[Clinical Comparison of a Trifocal and a Trifocal-Toric Intraocular Lens Based on the Same Diffractive Platform]. / Klinischer Vergleich einer trifokalen und einer trifokal-torischen Intraokularlinse auf gleicher diffraktiver Plattform.

Purpose To evaluate and compare the visual performance of a trifocal and a trifocal-toric intraocular lens (IOL) based on the same diffractive platform. Methods Prospective non-randomized comparative study enrolling 142 eyes of 77 patients (age 40-73 years) undergoing uneventful phacoemulsification lens surgery. Two groups were differentiated according to the implanted IOL: trifocal group, 98 eyes (50 patients) implanted with the trifocal diffractive IOL AT LISA tri 839MP (Carl Zeiss Meditec), and trifocal-toric group, 44 eyes (27 patients) implanted with the trifocal-toric diffractive IOL AT LISA trifocal-toric 939MP (Carl Zeiss Meditec). Visual and refractive changes were evaluated 3 months postoperatively. Results No significant differences between groups were found in postoperative refraction (p ≥ 0.144), monocular and binocular uncorrected intermediate visual acuity (UIVA; p = 0.519 and 0.398, respectively) and binocular uncorrected near visual acuity (UNVA; p = 0.073). In contrast, significantly better monocular and binocular uncorrected distance visual acuity (UDVA; p ≤ 0.002), as well as monocular UNVA (p = 0.005), were found in the trifocal group. A postoperative spherical equivalent within ± 1.00 D was found in 98 % and 100 % of eyes in the trifocal and trifocal-toric groups, respectively. Postoperative binocular UDVA, UIVA and UNVA of 20/30 or better were found in 100, 95 and 100 % of eyes, and in 96.3, 95.8 and 90.9 % of eyes in the trifocal and trifocal-toric groups, respectively. Conclusions The evaluated trifocal and trifocal-toric IOLs both provide a successful restoration of the visual function after cataract surgery, with good levels of refractive precision, as well as UIVA and UNVA.

[Correlation from Undiluted Vitreous Cytokines of Untreated Central Retinal Vein Occlusion with Spectral Domain Optical Coherence Tomography]. / Korrelation von intravitrealen Zytokinen und OCT-Parametern bei Zentralvenenverschluss.

PURPOSE: To correlate key inflammatory and pro-angiogenic cytokines from undiluted vitreous fluid of treatment-naïve patients with central retinal vein occlusion (CRVO) with SD-OCT parameters. METHODS: Thirty-five patients (age 71.1 years, 24 phakic, 30 non-ischaemic) underwent intravitreal combination therapy, including single-site 23-gauge core vitrectomy. Twenty-eight samples from patients with idiopathic, non-uveitis floaterectomy served as controls. Levels of interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF-A) were correlated with visual acuity (logMar), category of CRVO (ischaemic or non-ischaemic) and morphological parameters, such as central macular thickness (CMT), thickness of neurosensory retina (Tneuro), extent of serous retinal detachment (SRT) and disintegrity of the IS/OS and others. RESULTS: Mean IL-6 was 64.7 pg/ml (SD ± 115.8), mean MCP-1 1015.7 pg/ml (± 970.1), and mean VEGF-A 278.4 pg/ml (± 512.8), which was significantly higher than the control values of IL-6 6.2 ± 3.4 pg/ml (p = 0.06), MCP-1 253.2 ± 73.5 pg/ml (p < 0.0 000 001) and VEGF-A 7.0 ± 4.9 pg/ml (p < 0.0006), respectively. All cytokines correlated highly with one another (correlation coefficient r = 0.82 for IL-6 and MCP-1; r = 0.68 for Il-6 and VEGF-A; r = 0.64 for MCP-1 and VEGF-A). IL-6 correlated significantly with CMT, TRT, SRT, dIS/OS, and dELM. MCP-1 correlated significantly with SRT, dIS/OS, and dELM. VEGF-A did not correlate with changes in SD-OCT, while it had a trend to be higher in the ischaemic versus the non-ischaemic CRVO groups (p = 0.09). CONCLUSIONS: The inflammatory cytokines were more often correlated with morphological changes assessed by SD-OCT, whereas VEGF-A did not correlate with CRVO-associated changes in SD-OCT. VEGF inhibition alone may not be sufficient to decrease the inflammatory response in CRVO therapy.

