To compare success rates of trabeculectomy (TE) and Preserflo MicroShunt (PMS) in heterogenous glaucoma cohorts with regards to different pre- and postoperative therapeutic regimens. Data of 187 glaucoma patients who either received TE (73 eyes) or PMS implantation (114 eyes) between January 2018 and December 2022 were retrospectively evaluated. Surgical success and failure rates were analyzed within six months of follow-up. Intraocular pressure (IOP) development over the course of follow-up was compared between both groups. Tertiary outcome measures were best-corrected visual acuity (BCVA), number and type of medications, frequency of postoperative complications and revision surgeries. Outcome measures underwent additional assessment based on subgroup categorizations, and failure time hazard ratios were computed. The success rates were comparable between both procedures (TE: 54.1%, PMS: 60.0%;
Abstract The EyeMatics project, embedded as a clinical use case in Germany’s Medical Informatics Initiative, is a large digital health initiative in ophthalmology. The objective is to improve the understanding of the treatment effects of intravitreal injections, the most frequent procedure to treat eye diseases. To achieve this, valuable patient data will be meaningfully integrated and visualized from different IT systems and hospital sites. EyeMatics emphasizes a governance framework that actively involves patient representatives, strictly implements interoperability standards, and employs artificial intelligence methods to extract biomarkers from tabular and clinical data as well as raw retinal scans. In this perspective paper, we delineate the strategies for user-centered implementation and health care–based evaluation in a multisite observational technology study.
Abstract Purpose: To investigate seasonal variations in the onset of acute submacular hemorrhages (SMHs) in a European population and analyze the influence of the seasons, arterial hypertension and intake of anticoagulatory/antiplatelet (AC/AP) medication on hemorrhage size. Methods: This retrospective, monocentric study included 164 eyes of 164 patients treated for acute SMH at the University Hospital Münster, Germany, between 01/01/2016 and 12/31/2021. Data on the day of occurrence, hemorrhage size and general patient characteristics were recorded. “Test for cyclic trends in incidence data” was applied to investigate seasonal variations in SMH incidence. Fisher’s exact test was used to investigate the influence of the seasons, arterial hypertension and intake of AC/AP medication on hemorrhage size. Results: Statistical analysis did not reveal significant seasonal variations in the occurrence of SMHs (p = 0.81). While the seasons and the presence of systemic arterial hypertension did not exert a significant influence, intake of AC/AP medication significantly affected the size of SMH (p = 0.03). Conclusion: In this European cohort no significant seasonal variations of SMHs were observed. However, in patients with risk factors, such as neovascular age-related macular degeneration (nAMD), the chance of an increase in hemorrhage size should be considered when initiating AC/AP therapy.
The aim of the article is to investigate the seasonality of acute submacular hemorrhages (SMHs) in a European population and analyze the influence of the seasons, arterial hypertension, and intake of anticoagulatory/antiplatelet (AC/AP) medication on hemorrhage size. This retrospective, monocentric study included 164 eyes of 164 patients treated for acute SMH at the University Hospital Münster, Germany, between 1 January 2016 and 31 December 2021. Data on the day of occurrence, hemorrhage size, and general patient characteristics were recorded. "Test for cyclic trends in incidence data" and the Chi-Square Test were applied to investigate seasonal variations in SMH incidence. Fisher's exact test was used to investigate the influence of the seasons, arterial hypertension, and intake of AC/AP medication on hemorrhage size. A statistical analysis did not reveal significant seasonal variations in the occurrence of SMHs (p = 0.81). While the seasons and the presence of systemic arterial hypertension did not exert a significant influence, the intake of AC/AP medication significantly affected the size of SMH (p = 0.03). In this European cohort, no significant seasonal variations of SMHs were observed. However, in patients with risk factors, such as neovascular age-related macular degeneration (nAMD), the chance of an increase in hemorrhage size should be considered when initiating AC/AP therapy.
Glaucoma is one of the leading causes of blindness worldwide. Therefore, early detection and diagnosis are key to preserve full vision in patients. As part of the SALUS study, we create a blood vessel segmentation model based on U-Net. We trained U-Net on three different loss functions and used hyperparameter tuning to find their optimal hyperparameters for each loss function. The best models for each of the loss functions achieved an accuracy of over 93%, Dice scores around 83% and Intersection over Union scores over 70%. They each identify large blood vessels reliably and even recognize smaller blood vessels in the retinal fundus images and thus pave the way for improved glaucoma management.
