Twelve-Year Follow-Up of Navigated Computer-Assisted Versus Conventional Total Knee Arthroplasty: A Prospective Randomized Comparative Trial.

BACKGROUND: Navigated computer-assisted total knee arthroplasty (TKA) was introduced to expedite long-term survival based on improved postoperative implantation accuracy. However, long-term outcome data after 10 years or more are rare, even available meta-analyses show controversial study results. METHODS: In a prospective randomized trial, 100 conventional TKAs (group CONV) were compared with 100 computer-assisted TKAs (group NAV) after a mean follow-up of 12 years postoperatively. A long-leg weight-bearing X-ray was performed for measuring mechanical axis of the limb, lateral distal femoral angle, and medial proximal tibial angle. Tibial slope, patella alpha angle, and radiolucent lines were also observed. Clinical investigation included evaluation of 4 different scores: Insall Knee Score, Western Ontario and MacMaster University Index score, Hospital for Special Surgery Knee Score, and visual analog scale. RESULTS: Based on a follow-up rate of at least 75%, no difference in TKA survival was found 12 years postoperatively: 91.5% in group CONV vs 98.2% in group NAV (P = .181). Since 5-year follow-up, no additional TKA revision had been performed in both groups. Group CONV showed a nonsignificant higher inaccuracy of neutral lower limb axis (1.8° ± 1.4°) compared to group NAV (1.6° ± 1.7°, P = .700). All X-ray assessments were not significant different within both study groups (P ≥ .068). Clinical examination showed no differences in evaluations (P ≥ .204). All collected outcome score results were similar (P ≥ .222). CONCLUSION: Twelve years postoperatively, no differences were found in terms of long-term survival, implantation accuracy, clinical outcome or score results.

Implication of femoral stem on performance of articular surface replacement (ASR) XL total hip arthroplasty.

Taper junctions of large diameter metal-on-metal femoral heads and femoral stems were described as metal ion generator due to accelerated wear and corrosion. However, literature about the Articular Surface Replacement (ASR) total hip arthroplasty (THA) invariably deals with stems manufactured by DePuy Orthopedics (Warsaw, IN, USA). Nothing is known whether different stems with common 12/14 mm tapers affect failure rate or ion release. 99 ASR THA (88 patients) implanted with CoxaFit or ARGE Geradschaft stems (K-Implant, Hannover, Germany) were retrospectively analyzed. After a mean follow-up of 3.5 years revision rate was 24.5%, mostly due to adverse reaction to metal debris (ARMD). CT scan revealed component loosening in 10.3% and pseudotumoral lesions in 12.6%. Elevated ion concentrations (>7 µg/l) were found in 38.6%.

Conventional versus computer-assisted technique for total knee arthroplasty: a minimum of 5-year follow-up of 200 patients in a prospective randomized comparative trial.

In the literature, studies of computer-assisted total knee arthroplasty (TKA) after mid-term period are not conclusive and long-term data are rare. In a prospective, randomized, comparative study 100 conventional TKAs (group REG) were compared with 100 computer-assisted TKAs (group NAV). Minimum follow-up was 5years. No difference in implant failure was found with 1.1% in group NAV versus 4.6% in group REG (P=0.368). Group NAV showed a significantly less mean deviation of mechanical limb axis (P=0.015), more TKAs (90% versus 81% in group REG) were within 3° varus/valgus and a higher tibial slope and lateral distal femoral angle (LDFA) accuracy was found (P≤0.034). Clinical investigational parameters showed no differences (P≥0.058). Insall and HSS score total were also higher in group NAV (P≤0.016).

Evaluation of optical coherence tomography findings in age-related macular degeneration: a reproducibility study of two independent reading centres.

