Bilateral Acute Macular Neuroretinopathy (AMN) after COVID-19 and its Clinical Course. / Bilaterale akute makuläre Neuroretinopathie (AMN) nach COVID-19 und Verlauf.

Acute macular neuroretinopathy (AMN) is a rare disease entity. It is mainly observed in young women with a history of influenza-like infection or who have been taking oral contraceptives for several years. Patients typically describe subjective visual deterioration and mono- or bilateral paracentral relative scotomas. In some cases, funduscopic ophthalmic examination may reveal subtle sharply demarcated flat lesions of reddish-brown or orange colour in the macular region. Diagnosis is usually made by near-infrared fundus imaging which shows hyporeflective areas, and SD-OCT imaging which manifests changes in the outer retinal layers. In the following, three patient cases with bilateral AMN are described which occurred in direct temporal relationship to a recent SARS-CoV-2 infection.

Applications of Artificial Intelligence in Optical Coherence Tomography Angiography Imaging.

Optical coherence tomography angiography (OCTA) and artificial intelligence (AI) are two emerging fields that complement each other. OCTA enables the noninvasive, in vivo, 3D visualization of retinal blood flow with a micrometer resolution, which has been impossible with other imaging modalities. As it does not need dye-based injections, it is also a safer procedure for patients. AI has excited great interest in many fields of daily life, by enabling automatic processing of huge amounts of data with a performance that greatly surpasses previous algorithms. It has been used in many breakthrough studies in recent years, such as the finding that AlphaGo can beat humans in the strategic board game of Go. This paper will give a short introduction into both fields and will then explore the manifold applications of AI in OCTA imaging that have been presented in the recent years. These range from signal generation over signal enhancement to interpretation tasks like segmentation and classification. In all these areas, AI-based algorithms have achieved state-of-the-art performance that has the potential to improve standard care in ophthalmology when integrated into the daily clinical routine.

Are There Static-Structural Biomarkers for Glaucoma with OCT? / Gibt es statisch-strukturelle Biomarker bei den Glaukomen mit der OCT?

Glaucomas lead to uniform, specific and slowly developing atrophy of the optic nerve with progressing visual field defects in late stages. Early diagnosis is challenging, but necessary as optic nerve damage is irreparable. Biomarkers with structural optical coherence tomography (OCT) flag optic atrophy but do not prove to be specific in the differential diagnosis to other forms of optic atrophy. Combination of OCT parameters and their correlation to other variables facilitate glaucoma diagnosis. Use of artificial intelligence (AI) in structural OCT images may prove to be superior and as biomarker more specific to thickness measurements of neuronal tissues alone.

OCT Angiography as an Interdisciplinary Diagnostic Tool for Systemic Diseases. / OCT-Angiografie als interdisziplinäres Diagnostikum für Systemerkrankungen.

In recent years, OCT angiography (OCT-A) has emerged as a well established imaging modality of the retina. This allows non-invasive visualisation of the retinal circulation at a micrometre scale in eye disorders and systemic diseases with potential ocular involvement. This review summarises the current state of this topic.

[Clinical Decision Making for Treatment of Diabetic Macular Oedema with DEX Implant: a Consensus Paper]. / Klinische Entscheidungsfindung bei der Behandlung des diabetischen Makulaödems mit DEX-Implantat: ein Konsenspapier.

BACKGROUND: Currently two intravitreally applied corticosteroids (dexamethasone and fluocinolone) are licensed in Germany for treatment of diabetic macular oedema (DME). The use of DEX implant for DME in daily clinical practice has not been defined in detail. Following a Delphi panel survey, a group of retina experts set out to come up with a consensus for use of the DEX implant in DME. MATERIAL AND METHODS: International and national treatment recommendations were identified from the literature. A steering group generated a catalogue of 72 statements on the aetiology and pathogenesis of DME, therapy with DEX implant, use of DEX implant in patients previously treated with VEGF-inhibitors, use of DEX implant in combination therapy, safety of DME therapies as well as patients' burden of treatment. Twenty-two ophthalmologists from private practice and 6 hospital ophthalmologists participated in the Delphi panel via Survey Monkey. Consensus was reached if at least 75% of participants agreed or disagreed with a statement. Statements for which consensus was not reached were discussed once more during the expert consensus meeting and a vote was taken. Based on these results a treatment algorithm for foveal DME was proposed. RESULTS: If a patient does not show sufficient response after 3 - 6 months of anti-VEGF treatment (visual acuity gain of < 5 ETDRS letters or reduction of central retinal thickness ≤ 20%), a switch to DEX implant should take place. DEX implant is also suitable in eyes with longer presentation of DME, showing e.g. massive lipid exudates. DEX implant is suitable as first-line therapy especially in pseudophakic patients, patients unwilling or able to comply with tight anti-VEGF injection intervals or patients with known vascular diseases. With fixed control visits every 4 - 8 weeks, use of DEX implant is flexible and individual. Decision parameters for repeated use should be visual acuity, retinal thickness and intraocular pressure. Treatment of both eyes on the same day should not take place. CONCLUSION: The algorithm presented reflects survey as well as expert discussion results and may differ from recommendations issued by the German professional society. The consensus recommendations for the treatment of DME generated during the survey and meeting of retina experts are intended to guide use of DEX implant in daily practice.

