Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study

PURPOSE

The oral cavity and, in particular, potential oral foci might pose a risk of periprosthetic joint infection (PJI). The aim of this cohort study was to determine whether practical preoperative dental screening would reduce the prevalence of early PJI in the first month after surgery.

METHODS

Patients attending a specialized endoprosthesis implantation clinic between 2018 and 2022 were recruited. Two groups were examined. The test group consisted of patients attending the clinic between 2020 and 2022 and who were referred to their family dentist using a standardized form. The comparison group consisted of patients who were treated in the clinic between 2018 and 2020. They were not referred to their family dentist. The two groups were compared for the prevalence of PJI. Univariate analysis followed by multiple logistic regression was performed to confirm risk factors for PJI in this cohort.

RESULTS

2560 individuals (test group: 1227, comparison group: 1333) were included. The prevalence of PJI was significantly lower in the test group (0.8% vs. 1.8%, p = 0.04). Multiple logistic regression with PJI as the dependent variable showed that a dental referral was a strong predictor of a lower prevalence of PJI (OR: 0.43, CI95 0.205-0.917, p = 0.03). Male gender was also strongly associated with a higher frequency of PJI (OR: 2.68, CI95 1.32-5.42, p = 0.01). Age (OR: 1.06, CI95 1.01-1.10, p = 0.01) and BMI (OR: 1.11, CI95 1.05-1.17, p < 0.01) had little effect on the risk of PJI.

CONCLUSION

Dental referral using a standardized form can reduce the prevalence of early PJI. Accordingly, orthopedists and dentists should collaborate in this practical way.

Irradiation Dose to the Swallowing Muscles Impacts Nutritional Status in Head and Neck Cancer Patients: The Prospective Randomized HEADNUT Trial

PURPOSE/OBJECTIVE(S)

To evaluate the influence of radiation dose on swallowing muscles and associated side effects as well as on nutritional status in patients with head and neck cancer undergoing primary or adjuvant (chemo)radiotherapy.

MATERIALS/METHODS

Between 2018 and 2020, sixty-one patients were prospectively randomized into the so-called HEADNUT-trial (HEAD and neck cancer patients undergoing NUTritional intervention). Follow-up was continued until 2022. Contouring of the swallowing apparatus included and the swallowing muscles with the superior (scm), middle (mcm), and inferior constrictor muscle (icm), the cricopharyngeal muscle and the inlet of the esophagus. Nutritional status was assessed by bioelectrical impedance analysis (BIA) at the beginning and the end of radiotherapy. The post-therapeutic nutritional status was evaluated by the BIA-derived FFMI (fat-free mass index; kg/m²). Malnutrition was assumed at FFMI values of <15 (♀) and <17 (♂) kg/m². To find differences between dosimetric parameters in well- and malnourished patients, Mann-Whitney-U-test was used. To estimate the relationship between malnutrition and its influencing variables a logistic regression model was built.

RESULTS

The following structures differed between well- and malnourished patients at the end of therapy: icm (Dmean, V40Gy (%), V50Gy (%), V60Gy (%)) and cricopharyngeal muscle (V40Gy (%)). After entering these parameters into a multivariable logistic regression model icm Dmean (b = -0.12; Exp(b) = 0.88; 95%-CI: 0.78-1.0; p = 0.06) and icm V40Gy (%) (b = 0.06; Exp(b) = 1.07; 95%-CI: 1-1.13; p = 0.04) proved to be independent predictors of malnutrition. We only determined the cut-off value for icm V40Gy (%) since it was the only parameter which met p<0.05. The optimal cut-off value for the predictor V40Gy (%) based on the Youden Index was 85.6%.

CONCLUSION

Adherence to dose constraints for the swallowing apparatus may prevent malnutrition in head and neck cancer patients at the end of therapy. Specifically, we suggest an icm V40Gy (%) of more than 86% being predictive for nutritional complications.

Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses-Results of a Prospective Cohort Study

This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients' general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts.

