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Foerster P, Klaas J, Furweger C, Ehret F, Muacevic A, Santacroce A. Self-Shielding Gyroscopic Radiosurgery for Uveal Melanoma: A First Case Report. Cureus 2024; 16:e59859. [PMID: 38854187 PMCID: PMC11157358 DOI: 10.7759/cureus.59859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Stereotactic radiosurgery (SRS) is a well-established treatment modality for the management of uveal melanoma, achieving high tumor control and eye retention rates. There are several SRS treatment platforms available, including the recently developed self-shielding gyroscopic radiosurgery (GRS) system. We report the first use of GRS in the treatment of uveal melanoma. We report the treatment of a 63-year-old female patient with a left-sided uveal melanoma. Akinesia of the ocular globe in the orbit was achieved by retrobulbar anesthesia. The treatment plan used six isocenters (three with the 10 mm and three with the 7.5 mm apertures) and 140 beams to cover 99.2% of the planning target volume (PTV) with 21 Gy at the 54% isodose line. Treatment was delivered in a single session with the GRS device. The total workflow time from retrobulbar anesthesia to completion of treatment was 122 minutes. The procedure was flawless, clinically well tolerated by the patient, and reliably performed in an outpatient setting, thus comparable to our published experience with robotic SRS. The evaluation of new radiosurgery treatment platforms is critical to maintaining quality standards and refining future treatments.
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Knebel D, Priglinger S, Scherer N, Klaas J, Siedlecki J, Schworm B. Assessment of ChatGPT in the Prehospital Management of Ophthalmological Emergencies - An Analysis of 10 Fictional Case Vignettes. Klin Monbl Augenheilkd 2024; 241:675-681. [PMID: 37890504 DOI: 10.1055/a-2149-0447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND The artificial intelligence (AI)-based platform ChatGPT (Chat Generative Pre-Trained Transformer, OpenAI LP, San Francisco, CA, USA) has gained impressive popularity in recent months. Its performance on case vignettes of general medical (non-ophthalmological) emergencies has been assessed - with very encouraging results. The purpose of this study was to assess the performance of ChatGPT on ophthalmological emergency case vignettes in terms of the main outcome measures triage accuracy, appropriateness of recommended prehospital measures, and overall potential to inflict harm to the user/patient. METHODS We wrote ten short, fictional case vignettes describing different acute ophthalmological symptoms. Each vignette was entered into ChatGPT five times with the same wording and following a standardized interaction pathway. The answers were analyzed following a systematic approach. RESULTS We observed a triage accuracy of 93.6%. Most answers contained only appropriate recommendations for prehospital measures. However, an overall potential to inflict harm to users/patients was present in 32% of answers. CONCLUSION ChatGPT should presently not be used as a stand-alone primary source of information about acute ophthalmological symptoms. As AI continues to evolve, its safety and efficacy in the prehospital management of ophthalmological emergencies has to be reassessed regularly.
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Maierhofer NA, Jablonka AM, Roodaki H, Nasseri MA, Eslami A, Klaas J, Lohmann CP, Maier M, Zapp D. iOCT-guided simulated subretinal injections: a comparison between manual and robot-assisted techniques in an ex-vivo porcine model. J Robot Surg 2023; 17:2735-2742. [PMID: 37670151 PMCID: PMC10678791 DOI: 10.1007/s11701-023-01699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
The purpose of this study is to compare robot-assisted and manual subretinal injections in terms of successful subretinal blistering, reflux incidences and damage of the retinal pigment epithelium (RPE). Subretinal injection was simulated on 84 ex-vivo porcine eyes with half of the interventions being carried out manually and the other half by controlling a custom-built robot in a master-slave fashion. After pars plana vitrectomy (PPV), the retinal target spot was determined under a LUMERA 700 microscope with microscope-integrated intraoperative optical coherence tomography (iOCT) RESCAN 700 (Carl Zeiss Meditec, Germany). For injection, a 1 ml syringe filled with perfluorocarbon liquid (PFCL) was tipped with a 40-gauge metal cannula (Incyto Co., Ltd., South Korea). In one set of trials, the needle was attached to the robot's end joint and maneuvered robotically to the retinal target site. In another set of trials, approaching the retina was performed manually. Intraretinal cannula-tip depth was monitored continuously via iOCT. At sufficient depth, PFCL was injected into the subretinal space. iOCT images and fundus video recordings were used to evaluate the surgical outcome. Robotic injections showed more often successful subretinal blistering (73.7% vs. 61.8%, p > 0.05) and a significantly lower incidence of reflux (23.7% vs. 58.8%, p < 0.01). Although larger tip depths were achieved in successful manual trials, RPE penetration occurred in 10.5% of robotic but in 26.5% of manual cases (p > 0.05). In conclusion, significantly less reflux incidences were achieved with the use of a robot. Furthermore, RPE penetrations occurred less and successful blistering more frequently when performing robotic surgery.
