Zusammenfassung Hintergrund Die Zahl der Ophthalmologinnen hat in den letzten Jahren stetig zugenommen. Ziel dieser Arbeit ist es, die Geschlechterverhältnisse an den deutschen Universitätsaugenkliniken zu untersuchen. Auch der Anteil der Frauen an Förderprogrammen, wie dem Clinician Scientist Programm, wird analysiert. Methodik Die Datenerhebung erfolgte im August 2023 anhand der offiziellen Internetplattformen der Universitätsaugenkliniken und der Deutschen Ophthalmologischen Gesellschaft (DOG). Es wurde die Anzahl an männlichen und weiblichen Ärzt*innen in Weiterbildung, Fach‑, Oberärzt*innen und Klinikdirektor*innen, Subspezialisierungen und akademischen Grade ermittelt. Die Informationen zum Clinician Scientist Programm wurden 2022 in einer Umfrage des Medizinischen Fakultätsrats erhoben. Ergebnisse Im August 2023 gab es 2 Klinikdirektorinnen an den Universitätsaugenkliniken (5 %), beide mit Schwerpunktbereich der Netzhautchirurgie. Mit 59,9 % gab es mehr Oberärzte als Oberärztinnen (40,1 %). Kein signifikanter Unterschied bestand zwischen beiden Geschlechtern hinsichtlich der Anzahl an Habilitationen ( p = 0,554). Es gab mehr Fachärztinnen als Fachärzte für Augenheilkunde an den Universitätskliniken (F: 58,6 %; M: 41,4 %) sowie mehr Ärztinnen in Weiterbildung (F: 56,9 %; M: 43,1 %). Die Fachärztinnen waren signifikant häufiger promoviert als ihre männlichen Kollegen ( p = 0,037). Der Prozentsatz an weiblichen Bewerbungen für das Clinician Scientist Programm lag deutschlandweit 2022 bei 46,6 %, der Programmstarterinnen 2021 bei 41,8 % und der Programmabsolventinnen 2021 bei 39,7 %. Schlussfolgerung Die oberärztlichen Positionen und die Positionen der Klinikdirektor*innen an den Universitätsaugenkliniken werden weiterhin überwiegend vom männlichen Geschlecht bekleidet. Auch werden Förderprogramme für wissenschaftlichen Nachwuchs noch in der Mehrzahl an Männer vergeben.
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.
Epiretinal membranes (ERM) represent one of the most common findings in retinal examination. Structural changes of the retinal layers in patients with ERM can be visualized and classified using OCT. The purpose of this study is to evaluate structural and functional changes related to surgical treatment of ERM.Monocentric retrospective analysis of 92 patients who underwent 23-gauge-pars plana vitrectomy (ppV) combined with cataract surgery for idiopathic ERM from 2015 to 2020. Visual acuity was determined directly preoperatively, at four weeks and three months postoperatively. Disease stage and tomographic biomarkers related to ERM were assessed in OCT imaging.92 eyes of 92 patients were included. At the time of surgery, the mean patient age was 71 years. Visual acuity improved significantly by 2 lines postoperatively, on average from LogMar 0.4 to 0.2 (p < 0.001). Disease stage regressed from stage 3 to stage 2 postoperatively (p < 0.001). No patient had stage 4 postoperatively (n = 0). In the presence of preoperative intraretinal fluid, mean retinal thickness was 488 μm and decreased to 392 μm postoperatively (n = 32; p < 0.001). Preoperative presence of a Cotton Ball Sign (n = 30) was associated with better visual acuity (p = 0.009). This was also visible in patients with preoperative vitreomacular traction syndrome (p < 0.001). The presence of preoperative intraretinal fluid showed a tendency towards better disease staging after surgery (p = 0.080).Surgery was able to achieve visual improvement and morphological regression of the preoperative OCT findings related to ERM. ppV led to a reduction in retinal thickness and disease stage. The presence of the Cotton Ball Sign and vitreomacular traction was associated with better visual acuity in the follow-up period. In our cohort the preoperative presence of intraretinal fluid showed a tendency for better postoperative disease staging.
Zusammenfassung Hintergrund Das Susac-Syndrom (SS) stellt eine Endotheliopathie der Gefäße im Bereich des zentralen Nervensystems dar. Die Beteiligung der Netzhaut spielt in der Krankheitsmanifestation eine zentrale Rolle. Ziel der Arbeit Ziel dieser Fall-Kontroll-Studie ist die Untersuchung der makulären Gefäßstruktur bei Patienten mit chronischem SS im Vergleich zu Kontrollpersonen mittels optischer Kohärenztomographie Angiographie (OCTA). Material und Methoden Es wurden 12 Augen von 12 Susac-Patienten mit altersgleichen gesunden Kontrollpersonen hinsichtlich ihrer OCT-angiographischen Parameter verglichen. Die Flussdichte (FD) verschiedener makulärer Schichten, Parameter der fovealen avaskulären Zone (FAZ) sowie die Werte der zentralen Netzhautdicke und des zentralen Netzhautvolumens wurden zwischen den beiden Gruppen verglichen. Ergebnisse Die FD-Werte der Choriokapillaris waren in Susac-Patienten im Vergleich zu gesunden Kontrollen signifikant verringert. Die FD-Werte des oberflächlichen und tiefen Kapillarplexus der inneren Netzhaut, die Parameter der FAZ sowie die zentrale Netzhautdicke und -volumen zeigten keine signifikanten Unterschiede zwischen den beiden Gruppen. Diskussion Das therapierte, chronische SS scheint keinen signifikanten Einfluss auf den vaskulären und strukturellen Aufbau der zentralen, inneren Netzhaut zu haben. Unterschiede der Choriokapillaris deuten jedoch auf Veränderungen in tiefer liegenden, stark vaskularisierten Kapillarschichten hin.
