Attitudes toward postmortem cornea donation in Germany: a multicenter survey.

PURPOSE: To analyse the willingness for postmortem cornea donation in Germany. METHODS: Employees in two cities (UKM, UKS), and university hospitals (STM, STE), members of the German Ophthalmological Society (DOG), and employees of an automobile company (BO) participated in a questionnaire about postmortem cornea donation attitudes. The questionnaire consisted of demographic items, motives concerning postmortem cornea donation, general attitudes toward donation, and questions concerning the perceived needs for information about donation. The statistical analyses included logistic regression with the target parameter of 'willingness to donate cornea postmortem'. RESULTS: Of the participants, 67.7 % (UKM, UKS), 70.9 % (STM, STE), 70.8 % (BO), and 79.4 % (DOG) declared their intention to donate their corneas postmortem. Younger age (p < 0.001), poorer general health (p < 0.05), faith in an eternal life (p < 0.05), disagreement with brain death diagnostics (p < 0.001), fear of receiving worse medical treatment (p < 0.001), and fear of the commercialization of organs (p < 0.001) were found to be risk factors for a negative attitude toward postmortem cornea. The majority of participants (57.4 %) indicated that additional information about donation would be appreciated, and the internet (69.9 %) was considered the most appropriate means for conveying this information. CONCLUSIONS: Emotional items were revealed to be the most relevant factors influencing the willingness to donate cornea postmortem, which may be counteracted by means of public education. The relatively low willingness among the medical staff contrasts with previous observations in a professional ophthalmologic society.

[Results of an internet-based survey amongst members of the German Ophthalmological Society concerning postmortem cornea donation]. / Ergebnisse einer internetbasierten Umfrage zur Hornhautspendebereitschaft bei DOG-Mitgliedern.

BACKGROUND: Analysis of willingness for postmortem cornea donation by professionals in ophthalmology and their motives in favor of or against donation. PATIENTS AND METHODS: 3887 members of the German Ophthalmological Society received an anonymous questionnaire concerning sociodemographic background, physical health, experiences with organ explantation and their former engagement and motives concerning organ and cornea donation. RESULTS: 722 of the questionnaires were partially and 533 completely answered with an average willingness for cornea donation of 79.4%. Significant parameters for cornea donation were gender, former experience with organ explantation, ophthalmological health and fear of false diagnosis of brain death, worse medical treatment or organ commercialization. Of the participants 53.9% suggested the internet as a favorite source of information in this matter. CONCLUSION: The factors which had a significant impact on cornea donation in this survey seem to be mainly a result of insufficient information. Detailed information regarding this topic should preferentially be presented on internet pages of professional societies and could probably increase donation approval of DOG members.

A brief review of Susac syndrome.

Susac syndrome was named after J.O. Susac who first described the syndrome in 1979. It is characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. It mainly occurs in young women. This underdiagnosed disease needs to be considered in the differential diagnosis of a broad variety of disorders. In Susac syndrome, autoimmune processes leading to damage and inflammation-related occlusion of the microvessels in brain, retina, and inner ear are thought to play a causal role. The diagnosis is based primarily on the clinical presentation, the documentation of branch retinal artery occlusion by fluorescence angiography, and characteristic findings on cerebral MRI, that help in distinguishing Susac syndrome from other inflammatory entities, like multiple sclerosis. Antiendothelial cell antibodies could be detected in some patients. Patients are successfully treated with immunosuppression, however, the best regimen still needs to be defined. As a result of the rarity of the disease, controlled therapeutic trials are missing so far. In this review, we want to demonstrate the clinical features, natural history, treatment, and clinical course of Susac syndrome, illustrated by a typical case history.

[Susac syndrome: an interdisciplinary challenge]. / Susac-Syndrom : Eine interdisziplinäre Herausforderung.

Susac syndrome, named after John Susac, the first to describe this condition, is characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. Although certainly a rare disease, Susac syndrome needs to be considered in the differential diagnosis of a broad variety of diseases. The pathogenesis is not yet clear. Autoimmune processes leading to damage and inflammation-related occlusion of the microvessels in brain, retina, and inner ear are thought to play a causal role. The diagnosis is based primarily on the clinical presentation, the documentation of branch retinal artery occlusion by fluorescence angiography, and characteristic findings on cerebral MRI. Usually, immunosuppressive therapy is required, though controlled therapy trials are missing so far. The intention of this review article is to raise awareness of this disease among neurologists, psychiatrists, ophthalmologists, and ENT specialists as a high number of unreported cases probably exists. Accordingly, the focus is on the clinical presentation and the diagnostic approach.

[Bacteriology of occluded nasolacrimal ducts in infants]. / Bakterielles Keimspektrum bei kindlichen Tränenwegsstenosen.

BACKGROUND: Connatal lacrimal duct stenosis (cLDO) commonly causes purulent bacterial dacyrocystitis. The recommended treatment of choice is up to the sixth month of life a conservative antimicrobiological therapy. After the sixth month lacrimal duct irrigation with silicone tube intubation remains the gold standard. Our purpose was to analyse the current bacterial spectrum in cLDO and to compile a bacterial resistogram in order to specify antimicrobiological therapy. METHODS: 66 samples from the lacrimal duct of 6- to 16-month-old children (41 female, 25 male) were obtained by collecting the refluxing liquids with cotton wool swabs after irrigation of the lacrimal drainage system with sterile saline during lacrimal duct surgery. Cultures were incubated aerobically and anaerobically and the infectious agents were isolated. Sensitivity testing was performed for each isolate, testing 8 different commonly used local antibiotics. Data were statistically analysed using SPSS. RESULTS: Cultures were positive in cLDO in 97 %, showing co-colonisation in 87 % with up to five bacterial strains. Gram-positive bacteria were seen in 72 % of the isolates in cLDO with Streptococcus pneumoniae (31 %) being the most abundant strain, followed by Staphylococcus aureus (13 %) and S. epidermidis (13 %). In 85 % of the samples at least one Gram-negative rod was present, most often Branhamella (12 %), followed by Haemophilus influenzae (11 %). Sensitivity testing revealed chloramphenicol, fusidic acid and ciprofloxacin/levofloxacin to be the most effective drugs in cLDO, whereas erythromycin and gentamycin turned out to be insufficient in treating cLDO. CONCLUSION: Bacterial colonisation plays a crucial role in cLDO, showing a positive culture in 97 % with frequent co-colonisation of several bacterial strains (often in combination with at least one Gram-negative strain). The sampling of a microbiological probe of the lacrimal duct is recommended at least in therapy-refractory cases. Current bacteria in cLDO can be effectively treated with chloramphenicol, fusidic acid and ciprofloxacin. The commonly used antibiotics erythromycin and gentamicin are inappropriate as monotherapeutics.