Die Ophthalmologie最新文献

Comprehensive multimodal imaging is essential for the precise clinical diagnostics of neovascular age-related macular degeneration (nAMD). Noninvasive optical coherence tomography (OCT) is of prime importance regarding the baseline examination, follow-up and monitoring during treatment. The OCT imaging in nAMD eyes enables a high-resolution assessment of the retinal micromorphology, which can be considerably disturbed in different layers. A large number of pathological OCT alterations represent distinct micromorphological OCT biomarkers. These should be taken into account in the assessment of OCT images. This article covers the following important biomarkers: intraretinal, subretinal and subpigment epithelial fluid, outer retinal tubulations, ellipsoid zone integrity, hyperreflective foci, subretinal drusenoid deposits, onion sign, hyporeflective prechoroidal cleft, double layer sign, subretinal hyperreflective material and bacillary layer detachment.

The new Maternity Protection Act (MuSchG) enacted in 2018, is intended to enable pregnant employees to carry out their work, to protect the pregnant employee and the child and to counteract discrimination. Nevertheless, a ban on surgical activities or even a ban on employment is often issued, although the law first requires the workplace to be reorganized to enable the pregnant employee to continue working. In many cases, such bans are issued without the legally required risk assessment, which constitutes prohibited discrimination. In ophthalmology, the sedentary nature of the work and the short operating times mean that conditions are comparatively favorable to enable pregnant doctors to continue their surgical work. The procedures following notification of pregnancy by a member of staff as well as some innovations in the MuSChG are explained. Hazards in ophthalmology, such as infection risks and the handling of hazardous substances (e.g., mitomycin C or 5‑fluorouracil) are discussed in detail. The potential handling of anti-vascular endothelial growth factor (VEGF) drugs in intravitreal injections and the risks of needlestick injuries in relation to human immunodeficiency virus (HIV) and hepatitis C are also discussed. The nondiscriminatory requirements and support of female doctors during pregnancy are not only required by law but are also socially, organizationally and economically necessary in times of a shortage of doctors. This includes not only enabling surgical activities during pregnancy but also nondiscriminatory planning of the return to work in order to promote the training and further education of women during and after pregnancy.

The accurate diagnosis of central serous chorioretinopathy (CSC) and its distinction from differential diagnoses is crucial for effective patient counseling and treatment. This is achieved through a targeted patient history and multimodal imaging, which distinguish CSC from other ocular diseases also characterized by subretinal fluid and changes in the retinal pigment epithelium. In this article we identify the key differential diagnoses of CSC and illustrate the characteristic differential diagnostic features of each disease. The differential diagnoses of CSC can be categorized into eight groups: 1) (neo)vascular choroidal diseases, 2) retinal diseases, 3) inflammatory diseases of the posterior segment, 4) benign and malignant ocular tumors, 5) malignant hematological diseases, 6) genetic disorders, 7) ocular developmental anomalies and 8) medication-related and toxic retinal changes.

Since the initial description of central serous chorioretinopathy (CSC) by von Graefe in 1866, various risk factors for this condition have been described and discussed. In addition to established factors, such as the use of corticosteroids, psychosomatic factors, particularly stress, have increasingly come into focus in the literature. Studies have shown that psychological stress and emotional stressors not only impair well-being but also trigger physiological responses that could increase the risk of CSC. This review article summarizes the most frequent risk factors for CSC and examines their influence on the pathophysiology and progression of the disease. For many of the currently discussed risk factors it remains unclear whether they have a causal relationship or should be viewed more as epiphenomena. The modification of risk factors such as stress reduction and smoking cessation is currently being debated; however, due to insufficient evidence further prospective studies with longer follow-up periods are needed to provide clear treatment recommendations.

Background: Challenges in practice-oriented teaching at university clinics are increasing. A lack of resources contrasts a growing number of students. Digital lectures, seminars, and blended-learning concepts enable resource-efficient and effective teaching in ophthalmology.

Aim: To implement and evaluate a digital teaching concept combining lectures, seminars, and bedside teaching at the Department of Ophthalmology at Hannover Medical School (MHH).

Material and methods: Following the National Competence-Based Learning Objectives Catalogue for Medicine (NKLM), digital theoretical units were combined with practical in-person formats. The concept includes: on-demand digital lectures, a three-day, digitally pre- and post-prepared seminar on basic examination methods, and digitally enhanced bedside teaching. The concept was piloted in a cohort. Student feedback was recorded via the eLearning system and compared with previous evaluations.

Results: The concept proved feasible, communicable, and digitally verifiable. Educators were satisfied with student preparation. Learners rated the implementation positively, and ophthalmology improved by 10 ranks in the MHH medical subject rankings. Satisfaction with digital teaching increased significantly.

Discussion: Combining asynchronous digital preparation and review with synchronous bedside teaching and in-person seminars enables resource-efficient and effective teaching. The concept was well-accepted. Further studies are required to evaluate its nationwide implementation and its impact on exam performance.