[Half-Dose Verteporfin Photodynamic Therapy (hdPDT) in the Treatment of Central Serous Chorioretinopathy]. / Photodynamische Therapie mit halber Verteporfin-Dosis zur Behandlung der Chorioretinopathia Centralis Serosa.

BACKGROUND: To estimate the efficacy and safety profile of half-dose photodynamic therapy (hdPDT) for treating central serous chorioretinopathy (CSC). PATIENTS AND METHODS: An interventional, retrospective case series of patients with CSC (symptoms ≧ 3 months) receiving half-dose PDT (3 mg/m2 verteporfin). The ophthalmic examination at baseline and at 8 and 16 weeks after treatment included slit-lamp biomicroscopy, indirect ophthalmoscopy, measurement of intraocular pressure (IOP), ETDRS best-corrected visual acuity (BCVA), Amsler grid screening and contrast visual acuity (CVA). Fluorescein angiography (FA), autofluorescence (FAF) and optical coherence tomography (OCT) were measured at each visit. Central macular thickness (CMT) was measured automatically. RESULTS: 12 eyes of 12 patients (10 male and 2 female patients; mean age 46.6 ± 7.91 years) were included in this study. Anatomical resolution was obtained in 10 eyes (83.4 %) at week 16, but 2 eyes (16.6 %) exhibited persistent SRD throughout the follow-up period. Baseline CMT decreased from initially 330.1 µm ± 131.3 to 205.6 µm ± 97.6 (p = 0.034) at week 8 and to 220.3 µm ± 120.1 (p = 0.05) at week 16. Visual acuity (number of total letters read) significantly improved from initially 82.8 ± 11.5 to 86.8 ± 13.9 at week 8 and 91.3 ± 13.8 at week 16 (p = 0.012). Contrast visual acuity (calculated decimal visual acuity) significantly improved from initially 0.14 ± 0.09 to 0.38 ± 0.28 (p = 0.002) at week 16. After therapy, no significant changes in RPE could be detected with FAF and no ocular adverse events were observed. CONCLUSION: PDT with half-dose verteporfin resulted in reduced leakage in FA, enhanced visual acuity and resolution of subretinal fluid in OCT in patients with CSC, with no detected side effects of treatment.

[Clinical Results After Implantation of a New Diffractive, Multifokal Intraocular Lens with a Reduced Near Add Power (+ 2.75 D)]. / Klinische Ergebnisse nach Implantation einer neuen diffraktiven multifokalen Intraokularlinse mit einer reduzierten Nahaddition (+ 2,75 dpt).

PURPOSE: Evaluation of the clinical data 3 months after implantation of a new diffractive multifocal intraocular lens (MIOL) with a reduced near add power of + 2.75 D. METHODS: In a prospective study, patients who underwent cataract surgery or refractive lens exchange with implantation of an MIOL (Tecnis ZKB00, Abbott Medical Optics, Santa Ana, California, USA) were included. Three months postoperative corrected and uncorrected visual acuities at different distances were measured and evaluated. Those patients that underwent bilateral MIOL implantation additionally filled out a questionnaire 3 months postoperatively. RESULTS: Between October 2013 and August 2014, 115 eyes of 62 patients were implanted with the ZKB00 IOL. Mean postoperative refractions were - 0.27 ± 0.44 D for the spherical equivalent, respectively. Mean binocular CDVA was - 0.01 ± 0.3 logMAR with a mean binocular UDVA of 0.06 ± 0.08 logMAR. For near distance in 40 cm, an UNVA of 0.07 ± 0.10 logMAR three months postoperatively was measured. CONCLUSION: The ZKB00 IOL belongs to a group of novel MIOL with an increased intermediate visual performance. Our study shows good visual acuity at all distances, as well as a high rate of satisfaction and subjectively good image quality.

