volunteers donated blood on two separate occasions, 2 - 8 days apart. Thus, a total of 20 blood samples were processed to obtain both SED and PRGF. Concentrations of VEGF-A were quantified by a Simple Plex platform run in triplicate. RESULTS: The VEGF-A concentration in SED and PRGF was very similar between the two blood samples drawn from one individual donor but showed substantial interindividual variability. However, in all 20 samples, VEGF concentrations were substantially higher in SED samples (mean 238.7 ± 146.6 pg/mL) compared to PRGF samples (mean 67.4 ± 46.3 pg/mL). Based upon the analysis of variance (ANOVA) model for the measured concentrations with fixed effects for specimen (SED vs. PRGF) and subject, the mean difference between the SED and PRGF concentration was 168.1 pg/mL (95% confidence interval: [142.4, 193.9], p < 0.001). CONCLUSION: Our study showed that the VEGF concentration was higher in SED than in PRGF. This is an important finding, particularly for potential treatment of dry eye disease in patients with neuropathic eye disease, especially in patients that received repeated anti-VEGF intravitreal injections, or in patients with Sjögren's disease, where the level of VEGF in tears might be pathologically decreased. Hypothetically, VEGF might be needed to restore ocular surface homeostasis. Although growing evidence has shown that VEGF-A plays an important role in corneal homeostasis, only a randomized prospective clinical trial will show whether supplying VEGF-A to the ocular surface might successfully restore the corneal homeostasis and overcome the problem of corneal neuropathy in these patients. For such a trial, based on our results, an undiluted SED should be preferred over a PRGF due to the higher content of VEGF-A.

Effect of Protective Measures on the Risk of SARS-CoV-2 Infection among Eye Clinic Staff Members.

BACKGROUND: Switzerland was strongly affected by the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that resulted in a nationwide lockdown in March 2020. Ophthalmologists were at most risk of contracting a SARS-CoV-2 infection due to their close working distance from patients. The aim of the study is to evaluate the overall effectiveness of protective measures on the risk of SARS-CoV-2 infection among employees in a large public eye hospital. MATERIAL AND METHODS: After lifting the lockdown in April 2020, standard precaution measures were taken, such as no handshaking and the use of operating face masks and a protective plastic shield on slit lamps and diagnostic devices. Only patients with no signs of SARS-CoV-2 disease were seen during the study period. Specific anti-SARS-CoV-2 IgG antibody titers were measured in eye clinic employees at the end of April 2020 (1st test phase) and in January 2021 (2nd test phase). The prevalence of SARS-CoV-2 IgG antibody titers among employees with daily patient contact was compared to staff members with no patient contact. RESULTS: The SARS-CoV-2 prevalence in employees with daily patient contact, with 0% in the 1st phase and 7.4% in the 2nd phase, was not significantly higher than the prevalence in the control group with no patient contact (0.9% in the 1st phase, p = 0.4; and 8.6% in the 2nd phase, p = 0.8). Furthermore, physicians were not at a significantly higher risk of SARS-CoV-2 infection compared to technicians, nurses, or office staff. CONCLUSIONS: This study shows that the abovementioned precaution measurements are effective in preventing transmission of SARS-CoV-2 infection in eye hospitals and enable us to resume practicing ophthalmology in a safe manner.

Occurrence of motility disorders in patients undergoing tube surgery-consecutive, retrospective follow-up case series analysis.