[Functional results and complications in the long-term follow-up after 25-gauge vitrectomy of epiretinal membrane]

BACKGROUND

Idiopathic epiretinal membranes can lead, among other things, to visual impairment and metamorphopsia. The treatment of choice is a pars plana vitrectomy with removal of the membrane. The improvement of visual acuity and postoperative complications have already been described in several studies.

OBJECTIVE

The aim of this retrospective study is to evaluate the long-term outcome of at least 3 years.

MATERIAL AND METHODS

In the period from 2011 to 2016, a total of 667 eyes underwent 25-gauge pars plana vitrectomy, membranectomy and peeling of the ILM (Internal limiting membrane) because of epiretinal membrane by the same surgeon. This study included 51 eyes from 51 patients who had returned to our clinic after at least 3 years. For the follow-up, data were collected after 3 months and then annually, if available. The mean follow-up time was 57 months (37-104 months). In the postoperative follow-up visual acuity, intraocular pressure and complications were recorded.

RESULTS

Of the 51 eyes included 34 had a 25-gauge pars plana vitrectomy with phacoemulsification and artificial lens implantation, 8 eyes without phako and 9 eyes were already pseudophakic. The most common complication in the follow-up period was a persistent macular edema with 5.9% (3 eyes) and a recurrence of epiretinal membrane in 5.9% of cases. The best corrected logMar visual acuity was 0.4 (0.1-1.3; n = 51) preoperatively, at the last examination 0.23 (0-1.0; n = 51, p < 0.001). Three months postoperatively, the logMar visual acuity was 0.29 (n = 41), after 1 year 0.25 (n = 35), 2 years 0.23 (n = 29), after 3 years 0.26 (n = 29), after 4 years 0.27 (n = 27), after 5 years 0.24 (n = 17) and after 6 years 0.24 (n = 13).

CONCLUSION

The 25-gauge pars plana vitrectomy is a low complication procedure for the removal of epiretinal membranes. The clearest increase in visual acuity can be seen within the first 3 months postoperatively, but then stabilizes. In the long-term follow up a change in visual acuity can also be found after more than 3 years.

“Health Situation of Women in Germany 2020” - The new report of the Federal Health Reporting is published

Introduction

In Germany, there are more than 35 million women. The German Women's Health Report being published in December 2020 by the Federal Health Reporting Unit at the Robert Koch Institute describes their health status.

Methods

The report uses a broad data basis and shows differences and similarities in the health of women and men (‘differences between') as well as within the group of women (‘differences within'). It includes an overview on their health status, health behaviour and health care. Focus chapters are devoted to health over the life course, specific groups of women, e.g. women with disabilities, and specific health topics, e.g. sexual and reproductive health.

Results

Women's average life expectancy has been increasing for many decades. Two thirds of women rate their health as good or very good. The most common cause of death among women are cardiovascular diseases, accounting for around 40% of all deaths. Nevertheless, they are still considered as ‘male' diseases, thus women often underestimate their risk of disease. Women are in general more health conscious than men, e.g. they have a healthier diet. Women use prevention measures, health promotion and health care services more often. Two thirds of those in need of care are women and it is mainly women who are responsible for the care of others. Data gaps exist for certain conditions such as benign gynaecological diseases as well as for certain groups of women, e.g. migrant women.

Conclusions

In Germany, the health status and health care for women are at a high level. But inequalities in the opportunities for a healthy life exist: socio-economic factors such as age, education, occupation, income, family type, migration background and many other aspects have an important impact on their health status. The report provides current data and information for policymakers, science and practice and raises the awareness and the need for sex and gender-appropriate health promotion, prevention and care.

Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs

OBJECTIVES

Gastroesophageal reflux can occur during anaesthesia and may lead to esophagitis and occasionally oesophageal stricture formation. The aim of the study is to assess two omeprazole protocols on gastroesophageal reflux incidence and pH in anaesthetised dogs.

MATERIALS AND METHODS

Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1 mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1 mg/kg orally the evening and 3 hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs). An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia.

