Comparability of input parameters in the German Retina.net ROP registry and the EU-ROP registry - An exemplary comparison between 2011 and 2021

PURPOSE

The German Retina.net ROP registry and its Europe-wide successor, the EU-ROP registry, collect data from patients treated for ROP. This analysis compares input parameters of these two registries to establish a procedure for joint analyses of different registry data using exemplary datasets from the two registries.

METHODS

Exemplary datasets from the two databases over a 1-year period each (German Retina.net ROP Registry, 2011, 22 infants; EU-ROP Registry, 2021, 44 infants) were compared. The parameters documented in the two databases were aligned and analysed regarding demographic parameters, treatment modalities, complications within first 24 h and retreatments.

RESULTS

The current analysis showed that data can be aligned for joint analyses with some adjustments within the data structure. The registry with more detailed data collection (EU-ROP) needs to be reduced regarding granularity in order to align the different registries, as the registry with lower granularity determines the level of analyses that can be performed in a comparative approach. In the exemplary datasets, we observed that the overall most common ROP severity in both registries was zone II, 3+ (2011: 70.5%; 2021: 65%), with decreasing numbers of clock hours showing preretinal neovascularisations (2011: 10-12 clock hours in 29% of cases, 2021: 4-6 clock hours in 38%). The most prevalent treatment method was laser coagulation in 2011 (75%) and anti-VEGF therapy in 2021 (86.1%). Within the anti-VEGF group, all patients were treated with bevacizumab in 2011 and with ranibizumab in 2021. Retreatment rates were comparable in 2011 and 2021.

CONCLUSION

Data from two different ROP registries can be aligned and jointly analysed. The analysis reveals a paradigm shift in treatment modalities, from predominantly laser to anti-VEGF, and within the anti-VEGF group from bevacizumab to ranibizumab in Germany. In addition, there was a trend towards earlier treatment in 2021.

[Treated cases of retinopathy of prematurity in Germany : 5-year data from the Retina.net ROP registry]

BACKGROUND

Retinopathy of prematurity (ROP) is one of the main reasons for childhood blindness. The number of infants requiring treatment, however, is low for individual centers. The Retina.net ROP registry has been founded to allow a joint analysis of treatment patterns and courses post treatment.

OBJECTIVE

This paper reports treatment patterns over 5 years.

MATERIAL AND METHODS

All infants born between January 2011 and December 2015 who were entered into the treatment registry by one of the 12 participating centers were analyzed.

RESULTS

The data of 150 infants (292 eyes) were analyzed and ROP 3+ in zone II was the most prevalent treatment indication. Gestational age and birth weight remained stable over the years. The treatment patterns, however, changed with anti-VEGF treatment (bevacizumab or ranibizumab) accounting for only 10% of treated eyes in 2011 but for 56% and 30% in 2014 and 2015, respectively. Almost all eyes with AP-ROP or zone I disease received anti-VEGF treatment. Zone II disease was predominantly treated with laser photocoagulation. Recurrences were more common and appeared later in the anti-VEGF group compared to the laser group (23%/interval 60 days vs. 17%/interval 23 days). Perioperative complications were evenly distributed across treatment groups.

CONCLUSION

The data in this analysis represent about 10-15% of treated infants in Germany. The results provide evidence for an increasing use of anti-VEGF agents for ROP. The data reflect a selection bias for anti-VEGF treatment in eyes with a more aggressive disease. This needs to be considered when interpreting data such as disease recurrence rates. The risk for late recurrences after anti-VEGF treatment is of particular clinical significance.