[Refraction after Implantation of Multifocal and Presbyopia-Correcting Intraocular Lenses]. / Richtiges Refraktionieren nach Implantation von Multifokal- und presbyopiekorrigierenden Intraokularlinsen.

Nowadays, further developments in the field of intraocular lenses offer a higher level of spectacle independence for our patients. As light gets scattered on different focal points a wider range of defocus is created. This greater defocus area makes it more difficult for us to determine the objective or subjective refraction. This contribution is concerned with the difficulties of measuring visual acuity in different intraocular lens designs and different measurement distances. Measuring refraction after implantation of a multifocal intraocular lens is a complex procedure and the experience of the examiner plays a crucial role. Retinoscopy, keratometry and the defocus curve are reliable methods for testing, while the auto refractometer, bichromatic testing and the cross-cylinder have limitations.

[Functional Results One Year after Implantation of a Bitoric, Trifocal Intraocular Lens]. / Funktionelle Ergebnisse 1 Jahr nach Implantation einer bitorischen, trifokalen Intraokularlinse.

PURPOSE: An evaluation of the visual and refractive results was undertaken one year after implantation of a trifocal diffractive toric intraocular lens (IOL) during cataract surgery. METHODS: In a prospective study patients with a calculated postoperative corneal astigmatism of ≥ 0.75 D received a diffractive trifocal toric IOL (AT LISA tri toric 939MP, Carl Zeiss Meditech, Jena, Germany) during cataract surgery. One year postoperatively the near, intermediate and distance visual acuity, corrected and uncorrected vision as well as refraction were evaluated. RESULTS: 20 patients (40 eyes) with a median age of 59 ± 11 years of which 15 were female underwent bilateral cataract surgery. One year postoperatively a binocular uncorrected distance visual acuity (UDVA) of 0.10 logMAR ± 0.11 and a corrected distance visual acuity (CDVA) of 0.00 logMAR ± 0.08 could be found. Binocular intermediate visual acuity (UIVA) and near visual acuity (UNVA) were 0.00 logMAR ± 0.05 and 0.09 logMAR ± 0.07, respectively. 100 % of patients were between ± 1.0 D from target refraction. Even 1 year after surgery no patient had an IOL rotation greater than 5°. CONCLUSION: The implantation of a trifocal toric intraocular lens offers an effective way for visual rehabilitation in near, intermediate and far distances with a good rotational stability of the IOL platform.

[Significant improvement in compliance with the face-down position after vitrectomy and gas tamponade]. / Verbesserung der Compliance bei postoperativer "Gesicht-nach-unten-Lagerung" nach Vitrektomie mit Gastamponade.

BACKGROUND: The positioning of a patient in a "prone position" ("face down position", fdp) after pars plana vitrectomy with gas tamponade has been discussed controversially since the beginning of macular surgery. The "prone positioning" is almost standard although the duration varies. In most of the study designs for macular surgery "face-down positioning" is advised. However it is not clearly described how the "prone position" was achieved. In most of the studies it is not shown if the patients had suitable aids and how long and how efficiently they used them. Experience while practising this shows that the patient's compliance is a great challenge. Patients are mostly unable to comply, which could result in refusal. METHODS: In our prospective, controlled and randomised pilot study we observed postoperatively 40 patients who all underwent a pars-plana vitrectomy and sulfur hexafluoride-gastamponade (SF6 25%). All patients of the supported group (SG) and the control group (CG) were requested to keep their face downwards until the gas bubble was resorbed completely. In the postoperative time in hospital the participants of the SG used a simple prone-positioning support. In the time at home after hospital, the patients were supplied with an inflatable device. In this trial we wanted to show whether or not it is possible to improve the patient's compliance by using a prone-positioning support, designed to be particularly comfortable, so that real time in "face-down position" in hours per day could be increased significantly. Additionally, the contentment of the patient in reference to the available supports and the appearance of complications has been reported. RESULTS: In particular the real time of "fdp" in hours per day (24 h) varied greatly (SG: 19.5/24; CG: 5.5/24; P < 0.0001). Equivalent results were reflected in the contentment in reference to the available supports (SG: 99%; CG: 25%; P < 0.0001). Postoperative complications such as moderate or severe back-, neck- or headache only were observed in the CG. Development of a postoperative cataract was observed mainly in the non-supported group. CONCLUSIONS: By placing supports at the disposal of the patients, it is possible to improve significantly the compliance after surgery. To succeed in using the prone position also at home it is necessary to supply the patient with a support which is comfortable, cheap and easy to handle.

