Research during residency

Physicians in German university hospitals feel themselves confronted with a multiple workload due to patient care, teaching and research. Furthermore, this load is increased by administrative duties and conference trips; however, the framework conditions surrounding this multiple workload of patient care, research and teaching as well as administrative activities are becoming increasingly more difficult. In particular, there is very little free time for scientific activities. Research is therefore often carried out during leisure time. The path of the clinician scientist, a duo of scientiific and clinical activities, opens up many possibilities; however, the question arises whether the career path of a clinician scientist is even possible under the current conditions or whether this is an endangered aEurospecies. This article presents the problems but solutions and ideas are also developed for optimum organization of this multiple workload and to appreciate the additional value of clinician scientists

Revision of encapsulated blebs after trabeculectomy: Long-term comparison of standard bleb needling and modified needling procedure combined with transconjunctival scleral flap sutures.

To compare two surgical approaches for treating encapsulated blebs after trabeculectomy with mitomycin C, in terms of the development of intraocular pressure and progression of glaucoma in a long-term follow up: 1. bleb needling alone vs. 2. a combined approach of needling with additional transconjunctival scleral flap sutures, to prevent early ocular hypotony.Forty-six patients with failing blebs after trabeculectomy with mitomycin C were enrolled in this study. Patients received either needling revision alone (group 1; n = 23) or a combined needling with additional transconjuctival flap sutures, if intraoperatively the intraocular pressure was estimated to be low (group 2; n = 23). Intraocular pressure (IOP), visual acuity, visual fields, and optic nerve head configuration by means of Heidelberg Retina Tomograph (HRT®) were analysed over time. Results from both groups were compared using Mann-Whitney U-test for single timepoints.IOP did not differ significantly between the two groups during follow-up at three months (P = 0.13), six months (P = 0.12), one year (P = 0.92) and two years (P = 0.57) after surgery. Furthermore, there was no significant difference in the course of glaucoma concerning the optic nerve anatomy between the two groups (Rim Area Change in the Moorfields Regression Analysis of HRT®) till two years after surgery (P = 0.289). No functional impairment in visual acuity and visual fields was found in the groups of the study.Single needling procedure is a standard successful method for restoring the function of encapsulated blebs. Postoperative hypotony represents a possible hazard, which can be minimized by additional transconjunctival flap sutures. Long-term results suggest that this modification is equally effective in lowering the IOP and preventing the progression of glaucoma as the standard needling procedure. To our knowledge this is the first study to investigate the long-term effect of tranconjunctival sutures for the prevention of hypotony

Intraocular pressure (A), visual acuity (B), mean deviation (C) and pattern standard deviation (D) in the visual fields examination before bleb revision and at specific time points within the following two years in both study groups.

<p>Results are presented as means with standard deviation. P values for the comparison between the study groups are also shown.</p