[Evaluation of a virtual reality simulator for learning direct ophthalmoscopy in student teaching]. / Evaluierung eines VR-Simulators zum Erlernen der direkten Ophthalmoskopie in der studentischen Lehre.

BACKGROUND: The use of direct ophthalmoscopy in non-ophthalmological specialties seems to be decreasing in the clinical routine. This could be due to a lack of training and thus an uncertain assessment. OBJECTIVE: The aim of this study was to evaluate the effectiveness and acceptance of learning direct ophthalmoscopy on a simulator in comparison to the classical teaching method among students. MATERIAL AND METHODS: Within the framework of the student block internship for ophthalmology, a total of 34 students took part in the project. The first group received classical training, the second group received simulator training. The learning success was assessed by an objective structured clinical examination (OSCE). RESULTS: The simulator training group showed a significantly higher points score in individual disciplines. The subjects in the classical group achieved a learning success in the OSCE of 78%. In the simulator-based group a higher score of 91% was achieved with a lower scatter in all subdisciplines. DISCUSSION: The patient and instructor-independent availability of the teaching materials, a reduction of light exposure for patients and test subjects, as well as a standardized and controlled mediation of physiological and pathological findings can be emphasized as advantages of the tested simulator. CONCLUSION: The simulator-based training for learning direct funduscopy is effective. The virtual reality simulator evaluated in this project can improve the training of students and residents.

[The German Acanthamoeba keratitis register: Initial results of a multicenter study]. / Das Deutsche Akanthamöbenkeratitis-Register : Erste Ergebnisse einer multizentrischen Erhebung.

BACKGROUND AND PURPOSE: In September 2011 the cornea section of the German Ophthalmological Society (DOG) established the first German Acanthamoeba keratitis registry. The data of this multicenter survey are being collected, compiled and evaluated at the Department of Ophthalmology at the Saarland University. The aim of this article is to present an intermediate report. PATIENTS AND METHODS: Data from 172 eyes with Acanthamoeba keratitis were collected during the last 10 years. For this interim report we actually evaluated 121 eyes (60.2 % female patients, average age 41.3 years) and collected the following data: date of onset of symptoms, date and method of diagnosis, initial diagnosis, anamnestic data, clinical symptoms and signs at diagnosis and during follow-up, conservative and surgical therapy. Criteria for inclusion in the Acanthamoeba registry was the established diagnosis of an Acanthamoeba keratitis with at least one of the methods described in this article. RESULTS: Acanthamoeba keratitis could be histologically proven in 55.3 % of the cases, via PCR in 25.6 %, with confocal microscopy in 20.4 % and using in vitro cultivation in 15.5 %. Clinical symptoms and signs in Acanthamoeba keratitis were pain in 67.0 %, ring infiltrates in 53.4 %, pseudodendritiform epitheliopathy in 11.7 % and keratoneuritis in 5.8 %. In 47.6 % of the cases the initial diagnosis was herpes simplex virus keratitis followed by bacterial keratitis in 25.2 % and fungal keratitis in 3.9 %. Acanthamoeba keratitis was the correct initial diagnosis in only 23.2 % of cases. The average time period between first symptoms and diagnosis was 2.8 ± 4.0 months (range 0-23 months). A triple therapy with Brolene® Lavasept® and antibiotic eye drops at least 5 ×/day was used in 54.5 % of eyes (n = 66). Penetrating keratoplasty was performed in 40.4 %, in 18 cases in combination with cryotherapy of the cornea. The mean graft diameter was 7.9 ± 1.1 mm (range 3.5-11.0 mm). The final visual acuity (Snellen visual acuity chart at 5 m) was comparable in the two groups of eyes with (5/40 ± 5/25) and without (5/32 ± 5/25) keratoplasty. CONCLUSION: Acanthamoeba keratitis is a rare and often very late diagnosed disease and two thirds of the cases were initially misdiagnosed. The early recognition of the typical symptoms is crucial for the prognosis of the disease. All ophthalmological departments in Germany are invited to submit further data of all confirmed cases (berthold.seitz@uks.eu), whether retrospectively or prospectively in order to generate an adequate standardized diagnostic and therapeutic approach for this potentially devastating disease.

[Clinical results of a multifocal pseudophakic additional lens]. / Klinische Ergebnisse einer multifokalen pseudophaken Zusatzlinse.

