Physician deaths from corona virus (COVID-19) disease.

BACKGROUND: The COVID-19 pandemic has caused much morbidity and mortality to patients but also health care providers. AIMS: We tabulated the cases of physician deaths from COVID-19 associated with front-line work in hopes of mitigating future events. METHODS: On 15 April 2020, a Google internet search was performed using the keywords 'doctor', 'physician', 'death', 'COVID' and 'coronavirus' in English and Farsi, and Chinese using the Baidu search engine. The age, sex and medical speciality of physicians who died from COVID-19 in the line of duty were recorded. Individuals greater than 90 years of age were excluded. RESULTS: We found 278 physicians who died with COVID-19 infection, but complete details were missing for 108 individuals. The average age of the physicians was 63.7 years with a median age of 66 years, and 90% were male (235/261). General practitioners and emergency room doctors (108/254), respirologists (5/254), internal medicine specialists (13/254) and anaesthesiologists (6/254) comprised 52% of those dying. Two per cent of the deceased were epidemiologists (5/254), 2% were infectious disease specialists (4/254), 6% were dentists (16/254), 4% were ENT (9/254) and 3% were ophthalmologists (8/254). The countries with the most reported physician deaths were Italy (121/278; 44%), Iran (43/278; 15%), Philippines (21/278; 8%), Indonesia (17/278; 6%), China (16/278; 6%), Spain (12/278; 4%), USA (12/278; 4%) and UK (11/278;4%). CONCLUSIONS: Physicians from all specialities may die from COVID. Lack of personal protective equipment was cited as a common cause of death. Consideration should be made to exclude older physicians from front-line work.

Sleep parameters associated with long-term outcome following subthalamic deep brain stimulation in Parkinson's disease.

INTRODUCTION: We aimed to investigate the effects of changes in sleep architecture on long-term clinical outcome in patients with Parkinson's disease (PD) who underwent deep brain stimulation of subthalamic nuclei (STN DBS). METHODS: We followed up eight PD patients before and three years after STN DBS surgery. In addition to clinical assessments, polysomnography (PSG) followed by multiple sleep latency tests was performed before and after STN DBS, while stimulator was ON and OFF. RESULTS: Subjective sleep latency was significantly decreased (P=0.033) and sleep duration was increased (P=0.041), as measured by Pittsburgh sleep quality index. Latency to REM sleep stage was shortened after surgery with STN DBS ON (P=0.002). Index of central type of abnormal respiratory events was significantly increased while stimulator was ON (P=0.034). Total number of major body movements was found to be increased when stimulator was turned OFF (P=0.012). Among PSG data obtained during STN DBS ON, it was observed that duration of N3 sleep was negatively correlated with UPDRS scores at 1st (P=0.038) and 3rd (P=0.045) post-operative years. Among PSG variables during STN DBS OFF, durations of N3 sleep (P=0.017) and REM sleep (P=0.041) were negatively correlated with UPDRS scores at post-operative 1st year. CONCLUSION: Disturbances in sleep architecture are associated with higher UPDRS scores and worse prognosis at 1st and 3rd post-operative years. Similar results obtained while stimulator was OFF at the end of 1st year support the presence of microlesion effect after STN DBS, which is probably not long lasting.

[Long-term Outcomes and Complications after Surgical Posterior Capsule Polishing Due to Secondary Cataract]. / Langzeitergebnisse und Komplikationen nach chirurgischer Nachstarabsaugung.