[Immunotherapy of uveal melanoma: vaccination against cancer. Multicenter adjuvant phase 3 vaccination study using dendritic cells laden with tumor RNA for large newly diagnosed uveal melanoma]

Uveal melanomas are the most common malignant tumors of the eye. With modern molecular biological diagnostic methods, such as chromosome 3 typing and gene expression analysis, these tumors can be categorized into highly aggressive (monosomy 3, class II) and less aggressive forms. This molecular biological stratification is primarily important for determining the risk of these tumors as no therapy is currently available that is able to prevent or delay metastases. A randomized study of patients with a poor prognosis (monosomy 3) is currently being carried out in order to determine whether a cancer vaccine prepared from autologous (patient's own) dendritic cells and uveal melanoma RNA can prevent or delay progression and further metastases of this extremely aggressive form of cancer. Inclusion in the uveal melanoma study, which hopes to provide a potential therapeutic option for patients, is only possible if patients are referred to an institution that is able to manufacture and provide this vaccination before the patient is operated on or treated with radiation. Untreated tumor material is necessary for producing the vaccine on an individualized patient basis.

TERT promoter mutations in ocular melanoma distinguish between conjunctival and uveal tumours

BACKGROUND

Recently, activating mutations in the TERT promoter were identified in cutaneous melanoma. We tested a cohort of ocular melanoma samples for similar mutations.

METHODS

The TERT promoter region was analysed by Sanger sequencing in 47 uveal (ciliary body or choroidal) melanomas and 38 conjunctival melanomas.

RESULTS

Mutations of the TERT promoter were not identified in uveal melanomas, but were detected in 12 (32%) conjunctival melanomas. Mutations had a UV signature and were identical to those found in cutaneous melanoma.

CONCLUSION

Mutations of TERT promoter with UV signatures are frequent in conjunctival melanomas and favour a pathogenetic kinship with cutaneous melanomas. Absence of these mutations in uveal melanomas emphasises their genetic distinction from cutaneous and conjunctival melanomas.

[The situation of ophthalmic pathology in Germany: the current status]

BACKGROUND

Ophthalmic pathology with its 150 year-old tradition is a subspecialty which since its beginning has contributed substantially to progress in ophthalmology. Nevertheless, deactivation or even termination of ophthalmopathological laboratories has occurred in the past years mainly due to economic pressure. In order to evaluate the situation and future perspectives of the existing, active laboratories in Germany and to ask for the kind of support desired from the Section for Ophthalmic Pathology of the German Ophthalmological Society (DOG) a survey was carried out using a questionnaire.

RESULTS

The main results were as follows. 1. Specialised ophthalmic pathology is performed in Germany almost exclusively in laboratories integrated in university eye clinics. 2. There is close cooperation with institutes for pathology and dermatopathology. 3. The main focus is placed on the cornea, tumours of the eye and its adnexae, and the conjunctiva. 4. The number of ophthalmopathological specimens investigated per year is generally below 1000 and often below 500. 5. The diagnostic spectrum and equipment of the laboratories is generally good. 6. There are some deficits concerning ophthalmopathological education and the status of ophthalmic pathology within the clinics. 7. A considerable number of scientific publications is generated by the members of the laboratories. 8. At present there is only minimal fear that the own laboratory will be eliminated in the near future. 9. Ophthalmic pathology is established as an integral component of ophthalmology in patient care and, even more, in ophthalmic research. 10. The DOG-Section "Ophthalmic pathology" is requested to initiate stays in foreign laboratories, to initiate scientific multicentre studies, and to support activities dedicated to preserve the ophthalmopathological laboratories.

DISCUSSION

For the first time valid data concerning the situation of ophthalmopathological laboratories in Germany have been collected. The information gathered can and should be used as an argument for the preservation and, if possible, even expansion of the occupation with normal and pathologic eye morphology at eye hospitals in and beyond Germany.

[Asteroid hyalosis within an epiretinal membrane]

CASE REPORT

In May 2007 an 80-year-old man with a known proliferative diabetic retinopathy presented in our outpatient department with a decrease in visual acuity of his right eye. There was a thick asteroid hyalosis preventing fundus examination. Sonographically, there were vitreoretinal tractions requiring a vitrectomy. During surgery an epipapillary membrane was removed.

