Complications during elective cataract surgery: did the COVID-19 lockdown affect outcomes of ophthalmic surgery?

PURPOSE: One of the many consequences of the COVID-19 pandemic was a worldwide lockdown of ophthalmic surgery procedures for several months in 2020. The present study aims to answer the following question: does an intermission of cataract surgery for two months cause an increase in complication rates? METHODS: In this retrospective clinical chart review, data was taken from Dutch cataract complication registration database that contains pre-, intra- and postoperative information of patients that underwent cataract surgery in the Netherlands. The amount as well as type of complications were extracted before and after the eight weeks surgical intermission period (SIP): six weeks before (SIP-6) and six weeks after this period (SIP+6) for the years 2016-2020. RESULTS: A significant decrease in complication rates was found between SIP-6 and SIP+6 in 2020. When SIP+6 2020 is compared to SIP+6 2019, a significant reduction is found. Overall, a downward trend in complication rates was observed in the period 2016-2020. CONCLUSION: A two-months intermission of performing elective cataract surgery does not cause an increase in complications. In contrast, we observe a reduction of postoperative complications. This implicates that refraining from cataract surgery for two months might not compromise operative skills. The possible downward trend over the years can be partially explained by improved training, education and equipment, as well as an increased use of intracameral antibiotics during operation. Possible explanations for the reduction of complications after lockdown could be decreased time pressure as a consequence of a reduced number of operations at the restart of surgeries, and heightened awareness and cautiousness when resuming the operations.

The Eye Color Experiment: From Berlin to Auschwitz and Back.

BACKGROUND: In an effort to alter eye color during World War II, devout Nazi researcher Karin Magnussen had adrenaline eye drops administered to inmates at the concentration camp Auschwitz-Birkenau. A Sinti family, with a high prevalence of heterochromia iridis, was forced to participate in this study. Members of this family, as well as other victims, were later killed and had their eyes enucleated and sent to Magnussen for examination. Magnussen articulated the findings of these events in a manuscript that has never been published. The author is the first ophthalmologist to review this manuscript. The generation who experienced the atrocities of World War II will soon be gone and awareness of what happened during this tragic chapter of world history is fading. OBJECTIVES: To describe these events to raise awareness among future generations. METHODS: A literature review and archival search was conducted. RESULTS: Magnussen's research was based on an animal study published in 1937. For Magnussen's study, adrenaline drops were administered to inmates, including a 12-year-old girl from the Sinti family. As there was a reported case of deaf-mutism within the family, Waardenburg syndrome seems to be the most plausible explanation for this family's heritable heterochromia. CONCLUSIONS: The effort to change eye color was doomed to fail from the beginning because there was a probable diagnosis of Waardenburg syndrome. Extinction of humans for ophthalmological research is an insane act beyond imagination. For the sake of these victims, and for the generations who still feel their pain, it is imperative to tell their stories.

Common genetic variants associated with open-angle glaucoma.

Open-angle glaucoma (glaucoma) is a major eye disorder characterized by optic disc pathology. Recent genome-wide association studies identified new loci associated with clinically relevant optic disc parameters, such as the optic disc area and vertical cup-disc ratio (VCDR). We examined to what extent these loci are involved in glaucoma. The loci studied include ATOH7, CDC7/TGFBR3 and SALL1 for optic disc area, and CDKN2B, SIX1, SCYL1/LTBP3, CHEK2, ATOH7 and DCLK1 for VCDR. We performed a meta-analysis using data from six independent studies including: the Rotterdam Study (n= 5736), Genetic Research in Isolated Populations combined with Erasmus Rucphen Family study (n= 1750), Amsterdam Glaucoma Study (n= 296) and cohorts from Erlangen and Tübingen (n= 1363), Southampton (n= 702) and deCODE (n= 36 151) resulting in a total of 3161 glaucoma cases and 42 837 controls. Of the eight loci, we found significant evidence (P= 1.41 × 10(-8)) for the association of CDKN2B with glaucoma [odds ratio (OR) for those homozygous for the risk allele: 0.76; 95% confidence interval (CI): 0.70-0.84], for the role of ATOH7 (OR: 1.28; 95% CI: 1.12-1.47) and for SIX1 (OR: 1.20; 95% CI: 1.10-1.31) when adjusting for the number of tested loci. Furthermore, there was a borderline significant association of CDC7/TGFBR3 and SALL1 (both P= 0.04) with glaucoma. In conclusion, we found consistent evidence for three common variants (CDKN2B, ATOH7 and SIX1) significantly associated with glaucoma. These findings may shed new light on the pathophysiological protein pathways leading to glaucoma, and point to pathways involved in the growth and development of the optic nerve.