BACKGROUND: The two glaucoma drainage devices (GDD) Ahmed and Baerveldt tubes are most commonly used for the treatment of refractory glaucoma. We noticed a significant number of patients with postoperative motility disorders resulting in diplopia. We investigated the occurrence and patterns of postoperative motility disorders overall and between the two GDD tubes using the Hess Screen Test. METHODS: Retrospective single-center matched case series of 20 patients undergoing Ahmed and 20 patients undergoing Baerveldt tube implantation with a follow-up of at least 1 year. In order to investigate the dynamic of GDD-induced motility disorder over time, from 25 patients, a follow-up examination from two different time periods (3 to 6 months and 12 to 24 months postoperatively) was available. From these 25 patients, 12 had received an Ahmed and 13 a Baerveldt GDD. To compare the different Hess Screen Tests, we developed nine categories of possible emerging motility disorder in the operated eye as a primary endpoint: Motility restriction in up-gaze, in down-gaze, in abduction, in adduction; combined motility disorders in up-gaze and adduction, up-gaze and abduction, down-gaze and adduction, down-gaze and abduction. If there was no motility disorder, this was also separately classified. RESULTS: Regardless of the used device, Ahmed or Baerveldt, most patients experienced motility disorders to some extent; mainly down-gaze and adduction were affected. However not every motility disorder resulted in diplopia. Although over time a decrease in ocular misalignment was seen, the incidence of diplopia was stable. Nevertheless, only few required therapy. We noted no difference between Ahmed and Baerveldt tube implant devices. CONCLUSION: Ocular misalignment and restriction of motility is a common finding after GDD. Although not every motility disorder results in diplopia, it is frequent. Therefore, it needs to be taken into consideration in informed consent.

Mismatch of corneal specialists' expectations and keratoconus knowledge in general ophthalmologists - a prospective observational study in Switzerland.

BACKGROUND: To assess whether Swiss general ophthalmologists have the minimal keratoconus knowledge that corneal specialists would expect them to have. METHODS: Corneal specialists defined "minimal keratoconus knowledge" (MKK) with respect to definition, risk factors, symptoms and possible treatment options of keratoconus. A telephone interview survey was conducted among one hundred ophthalmologists (mean age 51.9 years (SD 9.5), 60 % male) from the German-speaking part of Switzerland. For each participant, years of work experience, number of keratoconus patients seen per year and access to a topography device were obtained. We calculated the proportion of MKK and examined in multivariate analyses whether ophthalmologists with access to topography and with greater work experience performed better than other groups. RESULTS: No single ophthalmologist had MKK. The mean MKK was 52.0 %, and the range was 28.6-81.0 %. Per 10 years of working in private practice, the MKK decreased by 8.1 % points (95 % CI: -14.2, -2.00; p = 0.01). Only 24 % of participants correctly recalled the definition of keratoconus, 9 % all risk factors, 5 % all symptoms and 20 % all treatment modalities. The MKK values were not associated with the number of keratoconus patients seen per year and the availability of topography to diagnose keratoconus. CONCLUSIONS: There is a substantial mismatch between corneal specialist' expectations and general ophthalmologists' knowledge about keratoconus. The low recall of symptoms and risk factors may explain why ophthalmologists diagnose relatively few cases of keratoconus, resulting in inefficient care delivery and delayed intervention.

Detecting cocoa plantations in Côte d'Ivoire and Ghana and their implications on protected areas.

Côte d'Ivoire and Ghana are the largest producers of cocoa in the world. In recent decades the cultivation of this crop has led to the loss of vast tracts of forest areas in both countries. Efficient and accurate methods for remotely identifying cocoa plantations are essential to the implementation of sustainable cocoa practices and for the periodic and effective monitoring of forests. In this study, a method for cocoa plantation identification was developed based on a multi-temporal stack of Sentinel-1 and Sentinel-2 images and a multi-feature Random Forest (RF) algorithm. The Normalized Difference Vegetation Index (NDVI) and second-order texture features were assessed for their importance in an RF classification, and their optimal combination was used as input variables for the RF model to identify cocoa plantations in both countries. The RF model-based cocoa map achieved 82.89% producer's and 62.22% user's accuracy, detecting 3.69 million hectares (Mha) and 2.15 Mha of cocoa plantations for Côte d'Ivoire and Ghana, respectively. The results demonstrate that a combination of an RF model and multi-feature classification can distinguish cocoa plantations from other land cover/use, effectively reducing feature dimensions and improving classification efficiency. The results also highlight that cocoa farms largely encroach into protected areas (PAs), as 20% of the detected cocoa plantation area is located in PAs and almost 70% of the PAs in the study area house cocoa plantations.

