[Digital teaching 2020: Online teaching receives a better assessment than face-to-face teaching]. / Digitale Lehre 2020: Online-Unterricht erhält bessere Bewertung als Präsenzunterricht.

BACKGROUND: Due to the corona pandemic, face-to-face teaching was no longer permitted in the summer semester 2020 and online alternatives were quickly found. OBJECTIVE: In our article, we illustrate the switch from face-to-face to online teaching in ophthalmology at the University of Lübeck and compare online teaching with face-to-face teaching. METHODS: The central teaching evaluation takes place every semester with a standardized questionnaire. Based on the evaluation of these questions, a direct comparison of the attendance semester of the winter semester 2019/2020 with the online semester of the summer semester 2020 was carried out. RESULTS: The structure (p = 0.003), the organization (p = 0.001), the resources made available (p = 0.034), the attendance of the lectures (p < 0.001) and further dates (p = 0.041), the increase in interest (p = 0.039) and learning (p = 0.001) were rated better in the online semester than in the face-to-face semester. Overall, the digital summer semester 2020 (p < 0.01) received a significantly better overall grade than the face-to-face semester in winter 2019/2020. CONCLUSION: The structure of our courses has also been proven online. The theoretical content could be excellently mediated; however, practical exercises are not possible online. For the learning of practical skills, face-to-face instruction is still necessary.

[Digital teaching 2020: students assess attention during an online lecture as equivalent to a face-to-face lecture]. / Digitale Lehre 2020: Studenten schätzen die Aufmerksamkeit während einer Onlinevorlesung gleichwertig zu einer Präsenzvorlesung ein.

BACKGROUND: The corona pandemic has led to short-term adjustments of the procedures in medical courses. In many departments classroom teaching was no longer possible so that it was necessary to implement digital courses to provide an adequate medical training. METHODS: We developed a digital curriculum based on the contents of our established courses using primary in-house tools, such as Cisco WebEx and Moodle. We then performed a student survey to evaluate the implementation of the concept. RESULTS: The evaluation showed good ratings according to teaching content and didactics. The communication with the students and between each other was also considered good. Students assessed attention during the course to be equivalent in comparison to classroom teaching. As expected, the training of practical skills was evaluated as poor. For future courses most of the students could imagine a combination of digital and classroom teaching. DISCUSSION: Implementing a digital course was a sudden challenge for students and tutors. With suitable software solutions and good communication, it is possible to adequately teach theoretical content via digital courses. Students assessed the digital training in most parts to be a good and an equivalent option compared to classroom teaching. A remaining problem is the lack of practical training.

Canaloplasty ab interno (AbiC) - 2-Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique. / Kanaloplastik ab interno (AbiC) ­ 2-Jahres-Ergebnisse einer neuen minimalinvasiven Glaukomchirurgie (MIGS)-Technik.

PURPOSE: The aim of this study is to evaluate the long-term efficacy of a novel minimally invasive glaucoma surgery technique (MIGS), Ab interno Canaloplasty (AbiC). MATERIAL AND METHODS: For this retrospective cohort study, we analysed the data of 25 eyes of 23 patients with open angle glaucoma who underwent an AbiC (6 eyes) or in case of an additional cataract, a combined cataract-AbiC procedure ("phacocanaloplasty ab interno", 19 eyes), respectively. Postoperatively, we investigated the intraocular pressure (IOP) and the number of still required IOP-lowering medication, as well as surgery-related complications. RESULTS: Overall, the mean baseline IOP of 20.24 mmHg ± 5.92 (n = 25) was reduced to 10.64 mmHg ± 2.77 (n = 25, p < 0.001), 12.55 mmHg ± 3.33 (n = 22, p < 0.001) and 13.67 mmHg ± 2.15 (n = 21, p < 0.001) at 1 day, 1 year and 2 year follow-up visit, respectively. Compared to baseline, this implies a reduction in IOP of 47.4, 37.9 and 32.5%. An average glaucoma medication usage of 1.92 ± 1.04 was registered at baseline visit and was reduced to 0,05 ± 0,23 after 2 years of follow-up. 80% of patients were off medication. In 5 eyes (20%) further antiglaucomatous eye drops or surgical treatment were administered. The only surgical complications were hyphema in 5 eyes (20%) and a localized peripheral detachment of the Descemet's membrane in one eye (4%) with no late sequelae. CONCLUSION: AbiC performed independently or combined with cataract surgery seems to be a safe and effective MIGS-technique with good long-term regulation of IOP and low risk profile.