BACKGROUND: In order to meet the patients wish for compensation of presbyopia in a flexible way, even in cases of an already pseudophacic eye, sulcus-fixated additional intraocular lenses (IOL) have been developed as an alternative to multifocal IOLs (MIOL) in the capsular bag. This allows subsequent application of multifocal optics. Furthermore, these additional lenses offer a relatively simple opportunity for postoperative refractive fine tuning or, in cases of incompatibility, a minimally invasive explantation of the multifocal part of the optical system. PURPOSE: The objective of our work was the examination of a diffractive multifocal additional IOL and its functional characteristics. MATERIAL AND METHODS: In a prospective, monocentric trial 32 eyes of 21 patients had cataract surgery with implantation of a monofocal IOL into the capsular bag and simultaneous implantation of a multifocal additional IOL into the sulcus. The visual acuity was tested at different distances 6 weeks and 3 months postoperatively. At the 3 month follow-up contrast sensitivity and defocus curves were additionally assessed. Patients with bilateral implantation filled in a questionnaire to assess their subjective satisfaction of postoperative visual quality. RESULTS: All eyes had an uneventful postoperative course. At both follow-ups an uncorrected distance and near visual acuity (VA) of 0.2 LogMAR or better was achieved. In intermediate vision 29 out of 32 eyes after 6 weeks and 31 out of 32 eyes after 3 months reached an uncorrected VA of 0.2 LogMAR or better. The defocus curves showed a typical two-peaked shape. At intermediate distance (-1.5 D of defocus) the median VA was 0.35 LogMAR. Contrast sensitivity testing showed results in the upper region of the standard range of age-matched, healthy patients. DISCUSSION: The examined type of diffractive additional IOL achieved good to very good functional results, which are comparable to corresponding IOLs in the capsular bag. Multifocal additional IOLs can be considered as a useful extension of refractive surgical alternatives for the compensation of presbyopia. The possibility to implant the multifocal optic part independently of the primary surgery, the minimal invasivity of the procedure and the likewise time-independent reversibility can be pointed out as special qualities of these IOL.

Comparison of additional pseudophakic multifocal lenses and multifocal intraocular lens in the capsular bag.

AIMS: To compare the clinical results and the intraoperative and postoperative performance of an additional sulcus-fixated multifocal intraocular lens (IOL) with a conventional multifocal IOL implanted in the capsular bag. METHODS: In this prospective, randomised, monocentric study, the intraoperative and postoperative outcomes after implantation of an additional sulcus-fixated multifocal IOL (group A; 29 eyes) and a conventional, multifocal posterior chamber IOL (group B; 25 eyes) are compared. 1-year postoperatively, visual acuity, contrast sensitivity and defocus curve were determined. Patients implanted bilaterally with the same IOL filled in a questionnaire to assess patient satisfaction. RESULTS: Between the groups, only slight differences were found in visual acuity at all distances. All patients achieved an uncorrected distance visual acuity of 0.1 LogMAR or better and an uncorrected intermediate/near visual acuity of 0.3 LogMAR or better. Slightly better results in contrast sensitivity were achieved in group A at high spatial frequencies under almost all lighting conditions. Patient survey showed a higher degree of satisfaction of patients in group B, while a smaller proportion of group A stated to have disturbing light phenomena. CONCLUSIONS: Only small functional differences between the examined methods were found. Both types of multifocal IOL performed well at all distances. There were no intraoperative and postoperative complications in the add-on IOL group which affirms the high safety level such as with conventional multifocal IOL in the capsular bag.

Antibody response to pneumococcal polysaccharide vaccine in myasthenia gravis: effect of therapeutic plasmapheresis.

The removal of specific antibody in experimental animals has been reported to result in a subsequent increase in antibody to levels equal to (rebound) or exceeding those existing prior to removal (overshoot). Anecdotal reports suggest that rebound antibody synthesis after plasmapheresis may occur in humans with autoimmune disorders. We measured the antibody response to 12 pneumococcal polysaccharide antigens in patients with myasthenia gravis (MG) receiving a variety of therapies in order to determine whether the T-cell-independent IgG response to these antigens was augmented by plasmapheresis. MG patients receiving no immunotherapy or receiving prednisone had pre- and post-immunization titers similar to those of control patients. MG patients receiving prednisone and chronic plasmapheresis had higher pre-immunization titers than did other patient groups and had significantly higher post-immunization titers against multiple pneumococcal serogroups. Aggregate post-immunization geometric mean titers were more than three-fold higher in the plasmapheresis group as compared with other MG treatment groups. Enhancement of antibody response by plasmapheresis was abolished by the concomitant administration of azathioprine. Antibody rebound and overshoot after antibody removal may have important implications for the therapy of immune disorders by plasmapheresis.