BACKGROUND/AIMS: To determine the reproducibility among readers of two independent certified centres, the Vienna Reading Center (VRC) and the University of Wisconsin-Madison Reading Center (UW-FPRC) for optical coherence tomography (OCT) images in age-related macular degeneration (AMD). METHODS: Fast macular thickness scans and 6 mm cross hair scans were obtained from 100 eyes with all subtypes of AMD using Stratus OCT. Consensus readings were performed by two certified OCT readers of each reading center using their grading protocol. Common variables of both grading protocols, such as presence of cystoid spaces, subretinal fluid, vitreomacular traction and retinal pigment epithelial detachment, were compared using κ statistics. In addition, the intraclass correlation coefficient (ICC) was calculated for centre point thickness (CPT) of values re-measured manually in the presence of alignment errors. RESULTS: The reproducibility was dependent on the variable measured with a κ value of 0.81 for the presence of cystoid spaces, 0.78 for the presence of subretinal fluid and 0.795 for the presence of vitreomacular traction. The lowest reproducibility was found for the presence of retinal pigment epithelial detachment with a κ value of 0.51. The CPT was re-measured in 29 out of 100 scans at both sites with an ICC of the re-measured thicknesses of 0.92. CONCLUSION: OCT scan data are crucial in monitoring treatment efficacy in AMD clinical trials. For comparison of results obtained by different reading centers, the inter-reading center reproducibility is essential. Although the reproducibility is generally high, the reliability depends on the selected morphological parameters.

Retinal thickness and volume measurements in diabetic macular edema: a comparison of four optical coherence tomography systems.

PURPOSE: To compare different spectral domain optical coherence tomography devices regarding retinal thickness values in patients with diabetic macular edema and to correlate the results with conventional time domain Stratus OCT data. METHODS: Thirty eyes of 30 consecutive patients with diabetic macular edema were included into a prospective study. The macula was examined by Spectralis HRA+OCT, Cirrus HD-OCT, 3D OCT-1000, and Stratus OCT. The procedures' sequence was performed by a single experienced technician in a randomized fashion according to a computer-generated list. In each eye, foveal thickness, foveal volume, and total macular volume were measured automatically. Intraclass correlation, coefficients of variance, and coefficients of repeatability were calculated. RESULTS: Foveal thickness differed between the particular devices with a mean ± SD ranging from 359.97 ± 105.84 µm to 437.70 ± 115.84 µm. Correlation between the different OCT devices resulted in r > 0.7 (Pearson), and intraclass correlation was >0.9. Agreement of measurements was assessed showing a mean difference of foveal thickness values ranging from 19.2 µm to 77.7 µm (P < 0.05) and coefficients of repeatability ranging from 37.7 µm to 87.4 µm. CONCLUSION: While intradevice reproducibility is satisfactory, retinal thickness and volume measurements should not be used interchangeably because measurements differed significantly between systems. The lack of interdevice agreement seems to be related to the different segmentation algorithm of thickness measurement and should be considered because it may strongly influence treatment decisions and conclusions.

Angiogenic and inflammatory markers in the intraocular fluid of eyes with diabetic macular edema and influence of therapy with bevacizumab.

PURPOSE: The purpose of this study was to determine the concentrations of angiogenic and inflammatory markers in human eyes with diffuse diabetic macular edema before and during therapy with intravitreal bevacizumab and their association with disease activity. METHODS: In a prospective clinical trial, 10 eyes of 10 consecutive patients with vision loss because of diabetic macular edema were compared with 10 eyes of 10 age-matched controls. Bevacizumab was administered at baseline; retreatments were given monthly according to disease activity. During a follow-up of 6 months, aqueous humor samples were taken each time intravitreal therapy was administered. A multiplex assay was used for measurement of 12 different growth factors and cytokines. RESULTS: Aqueous humor of eyes with diabetic macular edema demonstrated a significantly increased expression of monocyte chemoattractant protein-1 and interleukin-8 and higher, but not significant, levels of interleukin-6 and vascular endothelial growth factor. Intravitreal therapy with bevacizumab resulted in a significant decrease of vascular endothelial growth factor below physiologic levels. This change was not associated with clinical disease activity as measured by visual acuity and central retinal thickness. CONCLUSION: Eyes with diabetic macular edema showed a different profile of monocyte chemoattractant protein-1 and interleukin-8 as compared with controls. The intraocular vascular endothelial growth factor expression decreased significantly after the first intravitreal injection of bevacizumab; this reduction was prolonged by consecutive monthly retreatment.

A systematic correlation between morphology and functional alterations in diabetic macular edema.

