Martin-Luther-Krankenhaus

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.

In hospitalised patients, clinical deterioration can be detected at an early stage using early warning scores (EWS), enabling timely interventions. However, it remains unclear to what extent EWS have been implemented within the network of the Initiative of Quality in Medicine (IQM), comprising 480 hospitals, and what facilitating and challenging factors have been reported in this context. An online survey within the IQM was conducted to assess EWS-specific structures and processes, barriers, and facilitators. The degree of implementation was self-rated by participants on anumerical rating scale from 1to 10(10 = maximum). Of the 480 individuals contacted, 18.7% (n = 90) responded; 6.3% (n = 30) reported using EWS in clinical practice for an average of 4.3years. Among these, the National-EWS (NEWS) was most frequently used (37.9%, n = 11), primarily on general medical wards (66.7%, n = 20). Rapid response teams were mostly formed by resuscitation teams (33.3%, n = 10). Electronic systems were used for EWS recording in 82.2% (n = 24), and documentation was most often performed in response to clinical abnormalities (56.7%, n = 17). The self-rated median implementation score was 3.5. The top three facilitating factors included committed staff, clear communication and training strategies, and technological support; barriers identified were lack of staff acceptance, insufficient technical infrastructure, and time required for training. The implementation of EWS within the IQM appears to be limited and might be achallenging and complex process. The low participation rate limits the informative value of this study.

To determine whether posterior tibial slope (PTS) measured to proximal anatomical axes can serve as a reliable proxy for PTS measured to the mechanical tibial axis (mTA). In patients ≥18 years with failed anterior cruciate ligament reconstruction, medial and lateral PTS were measured relative to the mTA on a lateral lower-leg radiograph, and relative to the proximal tibial anatomical axis (PTAA), anterior tibial cortical axis (ATC) and posterior tibial cortical axis (PTC) on a lateral knee radiograph. Agreement was assessed using correlation coefficients, measurement error and Bland-Altman analysis. Diagnostic accuracy of the conventional ≥12° PTAA-based PTS cut-off for slope-reducing osteotomy was determined. Fifty-nine knees were analyzed. Correlation between proximal anatomical axes and mTA-based PTS measurements was strong (r ≥ 0.71), but agreement was poor. Mean measurement error for PTAA was 0.1 ± 2.4° (range: -5.7° to 7.6°) and -0.5 ± 2.4° (range: -6.6° to 5.2°), for ATC -3.4 ± 2.6° (range: -8.6° to 5.9°) and -3.7 ± 2.6° (range: -9.9° to 2.7°) and for PTC 3.0 ± 2.6° (range: -2.9° to 10.4°) and 2.7 ± 2.4° (range: -3.6° to 7.8°) for the medial and lateral plateau, respectively. For PTAA, absolute measurement error ≥2° occurred in approximately 50% of knees. Bland-Altman analysis showed 95% levels of agreement ranging from -4.89° to 4.62° (medial) and -5.11° to 4.11° (lateral). Using the ≥12° cut-off on PTAA-based PTS values misclassified approximately one in three knees (19.5% false-positive and 13.2% false-negative) relative to the mTA-based PTS reference values. Despite strong correlation, proximal anatomical axes-based PTS measurements on routine lateral knee radiographs show substantial, bidirectional measurement error outside clinically acceptable limits of agreement compared to mTA-based PTS measurements on full-length lateral lower-leg radiographs. Single-exposure, full-length lateral lower-leg radiographs should be obtained to measure PTS relative to the mTA when considering slope-reducing osteotomy. Level IV.

This report covers a case of bilateral choroidal detachment due to routine use of systemic acetazolamide after cataract surgery. A 67-year-old woman was referred with a presumed rhegmatogenous retinal detachment in the left eye, complaining about the acute onset of a grayish veil at the temporal margin of the left visual field. The asymptomatic right eye had undergone cataract surgery elsewhere 3 days prior. Dilated fundus exam showed both a bullous choroidal detachment in the nasal mid-periphery of the left eye and in the lower nasal periphery of the right eye. The anterior chamber was deep; there was no angle closure and no myopic shift. Later, it was revealed that 500 mg of intravenous acetazolamide were prophylactically administered after cataract surgery, unbeknownst to the patient. Uveal effusion due to systemic acetazolamide use can manifest posteriorly without angle closure or myopic shift. The respective symptoms, if present at all, can resemble those of a rhegmatogenous retinal detachment.

To determine the accuracy of two axis-marking methods for toric intraocular lens (IOL) implantation, one picture-assisted approach based on scleral vessel vectors, and the other based on a self-leveling device for manual marking. This retrospective single-center study involved 60 eyes of 51 participants, who underwent phacoemulsification with toric IOL implantation. In all eyes, preoperative markings were made in a seated position both manually via a self-leveling corneal marker (RoboMarker), and digitally on slit-lamp photographs, defining scleral vessels as landmarks, aiding to find the correct intraoperative orientation for an angular graduation instrument. The axis of IOL alignment at the end of surgery was determined from high resolution, intraoperative footage from a microscope-integrated camera and the axis-marking error served as an outcome measurement for both marking techniques. The endpoint was the alignment of the lens at the end of surgery. The average axis-marking error was 2.5 ± 1.9 degrees for picture-assisted marking, which was significantly less than that of the self-leveling corneal marker, being 5.4 ± 4.4 degrees. Our results indicate that scleral vessel vector marking leads to highly accurate toric IOL alignments, while being an inexpensive technique, as solely a slit-lamp camera is required for preoperative preparation.