Intraindividual comparison of Canaloplasty versus trabeculectomy with mitomycin C in a single-surgeon series.

PURPOSE: To compare the safety, efficacy, and postoperative management of canaloplasty in one eye versus trabeculectomy with mitomycin C in the contralateral eye in patients with open-angle glaucoma. METHODS: This study was a consecutive case series of 30 eyes of 15 patients who had prior trabeculectomy with mitomycin C (group II) and later were treated with canaloplasty (group I) in the fellow eye. Primary outcome measures included intraocular pressure (IOP) and glaucoma medication after 6- and 12-month follow-up. Secondary outcome measures were number of postoperative interventions, hospitalization, and follow-up visits. RESULTS: Mean preoperative IOP±SD was 26.73±6.4 mm Hg in group I and 26.3±10.9 mm Hg in group II (P=0.9), which decreased to 13.21±2.83 mm Hg for canaloplasty (P<0.0001) and 11.64±5.2 mm Hg for trabeculectomy (P<0.0005) including 3 patients with hypotony at 12 months. Glaucoma medication decreased from 2.5 in group I and 2.7 in group II to no medication in group I and 0.36±0.74 supplemental medication in group II 12 months postoperatively (P<0.0001). Best corrected visual acuity (±SD) was logMAR 0.06±0.09 (group I) and 0.28±0.56 (group II) before and logMAR 0.07±0.09 (group I) and 0.31±0.58 (group II) after surgery. In group I, 2 interventions were necessary. In group II, 8 eyes needed 112 interventions for filtering bleb management. Although canaloplasty took significantly longer to perform, trabeculectomy group required a longer initial postoperative hospitalization (mean 10.4 vs. 5.4 d, P<0.0001) and more postoperative follow-up visits (mean 3.9 vs. 8.5, P<0.001). CONCLUSIONS: Canaloplasty and trabeculectomy were both effective in lowering IOP. However, less follow-up visits and significantly fewer complications and interventions were favorable for canaloplasty.

Pars plana vitrectomy for diabetic macular edema. Internal limiting membrane delamination vs posterior hyaloid removal. A prospective randomized trial.

BACKGROUND: Diabetes mellitus, as well as subsequent ocular complications such as cystoid macular edema (CME), are of fundametal socio-economic relevance. Therefore, we evaluated the influence of internal limiting membrane (ILM) removal on longterm morphological and functional outcome in patients with diabetes mellitus (DM) type 2 and chronic CME without evident vitreomacular traction. METHOD: Forty eyes with attached posterior hyaloid were included in this prospective trial and randomized intraoperatively. Prior focal (n = 31) or panretinal (n = 25) laser coagulation was permitted. Group I (n = 19 patients) underwent surgical induction of posterior vitreous detachment (PVD), group II (n = 20 patients) PVD and removal of the ILM. Eleven patients with detached posterior hyaloid (group III) were not randomized, and ILM removal was performed. One eye had to be excluded from further analysis. Examinations included ETDRS best-corrected visual acuity (BCVA), fluorescein angiography (FLA) and OCT at baseline, 3 and 6 months postoperatively. Main outcome measure was BCVA at 6 months, secondary was foveal thickness. RESULTS: Mean BCVA over 6 months remained unchanged in 85% of patients of group II, and decreased in 53% of patients of group I. Results were not statistically significant different [group I: mean decrease log MAR 95% CI (0.06; 0.32), group II: (-0.02; 0.11)]. OCT revealed a significantly greater reduction of foveal thickness following PVD with ILM removal [group I: mean change: 95% CI (-208.95 µm; -78.05 µm), group II: (-80.90 µm: +59.17 µm)]. CONCLUSION: Vitrectomy, PVD with or without ILM removal does not improve vision in patients with DM type 2 and cystoid diabetic macular edema without evident vitreoretinal traction. ILM delamination shows improved morphological results, and appears to be beneficial in eyes with preexisting PVD.