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Siedlecki J, Klaas J, Keidel L, Asani B, Schiefelbein J, Knebel D, Luft N, Priglinger SG, Schworm B. Optical coherence tomography-based misdiagnosis and morphological distinction in pachychoroid neovasculopathy vs. polypoidal choroidal vasculopathy. Eye (Lond) 2023; 37:3435-3441. [PMID: 37156864 PMCID: PMC10630494 DOI: 10.1038/s41433-023-02529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/17/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
PURPOSE To evaluate the rate of misdiagnosis of aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV) among cases diagnosed as non-aneurysmatic pachychoroid neovasculopathy (PNV) and to define optical coherence tomography (OCT) features facilitating their distinction. METHODS The database of the Department of Ophthalmology, Ludwig-Maximilians University Munich, was screened for patients diagnosed with PNV. Multimodal imaging was screened for the presence of choroidal neovascularization (CNV) and aneurysms/polyps. Imaging features facilitating the diagnosis of PAT1/PCV were analysed. RESULTS In total, 49 eyes of 44 patients with a clinical PNV diagnosis were included, of which 42 (85.7%) had PNV and 7 (14.3%) represented misdiagnosed PAT1/PCV. SFCT was comparable (PNV: 377 ± 92 vs. PAT1/PCV: 400 ± 83 µm; p = 0.39). Whereas no difference was detected in total pigment epithelium detachment (PED) diameter (p = 0.46), maximum PED height was significantly higher in the PAT1/PCV group (199 ± 31 vs. 82 ± 46, p < 0.00001). In a receiver operating characteristic (ROC) analysis, the optimum cutoff for defining "peaking PED" was 158 µm with an area under the curve of 0.969, a sensitivity of 1.0 (95% CI: 0.59-1.0), and a specificity of 0.95 (95% CI: 0.84-0.99). Sub-retinal hyperreflective material (SHRM; p = 0.04), sub-retinal ring-like structures (SRRLS; p < 0.00001), and sub-RPE fluid (p = 0.04) were significantly more frequent in eyes with PAT1/PCV. CONCLUSION A relevant percentage of eyes diagnosed with PNV might instead suffer from PAT1/PCV. The detection of a maximum PED height ("peaking PED") exceeding approximately 150 µm, SHRM, SRRLS, and sub-RPE fluid might greatly aid in the production of a more accurate diagnosis.
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Bleidißel N, Friedrich J, Feucht N, Klaas J, Maier M. Visual improvement and regeneration of retinal layers in eyes with small, medium, and large idiopathic full-thickness macular holes treated with the inverted internal limiting membrane flap technique over a period of 12 months. Graefes Arch Clin Exp Ophthalmol 2022; 260:3161-3171. [PMID: 35475915 PMCID: PMC9477954 DOI: 10.1007/s00417-022-05676-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/18/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study aims to compare the improvement of best-corrected visual acuity (BCVA) and the reduction in defect length of external limiting membrane (ELM) and ellipsoid zone (EZ) in small ([Formula: see text] 250 μm), medium ([Formula: see text] 250 μm), and large ([Formula: see text] 400 μm) full-thickness macular holes (FTMH) treated with inverted internal limiting membrane (I-ILM) flap technique over a follow-up period of 12 months. METHODS Ninety-one eyes of 87 patients were enrolled in this retrospective study. BCVA and spectral-domain optical coherence tomography (SD-OCT) were conducted preoperatively as well as after 1, 3, 6, 9, and 12 months postoperatively. The defect length of the ELM and the EZ was measured using the caliper tool at each follow-up time point. RESULTS BCVA improved significantly in the group of small, medium, and large FTMH over the time of 12 months, whereby the improvement did not depend on FTMH size over 9 months. Only after 12 months, large FTMH showed significantly higher BCVA improvement compared to small and medium FTMH. The closure rate was 100% (91/91). The defect length of ELM and EZ reduced continuously over the period of 12 months. There was a significant correlation between defect length of ELM and EZ with postoperative BCVA. CONCLUSION The I-ILM flap technique has very good morphological and functional outcomes in small, medium, and large FTMH over a long-time period, indicating that it can be considered as a treatment option in small and medium FTMH. The defect length of ELM and EZ is directly connected to postoperative BCVA.