BACKGROUND: To evaluate the long-term outcome and complication rate after surgical posterior capsule polishing as an alternative to Nd : YAG-Laser posterior capsulotomy in the treatment of posterior capsule opacity after cataract extraction in eyes with high risk of developing pseudophakic retinal detachment. PATIENTS AND METHODS: This retrospective study comprised 265 eyes in 234 patients (134 women, 100 men, mean age: 61 years) with posterior capsule opacity who underwent surgical posterior capsule polishing between 1997 and 2010, with a follow-up of at least 12 months. RESULTS: Surgical posterior capsule polishing was performed in 220 myopic eyes (axial length > 25 mm), in 28 eyes after retinal detachment surgery and in 17 eyes with traumatic cataract. The mean follow-up was 73 months (range: 12 to 202 months); in 206 eyes (77.8 %), follow-up was more than 3 years. The final best-corrected visual acuity (BCVA) in logMAR (mean 0.56 ± 0.63) improved significantly (p < 0.001) compared to the preoperative BCVA (mean 0.93 ± 0.72). Recurrent posterior capsule opacity occurred in 74 eyes (27.9 %) and was treated by one or more surgical posterior capsule polishing procedures. Nd : YAG-Laser posterior capsulotomy was performed in 28 eyes (10.6 %) and surgical capsulectomy in 8 eyes (3.0 %). Complications after surgical posterior capsule polishing included intraoperative capsule rupture in 9 eyes (3.5 %). No postoperative endophthalmitis was observed. However, retinal detachment occurred in 6 eyes (2.3 %) 62 months after surgical posterior capsule polishing. All eyes were myopic (axial length > 25 mm) and initially vitrectomised during first retinal detachment surgery. CONCLUSIONS: Long-term outcome and complication rate indicate that surgical posterior capsule polishing is not only a more complex procedure but is also associated with a higher relapse risk than Nd : YAG-Laser posterior capsulotomy in the treatment of regenerative secondary cataract. Furthermore, conserving the posterior lens capsule does not always seem to minimise the cumulative risk of developing pseudophakic retinal detachment in high risk patients.

[Trabeculectomy Ab Interno in Primary Open Angle Glaucoma and Exfoliative Glaucoma]. / Trabekulotomie ab interno (Trabectome) - Kumulierte klinische Ergebnisse eines großen Glaukomkollektivs.

BACKGROUND: To assess the outcome of routine trabectomy surgery in the treatment of primary (POAG) and secondary open angle glaucoma. PATIENTS/METHODS: 296 eyes of 296 patients with diagnosed open angle glaucoma and exfoliative glaucoma were analysed from June 2012 until June 2014. IOP readings (intraocular pressure) and the number of antiglaucoma medications was evaluated at every follow-up visit. For statistical analysis, 4 study cohorts were built (cohort 1 = trabectomy in POAG, cohort 2 = trabectomy in exfoliative glaucoma (PEX), cohort 3 = trabectomy + IOL in POAG, cohort 4 = trabectomy + IOL in PEX glaucoma). RESULTS: Mean IOP before trabectomy surgery was 19.8 ± 5.9 mmHg and 23.7 ± 9.5 mmHg in cohorts 1 and 2, respectively. At 1 year follow-up, IOP was reduced to normal level for cohorts 1 and 2 (14.8 ± 3.2 mmHg (p = 0.001) and 14.0 ± 3.3 mmHg (p = 0.046), respectively). The number of topical antiglaucoma medications changed to 2.1 ± 1.2 (p = 0.004) and 2.4 ± 1.2, respectively (p = 0.593) at one year follow-up, respectively, for POAG and exfoliative glaucoma. In study cohort 3 and 4, mean IOP before trabectomy surgery was 19.2 ± 4.0 mmHg and 23.2 ± 9.2 mmHg, respectively. At 1 year follow-up, IOP was reduced to normal levels in cohorts 3 and 4 (11.8 ± 3.1 mmHg (p < 0.01) and 12.6 ± 1.1 mmHg, respectively (p = 0.043)); the number of topical antiglaucoma medications changed to 2.3 ± 1.4 (p = 0.469) and 1.4 ± 0.8, respectively, (p = 0.102) at 1 year follow-up. A significant difference in IOP reduction could be demonstrated in POAG between the trabectomy + IOL group and the trabectomy cohort 1 year postoperative (p = 0.017); in the PEX trabectomy + IOL versus PEX trabectomy cohort no statistically significant difference (p = 0.678) could be demonstrated. No serious postoperative complications were recorded. CONCLUSION: Trabectomy surgery seemed to be a reliable and effective tool for the management of mild and moderate primary and secondary open angle glaucoma with uncontrolled IOP in daily routine. One year follow-up showed a significant reduction in intraocular pressure in all cohorts.

[Comparison of dynamic contour tonometry versus Goldmann applanation tonometry according to the International Ocular Tonometer Standards ISO 8612 in glaucoma patients]. / Vergleich der dynamischen Konturtonometrie vs. Goldmann-Applanationstonometrie nach dem internationalen Standard für Augentonometer (ISO 8612) in einem Glaukomkollektiv.

