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To determine the effect of lockdown on medical care, with the example of ophthalmology.Patients in a period during the first lockdown were compared to a non-lockdown period, with a total of 12 259 patients included in an observational study. Changes in different areas (elective, emergency, inpatients, surgeries) and eye care subspecialties were compared. Emergency patients were analyzed according to severity and urgency. Patients showing hints requiring treatment for urgent cardiovascular diseases were determined. Differences in patients who would have suffered severe vision loss without treatment were identified and the QALY (quality-adjusted life years) loss was determined accordingly. A model to prioritize patient visits after the end of lockdown or in future lockdown scenarios was developed. Data were collected at the University Eye Hospital LMU Munich and patient files were reviewed individually by ophthalmologists.The average patient number decreased by - 59.4% (p 0.001), with a significant loss in all areas (elective, emergency, inpatients, surgeries; p 0.001). There was a decline of - 39.6% for patients at high risk/high severity. Patients with indications of a risk factor of future stroke declined significantly (p = 0.003). QALY loss at the university eye hospital was 171, which was estimated to be 3160 - 24 143 for all of Germany. Working up high losses of outpatients during these 8 weeks of projected lockdown in Germany would take 7 - 23 weeks under normal circumstances, depending on ophthalmologist density. The prioritization model can reduce morbidity by up to 78%.There was marked loss of emergency cases and patients with chronic diseases. Making up for the losses in examinations and treatments will theoretically take weeks to months. To reduce the risk of morbidity, we recommend a prioritization model for rescheduling and future lockdown scenarios.Erfassung der Auswirkungen eines Lockdowns auf die medizinische Versorgung am Beispiel der Augenheilkunde.In einer Beobachtungsstudie wurden Patienten in einem Zeitraum während des ersten Lockdowns mit einem Zeitraum ohne Lockdown verglichen. Hierbei wurden insgesamt 12 259 Patienten eingeschlossen. Es wurden Veränderungen in verschiedenen Bereichen (elektive Fälle, Notfälle, stationäre Fälle, Operationen) und augenärztlichen Subspezialitäten verglichen. Notfallpatienten wurden nach Schweregrad und Dringlichkeit analysiert. Patienten mit ophthalmologischen Erkrankungen, die einen Hinweis auf behandlungsbedürftige, dringende kardiovaskuläre Erkrankungen darstellen, wurden ermittelt. Unterschiede von Patienten, die ohne Behandlung einen schweren Sehverlust erlitten hätten, wurden identifiziert und der QALY-Verlust entsprechend ermittelt. Ein Modell zur Priorisierung von Patientenbesuchen nach dem Ende des Lockdowns oder in zukünftigen Lockdownszenarien wurde entwickelt. Die Daten wurden an der Universitätsaugenklinik LMU München erhoben und die Patientenakten einzeln von Augenärzten geprüft.Die durchschnittliche Patientenzahl sank um − 59,4% (p 0,001) mit einem signifikanten Verlust in allen Bereichen (elektive Fälle, Notfälle, stationäre Fälle, Operationen; p 0,001). Bei Patienten mit hohem Risiko/hohem Schweregrad ergab sich ein Rückgang von − 39,6%. Patienten mit ophthalmologischen Erkrankungen, die einen Hinweis auf ein mögliches erhöhtes Risiko für einen zukünftigen Schlaganfall geben, nahmen signifikant ab (p = 0,003). Der QALY-Verlust an der Universitätsaugenklinik betrug 171, geschätzt für Deutschland 3160 – 24 143. Die Aufarbeitung der hohen Verluste an ambulanten Patienten während der 8 Wochen Sperrung würde auf Deutschland hochgerechnet unter normalen Umständen je nach Augenarztdichte 7 – 23 Wochen dauern. Das Priorisierungsmodell kann die Morbidität um bis zu 78% reduzieren.Es kam zu eminenten Verlusten sowohl bei Notfallpatienten als auch bei Patienten mit chronischen Erkrankungen. Das Aufarbeiten der verpassten Untersuchungen und Behandlungen wird theoretisch Wochen bis Monate dauern. Um das Morbiditätsrisiko zu reduzieren, empfehlen wir ein Priorisierungsmodell für die Wiedereinbestellung nach dem Lockdown und künftige Lockdownszenarien.

BackgroundTo investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy.MethodsTwenty-two consecutive eyes of 11 patients with uni- or bilateral PNV were analyzed. Anti-VEGF treatment was correlated with changes in choroidal thickness on enhanced depth imaging optical coherence tomography.ResultsThere were 14 eyes with PNV and 8 non-neovascular partner eyes. Mean age was 64.2 ± 4.0 (range: 60–72), total follow-up was 1.8 ± 0.4 (1–2) years. In PNV eyes, choroidal thickness at baseline was 400 ± 58 (269–485) µm. After two years and 13 anti-VEGF injections on average, a mean reduction of -39 ± 10 (-26 to -56) % to final 241 ± 52 (162–327) µm was observed (p 0.13 for all comparisons). A significant correlation of choroidal thinning and anti-VEGF injection rate was observed at year one (r=-0.79 ; R2 = 0.63 ; p = 0.00073) and two (r=-0.69; R2 = 0.48 ; p = 0.019). While 85.7 % of PNV eyes exceeded a pachychoroid threshold of ≥ 350 µm at baseline, this figure dropped to 21.4 % at year one and 0 % at year two.ConclusionIn PNV, choroidal thickness significantly decreases with anti-VEGF therapy, resembling a “vanishing pachy-choroid”, and thus does not represent a valid long-term diagnostic criterium, especially when differentiating PNV from nAMD.