The Lucerne Protocol for the Production of Autologous Serum Eyedrops.

BACKGROUND: There are a variety of protocols for manufacturing autologous serum (AS) eye drops. The Lucerne protocol for the production of AS eye drops uses a slightly reduced gravitational (g)-force and time for the centrifugation process (2500 × g for 10 minutes), compared to previously published optimised protocols, to obtain high levels of epitheliotropic growth factors (3000 × g for 15 minutes). The goal of this study was to compare the concentrations of growth factors, albumin and lysozyme in autologous serum eye drops manufactured with these protocols. MATERIAL AND METHODS: Blood from 5 healthy volunteers was placed in plastic tubes without an anticoagulant. Tubes from each donor were left in a vertical position for 2 hours at room temperature to facilitate coagulation, followed by centrifugation at either 2500 × g for 10 minutes or at 3000 × g for 15 minutes at room temperature. The serum levels of beta nerve growth factor (ß-NGF), transforming growth factor ß1 (TGF-ß1), epidermal growth factor (EGF), hepatocyte growth factor (HGF), platelet-derived growth factor BB (PDGF-BB) and vascular endothelial growth factor A (VEGF-A) were measured in triplicate with a multi-analyte Simple Plex platform. The Simple Plex cartridge allows each sample to be run in triplicate for each analyte and prevents any interaction between the antibody components for each biomarker. The serum level of albumin was measured by turbidimetric immunoassay Tina-quant and of lysozyme by single radial immunodiffusion assay. RESULTS: For all analytes, the reduced g-force and centrifugation time did not result in a significant difference in serum levels. CONCLUSIONS: The Lucerne protocol for the production of autologous serum eye drops with reduced g-force and a shorter centrifugation time does not affect the concentrations of the main epitheliotropic growth factors, albumin and lysozyme, in AS eye drops.

Outcomes and costs of Ranibizumab and Aflibercept treatment in a health-service research context.

BACKGROUND: To compare anti-VEGF treatments for macular disease in terms of costs and clinical outcomes. METHODS: We identified patients suffering from macular disease and treated either with aflibercept, ranibizumab or both at the largest public eye clinic in Switzerland between January 1st and December 31st 2016 who were insured in one of the two participating health insurance companies. Clinical data were extracted from the electronic health record system. The health insurers provided the health claim costs for the ophthalmologic care and the total health care costs of each patient in the observation period. Using multivariate regression models, we assessed the monthly ophthalmologic and the monthly total costs of patients with no history of switching (ranibizumab vs. aflibercept), patients with a history of switching from ranibizumab to aflibercept, patients switching during the observation period and a miscellaneous group. We examined baseline differences in age, proportion of males, visual acuity (letters), central retinal thickness (CRT) and treatment history before entering the study. We investigated treatment intensity and compared the changes in letters and CRT. RESULTS: The analysis involved 488 eyes (361 patients), 182 on ranibizumab treatment, and 63 on aflibercept treatment, 160 eyes with a history of switching from ranibizumab to aflibercept, and 45 switchers during follow-up and 38 eyes of the miscellaneous group. Compared to ranibizumab, monthly costs of ophthalmologic treatment were slightly higher for aflibercept treatment + 175.0 CHF (95%CI: 1.5 CHF to 348.3 CHF; p = 0.048) as were the total monthly costs + 581.0 CHF (95%CI: 159.5 CHF to 1002.4 CHF; p = 0.007). Compared to ranibizumab, the monthly treatment intensity with aflibercept was similar (+ 0.057 injections/month (95%CI -0.023 to 0.137; p = 0.162), corresponding to a projected annual number of 5.4 injections for ranibizumab vs. 6.1 injections for aflibercept. During follow-up, visus dropped by 0.7 letters with ranibizumab and increased by 0.6 letters with aflibercept (p = 0.243). CRT dropped by - 14.9 µm with ranibizumab and by - 19.5 µm with aflibercept (p = 0.708). The monthly costs of all other groups examined were higher. CONCLUSION: These real-life data show that aflibercept treatment is equally expensive, and clinical outcomes between the two drugs are similar.

