Purpose Patients with extensive submacular hemorrhage (SMH) caused by age-related macular degeneration (AMD) have a poor visual prognosis despite surgical intervention. Systemic blood-thinning drugs, which are commonly prescribed in the same age group, are known to increase the risk of severe hemorrhage in many parts of the body. This study aimed to investigate whether systemic blood-thinning drugs have an impact on the severity of SMH and if there are differences between the different types of blood-thinning medication. Methods We reviewed the medical records of patients who suffered from surgically treated SMH between 2020 and 2022. All patients received a full ophthalmologic examination upon presentation including best-corrected visual acuity (BCVA) and optical coherence tomography. Other characteristics that were recorded included size of hemorrhage, blood-thinning therapy, and reason for intake. Results A total of 115 patients with a mean age of 82 years were included in this retrospective analysis. Eighty-three patients (72.2%) were on blood-thinning therapy. The mean size of SMH was 32.01 mm2. Mean BCVA at initial presentation was 1.63 logMAR and 1.59 logMAR 1 year after surgery. The size of SMH was significantly larger in patients on blood-thinning medication (35.92 mm2 vs. 21.91 mm2) (p = 0.001) and their BCVA postoperatively was worse with 1.68 logMAR compared to 1.30 logMAR after 1 year (p = 0.503). Patients with vitamin K antagonists had larger SMH size and worse outcomes regarding BCVA compared to direct oral anticoagulants. Conclusion Blood thinners in patients with AMD affect the severity of SMH. Consequently, the indication for their intake should be critically evaluated.

Zusammenfassung Hintergrund Der „Masterplan Medizin 2020“ umfasst eine 2017 verabschiedete politische Agenda von grundlegenden Veränderungen der medizinischen Ausbildung. Der Nationale Kompetenzbasierte Lernkatalog Medizin (NKLM) soll die inhaltliche Grundlage für diese Neustrukturierungen darstellen und wird in einer neuen Approbationsordnung rechtsverbindlich werden. Methode Der NKLM 2.0 wurde Ende 2021 verabschiedet. Die Grundlage ist ein kompetenzbasiertes Lernzielkonzept, welches die Arzt-Patienten-Kommunikation in das Zentrum des ärztlichen Handelns stellt. Die Struktur des NKLM soll dargestellt und die für die Lehre in der Augenheilkunde relevanten Inhalte sollen als Übersicht aufgearbeitet werden. Ergebnisse Spezifische Inhalte für die Lehre der Augenheilkunde finden sich in den Kapiteln V „Konsultationsanlässe“, Kapitel VI „Erkrankungen“, Kapitel VII „Übergeordnete und krankheitsbezogene Lernziele“ und Kapitel VIII „Übergeordnete Kompetenzen“. Die Kapitel werden stichpunktartig dargestellt. Schlussfolgerung Der NKLM 2.0 hat eine komplexe Struktur, die auf den ersten Blick nicht einfach zu durchdringen ist. Für die inhaltliche Neustrukturierung der Lehre der Augenheilkunde ist es notwendig, dass die Inhalte des NKLM 2.0 in der entsprechenden Tiefe vermittelt werden, da dieser in Zukunft rechtsverbindlich sein wird. Er bietet dennoch genug inhaltlichen Freiraum, um die Lerntiefe und die Lehre im Detail nicht einzuengen.

BackgroundTo report one‐year outcomes from a single‐centre cohort undergoing PAUL® Glaucoma Implant (PGI) surgery.MethodsRetrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021.ResultsForty‐five eyes of 41 patients were included. Qualified and complete success rates (95% CI) were 95.6% (88.9%–100%) and 73.3% (60%–86.7%) for Criterion A (IOP ≤ 21 mmHg), 84.4% (73.3%–93.3%) and 74.4% (51.1%–80.0%) for Criterion B (IOP ≤ 18 mmHg), 62.2% (48.9%–75.6%) and 46.7% (31.2%–62.2%) for Criterion C (IOP ≤ 15 mmHg) and 26.7% (13.3%–40.0%) and 22.2% (11.1%–33.3%) for Criterion D (IOP ≤ 12 mmHg), respectively. Mean IOP decreased from 26.1 mmHg (7–48 mmHg) to 12.0 mmHg (3–24 mmHg) (reduction of 48.83%) after 12 months with a reduction of IOP‐lowering agents from 0.5 (0–3). One eye (2.2%) needed an injection of viscoelastic due to significant hypotony with AC shallowing, and four eyes (8.9%) developed choroidal detachments due to hypotony which resolved without further interventions after 6 weeks. Three patients (6.7%) developed tube exposure which required conjunctival revision with an additional pericardial patch graft. An intraluminal prolene stent was removed in 19 eyes (42.2%) after a mean time period of 8.4 months (2–12 m). Mean IOP before the removal was 21.9 mmHg (12–38 mmHg) and decreased to 11.3 mmHg (6–16 mmHg).ConclusionsPGI surgery is an effective procedure for reducing IOP and pressure‐lowering therapy. An intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further IOP lowering without additional interventions during the postoperative course.