Ophthalmology research in the Warsaw Jewish ghetto-hunger disease and the story of Szymon Fajgenblat, MD.

PURPOSE: During World War II, scientific studies were conducted in the Jewish ghetto of Warsaw (Poland). This research, focusing on hunger-induced disease, was embedded in circumstances of omnipresent hunger and starvation. Ophthalmologist Szymon Fajgenblat (1900-1944) was one of the involved physicians and wrote a manuscript about ophthalmological changes during starvation. The background and the findings of his research are discussed in this article. METHODS: Literature and archival research. RESULTS: The Warsaw ghetto existed from 1941 to 1943 until it was destroyed, just like most of its inhabitants. Before destruction took place, the Nazis tried to kill the residents-almost half a million Jews-by means of starvation. Led by dermatologist Israel Milejkowski, a group of Jewish physicians decided to study the physical effects of hunger on human beings. Twenty-eight physicians would participate in the Hunger Disease Studies, including Fajgenblat. He linked cataracts to serious undernourishment and observed scleral thinning as another sign in hunger disease; the latter likely responsible for the low intraocular pressure found in the study population. Surprisingly, no complaints of night blindness or ophthalmological findings, characteristic of vitamin A deficiency, were observed in the study population. CONCLUSION: The Hunger Disease Studies are a unique written medical and historical monument of the Jewish physicians of the Warsaw ghetto. Ophthalmologist Szymon Fajgenblat was one of them and left behind an ophthalmological study as his legacy.

[Communication advice and demands of the hospital: how to deal with them?] / Communicatie-adviezen en -eisen van de zorginstelling.

The hospital should not actively involve with publications by physicians. It is undesirable and even unnecessary, especially in case of scientific publications: chances of a negative impact on the hospital are odd. A physician is bound by Hippocratic oath as well as by the guidelines and code of conduct of the own professional group. Nevertheless, this professional group should be more self-correcting when these guidelines and codes are not followed by physicians - like in (potential) media exposure of COVID-19 related issues that can increase the communal unrest and polarisation. Sometimes active involvement of the hospital can be recommended, for example in giving professional guidance in case of interviews. On many other occasions, the freedom of speech can be jeopardized or can be followed by censorship.

The death of Wolfgang Amadeus Mozart: an epidemiologic perspective.

The early death of the composer Wolfgang Amadeus Mozart on 5 December 1791 has fascinated the world for more than 2 centuries. It has been suggested that his final illness was caused by poisoning, renal failure, Henoch-Schönlein purpura, trichinosis, and many other conditions. The official daily register of deaths in Mozart's Vienna was evaluated to provide an epidemiologic framework into which the observations of contemporary witnesses of his death can be integrated. All recorded deaths in Vienna during November and December 1791 and January 1792 were analyzed, together with the corresponding periods in 1790 to 1791 and 1792 to 1793. The deaths of 5011 adults (3442 men, 1569 women) were recorded over these periods. The mean ages of death were 45.5 years (SD, 18.5) for men and 54.5 years (SD, 19.9) for women. Tuberculosis and related conditions accounted for the highest number of deaths; cachexia and malnutrition ranked second, and edema was the third most common cause. According to eyewitness accounts, the hallmark of Mozart's final disease was severe edema. Deaths from edema were markedly increased among younger men in the weeks surrounding Mozart's death compared with the previous and following years. This minor epidemic may have originated in the military hospital. Our analysis is consistent with Mozart's last illness and death being due to a streptococcal infection leading to an acute nephritic syndrome caused by poststreptococcal glomerulonephritis. Scarlet fever, which represents the same underlying disease from an etiologic perspective, is a less likely possibility.