Maize Cropping Systems Mapping Using RapidEye Observations in Agro-Ecological Landscapes in Kenya.

Cropping systems information on explicit scales is an important but rarely available variable in many crops modeling routines and of utmost importance for understanding pests and disease propagation mechanisms in agro-ecological landscapes. In this study, high spatial and temporal resolution RapidEye bio-temporal data were utilized within a novel 2-step hierarchical random forest (RF) classification approach to map areas of mono- and mixed maize cropping systems. A small-scale maize farming site in Machakos County, Kenya was used as a study site. Within the study site, field data was collected during the satellite acquisition period on general land use/land cover (LULC) and the two cropping systems. Firstly, non-cropland areas were masked out from other land use/land cover using the LULC mapping result. Subsequently an optimized RF model was applied to the cropland layer to map the two cropping systems (2nd classification step). An overall accuracy of 93% was attained for the LULC classification, while the class accuracies (PA: producer's accuracy and UA: user's accuracy) for the two cropping systems were consistently above 85%. We concluded that explicit mapping of different cropping systems is feasible in complex and highly fragmented agro-ecological landscapes if high resolution and multi-temporal satellite data such as 5 m RapidEye data is employed. Further research is needed on the feasibility of using freely available 10-20 m Sentinel-2 data for wide-area assessment of cropping systems as an important variable in numerous crop productivity models.

Phototherapeutic keratectomy (PTK) for treatment of recurrent corneal erosion: Correlation between etiology and prognosis - prospective longitudinal study.

BACKGROUND: To evaluate and compare the efficacy of phototherapeutic keratectomy (PTK) for recurrent corneal erosion (RCE) caused by trauma, map-dot-fingerprint dystrophy (MDF) or instances without an established cause. METHODS: Single center prospective longitudinal study. Between January 2003 and November 2006 we treated 89 eyes of 82 patients with PTK. All patients presented with refractory RCE caused either by trauma, MDF or with no established cause. During follow-up (until May 2013), patients, treating ophthalmologists and/or family doctors were interviewed about the patients' state of health, recurrence of pain, the necessity of further treatments or the occurrence of complications. Five patients died or were lost during follow-up and were thus excluded from the analysis. Freedom of recurrence was estimated using logistic regression analysis using indicator variates for the following three etiologic groups: trauma (55 eyes), MDF (29 eyes) and idiopathic (no established cause; 5 eyes). RESULTS: Overall 89 eyes of 82 patients were followed-up. Average follow-up among failures and non-failures was 51.56 months (standard deviation (SD) 21.22, range 24 to 91) and 95.25 months (SD 15.99, range 35 to 137 months), respectively. Fifty-seven percent were female and the average age at first PTK was 45.3 years (range: 23 to 70 years). During follow-up, there were 25 recurrences and 15 of these patients received a re-PTK. Compared to patients with a traumatic cause of epithelial erosions, the likelihood of experiencing a recurrence was higher in patients with MDF [odds ratio (OR) 5.48; 95 % confidence interval (CI) 1.93 to 15.59; p = 0.001]; the OR was 8.81 (95 % CI 1.27 to 61.32; p = 0.028) for patients with an idiopathic cause. CONCLUSIONS: In view of the available evidence, we want to raise the awareness of those managing patients with MDF and idiopathic causes that, in order to control the disease, recurrent PTK treatments are expected to be necessary more often than in cases of traumatic RCE.

3D direct laser writing using a 405 nm diode laser.