[Retinal nerve fiber layer thickness measurements with optical coherence tomography in glaucoma patients and healthy controls]. / Schichtdickenmessungen der retinalen Nervenfaserschicht mit optischer Kohärenztomografie bei Glaukompatienten und Gesunden.

Thickness measurements of the retinal nerve fiber layer in glaucomas have become an important tool for diagnosis and follow-up of progression. High image resolution and advanced evaluation algorithms led to this achievement. In the following OCT anatomy, imaging technique, normative values, monitoring of progression and the influence of artefacts on OCT measurements are matter of discussion. Knowledge of capabilities and pitfalls of RNF imaging with OCT should help to integrate this technique into daily patient routine.

[26 Years of the Erlangen Glaucoma Registry: Demographic and Perimetric Characteristics of Patients Through the Ages]. / 26 Jahre Erlanger Glaukomregister: demografische und perimetrische Charakteristika der Patienten im Wandel der Zeit.

BACKGROUND: The history of the Erlangen Glaucoma Registry goes back 26 years. In this study, we present retrospective demographic and perimetric data on the initial visit of patients with ocular hypertension (OHT), pre-perimetric (prePOAG) and perimetric primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) and secondary open-angle glaucoma (SOAG) and correlate these results with the latest perimetric data. MATERIAL AND METHODS: 1406 (754 patients) of the Erlangen Glaucoma Registry (EGR; NTC00494923) were investigated retrospectively between 1991 and 2016 covering: demographic data (age, visual acuity, intraocular pressure [IOP]), diagnosis and perimetric characteristics (mean defect [MD], loss variance [LV]) at the initial visit and the latest perimetric data. RESULTS: (1) 558 eyes of OHT, 347 prePOWG, 236 POAG, 161 NTG and 104 SOWG were recruited in the Erlangen Glaucoma Registry between 1991 and 2007. (2) The initial age was significantly lower for OHT (43.79 ± 13.64) than for perimetric open-angle glaucoma (NTG: 54.46 ± 11.41, p < 0.001; POAG: 54.00 ± 11.27, p < 0.001; SOAG: 47.92 ± 12.37, p = 0.008). Patients with prePOAG (48.62 ± 11.98) were significantly younger than patients with POAG/SOAG (p < 0.001). (3) The best corrected visual acuity was better for OHT (1.04 ± 0.14, p < 0.001) and prePOAG (1.05 ± 0.15, p < 0.001) than for POAG (0.95 ± 0.16), SOAG (0.93 ± 0.23) and NTG (0.93 ± 0.18). (4) Initial IOP was significantly higher for OHT (19.08 ± 2.25 mmHg), prePOAG (19.18 ± 3.90 mmHg), POAG (18.29 ± 4.11 mmHg) and SOAG (18.57 ± 5.34 mmHg) than for NTG (15.23 ± 2.83 mmHg, p < 0.001). (5) Since 1991, increasing numbers of patients with POAG and SOAG were seen at the initial visit. (6) Trend for MD and LV between 1991 and 2016: a trend for increasing MD at the initial visit was detected for prePOAG and POAG, yet OHT, NTG and SOAG showed a decreasing trend for MD at the initial visit. All patient groups showed perimetric progression. CONCLUSION: Since its start in 1991, the patients of the Erlangen Glaucoma Registry exhibited perimetric progression up to the year 2016, although antiglaucomatous therapy was re-evaluated and optimised if target IOP was not achieved.