INTRODUCTION: The aim of this study was to compare the dynamic contour tonometry PASCAL® (DCT) versus the Goldmann applanation tonometry (GAT) in a glaucoma population and to analyse the correlation with the central corneal thickness (CCT). PATIENTS/METHODS: 191 eyes of 107 Caucasian glaucoma patients (62 female, 45 male) were included: 3 repeated GAT and dynamic contour tonometry (DCT) measurements (quality factor 1-2) were analysed. CCT was measured by ultrasound pachymetry. Criteria of ISO 8612 were fulfilled: 3 groups of IOP measurements were formed: group 1: 7-16 mmHg, group 2: 16-23 mmHg and group 3: > 23 mmHg, each including at least 40 eyes. Only 5.0 % outliers per area of intraocular pressure were permitted in a tolerance of ± 5.0 mmHg. RESULTS: Data of 191 eyes (mean CCT 553 µm) were analysed. GAT (19.68 mmHg ± 7.56 mmHg) showed good correlation to DCT (20.54 ± 8.21 mmHg) (r = 0.770, p < 0.001). Mean difference DCT-GAT was 0.86 ± 2.45 mmHg. In regard to the criteria of ISO 8612, the number of outliers were: group 1: (n = 68) 29.4 %, group 2: (n = 62) 41.9 %, and group 3: (n = 61) 31.2 %. No correlation was shown between CCT vs. GAT (r = 0.184, p = 0.057) and CCT vs. DCT (r = 0.177, p = 0.09), respectively. DISCUSSION: In conclusion, despite good correlation to GAT measurements DCT does not fulfil the ISO 8612 reference criteria in glaucoma patients. DCT and GAT did not show correlation to CCT.

[Endothelial cell loss after retropupillary iris-claw intraocular lens implantation]. / Endothelzellverlust nach retropupillar fixierter Irisklauen-Linse.

BACKGROUND: The aim of this study was to evaluate the indication, visual and refractive outcome, endothelial cell loss and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL). PATIENTS AND METHODS: This retrospective study comprised 62 eyes of 56 patients without adequate capsular support undergoing posterior iris-claw aphakic IOL implantation (Verisyse™/Artisan®) between 2006 and 2012. Mean follow-up was 34 months (range from 13 to 78 months). RESULTS: The IOLs were inserted during primary lens surgery in 11 phakic eyes (17.8 %), during an IOL exchange procedure for dislocated posterior chamber IOLs in 34 eyes (54.8 %), and as a secondary procedure in 17 aphakic eyes (27.4 %). The final best spectacle-corrected visual acuity (BSCVA) in logMAR (mean 0.24 ± 0.45) improved significantly (p < 0.001) compared to the preoperative BSCVA (mean 0.61 ± 0.65). The mean spherical equivalent improved from preoperative 7,25 ± 5,04 diopters (D) (range - 10.25 to + 16.0 D) to - 0.21 ± 1.01 D (range - 4.0 to 3.0 D) postoperatively. Mean central endothelial cell density was 1844 ± 690 cells/mm(2) preoperatively. After surgery mean endothelial cell density decreased statistically not significant with a loss of 5.5 % to 1743 ± 721 cells/mm(2) (p > 0.05) at last follow-up visit. Complications included cystoid macular oedema in 4 eyes (6.4 %), early postoperative hypotony in 2 eyes (3.2 %), pupil ovalisation in 2 eyes (3.2 %), traumatic iris-claw IOL disenclavation in 2 eyes (3.2 %) and spontaneous IOL disenclavation in one eye (1.6 %). CONCLUSIONS: Retropupillar iris-claw IOL provides good visual and refractive outcomes with a low endothelial cell loss and can be used for a wide range of indications in eyes without adequate capsular support.

Toxoplasma serotype is associated with development of ocular toxoplasmosis.

