2-Jahres-Ergebnisse nach transskleraler MicroPulse-Lasertherapie bei Patienten mit primärem Offenwinkelglaukom

Hintergrund Untersuchung der langfristigen Effizienz und Sicherheit der transskleralen Lasertherapie (TLT) mittels MicroPulse über 24 Monate bei Patienten mit primärem Offenwinkelglaukom (POWG).

Material und Methoden In dieser prospektiven interventionellen Fallserie wurden die Daten von 44 Augen von medikamentös behandelten POWG-Patienten ausgewertet, die eine MicroPulse-TLT erhielten, um eine weitere Senkung des Augeninnendrucks (IOD) zu erreichen. Es wurden die Reduktion des 24-h-IODs, der zirkadianen IOD-Fluktuationen und der IOD-Spitzen nach 3, 12 und 24 Monaten untersucht. Zudem sollten postoperative Komplikationen, die Misserfolgsquote und Einflussfaktoren auf den Therapieerfolg analysiert werden.

Ergebnisse Der IOD ist von 16,1 ± 3,4 mmHg präoperativ auf 13,0 ± 2,9 mmHg (n = 31; p < 0,001) nach 3 Monaten, 12,3 ± 3,0 mmHg (n = 27; p < 0,001) nach 12 Monaten und 13,1 ± 2,6 mmHg (n = 23; p < 0,001) nach 24 Monaten gesunken. Nach 24 Monaten erreichten 23 Augen (52%) ihren individuellen Zieldruck. Es traten keine schwerwiegenden postoperativen Komplikationen auf. Es konnten keine Einflussfaktoren auf den Therapieerfolg identifiziert werden. Das häufigste Therapieversagen war innerhalb der ersten 3 postoperativen Monate zu beobachten und blieb danach nahezu stabil.

Schlussfolgerung Die MicroPulse-TLT zeigt eine gute IOD-Senkung bei Patienten mit primärem Offenwinkelglaukom und maximal tolerierter drucksenkender Lokaltherapie, wobei etwa 50% der Augen ihren individuellen Zieldruck erreichten.

Comparison of Different Nutritional and Lifestyle Factors between Glaucoma Patients and an Age-Matched Normal Population

PURPOSE

To compare nutritional and lifestyle factors between glaucoma patients and an age-matched control group.

METHODS

One hundred and ninety (190) glaucoma patients were enrolled in this study. The control group comprised 97 age-matched participants. Data on physical activity, nicotine smoking, and several nutritional habits like coffee and alcohol consumption as well as high-salt and high-protein intake were collected using a standardised questionnaire.

RESULTS

Age and gender were not statistically significantly different between the groups. There was a tendency for higher physical activity in the glaucoma group in comparison to the control group (47.3 vs. 35.4%; p = 0.056). Statistically significantly more glaucoma patients were nonsmokers (n = 169; 89.4%) compared to the control group (n = 64; 66.7%; p = 0.001). Glaucoma patients were also more often teetotal compared to the control group (21.6% compared to 14.4%; p < 0.001). Similarly, more glaucoma patients drank larger amounts of coffee in comparison to the control group (p = 0.001). One hundred and seventy-six (96.7%) glaucoma patients and 88 (90.7%) control subjects had high-protein intake (p = 0.035). High-salt intake was significantly lower in the glaucoma group (69.3 vs. 73.2%; p = 0.018). Of the 190 glaucoma patients, 81 had early visual field impairments (MD > - 6 dB) and 109 patients had moderate (MD between - 6 dB and - 12 dB) to severe (MD < - 12 dB) visual field defects. The severity of visual field defects, whether early, moderate, or severe, had no statistically significant impact on lifestyle parameters.

CONCLUSION

Contrary to our original hypothesis that glaucoma patients would tend to follow an unhealthier lifestyle than the control group, the opposite was seen. Presumably, the cause of this healthier lifestyle is the desire to contribute positively through the course of the disease.

[Results of Re-switch from Intravitreal Aflibercept to Ranibizumab in Patients with Exudative Age-related Macular Degeneration]

BACKGROUND

The purpose of this study was to investigate the effectiveness of re-switch from intravitreal aflibercept to ranibizumab in patients with exudative age-related macular degeneration.

MATERIALS AND METHODS

This retrospective case series included 17 eyes of 17 patients who had previously switched from ranibizumab to aflibercept and finally back to ranibizumab. Main outcomes were change of visual acuity (VA) and assessment of central macular thickness (CMT). Secondary outcomes included predictive factors which had a beneficial effect as VA and CMT before re-switch, number of previous injections and gender.

