[Incidence of retinal vein occlusion during the football World Cup in 2014 : A database analysis]. / Inzidenz von Zentralvenen- und Venenastverschlüssen während der Fußballweltmeisterschaft 2014 : Eine Datenbankanalyse.

BACKGROUND: The association between cardiovascular events, such as acute coronary syndrome and emotional triggers, such as football world cups is well-known. Significant differences could sometimes be identified depending on the country of origin and design of the study. From an ophthalmological perspective the correlation between pre-existing cardiovascular diseases and retinal angiopathy is well-known. This study investigated whether the incidence of retinal vein occlusion (RVO) at a German university eye clinic increased during and 4 weeks after the 2014 football World Cup. METHODS: From the electronic files of almost 290,000 patients contained in the Smart Eye database, those with RVO during and 4 weeks after the 2014 football World Cup (from 12 June to 13 August 2014) and during the same time period in 2013 could be identified. Demographic data, visual acuity, intraocular pressure (IOP) and laboratory parameters were extracted and compared, when available. RESULTS: From 10 male (average age 68 years) and 8 female (average age 62 years) a total of 9 central RVO (CRVO), 8 branch RVO (BRVO) and 1 hemi-CRVO were identified in 2013 with a visual acuity ranging from 0.05 to 0.9 (average 0.39) and an IOP from 12 mmHg to 25 mmHg (average 16 mmHg). In 2014 a total of 26 patients (11 male average age 67 years and 15 female average age 76 years) were identified, an increase of 69 % (15 CRVO, 6 BRVO and 5 hemi-CRVO). The visual acuity ranged from 0.05 to 1.0 (average 0.63) and the IOP from 8 mmHg to 24 mmHg (average 15 mmHg). CONCLUSION: Due to the high comparability of the patient collectives an increase of RVO during and 4 weeks after the 2014 football World Cup could be identified, compared to the same period in 2013. It can be assumed that emotional strain caused by a World Cup is a risk factor. Data from other centers have to be assessed in order to be able to make a more general statement.

[Smart eye data : Development of a foundation for medical research using Smart Data applications]. / "Smart eye data" : Entwicklung eines Fundaments für medizinische Forschung mittels Smart-Data-Applikationen.

BACKGROUND: Smart Data means intelligent data accumulation and the evaluation of large data sets. This is particularly important in ophthalmology as more and more data are being created. Increasing knowledge and personalized therapies are expected by combining clinical data from electronic health records (EHR) with measurement data. OBJECTIVE: In this study we investigated the possibilities to consolidate data from measurement devices and clinical data in a data warehouse (DW). MATERIAL AND METHODS: An EHR was adjusted to the needs of ophthalmology and the contents of referral letters were extracted. The data were imported into a DW overnight. Measuring devices were connected to the EHR by an HL7 standard interface and the use of a picture archiving and communications system (PACS). Data were exported from the review software using a self-developed software. For data analysis the software was modified to the specific requirements of ophthalmology. RESULTS: In the EHR 12 graphical user interfaces were created and the data from 32,234 referral letters were extracted. A total of 23 diagnostic devices could be linked to the PACS and 85,114 optical coherence tomography (OCT) scans, 19,098 measurements from IOLMaster as well as 5,425 pentacam examinations were imported into the DW including over 300,000 patients. Data discovery software was modified providing filtering methods. CONCLUSION: By building a DW a foundation for clinical and epidemiological studies could be implemented. In the future, decision support systems and strategies for personalized therapies can be based on such a database.

[Development of an ophthalmological clinical information system for inpatient eye clinics]. / Entwicklung eines augenärztlichen klinischen Informationssystems für bettenführende Augenkliniken.

BACKGROUND: In times of increased digitalization in healthcare, departments of ophthalmology are faced with the challenge of introducing electronic clinical health records (EHR); however, specialized software for ophthalmology is not available with most major EHR sytems. The aim of this project was to create specific ophthalmological user interfaces for large inpatient eye care providers within a hospitalwide EHR. Additionally the integration of ophthalmic imaging systems, scheduling and surgical documentation should be achieved. MATERIAL AND METHODS: The existing EHR i.s.h.med (Siemens, Germany) was modified using advanced business application programming (ABAP) language to create specific ophthalmological user interfaces for reproduction and moreover optimization of the clinical workflow. RESULTS: A user interface for documentation of ambulatory patients with eight tabs was designed. From June 2013 to October 2014 a total of 61,551 patient contact details were documented. For surgical documentation a separate user interface was set up. Digital clinical orders for documentation of registration and scheduling of operations user interfaces were also set up. A direct integration of ophthalmic imaging modalities could be established. CONCLUSION: An ophthalmologist-orientated EHR for outpatient and surgical documentation for inpatient clinics was created and successfully implemented. By incorporation of imaging procedures the foundation of future smart/big data analyses was created.

[Anti-VEGF treatment for retinal angiomatous proliferation]. / Intravitreale Anti-VEGF-Behandlung retinaler angiomatöser Proliferationen.