PURPOSE: The aim of this study was to correlate different types of retinal morphologic alterations secondary to diabetic macular disease with their characteristic impact on retinal function. METHODS: In the present cross-sectional study, 26 eyes of 26 diabetic patients with clinically significant macular edema were examined. All patients underwent complete standardized ophthalmologic examination, including SD-OCT and microperimetry. Microperimetric values were projected over the scanning laser ophthalmoscope image of the OCT device, allowing direct correlation of functional and morphologic parameters. Results over all 1066 individual areas were analyzed using a general linear model. RESULTS: All the characteristic morphologic alterations demonstrated a significant effect on retinal function (P < 0.0002), except for outer nuclear layer (ONL) hyporeflectivity and small ONL cysts. Large ONL cysts (>220 µm) and serous retinal detachment had the greatest estimated negative effect on retinal sensitivity (-3.86 and -3.66 dB), followed by medium-sized ONL cysts, hard exudates associated with an extinction of the scan signal, and inner nuclear layer cysts. CONCLUSIONS: In diabetic macular edema, serous retinal detachment and large ONL cysts are the two morphologic changes with the greatest negative impact on retinal function.

Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery.

PURPOSE: To assess prognostic factors in epiretinal membrane (ERM) surgery using spectral-domain (SD) optical coherence tomography (OCT). DESIGN: Prospective, interventional case series. PARTICIPANTS: Forty-one patients. METHODS: Patients with a diagnosis of ERM were examined with spectral-domain and time-domain (TD) OCT before and after surgery. MAIN OUTCOME MEASURES: Main outcome measures were functional results and predefined OCT patterns. Cofactors analyzed were the type of ERM, the duration and grading of subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, and age. A multivariate regression analysis was performed. RESULTS: Thirty-nine patients (95%) showed an improved or stable best-corrected distance visual acuity (DVA) at 3 months, whereas 36 patients (88%) showed an improved or stable best-corrected near visual acuity (NVA) at 3 months. Significant correlations (P>0.4) were found between the course of central retinal thickness (CRT) assessed using SD OCT and TD OCT (P<0.02). No clinically relevant correlations (P<0.3) were seen between CRT and VA (P>0.1). Baseline DVA and NVA were found to be significant prognostic values for the postoperative decrease in CRT in both OCT systems (P<0.04) as well as for the visual outcomes (P<0.007) at 3 months. In addition, the integrity of the junction between the photoreceptor inner segment and outer segment (IS/OS) significantly influenced the visual outcomes at 3 months (P<0.038). The baseline profile of the internal limiting membrane (ILM) significantly influenced the NVA at 3 months (P<0.009), whereas the postoperative foveal contour significantly influenced the DVA at 3 months (P<0.025). The type of ERM, subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, or age had no significant influence on patient outcome (P>0.05). Compared with TD OCT, SD OCT allowed for a more precise differentiation between the ERM and the retinal surface and for a better evaluation of the IS/OS line. CONCLUSIONS: Besides the baseline VA, the integrity of the IS/OS line, better visualized by SD OCT, can be used to predict the functional outcomes after surgery. Additionally, analyzing the ILM profile and the foveal contour may help to understand limited visual outcomes after surgery. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of two minimally invasive implantation instrument-sets for total knee arthroplasty.

Several choices of instrument systems are available for minimally invasive surgical approaches. There are reports that one alternative, the quadriceps sparing, side-cutting instrumentation, results in diminished implantation accuracy. A total of 108 patients were randomized to undergo TKA either using side-cutting implant instrumentation (Group A) or anterior-posterior mini-incision instrumentation (Group B). All TKAs were operated on with a minimal invasive, mini-midvastus surgical approach. 50% of the TKAs were performed with computer-assistance in each cohort. The radiographic parameters, clinical outcomes and knee scores were evaluated preoperatively and 3 months postoperative. In Group B, we found significantly higher accuracy for the mechanical axis of the limb (range +/-3 degrees: Group A 54% versus Group B 89%, p = <0.001), medial proximal tibial angle (range +/-3 degrees: Group A 85% versus Group B 98%, p = <0.027) and tibial slope (range +/-3 degrees: Group A 59% versus Group B 85%, p = <0.007). The application of the navigation system could only significantly reduce outliers (accuracy >3 degrees) in Group B. Clinical outcomes and knee scores were similar in both groups and were not influenced by computer-assistance. Using the anterior-posterior, mini-incision instruments for minimally invasive TKA will lead to higher implantation accuracy when compared to the quadriceps sparing side-cutting instrumentation. The navigation technique could not compensate for shortcomings of the side-cutting instrumentation. The clinical relevance of this study is that the quadriceps sparing side-cutting instrumentation should not be used for TKA because of unacceptable reduced implantation accuracy.

