Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular oedema.

AIM: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular oedema. METHODS: The prospective, randomised, double masked, clinical interventional study included 27 eyes (27 patients) with diffuse diabetic macular oedema. They were randomly divided into three study groups receiving an intravitreal injection of filtered triamcinolone acetonide of about 2 mg (n = 8 eyes), 5 mg (n = 10), or 13 mg (n = 9), respectively. Dosage measurement was performed before filtration. Mean follow up was 6.6 (SD 2.4) months (3-12 months). Main outcome measures were visual acuity and intraocular pressure. RESULTS: Maximal increase in visual acuity was significantly (p = 0.046; 95% CI: 0.032 to 2.99; r = 0.38) correlated with the dosage of intravitreal triamcinolone acetonide. Additionally, the duration of the effect of intravitreal triamcinolone acetonide increased significantly with the dosage of intravitreal triamcinolone acetonide (r = 0.45; p = 0.014). Increase in intraocular pressure during follow up was statistically not significantly associated with the dosage used (p = 0.77). CONCLUSIONS: In patients with diffuse diabetic macular oedema receiving intravitreal triamcinolone acetonide, treatment response may last longer and be more pronounced with a dosage of 13 mg than in lower doses of 5 mg or 2 mg. Triamcinolone acetonide induced increase in intraocular pressure may not be markedly associated with the dosage used.

[New diagnostic aids in automatic perimetry]. / Neue diagnostische Hilfen in der automatischen Perimetrie.

The Conformity Analysis is a new procedure for objective recognition of specific defect patterns in automated perimetry. The "Conformity Index," the measure of conformity between the distribution of defect values and several standard defect patterns, is calculated from the ratio of global variance and mean variance in particular regions. Using 68 visual fields from 68 normal persons, we determined normal values and limits of the Conformity Index for seven standard defect patterns: hemifields right-left, hemifields upper-lower, quadrants, sectors, rings with 5 degrees and 10 degrees radius interval and the perimetric nerve fiber bundles of Weber and Ulrich. The evaluation of 148 visual fields (68 normal eyes, 80 eyes with chronic glaucoma and all stages of damage) by both the Conformity Index and two experienced clinicians revealed an identical result in 89%. Using the Conformity Analysis in 37 cases of pituitary adenoma, we could objectively identify quadrants, sectors and hemifields right-left to be the most common defect patterns in this disease. In glaucoma fields with marked damage (n = 46), the most frequent pathological Conformity Index was the index for perimetric nerve fiber bundles.

[Cartographic errors in perimetry]. / Der kartographische Fehler in der Perimetrie.

Cartography in perimetry repeats the problem of the cartography of the globe: it is impossible to transfer the image properly without a distortion of either angles, distances or areas. The projection type mostly used in perimetry leads to an enlargement and a tangential deformation that increases overproportionally towards the periphery (30 degrees: +5%, 60 degrees: +20%, 90 degrees: +57%). A circular scotoma, for example, is charted as en ellipse. In the opposite case, when a test point pattern is transferred from the perimetric chart to a perimetric sphere, there is a deformation, too. The distances between the test points are reduced in tangential direction, compared to the chart. A test grid with equidistant points on the chart appears in a rhomboid or rectangular distortion. This phenomenon has to be considered in the design of test point patterns for automatic static perimeters.

[Graphic analysis of topographic trends in perimetry follow-up of glaucoma]. / Die graphische Analyse topographischer Trends (GATT) in der perimetrischen Verlaufskontrolle des Glaukoms.

GATT is a new, graphic method of showing the development of visual fields in glaucoma and other diseases. The grayscale maps of a series of two or four fields are superimposed with a simple logic, producing the following pattern: all stable areas are displayed in the usual way, thus giving defects a typical appearance. Changed areas appear as stripes, alternately showing the grayscale of the two fields. The orientation of the stripes is vertical in zones of improvement and horizontal in areas of deterioration. The level of contrast indicates the amount of change. The authors examined the development of the visual fields in 30 glaucomatous eyes. With the help of GATT it was established that areas of change were close to existing defects. Second, most of the changes were at the periphery. GATT is not only proving to be a method for perimetric follow-up in glaucoma cases that furnishes much useful information, but is also raising hopes of new findings concerning the course of glaucoma.

[A simple point score for definition of the risk of postoperative complications]. / Ein einfacher Punktescore zur Definition des postoperativen Komplikationsrisikos.

During a 5-year-period we recorded prospectively 5,823 patients who had undergone general surgery and documented the postoperative complications as wound infection, pneumonia, reoperations and death. A score including all these complications was developed to evaluate the risk of an operation more exactly than using the wound infection rate alone. This method seems to provide a continuous monitoring and the comparison of the complication risks of certain operations within a quality assurance program. For gastric and colon surgery we found a correlation between postoperative antibiotic use and score, but not between score and postoperative hospitalization time.