RESULTS

Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups. Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH < 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively.

CLINICAL SIGNIFICANCE

Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.

How are the women in Germany? The Women’s Health Report of German Federal Health Reporting

Issue

The aim of Federal health reporting (GBE) is to continuously provide up-to-date information on the population's health and healthcare utilisation in Germany. Since women and men differ significantly in terms of health and disease, health reporting should always take gender into account.

Description of the Problem

A new report on women's health in Germany is published in mid-2020 by the Robert Koch Institute (RKI), containing data on women's health situation, health behaviour and health care. GBE publications are based on a comprehensive database, including official statistics, RKI health monitoring data, routine data and cancer registry data. We will present exemplary data on key indicators of the report.

Results

Life expectancy of women in Germany has been rising for many decades. With currently 83.2 years, it is at the EU average. Cardiovascular diseases are still the leading cause of death, accounting for 40% of all deaths. The second leading cause of death in women is cancer. With about 69,000 new cases per year, breast cancer is most common, although incidence and mortality rates have significantly declined. 53% of women in Germany are overweight (EU: 44%), 22% undertake health-enhancing physical activities at least once a week (EU: 10%), the 30-day prevalence of binge drinking is 19% (EU: 10%). Women with a migration background have a lower prevalence of risky alcohol consumption and practice physical activities less frequently. A low birth rate and the postponement of the first birth to a later age are characteristic for Germany (summarized birth rate: 1.57). The caesarean section rate slightly decreased to 30.5% in 2017. In 2018 there were 100,986 terminations of pregnancy, with a declining trend.

Lessons

The Women's Health Report provides an overview of key issues of women's health in Germany. These can help to improve prevention and health care. In some areas (e.g. benign gynaecological diseases), there are still data gaps in spite of high prevalences.

Key messages

The Women's Health Report of Federal Health Reporting is published in mid-2020 and provides an overview of key issues of women's health in Germany. Women’s life expectancy in Germany has been rising for many decades and is currently 83.2 years, with cardiovascular diseases and cancer still being the most common causes of death.

Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke

Background and Purpose—

Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs).

Methods—

Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry–Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables.

Results—

Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%; P =0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%; P <0.001) compared with noncardioembolic LVO. Cardioembolic LVO was associated with better functional outcome at discharge (adjusted odds ratio, 1.61 [95% CI, 1.37–1.88]) and 90 days (adjusted odds ratio, 1.29 [95% CI, 1.09–1.53]). In mediation analysis, reperfusion explained 47% of the effect of etiology on functional outcome at discharge.

Conclusions—

These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.

Health situation and health care of women aged 50 years and older in rural regions in Germany

Background

In many countries demographic changes and regional differences lead to inequalities in healthcare provision. In Germany, this applies especially to rural regions and could affect the healthcare situation of middle-aged and older women in particular. Our study, which is part of the project “Frauen 5.0”, explores the health and healthcare situation of women 50 years and older in Northeastern Germany, with focus on outpatient gynaecological and general medical care and reasons for healthcare utilisation.

Methods

Our analyses comprise the health situation of women aged 50 years and older, their utilisation of outpatient gynaecologists and general practitioners (GPs), reasons for utilisation, access barriers to outpatient care, the demographic situation and the spatial distribution of gynaecological and GP practices in Northeastern Germany. We use a variety of data sources; main data source is the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), which was carried out by the Robert Koch Institute and is representative of the German adult population.

Results

There is an unequal distribution of gynaecologic and GP practices in Northeastern Germany, with the highest density in and around Berlin. About 30% of gynaecologists and GPs in the study region are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women. Most important reasons for seeking gynaecological treatment are menopause and early detection of cancer.

Conclusions

The analyses show that there is need to ensure adequate health care for women aged 50 and over in rural regions in Germany. Based on the results, within the project “Frauen 5.0” innovative solutions for this task, e.g. interprofessional cooperation, will be identified.

