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Purpose: This study investigates the course of the endothelial cell density over a period of 5 years after XEN45 implantation (XEN45µm, Allergan Plc., USA) with or without combined cataract surgery. Methods: This is a prospective, cross-sectional, monocentric, non-randomized clinical trial with the intention to treat a population of the University Eye Clinic Glaucoma Service Salzburg. One hundred and fifty-five eyes with preoperative central corneal endothelial cell counts were subjected to XEN45 implantation with (combined surgery group) or without (solo surgery group) combined cataract surgery. Endothelial cell density was measured at 3 corneal positions. XEN45 location parameters were determined with anterior segment OCT and gonioscopy. Results: In the combined surgery group, a significant reduction of central endothelial cell count was found at years 2 and 4 when compared to baseline (p = 0.001 and p = 0.02, n = 86), whereas at years 1, 3, and 5, no change was detected (all p > 0.09). The median reduction of endothelial cell count was − 79 (95% CI: − 183 to − 9) and − 93 (95% CI: − 220 to 23) cells at years 2 and 4, respectively. In the solo surgery group (n = 69), no significant change in endothelial cell counts was detected at any time during the 5-year evaluation period (all p > 0.07). Explorative data analyses revealed that XEN45 location parameters did not significantly influence the course of endothelial cell count over time. Conclusions: Endothelial cell loss after XEN45 implantation seems to be low. The present data suggest no impact on the position of the implant with regard to central endothelial cell counts in this study. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the surgical success and efficacy of XEN45 implantation (XEN45 μm, AbbVie Inc., USA) with and without combined cataract surgery up to the first 5 years. Methods: In a prospective observational monocentric trial, 192 eyes of 157 patients with open‐angle glaucoma received either XEN45 implants only (solo surgery group) or combined surgery/cataract surgeries (combined surgery group). Surgical success (qualified and full success; IOP‐limit: ≤12, 15, 18, 21 mmHg), time to secondary IOP‐lowering procedure, IOP and number of IOP‐lowering medications were analysed for 1, 2, 3, 4 and 5 years. Results: Compared to baseline, IOP (24.1 ± 8.1 to 12.6 ± 2.8 mmHg, −48%, p < 0.001) and the number of IOP‐lowering medications (3.0 ± 1.0 to 1.5 ± 1.2, −50%, p < 0.001) decreased significantly at 5 years. Although no differences between IOP and the number of IOP‐lowering medication courses between the groups were detected at 5 years (p > 0.11), the combined procedure (63%, 37%) showed better success rates compared to the solo procedure (36%, 13%) in the definition IOP ≤18 and ≤12 mmHg (p = 0.035, 0.028). Solo XEN45 procedures had a higher rate of secondary IOP‐lowering procedures compared to combined XEN45 cataract procedures (hazard ratio: 2.02, 95%CI: 1.03–3.97, p = 0.04). Twenty per cent of the eyes, including both procedures, required a secondary IOP‐lowering procedure within 5 years. Conclusions: The XEN45 implant is effective in lowering IOP and the number of IOP‐lowering medications in patients with open‐angle glaucoma in the mid‐term. Comparing XEN45 implant results with the results of trabeculectomy available in current literature, we speculate that there might be a higher surgical success rate without medications in favour of trabeculectomy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Association of cystic fibrosis with abnormalities in fatty acid metabolism," by S.D. Freedman et al. which appeared in the February 5, 2004 issue.

Presents a letter to the editor regarding Dalton and colleagues' article on movies and smoking (July 26, 2003).

Aims: To evaluate the arteriovenous (AV) pH difference in cord blood as a possible indicator of fetal O2-utilization at delivery. Furthermore to examine which maternal, fetal and obstetrical factors lead to elevated O2-utilization. Methods: In this retrospective study all singleton live births, delivered within a four-month period at the University Hospital in Innsbruck, Austria, were analyzed. In total 491 deliveries were evaluated. Arterial and venous cord blood samples were collected at birth and analyzed by using a Radiometer ABL 510. Results: Spontaneous deliveries showed a highly significant elevation in AV-difference (pH 0.10) as compared to cesarean sections (pH 0.05). In spontaneous births, the AV-difference was high in the case of low arterial cord blood pH (P<0.01), as well as in nuchal cord (P<0.01), high parity (P<0.01), very short labor (P<0.05) and elevated birth size and weight (P<0.05). Conclusions: As a result of increased fetal stress at birth, spontaneous delivery leads to higher O2-utilization than cesarean section, which is detectable in an elevated AV-difference. The AV-difference in combination with absolute pH-values can be used for the objective evaluation of fetal O2-utilization and consecutively the fetal stress at birth. [ABSTRACT FROM AUTHOR]

Purpose: Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population. Methods: Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP. Results: IOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months. Conclusion: The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor abouse the case of a woman who developed toxic shocklike syndrome with multiple organ failure several hours after two intra-articular injections of a corticosteroid in her right shoulder due to pain.