Die Ophthalmologie最新文献

Currently, two thirds of medical students are female. However, women continue to be clearly underrepresented in leading medical positions, which is also true for ophthalmology. The scientific output of female ophthalmologists is increasing, more pronounced as first authors than last, but remains below that of male colleagues. However, a significant gender bias has been shown in the grant application processes. There are significantly more male surgeons in vitreoretinal, refractive, and corneal surgery. Concerning surgical training, it has been shown that female ophthalmologists operate less during their residency, especially in cataract surgery. Also among surgeons do women continue to shoulder the main responsibility for family and household, despite the negative consequences for their career. This publication presents an overview of the present career situation for women in ophthalmology and discusses possible measures to achieve gender equality, such as the establishment of mentoring programs and networks.

Background: Imparting knowledge in the operating room represents a particular challenge in student teaching.

Objective: Participation in the operating room was compared with teaching via a surgical video course as part of the block practical course in ophthalmology at the University of Lübeck.

Methods: All students took part in both observation in the operating room and in the video course. Thereafter, they were surveyed on both forms of teaching using the same items taken from a catalogue of questions. Based on the evaluation of these answers, we carried out a direct comparison between participation in the operating room and teaching with surgical videos.

Results: Teaching of the surgical content and steps (p < 001), the underlying clinical picture (p < 001), the surgical indication (p < 001), and the surgical outcome (p < 001) was rated better in the surgical video course than for participation in the operating room. The assessment of learning gain (p < 001) was also higher in the surgical video course. Only the interest in ophthalmic surgery (p = 0.62) was rated similarly between participation in the operating room and teaching with surgical videos.

Conclusion: The video format is well suited for pure knowledge transfer. However, it does not replace participation in the operating room, where not only the operation itself can be followed but also the preparation and post-processing of the surgery. We therefore prefer a combination of both parts of the course and will retain the structure presented. In addition, we will use the knowledge gained to further improve teaching in the operating room.

Objective of surgery: The aim of endothermal pupilloplasty (EP) is to optimize centering of the pupil, contour, or size.

Indications: The EP is performed in patients with congenital or acquired corectopia or an irregular pupil shape. In individual cases the technique has also been used to tighten the iris in floppy iris syndrome and to adapt iris tissue edges in patients with sectoral iris defects or iridodialysis.

Contraindications: In patients with pronounced iris stromal atrophy or major iris tissue defects, e.g., congenital or posttraumatic, EP could be indicated after careful consideration.

Surgical technique: Viscoelastic substances are injected into the anterior chamber via a 23-gauge paracentesis. Using the blunt tip of a bipolar endodiathermy probe, the iris tissue is selectively cauterized at several points, stretching the pupil in the direction to which cauterization is applied. The higher the energy level applied and the closer the cauterization is to the pupil margin, the more effect is achieved. The viscoelastic agents are suctioned off and the paracentesis is sealed by hydration (and additionally sewn in children). A video of the operation, which is available online, shows the surgical technique in detail.

Follow-up: Control examinations are recommended after 1 day, 1 week and 1-3 months post-EP. A combination of topical steroids and antibiotics, e.g., dexamethasone and gentamicin eye drops, should be applied 5 times daily for 1 week and 3 times daily for another week.

Evidence: To date, isolated positive retrospective case reports on EP have been published. There is a lack of prospective studies, reviews or meta-analyses.

Electrophysiological examinations are used in ophthalmology to determine the functionality of the neurons of the visual pathway. As electrophysiological examinations are independent of the subjective perception and response of the patient, they are considered to be objective functional diagnostics of vision. Electroretinography (ERG) is used to examine the retina (especially the photoreceptors), electro-oculography (EOG) is used to examine the functionality of the retinal pigment epithelium and visually evoked potentials (VEP) are used to evaluate the integrity of the entire visual pathway. Abnormalities in electrophysiological responses should always be interpreted in the context of other functional and morphological findings.

Background: Cell-free DNA (cfDNA) and the tumor DNA it contains can be detected in various body fluids and can be obtained in a minimally invasive manner using a liquid biopsy. The fragmented cell-free tumor DNA (ctDNA) serves as a marker for the presence of tumor cells in the body and its analysis enables genetic tumor characteristics to be determined. For some nonocular tumors ctDNA is already approved as a predictive or prognostic marker.

Methods: This literature review article describes examples of the use of ctDNA as a biomarker in nonocular tumors and the current status of ctDNA analysis in cases of uveal melanomas. For this purpose, a selective literature search was carried out via PubMed.

Results: Uveal melanomas are nowadays usually treated by eye-preserving therapy. In these cases, there is usually no tumor tissue available for further diagnostic testing. Alternatively, molecular characteristics of the tumor can be determined by the genetic analysis of ctDNA. In uveal melanomas the presence of ctDNA in the plasma at the time of the primary diagnosis is controversial; however, an increase in the amount of ctDNA, which can be used to investigate diagnostically and prognostically relevant genetic changes, was detected during irradiation therapy of the primary tumor in some patients. In the later course of the disease, the amount of ctDNA in the plasma is a suitable marker for metastatic progression. In some cases, an increase in ctDNA levels could be recognized several months before the clinical detection of metastases.

Conclusion: The analysis of cfDNA in patients with a uveal melanoma is a promising and minimally invasive method for obtaining information about the tumor or the course of the disease. It is currently being investigated which patients could benefit from it in the future. Several issues related to standardization and technical validation must be addressed for its routine clinical application.

Background: A fundamental prerequisite for the development of clinically manifested metastases in uveal melanoma (UM) is the hematogenous dissemination of melanoma cells, which circulate in the systemic circulation, deposit in organs and can subsequently colonize the organs.

Material and methods: This article presents a review of the literature on the detection of circulating tumor cells (CTC) from UM and their relevance for the clinical and pathophysiological aspects of the malignancy.

Results: Since the first description of CTC in UM patients 20 years ago, only 20 articles have been published on the detection of intact CTCs in UM. Besides demonstrating the presence of CTCs in the systemic circulation, these articles give insights into the pathophysiology and chronology of CTC dissemination, the diagnostics and risk stratification of UM.

Conclusion: The detection of CTC in UM has proved to be beneficial in many ways. The early time of cell dissemination and also the associated factors should lead to a rethinking in the clinical routine in the context of the fatal danger of metastases.