RESULTS

The mean VA was 0.64 ± 0.36 logMAR before the switch, and 0.87 ± 0.40 logMAR before the re-switch, and gained with a slight but not significantly improvement up to 0.85 ± 0.58 logMAR after the re-switch (p = 0.896). The average CMT before the switch was 448.6 µm ± 181.5. This decreased to 343.8 µm ± 161.3 after the switch (p = 0.614) to 299.1 µm ± 155.8 at switchback (p = 0.133). Overall, 8 patients (47%) had an improvement of vision, whereas in 5 patients (30%) VA deteriorated. Further analysis of predictive factors revealed a mean improvement of VA in male patients after re-switch, while female patients lost VA, with statistical significance between after the switch and after the re-switch to the benefit of male patients (p = 0.016).

CONCLUSIONS

A re-switch from aflibercept to ranibizumab may enable improvement in morphological parameters and stabilization of VA in patients with exudative age-related macular degeneration who achieved no more benefit from the initial switch.

[Quality of Glaucoma Care in the Greater Hamburg Area]

Background There is insufficient data on the quality of health services and health-related quality of life of patients with glaucoma. The purpose of this study was to investigate the extent to which the health services for glaucoma patients in the Greater Hamburg area conform to the guidelines set by the German Ophthalmological Society (DOG). Materials and Methods 196 glaucoma patients were offered an interview-administered questionnaire during their inpatient diurnal IOP measurement. The quality of glaucoma care and examinations recommended by the DOG were analysed. The results of the questionnaire were correlated with glaucoma severity, according to the stage of visual field defects. The correlation to the type of glaucoma was also analysed. Results The frequency of visits to the ophthalmologist was 5.1 per year. Most patients reported quarterly medical consultations. The majority of patients reported short waiting periods, because appointments were made in advance. In 92 % of cases, an intraocular pressure measurement was performed with each medical consultation. Half of the patients stated that their intraocular pressure had been measured at different times of the day. The visual field was tested a mean of 0.9 times per year at the ophthalmology clinic, but 1.4 times per year in the outpatient area. Further measures for glaucoma diagnostic testing were carried out 0.8 times per year at the ophthalmology clinic, and 0.4 times per year in the outpatient area. For the majority of patients, there were no additional costs for outpatient glaucoma diagnostic testing. Only 4 % of patients had to pay more than 100 € per year for these services. Conclusions For the majority of glaucoma patients in the Greater Hamburg area, the glaucoma health services conform to the guidelines set by the German Ophthalmological Society. Intraocular pressure measurements were performed on almost all patients at the regular check-ups and visual fields were examined as recommended. However, for about one-fifth of the patients, regular procedures for optic nerve analysis do not take place. The date of the next appointment was arranged immediately, allowing close follow-up, with little or no additional costs for the majority of patients.

Truncating mutations in FUS/TLS give rise to a more aggressive ALS-phenotype than missense mutations: a clinico-genetic study in Germany

BACKGROUND AND PURPOSE

Mutations in the FUS/TLS have been associated with amyotrophic lateral sclerosis (ALS) in a few percent of patients.

METHODS

We screened 184 familial (FALS) and 200 sporadic German patients with ALS for FUS/TLS mutations by sequence analysis of exons 5, 6 and 13-15. We compared the phenotypes of patients with different FUS/TLS mutations.

RESULTS

We identified three missense mutations p.K510R, p.R514G, p.R521H, and the two truncating mutations p.R495X and p.G478LfsX23 in samples from eight pedigrees. Both truncating mutations were associated with young onset and very aggressive disease courses, whereas the p.R521H, p.R514G and in particular the p.K510R mutation showed a milder phenotype with disease durations ranging from 3 years to more than 26 years, the longest reported for a patient with a FUS/TLS mutation. Also, in a pair of monozygous twins with the p.K510R mutation, a remarkable similar disease course was observed.

CONCLUSIONS

Mutations in FUS/TLS account for 8.7% (16 of 184) of FALS in Germany. This is a higher prevalence than reported from other countries. Truncating FUS/TLS mutations result in a more severe phenotype than most missense mutations. The wide phenotypic differences have implications for genetic counselling.

Novel missense and truncating mutations in FUS/TLS in familial ALS

BACKGROUND

Mutations in the FUS/TLS gene have been associated with familial amyotrophic lateral sclerosis (FALS).

METHODS

We analyzed the presence and frequency of C-terminal FUS/TLS mutations in a German amyotrophic lateral sclerosis (ALS) cohort, including 133 patients with sporadic ALS (SALS) and 58 patients with FALS by sequence analysis of exons 13-15.

RESULTS

We identified 2 novel heterozygous FUS/TLS mutations in 4 German ALS families including the novel missense mutation K510R and the truncating mutation R495X. The truncating mutation was associated with an aggressive disease course whereas the K510R mutation showed a mild phenotype with disease duration ranging from 6 to 8 years. No mutation was detected in 133 patients with SALS.

CONCLUSIONS

Mutations in FUS/TLS account for 7% (4 of 58) of FALS in our German cohort.

