[Work in progress: adaptation of electronic medical records to the requirements of a university eye clinic : Individual extensions of the software "FIDUS" at the Department of Ophthalmology of the Saarland University Medical Center UKS]. / Work in Progress: Anpassung der elektronischen Patientenakte an die Anforderungen einer Universitätsaugenklinik : Individuelle Erweiterungen der Software "FIDUS" an der Klinik für Augenheilkunde am Universitätsklinikum des Saarlandes UKS.

BACKGROUND: The implementation of electronic medical records (EMR) in the Department of Ophthalmology at the Saarland University Medical Center (UKS) in January 2016 was a timely response to growing documentation requirements and rapidly increasing electronic diagnostic data. The software system was primarily developed for private practices and cannot therefore meet the different requirements of various clinics out of the box. The purpose of this study was to identify features of the EMR beyond purely paper replacement that can assist in the clinical workflow and whether these features can be implemented in a running system. METHODS: The EMR was specifically individualized with respect to the work processes and documentation requirements of the Department of Ophthalmology at the UKS. In addition to a seamless integration into the hospital information system (HIS) the modifications included changes in the structure and visual presentation of the EMR as well as functional extensions. An internet-based platform was set up to enable a direct exchange of appointments and patient data with specialist practices. RESULTS: Due to the introduction of a so-called ghost list the position of patients within the hospital who are allocated to a physician, e.g. for diagnostics, can be reconstructed at any point in time. The logging of the individual treatment times enables tracking of patient flow within the clinic and a reduction of waiting times. Existing paper documents particularly for the graphic recording of findings, such as sketches, are digitalized eliminating the need to scan documents. The UKS.AUGEN.NETZ is an internet-based portal to facilitate direct organization of appointments with specialist practitioners and for the exchange of digital examination data and medical correspondence. CONCLUSION: The permanent close cooperation between employees of the Department of Ophthalmology at the UKS and the manufacturer of the software enables a continuous optimization of the EMR in a fully operational clinical workflow. In addition, the web-based interface improves the cooperation between the hospital and private practices.

[Muraine sutures accelerate healing of corneal hydrops in acute keratotorus]. / Muraine-Nähte beschleunigen die Abheilung des Hydrops corneae bei akutem Keratotorus.

We report on a 52-year-old male patient presenting with unilateral loss of vision of one week's duration. Pellucid marginal corneal degeneration was known. Slit lamp examination showed pronounced corneal edema as defined by acute corneal hydrops. After inferior preventive YAG iridotomy through clear cornea, intracameral air injection was performed. Deep stromal 10-0 nylon sutures were applied along the Descemet's membrane tear. The next day, the corneal edema had already begun to decrease.

Anatomy-based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach descemet membrane endothelial keratoplasty.

Use of Descemet Membrane Endothelial Keratoplasty (DMEK) has been limited because of problems with donor preparation, i.e. tearing of the Descemet membrane and difficulties in unfolding the Endothelium-Descemet-Membrane-Layer (EDML) in the anterior chamber (AC). The purpose of this work was to describe a novel approach to teaching anatomy-based donor and recipient preparation in a DMEK-Wetlab. We teach successful mono-manual donor preparation of human corneas in organ culture not suitable for transplantation, including peripheral markers for orientation. We also teach safe recipient preparation in a freshly-enucleated pig eye in organ culture preservation medium for atraumatic introduction of the EDML roll into the AC, reliable orientation of the EDML during surgery, and stepwise unfolding within the AC. Twenty-two candidates in the 1. Homburg Cornea Curriculum HCC 2015 who practiced both preparations using three human donor corneas and three pig eyes assessed the procedure as follows: (1) overall grade of the Wetlab 1.4 (median 1, range 1 to 2 - on a scale from 1 (excellent) to 6 (terrible); (2) most participants and tutors stated that the Wetlab is most effective for colleagues who have some previous experience with corneal microsurgery. Our novel anatomy-based approach to simulating donor preparation and graft implantation for DMEK seems to meet the expectations and requirements of colleagues with previous experience in corneal microsurgery and will help to reduce the rate of complications for incipient DMEK surgeons in the future. Clin. Anat. 31:16-27, 2018. © 2017 Wiley Periodicals, Inc.

[Ultrasound biomicroscopy in giant cell arteritis]. / Ultraschallbiomikroskopie bei Riesenzellarteriitis.

Giant cell arteritis may lead to irreversible blindness due to an anterior ischemic optic neuropathy or central retinal artery occlusion. Diagnosis of the giant cell arteritis is sometimes a problem: Difficulties may arise since a negative biopsy can not rule out the diagnosis. This case report demonstrates acute changes in the temporal artery as demonstrated by Ultrasound Biomicroscopy and documents its course during therapy with corticosteroids.

[Per aspera ad astra: implementation of electronic patient records in a university eye hospital : Experience with FIDUS in the Clinic for Ophthalmology at the Saarland University Medical Center UKS]. / Per aspera ad astra: Einführung einer elektronischen Patientenakte an einer Universitätsaugenklinik : Erfahrungen mit "FIDUS" in der Klinik für Augenheilkunde am Universitätsklinikum des Saarlandes UKS.