Intracytoplasmic enzymes in gingival crevicular fluid of patients with aggressive periodontitis.

BACKGROUND AND OBJECTIVE: Biochemical parameters of crevicular fluid could provide evidence of periodontal tissue disease. The aim of this study was to analyze enzymes in crevicular fluid in aggressive localized and generalized periodontitis. MATERIAL AND METHODS: One hundred and twenty-four subjects were classified as having localized (n = 36) or generalized aggressive periodontitis (n = 38) and subclassified into moderate and severe groups. Controls were 50 periodontitis-free subjects. Activities of the enzymes lactate dehydrogenase, neutrophil elastase, alkaline phosphatase and aspartate aminotransferase were determined. Data were analyzed using one-way ANOVA and Tukey's test. RESULTS: Among the subjects with localized aggressive periodontitis, values of lactate dehydrogenase and alkaline phosphatase increased notably in moderate and severe periodontitis compared with control subjects. Values for aspartate aminotransferase increased with the severity of the disease, and neutrophil elastase was increased in the moderate and severe states. In generalized aggressive periodontitis, lactate dehydrogenase showed higher values than in control subjects in both periodontal subgroups. Alkaline phosphatase and neutrophil elastase showed higher significant differences between moderate and severe periodontitis compared with the control group. Aspartate aminotransferase showed differences between the severe and moderate periodontitis groups compared with the control group. Of all the enzymes analyzed, only lactate dehydrogenase showed higher values in localized than in generalized aggressive periodontitis. CONCLUSION: Lactate dehydrogenase may distinguish localized and generalized aggressive periodontitis. Alkaline phosphatase increases from moderate to severe states in both types of periodontitis. Aspartate aminotransferase and neutrophil elastase only increase with strong evidence of periodontal destruction.

[Combined pharmacosurgery as treatment for diabetic macular edema: core pars plana vitrectomy and intravitreal injection of bevacizumab and triamcinolone]. / Kombinierte Pharmakochirurgie zur Behandlung des diabetischen Makulaödems: Kernvitrektomie mit intravitrealer Injektion von Bevacizumab und Triamcinolon.