Lamellar macular holes (LMHs) are an entity of a progressive disease in which the efficacy of the therapy of choice, vitrectomy, seems to be reduced. It is unknown whether highly concentrated autologous platelet-rich plasma (PRP) is of value in the therapy of LMHs. The purpose of this study was to gauge the potential of highly concentrated PRP to restore foveal anatomy in LMH surgery.In this interventional case series, eight eyes of eight patients with progressive LMH were included. All patients underwent a 23-gauge pars plana vitrectomy with induction of a posterior vitreous detachment and peeling of tractive epiretinal membranes whenever present. Under air tamponade, 0.1 mL of highly concentrated autologous PRP was applied. Subsequently, a gas or air tamponade was performed. All patients were instructed to rest in the supine position for the first 1 to 2 postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT) and fundus photography were performed prior to and 3 months after surgery.SD-OCT showed closure of the macular defect with restoration of a normal foveal configuration in all (8 of 8) patients 3 months postoperatively. BCVA improved significantly, from 0.28 ± 0.08 to 0.12 ± 0.14 logMAR (Wilcoxon: p = 0.03). Microperimetry remained unchanged (24.13 ± 1.96 vs. 23.7 ± 1.54 dB; p = 0.46). No clinically significant intra- or postoperative complications were observed.The use of highly concentrated PRP enables excellent anatomical and functional outcomes in the surgical therapy of LMH. Further prospective comparative trials are warranted to compare this promising technique with existing surgical strategies.Makulaschichtforamina sind eine progrediente Erkrankung, bei der die Wirksamkeit der Therapie der Wahl, der Vitrektomie, reduziert zu sein scheint. Das Potenzial von hochkonzentriertem autologem Thrombozytenkonzentrat (Platelet-rich Plasma, PRP) in der Therapie von Makulaschichtforamina ist unbekannt. Ziel dieser Studie ist die Beurteilung des Potenzials von hochkonzentriertem autologem Thrombozytenkonzentrat in der chirurgischen Therapie von Makulaschichtforamina.In diese interventionelle Fallserie wurden 8 Augen von 8 Patienten mit progressivem LMH eingeschlossen. Alle Patienten erhielten eine 23-Gauge-Pars-plana-Vitrektomie mit Induktion einer hinteren Glaskörperabhebung und Peeling traktiver epiretinaler Membranen, sofern vorhanden. Unter Lufttamponade wurde 0,1 ml hochkonzentriertes autologes Thrombozytenkonzentrat appliziert. Anschließend wurde eine Gas- oder Lufttamponade eingegeben. Alle Patienten wurden angewiesen, in den ersten 1 – 2 postoperativen Stunden in Rückenlage zu ruhen. Der bestkorrigierte Visus (BCVA), Mikroperimetrie, optische Kohärenztomografie (SD-OCT) und die Fundusfotografie erfolgten präoperativ sowie 3 Monate postoperativ.In der SD-OCT zeigte sich einen Verschluss des Makuladefekts mit Wiederherstellung der normalen fovealen Konfiguration bei allen (8 von 8) Patienten 3 Monate postoperativ. Die bestkorrigierte Sehschärfe verbesserte sich signifikant von 0,28 ± 0,08 auf 0,12 ± 0,14 logMAR (Wilcoxon: p = 0,03). Die Mikroperimetrie blieb stabil (24,13 ± 1,96 vs. 23,7 ± 1,54 dB; p = 0,46). Es wurden keine klinisch signifikanten intra- oder postoperativen Komplikationen beobachtet.Die Verwendung von hochkonzentriertem autologem Thrombozytenkonzentrat ermöglicht hervorragende anatomische und funktionelle Ergebnisse in der chirurgischen Therapie der Makulaschichtforamina. Weitere prospektive Vergleichsstudien sind notwendig, um diese vielversprechende Technik mit bestehenden chirurgischen Strategien zu vergleichen.

Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique.Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z).Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up.The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.Evaluation der 3 aktuell meistverwendeten Sklerafixationstechniken für Intraokularlinsen (IOL) (1) Prolene-Naht mit Hoffman-Skleratasche, (2) GoreTex-Naht mit 4-Punkt-Aufhängung, (3) nahtlose intrasklerale Fixation mit gekauterten IOL-Haptikenden und Doppelnadeltechnik („Yamane-Technik“).IRB-genehmigte retrospektive klinische Studie an der Augenklinik der Ludwig-Maximilians-Universität (LMU) München. 55 Augen (n = 55) von 51 Patienten wurden eingeschlossen. Bestkorrigierter Fernvisus (BCVA), objektive Refraktion (OR), Hornhauttopografie (CCT), Biometrie, zentrale Makuladicke (CMT) mittels optischer Kohärenztomografie (OCT), Augeninnendruck (IOD), IOL-Typ und IOL-Stärke wurden vor und 3 – 12 Monate nach IOL-Sklerafixation untersucht. Eine statistische Auswertung über Unterschiede präoperativ zu postoperativ wurde mittels eines Wilcoxon-Rangsummentests (z) durchgeführt.Eine Sklerafixation mittels GoreTex-Naht wurde in 14 (25,5%) Augen, mittels Prolene-Naht in 19 (34,5%,) und mittels Yamane-Technik in 22 (40,0%) Augen durchgeführt. Innerhalb der 3 – 12 Monate Beobachtungszeitraum nach Sklerafixation mussten insgesamt 2 × (14,3%) GoreTex-, 3 × (15,8%) Prolene-, 1 × (4,5%) Yamane-Augen refixiert werden. Die Analyse zeigte einen statistisch signifikanten Unterschied bei der BCVA in der gesamten Kohorte (exakter Wilcoxon-Test: z = − 3,202; p = 0,001; n = 55) und in der Yamane-Subgruppe (exakter Wilcoxon-Test: z = − 2,068; p = 0,001; n = 22) im Vergleich zu prä-OP. Die GoreTex- (n = 14) und die Prolene-Subgruppe (n = 19) zeigten keine statistisch signifikanten Unterschiede zu prä-OP. Gruppenübergreifend war kein statistisch signifikanter Unterschied bei IOD, CMT und CCT festzustellen. Es traten keine retinalen Komplikationen auf, weder während der OP noch im Beobachtungszeitraum.Die Anzahl der IOL-Revisionen nimmt zu. Oft bleibt als einzige Option nur eine IOL-Sklerafixation zur visuellen Rehabilitation. Alle 3 untersuchten Sklerafixationsmethoden zeigten ein gutes Sicherheitsprofil ohne statistisch signifikanten Einfluss auf IOD, CMT, CCT, aber eine nennenswerte Revisionsrate. Eine visuelle Rehabilitation des BCVA auf den präoperativen Status (GoreTex [n = 14] und Prolene [n = 19]) bzw. ein statistisch signifikanter Visusanstieg (Gesamtkohorte [n = 55] und Yamane [n = 22]) scheint möglich. Verglichen mit der Irisfixation ist die Sklerafixation chirurgisch komplexer und hat eine steilere Lernkurve für den Chirurgen.

PURPOSE The study was performed to evaluate the refractive and visual outcome of patients with misaligned toric intraocular lenses (IOLs) after operative realignment, with and without back-calculation of the toric axis after implantation of the IOL. DESIGN Institutional, retrospective case-control study. METHODS This is a retrospective case series of 39 patients who underwent a second operation to realign a misaligned toric IOL from August 2013 to December 2019 at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Ideal toric axis was calculated using the back-calculator astigmatismfix.com. RESULTS The study consists of 39 treated eyes (20 [51%] right eyes). The toric IOLs showed a postoperative misalignment of 25.69 ± 26.06°. Postrotational, uncorrected distance visual acuity (UDVA) improved from 0.39 ± 0.29 logMAR to 0.27 ± 0.18 logMAR. Refractive outcome showed a reduction of residual sphere and cylinder. The postoperative UDVA when performing alignment to the preoperative calculated axis (51%) was 0.24 ± 0.16 logMAR with a cylinder of 0.90 ± 0.90 diopter (D). In the group with alignment to a back-calculated axis (49%), the UDVA was 0.32 ± 0.20 logMAR with a cylinder of 0.76 ± 0.72 D. High cylinder power IOLs (≥2 D) showed a higher decrease in residual cylinder when back-calculation was performed than low cylinder power IOLs (

