[Prospective noninterventional BLUE SKY study evaluating the efficacy of brolucizumab in treatment-naïve and previously treated patients with neovascular AMD]. / Prospektive nichtinterventionelle BLUE SKY-Studie zur Beurteilung der Wirksamkeit von Brolucizumab bei unbehandelten und vorbehandelten Patienten mit neovaskulärer AMD.

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) is the standard treatment for patients with neovascular age-related macular degeneration (nAMD). In addition to the approved substances ranibizumab (Lucentis®, Novartis) and aflibercept (Eylea®, Bayer), bevacizumab (Avastin®, Roche) is also available. Furthermore, brolucizumab (Beovu®, Novartis) has been approved and has been available in Germany since April 2020. The multicenter, noninterventional prospective BLUE SKY study investigates brolucizumab treatment with different schemes in 600 treatment-naive and pretreated nAMD patients in routine clinical practice over a 24-month period. Besides general patient data, visual acuity and treatment data will be documented. Fluorescein angiography, fundus photography, spectral domain optical coherence tomography and swept-source optical coherence tomography angiography will be performed and analyzed by reading centers. The focus of the analysis will be on the intraretinal and subretinal fluid distribution as well as morphological MNV changes and injection frequency. Also, safety and adverse drug effects of brolucizumab, with a specific focus on inflammatory complications, particularly retinal (occlusive) vasculitis will be evaluated.

[Intraoperative OCT in ophthalmic microsurgery]. / Intraoperative OCT in der ophthalmologischen Mikrochirurgie.

Recent improvements in technology have enabled integration of SD-OCT into the optical path of an operating microscope. Here we present an overview of possible applications of iOCT (intraoperative optical coherence tomography) for retinal, glaucoma and corneal surgery. iOCT-based imaging can not only improve safety and quality of the surgery but also the learning curve of the surgeon. The ability to visualize barely visible or transparent structures with iOCT has achieved a significant added value intraoperatively, particularly in macular surgery, trabeculectomy and lamellar keratoplasty. Further, systematic assessment is warranted to define the usefulness of the iOCT more precisely.

[Stem cell therapy for retinal diseases]. / Stammzelltherapie für Netzhauterkrankungen.

BACKGROUND: Due to an ageing population the incidence and prevalence of retinal diseases and visual disabilities will continue to grow. A great number of patients would principally be able to benefit from a stem cell-based therapy. OBJECTIVES: To introduce readers to the terminology and current concepts associated with stem cell therapy in ocular research and to provide an overview of the current status of preclinical and clinical research. MATERIAL AND METHODS: We performed a systematic review of relevant entries on ocular stem cell therapy for retinal diseases in PubMed and ClinicalTrials.gov. Differences between various stem cell types are displayed systematically, followed by a discussion of preclinical studies. Translational aspects are highlighted leading to the first clinical trials, including surgical and ethical facets. RESULTS: In preclinical studies, photoreceptor cell precursors and retinal pigment epithelium (RPE) cells were differentiated and subretinally transplanted into animal models. Besides exclusion of a teratoma formation, some functional improvements were also observed. Intraocular transplantation of stem cell-derived RPE cells was the first successful clinical application of pluripotent stem cells in man. CONCLUSION: Promising results of preclinical and clinical studies have identified important challenges and confirmed the potential of stem cell therapy for ophthalmology.

[New options for digital photo documentation during routine examination for ophthalmologists]. / Neue Möglichkeiten der digitalen Fotodokumentation im klinischen Alltag für Augenärzte.

BACKGROUND: Many clinical investigations cannot be carried out at the examination unit or a slit lamp. Here we present three new options to obtain digital pictures in a routine clinic at a slit lamp and evaluate how user friendly they are. METHODS: A) First, a digital photo documentation is examined at a conventional slit lamp by a modified binocular ray splitter. One ray of the binocular ray splitter is connected to a digital camera, while the second ray in this patented prototype is connected to the light sources of a synchronised flash light. B) A Smartphone generated fundus images via the monocular of a microscope. Macroscopic details up to 60× at the external eye were obtained by a magnifying gadget of the iPhone. C) With a USB microscope, high resolutions pictures were generated without large technical expense directly at the job and digitally were archived over an USB connection. RESULTS: A trained ophthalmologist demonstrated an excellent documentation at a slit lamp using all 3 digital camera systems. The new ray splitter allows enhanced the image quality at the anterior and posterior segments of the eye. Also the Smartphone obtained by its autofocus and automatic exposure control stunningly high resolution images at the fundus. An attached magnifying aperture glass enables documentation with a 20-fold magnification and is already used in dermatology as the "Handyskope". The USB microscope may be used to record macroscopic details with a 200-fold magnification and resolution of 2 million pixels. It is connected to a PC desktop at the workstation and has only a limited depth resolution, requiring a precise focus. CONCLUSION: The increasing distribution of the Smartphone and significant improvement of its digital camera make its use in medicine meaningful. Low-priced attempts and mobile applications open new implications in the evaluation of ophthalmological patients.