RESULTS

Microscopically round amorphous bodies were conspicuous which were slightly basophilic in the H&E stain. The amorphous bodies were strongly positive in the periodic acid-Schiff staining. They were embedded in a fibrovascular stroma and partly surrounded by inflammatory cells with numerous giant cells of foreign body reaction.

CONCLUSION

Asteroid hyalosis is a common degenerative disorder in the vitreous body. The aetiology and the pathogenesis of the asteroid bodies are not yet fully understood. An association of asteroid hyalosis with systemic diseases like diabetes mellitus, arterial hypertension, hyperlidpidaemia and atherosclerotic vasculopathy is postulated. Normally, therapy for an asymptomatic asteroid hyalosis is not necessary. The tractive proliferative diabetic retinopathy in our patient did require surgery. The incorporation of hyaloid bodies into an epiretinal membrane with the induction of a foreign body reaction is unusual.

Tuberöse Sklerose: eine interdisziplinäre Diagnose

BACKGROUND

Tuberous sclerosis is a relatively rare disease, but it often takes a progressive and severe course. We wish to demonstrate the typical changes in a patient with tuberous sclerosis and their relevance for the ophthalmologist.

FINDINGS

Ophthalmologic evaluation including funduscopy, 30 degree perimetry and fundus photography and clinical course of a 40-year-old man are described. We observed an elevated, multinodular, opaque hamartoma resembling mulberries, approximately (1/3)-(1/2) PD large, at the temporal superior arc with corresponding visual field defects.

CONCLUSIONS

An ophthalmologist should always think of a tuberous sclerosis as a differential diagnosis when confronted with a retinal hamartoma. Other characteristic ophthalmological findings include facial and eyelid angiofibromas, coloboma of the iris, lens and choroid, strabismus, poliosis of the eyelashes, papilloedema and sector iris depigmentation. Clinical diagnosis of tuberous sclerosis is in most cases relatively easy; however, an interdisciplinary cooperation is needed.

Hornhautstaphylom-Vorderkammeragenesie-Mikrophakie-Syndrom (kongenitales anteriores Staphylom)

CASE REPORT

Shortly after birth, a massive enlargement of the right eye was observed in an otherwise healthy male child. The cornea of the affected eye was vascularized and completely cloudy without a sharp border between cornea and sclera. The diagnosis of a congenital glaucoma was made but an operation was not undertaken because of the difficult anatomical situation and the lost function. When the child was almost 3 years old enucleation was performed to prevent complications due to corneal exposure, and to improve the cosmetic aspect.

RESULTS

The morphological investigations of the enucleated eye disclosed findings typical of what is called in the literature "congenital anterior staphyloma" or "congenital corneal staphyloma", namely a massively staphylomatous cornea with superficial neovascularization, destruction of Bowman's layer, and absence of Descemet's layer as well as corneal endothelium. Angle structures were completely absent, and the corneal back-side was lined by a pigment epithelial layer and focally by an additional inner layer of non-pigmented epithelium. There was no anterior chamber. The lens was markedly diminished in size (microphakia) and partly embedded in the corneal stroma. Pars muscularis and pars ciliaris of the ciliary body were separated. Elongated, thin ciliary processes were extended towards the small lens while the pars muscularis was fully covered by the retina.

CONCLUSIONS

This rare, complex malformation syndrome which can be easily distinguished from primary congenital glaucoma should not be reduced conceptually to the corneal staphyloma because this staphyloma constitutes only a part of the whole. Taking the leading morphological aberrations into consideration we would rather propose the new term " corneal staphyloma- anterior chamber agenesia- microphakia syndrome (CSAMS). We hypothesize that CSAMS may be due to a pathological fusion of the early anterior optic cup. As the posterior eye segment is often normal in CSAMS, a staphyloma excision along with a sclero-keratoplasty might be an alternative therapeutic option to avoid enucleation and restore ambulatory vision.