Augenklinik Heidelberg

This retrospective, single-center study aimed to determine the long-term real-world efficacy and safety of the MicroShunt over up to a 6-year period in a heterogeneous glaucoma population of 1001 eyes: including pseudophakic eyes and eyes undergoing combined cataract and MicroShunt surgery. Data were analyzed from 1001 eyes implanted with the MicroShunt between January 2019 and May 2025. The outcomes collected were intraocular pressure (IOP) reduction, complete and qualified surgical success at targets of 6-14, 6-18, and 6-21 mmHg, the medication burden, and the postoperative complications. Subgroup analyses compared all the eyes implanted with pseudophakic eyes or those undergoing combined cataract and MicroShunt surgery. The mean baseline IOP was 24.8 ± 8.4 mmHg across all eyes. IOP decreased to 9.6 ± 4.4 mmHg on postoperative day 1 and remained significantly reduced at 1 year (13.2 ± 3.9 mmHg) and 6 years (13.9 ± 2.3 mmHg). The IOP trajectories were similar in the subgroups. The IOP was slightly lower in eyes that had combined surgery. At 5 years, the complete success was 54%, 36%, and 8% for IOP thresholds of 6-21, 6-18, and 6-14 mmHg, respectively; while the qualified success rates were 62%, 38%, and 15%, respectively. The number of medications decreased significantly after surgery. Early postoperative complications were infrequent and usually transient. The complications were similar across subgroups with choroidal detachment (≤ 12%) and microhyphaema (10-15%) being the most common. Late complications occurred less often, and device-related failure leading to secondary glaucoma surgery rarely occurred (≤ 4%). The MicroShunt provided a sustained reduction in IOP and medication burden with a low incidence of complications over the follow-up period. The outcomes in pseudophakic eyes and those undergoing combined cataract surgery were like the cumulative population. The inclusion of pseudophakic and combined surgery eyes reflects the real-world situation in glaucoma practice. These results build on mid-term evidence to support the reliability and safety of the MicroShunt.

There is a significant gap in routine clinical data concerning cochlear implant (CI) users, particularly regarding real-world outcomes. To address this, the present study focuses on the MED-EL Hearing Solution (MEHS) multicenter registry, which covers 5 clinics in Germany. Participants were users of a SONNET 2 or SONNET 2 EAS audio processor. Anonymized data that were routinely collected were extracted and analyzed by a third-party organization. Speech test outcomes (monosyllables and numbers), hours of daily use, self-perceived level of auditory benefit, and safety were assessed. Outcomes from 361 SONNET 2 (or SONNET 2 EAS) users, including 57 bilateral users, were extracted and analyzed. Speech test outcomes increased significantly from pre-operatively to 1 year of CI use in monosyllables (median 10.0% to 65.0%) and numbers (median 77.8% to 100.0%) (both p < 0.001). The majority (79%) of people used their device for at least 9 hours a day. The level of self-perceived auditory benefit was "moderate". Safety was assessed as per participant self-report: 17 minor clinical events were reported, none were new or unresolved. The data obtained from the MEHS registry offers valuable real-life evidence from routine clinical evaluations, which can support clinicians in developing more informed guidelines and treatment plans. The SONNET 2 (EAS) is effective and safe to use. Registries have the potential to provide a wealth of data that can be used to improve hearing health care. However, the success of registries depends on consistent participation and adherence to standardized protocols by clinical centers. Variability in clinical practices, demographic factors, and reporting standards across centers poses significant challenges to achieving homogeneous and usable data.

BackgroundSymptomatic vitreous opacities (SVO) are a condition that can significantly affect patientsʼ quality of life. This online survey aims to contribute to the scientific understanding of symptomatic vitreous opacities, by investigating the subjective burden and individual perception of floaters, using a novel tool for field of view reconstruction. In addition, correlations with demographic data and refractive status will be analysed to identify patterns and potential influencing factors.MethodsWe introduce a VO-related online survey covering patient education, experience with floaters and treatment, refraction error and eye diseases, quality of life, and a new sketching tool to simulate the individual field of view with VO. The data were collected between August 2022 and November 2023 and are analysed for correlations; participantsʼ answers are compared to the sketching tool results. We used linear regression with gradient descent to test whether a subjective suffering index from the questionnaire can be matched with an objective suffering index from the new sketching tool.ResultsA total of 1502 people participated in the survey, of whom, 1384 reconstructed their field of view by positioning a total of 10,571 VO. There was no robust correlation between the sketched floaters and the subjective degree of suffering. Translucent VO types are more frequent in younger attendees. The dataset shows a higher prevalence of myopic participants and a lower prevalence of hyperopes with VO compared to global data.ConclusionWe were able to collect the largest dataset to date quantifying individual experience with floaters. As evidenced by the large number of participants with SVO and individual remarks on their psychological burden, greater effort is needed to improve the care for floater patients.

The majority of patients report a high degree of satisfaction after implantation of premium intraocular lenses (IOL); however, cases of postoperative dissatisfaction occasionally occur. The most frequent symptoms are blurred vision and dysphotopsia. The possible causes include a deviation of the target refraction, cystoid macular edema, dry eye, secondary cataract, decentration of the IOL and a large pupil size. A standardized evaluation can help to identify the possible cause and to initiate an adequate treatment when a pathology has been identified. If the complaints are inherent to the IOL optics, an exchange of the IOL is available as a last resort.

Corneal allogeneic intrastromal ring segments (CAIRS) were recently introduced as anovel treatment modality for corneal diseases, such as keratoconus or postoperative ectasia after laser-refractive surgery. Contrary to other conventional surgical treatments for ectatic conditions, CAIRS is minimally invasive, freely adjustable in its size and length and has ashort learning curve as well as agood safety profile. This article provides step-by-step instructions for the performance and integration of the CAIRS procedure into clinical practice.

To quantitatively assess intraocular lens (IOL) calcification using anterior segment optical coherence tomography (AS-OCT) and correlate findings with straylight measurements in patients with homogenous IOL calcification. Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany. Prospective, observational clinical study. Healthy patients with homogenous IOL calcification underwent AS-OCT imaging with the ANTERION, with IOL opacity being automatically quantified using a custom image-analysis script. Straylight was assessed using the C-Quant straylight meter. Correlation between IOL opacity and straylight was analyzed using Spearman ρ coefficient. 35 eyes of 35 patients (mean age 72.9 ± 7.8 years) were included. Mean IOL opacity was 69.15 ± 13.55 pixel intensity units (PIUs), and mean straylight was 2.24 ± 0.38 log(s). A statistically significant correlation was found between IOL opacity and straylight with ρ = 0.494, P = .003. After the linear regression model was established: straylight = 0.0569 × OCT opacity [log(s)] - 1.69 with R2 = 0.244. Of the 35 eyes, 17 underwent IOL exchange surgery, with a mean IOL opacity of 75.69 ± 7.58 PIU and a mean straylight of 2.33 ± 0.30 log(s). AS-OCT can quantitatively assess IOL calcification in vivo, with results correlating significantly with straylight measurements. This technique may serve as a valuable diagnostic tool for evaluating IOL opacification and assist in surgical decision-making, particularly in borderline cases.

Due to the global effects of climate change numerous infectious diseases are increasingly spreading to regions that were previously hardly or only slightly affected. As ocular involvement is possible in many of these infectious diseases, we must also adapt to new pathogens and clinical pictures in Germany in the medium to long term. Using selected bacterial, viral and mycotic pathogens and diseases as examples, the causes of the increase in dissemination and the consequences for ophthalmology are presented.