To perform a systematic analysis of articles on the ophthalmological implications of the global COVID-19 pandemic.PubMed.gov was searched for relevant articles using the keywords "COVID-19", "coronavirus", and "SARS-CoV-2" in conjunction with "ophthalmology" and "eye". Moreover, official recommendations of ophthalmological societies were systematically reviewed, with a focus on the American Academy of Ophthalmology (AAO) and the Royal College of Ophthalmologists (RCOphth).As of April 16, 2020, in total, 21 peer-reviewed articles on the ophthalmological aspects of COVID-19 were identified. Of these, 12 (57.1%) were from Asia, 6 (28.6%) from the United States of America, and 3 (14.3%) from Europe. There were 5 (23.8%) original studies, 10 (47.6%) letters, 3 (14.2%) case reports, and 3 (14.2%) reviews. These articles could be classified into the topics "Modes and prevention of (ocular) transmission", "Ophthalmological manifestations of COVID-19", "Clinical guidance concerning ophthalmological practice during the COVID-19 pandemic", and "Practical recommendations for clinical infrastructure". Practical recommendations could be extracted from official statements of the AAO and the RCOphth.Within a short period, a growing body of articles has started to elucidate the ophthalmological implications of COVID-19. As the eye can represent a route of infection (actively via tears and passively via the nasoacrimal duct), ophthalmological care has to undergo substantial modifications during this pandemic. In the eye, COVID-19 can manifest as keratoconjunctivitis.Ein substanzieller Teil der aktuellen Literatur zur COVID-19-Pandemie beschäftigt sich mit deren ophthalmologischen Aspekten. In diesem Übersichtsartikel soll ein Überblick über die bisher publizierten Studien gegeben werden, die für die Ophthalmologie relevant sind.PubMed.gov wurde systematisch nach Artikeln mit den folgenden Schlüsselwörtern durchsucht: „COVID-19“, „Coronavirus“ und „SARS‐CoV‐2“ in Verbindung mit „Ophthalmology“ und „Eye“. Darüber hinaus wurde eine Analyse der Empfehlungen der ophthalmologischen Fachgesellschaften durchgeführt, insbesondere der American Academy of Ophthalmology (AAO) und des Royal College of Ophthalmologists (RCOphth).Es wurden 21 Artikel mit Peer Review zu den ophthalmologischen Aspekten von COVID-19 identifiziert (Stand: 16. April 2020). Davon stammten 12 (57,1%) aus Asien, 6 (28,6%) aus den Vereinigten Staaten und 3 (14,3%) aus Europa. Darunter befanden sich 5 Originalarbeiten (23,8%), 10 (47,6%) Briefe an den Herausgeber, 3 (14,2%) Fallberichte und 3 (14,2%) Übersichtsartikel. Es erfolgte eine Sortierung in folgende Themen: „(Okuläre) Übertragungswege und Prävention“, „Ophthalmologische Manifestation von COVID-19“, „Klinische Richtlinien für die ophthalmologische Praxis während der COVID-19-Pandemie“ und „Praktische Empfehlungen für den klinischen Alltag“. Letztere wurden den Empfehlungen der AAO und des RCOphth entnommen.Eine Vielzahl kürzlich erschienener Artikel befasst sich mit den ophthalmologischen Aspekten von COVID-19. Da COVID-19 über das Auge übertragen werden kann (aktiv über die Tränenflüssigkeit und passiv über den Ductus nasolacrimalis), ist eine sorgfältige Infektionsprävention in der ophthalmologischen Praxis von großer Bedeutung. Eine Augenbeteiligung kann sich als Keratokonjunktivitis manifestieren.

PURPOSE To evaluate the repeatability and validity of total corneal power measurements (total keratometry [TK]) obtained with a recently introduced optical biometer (IOLMaster 700, Carl Zeiss Meditec AG) to a Scheimpflug device (Pentacam, Oculus). SETTING Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. DESIGN Prospective randomized controlled trial. METHODS The inclusion criteria were a corneal astigmatism of 3.00 diopters (D) or less, no previous ocular surgery, no known corneal irregularities, and no known dry eyes. All eyes were measured 3 times using the optical biometer and the Scheimpflug device. The results were statistically compared using Bland-Altman, within-subject SD, and astigmatism vector analysis. RESULTS Ninety-three eyes of 93 subjects were included. Overall, the repeatability of all eyes measured was 0.42 for standard K, 0.40 for TK, 0.45 for total corneal refractive power (TCRP), 0.43 for true net power (TNP), and 0.39 for simulated K. Bland-Altman analysis showed no significant difference between the optical biometer's TK compared with standard K and the Scheimpflug device's simulated K, TNP, and TCRP, the P value exceeding .05 in each case. A difference of >0.50 diopters between astigmatism measurements between TK and TCRP was found in 10 cases compared with standard K and TNP with 0 and 2 cases. CONCLUSIONS Repeatability of both devices was high, although measurements of meridian showed a great variability, suggesting that numerous measurements are needed to enhance accuracy. TCRP measurements between recently introduced TK and TCRP cannot be used interchangeably. Future studies are necessary to evaluate which measurement will result in a better outcome when respective measurements are used for toric intraocular lens calculations.

With more than 1.5 million Small Incision Lenticule Extraction (SMILE) procedures having already been performed worldwide in an ageing population, intraocular lens (IOL) power calculation in post-SMILE eyes will inevitably become a common challenge for ophthalmologists. Since no refractive outcomes of cataract surgery following SMILE have been published, there is a lack of empirical data for optimizing IOL power calculation. Using the ray tracing as the standard of reference – a purely physical method that obviates the need for any empirical optimization - we analyzed the agreement of various IOL power calculation formulas derived from the American Society of Cataract and Refractive Surgeons (ASCRS) post-keratorefractive surgery online calculator. In our study of 88 post-SMILE eyes, the Masket formula showed the smallest mean prediction error [−0.36 ± 0.32 diopters (D)] and median absolute error (0.33D) and yielded the largest percentage of eyes within ±0.50D (70%) in reference to ray tracing. Non-inferior refractive prediction errors and ±0.50D accuracies were achieved by the Barrett True K, Barrett True K No History and the Potvin-Hill formula. Use of these formulas in conjunction with ray tracing is recommended until sufficient data for empirical optimization of IOL power calculation after SMILE is available.