VAMP5 and VAMP8 are most likely not involved in primary open-angle glaucoma.

PURPOSE: To select and characterize novel POAG disease genes. On the basis of genetic position (GLC1B), expression in the optic nerve, and biochemical function (targeted membrane transport processes), we selected the human VAMP5 and VAMP8 (encoding vesicle-associated membrane proteins 5 and 8) as potential candidate disease genes for POAG. We subsequently analyzed whether or not sequence changes in VAMP5 or VAMP8 were implicated in POAG. METHODS: Genomic DNA samples from 90 POAG cases and 60 controls were screened by denaturing high performance liquid chromatography of fragments amplified by the polymerase chain reaction. Direct sequencing identified nucleotide changes. RESULTS: No nonsynonymous rare sequence variants were found in VAMP5 or VAMP8. In VAMP5, three previously identified and five new single nucleotide polymorphisms (SNPs) were found. In VAMP8, four known and two new SNPs were detected. All new SNPs did not appear to change gene function or alter gene splicing. No significant differences were found between the allele frequencies in POAG cases and controls. CONCLUSIONS: Our findings indicate that VAMP5 and VAMP8 are not involved in POAG in the Dutch population.

The eyes of Johann Sebastian Bach.

Johann Sebastian Bach's only physical problem seems to have been his vision. Myopia seems most likely, and it is probable that he developed cataracts at an older age. In addition to the cataracts, his worsening vision may have been due in part to some other eye problem. During the last year of his life, Bach's vision became so poor that he decided to have his eyes operated on. Two operations were performed in 1750 by the traveling English eye surgeon John Taylor. Most likely the first operation was Taylor's standard couching procedure. About 1 week after the first operation, Bach had to be operated on again because of a reappearance of the cataract. Many painful and/or vision-reducing complications could have been induced by these intraocular operations: uveitis or endophthalmitis, secondary glaucoma, hemorrhage, retinal detachment, and even sympathetic ophthalmia. Bach was "completely blind" after the operations, and he died less than 4 months after the final operation.

[Eponym 'Reiter' should better no longer be used]. / Het eponiem 'Reiter' zou beter verdwijnen.

From 1977 onwards international appeals have been made to use the descriptive term 'reactive arthritis' instead of the eponym 'Reiter' in medical literature. However, contrary to English publications the Dutch medical literature is not showing any obvious decline in the use of this eponym. As well as the fact that Reiter was not the first to describe the triad of arthritis, urethritis and conjunctivitis, he also was responsible for lethal medical experiments conducted in concentration camps during World War II. Since these two facts do not warrant eponymous regard for Reiter, the author proposes that this eponym no longer should be used in Dutch medical vocabulary and that the descriptive term should be used instead.

[A saxophonist with severe glaucoma; stop playing or not?]. / Ernstig glaucoom bij een saxofonist; stoppen met spelen of niet?

BACKGROUND: Glaucoma is a disease of the eye in which the level of intraocular pressure (IOP) determines the rate of disease progression to an important extent. A less well known cause of IOP elevation is playing a wind instrument. CASE DESCRIPTION: In a 49-year-old man with only one functional eye suffering from advanced glaucoma in the other eye, IOP appeared to double when he played the saxophone. He was advised to stop playing; this advice had serious consequences as the patient was a professional musician. CONCLUSION: Despite limited scientific evidence this advice seems justifiable on account of the patient's relatively young age and the advanced glaucoma .

[The development of cataract surgery after 1745]. / De ontwikkeling van cataractchirurgie na 1745.

