[Clinical approach for solid intraocular metastases]

BACKGROUND

Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with a poor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have a special responsibility here.

OBJECTIVE

This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care.

METHODS

A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar.

RESULTS

Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between a curative or palliative treatment situation must always be made.

CONCLUSION

Intraocular metastases are the most frequent intraocular tumor and are usually associated with a poor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.

In vivo evaluation of a nanotechnology-based microshunt for filtering glaucoma surgery

To carry out the preclinical and histological evaluation of a novel nanotechnology-based microshunt for drainage glaucoma surgery. Twelve New Zealand White rabbits were implanted with a novel microshunt and followed up for 6 weeks. The new material composite consists of the silicone polydimethylsiloxane (PDMS) and tetrapodal Zinc Oxide (ZnO-T) nano-/microparticles. The microshunts were inserted ab externo to connect the subconjunctival space with the anterior chamber. Animals were euthanized after 2 and 6 weeks for histological evaluation. Ocular health and implant position were assessed at postoperative days 1, 3, 7 and twice a week thereafter by slit lamp biomicroscopy. Intraocular pressure (IOP) was measured using rebound tonometry. A good tolerability was observed in both short- and medium-term follow-up. Intraocular pressure was reduced following surgery but increased to preoperative levels after 2 weeks. No clinical or histological signs of inflammatory or toxic reactions were seen; the fibrotic encapsulation was barely noticeable after two weeks and very mild after six weeks. The new material composite PDMS/ZnO-T is well tolerated and the associated foreign body fibrotic reaction quite mild. The new microshunt reduces the IOP for 2 weeks. Further research will elucidate a tube-like shape to improve and prolong outflow performance and longer follow-up to exclude medium-term adverse effects.

Diagnosis and treatment of malignant eyelid tumors

BACKGROUND

Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients.

OBJECTIVE

This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors.

METHODS

This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases.

RESULTS

The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis.

CONCLUSION

It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.

[Digital teaching 2020: Online teaching receives a better assessment than face-to-face teaching]

BACKGROUND

Due to the corona pandemic, face-to-face teaching was no longer permitted in the summer semester 2020 and online alternatives were quickly found.

OBJECTIVE

In our article, we illustrate the switch from face-to-face to online teaching in ophthalmology at the University of Lübeck and compare online teaching with face-to-face teaching.

METHODS

The central teaching evaluation takes place every semester with a standardized questionnaire. Based on the evaluation of these questions, a direct comparison of the attendance semester of the winter semester 2019/2020 with the online semester of the summer semester 2020 was carried out.

RESULTS

The structure (p = 0.003), the organization (p = 0.001), the resources made available (p = 0.034), the attendance of the lectures (p < 0.001) and further dates (p = 0.041), the increase in interest (p = 0.039) and learning (p = 0.001) were rated better in the online semester than in the face-to-face semester. Overall, the digital summer semester 2020 (p < 0.01) received a significantly better overall grade than the face-to-face semester in winter 2019/2020.

CONCLUSION

The structure of our courses has also been proven online. The theoretical content could be excellently mediated; however, practical exercises are not possible online. For the learning of practical skills, face-to-face instruction is still necessary.

Tetrapodal ZnO-Based Composite Stents for Minimally Invasive Glaucoma Surgery

The glaucoma burden increases continuously and is estimated to affect more than 100 million people by 2040. As there is currently no cure to restore the optic nerve damage caused by glaucoma, the only controllable parameter is the intraocular pressure (IOP). In recent years, minimally invasive glaucoma surgery (MIGS) has emerged as an alternative to traditional treatments. It uses micro-sized drainage stents that are inserted through a small incision, minimizing the trauma to the tissue and reducing surgical and postoperative recovery time. However, a major challenge for MIGS devices is foreign body reaction and fibrosis, which can lead to a complete failure of the device. In this work, the antifibrotic potential of tetrapodal ZnO (t-ZnO) microparticles used as an additive is elucidated by using rat embryonic fibroblasts as a model. A simple, direct solvent-free process for the fabrication of stents with an outer diameter of 200-400 μm is presented, in which a high amount of t-ZnO particles (45-75 wt %) is mixed into polydimethylsiloxane (PDMS) and a highly viscous polymer/particle mixture is extruded. The fabricated stents possess increased elastic modulus compared to pure PDMS while remaining flexible to adapt to the curvature of an eye. In vitro experiments showed that the fibroblast cell viability was inhibited to 43 ± 3% when stents with 75 wt % t-ZnO were used. The results indicate that cell inhibiting properties can be attributed to an increased amount of protruding t-ZnO particles on the stent surface, leading to an increase in local contacts with cells and a disruption of the cell membrane. As a secondary mechanism, the released Zn ions could also contribute to the cell-inhibiting properties in the close vicinity of the stent surface. Overall, the fabrication method and the antifibrotic and mechanical properties of developed stents make them promising for application in MIGS.

[Digital teaching 2020: students assess attention during an online lecture as equivalent to a face-to-face lecture]

Hintergrund

Die Corona-Pandemie hat zu einer kurzfristigen Anpassung der Lehrveranstaltungen im Studiengang Humanmedizin geführt. Präsenzlehre war in vielen Bereichen nicht mehr möglich, sodass ein digitales Lehrkonzept etabliert werden musste, um weiterhin eine adäquate medizinische Ausbildung zu gewährleisten.

Methodik

Basierend auf den Lehrinhalten unserer Präsenzveranstaltung, haben wir ein digitales Curriculum erarbeitet. Primäre Werkzeuge zur Umsetzung dieses Vorhabens waren Cisco WebEx und Moodle, welche bereits an der Universität zu Lübeck etablierte Softwarelösungen waren. Anschließend wurde anhand einer Umfrage unter den Studierenden dieses Konzept evaluiert.

Ergebnisse

Die Auswertung der Evaluation hat gezeigt, dass Inhalt und Didaktik der Lehrveranstaltung als „gut bis sehr gut“ bewertet wurden. Die Kommunikation mit den Studenten und unter den Studenten selbst wurde als „gut“ eingestuft. Es hat sich insbesondere gezeigt, dass die Aufmerksamkeit der Studenten während der Vorlesung als „gleichwertig“ zu der Aufmerksamkeit einer Präsenzvorlesung bewertet wurde. Die Vermittlung von praktischen Fähigkeiten wurde erwartungsgemäß als „schlecht“ beurteilt. Abschließend konnte sich ein Großteil der Studierenden eine Kombination aus digitaler und Präsenzlehre auch in Zukunft vorstellen.

Diskussion

Die kurzfristige Umstellung auf einen digitalen Lehrbetrieb hat Lehrende und Studierende vor eine Herausforderung gestellt. Durch geeignete Softwarelösungen können theoretische Inhalte adäquat vermittelt werden. Die Studenten werteten die digitale Lehrveranstaltung im Vergleich zur Präsenzlehre als gleichwertig und auch für die Zukunft als eine attraktive Option. Ein weiterhin zu lösendes Problem bleibt aber das Erlernen von praktischen Fähigkeiten.

Video online

Die Online-Version dieses Beitrags (10.1007/s00347-021-01344-1) enthält (ein) Video(/s).