Intraocular pressure (IOP) lowering surgery has been shown to alter microvascular density in glaucoma patients. The aim of this study is to report changes in retinal flow density (FD) over the course of treatment with the Preserflo MicroShunt, using optical coherence tomography angiography (OCTA). 34 eyes from 34 patients who underwent Preserflo MicroShunt implantation were prospectively enrolled in this study. OCTA imaging was conducted at the superficial (SCP), deep (DCP) and radial peripapillary plexus (RPC) levels. The progression of FD and IOP was assessed at different time points from baseline to six months postoperatively for the entire patient population, as well as disease severity subgroups. The Preserflo MicroShunt achieved a significant reduction in IOP over the course of six months (median: 8 mmHg; p < 0.01). FD values of the SCP and DCP did not show significant fluctuations, even after adjusting for disease severity. FD of the RPC decreased significantly over the course of six months postoperatively from 42.31 at baseline to 39.59 at six months postoperatively (p < 0.01). The decrease in peripapillary FD was strongest in patients with advanced glaucoma (median: -3.58). These observations hint towards dysfunctional autoregulatory mechanisms in capillaries surrounding the optic nerve head in advanced glaucoma. In comparison, the microvascular structure of the macula appeared more resilient to changes in IOP.
Abstract Chemosensory (gustatory and olfactory) dysfunction contributes to obesity, but the association between body mass index (BMI) and chemosensory dysfunction are inconsistently reported. The present study included 4,390 subjects at a Smell and Taste Clinic. Results suggested that both the obesity class II group (BMI ≥ 35) and underweight group (BMI < 18.5) exhibited impaired taste function compared with the normal weight group ( p < .05). Comparing with the other groups, the obesity class II group exhibited a higher proportion of impaired bitter identification (8.6%), and the underweight group showed a higher proportion of impaired salty identification (7.9%). When investigating differences for individual tastes, subjects with impaired bitter identification had higher BMI ( t = 2.79, p = .005) and lower olfactory scores ( p < .05) compared with those with intact bitter identification. Finally, reduced taste scores are associated with an increased BMI ( r = −.04, p = .022). This correlation becomes more pronounced with age ( F = 1.42, p < .001). Practical Application The nonlinear association between chemosensory dysfunction and BMI suggested that maintaining the gustatory and olfactory function is of significance for normal metabolism. In obesity regulating bitter taste appears to be more important than the other tastes.
Recent studies have questioned the traditional view, which regards Coats disease as a strictly unilateral entity. Applying optical coherence tomography angiography, this prospective, monocentric study investigates quantitative capillary changes of the macula associated with Coats disease.Twenty-four eyes (4 untreated, 8 pre-treated) of 12 patients with stage 2 Coats disease (age range: 9-61 years) and 15 eyes of healthy, age-matched controls from the University of Muenster Medical Center, Germany received macular optical coherence tomography angiography measurements of the superficial, deep, and choriocapillary capillary plexus. Flow density and parameters related to the foveal avascular zone were compared between Coats eyes and fellow eyes, and between fellow eyes and control eyes. Additional subanalyses investigated changes based on disease stage.Flow density did not differ between fellow eyes of Coats disease patients and control eyes in any of the parameters investigated. Comparison of Coats eyes to their respective fellow eyes revealed Coats disease to be associated with lower flow density in superficial, deep, and choriocapillary capillary plexus regions, irrespective of disease stage (all P < 0.03). There were no noticeable differences regarding the size or symmetry of the foveal avascular zone.In light of the recent discussion around the unilateral character of Coats disease, this trial provides evidence against a bilateral presentation of vascular changes in the macula.
Zusammenfassung Epiretinale Membranen (ERM) sind ein häufig auftretender Untersuchungsbefund bei Patienten mit steigendem Alter. Diagnostik und Therapie der ERM haben sich in den letzten Jahren aufgrund des technischen Fortschritts in der ophthalmologischen Versorgung stark gewandelt. Kohärenztomografische Untersuchungen erlauben die exakte Darstellung von ERM und haben zum wachsenden Verständnis um die Pathophysiologie dieses komplexen Krankheitsbildes beigetragen. Die hier durchgeführte Literaturrecherche fasst kürzliche Neuerungen in Diagnostik, Klassifikation und Therapie der idiopathischen ERM zusammen und geht insbesondere auf neuartige Biomarker in der optischen Kohärenztomografie (OCT) ein, welche die Erstellung von Prognosen bez. des klinischen, postoperativen Outcomes ermöglichen.