Nowadays, cataract surgery is the most commonly performed surgical procedure in the Netherlands. This is due to the increasing incidence of cataracts, the changing indication for surgery in our society where good vision is becoming increasingly important, and the quality of the operation. How was this modern procedure developed? Cataracts were treated by couching until the middle of the 18th century. Since then, many discoveries by a number of doctors changed the procedure gradually from couching to lens extraction and through extracapsular to intracapsular extraction with the simultaneous implantation of an intraocular lens. This article outlines the development and also discusses some of the many inventions in the field of instrumentation and materials that have brought this intervention to its current high level; these include the cryo-probe, implantation of artificial lenses, the use of hyaluronic acid, phaco-emulsification, smaller incisions without sutures and the development of foldable intraocular lenses.

[Couching then and now]. / Staarsteek vroeger en nu.

Cataracts are the most important cause of acquired blindness worldwide. The oldest known surgical treatment for cataracts dates back to around 1,000 years before Christ. The Indian surgeon Sushruta described the technique of 'couching', in which the opaque lens is pushed from the line of vision using a needle. At the time of Alexander the Great this technique spread across Europe and then to the rest of the world. Couching was the only available treatment for cataracts for a long time, until the discovery of lens extraction by Jacques Daviel in 1748. Since then lens extraction has replaced couching in the western world, because of poor results and high complication rates. This procedure is, however, still practiced in areas of Africa and Asia.

[Voices from the past: castrate singers]. / Stemmen uit het verleden: castraatzang.

Castration is a severely mutilating procedure. In Italy in the period around 1600-1850 even up to 4,000 yearly prepubescent boys per year underwent a bilateral orchidectomy to preserve their boyish high voice in order to become a 'castrato' singer. The operation was not without health risks and must have caused severe psychological problems, but some of the victims would become very famous, such as Carlo Broschi (1705-1782), better known as Farinelli. However, the majority of the castrati would remain unknown. Tradition has it that that the castrati were welcomed with euphoria by the general public. The last castrato at the Vatican, Alessandro Moreschi, died in 1922. The surviving recordings of the voice of this last official castrato give an impression of how the castrati's singing may have sounded. Several attempts have been made since to imitate the sound of the castrati, for example by digitally mixing soprano and countertenor voices.

Are the alleged remains of Johann Sebastian Bach authentic?

A skeleton alleged to be that of Johann Sebastian Bach (1685-1750) was exhumed from a graveyard in Leipzig, Germany, in 1894, but its authenticity is not established. In 1895, anatomist Wilhelm His concluded from his examination of the skeleton and reconstruction of the face that it most likely belonged to Bach. In 1949, surgeon Wolfgang Rosenthal noticed exostoses on the skeleton and on x-rays of 11 living organists and proposed a condition, Organistenkrankheit, which he interpreted as evidence that the skeleton was Bach's. However, our critical assessment of the remains analysis raises doubts: the localisation of the grave was dubious, and the methods used by His to reconstruct the face are controversial. Also, our study of the pelvic x-rays of 12 living professional organists failed to find evidence for the existence of Organistenkrankheit. We believe it is unlikely that the skeleton is that of Bach; techniques such as DNA analysis might help resolve the question but, to date, church authorities have not approved their use on the skeleton.

Mozart and smallpox.

In 1767 at 11 years of age, composer Wolfgang Amadeus Mozart contracted smallpox, allegedly causing him temporary blindness. Although now eradicated, smallpox in those days had a high mortality rate, and the history of classical music would have been very different if Mozart had become permanently blind, or died, as a result of the disease.

The large eyes of Wolfgang Amadeus Mozart. (On the occasion of the 250th Mozart anniversary year).

This article discusses the eyes of Wolfgang Amadeus Mozart (1756-1791) which, based on portraits, can be said to have a certain noticeable feature--some degree of exophthalmos. In fact, even contemporary observers made particular mention of Mozart's eyes being large. Although cicatricial ectropion, caused by infectious disease, cannot be excluded, mild myopia, in combination with shallow orbits or combined with a genetic predilection, would be one possible explanation for Mozart's large eyes. Graves' orbitopathy, the ophthalmic manifestation of hyperthyroidism, or hypothyroidism have both been suggested to be the cause of Mozart's large eyes. However, these diseases are unlikely causes given their topical and systemic features.