Neovascular age-related macular degeneration: intraocular cytokines and growth factors and the influence of therapy with ranibizumab.

PURPOSE: To investigate concentrations of growth factors and inflammatory cytokines in eyes with neovascular age-related macular degeneration (AMD) before and during therapy with intravitreal ranibizumab and to identify associations with disease activity. DESIGN: Prospective clinical trial. PARTICIPANTS AND CONTROLS: Twenty-eight eyes of patients with neovascular AMD were compared with 28 eyes of age-matched patients with cataract as control. METHODS: Ranibizumab was administered intravitreously once at baseline, and retreatments were given at monthly visits if optical coherence tomography (OCT) revealed macular edema or vision loss had occurred. Aqueous humor samples were taken each time intravitreal interventions were performed. Follow-up was 12 months. Luminex (Luminex Inc., Austin, TX) multiplex assays were used for measurement of 29 different growth factors and cytokines, including vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). MAIN OUTCOME MEASURES: Differences in the concentrations of growth factors and inflammatory cytokines in eyes with neovascular AMD compared with control eyes and the influence of therapy with intravitreal ranibizumab. RESULTS: A significantly increased expression of VEGF (P = 0.033) and a significantly decreased expression of PDGF (P = 0.038) were measured in the aqueous humor of eyes with neovascular AMD. Furthermore, a significant decrease of VEGF (P<0.001) was observed after intravitreal injection of ranibizumab along with significant changes in visual acuity and central retinal thickness (P = 0.039 and P<0.001). During follow-up with a flexible regimen, a correlation was identified between increased VEGF levels and persistent or recurrent macular edema. Changes in PDGF levels were strongly associated with alterations in VEGF concentration. CONCLUSIONS: Vascular endothelial growth factor and PDGF-AA seemed to be associated with disease activity of neovascular AMD. Intravitreal anti-angiogenic treatment with ranibizumab resulted in significantly decreased intraocular VEGF expression below physiologic levels compared with controls. This effect was measurable as long as 4 weeks after each injection and was prolonged by consecutive retreatment. With recurrence after discontinuation of treatment, VEGF levels increased again.

Association of retinal sensitivity and morphology during antiangiogenic treatment of retinal vein occlusion over one year.

PURPOSE: Evaluation of the association between functional and anatomic retinal changes during anti-vascular endothelial growth factor (VEGF) therapy with bevacizumab (Avastin) in patients with cystoid macular edema secondary to retinal vein occlusion (RVO) using microperimetry and spectral domain optical coherence tomography (SD-OCT). DESIGN: Prospective, uncontrolled study (EUDRACT NR-2005-003288-21). PARTICIPANTS: Twenty-eight patients with cystoid macular edema secondary to RVO. METHODS: Patients initially received 3 consecutive intravitreal injections of 1.25 mg bevacizumab at 4-week intervals. Further treatment was based on morphologic (OCT) and functional best-corrected visual acuity (BCVA) findings. During the 1-year follow-up, a rigorous standardized evaluation was performed monthly. Macular function was documented by microperimetry (Nidek, MP1 Microperimeter) and BCVA based on the Early Treatment in Diabetic Retinopathy Study (ETDRS). Morphologic parameters included central retinal thickness (CRT) as measured by conventional OCT (Stratus), and central subfield thickness (CST), mean retinal thickness (MRT), and retinal volume (RV) measured by SD-OCT. MAIN OUTCOME MEASURES: Imaging of retinal morphology using OCT and SD-OCT and evaluation of retinal function assessed with microperimetry and ETDRS charts during 12 months of anti-VEGF treatment. RESULTS: Within 6 months, the mean area of absolute scotoma was reduced from 21.4% of the central visual field to 6.4% and remained at this level until month 12 (7.4%). Mean BCVA improved from 51 to 66 letters on ETDRS charts. The CRT, CST, and MRT decreased significantly (P<0.002) and remained stable during the follow-up. The RV values did not improve significantly under therapy. Statistical analysis using a linear effects model revealed significant associations between the functional and morphologic outcomes, most notably between BCVA, macular sensitivity, CRT (Stratus OCT), CST, and MRT (Cirrus OCT) values. CONCLUSIONS: Central retinal morphology, especially CRT and CST measured by conventional and SD-OCT, and retinal function improved significantly during treatment of RVO with a flexible dosing regimen of intravitreal bevacizumab. Functional (central visual acuity and visual field) and morphologic parameters (retinal thickness) were significantly related. These associations highlight the value of OCT imaging for assessing this disease entity.

