The Impact of the First COVID-19 Lockdown Period on the Inpatient and Outpatient Volume of a University Based Tertiary Referral Center with Corneal Subspecialization in Germany

Background/Aims: To determine the impact of COVID-19 on the number of in- and outpatients surgical and diagnostic procedures performed at a southwestern German university hospital with corneal subspecialization. Methods: A retrospective examination of the number of inpatients, several outpatients subunits, in- and outpatient surgeries as well as diagnostic procedures at the Department of Ophthalmology, Saarland University Medical Centre during the COVID-19 pandemic “lockdown period” from 18 March until 8 May 2020 in comparison with the corresponding period in 2019 (source: SAP database and electronic patient record FIDUS). Results: The year 2020 showed a significant decrease in the number of inpatient surgeries with a total number of 285 vs 412 in 2019. However, the number of corneal transplantations increased significantly (60 in 2020 vs 54 in 2019, p=0.0089). In the various outpatient units of our department, we observed a significant decrease in the number of consultations (1.711 in 2020 vs 3.194 in 2019), especially for cataract surgery consultations (34 vs 137, p<0.0001). The number of outpatient surgeries was significantly reduced in 2020, especially for cataract surgery (64 vs 216, p=0.007) and intravitreal injections (577 vs 768, p<0.0001). Conclusion: Despite taking all the necessary precautions to ensure that our medical care can continue to be available reliably and completely safe during the “Corona lockdown period”, the number of in- and outpatient surgeries and the number of outpatient consultations decreased significantly. However, the number of corneal transplantations still increased

Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases

Purpose For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side efects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of various steroidal medication, the time of onset, and the efcacy of the administered IOP-lowering therapies. Methods We included 428 eyes with a postoperative (n=136), diabetic (n=148), uveitic macular edema (n=61), and macular edema after retinal vein occlusion (n=83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or subTenon (TMC ST), as well as dexamethasone (DXM) and fuocinolone acetonide (FA) intravitreally. An increase of IOP of≥25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the frst administration, and the therapy administered were documented. Results Of 428 eyes, 168 eyes (39.3%) had IOP elevation up to a mean of 29.7 (SD ±5.6) mmHg, which occurred at a median of 5.5 months. Steroids most frequently leading to rise of IOP included DXM (39.1% of all eyes receiving that drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). A Kaplan–Meier analysis and the Log Rank test showed a signifcant diference (p<0.001). IOP rise was treated as follows: 119 conservatively (70.8%), and 21 surgically (12.5%, cyclophotocoagulation 8.3%, fltering surgery 1.8%, in 4 the steroidal drug implant was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufcient IOP regulation was achieved in 82 eyes (68.9%) with topical therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20±7 months. Conclusions IOP increases after any type of steroid application are not rare. Results of our study let us suspect that especially therapy with intravitreal dexamethasone, either as a monotherapy or in combination with another steroid, tends to increase IOP more than other steroids. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary

Epidemic keratoconjunctivitis: efficacy of outbreak management

Purpose Epidemic keratoconjunctivitis (EKC) is one of the most severe ocular viral infections. The aim of this interruptive time series study was to quantitatively evaluate the effectiveness of a hygienic EKC outbreak management concept developed in our ophthalmological department. Methods All patients with suspected EKC in the period from August to November 2018 were included in the study. Data were retrospectively collected from the patient’s medical documents and records. The disease was diagnosed clinically and confirmed by virus detection through polymerase chain reaction (PCR) from conjunctival swabs. With the beginning of the epidemic, an outbreak management plan was implemented to reduce the nosocomial spread. Results The outbreak lasted 77 days (20th August 2018 to 4th November 2018) and affected a total of 120 patients. This corresponds to a mean of 1.5 patients per outbreak day. The median age was 58 [1–92] years. Of all patients, 61 (50.8%) were female. Conjunctival swabs were collected in 100/120 (83.3%) cases, the adenovirus being detected in all positive smears (63/63, 100%). The implementation of our outbreak management plan reduced significantly the number of EKC cases per outbreak day and resulted in a reduction of the basic reproduction number by a factor of 2.2. Conclusion The detection of EKC together with the immediate implementation of hygienic outbreak measures can significantly reduce the spread of infection. The implementation of a strict outbreak management concept can significantly reduce the number of EKC cases, thus avoiding possible complications and therefore unnecessary health-related costs

'Bridging the Differences' - Die Arbeit des 'boundary spanning' und ihre Regulierung in Transnationalen Unternehmen

Mense-Petermann U. 'Bridging the Differences' - Die Arbeit des 'boundary spanning' und ihre Regulierung in Transnationalen Unternehmen. In: Löw M, ed. Vielfalt und Zusammenhalt. Verhandlungen des 36. Kongresses der Deutschen Gesellschaft für Soziologie in Bochum und Dortmund 2012, Teil 1. Frankfurt/New York: Campus; 2014: 297-311