[Smartphones in ophthalmology : Relief or toys for physicians?]. / Smartphones in der Augenheilkunde : Erleichterung oder Spielerei für den Augenarzt?

INTRODUCTION: Smartphones offer a number of so-called medical and ophthalmic "apps" and their use will be investigated in this survey. METHODS: An Internet analysis was performed to identify available medical "apps" and evaluate their utilization. Search engines, developers' websites and webstores were screened with key words such as: "smartphone", "medical apps" and "eye test". The "apps" were evaluated for usability and with respective published reviews. In addition, an international survey among ophthalmologists asked about the use of a Smartphone and "apps" preferences. Direct inquiries were undertaken with developers on selected promising novel "apps". RESULTS: The more than 70 identified "apps" examined were subdivided into different categories A) examining function, B) photo and video recordings, C) office, D) patient education and informed consent as well as E) medical continued education functions and literature searching. The survey determined the iPhone to be the most popular Smartphone among the sampled ophthalmologists worldwide. Many popular "apps" have become available only recently and hence suffer in part from some initial technical problems. Some ophthalmic "apps" are very helpful in the emergency room or during consultations. Only a few "apps" were approved as medical products and therefore cannot substitute a full ophthalmic examination. CONCLUSIONS: The increasing distribution of Smartphone "apps" in ophthalmology may have the potential to facilitate patient treatment, data management and communication.

[Healthcare "Apps" for Smartphones : Relief or toy for patients and the visual impaired?]. / Apps für Smartphones im Gesundheitsbereich : Erleichterung oder Spielerei für Patienten und Sehbehinderte?

INTRODUCTION: Among the more than 1,500 "Apps" in the health sector numerous medical "Apps" and "Apps" for visually impaired persons are available. METHODS: An Internet survey was performed to determine available medical "Apps" and evaluate their usability. The corresponding web pages were evaluated and the described "Apps" evaluated in a first analysis for the medical seriousness and usability. Identified "Apps" were entered again as key words to search for the most current and comprehensive assessment. In addition visual impaired persons possessing and using Smartphones were asked for their personal and subjective experiences and preference of selected "Apps". RESULTS: The more than 50 "Apps" examined can be subdivided into different categories (A) stand-alone "Apps" and (B) global positioning system (GPS) driven navigation"Apps". Many "Apps" have only been available for a short time, still having some initial technical problems and are presently under further development. Medical "Apps" can support healthy and visually impaired people in many healthcare areas. A barrier-free access to these new technologies is essential for an unhindered utilization of "Apps" by visually impaired persons. Many "Apps" developed by and for visual impaired people received a high acceptance and popularity in practical applications. CONCLUSION: The use of "Apps" in medical healthcare, especially for visually impaired persons, has a great potential to achieve a relief in the clinical provision for visually impaired persons with increasing distribution of smartphones and new technical developments.

[Complication cascade after hyperopic LASIK]. / Komplikationskaskade nach hyperoper LASIK.

This report concerns the case of a 28-year-old female patient who was treated with topical steroids for 2 years following complicated hyperopic LASIK surgery with a re-treatment including a re-lift of the flap. A steroid-induced rise in the intraocular pressure (IOP) was subsequently observed on the treated eye, together with a glaucomatous subtotal destruction of the optic nerve, resulting in a residual vision of 1/15. An erroneously low IOP measurement, which was probably the reason for the delay in detecting steroid-induced glaucoma, has been reported in several cases concerning LASIK patients. The reason for the unusually severe course in the case in question can only be presumed, namely a possible accumulation of fluid at the interface or altered biomechanics following hyperopic LASIK surgery. The need for a thorough postoperative examination following refractive surgery must be emphasized. This case shows a cascade of complications following hyperopic LASIK surgery resulting in the functional blindness of one eye.