BACKGROUND: The aim of this work is to report the efficacy of a 1.5 mL core pars plana vitrectomy (cppV) combined with isovolumetric substitution with 1.25 mg bevacizumab and 8 mg triamcinolone for the treatment of diabetic macular edema (DME). METHODS: Data of 73 eyes (60 patients; mean age: 65.4 ± 10.4 years) with diabetic macular edema were retrospectively analysed. Main outcome measures were changes in visual acuity, central macular thickness (CMT) and the need for re-intervention and further treatment modalities, i. e., laser photocoagulation (LPC) or pars plana vitrectomy (ppV). Study eyes were assigned to one of three groups: non-proliferative diabetic retinopathy without ischaemic maculopathy (NPDR I. M.; group I; n = 38 eyes); NPDR with I. M. (group II; n = 17 eyes); proliferative diabetic retinopathy with or without I. M. (group III; n = 18). Mean follow-up times were 9 weeks (T1), 25 weeks (T2) and 44 weeks. RESULTS: Preoperative mean VA was 0.69 ± 0.4 logMAR. A statistically significant increase in mean VA was observed in all study eyes at 2 months after the initial operation (T1; 0.51 ± 0.22 logMAR; p < 0.01). This remained stable at T 2 (0.52 ± 0.33 logMAR; p = 0.6) and T 3 (0.55 ± 0.35 logMAR; p = 0.99). At baseline mean VA was 0.52 ± 0.21 logMAR in group I, 0.99 ± 0.5 logMAR in group II and 0.77 ± 0.42 logMAR in group III. At T 1 (2 months) the VA change was statistically significant in group II (0.64 ± 0.18 logMAR; p < 0.05) only. In contrast, group I had a highly significant VA gain after 6 months (0.36 ± 0.16; p < 0.01). Patients with PDR (group III) had a non-significant VA gain at T 1 (0.53 ± 0.24; p = 0.08) and remained stable at T 2 and T 3. The mean central macular thickness (CMT) in all study eyes decreased significantly from 393.7 ± 120.6 µm to 269.7 ± 100.2 µm (delta -28 %; p < 0.01) at T 1. Thereafter CMT slightly increased but, on the whole, remained stable at that level. Retreatment with the intravitreal combination therapy was performed in 20 of 73 eyes (27.4 %). Laser photocoagulation was only carried out in more than half of the eyes with PDR (10 / 18; 55.6 %). An increase in IOP was noted in 12 / 73 eyes (16.4 %) at different follow-up, and was controlled using topical medication. Systemic side effects were not reported. CONCLUSION: Our data show that the majority of the study eyes maintained or improved their visual acuity after pharmacosurgical therapy. Furthermore we observed a reduction of the central macular thickness in almost all study eyes. Only few retreatments and other treatment modalities were needed during the follow-up period. This combind pharmacosurgical treatment may supplement current treatment standards like laser photocoagulation, classical pars plana vitrectomy or intravitreal monotherapy for DME.

Combined intravitreal pharmacosurgery in patients with occult choroidal neovascularization secondary to wet age-related macular degeneration.

AIM: The aim was to investigate the efficacy and safety of combined intravitreal therapy in patients with occult choroidal neovascularization (CNV) secondary to wet age-related macular degeneration (AMD) over 6 months. METHODS: In this prospective pilot study of a case series, 106 patients (mean age 75.4 years) with predominantly occult CNVs were treated with a 1.5-ml core pars plana vitrectomy with intravitreal injections of triamcinolone (8 mg), bevacizumab (1.25 mg) and balanced salt solution. The best-corrected visual acuity (BCVA; logMar), central macular thickness (optical coherence tomography), and intraocular pressure (IOP; Goldmann tonometry) were assessed at baseline and follow-up visits. RESULTS: Statistically significant increases in BCVA (vs. baseline) were observed at 2 months (mean +0.9; standard deviation +/-0.6 lines), 4 months (+1.3; +/-0.7), and 6 months (+1.2; +/-0.7) after the initial combined intravitreal therapy in 96/106 patients. At 6 months, BCVA had deteriorated in 20 of 96 (20.8%) patients by <2.5 lines, remained stable in 38 of 96 (39.6%) and improved in 31 (32.3%) patients by 1-3 lines, and in 7 (7.3%) patients by >3 lines. The mean central retinal thickness decreased by -41.2% (-195; +/-46 microm) over 6 months. 55% demanded intravitreal anti-vascular endothelial growth factor (VEGF) treatment after initial therapy. Increases in IOP were managed by eye drops in 11 (10%) patients with no other adverse event occurring. CONCLUSION: After the combined intravitreal therapy, including two drugs and a limited core vitrectomy, a significant and sustained improvement in vision of patients with occult CNVs was observed over 6 months. In 45% of the initially treated patients, anti-VEGF therapy did not have to be continued, which might be attributed to both the pharmacological effects of the drugs and the physiological changes induced by the vitrectomy (posterior vitreous detachment, liquefaction, and oxygen redistribution).