Trabeculectomy with mitomycin C and Ologen® implant in comparison to classical trabeculectomy

Hintergrund Die Trabekulektomie (TE) mit Mitomycin C (MMC) gilt als Goldstandard der Glaukomchirurgie. Eine neuere Modifikation ist die Verwendung von Ologen®-Implantaten (AEON Astron Europe B.V., Leiden, Niederlande) bei der TE, die in dieser Studie bewertet und mit der klassischen TE verglichen werden soll. Patienten und Methoden In die Studie wurden 98 Augen nach TE mit MMC (Gruppe 1) sowie 70 Augen nach TE mit Ologen® und MMC (Gruppe 2) aufgenommen. Beide Gruppen wurden hinsichtlich des intraokulären Drucks (IOD), der medikamentösen Glaukomtherapie sowie Komplikationen und Nachbehandlungen verglichen. Die Daten wurden präoperativ und bis 2 Jahre postoperativ erhoben. Ergebnisse In Gruppe 1 verringerte sich der IOD von 28,0 mmHg (95 %-Konfidenzintervall: 26,6–29,4 mmHg) präoperativ auf 16,0 mmHg (14,0–18,1) nach 2 Jahren. In Gruppe 2 wurde der IOD von 28,5 mmHg (26,8–30,1) auf 14,3 mmHg (11,7–17) gesenkt. Zu allen Zeitpunkten war die Drucksenkung in beiden Gruppen signifikant (p  0,05). Alle glaukomspezifischen Nachbehandlungen waren in Gruppe 1 häufiger, jedoch nicht signifikant. Schlussfolgerung Beide Verfahren zeigten sich gleichwertig effektiv bezüglich der IOD-Reduktion. In unserer Studienpopulation waren nach TE mit Ologen® weniger Nachbehandlungen und folglich seltener Klinikaufenthalte nötig.Background Trabeculectomy (TE) with mitomycin C (MMC) is considered the gold standard in glaucoma surgery. A new modification is the use of an Ologen® implant (AEON Astron Europe B.V., Leiden, Netherlands) during TE, which was analyzed and compared to the standard TE in this retrospective study. Patients and methods On 70 eyes Ologen® was applied during surgery (group 2), whereas 98 eyes were operated on without the implant (group 1). Both surgical procedures were compared regarding the efficiency of lowering the intraocular pressure (IOP), the number of glaucoma medications, the rate of complications and follow-up treatment. Data were collected up to 24 months after surgery. Results In group 1 the IOP was lowered from 28.0 mmHg (95% confidence interval, CI 26.6–29.4 mmHg) to 16.0 mmHg (14.0–18.1) after 24 months. In group 2, the pressure dropped from 28.5 mmHg (26.8–30.1) to 14.3 mmHg (11.7–17.0). The IOP reduction was significant in both groups (p  0.05). Glaucoma-related follow-up treatments were performed more often in group 1 but the difference was not significant. Conclusion Both procedures significantly lower the IOP and the number of glaucoma medications. For our cases, TE with Ologen® and MMC is considered to be superior to TE with MMC regarding the lower rates of follow-up treatments as it is less time-consuming for the patients and the clinic

Recurrence risk of periocular basal cell carcinoma after histologically controlled excision

