Not only disease activity but also chronic hypertension and overweight are determinants of pregnancy outcomes in patients with systemic lupus erythematosus.

INTRODUCTION: Pregnancies in women with lupus nephritis are at high-risk of complications, while scarcity of scientific knowledge on prognostic factors impedes a fair medical counseling. We aimed to identify determinants associated with maternal and fetal complications. MATERIALS: We retrospectively reviewed medical charts of pregnancies that lasted more than 22 weeks in 66 patients with pre-existing lupus nephritis between 2004 and 2013 in France. Univariate and multivariate analyses were conducted to identify determinants for maternal complications, lupus renal flare and fetal prematurity or death. RESULTS: Eighty-four pregnancies were identified. A maternal complication occurred in 31 pregnancies (36.9%): mostly preeclampsia (17 pregnancies, 20.2%) and renal flares (12 pregnancies, 14.3%). Overall fetal survival was 94.0% (79/84). Maternal pregnancy complications were independently associated with prepregnancy body mass index >25 kg/m2 (OR 3.81, 95% CI 1.03-14.09) and immunological activity (positive anti-dsDNA antibodies or Farr assay lupus) (OR 4.95, 95% CI 1.33-18.43). Renal lupus flares were independently associated with maternal age (OR 1.50, 95% CI 1.12-2.01) and prepregnancy immunological activity (OR 15.99, 95% CI 1.57-162.68) while a remission time >12 months had a protective effect (OR 0.17, 95% CI 0.04-0.68). Three parameters were associated with a higher risk of fetal prematurity or death: a prepregnancy body mass index >25 kg/m2 (HR 3.58, 95% CI 1.45-8.83), hypertension (HR 8.97, 95% CI 3.32-24.25), and immunological activity (HR 3.34, 95% CI 1.30-8.63). CONCLUSION: Maternal age, prepregnancy hypertension, body mass index >25 kg/m2 and lupus immunological activity may be considered as the main determinants for fetal and maternal complications. A remission time above 12 months for patients with lupus nephritis could be associated with a reduced risk of renal flare during pregnancy.

[Lacrimal duct endoscopy with the rigid GRIN endoscopy]. / Tränenwegendoskopie mit einem starren GRIN-Endoskop.

BACKGROUND: Endoscopes play a more and more important role in visualizing and treating pathologies of the lacrimal drainage system. The present study analyzes the results obtained during endoscopy of the lacrimal ducts using a gradient-index (GRIN-) endoscope. PATIENTS AND METHODS: 44 patients, 18 to 87 years old (mean 59 years +/- 18.9), with chronic epiphora or symptoms of affection within the lacrimal ducts were examined using a rigid gradient-index (GRIN-) endoscope. Examination was performed ambulatory using drops for local anesthesia. RESULTS: All 44 patients showed pathologic conditions in the lacrimal drainage system. 2 patients had chronic changes. 25 patients had a relative stenosis (16 presaccal, 9 postcanalicular ones). 17 patients had a total stenosis (12 presaccal, 5 postcanalicular ones). 33 patients showed a single-sided pathology while 11 patients showed a bilateral one. The GRIN-endoscope could be used in all patients and gave excellent image quality of the pathologies. CONCLUSIONS: Endoscopy with a GRIN-endoscope can complement the ambulatory diagnostics and therapy of the lacrimal drainage system. In the patient group studied (n = 44), presaccal pathologies (n = 28) were twice more frequent than postcanalicular ones (n = 14). Further developments could enlarge the indications of the GRIN-endoscope.

[60 years Alfred Vogt Foundation. The prize winners and their work]. / 60 Jahre Alfred-Vogt-Stiftung. Die Preisträger und ihre Arbeiten.

BACKGROUND: The Alfred Vogt-Prize is the highest award in Switzerland for scientific research in ophthalmology and related fields of research. The Alfred Vogt institution was founded 60 years ago in Zürich, where Alfred Vogt was working as the head of the department of Ophthalmology of the University Hospital. For this reason the activity of the foundation was recognized on the occasion of the annual meeting of the Swiss Ophthalmology Society in Zürich 1998. METHOD AND RESULTS: The biographical notes of Alfred Vogt were compiled. The winners of the prize and their distinguished papers are listed below. During the 60 years since the establishment of the foundation the prize was rewarded to 53 researchers or research teams. The awards were divided among several researchers in those years when many outstanding papers were submitted. On the other hand in many years no award was given due to lack of award worthing research papers. 7 researchers received the prize more than once. CONCLUSION: The list of the winners of the Alfred Vogt-Prize reflects the history of the Swiss Ophthalmology. To a number of researchers the awards allowed them further research, which let to excellent contributions to international Ophthalmology.

[GRIN (gradient-index) intraocular endoscopy--possibilities and limits--a review]. / GRIN-Endoskopie intraokular--Möglichkeiten und Grenzen--eine Ubersicht.