Patienten haben mittlerweile die Moglichkeit, sich bei der Linsenchirurgie fur Sonderlinsen zu entscheiden. Mittels dieser Intraokularlinsen (IOL) kann z. B. eine ausgepragte Hornhautverkrummung ausgeglichen werden (torische IOL) oder dem Patienten ermoglicht werden, in mehreren Distanzen scharf zu sehen (multifokale IOL). Von dem ausgepragten Wettbewerb im Linsenmarkt profitiert der Patient, da es zur schnellen Weiterentwicklung von Linsenmodellen kommt. In diesem Ubersichtsbeitrag werden die am haufigsten eingesetzten Arten von Sonderlinsen, aspharische, torische und multifokale IOL, vorgestellt, und die aktuelle Studienlage zu den Linsentypen wird zusammengefasst. Sonderlinsen konnen im Vergleich zu Standardlinsen das unkorrigierte Sehvermogen in der Ferne oder in der Nahe verbessern. Andererseits kann ihr Nutzen bei einigen Patienten nur marginal sein, dann stellen sie v. a. einen unnotigen Kostenfaktor fur den Patienten dar. Bei Nichtbeachtung von Ein- und Ausschlusskriterien konnen die Sonderlinsen sogar zu einem schlechteren Gesamtergebnis fuhren.

Frau T., 54 Jahre alt, kommt in die Sprechstunde und beklagt, seit drei Tagen stark gerotete, brennende und tranende Augen zu haben. Die Beschwerden werden immer schlimmer. „Herr Doktor, ich glaube ich habe ein entzundetes Auge, was soll ich tun?“

Small incision lenticule extraction (SMILE), with over 5 million procedures globally performed, will challenge ophthalmologists in the foreseeable future with accurate intraocular lens power calculation in an ageing population. After more than one decade since the introduction of SMILE, only one case report of cataract surgery with IOL implantation after SMILE is present in the peer-reviewed literature. Hence, the scope of the present multicenter study was to compare the IOL power calculation accuracy in post-SMILE eyes between ray tracing and a range of empirically optimized formulae available in the ASCRS post-keratorefractive surgery IOL power online calculator. In our study of 11 post-SMILE eyes undergoing cataract surgery, ray tracing showed the smallest mean absolute error (0.40D) and yielded the largest percentage of eyes within ± 0.50/±1.00D (82/91%). The next best conventional formula was the Potvin-Hill formula with a mean absolute error of 0.66D and an ± 0.50/±1.00D accuracy of 45% and 73%, respectively. Analyzing this first cohort of post-SMILE eyes undergoing cataract surgery and IOL implantation, ray tracing showed superior predictability in IOL power calculation over empirically optimized IOL power calculation formulae that were originally intended for use after Excimer-based keratorefractive procedures.

The aim of this study was to evaluate the long-time results of highly concentrated autologous platelet-rich plasma (PRP) used as an adjunct in lamellar macular hole (LMH) surgery. Nineteen eyes of nineteen patients with progressive LMH were enrolled in this interventional case series, on which 23/25-gauge pars plana vitrectomy was performed and 0.1 mL of highly concentrated autologous platelet-rich plasma was applied under air tamponade. Posterior vitreous detachment was induced, and the peeling of tractive epiretinal membranes, whenever present, was performed. In cases of phakic lens status, combined surgery was carried out. Postoperatively, all patients were instructed to remain in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, and spectral domain optical coherence tomography (SD-OCT) were carried out preoperatively and at minimum 6 months (in median 12 months) postoperatively. Foveal configuration was postoperatively restored in 19 of 19 patients. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (p = 0.028, Wilcoxon signed-rank test). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p = 0.67). No patients experienced vision loss after surgery, and no significant intra- or postoperative complications were observed. Using PRP as an adjunct in macular hole surgery significantly improves morphological and functional outcomes. Additionally, it might be an effective prophylaxis to further progression and also the formation of a secondary full-thickness macular hole. The results of this study might contribute to a paradigm shift in macular hole surgery towards early intervention.

Importance A small number of COVID-19 patients has been reported to suffer from acute keratoconjunctivitis. In very rare cases, acute inflammatory retinal vein occlusion, papillophlebitis or retinopathy have been observed. Objective To determine possible long-term effects on the eye, especially on the retina, in patients who had suffered from COVID-19 at least 3 months after recovery. Design Prospective cross-sectional study. Setting Hospital of the Ludwig Maximilians University, Munich. Participants Patients who had been tested positive for SARS-CoV-2 or for anti-SARS-CoV-2 IgG serum antibodies in the Hospital of the Ludwig Maximilians University, Munich between May and September. Methods Patients who had tested positive were either hospitalized or discharged into home quarantine via the emergency room. Three months after recovery, they were invited to participate voluntarily for this study during their follow-up in our clinic. A complete ophthalmological exam including functional and imaging end points (including optical coherence tomography (OCT), OCT angiography) was performed. Main outcomes and measures Visual acuity, slit lamp, bio microscopy and fundoscopy, multimodal imaging findings. Results In total, 21 patients were examined. The mean age (SD) of the patients was 48.7 (18.3) years. Of these, 14 (66.6%) were hospitalized and 7 (33.3) were discharged home. Two hospitalized patients (9.5%) received invasive ventilation. During the infection, 14 of the 21 patients (66.6%) were in regular care whereas 2 patients (9.5%) received intensive care ventilation for 8.5 (SD) (0.7) days on average in the COVID ICU. Ophthalmological examination of the previously hospitalized group took place 111.4 (23.2) days after recovery and discharge from the hospital, while non-hospitalized patients were examined after mean 123.4 (44.7) days. All patients showed normal findings for anterior and posterior segment of both eyes. OCT and OCT-A showed no evidence of retinal damage, or vascular or microvascular events. Conclusion and relevance This study with a small prospective cohort of 21 patients indicates that there might be no evidence of ocular complications at 3 months after recovery from COVID-19, without previous eye involvement. Further studies with more participants with and without acute ocular symptoms are necessary for final evidence.