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in adults]. / Evaluation anatomischer Veränderungen des vorderen Augenabschnitts nach Augenmuskelchirurgie bei Erwachsenen mittels optischer Kohärenztomografie.

BACKGROUND: In the light of studies in children which showed no significant changes concerning anterior chamber depth, central corneal thickness and chamber angle width after eye muscle surgery, the aim of this study was to evaluate such changes in adults by means of optical coherence tomography. PATIENTS AND METHODS: Using the Visante™ OCT (Carl Zeiss, Meditec, Jena) we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0° (CW0) and 180° (CW180) in 17 patients who had undergone eye muscle surgery on a minimum of one horizontal muscle preoperatively, one week and four months postoperatively. Exclusion criteria were an age under fifteen years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 43 years (min: 15; max: 67 years). RESULTS: In all eyes (one and two muscles), no significant differences of mean values taken preoperatively, one week and four months postoperatively were seen: CCT: 538 ± 51 mm; 535 ± 39 mm; 535 ± 46 mm (p = 0.77); ACD: 2.98 ± 0.44 µm; 3.01 ± 0.45 µm; 3.01 ± 0.40 µm (p = 0.42); KW 0: 38.0 ± 5.2° 38.4 ± 6.0° 37.8 ± 5.2° (p = 0.98); KW 180: 33.7 ± 5.6° 35.6 ± 5.7° 34.5 ± 6.8° (p = 0.32). The differences between the corresponding data of both subgroups (one vs. two muscles) concerning central corneal thickness (p-value: 0.74; 0.89; 0.42), anterior chamber depth (p-value: 0.31; 0.23; 0.36) as well as chamber angle width at 0° (p-value: 0.73; 0.27; 0.81) and at 180° (p-value: 0.87; 0.67; 0.89) were not significant. CONCLUSION: Using optical coherence tomography of the anterior eye segment in adults after muscle surgery, either in one or in two muscles - in accord with the results in children - no significant changes concerning central corneal thickness, anterior chamber depth and chamber angle width were seen.

[Virtual reality in ophthalmology]. / Virtuelle Realität in der Ophthalmologie.

BACKGROUND: The use of virtual reality (VR) has gained increasing interest for the acquirement of ophthalmosurgical skills outside the operating room and is thereby increasing patients' safety. The aim of this study was to evaluate trainees' acceptance of VR for assessment and training during several Drylabs with an ophthalmosurgical simulator (EYESi, VRmagic). METHODS: All 247 surgical trainees of several ophthalmological Drylabs between 2007 and 2008 underwent VR training during the course. Each participants performed several basic skills tasks followed by a virtual operation such as core vitrectomy or ILM peeling. The participants' opinion on VR was analysed with a standardised questionnaire. Participants were divided into 2 groups (more versus less experienced ophthalmologists/residents) and evaluated the visual quality of the simulator (aspect 1), the complexity of the tasks (2), the clinical impact (3), the learning effect (4) and the overall impression (5). RESULTS: We evaluated a total of 156 questionnaires. The study enrolled 108 surgical residents with a mean of 2.5 years (+/- 1.1) since graduation who had similar limited experience (less than 10 operations) and 48 more experienced ophthalmologists (more than 10 procedures) with a mean of 8.3 years (+/- 3.0) of experience. In group I the aspects were scored with 4.6 (quality), 4.5 (complexity), 4.5 (clinical impact), 4.7 (learning effect), and 4.6 (overall impression) and in group II with 4.2, 3.1, 4.1, 3.6 und 4.0. The evaluation of the quality deviated with a p value of < 0.05 whereas the other aspects deviated with a p value of < 0.01. CONCLUSION: The majority of the participants of the two groups accepted and highly appreciated VR simulation for ophthalmosurgical assessment and training.

[Combined intravitreal therapy for age-related macular disease]. / Kombinierte intravitreale Therapie zur Behandlung der altersbedingten Makuladegeneration.