Three-dimensional (3D) direct laser writing commonly uses near-infrared femtosecond laser pulses. Here, we use a quasi-cw blue diode laser at a 405 nm wavelength. As prerequisite, we identify photoresist systems that unambiguously show nonlinear multiphoton polymerization at this excitation wavelength. Next, we obtain a diffraction-limited focus with a high-numerical-aperture objective lens (NA=1.4), which is crucial to actually benefit from the wavelength advantage. To evaluate the anticipated reduced linewidths and improved resolution, we fabricate and characterize 2D and 3D benchmark structures. Finally, we also demonstrate dip-in direct laser writing with our setup.

Deep Learning Models Used in the Diagnostic Workup of Keratoconus: A Systematic Review and Exploratory Meta-Analysis.

PURPOSE: The prevalence of keratoconus in the general population is reported to be up to 1 of 84. Over the past 2 decades, diagnosis and management evolved rapidly, but keratoconus screening in clinical practice is still challenging and asks for improving the accuracy of keratoconus detection. Deep learning (DL) offers considerable promise for improving the accuracy and speed of medical imaging interpretation. We establish an inventory of studies conducted with DL algorithms that have attempted to diagnose keratoconus. METHODS: This systematic review was conducted according to the recommendations of the PRISMA statement. We searched (Pre-)MEDLINE, Embase, Science Citation Index, Conference Proceedings Citation Index, arXiv document server, and Google Scholar from inception to February 18, 2022. We included studies that evaluated the performance of DL algorithms in the diagnosis of keratoconus. The main outcome was diagnostic performance measured as sensitivity and specificity, and the methodological quality of the included studies was assessed using QUADAS-2. RESULTS: Searches retrieved 4100 nonduplicate records, and we included 19 studies in the qualitative synthesis and 10 studies in the exploratory meta-analysis. The overall study quality was limited because of poor reporting of patient selection and the use of inadequate reference standards. We found a pooled sensitivity of 97.5% (95% confidence interval, 93.6%-99.0%) and a pooled specificity of 97.2% (95% confidence interval, 85.7%-99.5%) for topography images as input. CONCLUSIONS: Our systematic review found that the overall diagnostic performance of DL models to detect keratoconus was good, but the methodological quality of included studies was modest.

Multiple use of preservative-free single dose unit dexamethasone 0.1% eye drops is safe within 24 hours.

BACKGROUND: Unpreserved single-dose unit (SDU) eye drops are commonly used to avoid benzalkonium chloride-related toxicity. Although intended for single use, many patients report off-label repeated use of SDUs over a prolonged period. We investigated whether repeated use of dexamethasone 0.1% SDUs in the same patient increases the bacterial contamination rate. METHODS: We prospectively enrolled patients scheduled for inpatient corneal and glaucoma surgery receiving dexamethasone 0.1% SDU four times per day from the same vial. To assess contamination rates, one drop from the vial was cultured immediately after opening the SDU (t0), 10 hours later after four drop applications (t10) and 24 hours after opening without further drop applications (t24). Conjunctival swabs were taken before and after drop application. Contamination rate was assessed with a standard clinical culturing protocol without introducing a positive control. RESULTS: 110 eyes of 109 patients were evaluated. Drops collected immediately after opening the SDU (t0) were contaminated in 9/110 cultures (8.1%). At t10, 13/110 cultures were contaminated (11.8%; p=0.267) and 11/110 at t24 (10.0%; t24 vs t0; p=1.00). In 5 of 21 cases of contaminated drops at t10 and/or t24, the same isolates were cultured from the initial conjunctival swab and the SDU. In three cases, the same bacterial species was found in consecutive samples. CONCLUSION: The contamination rate of the SDU did not increase after multiple use within 24 hours. Contamination from fingertip flora was more likely than from ocular surface flora. Reuse of dexamethasone 0.1% SDU in the same patient within 24 hours appears to be safe.