Purpose To evaluate the use of highly concentrated autologous platelet-rich plasma (PRP) in lamellar macular hole (LMH) surgery with regard to function and morphology. Methods We included 12 eyes of 12 patients with progressive LMH in this interventional case series. After 23/25-gauge pars plana vitrectomy, 0.1ml highly concentrated autologous platelet-rich plasma was applied under air tamponade. Induction of posterior vitreous detachment and peeling of tractive epiretinal membranes were performed whenever present. Phacovitrectomy was undertaken in cases of phakic lens status. Postoperatively, all patients were instructed to rest in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT), and fundus photography were carried out preoperatively and 6 months postoperatively. Results Foveal configuration was restored in 10 of 12 patients (83.3%) at 6 months postoperatively. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (Wilcoxon: p=0.028). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p=0.67). No patient experienced vision loss after surgery, and no significant intra- or postoperative complications occurred. Conclusion The application of PRP in the surgical therapy of LMH results in good morphological and functional outcomes. Additional peeling of the ILM seems to be mandatory when using PRP to prevent the recurrence of LMH. Strict postoperative supine positioning for 2 h avoids PRP dislocation. Larger sample sizes are needed to confirm the results.

PURPOSE: To compare different new-generation biometric formulas and ray-tracing for small-aperture intraocular lens (IOL) (IC-8; Acufocus, Inc) implantation in patients undergoing cataract and refractive lens exchange surgery with highly irregular corneas. METHODS: This monocenter study included 17 eyes of 17 patients with highly irregular corneas of different genesis. Biometric and topographic corneal data were assessed using the IOLMaster 700 (Carl Zeiss Meditec) and Pentacam (Oculus Optkigeräte GmbH). Prediction and absolute error were compared after 3 months based on manifest refraction. Furthermore, change of total corneal refractive power in different corneal pathologies was also evaluated. For IOL power calculation, three fourth-generation IOL formulas were compared (Haigis, SRK-T, and Barrett Universal II). The dataset was then checked against ray-tracing and analyzed to improve prediction error in these highly irregular corneas. RESULTS: All patients showed an improvement in visual acuity postoperatively with a mean spherical equivalent of −1.22 ± 0.49 diopters (D). Overall comparison of the three formulas showed the Haigis formula to be superior in terms of the smallest deviation of predictive and absolute error. IOL calculations with ray-tracing were possible in all eyes, but showed inaccurate results with keratometric values of 48.00 D and greater. CONCLUSIONS: The IC-8 IOL is well suited for patients with lens exchange in highly irregular corneas. The Haigis formula seemed to be the most accurate in the patient group. Ray-tracing confirmed the results of biometric formulas up to a keratometric value of 48.00 D and should be compared with standard biometric formulas to address corneal irregularities and to minimize refractive surprises after surgery. A comparison with ray-tracing in eyes with a keratometric value of greater than 48.00 D should not be considered due to the inaccurate results. [ J Refract Surg . 2021;37(5):312–317.]

PURPOSE To evaluate functional outcome after retinal detachment (RD) repair surgery in eyes with a multifocal intraocular lens (mIOL). SETTING Ludwig-Maximilians-University, Munich, Germany. DESIGN Single-center case control study. METHODS 52 pseudophakic eyes with successful anatomical outcome after surgical RD repair were included. Retrospectively, 21 mIOL eyes were compared with a matched group of 21 monofocal eyes over 6 weeks. Prospectively, corrected distance visual acuity (CDVA) was evaluated over 12 months in these eyes. Furthermore, uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), defocus curves, and patient-reported outcomes were evaluated at 1 year in 24 mIOL eyes. RESULTS 52 eyes of 48 patients comprised the study. The mean CDVA (logMAR) improved significantly from 1.35 ± 1.38 to 0.29 ± 0.37 at 6 weeks and remained stable at 12 months postoperatively in monofocal eyes (P = .001) and from 1.16 ± 1.2 to 0.37 ± 0.29 (6 weeks) and 0.20 ± 0.36 (12 months) in mIOL eyes (P = .001). Univariate factorial analysis of variance showed no statistically significant differences in CDVA at 6 weeks or 12 months postoperatively for IOL type or for preoperative macular status (P > .05). In the prospective cohort of 24 mIOL eyes, a mean CDVA of 0.13 ± 0.33 logMAR, UDVA of 0.21 ± 0.34 logMAR, UIVA of 0.17 ± 0.28 logMAR, and UNVA of 0.23 ± 0.32 logMAR was achieved. Macular status did not affect final outcome significantly (P > .05). Most patients stated they usually did not need spectacles; no patient wanted mIOL replacement. CONCLUSIONS 1 year after successful anatomical repair after 23-gauge vitrectomy with gas tamponade, functionality of mIOL was restored, and CDVA was comparable with that of patients with monofocal IOL.

Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting.Design: Retrospective cohort study.Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment.Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY; Alcon Inc., Fort Worth, Texas, USA; n = 70 eyes) or a SOM setting (n = 70 eyes); in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months.Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery.Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%; p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%; p = 0.40) and final BCVA (0.26 ± 0.40 vs. 0.21 ± 0.38 logMAR; p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 ± 16.5 vs. 61.2 ± 17.1 min; p = 0.04), an effect which however vanished after a “learning curve” of the first 35 eyes (p = 0.49).Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve.

Myopia is the most common refractive error. Surgical correction with laser is possible. LASIK and SMILE are the techniques currently most used. Aim of the study was to compare changes in corneal volume and thickness after the respective laser treatment. 104 eyes of 52 patients were matched based on refractive error into two equally sized groups, either treated with LASIK or SMILE. Measurements were obtained from the Scheimpflug camera (Pentacam) preoperatively and at 3 and 12 months postoperatively. 3 months postoperatively, the flapless SMILE procedure resulted in a significant overall greater loss of corneal volume (P < 0.01) and corneal thickness (P < 0.01) compared to LASIK. No significant difference was found when comparing the 3 to 12-months values in each group. Within the currently used ranges of refractive error correction, loss in central corneal thickness and corneal volume with SMILE is higher in comparison to LASIK. As greater loss in corneal volume and thickness might contribute to higher level of corneal instability maximum ranges of refractive error correction with SMILE should not supersede those set currently for LASIK until more long-term results on corneal ectasia are available for SMILE.

Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. Incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3–5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61–86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1–3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRF only in treat & extend anti-VEGF regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRF might be an indicator of a more benign form of nAMD.

PURPOSE To implant a small-aperture intraocular lens (IOL) (IC-8) in eyes with severe corneal irregularities to reduce higher-order aberrations and provide better central visual acuity. SETTING University Hospital, LMU Munich, Germany. DESIGN Prospective nonrandomized interventional case series. METHODS Eyes with severe corneal irregularities due to keratoconus, previous penetrating keratoplasty, status postradial keratotomy, or scarring after ocular trauma were enrolled. Exclusion criteria were progressive keratoconus, pseudoexfoliation, glaucoma, maculopathy, reduced endothelial cells (

PURPOSE We assessed differences in compliance and adherence (lateness of patients, visual acuity, reasons for abstaining) between patients with diabetic macular edema (DME) and patients with age-related macular degeneration (AMD), both under anti-vascular endothelial growth factor therapy. METHODS We included 136 patients with DME (36% women, 65 years, 22 visits, 13.9 injections, and 29.9 months of follow-up) and 109 patients with AMD (59% women, 76 years, 20 visits, 14.7 injections, and 22.3 months of follow-up) (minimum follow-up of 12 months and at least 5 injections). We assessed missed appointments (lateness >14 days) and therapy break-offs (lateness >100 days). All delayed patients were called and interviewed for abstaining reasons. RESULTS Forty-six percent of patients with DME and 22% of patients with AMD had at least one break-off. Thirty-five percent of patients with DME and 50% of patients with AMD were always on schedule. In patients with DME, there was significant correlation (P = 0.017) between the number of break-offs and change of visual acuity. In 60% DME and 38% AMD of break-off cases, visual acuity was worse than the before break-off. The most common reason for abstaining was comorbidities (33% AMD and 20% DME). CONCLUSION There are significant differences between patients with AMD and DME regarding compliance and adherence, which also affects outcome. Strategies to tie patients with DME to costly intravitreal therapy need to be developed to improve outcomes and efficacy.

PURPOSE: To report the impact of increasing minimum lenticule thickness on the safety and efficacy of small incision lenticule extraction (SMILE) in low myopia up to −3.50 diopters (D). METHODS: SMILE was performed in 76 eyes of 76 patients. Thirty-eight eyes of 38 patients with low myopia were prospectively operated on with a programmed minimum lenticule thickness of 15 to 30 μ m (thicker lenticule group). Thirty-five eyes suitable for analysis were then retrospectively matched by spherical equivalent to 35 eyes operated on with a minimum standard setting of 10 μ m (standard thickness group), as provided in the database of the SMILE Eyes Clinic Linz, Linz, Austria. Comparison of outcomes was performed with the Standard Graphs for Reporting Refractive Surgery and by analysis of higher order aberrations as provided by Scheimpflug imaging. RESULTS: Apart from lenticule thickness, there was no significant difference in preoperative baseline or treatment parameters between both groups. Mean minimum lenticule thickness differed significantly (standard thickness = 10 ± 0 μ m; thicker lenticule = 20 ± 5 μ m; P < .0001). This also translated into a significant difference in maximum lenticule thickness (standard thickness: 54 ± 11 μ m; thicker lenticule: 62 ± 8 μ m; P = .0002). Mean SEQ preoperatively was −2.25 ± 0.51 (standard thickness) and −2.24 ± 0.46 (thicker lenticule) D, respectively, and changed to −0.11 ± 0.50 (standard thickness) and +0.01 ± 0.36 (thicker lenticule) D postoperatively ( P < .0001 for both comparisons). Uncorrected postoperative visual acuity was −0.08 ± 0.35 (standard thickness) versus −0.10 ± 0.09 (thicker lenticule) logMAR ( P = .706). After SMILE, the thicker lenticule group showed better safety (1.20 vs 1.08; P = .025) and efficacy (1.14 vs 0.96; P = .011) indices, translating into more eyes within ±0.50 D from target (91% vs 77%) and with at least 0.0 logMAR visual acuity (97% vs 86%), and fewer eyes losing one (3% vs 17%) and two (0% vs 3%) lines. CONCLUSIONS: Increasing minimum lenticule border thickness seems to improve the safety and efficacy of SMILE in low myopia. [ J Refract Surg. 2018;34(7):453–459.]

