Page 38 - A Magyar Szemorvostársaság 2022. évi kongresszusának programja és az előadások kivonata

Elődáskivonatok/Abstracts

Nurse administered intravitreal injections
Miklos Schneider , Camille Rostgaard , Javad Nouri Hajari , Helle Josefine Fuchs 1
1
1,2
1
1 Rigshospitalet – Glostrup, Department of Ophthalmology, Glostrup, Denmark
2 Semmelweis University, Department of Ophthalmology, Budapest, Hungary
Background: Intravitreal anti-VEGF injections improved the prognosis of quality of life of patients with age-related macular degeneration
(AMD), retinal vein occlusion (RVO) and diabetic macular edema (DME). The number of administered intravitreal injections is steadily
on the rise putting an increasing workload on physicians. To relieve that workload, we trained nurses to administer intravitreal injections
and to screen AMD patients.
Aim: To report on the results of the nurse administered injection program.
Methods: Retrospective data collection and the demonstration of the system. There are 28 nurses and 4 optometrists working in medical
retina team at the Department of Ophthalmology at Rigshospitalet, 10 of those are authorized to give intravitreal injections (injection-nurse)
and 7 are trained to do follow-ups for AMD patients (screening-nurse). To be authorized to fulfill either role, candidates need to go through a
theoretical and practical education, pass a theoretical and practical exam, and to maintain their competency they need to perform a required
number of cases continuously. Their work is monitored by the senior injection nurse responsible for quality assurance. Patients are treated
from a joint list simultaneously in maximum 6 injection rooms with 2 nurses in each. Follow-ups of AMD patients are carried out based on
an algorithm by screening-nurses who consult with physicians if necessary.
Results: In 2021, a total of 41 309 intravitreal injections were administered at Rigshospitalet. Endophthalmitis occurred in 8 patients
(0.019%). The rate of endophthalmitis did not increase since nurses took over the injections. Since the introduction of the program, patient
waiting times went down notably and patient satisfaction is very high.
Conclusions: By providing proper training and quality assurance, nurse-administered injections proved to be safe, pose no risk to patient
safety, increase patient satisfaction, increase the knowledge and competency of nurses and their job satisfaction. With the introduction of the
program, the required number of injections is manageable, and physicians have time to carry out other medical activities.

Chorioidea ruptura és szövődményeinek (diagnosztikus és terápiás)
bemutatása eseteink kapcsán
Baranyi Nóra, Kovács Attila, Dégi Rózsa
Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szemészeti Klinika, Szeged
Bevezetés: A chorioidea ruptura (CR) tompa traumát követően, 5–10%-ban jelentkező chorioidea-Bruch membrán-RPE komp-
lexum megszakadás. A sérülés mechanizmusából fakadóan kifejezetten fiatal betegcsoportot érint (átlag életkor 30 év). CR
asszociált korai (subretinális vérzés), illetve késői szövődmények (secunder chorioidea neovascularizáció) nagy százalékban
alakulhatnak ki. Előadásunkban CR típusos eseteit, annak szövődményeit és terápiás stratégiáinkat mutatjuk be.
Anyag és módszer: A 17 éves nőbeteget tompa trauma következtében kialakult peripapillaris CR miatt vizsgáltunk. Obszer-
vációnk 4 éve alatt CNV nem fejlődött ki. A 28 éves férfibeteg szintén makuláris CR, késői secunder CNV miatt összesen 4
alkalommal intravitreális bevacizumab kezelésben részesült (treat-and-extend), amelyet követően 2 éve aktivitásmentes. A 34
éves férfibeteget több fókuszú makuláris CR, következményes subretinális, subfoveális vérzés miatt észleltünk. Ellátása során
akutan 0,3 ml tömény C3F8 gázt injektáltunk az üvegtesti térbe, majd a korai secunder CNV kialakulása, aktivitási jelek miatt
intravitreális bevacizumab injekciót indikáltunk.
Következtetés: 5–12%-ban egy éven belül secunder CNV alakulhat ki CR talaján, melyet a természetes gyógyulási folya-
mat részeként is értékelhetünk. OCT és OCTA gyors és non-invazív módja a korai CNV detektálásának. CR direkt adekvát
kezelésére nincs lehetőség, azonban korai és késői szövődményeinek mielőbbi felismerése és ellátása létfontosságú a későbbi
vizuális potenciál szempontjából.

Choroidal rupture and its complications – diagnostic and therapeutic
approaches based on our case reports
Nóra Baranyi, Attila Kovács, Rózsa Dégi
Department of Ophthalmology, University of Szeged
Purpose: Choroidal rupture (CR) is a posterior segment injury following blunt trauma that results in a break in the choroid-Bruch memb-
rane-RPE complex. In 5–10% of patients with such injury develops CR. Due to the mechanism of the trauma predominantly young men are
affected (mean age is 30 years). CR associated early (subretinal hemorrhage) and late complications (exudative choroidal neovasculariza-
tion) may be developed in a large proportion. Typical CR cases, complications and therapeutic strategies are presented in our review.
Methods: A 17-year-old woman with peripapillary CR following blunt trauma was evaluated. During the four year follow-up period seconda-
ry CNV has not developed. A 28-year-old man presented with traumatic CNV due to macular CR was treated with intravitreal bevacizumab
(treat-and-extend regimen). After the 4th injection CNV became inactive. A 34-year-old man presented with subretinal, subfoveal hemorrhage
following blunt trauma due to multifocal macular CR. He was treated with an intravitreal 0,3 ml injection of 100% C3F8 and face down posi-
tioning for a week. CNV was diagnosed after three weeks of follow-up, therefore a single dose of intravitreal bevacizumab was applied.
Conclusions: The occurrence rate of post-traumatic CNV is about 5–12% in eyes with CR. CNV by itself can be considered as a part of the
natural healing process. Multimodal imaging, such as OCT and OCTA, is a quick and non-invasive method to detect CNV. Although there is
no treatment for CR per se, the diagnostic and therapeutic interventions of associated complications could be vital for the future visual outcome.

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