Key messages

Analyses of outpatient healthcare services show an unequal distribution of gynaecologic and GP practices in Northeastern Germany; about 30% of the gynaecologists and GPs are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women.

[Headache, abdominal pain, and back pain in children and adolescents in Thuringia : Representative results of a regional module study in KiGGS wave 1]

Recurring pain in children and adolescents can have a negative impact on health and well-being. This study investigates recurring headache, abdominal pain, and back pain in children and adolescents in Thuringia. Data is based on a representative sub-sample from the federal state module Thuringia (2010-2012, n = 4096, 3-17 years), carried out in KiGGS wave 1 (first follow-up interview of the "German Health Interview and Examination Survey for Children and Adolescents"). The 3‑month prevalence of recurrent headache, abdominal pain, and back pain is reported according to socio-demographic factors and is compared with the prevalence for the whole of Germany. In addition, possible associated factors of recurring headache, abdominal pain, and back pain in the previous 3 months are analyzed. Results for Thuringia show that 3‑ to 10-year-old children were most frequently affected by recurrent abdominal pain (girls: 24.1%; boys: 16.7%), while 11- to 17-year-old adolescents were most frequently affected by recurrent headaches (girls: 36.8%; boys: 20.6%). There were isolated socio-economic differences in the 3‑month prevalences of recurrent headache and back pain to the detriment of the low status group. Compared to peers in the whole of Germany, girls and boys in Thuringia did not report headache, abdominal pain, and back pain in the previous 3 months more frequently. The investigated associated factors-fair to very poor self-rated health, emotional problems such as anxiety and depressive symptoms, chronic diseases and other health complaints, migraine, use of a general medical practice, as well as practices for orthopedics and neurology, and in-patient treatment at a hospital-were positively related to the 3‑month prevalence of recurrent headache, abdominal pain, and back pain. Overall, the results confirm that recurring pain is a common phenomenon in childhood and adolescents and, therefore, underline the public health relevance of pain in this young age group.

Is the humoral immunity dispensable for the pathogenesis of psoriasis?

BACKGROUND

Imbalances of T-cell subsets are hallmarks of disease-specific inflammation in psoriasis. However, the relevance of B cells for psoriasis remains poorly investigated.

OBJECTIVE

To analyse the role of B cells and immunoglobulins for the disease-specific immunology of psoriasis.

METHODS

We characterized B-cell subsets and immunoglobulin levels in untreated psoriasis patients (n = 37) and compared them to healthy controls (n = 20) as well as to psoriasis patients under disease-controlling systemic treatment (n = 28). B-cell subsets were analysed following the flow cytometric gating strategy based on the surface markers CD24, CD38 and CD138. Moreover, immunofluorescence stainings were used to detect IgA in psoriatic skin.

RESULTS

We found significantly increased levels of IgA in the serum of treatment-naïve psoriasis patients correlating with disease score. However, IgA was only observed in dermal vessels of skin sections. Concerning B-cell subsets, we only found a moderately positive correlation of CD138⁺ plasma cells with IgA levels and disease score in treatment-naïve psoriasis patients. Confirming our hypothesis that psoriasis can develop in the absence of functional humoral immunity, we investigated a patient who suffered concomitantly from both psoriasis and a hereditary common variable immune defect (CVID) characterized by a lack of B cells and immunoglobulins. We detected variants in three of the 13 described genes of CVID and a so far undescribed variant in the ligand of the TNFRSF13B receptor leading to disturbed B-cell maturation and antibody production. However, this patient showed typical psoriasis regarding clinical presentation, histology or T-cell infiltrate. Finally, in a group of psoriasis patients under systemic treatment, neither did IgA levels drop nor did plasma cells correlate with IgA levels and disease score.

CONCLUSION

B-cell alterations might rather be an epiphenomenal finding in psoriasis with a clear dominance of T cells over shifts in B-cell subsets.