Effect of various platelet preparations on retinal muller cells.

PURPOSE: Peeling of the internal limiting membrane is the treatment of choice for macular holes. Fresh platelet suspension (PS) is used to support wound healing in persistent macular holes. The concentration of growth factors in fresh, frozen, and thrombin-activated PSs were compared, to optimize their trophic potential and examine their capacity to support proliferation, migration, and contraction of human retinal Müller cells. METHODS: The concentration of various growth factors in frozen PS, thrombin-activated PS, and plasma were evaluated by ELISA. The effect of these preparations on proliferation, migration, and contraction of human Müller cells were evaluated with an ATP-assay, a colony-dispersion assay, and a detached collagen gel contraction assay respectively. Plasma was tested as a control. RESULTS: Frozen and thrombin-activated PSs contained significantly more EGF, TGF-beta1, and PDGF than did plasma. The highest concentrations of EGF and FGF were found in frozen PS. All platelet preparations and plasma supported cell growth significantly better than the control, which was serum-free culture medium. Müller cells migrated better when incubated with thrombin-activated PS than with any other test solution. Contraction was extremely strong after incubation with fresh PS compared with plasma or thrombin-activated or frozen PSs. CONCLUSIONS: Frozen and thrombin-activated PSs may be suitable alternatives to fresh PS for persisting macular holes, due to their superior effect on Müller cell migration.

Massive coats disease-like tumor after retinal detachment.

PURPOSE: To describe two patients with peripheral Coats disease-like tumor reaction years after surgical repair for rhegmatogenous retinal detachment. METHODS: Retrospective review of two clinical cases. RESULTS: Patient 1 presented with visual deterioration caused by a retinal angiomatous tumor and lipid exudates originating from telangiectatic vessels on the scleral buckle 8 years after vitrectomy and encircling band surgery for a giant retinal tear. In Patient 2, a vascularized retinal mass was detected during vitrectomy for a vitreous hemorrhage 24 years after scleral buckling procedures. Both patients were highly myopic and had no history of scleral perforation or angiomatous proliferation before surgery. They underwent vitrectomy and removal of the vascularized tumor. Histologic examination revealed wide lacunae filled with erythrocytes, connective tissue strands with inflammatory cells, and capillaries that showed thickened multilamellar basement membranes. CONCLUSION: Secondary Coats disease-like tumor reaction may occur as a late complication years after successful retinal detachment surgery and may be caused by a chronic ischemic and inflammatory stimulus induced by prominent buckling elements in highly myopic eyes.

Comparison of Cornea Module and DermaInspect for noninvasive imaging of ocular surface pathologies.

Minimally invasive imaging of ocular surface pathologies aims at securing clinical diagnosis without actual tissue probing. For this matter, confocal microscopy (Cornea Module) is in daily use in ophthalmic practice. Multiphoton microscopy is a new optical technique that enables high-resolution imaging and functional analysis of living tissues based on tissue autofluorescence. This study was set up to compare the potential of a multiphoton microscope (DermaInspect) to the Cornea Module. Ocular surface pathologies such as pterygia, papillomae, and nevi were investigated in vivo using the Cornea Module and imaged immediately after excision by DermaInspect. Two excitation wavelengths, fluorescence lifetime imaging and second-harmonic generation (SHG), were used to discriminate different tissue structures. Images were compared with the histopathological assessment of the samples. At wavelengths of 730 nm, multiphoton microscopy exclusively revealed cellular structures. Collagen fibrils were specifically demonstrated by second-harmonic generation. Measurements of fluorescent lifetimes enabled the highly specific detection of goblet cells, erythrocytes, and nevus-cell clusters. At the settings used, DermaInspect reaches higher resolutions than the Cornea Module and obtains additional structural information. The parallel detection of multiphoton excited autofluorescence and confocal imaging could expand the possibilities of minimally invasive investigation of the ocular surface toward functional analysis at higher resolutions.