Since the introduction of anti-VEGF drugs for the treatmet of CNV in age-related macular degeneration (AMD), visual acuity can be stabilised or improved in a significant number of patients. There is an ongoing debate on the safety, efficiency and economic aspects related to current intravitreal therapeutic concepts. Twenty-four to 36 hours after 80 % low-fluence verteporfin photodynamic therapy (PDT) a combined phrarmacosurgical intravitreal therapy for 52 patients with wet AMD was conducted (multiple therapy). By performing a 23-gauge core vitrectomy with the Intrector, an intravitreal substitution with BSS, dexamethasone and bevacizumab was achieved via a self-adapting two-channel cannula for aspiration and injection in one probe tip. After 14 months the mean gain in visual acuity (VA) was 0.18 Snellen lines, with VA stabilisation in 14 / 52 (27 %) and VA gain in 38 / 52 (73 %) of the patients. This safe pharmacosurgical regimen indicated a low intravitreal retreatment rate of (13 / 52) 25 %.

[Proteome analysis of undiluted vitreous humor in patients with branch retinal vein occlusion]. / Proteomanalyse unverdünnter Glaskörperflüssigkeit bei Patienten mit einem Venenastverschluss.

BACKGROUND: The pathophysiological mechanisms of macular edema secondary to branch retinal vein occlusion (BRVO) remain unclear. OBJECTIVES: To analyze the protein profile of human vitreous of patients with BRVO and to identify specific dysregulated proteins. MATERIALS AND METHODS: Undiluted vitreous humor samples from patients with treatment naïve BRVO and 15 controls with idiopathic floaters were analyzed in this clinical-experimental study using capillary electrophoresis coupled to a mass spectrometer (CE-MS) and tandem mass spectrometry (MS/MS). Quantitative analysis of the dysregulated proteins was performed with enzyme-linked immunosorbent assay (ELISA). Protein-protein interactions were depicted with the STRING database. RESULTS: A total of 84 proteins were found in the human vitreous samples of 15 patients with BRVO and 15 controls. In all, 14 proteins were significant when comparing the signal intensities of BRVO and control samples. Six significant dysregulated proteins with p < 0.001 were further verified with ELISA. Clusterin, complement factor C3, prostaglandin-H2 D­isomerase and vitronectin were significantly upregulated in the BRVO group and opticin was downregulated. The protein interactions analysis showed associations with inflammatory cascades, matrix changes, mechanisms of cell survival und death. CONCLUSIONS: The results of the study reveal that the proteomic composition of vitreous humor differed significantly between the patients with BRVO and the controls. Whether the identified proteins may serve as potential biomarkers for pathophysiology, diagnostics or therapy should be examine in further studies.

Increased sensitivity of gastric acid secretion to gastrin in cirrhotic patients with portacaval shunt.

We studied acid secretory responses to exogenous pentagastrin and to exogenous and endogenous gastrin in 12 stable cirrhotic subjects with portacaval shunt, 12 unshunted cirrhotics, and 12 normal subjects. Basal and stimulated serum gastrin concentrations as well as basal and maximum acid outputs were similar in the three groups. At low doses of either exogenous pentagastrin or gastrin-17 (G17), cirrhotics with portacaval shunt secreted significantly greater amounts of gastric acid than unshunted subjects. After low doses of intragastric peptone, cirrhotics with portacaval shunt secreted significantly more acid than unshunted cirrhotics and normal subjects. At each measured serum gastrin concentration after either exogenous G17 or intragastric peptone meals, cirrhotics with portacaval shunt secreted more acid than the unshunted control groups and their dose-response curve was significantly shifted to the left. Thus, in cirrhotic patients with portacaval shunt, gastric acid secretion is abnormally sensitive to both exogenously administered or endogenously released gastrin.

[The effectiveness of the new fluoroquinolones against the normal bacterial flora of the conjunctiva]. / Wirksamkeit neuer Fluorchinolone gegenüber der bakteriellen Normalflora der Bindehaut.