Intravitreal triamcinolone for persistent cystoid macular oedema in eyes with quiescent uveitis.

BACKGROUND: To determine the outcome following injections of triamcinolone acetate (IVTA) in the treatment of persistent cystoid macular oedema (CMO) in quiescent, non-infectious uveitis. METHODS: Retrospective analysis of patients with inactive uveitis requiring/not requiring immunosuppressive therapy who received IVTA because of chronic CMO refractory to previous systemic steroids. Number of IVTA (re-)treatments, distance visual acuity, near visual acuity, mean foveal thickness, intraocular pressure, duration of CMO, type of uveitis and systemic therapy were assessed previous to and 1, 4, 12 weeks following each IVTA treatment. RESULTS: Between March 2003 and May 2006, 24 eyes of 18 patients received between one and three IVTA injections. A resolution of chronic CMO was observed in 7/24 eyes (29.2%, 5 eyes after single injection of IVTA, 1 eye each after two and three injections of IVTA), a significant increase in distance visual acuity in 9/24 eyes (37.5%; 5 eyes with resolution of CMO, 4 eyes despite persistent CMO) and in near visual acuity in 13/24 eyes (54.6%; 6 eyes with resolution of CMO, 7 eyes despite persistent CMO). CONCLUSIONS: IVTA might be considered as a treatment for patients with chronic CMO when persistent despite previous systemic steroid therapy. Even patients without sustained resolution of CMO after IVTA might benefit in terms of transiently increasing visual acuity, but progression of cataract and rise in intraocular pressure limit repeatability.

Ventricular interaction in children after repair of tetralogy of Fallot: a longitudinal echocardiographic study.

AIMS: Progressive right ventricular (RV) dilation due to pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) may impair left ventricular (LV) filling. Our aim was to analyse long-term time courses of M-mode LV and RV measurements and to relate these to the degree of PR. METHODS AND RESULTS: Retrospective longitudinal cohort of children (n = 88) after repair of TOF followed by serial echocardiography over 9 years. LV and RV diameters were expressed by z-scores based on normal paediatric reference values. Time courses of LV and RV diameter z-scores, degree of PR, and influence of co-variables were analysed using mixed regression models. LV diameter z-scores were significantly lowered before repair, increased after surgery, but fell again over time; thus, mean LV diameters were significantly lower than normal population means at all times. LV diameter z-scores correlated negatively with RV dilation and degree of PR. Notably, they were significantly higher in patients with previous shunts. After pulmonary valve replacement, LV diameter z-scores recovered to normal, whereas RV diameter z-scores remained abnormal. CONCLUSION: Our results confirm progressive adverse RV-LV interaction in the long-term post-operative follow-up of TOF. The use of z-scores facilitated the analysis of time courses of LV and RV diameters.

Biomechanical comparison of modified Kessler and running suture repair in 3 different animal tendons and in human flexor tendons.

PURPOSE: To establish the animal flexor tendon that best mimics the biomechanical performance of human flexor tendons. We investigated the biomechanical behavior of core and running sutures in 3 different animal flexor tendons and in human flexor tendons. Additionally, we attempted to help standardize future flexor tendon studies. To that purpose, nearly all variables occurring in the test setup have been highlighted. METHODS: The species selected were pig, calf, sheep, and human. Two groups were formed. In the first group we tested 3-0 core sutures (Ticron; Tyco Healthcare, Vienna, Austria), and in the second group we tested 5-0 running sutures (Ethilon; Ethicon, Vienna, Austria). In each group, 10 tendons of each specimen were tested, which yielded a total of 80 tendons. In each group, the repaired tendons were subjected to 3,000 linear load cycles at a load of 15 N. At the end of this procedure, final gap values were recorded. In the next step, ultimate load-to-failure data were obtained from each specimen. RESULTS: Core sutures behaved similarly in the human, sheep, and pig tendons with respect to ultimate loads. With respect to gap formation, core sutures behaved similarly in the human, sheep, and calf tendons. Deep running sutures behaved similarly in the human, sheep, and pig tendons in terms of ultimate load to failure. CONCLUSIONS: In this study, sheep tendons were found to best mimic the biomechanical behavior of human tendons. Calf tendons seem to be unsuitable. There is a strong need for consistency in biomechanical test setups.