BACKGROUND: For more than 60 years patient records of the Department of Ophthalmology at the Saarland Medical Center in Homburg were documented on handwritten paper documents and filed in archives. Increasing requirements for medical documentation, exploding volumes of diagnostic data, overcrowded archives and unavailable files when needed, were the essential rationales for the implementation of an electronic patient archive (EPA). METHODS: The EPA has been specifically adapted to the requirements of the Department of Ophthalmology in order to guarantee a standardized unobstructed documentation and patient care across all sections of the department. Seamless integration into the clinic information system (KIS) and network-compatible diagnostic software were essential as well as a timely digitization of existing paper charts. Decisive factors for using FIDUS (Arztservice Wente GmbH, Darmstadt, Germany) as the EPA software were the visual layout of the EPA, user friendliness and reference installations of the software in other ophthalmology departments. RESULTS: After one and a half years of meticulous preparation with specific adaptations to the requirements of our department, the EPA was finally implemented in January 2016 and since then we have been working on improvements. The EPA software retrieves basic patient data from the KIS and diagnostic data from electronic devices via various interfaces. Expenses for printers could be reduced but computer workplaces had to be expanded or newly created. For previous patients paper files are digitized externally and stored in an electronic archive directly accessible from the EPA. DISCUSSION: Successful reorganization and implementation of electronic documentation during clinical routine is feasible with careful preparation and timely involvement of information technology experts, motivated physicians, nurses, research departments and the administration.

[Effect of Morphological and Functional Parameters on Ocular Pulse Amplitudes: An Analysis in Ocular Hypertension and Different Types of Glaucoma]. / Der Einfluss von morphologischen und funktionellen Parametern auf die okuläre Pulsamplitude: eine Analyse bei verschiedenen Glaukomformen und okulärer Hypertension.

Background and Purpose: Ocular blood flow imbalance and the loss of autoregulation are widely believed to be important factors in the pathogenesis of glaucoma. The purpose of this study was to investigate the impact of morphometric and functional changes on ocular pulse amplitude (OPA) in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), pseudoexfoliation-glaucoma (PEX) and ocular hypertension (OHT). Patients and Methods: This prospective study included 172 patients with manifest glaucoma and OHT. All patients were examined with dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT), Heidelberg retina tomography II (HRT), and Octopus visual field analysis (program 30II). In order to identify potential determinants of OPA, a generalised linear model (GLM) analysis was defined. As effect sizes, we included gender as a factor and intraocular pressure (measured by DCT [IOP]), optic disc area, cup area, mean deviation (MD), central corneal thickness (CCT), cup-disc ratio (CDR), and patient age as covariates. Results: Mean OPA was lower in patients with NTG than in other groups. In the generalised linear model in the entire population, a larger OPA was associated with a larger IOP and female gender. In the NTG group, we did not identify effect sizes, whereas, in the OHT group, IOP (measured with DCT) and MD, in the POAG group IOP (measured with DCT) and gender and in the PEX group MD and gender showed a positive effect on OPA. Conclusions: In this study, we showed that in the NTG group neither demographic nor morphological or functional factors affected OPA. However, in the OHT and POAG groups, OPA was influenced by IOP (measured with DCT), in the OHT and PEX group by MD and in the POAG and PEX groups by gender.

[Unusual course of a chalazion]. / Ungewöhnlicher Verlauf eines "Chalazions".

BACKGROUND: A chalazion is a benign, inflammatory tumor of the eyelid caused by an obstruction of the excretory duct of a meibomian gland. Usually a chalazion shows a slow painless and non-inflammatory progression. Interestingly, sinus infections can initially simulate chalazia by causing an orbital involvement with eyelid swelling. CASE REPORT: We report the case of a 15-year-old boy with frontal and ethmoidal sinusitis with inflammatory orbital infiltration and subacute eyelid swelling. The cerebral imaging showed an encapsulated brain abscess so that an urgent surgical removal of the abscess cavity was indicated. After several neurosurgical procedures a complete remission of the abscess could be achieved. In spite of the large abscess in the frontal lobe the boy never showed any neurological or psychiatric symptoms. CONCLUSION: In atypical courses of a chalazion the clinical picture requires further diagnosis including evaluation and imaging in otorhinolaryngology and neurology.

[Unclear deterioration of vision after renal transplant]. / Unklare Visusminderung nach Nierentransplantation.

A 27-year-old female patient reported a variable but unsatisfactory visual acuity which had persisted for several years. The patient had been dependent on dialysis from the age of 14 years old and from then on also needed a hearing aid. A kidney had been transplanted 5 years ago. The diagnosis was anterior lenticonus due to Alport syndrome.

Mapping the agonist-binding site of GABAB type 1 subunit sheds light on the activation process of GABAB receptors.

The gamma-amino-n-butyric acid type B (GABA(B)) receptor is composed of two subunits, GABA(B)1 and GABA(B)2, belonging to the family 3 heptahelix receptors. These proteins possess two domains, a seven transmembrane core and an extracellular domain containing the agonist binding site. This binding domain is likely to fold like bacterial periplasmic binding proteins that are constituted of two lobes that close upon ligand binding. Here, using molecular modeling and site-directed mutagenesis, we have identified residues in the GABA(B)1 subunit that are critical for agonist binding and activation of the heteromeric receptor. Our data suggest that two residues (Ser(246) and Asp(471)) located within lobe I form H bonds and a salt bridge with carboxylic and amino groups of GABA, respectively, demonstrating the pivotal role of lobe I in agonist binding. Interestingly, our data also suggest that a residue within lobe II (Tyr(366)) interacts with the agonists in a closed form model of the binding domain, and its mutation into Ala converts the agonist baclofen into an antagonist. These data demonstrate the pivotal role played by the GABA(B)1 subunit in the activation of the heteromeric GABA(B) receptor and are consistent with the idea that a closed state of the binding domain of family 3 receptors is required for their activation.