Prospective PED-study of intravitreal aflibercept for refractory vascularized pigment epithelium detachment due to age-related macular degeneration: morphologic characteristics of non-responders in optical coherence tomography.

PURPOSE: The aim of this study was to investigate the outcomes of a fixed intravitreal aflibercept regimen in patients with vascular pigment epithelium detachment (vPED) secondary to age-related macular degeneration with refractory subretinal fluid. METHODS: A prospective, interventional case series involved 20 eyes of 20 patients with refractory subretinal fluid and vPED treated with at least three injections of intravitreal anti-VEGF prior to study inclusion. After study inclusion, patients were treated with three injections of intravitreal aflibercept 2 mg/0.05 mL monthly followed by injections every 8 weeks. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated at all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and quarterly. Primary outcomes were effectivity of a fixed treatment as measured in change in BCVA, PED greatest linear diameter (GLD), and PED height from baseline to month 12. In an additional post hoc analysis, vPED patients were differentiated into two groups: (1) vPED lesions that showed persistence of subretinal fluid throughout 1 year of treatment and (2) vPED lesions that showed complete resolution of subretinal fluid at least at one of the monthly performed OCT volume scans. Reflectivity values were determined in the subretinal pigment epithelium (RPE) compartment in OCT scans at baseline, month 6 and 12. RESULTS: A total of 18 patients completed the study protocol. The mean age was 74.8 ± 10.6 years, and six patients were female. The median BCVA of all patients was 72.0 ± 8.0 EDTRS letters at baseline and 72.5 ± 9.5 EDTRS letters at 12-month follow-up (p = 0.7420). The median PED height in all patients as measured in the OCT images significantly decreased from 372.0 ± 140.0 µm to 149.0 ± 142.0 µm after 12 months of treatment (p = 0.0020). Persistent subretinal fluid was present at every OCT control in six patients (group 1). Twelve patients showed resolution of subretinal fluid at least at one OCT control (group 2). Reflectivity values in the sub-RPE compartment in OCT scans were 41.48 ± 4.48 (group 1) and 42.62 ± 12.34 (group 2) at baseline (p = 0.854) and 65.88 ± 6.74 and 50.87 ± 14.11 at month 12 (p = 0.038). CONCLUSIONS: Intravitreal aflibercept in refractory vPED leads to a significant reduction in PED height and disease activity as well as preservation of BCVA over 1 year. Persistent subretinal fluid was present in PED lesions with high values of reflectivity under the RPE, suggesting both a diffusion barrier and an increasing fibrovascular maturization of the choroidal neovascularization. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03370380.

[Foveal avascular zone and OCT angiography. An overview of current knowledge]. / Foveale avaskuläre Zone und OCT-Angiographie. Eine Übersicht aktueller Erkenntnisse.

BACKGROUND: The foveal avascular zone (FAZ) has often been analyzed under different aspects in the last decades, mainly by fluorescence angiography (FA); however, the novel technology of optical coherence tomography angiography (OCTA) enables a non-invasive examination, visualization and quantitative analysis of the FAZ, which has recently led to many new findings, especially in a multidisciplinary manner. This article provides an overview of the investigation of the FAZ using OCTA and the new findings that have been obtained using OCTA in recent years. METHODS: This article is based on a comprehensive literature review. RESULTS: In many studies a good reproducibility and repeatability of the FAZ measurements by OCTA could be proven, also by comparing different OCTA devices. In patients with ocular pathologies and systemic diseases, e. g. after retinal vein occlusion or retinal surgery and in patients with diabetes mellitus without diabetic retinopathy, differences to healthy control groups and correlations to visual function could be shown. Moreover, in patients with neurological diseases, such as Alzheimer's dementia, changes of the FAZ could be identified. CONCLUSION: The OCTA is a non-invasive technology, which enables a reliable visualization and reproducible quantification of the FAZ. The size of the FAZ seems to be altered in different retinal and systemic diseases, which also may correlate with visual function; however, long-term studies evaluating the diagnostic value of these changes in the course of the disease are currently lacking.

[Retinal pigment epithelial detachment in hyperviscosity syndrome]. / Seröse Amotio retinae bei Hyperviskositätssyndrom.

We present a case of a 57-year-old woman who reported bilateral visual impairment since 2 weeks. She had a medical history of congenital, cyanotic heart failure. Funduscopic examination revealed serous retinal detachment on the left side, central subneurosensory detachment on the right side, retinal vessel tortuosity and multiple retinal haemorrhages in the periphery. As blood analysis showed a distinct increase in haemoglobin and haematocrit, hyperviscosity syndrome was suspected to have caused bilateral serous retinal detachment. Isovolemic haemodilution was performed in close cooperation with the cardiology department with repeated phlebotomy, which resulted in a significant reduction of subretinal fluid and, concurrently, an increase in visual acuity.