BACKGROUND: Worldwide, ocular toxoplasmosis (OT) is the principal cause of posterior uveitis, a severe, life-altering disease. A Toxoplasma gondii enzyme-linked immunoassay that detects strain-specific antibodies present in serum was used to correlate serotype with disease. METHODS: Toxoplasma serotypes in consecutive serum samples from German uveitis patients with OT were compared with non-OT seropositive patients with noninfectious autoimmune posterior uveitis. OT patients were tested for association of parasite serotype with age, gender, location, clinical onset, size, visual acuity, or number of lesions (mean follow-up, 3.8 years) to determine association with recurrences. RESULTS: A novel, nonreactive (NR) serotype was detected more frequently in serum samples of OT patients (50/114, 44%) than in non-OT patients (4/56, 7%) (odds ratio, 10.0; 95% confidence interval 3.4-40.8; P < .0001). Non-OT patients were predominantly infected with Type II strains (39/56; 70%), consistent with expected frequencies in Central Europe. Among OT patients, those with NR serotypes experienced more frequent recurrences (P = .037). Polymerase chain reaction detected parasite DNA in 8/60 OT aqueous humor specimens but failed to identify Type II strain alleles. CONCLUSIONS: Toxoplasma NR and Type II serotypes predominate in German OT patients. The NR serotype is associated with OT recurrences, underscoring the value of screening for management of disease.

[Present state of the art in topical and systemic immunosuppression after keratoplasty]. / Aktueller Stand der lokalen und systemischen Immunsuppression nach Keratoplastik.

Today MMF can be considered as standard treatment besides cyclosporin A for immunosuppression after high-risk perforating keratoplasty. The efficacy of systemic MMF for this indication has been documented in several clinical studies including multicentre designs. Whether or not MPA therapy offers further advantages is currently under discussion. Sirolimus and tacrolimus are effective but could not achieve clinical importance due to higher rates of side effects. An additional benefit of combination therapies is not proven by clinical studies up to date. Everolimus shows pre-clinically a promising immunosuppressive and antiproliferative effect. Topical preparations of immunosuppressants as monotherapy are obviously insufficient as alternatives for systemic immunosuppressive therapy. Whether or not topical combination therapies will become established as alternatives to systemic treatment has to be demonstrated in the following years.

[Influence of corneal thickness in keratoconic corneas on IOP measurement with IOPen, iCare, dynamic contour tonometry and Goldmann applanation tonometry]. / Einfluss der Hornhautdicke bei Keratokonus auf die Messung des Augeninnendrucks mit 4 verschiedenen Messverfahren.

BACKGROUND: The aim of this study was to evaluate the effect of central corneal thickness (CCT) of keratoconic corneas on intraocular pressure (IOP) measurements as measured by four different techniques. PATIENTS AND METHODS: Forty-one eyes of forty-one keratoconus patients (group 1) and fifty eyes of fifty healthy subjects (group 2) were enrolled. IOP was measured with iCare, IOPen, Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). CCT was measured by ultrasonic pachymetry. These data were used for statistical analysis. RESULTS: The mean IOPs measured by GAT, DCT, iCare and IOPen were 11.4, 14.7, 10.8, and 15.7 mmHg in group 1; and 14.2, 15.4, 15.4 and 14.3 mmHg in group 2, respectively. Between both groups, there was a statistically significant difference in iCare (p < 0.001), GAT (p < 0.001) and IOPen (p = 0.040) measurements; with no difference between DCT (p = 0.266) measurements. IOPen measurements were significantly associated with CCT (r = - 0.314; p = 0.046). CONCLUSION: IOPen seemed to be affected by CCT. IOP readings by iCare, GAT and DCT were found to be independent of CCT in keratoconic corneas.

[Influence of anterior chamber depth on optic disc measurements with OCT and HRT 3]. / Einfluss der Vorderkammertiefe auf die Vermessung des Sehnervenkopfs mit OCT und HRT 3.

BACKGROUND: The aim of this study was to investigate the influence of the anterior chamber depth (ACD) on the measurement of the optic nerve head size with OCT and HRT 3. PATIENTS AND METHODS: 100 pseudophakic eyes of 100 patients were enrolled in this prospective study. The measurement of the optic nerve head was performed with the optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Inc., Dublin, CA) and the confocal laser scanning tomography (Heidelberg retina tomograph, HRT 3, Heidelberg Engineering, GmbH, Dossenheim, Germany). Bland and Altman plots were used to examine the agreement between the parameters of the two techniques. The relationship between the optic nerve head size and the ACD was analysed by linear regression. RESULTS: Optic disc size measurement with the OCT and the HRT 3 showed no significant difference (p = 0.638). Measurement of the optic disc size with the OCT was significantly correlated with the ACD (- 0.234; p = 0.016). The optic disc size decreases with increasing values of the ACD. There was no influence of the ACD on the measurement of the optic disc size with the HRT 3 (r = 0.128; p = 0.193). CONCLUSION: While the optic disc size measured by OCT decreased with increasing ACD, the measurement with the HRT 3 turned out to be independent of the ACD. The OCT may underestimate the optic disc size in lower ACD. This may result in reduced agreement between the two devices.