Background: Early vitrectomy for postsurgical endophthalmitis may improve visual acuity outcomes. Silicone oil as a tamponade has some potential benefits in the management of endophthalmitis. This study aims to evaluate the use of a silicone oil tamponade in the surgical management of endophthalmitis. Material and Methods: All patients with a pars plana vitrectomy with silicone oil tamponade for postsurgical endophthalmitis at the Department of Ophthalmology, University of Bonn, Germany, between 2017 and 2021 were retrospectively reviewed. We included all preoperative data, including BCVA at diagnosis, clinical findings, and symptoms. For every follow-up visit, we looked at BCVA and complications. Results: In total, 82 patients were included in this study. The mean follow-up was 13.1 months (range 1–58 months). An intravitreal injection was the cause in 42 patients (51.2%) and cataract surgery in 29 patients (35.4%). The mean interval between the causing event and the date of onset was 8.8 days (range, 1–59 days). The most prevalent pathogen was Staphylococcus epidermidis in 16 patients (19.5%). In 47 patients (57.3%), no pathogen was found. The initial best-corrected visual acuity was 2.1 logMAR and improved significantly to 1.0 logMAR after six months (p < 0.001) and 1.1 logMAR after 1 year (p < 0.001). In a multivariate analysis, a low BCVA at diagnosis (p = 0.041) was a significant predictor for poor visual acuity outcomes. A total of 17 patients (20.1%) developed postoperative complications. Five patients (6.1%) needed an anterior chamber washout with repeated injections of antibiotics. Two patients (2.4%) had persistent fibrin and were treated with YAG-laser treatment. Three patients (6.7%) developed a retinal detachment. Two patients (2.4%) had persistent corneal decompensation with endothelial cell loss and received perforating keratoplasty. We performed a matched-pair analysis (n = 30, each group n = 15) to compare a silicone oil tamponade with BSS at the end of surgery. The visual acuity outcome showed no significant differences (BCVA after one year: 1.17 logMAR in eyes with silicone oil and 0.90 logMAR in eyes with BSS; p = 0.684). Conclusions: In our study, a vitrectomy with silicone oil tamponade in the surgical management of postoperative endophthalmitis led to a significant improvement in visual acuity and had a low complication rate. Low BCVA at diagnosis was significantly associated with poor visual acuity outcomes. A comparison of silicone oil and BSS at the end of surgery showed similar results.

Introduction COVID-19 has had a tremendous impact on our everyday life. A growing body of evidence indicates that subsequent lockdowns and fear of exposure may have impacted patient care. We analyzed data on incidence and time to surgery in cases of rhegmatogenous retinal detachments (RRD) at three defined time points before, during and one year after the first lockdown period in Germany. Methods In this single center study, we identified all patients who were admitted and treated for a primary RRD in April and May 2020, the time of the first lockdown period in Germany and compared them with cases of the same time period in the years 2019 and 2021. The time from first occurrence of symptoms to surgery as well as visual outcome were analyzed. Results A total of 192 patients presented to our tertiary academic referral center with a RRD during the months of April and May in 2019 (72 patients), 2020 (62 patients) and 2021 (58 patients) and were included in this study. There were no significant differences with regard to gender and age. In 2019 the time interval between occurrence and presentation to our hospital amounted to a mean of 5.96 days and in 2021 to mean of 5.45 days. However, in 2020, the time between occurrence and presentation was significantly longer with a mean of 15.36 days. The number of patients presenting with a macula-on retinal detachment was also lowest in 2020 (39.2%) compared to 2019 (50.7%) and 2021 (50.0%). Furthermore, with 1.24 logMAR the mean BCVA upon initial presentation was lower in 2020 compared to 0.93 logMAR in 2019 and 1.06 logMAR in 2021. Six to twelve weeks following surgery, visual acuity had improved in 56.1% of patients in 2019 and 60.0% of patients in 2021 as compared to 59.0% in 2020 Conclusion We found significant differences in terms of elapsed time from first symptoms to surgical management for patients in 2020 in comparison to the same time period in 2019 and 2021. Less strict lockdown policies appear to impact patient behavior and patient care. Further measures, such as questionnaires, might help to address which measures may provide safer circumstances for patients to consult health care providers in the case of future strict lockdowns.