To determine functional and anatomical outcomes of pars plana vitrectomy for persistent full-thickness macular hole (MH) after intravitreal injection of ocriplasmin.This is a multicenter retrospective interventional study of 37 eyes of 37 patients who underwent pars plana vitrectomy with internal limiting membrane peeling for persistent MH after ocriplasmin treatment between December 2013 and December 2015 and comparison with 35 eyes of 35 patients who were offered ocriplasmin injection but underwent pars plana vitrectomy alone without pharmacologic vitreolysis before surgery. In addition, 24 matched pairs (MH diameter at baseline ±5 µm) were analyzed. Clinical data such as visual acuity, intraoperative characteristics, and spectral domain optical coherence tomography images were reviewed. Main outcome measures were visual acuity and MH closure rate.After a mean follow-up period of 9 months, postoperative mean visual acuity showed no significant differences between ocriplasmin-treated eyes (logarithm of minimum angle of resolution 0.37 ± 0.26, Snellen 20/47) and eyes without ocriplasmin treatment (logarithm of minimum angle of resolution 0.39 ± 0.25; Snellen 20/49) (P0.9). After ocriplasmin injection, mean MH diameter enlarged from 217 ± 102 µm to 384 ± 239 µm (P0.001). Matched-pair analysis revealed no difference in gain of visual acuity between the first visit and the last follow-up (P = 0.29). Macular hole closure was observed in similar proportion in ocriplasmin-treated eyes (97%) and vitrectomy-only eyes (94%) (P0.5).Eyes with persistent MH after ocriplasmin injection showed significant visual improvement after pars plana vitrectomy. Matched-pair analysis revealed no statistical differences in functional and anatomical postoperative results comparing with eyes of similar MH diameter that proceeded directly to surgery without ocriplasmin pretreatment.

Purpose To develop a near-real-time data warehouse (DW) in an academic ophthalmologic center to gain scientific use of increasing digital data from electronic medical records (EMR) and diagnostic devices. Design Database development. Methods Specific macular clinic user interfaces within the institutional hospital information system were created. Orders for imaging modalities were sent by an EMR-linked picture-archiving and communications system to the respective devices. All data of 325 767 patients since 2002 were gathered in a DW running on an SQL database. A data discovery tool was developed. An exemplary search for patients with age-related macular degeneration, performed cataract surgery, and at least 10 intravitreal (excluding bevacizumab) injections was conducted. Results Data related to those patients (3 142 204 diagnoses [including diagnoses from other fields of medicine], 720 721 procedures [eg, surgery], and 45 416 intravitreal injections) were stored, including 81 274 optical coherence tomography measurements. A web-based browsing tool was successfully developed for data visualization and filtering data by several linked criteria, for example, minimum number of intravitreal injections of a specific drug and visual acuity interval. The exemplary search identified 450 patients with 516 eyes meeting all criteria. Conclusions A DW was successfully implemented in an ophthalmologic academic environment to support and facilitate research by using increasing EMR and measurement data. The identification of eligible patients for studies was simplified. In future, software for decision support can be developed based on the DW and its structured data. The improved classification of diseases and semiautomatic validation of data via machine learning are warranted.

Purpose To characterize patient-reported long-term quality of vision (QoV) after small-incision lenticule extraction (SMILE), and to identify potential clinical parameters that might predispose to experiencing deteriorated visual quality. Setting University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany. Design Prospective cross-sectional study. Methods For the assessment and scoring of visual symptoms, the Quality of Vision questionnaire was employed, which constitutes a clinically validated, linear-scaled 30-item instrument providing a QoV score on three scales (symptom frequency, severity, and bothersome). Subgroup analyses were performed for patient subgroups stratified by baseline characteristics (eg, age) and treatment parameters (eg, surgical refractive correction) as well as refractive outcomes (eg, residual refraction) and visual outcomes (eg, uncorrected distance visual acuity [UDVA]). Results The study comprised 394 eyes of 197 patients (117 women [59.4%], 80 men [40.6%]) were included with a mean postoperative follow-up of 24.4 months ± 14.1 (SD). The QoV scores for symptom frequency, severity, and bothersome were 34.63 ± 13.69, 29.60 ± 12.38, and 24.56 ± 16.00, respectively. Patients with a preoperative binocular corrected distance visual acuity (CDVA) of 20/12.5 or better, patients who lost 1 or more lines of UDVA as compared with preoperative CDVA, patients older than the age of 40, and patients with inadvertent anisometropia more than 0.375 diopters reported worse QoV scores. Conclusion The relationship between objective clinical parameters and patient-reported subjective QoV after SMILE seems complex. Defined prognostic factors that convey a higher risk for experiencing visual disturbances were identifiable and should be discussed with patients seeking SMILE treatment during preoperative counseling.