BACKGROUND: Microendoscope techniques got a more important role in intraocular diagnostic and therapy. The used optical systems are fiberbundle-endoscopes and gradient-index (GRIN)-endoscopes. This study is concerned with the possibilities and limits of GRIN-endoscopes in pig eye models and in clinical use. PATIENTS AND METHODS: Several simulated intraocular techniques (phacoemulsification, implantation of intraocular lenses, vitrektomie, extraction of lost lens parts out of the corpus vitreous, extraction of metal foreign bodies) were done on pig eyes under GRIN-endoscopic control (GRIN-endoscope with diameter of 0.89 mm, Volpi, Switzerland). 3 clinical patients with cornea or lens opacities were examined. RESULTS: The image quality of simulated operations on pig eyes in clear intraocular conditions with a GRIN-endoscope was good. Also the clinical intraocular examinations could be done well, although the additional information were different. The in vivo examinations gave in one case no information (vitreous opacities very tight), in one case a relative information (mild vitreous opacities) and in one case an additional information (vitreous opacities rare). CONCLUSIONS: GRIN-endoscopes could complement the intraocular endoscopic spectrum in selected cases. At clear intraocular conditions good pictures were possible. GRIN-endoscopes could be used in cases where endoillumination is necessary. Then additional visual informations to the illumination are possible. The possibility to get overview images is limited with the actual endoscope probes. Ultrasound examination should be done in all cases with opacities of the anterior parts of the eye to get informations about the conditions inside the eye. Working inside the eye is possible with experience in this technique although a GRIN-endoscope has no stereopsis. Future developments should be done in stereopsis, several endoscope-tips and better handling (footpedal-controlling, autofocus).

[Measuring nerve fiber thickness with laser scanning polarimetry in aging]. / Nervenfaserschichtdickenmessung mittels Laser-Scanning-Polarimetrie im Altersvergleich.

PURPOSE: In glaucoma, visual field defects are a late sign of retinal nerve fiber layer damage. Scanning laser polarimetry directly quantifies nerve fiber layer thickness (NFLT) and may allow early detection of defects and progression during follow-up. METHODS: The NFLT of 54 healthy eyes of 54 subjects (age range from 14 to 83 years) was measured with a scanning laser polarimeter (Nerve Fiber Analyzer II). Measurements were performed along an ellipse 1.75 disc diameters away from the disc margin. For each subject an average image was calculated from three measurements. The ellipse was divided into four sectors by the internal software. All measurements were performed by the same examiner. All examined eyes had a normal ophthalmological examination, normal eye pressure and a normal computerized perimetry. RESULTS: The mean NFLT was thicker in the superior (91.3 microns +/- 16.7 microns) and inferior sector (90.8 microns +/- 15.6 microns) as compared to the temporal (53.7 microns +/- 15.4 microns) and nasal sector (60.0 microns +/- 14.8 microns). There was an inverse linear correlation between age and NFLT (Pearson's correlation-coefficient r = -0.30, p < 0.025). On the average, the mean NFLT decreased by 2.5 microns for each decade of age. The interindividual variation of the NFLT (mean standard deviation (s) = 16.1 microns) was, even after correction for age, much larger than the intraindividual variation (s = 6.6 microns). CONCLUSIONS: In normal subjects the NFLT decreases with age. The interindividual NFLT variation is, even after correction for age, much larger than the intraindividual. Therefore, scanning laser polarymetry might be especially useful for follow-up of NFLT.

[Rigid GRIN-endoscope for endoscopy of the tear ducts]. / Starres GRIN-Endoskop zur Tränenwegsendoskopie.

BACKGROUND: Using small endoscopes it is now possible to evaluate the status of lacrimal ducts in vivo. GRIN-Lenses produce better pictures from the lacrimal ways than fiber-bundles. GRIN-endoscopes are rigid. The present study is concerned with the feasibility and indications of such GRIN-endoscopic examination. PATIENTS AND METHODS: Two different GRIN-endoscopes with a distal diameter of 0.89 mm were used. One with a phi 0.5 mm optic and an additional working channel and another one with a phi 0.35 mm optic and two additional working channels. One channel each was used for injection of air or 0.9% NaCl. Either a laser fiber or another instrument (max phi 0.16 mm) could be introduced into the second channel. 44 patients in age between 18 and 87 with symptoms of epiphora or signs of chronic lacrimal way affections were examined. RESULTS: The presaccal lacrimal ducts could be clearly visualized in all patients. In case of presaccal stenosis, the examination of the lacrimal sac was not always possible. The endoscope used, based of GRIN-lenses, gave an excellent image quality. Endoscopy under local anesthesia was well tolerated by all the patients with affection of the lacrimal drainage system. Because this ambulant examination does not stress the patient too much, it could be repeated a number of times. Endoscopy under general narcosis could enlarge the application spectrum. This method can complement the ambulant diagnostics and therapy of the lacrimal drainage system.