Filtering bleb evaluation with slit-lamp-adapted 1310-nm optical coherence tomography.

PURPOSE: Investigation of slit-lamp-adapted 1310-nm optical coherence tomography (OCT) as an in vivo imaging device in the postoperative course of glaucoma surgery. METHODS: Postoperative images of filtering blebs and deep sclerectomies and their healing processes were qualitatively evaluated with a slit-lamp-adapted anterior segment OCT (AS-OCT; Heidelberg Engineering, Heidelberg, Germany) in 28 patients. Ophthalmologic examinations included slit-lamp examination, applanation tonometry, and slit-lamp photography. The OCT scans were qualitatively correlated with the morphologic and functional outcome of the filtering bleb. RESULTS: 1310-nm OCT was able to demonstrate the internal structure and the dimensions of filtering blebs, as well as the scleral flap and the deep sclerectomy location including Descemet membrane. Functioning filtering blebs showed a low OCT signal, small fluid-filled cysts, superficial microcystic layer, and a slack internal texture. High internal reflectivity indicated an earlier scarring of the filtering bleb. Nonfunctioning filtering blebs delivered a high OCT signal, no or few cysts, and a dense internal texture. These different OCT patterns correlated with the clinical outcome. CONCLUSIONS: Slit-lamp-adapted 1310-nm OCT allowed the noncontact observation and documentation of the postoperative healing course of filtering blebs after glaucoma surgery. Internal structures of the filtering bleb and deep sclerectomies could be visualized. Functioning and dysfunctioning filtering blebs delivered different OCT pattern and correlated with the clinical outcome. This could be a new way to assess the postoperative healing process with the possibility of earlier intervention in cases of impending scarring.

Anterior chamber angle measurement with optical coherence tomography: intraobserver and interobserver variability.

PURPOSE: To assess intraobserver and interobserver variability of anterior segment optical coherence tomography (AS-OCT) as an objective diagnostic tool to quantify the anterior chamber angle and opening width. SETTING: University Eye Clinic, Lübeck, Germany. METHODS: The anterior chamber angle and opening width were assessed in 18 eyes of 9 healthy volunteers by 2 observers. Intraobserver reproducibility was evaluated by calculating an intraclass correlation coefficient (ICC) in a mixed model. Each observer had a separate model using information from 5 scans. Interobserver variability was determined by Bland-Altman analysis. The ICC was calculated in a mixed model using a residual maximum likelihood method. The results of 3 and 5 repeated scans were evaluated to indicate the change to 1 measurement application. RESULTS: The mean anterior chamber angle measurement was 35.9 degrees +/- 5.7 (SD) for observer A and 36.2 +/- 5.7 degrees for observer B. The ICC was 0.94 and 0.91, respectively. The mean opening width was 315 +/- 62 microm for observer A and 317 +/- 60 microm for observer B. The ICC was 0.97 and 0.93, respectively. Interobserver comparisons showed a mean difference between anterior chamber angle measurements of -0.27 +/- 1.6 degrees, a limit of agreement (LOA) interval from -3.52 to 2.98 degrees, and an ICC estimate of 0.96. The mean difference in opening width measurements was 2.40 +/- 12.40 microm, the LOA from -27.20 to 22.40 microm, and the estimated ICC 0.96. Using 1 instead of the mean of 5 measurements, the LOA range increased by 3.46 degrees for the anterior chamber angle and 30.0 microm for the opening width. CONCLUSION: Anterior chamber angle and opening width measurements by OCT showed low intraobserver and interobserver variability, indicating OCT is a valuable technique for quantitative assessment that provides reproducible measurements and objective documentation by different examiners.

Intraoperative 2-dimensional optical coherence tomography as a new tool for anterior segment surgery.

We tested a 1310-nm optical coherence tomograph coupled with a beam splitter on the front lens of an operating microscope for intraoperative, noncontact visualization of anterior segment procedures. This new modification of optical coherence tomography technology allows intraoperative, high-resolution, cross-sectional imaging and pachymetry of the cornea and sclera during anterior segment surgery. It is particularly helpful for lamellar dissection techniques such as deep anterior lamellar keratoplasty and trabeculectomy.