Diagnostic Utility of Optic Nerve Measurements with MRI in Patients with Optic Nerve Atrophy.

BACKGROUND AND PURPOSE: No MR imaging measurement criteria are available for the diagnosis of optic nerve atrophy. We determined a threshold optic nerve area on MR imaging that predicts a clinical diagnosis of optic nerve atrophy and assessed the relationship between optic nerve area and retinal nerve fiber layer thickness measured by optical coherence tomography, an ancillary test used to evaluate optic nerve disorders. MATERIALS AND METHODS: We evaluated 26 patients with suspected optic nerve atrophy (8 with unilateral, 13 with bilateral and 5 with suspected but not demonstrable optic nerve atrophy) who had both orbital MR imaging and optical coherence tomography examinations. Forty-five patients without optic nerve atrophy served as controls. Coronal inversion recovery images were used to measure optic nerve area on MR imaging. Retinal nerve fiber layer thickness was determined by optical coherence tomography. Individual eyes were treated separately; however, bootstrapping was used to account for clustering when appropriate. Correlation coefficients were used to evaluate relationships; receiver operating characteristic curves, to investigate predictive accuracy. RESULTS: There was a significant difference in optic nerve area between patients' affected eyes with optic nerve atrophy (mean, 3.09 ± 1.09 mm2), patients' unaffected eyes (mean, 5.27 ± 1.39 mm2; P = .008), and control eyes (mean, 6.27 ± 2.64 mm2; P < .001). Optic nerve area ≤ 4.0 mm2 had a sensitivity of 0.85 and a specificity of 0.83 in predicting the diagnosis of optic nerve atrophy. A significant relationship was found between optic nerve area and retinal nerve fiber layer thickness (r = 0.68, P < .001). CONCLUSIONS: MR imaging-measured optic nerve area ≤ 4.0 mm2 has moderately high sensitivity and specificity for predicting optic nerve atrophy, making it a potential diagnostic tool for radiologists.

[Diagnosis and treatment of ocular toxoplasmosis : a survey of German-speaking ophthalmologists]. / Diagnostik und Behandlung der okulären Toxoplasmose : Eine Bestandsaufnahme unter deutschsprachigen Ophthalmologen.

BACKGROUND/PURPOSE: Ocular toxoplasmosis is the most frequent cause of posterior uveitis in Germany. The purpose of this survey was to evaluate current strategies in the management of ocular toxoplasmosis by uveitis specialists in Germany. METHODS: An itemized questionnaire including clinical case reports with authentic photographs was distributed to physician members (n=40) of the German Uveitis Society. In addition, members were categorized regarding their clinical background, professional affiliation and experience with ocular toxoplasmosis. RESULTS: The completed questionnaire was returned by 72% (29/40) of the members. According to the answers, the majority (70%) of responders base their diagnosis of ocular toxoplasmosis on clinical examination and serological findings. Although a positive IgM titre or increasing IgG titres support the diagnosis only in cases of recently acquired disease, these are reported to support the diagnosis by 58 and 41%, respectively. Invasive procedures such as aqueous humour analysis are performed by 59% of colleagues to establish the diagnosis in selected patients. A total of six antimicrobial agents were reported for treatment in different regimens for typical clinical conditions in patients with recurrent toxoplasmic retinochoroiditis. The combination of pyrimethamine and sulfadiazine is the most commonly used (48%), followed by clindamycin (38%). CONCLUSIONS: Our survey indicates the lack of a "gold standard" for diagnosis and medical treatment in ocular toxoplasmosis. Further efforts have to be undertaken towards a better distribution of available information and to determine strategies for providing standards of continuously updated diagnostic and therapeutic recommendations for routine clinical practice.

[Ocular toxoplasmosis]. / Okuläre Toxoplasmose.