Hintergrund und Ziel der Arbeit: Die Inzidenz der Basalzellkarzinome (BCC) hat in den letzten Jahrzehnten deutlich zugenommen. Ziel dieser retrospektiven Studie war es, das Rezidivrisiko von periokulären BCC nach histologisch kontrollierter Resektion zu eruieren. Patienten und Methodik: Anhand der Klinikakten aus dem Zeitraum 2009 bis 2020 wurden konsekutiv 270 periokuläre BCC von 243 Patienten/Patientinnen hinsichtlich eines Rezidivauftretens nach chirurgischer Exzision untersucht. Erhoben wurden die Art des Tumors (primäres oder bereits rezidiviertes BCC), die BCC-Lokalisation innerhalb der Regio orbitalis (Oberlid nasal, mittig, temporal und Unterlid nasal, mittig, temporal), der histologische BCC-Subtyp (solide/nodulär [s/n], superfiziell-multizentrisch [sf-mz], infiltrativ/sklerodermiform [i/s], basosquamös [bsq] und gemischt [gem]) sowie der histologisch nachgewiesene Resektionsrand (in sano [R0], nicht sicher in sano [R?], nicht in sano [R1]). Die Rezidivraten wurden mittels Chi2 -Test verglichen. Ergebnisse: Die BCC ließen sich unterteilen in 231 primäre BCC (pBCC) und in 39 bereits rezidivierte BCC (rBCC). Bei den 231 pBCC erfassten wir für den oben genannten Zeitraum insgesamt 38 (16,5 %) Rezidive (2-Jahres-Rezidivrate 9,2 %). Bei den 39 rBCC beobachteten wir 18 (46,2 %) Rezidive (2-Jahres-Rezidivrate 37,8 %). Zudem konnte für die rBCC ein signifikant kürzerer rezidivfreier Verlauf (RFV) (∅52,6 ± 9,0 Monate) als bei den pBCC (∅ 108,6 ± 4,1 Monate) festgestellt werden (p< 0,001). Bezogen auf die Lokalisation, wiesen die Rezidivraten keinen signifikanten Unterschied auf. Als signifikant unterschiedlich stellten sich die Rezidivraten der 5 definierten Subtypen dar (p= 0,001): s/n = 15,9 %, sf-mz = 45,0 %, i/s = 27,8 %, bsq = 33,3 % und gem = 40,0 %. Nach R0-Resektion war die Rezidivrate von s/n-BCC signifikant geringer als nach R?/R1-Resektion (p= 0,008). Bei den Subtypen i/s (p= 0,433), bsq (p= 0,417) und gem (p= 0,143) wiesen die Rezidivraten nach R0- und nach R?/R1-Resektion keinen signifikanten Unterschied auf. Bei den sf-mz-BCC war keine Aussage zur statistischen Signifikanz möglich. Diskussion: Unsere Rezidivrate erscheint vergleichsweise hoch. Allerdings wurden bei dieser Studie bewusst auch R1-resezierte BCC eingeschlossen, um eine Auswertung zu erhalten, die den klinischen Alltag möglichst realistisch wiedergibt. Möglicherweise könnten auch das Operationsverfahren oder die Art der histologischen Untersuchung sowie die Interpretation des Begriffs „Lokalrezidiv“ Grund für unterschiedliche Literaturangaben zu Rezidiven sein. Eine Abhängigkeit der Rezidivrate von der genauen Lokalisation innerhalb der Regio orbitalis konnte in dieser Studie nicht nachgewiesen werden, der jeweilige BCC-Subtyp scheint hingegen relevant zu sein. Wichtig ist, dass auch mehrere Jahre nach einer BCC-Exzision Rezidive diagnostiziert wurden. Daraus ergibt sich, dass eine Langzeitnachsorge dringend zu empfehlen ist.Background and objective: The incidence of basal cell carcinoma (BCC) has significantly increased in the last decades. The aim of this retrospective study was to determine the risk of recurrence of periocular BCC after histologically controlled resection. Patients and methods: Based on the clinical records from 2009–2020 a total of 270 consecutive periocular BCCs from 243 patients were investigated with respect to recurrence after surgical excision. For this study, the type of BCC (primary or recurrent BCC) and localization within the orbital region (upper eyelid nasal, middle, temporal and lower eyelid nasal, middle, temporal) and the histological BCC subtype, e.g. solid/nodular (s/n), superficial multicentric (s-m), infiltrative/sclerodermal (i/s), basosquamous (bsq) and mixed (gem), were recorded. Recurrence rates were compared using χ2 -tests. Results: The 270 resected BCCs with 231 primary BCC (pBCC) and 39 already recurrent BCC (rBCC), were included in this study. Among the 231 pBCCs we recorded a total of 38 (16.5%, 2-year recurrence rate 9.2%) recurrences for the abovementioned period. In the 39 rBCCs we observed 18 (46.2%) recurrences (2-year recurrence rate 37.8%). In addition, a significantly shorter recurrence-free interval (RFV, ∅ 52.6 ± 9.0 months) was observed for the rBCC than for the pBCC (∅108.6 ± 4.1 months, p< 0.001). The recurrence rates did not differ significantly with respect to the location; however, there was a significant difference between the five defined subtypes (p= 0.001): s/n = 15.9%, s-m = 45.0%, i/s = 27.8%, bsq = 33.3% and gem = 40.0%. After R0 resection the recurrence rate of s/n BCC was significantly lower than after R?/R1 resection (p= 0.008). The histological subtypes i/s (p= 0.433), bsq (p= 0.417), and gem (p= 0.143), showed no significant difference between the recurrence rates after R0 and R?/R1 resection. In s-m BCC, a conclusion on the statistical significance was not possible. Discussion: The recurrence rate appears to be comparatively high; however, R1 resected BCCs were intentionally included in this study to obtain an evaluation that reflects clinical practice as realistically as possible. It is possible that the surgical procedure and/or the type of histological examination as well as the broad interpretation of the term local recurrence could be the reason for the different recurrence data in the literature. Our data indicate that the recurrence rate is not affected by the exact localization within the orbital region, but by the respective BCC subtype. As recurrences may develop years after BCC excision a long-term follow-up is strictly recommended

Femtosecond laser-assisted retinal imaging and ablation: experimental pilot study

To investigate retinal imaging and ablation using femtosecond laser pulses