[Contact lens-associated Paecilomyces lilacinus keratitis]. / Kontaktlinsenassoziierte Paecilomyces-lilacinus-Keratitis.

We present the case of a 23-year-old otherwise healthy female patient with contact lens-associated Paecilomyces lilacinus keratitis. The clinical findings stabilized after initial local antimycotic and antibacterial treatment; however, in the further course of local therapy an extensive relapse occurred which required treatment by perforating keratoplasty à chaud due to a penetrating corneal ulcer. The patient responded well to subsequent treatment with systemic and local antimycotic medication. After a few months HLA-matched keratoplasty was performed. During the follow-up time of 14 months there were no signs of recurrence of the infection.

[Choroidal neovascularisation in a patient with choroidal osteoma visualized by OCT angiography]. / OCT-angiographische Darstellung einer choroidalen Neovaskularisation infolge eines Aderhautosteoms.

We present the case of a 38-year-old Asian patient who reported vision loss of her left eye since 4 weeks. The funduscopy showed a choroidal tumor in the papillomacular bundle, which could be identified as a choroidal osteoma with secondary choroidal neovascularization (CNV). OCT angiography (OCT-A) detected abnormal flow in the choriocapillaris; the osteoma showed no flow in the OCT angiogram of the choroid level. Therefore, OCT-A can be a helpful adjuvant for diagnosis of CNV secondary to choroidal osteoma.

VITAMIN D STATUS IN PATIENTS WITH MENTAL DISORDERS: A CROSS-SECTIONAL ANALYSIS OF SINGLE COHORT FROM ROUTINE PRACTICE.

CONTEXT: Clinical research suggests that vitamin D deficiency correlates with mental illnesses. OBJECTIVE: The aim was to prove that the patients from the psychiatric health care service in Serbia had higher vitamin D deficiency than patients from general practice. DESIGN: The study had a cross-sectional design. METHODS: The study included 47 patients aged 19 - 76 of both sexes with different mental disorders. We performed sample size calculation on available data for vitamin D deficiency in patients in health care facilities compared with the general population. The concentrations of vitamin D in serums were measured by HPLC (high performance/pressure liquid chromatography). RESULTS: The mean value of vitamin D (standard deviation) in the whole group of study subjects was 16.27(10.62) ng/mL; 68.1% of the patients had a deficiency of vitamin D (25(OH)D<20 ng/mL). The difference is statistically significant from expected proportion of people with vitamin D deficiency in general practice (p=0.040). Serum concentrations of 25(OH)D were significantly correlated with serum concentrations of phosphorus (ϱ=0.336, p=0.024) and sodium (ϱ=0.304, p=0.038). CONCLUSIONS: The patients of psychiatry health care had significantly higher frequency of vitamin D deficiency than expected. There is a significant association between serum levels of vitamin D, and phosphate and sodium.

Long-Term Outcomes of External Dacryocystorhinostomy in the Age of Transcanalicular Microendoscopic Techniques.

Purpose. This study aimed to evaluate long-term results of external dacryocystorhinostomy (DCR) at a tertiary eye care center specializing in lacrimal duct surgery in Germany. Methods. The medical records of 1010 patients with acquired nasolacrimal duct obstruction (NLDO), who had undergone lacrimal duct surgery at a tertiary eye care center, were reviewed. Only adult patients who had undergone external DCR were included. The evaluation included the following parameters: age, gender, duration of symptoms, patient satisfaction, previous dacryocystitis, complication rates, and surgical outcome. Results. 154 eyes of 146 patients (14.5%) could be included in the study. The average age was 64.1 ± 29.7 years. 66.4% of patients were females and 33.6% were males. Acute or chronic dacryocystitis was found in 81 patients (55.5%). Overall, 82.8% of patients had full resolution of symptoms. The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.7% compared to 83.4% for patients without dacryocystitis in their medical history. Conclusion. In cases in which transcanalicular microendoscopic techniques are contraindicated (e.g., after dacryocystitis) or in complex cases where microendoscopic procedures have failed (revision surgery), external DCR is still the surgical treatment of choice with very good postoperative success.

[Ease of handling of first and second generation rebound tonometers]. / Handhabung von Reboundselbsttonometern der ersten und zweiten Generation.

