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Walz JM, Bemme S, Reichl S, Akman S, Breuß H, Süsskind D, Glitz B, Müller VC, Wagenfeld L, Gabel-Pfisterer A, Aisenbrey S, Engelmann K, Koutsonas A, Krohne TU, Stahl A. [Treated cases of retinopathy of prematurity in Germany : 5-year data from the Retina.net ROP registry]. Ophthalmologe 2019; 115:476-488. [PMID: 29637302 DOI: 10.1007/s00347-018-0701-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is one of the main reasons for childhood blindness. The number of infants requiring treatment, however, is low for individual centers. The Retina.net ROP registry has been founded to allow a joint analysis of treatment patterns and courses post treatment. OBJECTIVE This paper reports treatment patterns over 5 years. MATERIAL AND METHODS All infants born between January 2011 and December 2015 who were entered into the treatment registry by one of the 12 participating centers were analyzed. RESULTS The data of 150 infants (292 eyes) were analyzed and ROP 3+ in zone II was the most prevalent treatment indication. Gestational age and birth weight remained stable over the years. The treatment patterns, however, changed with anti-VEGF treatment (bevacizumab or ranibizumab) accounting for only 10% of treated eyes in 2011 but for 56% and 30% in 2014 and 2015, respectively. Almost all eyes with AP-ROP or zone I disease received anti-VEGF treatment. Zone II disease was predominantly treated with laser photocoagulation. Recurrences were more common and appeared later in the anti-VEGF group compared to the laser group (23%/interval 60 days vs. 17%/interval 23 days). Perioperative complications were evenly distributed across treatment groups. CONCLUSION The data in this analysis represent about 10-15% of treated infants in Germany. The results provide evidence for an increasing use of anti-VEGF agents for ROP. The data reflect a selection bias for anti-VEGF treatment in eyes with a more aggressive disease. This needs to be considered when interpreting data such as disease recurrence rates. The risk for late recurrences after anti-VEGF treatment is of particular clinical significance.
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Affiliation(s)
- J M Walz
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.,Fakultät für Chemie und Pharmazie, Lehrstuhl Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland.,European Foundation for the Care of Newborn Infants (EFCNI), München, Deutschland
| | - S Bemme
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S Reichl
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - S Akman
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Breuß
- Klinik für Augenheilkunde, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland
| | - D Süsskind
- Universitäts-Augenklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - B Glitz
- Klinik für Augenheilkunde, Universität Münster, Münster, Deutschland
| | - V C Müller
- Klinik für Augenheilkunde, Universität Münster, Münster, Deutschland
| | - L Wagenfeld
- Klinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - A Gabel-Pfisterer
- Klinik für Augenheilkunde, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - S Aisenbrey
- Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - K Engelmann
- Klinik für Augenheilkunde, Klinikum Chemnitz gGmbH, Chemnitz, Deutschland
| | - A Koutsonas
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - T U Krohne
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
| | - A Stahl
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Abstract
BACKGROUND Accurate acquisition of intraocular pressure (IOP) data, particularly short-term and long-term fluctuations, plays an important role in the medical care of glaucoma patients. Non-invasive self-tonometry with a telemetric IOP sensor can provide important data on the individual IOP profile. METHODS Within the framework of a prospective, single-centre pilot clinical trial, a ring-shaped telemetric IOP sensor was inserted into the ciliary sulcus after implantation of the intracapsular lens during planned cataract surgery. In accordance with the protocol, at the 5-month visit, all patients received a reading unit for one-month self-tonometry assessment. All patients were asked to measure the IOP at least once daily, and, if possible, at many different times. The first IOP measurement of each day was evaluated (covering one measurement daily per patient on 20 different days within the assessment interval). Furthermore, IOP data were analysed according to the time of day, divided into early phase (5 am to 11 am), midday (11 am to 4 pm) and late phase (4 am to 11 pm) (patients with at least 10 measurements and max. 20 measurements were included). Descriptive statistics of the original ARGOS system values were calculated, with evaluation of the percentiles and presentation in box plots. RESULTS All patients successfully performed self-tonometry at home after receiving brief instructions. The first IOP measurement of each day covered a very wide interindividual range (between 3.1 mmHg in patient 5 and 21.7 mmHg in patient 4). Analysis of IOP values by time of day showed that patient 1 had significantly higher IOP values in the late day phase. For patient 5, the highest values were at midday. Patients 3 and 4 showed no significant fluctuations during the day. CONCLUSIONS Self-tonometry encourages patients to be actively involved in the management of their own illness and allows non-invasive assessment of IOP at different times and during diverse activities. However, the analysis and interpretation of these new data require further study, especially in relation to Goldmann applanation tonometry.
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Affiliation(s)
- A Koutsonas
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen
| | - P Walter
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen
| | - N Plange
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen
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Abstract
PURPOSE Trabeculectomy is among the first choice surgical treatments for glaucoma. Antimetabolites, especially mitomycin C, have improved the success rate. The aim of this study is to present the results of trabeculectomy with 5-fluorouracil (5-FU). METHODS A total of 71 consecutive trabeculectomies with 5-FU for decompensated glaucoma with at least 1 year follow-up data were retrospectively evaluated. The absolute (without therapy) and relative (with therapy) success rates for glaucoma medication were determined for intraocular pressure (IOP) levels of ≤ 21 mmHg, ≤ 18 mmHg, ≤ 15 mmHg and ≤ 12 mmHg respectively. Postoperative 5-FU administration rates, needling procedures and complications were recorded. RESULTS Sufficient follow-up data were available for a total of 55 patients. The average IOP was preoperatively 29.6 ± 7.3 mmHg (3 ± 1.4 active ingredients, partly acetazolamide), after 6 months 13.2 ± 4.1 mmHg and after 1 year 13.7 ± 4.3 mmHg. Complete success at 6 months postoperatively for the given pressure levels: were 92 %, 87 %, 79 % and 52% and at 1 year 87 %, 84 %, 51 % and 56%, respectively. Postoperative relative success for these pressure levels at 6 months were 96 %, 90 %, 81 % and 54% and at 1 year 96 %, 93 %, 58 % and 58%, respectively. Administrations of 5-FU postoperatively were no intervention (n=30 patients), subconjunctival 5-FU administration (n=25) and needling procedures (n=6). A temporary hypotension with a shallow anterior chamber was seen in 6 patients, cataract development in 5 patients and 1 patient developed corneal decompensation (multiple previous operations before trabeculectomy). CONCLUSION Trabeculectomy with intraoperative 5-FU administration showed very high success rates after 1 year. Serious complications were rarely seen. Intraoperative 5-FU administration can be considered as an alternative treatment to trabeculectomy with intraoperative use of mitomycin C.
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Affiliation(s)
- A Koutsonas
- Augenklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52057, Aachen, Deutschland,
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