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Friedrich JS, Bleidißel N, Nasseri A, Feucht N, Klaas J, Lohmann CP, Maier M. [iOCT in clinical use : Correlation of intraoperative morphology and postoperative visual outcome in patients with full thickness macular hole]. Ophthalmologe 2021; 119:491-496. [PMID: 34735612 PMCID: PMC9076724 DOI: 10.1007/s00347-021-01527-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022]
Abstract
Hintergrund Die Beurteilung der intraoperativen Veränderung der Netzhautmorphologie, insbesondere des vitreoretinalen Überganges, ist mithilfe der intraoperativen optischen Kohärenztomografie (iOCT) möglich geworden. Ziel der Arbeit Um die Bedeutung der intraoperativen Morphologie beim durchgreifenden Makulaforamen (MF) für das postoperative funktionelle Ergebnis zu evaluieren, wurde eine retrospektive, klinische Beobachtungsstudie durchgeführt. Material und Methoden Die Netzhautmorphologie wurde in 32 Augen von 32 konsekutiven Patienten mit durchgreifendem Makulaforamen mittels iOCT zu verschiedenen Zeitpunkten während der Operation beobachtet. Die Veränderungen wurden anschließend mit dem postoperativen funktionellen Ergebnis korreliert. Ergebnisse Nach Induktion der hinteren Glaskörperabhebung (HGA) reduzierte sich der Makulaforamen-Index (MHI) um −0,05 (p = 0,01), die basale Foramenbreite (FB) stieg um +99,4 μm (SD = 197,8 μm; p = 0,04). Die Verschlussrate betrug 100 % zum Zeitpunkt der ersten postoperativen Vorstellung nach im Mittel 73 Tagen, der postoperative Visus verbesserte sich signifikant (p < 0,05). Es zeigte sich eine signifikant positive Korrelation von intraoperativer Morphologie und postoperativem Ergebnis zwischen einem niedrigen MHI und einem besseren postoperativen Visus (SKK = 0,50; p = 0,02), zwischen einer großen FB und einem besseren postoperativen Visus (SKK = 0,43; p = 0,05) sowie zwischen einer breiten Apertur nach HGA und einem größeren Visusanstieg postoperativ (SKK = 0,44; p = 0,03). Diskussion Wir konnten eine Abflachung sowie eine Verbreiterung des MF durch Lösen der vitreoretinalen Zugkräfte beobachten. Aufgrund des Zusammenhangs zwischen einer großen intraoperativen FB mit einem besseren postoperativen Visus scheint die intraoperative Relaxierung der Netzhaut bedeutsam.
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Maier M, Bohnacker S, Klein J, Klaas J, Feucht N, Nasseri A, Lohmann CP. [Vitrectomy and iOCT-assisted inverted ILM flap technique in patients with full thickness macular holes]. Ophthalmologe 2019; 116:617-624. [PMID: 30105564 DOI: 10.1007/s00347-018-0769-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND In large full thickness macular holes (FTMH) the closure rate after vitrectomy and conventional internal limiting membrane (ILM) peeling is less than 90%. The aim of this study was to examine the visual acuity and anatomical success rate with high-resolution optical coherence tomography (OCT) after transconjunctival sutureless 23-gauge pars plana vitrectomy as well as intraoperative OCT (iOCT) and Brilliant Peel (BP)-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMHs. METHOD In this retrospective study 25 eyes of 25 consecutive patients with large FTMH were treated by 23-G vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique followed by gas tamponade. In all patients best corrected visual acuity (BCVA) and the maximum diameter, base and height of the FTMH as well as intraretinal alterations were measured preoperatively using high-resolution spectral domain OCT (SD-OCT, Spectralis, Heidelberg Engineering, Germany). The BCVA was measured after 1, 3, and 6 months. Additionally, the closure rate and the microstructural integrity of the outer retinal layers, e.g. external limiting membrane (ELM), ellipsoid zone und photoreceptor outer segment (OS) were registered in the SD-OCT and correlated with the results of BCVA after macular hole surgery. RESULTS In all surgical procedures with the inverted ILM flap technique the application of iOCT enabled a good visualization and a controlled positioning of the ILM flaps. At baseline mean BCVA was 0.2 (0.7 logMAR) and improved significantly after 1, 3 und 6 months to 0.4 (0.4 logMAR), 0.5 (0.3 logMAR) and 0.63 (0.2 logMAR), respectively. The closure rate of the FTMHs was 100%. Microstructural integrity of the outer retinal layers was evaluated semiquantitatively and showed good correlation with BCVA. CONCLUSION Vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMH is a very controlled and safe microsurgical strategy and shows good functional and anatomical results. The morphology of the FTMH, the ILM flap and the position of the inverted ILM flap under air was well visualized by IOCT. The microstructural integrity of the outer retinal layers is displayed in detail on SD-OCT and represents an important predictive parameter for BCVA after macular hole surgery.
