[Impact of a more stringent organization of intravitreal injection treatment on the number of treatments and examinations in routine practice]

BACKGROUND

Results from recent studies show that less intravitreal injections are often performed in everyday practice than in controlled trials, which subsequently leads to worse treatment success. In this study we analyzed the introduction of a more stringent organization of treatment using workflow optimization and new IT systems and analyzed the effect on treatment continuity.

MATERIAL AND METHODS

In the second quarter of 2019 a new medical practice management software and a software for automated injection planning were implemented. There was also a change of the treatment regimen from pro re nata (PRN) to treat and extend (T&E ). We analyzed the results of the patients regarding the frequency of injections and treatment controls three quarters before (Q3/2018-Q1/2019) and three quarters after the change (Q2/2019-Q4/2019). Treatment-naive and pretreated patients were analyzed.

RESULTS

In group 1 (Q3/2018-Q1/2019) the average number of injections per quarter was 1.74 (SD = 0.4). Eyes of patients from group 2 (Q2/2019-Q4/2019) received on average 2.17 (SD = 0.3) injections. The number of check-ups per quarter was 1.71 (SD = 0.3) before the introduction, and thereafter 2.16 (SD = 0.3). There was a significant increase in the number of OCTs from 1.18 (SD = 0.2) to 1.98 (SD = 0.3). The visual acuity was stable in both groups.

CONCLUSION

We were able to show that the introduction of the medical practice management software and the change of the regimen from PRN to T&E can achieve numbers of injections, check-ups and OCT similar to those in studies. A standardized procedure facilitates efficient treatment planning and enables a better patient management.

Comparison of Two Toric IOL Calculation Methods

PURPOSE

To compare two calculators for toric intraocular lens (IOL) calculation and to evaluate the prediction of refractive outcome.

METHODS

Sixty-four eyes of forty-five patients underwent cataract surgery followed by implantation of a toric intraocular lens (Zeiss Torbi 709 M) calculated by a standard industry calculator using front keratometry values. Prediction error, median absolute error, and refractive astigmatism error were evaluated for the standard calculator. The predicted postoperative refraction and toric lens power values were evaluated and compared after postoperative recalculation using the Barrett calculator.

RESULTS

We observed a significant undercorrection in the spherical equivalent (0.19 D) by using a standard calculator (p ≤ 0.05). According to the Baylor nomogram and the refractive influence of posterior corneal astigmatism (PCA), undercorrection of the cylinder was lower for patients with WTR astigmatism, because of the tendency of overcorrection. An advantage of less residual postoperative SE, sphere, and cylinder for the Barrett calculator was observed when retrospectively comparing the calculated predicted postoperative refraction between calculators (p ≤ 0.01).

CONCLUSION

Consideration of only corneal front keratometric values for toric lens calculation may lead to postoperative undercorrection of astigmatism. The prediction of postoperative refractive outcome can be improved by using appropriate methods of adjustment in order to take PCA into account.

[Quality of Life in Patients with Glaucoma]

BACKGROUND

The goal of glaucoma treatment is to maintain the patient's visual function and related quality of life, at a sustainable cost. In this review, methods of measuring quality of life are presented, together with their impact in clinical practice.

METHODS

Searches were from the inception of the database to date. Electronic databases searched included Medline (Ovid), Medline In-Process (Ovid), and Embase (Ovid). In a semistructured approach, the articles were checked for their eligibility to provide information about the measurement and application of quality of life in glaucoma patients.

RESULTS

Well established questionnaires are available to measure quality of life in glaucoma patients, as well as instruments to measure benefits. Performance-based measures are more time-consuming. The Glaucoma Activity Limitation-9 Questionnaire (GAL-9) is a glaucoma-specific questionnaire in German, with a Rasch analysis. In eye diseases with central visual field defects, it is the better eye that determines the patient's quality of life, whereas in glaucoma patients with peripheral defects, it is the worse eye that has a stronger influence. Structural changes in glaucoma are less well correlated with quality of life than are functional impairments. There have been a few initial reports of patterns of visual field defects that correlate with subjective impairments.

CONCLUSIONS

The data can help to improve our understanding of individual patient impairment and support our efforts to improve the medical advice and therapy that these patients receive.

[Two cases of phototherapeutic keratectomy treatment of the recurrent corneal erosion caused by alkali burn]

BACKGROUND

Four eyes of two patients were injured simultaneously by industrial alkali while working. One eye of both patients healed without later consequences.

PATIENTS AND METHODS

Two eyes were treated with phototherapeutic keratectomy (PTK) because of recurrent corneal erosion syndrome caused by alkali burn.

RESULTS

In both cases reepithelisation of the cornea was completed by the end of the 1st postoperative week, the injured persons were able to work again. No recurrence was experienced in the next 6 months of follow-up.

CONCLUSION

With these cases the authors would like to draw attention to the possible complications, as well as the importance of careful balancing and adequate management.

[Significance of ophthalmological imaging in common hereditary retinal diseases]

BACKGROUND

Over the past years, a significant progress in genetic, functional and imaging diagnostics in hereditary retinal diseases has been made. Optical coherence tomography (OCT) as well as fundus autofluorescence (FAF) allow for high-resolution, non-invasive imaging - from various perspectives - of retinal and choroidal layers of the posterior fundus. Both techniques have gained more and more significance in the diagnosis of hereditary retinal diseases.

PATIENTS/METHODS

Of all patients presented in this review, extensive family history was taken and a clinical ophthalmological examination performed. OCT scans as well as FAF images were acquired and compared to results of other functional and molecular genetic tests in the context of each disease.

RESULTS

The presented cases in this review addressing hereditary retinal diseases (Best's disease, Stargardt's disease, cone-rod dystrophy, retinitis pigmentosa, achromatopsia, and X-linked retinoschisis) show the significance of ophthalmic imaging (OCT + FAF) for a targeted diagnosis of hereditary retinal diseases.

CONCLUSION

The described imaging techniques (OCT + FAF) are becoming more and more important in the diagnosis of hereditary retinal diseases. Due to increasing availability of the devices, earlier detection of typical morphological changes not seen in clinical fundoscopy is feasible.

Treatment of acute viral hepatitis with (+)-cyanidanol-3

A double-blind trial of (+)-cyanidanol-3 (2 g/day) versus placebo tablets was carried out in 100 patients with acute viral hepatitis. 51 received the drug and 49 placebo. (+)-Cyanidanol-3 accelerated the disappearance of HBsAg from the blood, lowered serum-bilirubin, and relieved symptoms such as anorexia, nausea, and pruritus. The drug was well tolerated. None of the patients had a relapse of acute hepatitis. Chronic active hepatitis developed in 1 of the placebo-treated patients. Thus, (+)-cyanidanol-3 seems to be of benefit in acute viral hepatitis.