Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs' endothelial dystrophy.

PURPOSE: To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs' endothelial dystrophy (FED). METHODS: Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3-26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). RESULTS: After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. CONCLUSION: Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

[Economic aspects of interdisciplinary plastic surgery: change in Diagnosis-Related Groups (DRG) due to procedures of reconstructive microsurgery]. / Ökonomische Aspekte der interdisziplinären Plastischen Chirurgie ­ Veränderung der diagnosebezogenen Fallgruppen (DRG) durch Eingriffe der rekonstruktiven Mikrochirurgie.

BACKGROUND: Advances in reconstructive microsurgery have led to significant improvements in the surgical care of complex interdisciplinary cases. At the same time, however, this also increases the resource expenditure of the plastic surgeon involved. This study aimed to analyse the relationship between increase in revenue and resource expenditure in reconstructive microsurgery at a university hospital of maximum care with regard to the treatment of interdisciplinary patients. METHODS: In 2018 and 2019, all cases of interdisciplinary cooperation were followed up at one location of a plastic surgery department of a university clinic. The interdisciplinary surgical cases were identified from the collective and evaluated prospectively with regard to inpatient treatment days, surgical resource expenditure and economic development (DRG before and after microsurgical reconstruction). RESULTS: In 2018 and 2019, a total of 68 free microsurgical flaps were performed in 64 interdisciplinary cases. 62 of these cases met the criteria for interdisciplinary surgical treatment. Considering the contribution of plastic surgery to the economic development and the associated resource expenditure, there is a significant increase in all parameters (p < 0.0001). Thus, the Case Mix Index (CMI) rose by 20.2 %, inpatient treatment days by 79.1 %, the number of surgical interventions by 62.4 %, cumulative incision-suture time by 131.4 % and total surgeon hours by 75.4 %. CONCLUSION: Reconstructive microsurgical procedures lead to a significant increase in revenue in interdisciplinary surgical cases. However, a significant increase in resource consumption is observed as well. Moreover, these additional costs are not always adequately reflected in the revenue of the DRG. This especially applies to DRGs with a high initial cost weight. To ensure modern, individual, patient-oriented and guideline-compliant patient care, there is, therefore, an urgent need to adapt the (G-)DRG system to the additional resource consumption. In addition, in the case of interdisciplinary surgical cases, a clear internal cost allocation must be carried out in accordance with the surgical resource expenditure.

[The COVID-19 Pandemia and its consequences for plastic surgery and hand surgery]. / Die COVID-19 Pandemie und ihre Folgen für die Plastische Chirurgie und Handchirurgie.

The first case of a SARS-Cov-2 virus infection was confirmed on January 27th in Munich. For both, plastic and hand surgeons it is crucial to act responsible, minimize the transmission of the virus and aid in reasonable and adequate allocation of resources for the treatment of affected patients during this pandemia. This article aims to provide an overview over the latest developments and insights that affect plastic and hand surgeons. At the same time plastic and hand surgeons are required to participate actively in the discussion of new regulatory measures that on one hand aim to ensure a proper medical care of COVID-19 patients and on the other hand need to guarantee coverage of all other patients. Furthermore exit - strategies after the pandemia need to be discussed by our societies. Naturally, this manuscript provides insight into the current situation, which might undergo changes due to the swift progression of the pandemia.