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Graff-Radford J, Fugate JE, Klaas J, Flemming KD, Brown RD, Rabinstein AA. Distinguishing clinical and radiological features of non-traumatic convexal subarachnoid hemorrhage. Eur J Neurol 2016; 23:839-46. [PMID: 26910197 DOI: 10.1111/ene.12926] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE The full spectrum of causes of convexal subarachnoid hemorrhage (cSAH) requires further investigation. Therefore, our objective was to describe the spectrum of clinical and imaging features of patients with non-traumatic cSAH. METHODS A retrospective observational study of consecutive patients with non-traumatic cSAH was performed at a tertiary referral center. The underlying cause of cSAH was characterized and clinical and imaging features that predict a specific etiology were identified. The frequency of future cSAH or intracerebral hemorrhage (ICH) was determined. RESULTS In all, 88 patients [median age 64 years (range 25-85)] with non-traumatic cSAH were identified. The most common causes were reversible cerebral vasoconstriction syndrome (RCVS) (26, 29.5%), cerebral amyloid angiopathy (CAA) (23, 26.1%), indeterminate (14, 15.9%) and endocarditis (9, 10.2%). CAA patients commonly presented at an older age than RCVS patients (75 years versus 51 years, P < 0.0001). Thirteen patients (14.7%) had recurrent cSAH, and 12 patients (13.6%) had a subsequent ICH. However, the risk was high amongst those with CAA compared to those caused by RCVS, with recurrent cSAH in 39.1% and subsequent lobar ICH in 43.5% of CAA cases. CONCLUSIONS Our study demonstrates the clinical diversity of cSAH. Older age, sensorimotor dysfunction and stereotyped spells suggest CAA as the underlying cause. Younger age and thunderclap headache predict RCVS. Yet, various other causes also need to be considered in the differential diagnosis.
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Klaas J, Kumar R, Ahlskog J, Matsumoto J, Pittock S, Lennon V, Bartleson JD, McEvoy K, Aksamit A, McKeon A. Adult-Onset Opsoclonus-Myoclonus Syndrome (P04.045). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dombrowski MA, Hasan IM, Klaas J, Schiau M, Watts S. Ties that bind. Understanding meralgia paresthetica. ADVANCE FOR NURSE PRACTITIONERS 2000; 8:61-4, 84. [PMID: 11761553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Pourshadi M, Klaas J. Evaluation of latex agglutination and microtube coagulase tests for detection of Staphylococcus aureus. Diagn Microbiol Infect Dis 1984; 2:287-91. [PMID: 6488745 DOI: 10.1016/0732-8893(84)90059-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In a blind study, a latex agglutination test (Serostat Staphylococcus, Scott Laboratories) and a microtube coagulase test (Staphase, API) were evaluated for their ability to detect Staphylococcus aureus. Of 289 isolates of catalase-positive, gram-positive cocci, 122 were identified as S. aureus based on positive reactions in at least three of the following tests: tube coagulase, slide coagulase, DNase production, or anaerobic fermentation of mannitol. The latex agglutination test gave positive reactions for all S. aureus isolates and 10 (6%) non-S. aureus isolates. The slide coagulase test was positive for 121 S. aureus isolates and three (2%) non-S. aureus isolates. The microtube coagulase test detected 53, 90, and 98% of the S. aureus isolates after 2, 4, and 24 hr, respectively. In contrast, the conventional tube coagulase test detected 97% of the S. aureus isolates after 2 hr, and 98% after 4 and 24 hr. Two isolates of S. aureus gave negative tube coagulase reactions at 37 degrees C, but positive reactions at room temperature after 24 hr. The combination of tube and slide coagulase tests provided the most reliable results. The slide and tube coagulase tests gave more reliable results than the latex agglutination and microtube coagulase tests, respectively.
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Rogers BS, Turner WA, Klaas J. A course in electronics and instrumentation. THE AMERICAN JOURNAL OF MEDICAL TECHNOLOGY 1981; 47:919-922. [PMID: 7315861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In response to the continued development of electronic instrumentation in all disciplines of clinical laboratory science, we have designed a new format for teaching electronic instrumentation. This course provides basic concepts in electronics, including safety precautions, the use of electronic testing equipment, methods for determining precision and accuracy of instruments, interpretation of the operating manual, and preventive maintenance. Students apply concepts by actually maintaining and adjusting improperly functioning instruments, using systematic techniques for trouble-shooting and adjustment. Student examinations indicate that the objectives are being met.
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Klaas J. Two new gastric mucin cultivation media and a chemically defined maintenance medium for Balantidium coli. J Parasitol 1974; 60:907-10. [PMID: 4436757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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