[Advantages of a designated IVI center for a German university eye hospital]. / Vorteile eines separierten IVOM-Zentrums an einer deutschen Universitäts-Augenklinik.

BACKGROUND: Since 2016, a designated center for the intravitreal injections (IVI) has been established at the department of ophthalmology. Many aims had supported the project of moving IVIs from the main operations theater. This study aimed to assess the practicality and feasibility of such a move. METHODS: In this IVI center, only patients with macular diseases are treated. The premises are arranged directly next to each other. The standardized treatment process starts with registration. Parallel to the formalities, a refraction test is carried out. If necessary optical coherence tomography (OCT) is carried out and then a full eye examination is performed by a doctor. Afterwards, a specialist/consultant decides on the subsequent treatment strategy. The injection takes place in an adjacent standard designated operating room. Patients are handed the computer-generated discharge letters immediately after the procedure and further appointments are booked on discharge. RESULTS: Despite a 25% increase in the number of IVIs to more than 4000 IVIs per year over the last 2 years, advantages from the establishment of the designated center have resulted as follows: optimal care through precise treatment systems and shorter waiting times. From July to August 2018, 85% of voluntarily participating patients pressed the green or light green smiley face on the "HappyOrNot smiley terminal system". Pressure is taken off the regular outpatient macular consultation service, fixed and direct contact person, pressure is taken off the main operations theater with a significant increase in the diagnosis-related groups (DRG) revenues of 900,000 € and easily accessible database for statistical and scientific purposes. CONCLUSION: The designated center proved to be an extremely useful and beneficial one-stop center (IVI carrousel) for patients requiring IVI and macular consultations. It significantly released the pressure on both the outpatient department and the outpatient operation center.

Negative impact of dextran in organ culture media for pre-stripped tissue preservation on DMEK (Descemet membrane endothelial keratoplasty) outcome.

PURPOSE: To assess the morphological and functional outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed with pre-stripped tissue preserved in organ culture medium containing dextran compared to tissue preserved in dextran-free medium. METHODS: In this retrospective study, we reviewed the clinical records of 103 patients who underwent DMEK surgery with pre-stripped tissue in our department between June 2015 and September 2016. The endothelium-Descemet membrane layer was preserved in organ culture medium for a maximum of 48 h for all patients. For group 1, 49 endothelium-Descemet membrane (EDM) were stripped and preserved in medium 1 (dextran-free organ culture medium), while 54 EDM were stripped and preserved in medium 2 (organ culture medium supplemented with 6% dextran T-500) for group 2. Outcome measures included best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) of all eyes in both groups at three consecutive postoperative time points: 2 weeks, 6 weeks, and 6 months postoperatively. We also compared the repeat keratoplasty rates between the groups. RESULTS: Group 1 showed a statistically significant better BCVA compared to group 2 at each time point (p < 0.05). The percentage of grafts achieving 0.5 or better after 6 months in group 1 was 96% and in group 2, it was 66% (P < 0.001). CCT was significantly lower in group 1 compared to group 2 at 2 weeks and 6 months after surgery (p < 0.05). ECD was comparable between donor grafts before surgery but was significantly greater in groups 1 after 2 and 6 weeks (p < 0.05), but not after 6 months. Necessity for repeat keratoplasty (repeat DMEK, subsequent penetrating keratoplasty (PKP)) was significantly lower in group 1 (p < 0.05). CONCLUSIONS: Pre-stripped tissue for DMEK preserved in dextran-free medium led to better visual recovery, thinner postoperative corneas, a higher endothelial cell density, and a lower rate of repeat keratoplasty, indicating that dextran has an unfavorable impact on the preservation of pre-stripped DMEK tissue.

Comparison of 3 biometry devices in cataract patients.

PURPOSE: Accurate biometry is an obligatory preoperative measurement for refractive surgery as well as cataract surgery. A new device based on partial coherence interferometry was compared with 2 currently used biometry devices. SETTING: Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany. DESIGN: Prospective case series. METHODS: Eyes of cataract patients were examined with a functional prototype of the new optical low-coherence reflectometry (OLCR) biometer OA-2000, the standard OLCR biometer Lenstar, and the partial coherence interferometry (PCI) biometer IOLMaster. The results were compared using a Wilcoxon-Mann-Whitney U test and Pearson correlation calculations. RESULTS: A total of 138 eyes of 74 cataract patients were examined. Pearson correlation showed excellent correlation for axial length, anterior chamber depth and keratometry among the 3 devices tested. The highest correlation was found between standard OLCR biometer and PCI biometer for AL, R1, and R2 (r = 1.0, r = 0.936, r = 0.952, respectively; all P ≤ .001). For anterior chamber depth (ACD), the highest correlation was found between the standard OLCR biometer and the new OLCR biometer (r = 0.943; P ≤ .001). The mean values of AL/ACD/R1/R2 differed very little, but the differences were significant (all P ≤ .05) (new OLCR biometer 23.31/3.21/7.74/7.64 mm; standard OLCR biometer 23.30/3.13/7.80/7.60 mm; PCI biometer 23.37/3.00/7.78/7.6 mm). CONCLUSIONS: Compared with other clinical instruments, the new OLCR biometer generated the most accurate results. Differences especially in measurement of axial length were statistically but not clinically significant. The new OLCR biometer yielded results that correlated very well with the values of the PCI biometer and standard OLCR biometer. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

In Vivo Confocal Microscopic Imaging of the Cornea After Femtosecond and Excimer Laser-assisted Penetrating Keratoplasty.

PURPOSE: To examine the microstructure of the cornea after excimer and femtosecond laser-assisted penetrating keratoplasty (ELAK and FLAK) in eyes with Fuchs' dystrophy and keratoconus. METHODS: Fifty-seven patients were divided into four groups according to corneal disease and surgical technique: Fuchs' dystrophy and ELAK (n = 9; mean age: 70.4 ± 10.6 years); Fuchs' dystrophy and FLAK (n = 13; mean age: 64.3 ± 11.2 years); keratoconus and ELAK (n = 9; mean age: 47.4 ± 13.9 years); and keratoconus and FLAK (n = 9; mean age: 43.5 ± 13.8 years). The control group comprised individuals without ocular disease (n = 17; mean age: 39.9 ± 17.3 years). In vivo investigation of the corneal graft and graft-host junction zone was performed with confocal corneal microscopy. RESULTS: All corneal grafts were transparent and no rejection reaction could be observed during the follow-up period. Confocal microscopy revealed no difference in basal epithelial cell density compared to controls. Anterior keratocyte density was lower than in the control group (818 ± 131 cells/mm(2)) in all four treatment groups (596 ± 174, 586 ± 113, 529 ± 75, 552 ± 91 cells/mm(2)). Langerhans cells could barely be seen; there was no difference in the cutting edge configuration and wound integrity. CONCLUSIONS: In vivo confocal microscopy provided evidence that good alignment of graft-host junction could be created with both techniques. The excimer laser was not inferior to the femtosecond laser in performing corneal cuts. The low density of Langerhans cells revealed well-controlled cellular immunological response and sustained corneal integrity in both laser groups.