Intraocular concentrations of growth factors and cytokines in retinal vein occlusion and the effect of therapy with bevacizumab.

PURPOSE: To investigate concentrations of growth factors and inflammatory cytokines in eyes with central (CRVO) and branch (BRVO) retinal vein occlusion before and during therapy with bevacizumab and to identify associations with disease activity. METHODS: In a prospective clinical trial, 13 eyes of patients with CRVO (n = 5) or BRVO (n = 8) were included. Bevacizumab was administered intravitreously at baseline and months 1 and 2. Retreatments were given at monthly visits if OCT showed edema or when vision loss occurred. Aqueous humor samples were taken each time injections were performed. Follow-up was 15 months. Samples from patients with cataract served as the control. Multiplex bead assays were used for measurement of 28 growth factors and cytokines. RESULTS: During therapy with bevacizumab, VEGF levels were reduced to below detection in the first 2 months. Whenever criteria for retreatment were met, VEGF was measurable again. The decrease in VEGF was associated with a decrease in central retinal thickness (CRT) and improvement in visual acuity (VA). Significantly increased concentrations of VEGF, IL-6, IL-8, IP-10, MCP-1, and PDGF-AA were observed in aqueous humor samples of patients with CRVO compared with the control samples. CONCLUSIONS: VEGF levels were significantly elevated in patients with CRVO compared with control subjects. Intravitreal injections of bevacizumab resulted in a substantial decrease of VEGF under physiologic levels and remained low under the loading dose of three consecutive monthly retreatments. Macular edema was related to VEGF levels in the aqueous humor.

Accuracy of preoperative biometry in vitrectomy combined with cataract surgery for patients with epiretinal membranes and macular holes: results of a prospective controlled clinical trial.

PURPOSE: To evaluate how adding vitrectomy to cataract surgery affects the accuracy of preoperative biometry and postoperative refractive outcomes. SETTING: Department of Ophthalmology, Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic, Vienna, Austria. METHODS: This study comprised 40 patients with vitreoretinal pathology and coexisting significant cataract (study group) and 40 patients with significant cataract only (control group). The main outcome measure was intraocular lens (IOL) power prediction error. Secondary outcome measures were spherical equivalent, anterior chamber depth, axial length, keratometry values, and intraocular pressure. A multivariate regression analysis was performed. RESULTS: There was a significant difference in prediction error between the study group and control group (P< .05). The addition of vitrectomy was associated with induced myopia of approximately -0.4 diopter, more so in patients who had epiretinal membrane removal than in patients with macular hole surgery (P= .04). There was no significant difference in prediction error between the 3 IOLs used (P= .2). CONCLUSION: The myopic shift was strongly dependent on the diagnosis and the need for intraocular tamponade, indicating that a slightly hyperopic IOL should be used in patients having combined surgery.

The effect of kidney transplantation on distal tubular vacuolar H+-ATPase.

BACKGROUND: The presence of vacuolar (v)H+-ATPase in distal tubule alpha-intercalated cells is essential for hydrogen excretion and maintenance of acid-base homeostasis. Loss of vH+-ATPase after kidney transplantation could cause posttransplant distal renal tubular acidosis (dRTA). METHOD: Immunostaining of the kidney specific vH+-ATPase of cortical collecting duct cells (CCT) was performed in 37 kidney biopsies taken immediately prior to transplantation and after engraftment (median [range]: 10 [1-181] months). Apical or intracytoplasmatic staining intensity was classified as grade 0 (absent), grade 1 (weak), or grade 2 (strong), and positive cells expressed as percentage of all CCT cells. In addition, kidney biopsies were scored for damage by the Banff schema. Serum and urinary pH, anion gap, and serum potassium were obtained for the diagnoses of dRTA. RESULTS: Fourteen transplant recipients had dRTA type I, 5 had rate-limited RTA, six had type IV dRTA, and 12 had no RTA. In pretransplant biopsies, 40% [3-77%] of CCT cells were positive for vH+-ATPase but only 17% [0-39%] after transplantation (P<0.0001). The loss of vH+-ATPase expression was similar in patients with dRTA type I (-21%), type IV (-25%), rate limited RTA (-21%), or no RTA (-29%). The decrease affected predominantly the apical proton pump expression. The individual loss of vH+-ATPase expression was not related to the time elapsed since transplantation, immunosuppressive drugs, acute transplant rejection, or tubulointerstitial changes. CONCLUSION: Kidney transplantation leads to a general decrease of distal tubular vH+-ATPase expression. Loss of proton pump activity occurs unrelated to immunosuppressive therapy or transplant related histologic changes.