Abstract Background/aim The aim of this paper is to compare retinal nerve fiber layer thickness (RNFL) and Bruch’s membrane opening-based minimum rim width (BMO-MRW) in terms of their performance in detecting early and moderate/advanced glaucoma using receiver operating characteristics (ROC) analysis and the classification using the 5th percentile as a cut-off. Methods One hundred eyes from 100 patients with early glaucoma (mean deviation (MD): < -5.0 dB) and 100 eyes from 100 patients with moderate/advanced glaucoma (MD: > -5.0 dB) were carefully matched to healthy controls based on optic disc size. Then, the dataset was divided, based on the 50th percentile of the measured Bruch’s membrane opening area (BMO-A), into small (BMO-A < 1.95 mm 2 ) and large optic discs (BMO-A > 1.95 mm 2 ). Finally, the discriminative performance of BMO-MRW and RNFL between glaucoma and controls using ROC analysis and the manufacturer’s classification based on the 5th percentile was analyzed. Results In discriminating between glaucoma and matched healthy controls, global BMO-MRW and global RNFL thickness had comparable areas under the ROC curve for eyes with early glaucoma and both small BMO-As (ROC ± confidence interval [CI] 0.91 [0.87 to 0.95] and 0.88 [0.83 to 0.93]) and large BMO-As (0.86 [0.82 to 0.92] and 0.84 [0.79 to 0.90]), as well as in moderate/advanced glaucoma with small BMO-As (0.99 [0.98 to 1.00] and 0.97 [0.95 to 1.00]) and large BMO-As (0.94 [0.91 to 0.98] and 0.97 [0.94 to 1.00]). Using the calculated 5th percentile as a threshold value, the sensitivities for the detection of early and moderate/advanced glaucoma were comparable for BMO-MRW and RNFL in eyes with small optic discs (early glaucoma: fifty-two percent and 61%; moderate/advanced glaucoma: ninety-one percent and 92%). In eyes with large optic discs, the sensitivity of BMO-MRW was inferior to that of RNFL for both early (38% versus 51%) and moderate/advanced (80% versus 91%) glaucoma. Conclusion Based on an ROC analysis, the discriminative performance of BMO-MRW and RNFL between patients with early and moderate/advanced glaucoma and a healthy control group matched based on optic disc size is comparable in eyes with BMO-As smaller and larger 1.95 mm 2 . Using a classification based on the 5th percentile, as used in clinical practice, RNFL is shown to be superior to BMO-MRW regarding sensitivity in glaucoma detection with large optic discs. This study underscores the importance of RNFL imaging and measurement in the diagnostic evaluation of glaucoma, especially in cases of large optic discs.
In keratoconus (KC) a progressive deformation and thinning of the cornea occurs. In contrast to Scheimpflug-based examinations, optical coherence tomography (OCT) can precisely measure the corneal layers separately, allowing separate analyses of corneal epithelial and corneal stromal thicknesses.The aim of this work was to analyze the corneal epithelial thickness measured by optical coherence tomography (OCT) in patients with KC in comparison to the corneal epithelial thickness in healthy subjects. The diagnostic value of the observed changes was evaluated.In a retrospective analysis 125 eyes of patients with KC and 140 eyes of healthy subjects were included. Corneal measurements were performed by OCT (Optovue, XR-Avanti, Fremont, CA, USA). Corneal stromal thicknesses and corneal epithelial thicknesses in different locations were measured and analyzed.There were significant differences in stromal and epithelial thickness measurements. Of the derived epithelial thickness parameters four showed a good discriminatory power between healthy controls and KC patients (area under the curve in the receiver operating characteristic analysis > 0.7).Patients with KC showed an altered epithelial thickness compared to healthy controls. The derived calculated parameters based on corneal epithelial thickness can distinguish between KC and a healthy cornea.HINTERGRUND: Beim Keratokonus (KK) kommt es zu einer progredienten Verformung und Ausdünnung der Hornhaut (HH). Im Gegensatz zu Scheimpflug-basierten Untersuchungen ist es mittels optischer Kohärenztomographie (OCT) möglich, die einzelnen Hornhautschichten separat präzise zu vermessen, sodass getrennte Analysen von Hornhautepithel- und Hornhautstromadicke möglich sind.Ziel dieser Arbeit ist es, die HH-Epitheldicke, gemessen mittels OCT, bei KK-Patienten im Vergleich mit der HH-Epitheldicke bei gesunden Probanden zu analysieren und den diagnostischen Wert der dargestellten Veränderungen zur evaluieren.In einer retrospektiven Analyse wurden 125 Augen von Patienten mit KK und 140 Augen von gesunden Probanden eingeschlossen. Messungen der Hornhaut erfolgten mittels OCT (Optovue, XR-Avanti, Fremont, CA, USA). Es wurden die HH-Stromadicke und die HH-Epitheldicke in unterschiedlichen Lokalisationen gemessen und analysiert.Es zeigten sich signifikante Unterschiede in der Stroma- und der Epitheldickenmessung. Vier der abgeleiteten Epitheldickenparameter zeigten eine gute Trennschärfe zwischen gesunden Kontrollen und Keratokonuspatienten („area under the curve“ in der Receiver-operating-characteristic-Analyse > 0,7).Patienten mit KK zeigen eine veränderte Epitheldicke im Vergleich zu gesunden Kontrollen. Hieraus abgeleitete berechnete Parameter, basierend auf der HH-Epitheldicke, können gut zwischen KK und gesunder HH unterscheiden.
Correction to: Retrospective Analysis of Bicanalicular Lacrimal Silicone Tube Intubation in Patients with Congenital Nasolacrimal Duct Obstruction: A Long-term Follow-up StudyKlin Monbl Augenheilkd eFirstDOI: 10.1055/a-2237-1139
The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A total of 160 eyes of 160 patients who underwent Preserflo MicroShunt implantation were retrospectively enrolled in this study. Patient characteristics, as well as success and failure rates, were assessed. The numbers of adverse events and revision procedures were recorded, along with any reduction in supplementary medication. The progression of intraocular pressure (IOP) was assessed over the course of 12 months, and fluctuations were analyzed. The overall success rate was 61.9% (complete success: 51.3%, qualified success: 10.6%). Revision surgery was performed in 25% of cases. Excessive hypotony occurred postoperatively in 54.4% of patients and regressed after 7 days in 88.8% of all cases. Median IOP decreased from 22 (interquartile range (IQR): 17-27) mmHg preoperatively to 14 (IQR 12-16) mmHg at 12 months postoperatively (p < 0.01). The median number of antiglaucomatous agents decreased from three to zero at latest follow-up. The Preserflo MicroShunt achieved a noticeable reduction in IOP over the course of 12 months in glaucoma patients, irrespective of disease severity or disease subtype. The frequency of postoperative adverse events and number for revision surgeries over the course of the follow-up period were low.
