Die Ophthalmologie最新文献

The liquid biopsy is playing an increasingly more important role in the diagnosis and treatment of retinoblastomas. The possibility of safe and uncomplicated retrieval and examination of aqueous humour from the anterior chamber contributes significantly to the differential diagnosis and to a better understanding of the disease. It helps with the prognosis both in terms of eye-preserving treatment and in estimating the risk of metastatic disease and helps with genetic uncertainties in unilateral disease. It is expected that the further development of liquid biopsy methods will form the basis for a personalized diagnosis and treatment of children with a retinoblastoma in the future.

Background: To evaluate the different treatment strategies for eyes with vitreomacular traction (VMT) and macular holes (MF) regarding the indications and initiation of treatment.

Objective: The aim of this study is to facilitate clinical decision making by presenting the opinions of experienced retinal specialists in the context of the current literature and the changed approval situation for ocriplasmin.

Material and methods: Members of the German Retina Society (RG) were questioned in an online survey. Based on a literature review a 100-question questionnaire was created and sent to all members of the RG via an electronic link to the online platform "LimeSurvey". Voluntary participation was possible from 15 October 2021 to 15 November 2021. Data collection and statistical analysis were anonymized.

Results: The responses of the 115 participants were congruent with the presentation of the new S1 guidelines on this topic. The indications for active treatment of focal VMT without MF were postponed in favor of watchful waiting, with the individual symptoms of the patient playing a major role in the proposed temporal management. The results on the indications for vitrectomy are consistent and convincingly confirm the opinions on the efficacy and risk assessment of this therapeutic procedure.

Conclusion: The results presented provide an overview of the consensus and controversies in the current treatment options for VMT and MF. With the help of a homogeneous and experienced group of retinal experts, it was possible to develop individual treatment strategies.

The liquid biopsy is a cutting-edge technique that involves analysing non-solid biological tissues, primarily blood but also ocular fluids, for the presence of cancer cells or fragments of tumour DNA. Unlike traditional biopsies, liquid biopsies are usually minimally invasive and can be performed more frequently, enabling continuous monitoring of disease progression and treatment efficacy. This article (and the associated series of articles) outlines the key developments in liquid biopsy, which include the analysis of circulating tumor DNA (ctDNA), circulating tumor cells (CTC) and exosomal RNA and protein biomarkers. Techniques, such as digital droplet PCR and next-generation sequencing (NGS) have made it possible to detect even very low levels of ctDNA, which is crucial for early cancer detection and monitoring minimal residual disease. The detection of rare CTCs is enhanced by techniques, such as microfluidic devices and immunomagnetic separation. Multiomic approaches, whereby exosomal RNA, protein and ctDNA analyses are combined, help to create a more comprehensive picture of tumour biology, including insights into tumour heterogeneity, potentially leading to better diagnostic and prognostic tools and helping to predict treatment response and resistance. The challenges of liquid biopsy application, which will be described in the following article, include (a) standardization, (b) cost and accessibility, (c) validation and clinical utility. However, the liquid biopsy represents a promising frontier in the application of precision ocular oncology, with ongoing research likely to expand its applications and improve its effectiveness in the coming years.

The evaluation of real-world data (RWD) enables insights to be gained from a wide range of patient data collected in routine clinical practice. In addition, multicenter analyses represent a broad and representative patient population and have the potential to capture the actual treatment situation. As a basis for this, the definition of datasets and an infrastructure for data exchange is necessary. Data integration centers (DIC) have already been established at (university) hospitals throughout Germany in order to extract RWD for scientific analyses from the various source systems and integrate them into research-compatible data infrastructures. The project described here aims to demonstrate the added value of this data integration using a case of application in ophthalmology, defining a core dataset as an ophthalmology extension module and establishing a cross-site data exchange infrastructure. As a first step, the treatment success of eye diseases treated with intravitreal injection (IVI) should be improved. To achieve this goal a dashboard for clinical data is provided that clearly visualizes the merged data. Furthermore, algorithms will be developed to identify new imaging biomarkers that can be used for treatment monitoring and predict treatment outcomes.