PURPOSE: To evaluate the ease of handling of two rebound tonometers, which are designed for self-measurement of intraocular pressure (IOP) in a clinical setting by untrained patients. METHODS: After self-measurement of the IOP with the rebound tonometers iCare ONE and iCare HOME, participants were asked to complete a questionnaire containing different subitems concerning ease of operation using a visual analog scale (1 = very good to 5 = very poor). Moreover, the feasibility and duration of measurement were tested. RESULTS: A total of 147 subjects participated in this study. The mean score for general handling ability was 2.79 ± 1.01 for the iCare ONE and 1.85 ± 0.87 for the iCare HOME (p < 0.001). The evaluation of the subitems sense of safety (iCare ONE: 2.71 ± 1.03 and iCare HOME: 1.87 ± 0.81, p < 0.001) and comfort of measurement (iCare ONE: 2.07 ± 1.01 and iCare HOME: 1.66 ± 0.72, p < 0.001) also showed a significant discrepancy between the two tonometers. Participants needed significantly less time for a single valid measurement when using the iCare HOME tonometer (mean 66.14 ± 61.54 s) compared to the iCare ONE tonometer (mean 81.54 ± 69.51 s, p < 0.001). CONCLUSIONS: A better handling of the iCare HOME rebound tonometer in comparison to the iCare ONE tonometer can be deduced on the basis of the subjective assessments of patients and the shorter duration of measurements. Moreover, the iCare HOME received a significantly better evaluation for all subitems. The accuracy of measurements using the iCare HOME still needs to be clarified.

Tolerance of Portulaca grandiflora to individual and combined application of Ni, Pb and Zn.

In the present study, metal accumulation capacity and tolerance of Portulaca grandiflora were investigated. Plants were grown under greenhouse conditions in pots on soil amended with Ni, Pb and Zn to the final concentration of 2 mmol kg(-1) for each metal. Results show considerable accumulating capacity and translocation of Ni and Zn, as well as significant accumulation of Pb in roots. A slight decrease of biomass with Zn and of chlorophyll content with Zn and Ni were observed, as well as an increase of proline content with each of the metals. Combinations of metals revealed mutual interference affecting both the uptake and translocation of the metals and their impact on physiological parameters. Results suggest that Portulaca grandiflora, although not a hyperaccumulator, shows a good tolerance and accumulation capacity for Ni, Pb and Zn, but, for the purposes of remediation, interference of the metals must be taken into account.

Quantification of transfer of (238)U, (226)Ra, (232)Th, (40)K and (137)Cs in mosses of a semi-natural ecosystem.

There is a lack of appropriate data on transfer of some radionuclides on many terrestrial biota groups. To expand the available data concentration ratios of (238)U, (226)Ra, (232)Th, (40)K and (137)Cs in mosses are presented in this paper. The relationship between concentration ratios of radionuclides and physicochemical characteristics of the underlying soil was also investigated. The data on concentration ratios obtained here will provide a useful addition to the currently used database of transfer parameters, particularly for natural radionuclides.

Analysis of mosses and topsoils for detecting sources of heavy metal pollution: multivariate and enrichment factor analysis.

In order to assess the contribution of emission sources to the pollution of areas remote from industrial facilities, a combined approach of enrichment factor analysis and multivariate statistics was used for detecting the origin of heavy metal pollution in the Zlatibor ecosystem, in Serbia. Samples of moss (Pleurozium schreberi, Hylocomium splendens, Scleropodium purum, Hypnum cupressiforme and Thuidum delicatulum) and of topsoil (0-5 cm) were collected in 2005. The concentrations of seven heavy metals (Cd, Cr, Cu, Mn, Ni, Pb and Zn) were determined in moss and soil samples by atomic absorption spectrometry. The results obtained by enrichment factor analysis and two multivariate statistical methods, principal component analysis and cluster analysis, enabled discrimination of the lithologic and anthropogenic sources of heavy metals in the mosses. Enrichment factors, calculated to evaluate the contribution to the metal content in moss from anthropogenic sources, revealed pollution of the investigated area by Cd and Pb, originating from long-range transport and fossil fuel burning.

Heavy metals in soils: distribution, relationship with soil characteristics and radionuclides and multivariate assessment of contamination sources.

The study is dealing with the distribution and the origin of heavy metals (Cd, Cr, Cu, Mn, Ni, Pb and Zn) in soils from a priori non-polluted areas. Positive correlations with organic matter and clay content but not with pH have been observed for most of elements analyzed in this study. Correlations of some metals (Cr, Pb and Zn) and radionuclides (238U and 137Cs) observed for analyzed soils could be explained by their common affinity for clay minerals. Enrichment factor (EF) analysis and cluster analysis (CA) highlighted the lithogenic origin of Cr, Cu, Mn, Ni, Pb and Zn and pointed out the primary input of Cd from anthropogenic sources. It also revealed the need for detailed geochemical surveys in the future in order to decrease the uncertainty of discrimination between lithogenic and anthropogenic origin of metals of interest.