BACKGROUND: Our aim was to determine the antibiotic susceptibility of the preoperative conjunctival bacterial flora against 25 commonly used antibiotics, especially the new fluoroquinolones levofloxacin, gatifloxacin, and moxifloxacin. PATIENTS AND METHODS: The Kirby-Bauer disk-diffusion technique was used to test for the in vitro antibiotic susceptibility of conjunctival bacterial strains isolated from 160 patients (median=74 years, mean=71 years) undergoing cataract surgery at the Department of Ophthalmology, Stanford University, CA, USA. RESULTS: Among the 256 bacteria isolated, 201 (79%) were coagulase-negative staphylococci (CNS), 26 Staphylococcus aureus, 15 Streptococcus group D and 14 gram-negative rods. A total of 100 of these 256 strains (39%) were classified as multiresitant (resistant to>or=five antibiotics). The resistance rate (RR) of commonly used antibiotics for all CNS was: gatifloxacin=moxifloxacin

Factors associated with HIV sero-positivity in young, rural South African men.

OBJECTIVE: To describe factors associated with HIV infection in men aged 15-26 years. SETTING: Rural Eastern Cape Province, South Africa. SAMPLE: A total of 1277 sexually experienced Xhosa male volunteers from 70 villages participating in a cluster randomized controlled trial of an HIV behavioural intervention. Xhosas circumcise during manhood initiation rituals. DESIGN: Cross-sectional, analysis of the study's baseline interviews. MAIN MEASURE: HIV sero-status, sexual practices measured with an interviewer-administered questionnaire. RESULTS: About 2% of the men were HIV positive. A logistic regression model showed HIV positivity to be associated with age (OR 1.55; 95%CI 1.22-1.95), having made a woman pregnant (OR 2.93; 95% CI 1.28-6.68), having been circumcised (OR 0.40; 95% CI 0.16-0.98), and having had sex with a man (OR 3.61; 95% CI 1.0-13.0). CONCLUSIONS: Our findings provide further evidence to suggest that circumcision is protective. There was much heterosexual risk taking among men but only pregnancy (with its association with sexual frequency) predicted HIV sero-positivity. Although relatively rare, same-sex sexual experiences were a risk factor. Male-male sexual contact is rarely assessed in HIV research in Africa and almost never addressed in general HIV prevention programming. Our findings suggest that it should be given more attention.

Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV.

BACKGROUND: This paper aims to describe factors associated with HIV sero-status in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. METHODS: A total of 1295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioural intervention. The main measures were HIV sero-status, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. RESULTS: About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviours. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). CONCLUSIONS: IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women and the importance of joint prevention.

Costs of health care use by women HMO members with a history of childhood abuse and neglect.

BACKGROUND: Early childhood maltreatment has been associated with adverse adult health outcomes, but little is known about the magnitude of adult health care use and costs that accompany maltreatment. We examined differences in annual health care use and costs in women with and without histories of childhood sexual, emotional, or physical abuse or neglect. METHODS: A random sample of 1225 women members of a health maintenance organization completed a 22-page questionnaire inquiring into childhood maltreatment experiences as measured by the Childhood Trauma Questionnaire. Health care costs and use data were obtained from the automated cost-accounting system of the health maintenance organization, including total costs, outpatient and primary care costs, and emergency department visits. RESULTS: Women who reported any abuse or neglect had median annual health care costs that were $97 (95% confidence interval, $0.47-$188.26) greater than women who did not report maltreatment. Women who reported sexual abuse had median annual health care costs that were $245 (95% confidence interval, $132.32-$381.93) greater than costs among women who did not report abuse. Women with sexual abuse histories had significantly higher primary care and outpatient costs and more frequent emergency department visits than women without these histories. CONCLUSION: Although the absolute cost differences per year per woman were relatively modest, the large number of women in the population with these experiences suggests that the total costs to society are substantial.