Blue light-filter intraocular lenses in vitrectomy combined with cataract surgery: results of a randomized controlled clinical trial.

PURPOSE: To evaluate the effect of the blue light-filter intraocular lenses (IOLs) in vitrectomy combined with cataract surgery, focusing on the surgeon's ability to perform specific vitreoretinal procedures and on the patients' outcome. DESIGN: Randomized clinical trial. METHODS: Sixty patients, recruited from our outpatient department, were assigned randomly to receive an ultraviolet-filter IOL (clear IOL group) or a blue light-filter IOL (yellow IOL group) combined with a vitreoretinal procedure. Main outcome measures were intraoperative conditions for the surgeon and the functional outcome. Second outcome measures were complication rates and vitreoretinal diagnoses. RESULTS: The questionnaire responses showed that the blue light-filter IOLs did not represent an impediment to vitreoretinal surgery (P>.05). No intraoperative complications were encountered in either group. Patients in both IOL groups showed comparable functional results with respect to visual acuity, contrast sensitivity, color vision, and glare effect (P>.05). The functional outcome was influenced significantly by the vitreoretinal diagnosis (P<.01). CONCLUSIONS: With the possible advantage of macular protection and no intraoperative or functional disadvantage, the routine use of the blue light-filter IOL in combined surgery can be recommended.

Accuracy of craniofacial measurements: computed tomography and three-dimensional computed tomography compared with stereolithographic models.

In a retrospective study, distance measurements of nine children with craniofacial malformation were analyzed. The accuracy of measurements was compared when measured on a workstation using a 16-slice multidetector spiral computed tomography and on a stereolithographic model. Three different methods of defining distances were investigated: 1) on the stereolithographic plastic models, 14 distances connecting landmarks were identified with a digitizer (Polaris Tracker); 2) the same distances were defined at axial, coronal, and sagittal reformats of the computed tomography data set and measured using a Philips MX View workstation; and 3) the same 14 distances were defined at three-dimensional virtual reality models of the skulls at the same workstation. All measurements were performed with all three methods by three different readers. The following conclusions could be drawn: stereolithographic models provide a highly exact reproduction of the skull in children with craniofacial malformations. They are a reliable basis for all analytic and probatory endeavors preparing complicated surgical corrections. Three-dimensional virtual reality display modes serve significantly better for exact distance measurements on the complex surface of the human skull than planar reformats of the same computed tomography data sets.

Anatomy and function of the macula after surgery for retinal detachment complicated by proliferative vitreoretinopathy.

PURPOSE: To investigate the macular changes following silicone oil removal after surgery for complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR). DESIGN: Retrospective interventional case series. METHODS: setting: Vienna, Austria. study population: Thirty-nine patients with attached retina after silicone oil removal following previous vitrectomy and silicone oil tamponade for complicated RD and PVR grade C3 and worse. observation procedures: Examination of macular anatomy with biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). Macular function was tested by assessing logMAR distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity and reading speed using a standardized test (Radner charts). main outcome measures: Macular anatomy, VA, reading acuity, and reading speed. RESULTS: The macula was clinically normal in five patients (12.8%). Retinal pigment epithelium (RPE) irregularities were found in nine patients (23.1%). Eight patients (20.5%) had macular pucker, seven (18.0%) had cystoid macular edema (CME), and 10 (25.6%) had subretinal fibrosis. The mean VA of all patients was logMAR 0.67 +/- 0.68 (range, -0.1 to 3.0). Six eyes did not achieve reading acuity. The distance VA of the remaining 33 eyes was logMAR 0.44 +/- 0.29 and their mean reading acuity was logRAD 0.62 +/- 0.35, with a reading speed ranging from 55 to 240 words per minute. CONCLUSIONS: We found macular changes in 87% of the patients, one-third thereof being eligible for further treatment (macular pucker or CME). Thus, the majority of these patients do not seem to be eligible for a further improvement of anatomic or functional outcome.