Toxoplasmosis is a parasitic zoonosis which occurs worldwide and is an important cause of blindness. The infection is naturally acquired by the ingestion of oocysts excreted by infected cats or by ingestion of tissue cysts in undercooked or raw meat. Primary infection during pregnancy may result in a congenital infection. Toxoplasmic retinochoroiditis is the most common cause of posterior uveitis in immunocompetent patients. Depending on the patient's age, ocular symptoms vary presenting with reduced visual acuity, strabismus, and nystagmus in young children - in adults decreased vision and floaters are most frequently reported. Active toxoplasmic retinochoroiditis typically presents as grey-white retinal necrosis with choroiditis, vasculitis and vitritis. However, atypical presentations including neuroretinitis, papillitis, Fuchs-like anterior uveitis, scleritis and acute retinal necrosis have been described. The diagnosis is based on clinical findings and can be supported by the detection of antibodies and Toxoplasma gondii DNA. Toxoplasmosis therapy includes antimicrobial drugs and corticosteroids. There are several regimens with different drug combinations including, among others, pyrimethamine, sulfadiazine, clindamycin, and trimethoprim-sulfamethoxazol. The prognosis for ocular toxoplasmosis is favorable in immunocompetent individuals, as long as the central macula is not directly involved. The present article reviews the epidemiology, pathogenesis, clinical presentation and management of toxoplasmic retinochoroiditis.

Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification.

PurposeTo assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption.Patients and methodsThe study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100-249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc.ResultsThe AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100-249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment.ConclusionsA flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation.

Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging.

OBJECTIVE: Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. MATERIALS AND METHODS: Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). RESULTS: The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. CONCLUSION: Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients.

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty.

PURPOSE: In this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient's satisfaction was evaluated. METHODS: A retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction. RESULTS: Best-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally. CONCLUSION: Patient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.

Trabeculectomy ab interno (trabectome): yet another possibility in the treatment of uncontrolled glaucomatocyclitic crisis under systemic valganciclovir therapy?

PURPOSE: To assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner-Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP). PATIENTS/METHODS: Trabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months. RESULTS: Mean IOP before trabectome surgery was 40±10 mm Hg (range 33-58 mm Hg). The mean number of antiglaucoma medication prior to surgery was 3.1±0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13±1 mm Hg) and their antiglaucoma medication was decreased to 0.8±1.1. No recurring attack of glaucomatocyclitic crisis occurred. DISCUSSION: In addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.

[Ocular toxoplasmosis antibodies in aqueous humor and serum]. / Okuläre Toxoplasmose-Antikörper in Kammerwasser und Serum.

BACKGROUND: The diagnosis of ocular toxoplasmosis is mainly based on ophthalmological examination but might be difficult to establish in some cases. The purpose of our study was to evaluate the value of aqueous humor and serum analysis in ocular toxoplasmosis. PATIENTS AND METHODS: We analyzed the avidity of toxoplasma-specific IgG in aqueous humor and serum samples from 50 patients with toxoplasmic retinochoroiditis, with 25 patients with uveitis posterior or panuveitis serving as controls. RESULTS: Specific intraocular antibody synthesis could be confirmed in 49 patients (98%). In two patients (8%) of the control group, antibody synthesis was detected (false positive). Forty-nine patients with diagnoses of ocular toxoplasmosis were positive for serum anti-T. gondii IgG, but only three patients had increased IgM levels. CONCLUSIONS: Analysis of local antibody production is a reliable method for confirming or excluding a suspected clinical diagnosis of toxoplasma retinochoroiditis. The determination of toxoplasma antibodies in the patients' serum is of limited value.

Post-thyroidectomy hypocalcemia: the role of calcitonin, parathormone and serum albumin.

To investigate the pathogenesis of post-thyroidectomy hypocalcemia calcium, phosphate, calcitonin, parathormone, albumin, triiodothyronine and thyroxine levels were monitored during operation and postoperatively in 25 female patients undergoing bilateral subtotal thyroidectomy for non-toxic nodular goiter. A highly significant fall in uncorrected serum calcium and albumin levels started with the completion of lobectomies and a significant correlation between the course of serum calcium and albumin levels were seen, an early peak in calcitonin corresponded well with the a drop in corrected calcium and inorganic phosphate levels. An overt parathyroid response to hypocalcemia was not observed. We conclude, on the basis of the postoperative hypoalbuminemia, that a calcitonin leak triggered the early onset of hypocalcemia while an insufficient parathyroid response contributed to the post-thyroidectomy hypocalcemia.