BACKGROUND: Retinal angiomatous proliferation (RAP) is a subform of neovascular age-related macular degeneration (AMD), which is characterized by a particularly poor prognosis. The aim of this study is to describe the loading phase and maintenance phase for RAP during intravitreal anti-VEGF treatment. MATERIAL AND METHODS: A total of 82 eyes in 82 patients with RAP stages 1-3 were treated during upload therapy with repeated intravitreal injections of 1.25 mg bevacizumab at intervals of 4 weeks until the retinal edema resolved. Baseline examination included measurement of the best corrected distance visual acuity (ETDRS chart), central retinal thickness using optical coherence tomography (OCT), and fluorescein angiography (FLA). During maintenance therapy, the patients' distance visual acuity was monitored at 4- to 12-week intervals and OCT or FLA performed if needed. The average follow-up was 7.4 months (SD 4.2). Treatment with intravitreal anti-VEGF therapy was repeated if there was evidence of sub- or intraretinal fluid with a decrease in visual acuity of 5 points or more, increase of the central retinal thickness of 100 microm or more on OCT, or subjective deterioration with verifiable sub- or intraretinal fluid. RESULTS: During upload therapy an improvement in visual acuity of an average of +5.1 letters (mean, n=82 eyes) was observed. During maintenance therapy it was initially possible to sustain this treatment effect. However, 5 months after loading therapy was concluded, a deterioration of -5.5 letters (mean, n=31) was evident in comparison with the end of loading therapy. During the further course deterioration continued (12-month follow-up: -8.6 letters, n=7). Recurrence occurred in 60% of the cases, on average 8 weeks after termination of loading therapy. During an observation period of 6 months (n=66) a total of 3.6 injections were necessary. CONCLUSIONS: Therapy with intravitreal anti-VEGF medications represents a treatment option for RAP, but in the long term the disease continues to progress accompanied by functional deterioration. We thus recommend that patients with RAP be monitored at 4-week intervals to permit early treatment of recurrence.

Staining and peeling of the internal limiting membrane using a fluorescent dye (Rhodamine 6 G).

AIM: To assess whether low concentrations of a fluorescent dye such as Rhodamine 6G would help the unaided human eye visualise the vitreous and the internal limiting membrane (ILM) under standard halogen illumination. MATERIAL/METHODS: The UV/Vis absorption (E) and fluorescence (I) spectra of Rhodamine 6G in water were measured and compared with Indocyanine Green (ICG). Surgery was performed in two rhesus monkeys and consisted of standard pars plana vitrectomy with halogen light source used for illumination. Rhodamine 6G was diluted in balanced salt solution (BSS). A few drops of the dye in a concentration of 0.1% (307 mOsm) were applied over the posterior pole in the air-filled globe and washed out by irrigation after 1 min. Immediately after surgery, the globes were enucleated, fixated and prepared for histological evaluation. RESULTS: In contrast to ICG, both the maximum of the absorption and emission of Rhodamin 6G are very much within the spectral sensitivity of the human eye. The Rhodamine 6G-BSS itself appears red in colour. Using a dye concentration of 0.1%, there was no visible red-staining of the ILM as such. As the dye was irrigated out with BSS, a marked green fluorescence of the fluid within the vitreous cavity was noted. With halogen illumination through a standard 20-gauge light pipe, the dye provided a sufficient green fluorescence to identify and safely remove the ILM and to clearly differentiate areas of peeled from non-peeled ILM. During light microscopy, eyes revealed a peeled ILM demarcation with no signs of acute retinal toxicity. CONCLUSION: The findings indicate that a fluorescent dye can be used for ILM peeling. Assuming that the fluorophore provides a high enough fluorescence quantum yield after adsorption to the ILM, much lower dye concentrations could be used compared with absorbent dyes, thereby minimising toxic effects.

Intravitreal bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion.

PURPOSE: To evaluate the effect of intravitreal bevacizumab (Avastin) injections on visual acuity (VA) and foveal retinal thickness in patients with macular oedema secondary to branch retinal vein occlusion. METHODS: A prospective, non-comparative, consecutive, interventional case series of 34 patients. Patients received repeated intravitreal injections of 1.25 mg bevacizumab. Main outcome measures were VA (Snellen charts and ETDRS) and retinal thickness (optical coherence tomography measurements) in a follow-up period of 6 months. RESULTS: Patients presented at a mean age of 69 years (range 44-86). Mean duration of symptoms was 40 weeks (range 1-300). Mean (SD) VA at baseline was 0.79 (0.39) logMAR, improving to 0.51 (0.34) logMAR at 6 months (p = 0.009). Mean number of letters on the ETDRS chart at baseline was 45.3 (19.0), improving to 60.6 (19.9) at 6 months (p = 0.003). Mean (SD) retinal thickness at baseline was 474 (120) microm, declining to 316 (41) microm at 6 months. CONCLUSION: Intravitreal injection of 1.25 mg bevacizumb appears to be an effective treatment option for branch retinal vein occlusion.

The fate of early experience following developmental change: longitudinal approaches to individual adaptation in childhood.

2 strategies were used to investigate the continued impact of early experience and adaptation given subsequent experience and/or developmental change in a poverty sample (N = 190). Groups were defined whose adaptation was similar during the preschool years but consistently different earlier; then these 2 groups were compared in elementary school. In addition, a series of regression analyses was performed in which variance accounted for by near-in or contemporary predictors of adaptation in middle childhood was removed before adding earlier adaptation in subsequent steps. Children showing positive adaptation in the infant/toddler period showed greater rebound in the elementary school years, despite poor functioning in the preschool period. Regression analyses revealed some incremental power of early predictors with intermediate predictors removed. The results were interpreted as supporting Bowlby's thesis that adaptation is always a product of both developmental history and current circumstances. While this research cannot resolve such a complicated issue, it does point to the need for complex formulations to guide research on individual development.