Identification of a plasma miRNA biomarker signature for allergic asthma: A translational approach

BACKGROUND

Asthma is a heterogeneous chronic disease with different phenotypes and treatment responses. Thus, there is a high clinical need for molecular disease biomarkers to aid in differentiating these distinct phenotypes. As MicroRNAs (miRNAs), that regulate gene expression at the post-transcriptional level, are altered in experimental and human asthma, circulating miRNAs are attractive candidates for the identification of novel biomarkers. This study aimed to identify plasmatic miRNA-based biomarkers of asthma, through a translational approach.

METHODS

We prescreened miRNAs in plasma samples from two different murine models of experimental asthma (ovalbumin and house dust mite); miRNAs deregulated in both models were further tested in a human training cohort of 20 asthma patients and 9 healthy controls. Candidate miRNAs were then validated in a second, independent group of 26 asthma patients and 12 healthy controls.

RESULTS

Ten miRNA ratios consisting of 13 miRNAs were differentially regulated in both murine models. Measuring these miRNAs in the training cohort identified a biomarker signature consisting of five miRNA ratios (7 miRNAs). This signature showed a good sensitivity and specificity in the test cohort with an area under the receiver operating characteristic curve (AUC) of 0.92. Correlation of miRNA ratios with clinical characteristics further revealed associations with FVC % predicted, and oral corticosteroid or antileukotriene use.

CONCLUSION

Distinct plasma miRNAs are differentially regulated both in murine and in human allergic asthma and were associated with clinical characteristics of patients. Thus, we suggest that miRNA levels in plasma might have future potential to subphenotype patients with asthma.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module

Background

As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6–17 years living in Germany is assessed in EsKiMo II – the Eating Study as a KiGGS Module.

Methods

EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6–11 years. Dietary intake for adolescents aged 12–17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02).

Discussion

EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

[Status-specific differences in the occurrence of overweight and obesity in the transitional period from childhood to adolescence - results from the cross-sectional German KiGGS study]

BACKGROUND

Individual studies point out that health inequalities decrease in the transitional period from childhood to adolescence. However, there is evidence that this effect can vary depending on the health aspect that is used. The present study analyses this effect for overweight and obesity.

METHODS

Representative data was obtained from a subsample (3-17 years, n=14,836) of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) which was conducted by the Robert Koch Institute from May 2003 to May 2006. Body height and weight were measured and body mass index (BMI) was calculated. Overweight and obesity are defined based on gender- and age-specific percentiles of BMI of the German reference system developed by Kromeyer-Hauschild and her colleagues. Socio-economic status (SES) was taken from information about parents' income, occupational status and education.

RESULTS

Boys and girls with low SES show the highest prevalence of overweight and obesity in all age groups, those with high SES the lowest. While the results indicate a constant impact of SES on the risk for overweight and obesity in boys, the status differences increase over the age groups in girls. Regarding the whole age range, boys with low SES possess a 2.0-fold increased risk for overweight, and a 2.2-fold increased risk for obesity compared to boys with high SES. Girls from low status group even have a 2.8-fold risk to become overweight, and a 4.4-fold risk to become obese in comparison to the reference group.

CONCLUSION

The findings reveal that SES has a significant impact on the occurrence of overweight and obesity in childhood and in particular adolescence. Therefore, the results underline the relevance of early childhood prevention in specific target groups and promotion of a healthy life style.

[Epidemiology of ocular involvement in Adamantiades-Behçets disease]

Epidemiological studies demonstrate a prevalence of Adamantiades-Behçets disease (MAB) in the range of 0.12-420 per 100,000 inhabitants with the highest rates in Istanbul, Turkey and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for MAB in Germany because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants and its multiethnic character renders it uniquely appropriate for epidemiological studies on MAB. This article summarizes the most important epidemiological data of 140 patients (63 female and 77 male) with a mean follow-up of 6.4 years (range 0.5-22 years) which we have recently published. The mean age was 23 years at the first manifestation and 32 years when the fully developed disease was recorded. The mean age at onset of ocular involvement was 30 years, 56% of patients developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3%. More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in MAB is 1.77/100,000 inhabitants for the population of Berlin.