Therapeutic vaccine for acute and chronic motor neuron diseases: implications for amyotrophic lateral sclerosis

Therapeutic vaccination with Copaxone (glatiramer acetate, Cop-1) protects motor neurons against acute and chronic degenerative conditions. In acute degeneration after facial nerve axotomy, the number of surviving motor neurons was almost two times higher in Cop-1-vaccinated mice than in nonvaccinated mice, or in mice injected with PBS emulsified in complete Freund's adjuvant (P < 0.05). In mice that express the mutant human gene Cu/Zn superoxide dismutase G93A (SOD1), and therefore simulate the chronic human motor neuron disease amyotrophic lateral sclerosis, Cop-1 vaccination prolonged life span compared to untreated matched controls, from 211 +/- 7 days (n = 15) to 263 +/- 8 days (n = 14; P < 0.0001). Our studies show that vaccination significantly improved motor activity. In line with the experimentally based concept of protective autoimmunity, these findings suggest that Cop-1 vaccination boosts the local immune response needed to combat destructive self-compounds associated with motor neuron death. Its differential action in CNS autoimmune diseases and neurodegenerative disorders, depending on the regimen used, allows its use as a therapy for either condition. Daily administration of Cop-1 is an approved treatment for multiple sclerosis. The protocol for non-autoimmune neurodegenerative diseases such as amyotrophic lateral sclerosis, remains to be established by future studies.

Impact of heavy metals on hormonal and immunological factors in women with repeated miscarriages

In 111 women with repeated miscarriages, the urinary excretion of heavy metals was determined in a challenge test with the chelating agent 2,3-dimercaptopropane-1-sulphonic acid in addition to hormonal, chromosomal, immunological and uterine investigations. The heavy metal excretion was correlated to different immunological (natural killer cells, T cell subpopulations) and hormonal (progesterone, oestradiol, prolactin, thyroid stimulating hormone) parameters. We conclude that heavy metals seem to have a negative impact on ovarian as well as on pituitary function. The heavy metal-induced immunological changes may interfere with the physiological adaptation of the immune system to the state of pregnancy with the result of a miscarriage. The observed heavy metal-induced hormonal and immunological changes may be important factors in the pathogenesis of repeated miscarriages.

Influence of the duration of the oestradiol rise on the success rate in GnRH analogue/HMG-stimulated IVF cycles

The influence of the duration of the serum oestradiol (E2) rise before human chorionic gonadotrophin (HCG) injection on the outcome of in-vitro fertilization (IVF) cycles was investigated. Two different stimulation protocols were compared. In 218 cycles, the Norfolk protocol for stimulation with human menopausal gonadotrophin (HMG) was used (protocol A). In 235 cycles, pituitary function was suppressed by a single injection of a long-acting GnRH analogue ('Decapeptyl microcapsules') before HMG stimulation was started (protocol B). The overall pregnancy rates were significantly higher with protocol B (22% per puncture, 21% per started cycle) than with protocol A (14% per puncture, 9% per started cycle). For each interval of E2 rise duration (5-11 days), the fertilization rates (per oocyte) and the pregnancy rates (per puncture) were evaluated. There was a clear-cut maximum of the pregnancy rates for 6 and 7 days of E2 rise (21 and 16% respectively) for protocol A. For protocol B, pregnancy rates were generally higher than for protocol A. There was also a maximum of the pregnancy rates for 6 (32%) and 7 (29%) days of E2 rise but this maximum was not as clear-cut as for protocol A. The fertilization rates showed no significant differences for each interval of E2 rise in both groups (between 63 and 89%). Therefore, it is concluded that endometrial maturity, and not the oocyte's ability for fertilization, is the most critical factor for success in IVF cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

Disposition of human fibrinopeptide A in normal and nephrectomized rabbits

The distribution, elimination, and metabolism of human fibrinopeptide A (FPA) were studied in normal and nephrectomized rabbits. The activity of 125-I-labeled desamino-tyrosyl human FPA (DAT-FPA) was followed over 4 hours after i.v. administration. Results show that in normal rabbits (n = 10) DAT-FPA is eliminated from plasma in four phases with half-lives of 30 sec, 3.5 min, 15 min, and 90 min. The distribution of 123-I-labeled DAT-FPA in plasma was determined in 15 control rabbits with scintigraphy over 2 hours. DAT-FPA was distributed primarily in the cardiovascular system, liver, and kidneys. In some animals minimal radioactivity was detected over the gall bladder. Radioactivity accumulated rapidly in the urinary bladder, approximately 50% being recorded after 15 min and 90% after 120 min. In the heart area radioactivity decreased with half-lives of 25 sec, 7.5 min, 25 min, and 180 min. Nephrectomized rabbits had similar initial fast distribution of DAT-FPA after administration of 125-I-labeled (n = 10) and 123-I-labeled peptide (n = 10). The estimated half-life of the slow component was in the order of several hours. The results of the scintigraphic and gel chromatographic studies show that FPA is primarily excreted in the urine. Previously reported half-lives of FPA reflect distribution rather than steady state conditions.