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Purpose: To evaluate and compare the digital cataract workflow with the existing conventional workflow in terms of time savings for overall diagnostic procedures from preoperative measurements, data transfer, intraocular lens (IOL) power calculation, and axis marking for cataract surgery in a corporate hospital chain setting., Patients and Methods: This prospective non-clinical study assessed the mean procedural times for preoperative assessments, calculation of IOL power, data transfer to operating devices, and total surgery for both digital and existing conventional workflows., Results: Overall, 430 workflows (digital cataract workflow: 227; existing conventional workflow: 203) were included for time measurements. The digital cataract workflow resulted in shorter mean (± standard deviation [SD]) preoperative assessments with lesser variability among individual assessments than the existing workflow (14.15 ± 1.86 vs 21.41 ± 1.18 min, respectively); with a time saving of 35%. Similarly, the mean (± SD) time required for the subsequent assessment steps such as IOL calculation (2.19 ± 1.23 vs 3.17± 2.29 min; 30%), data transfer (0 vs 1.33 ± 0.25 min; 100%), IOL axis marking and alignment (0 vs 3.07 ± 0.53 min; 100%) were shorter with digital cataract workflow versus existing conventional cataract workflow. Briefly, the overall mean time from preoperative assessments to final surgery was 16.48 min with digital cataract workflow and 30.58 min with existing conventional workflow; resulting in a time saving of 46%., Conclusion: The Zeiss digital cataract workflow demonstrated greater time savings at each step of the cataract surgery workflow compared to the existing conventional workflow. In addition, digitalization can lead to a more streamlined cataract surgery workflow that is more convenient and cost-effective than the existing conventional practices in a corporate chain hospital setting., Competing Interests: There is no conflict of interest to declare from all the authors., (© 2024 Rombold et al.)

Introduction: Stress hormones such as cortisol are involved in modulating emotional memory. However, little is known about the influence of cortisol on the formation of intrusive memories after a traumatic event. The aim of this study was to examine whether cortisol levels during encoding and consolidation of an intrusion-inducing trauma film paradigm would influence subsequent intrusion formation., Material and Methods: In an experimental, double-blind, placebo-controlled study a trauma film paradigm was used to induce intrusions in 60 healthy women. Participants received a single dose of either 20 mg hydrocortisone or placebo before watching a trauma film. Salivary cortisol and alpha-amylase as well as blood pressure were measured during the experiment. The consecutive number of intrusions, the vividness of intrusions, and the degree of distress evoked by the intrusions resulting from the trauma film were assessed throughout the following seven days., Results: Hydrocortisone administration before the trauma film resulted in increased salivary cortisol levels but did not affect the consecutive number of intrusions, the vividness of intrusions, and the degree of distress evoked by the intrusions throughout the following week., Conclusions: These results indicate that pharmacologically increased cortisol levels during an experimental trauma film paradigm do not influence consecutive intrusive memories. Current data do not support a prominent role of exogenous cortisol on intrusive memories, at least in healthy young women after a relatively mild trauma equivalent., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Intrusive memories of traumatic events are a core feature of post-traumatic stress disorder but little is known about the neurobiological formation of intrusions. The aim of this study was to determine whether the activity of the noradrenergic system during an intrusion-inducing stressor would influence subsequent intrusive memories., Method: We conducted an experimental, double-blind, placebo-controlled study in 118 healthy women. Participants received a single dose of either 10 mg yohimbine, stimulating noradrenergic activity, or 0.15 mg clonidine, inhibiting noradrenergic activity, or placebo. Subsequently, they watched an established trauma film which induced intrusions. The number of consecutive intrusions resulting from the trauma film, the vividness of the intrusions, and the degree of distress evoked by the intrusions were assessed during the following 4 days. Salivary cortisol and α-amylase were collected before and after the trauma film., Results: A significant time × treatment interaction for the number of intrusions and the vividness of intrusions indicated a different time course of intrusions depending on treatment. Post-hoc tests revealed a delayed decrease of intrusions and a delayed decrease of intrusion vividness after the trauma film in the yohimbine group compared with the clonidine and placebo groups. Furthermore, after yohimbine administration, a significant increase in salivary cortisol levels was observed during the trauma film., Conclusions: Our findings indicate that pharmacological activation of the noradrenergic system during an emotionally negative event makes an impact on consecutive intrusive memories and their vividness in healthy women. The noradrenergic system seems to be involved in the formation of intrusive memories.

Objective: Patients with both major depression and personality disorders have a high risk of suicidal behavior. Lithium is meant to have anti-suicidal properties in patients with affective disorders. The anti-suicidal effect of lithium in patients with affective disorders and comorbid personality disorders has not been investigated yet., Methods: A post-hoc analysis of a subsample of patients with depression and comorbid personality disorder (PD) and a recent suicide attempt (n = 19) from the prospective, placebo-controlled lithium intervention study (N = 167), was conducted., Results: Three patients in the lithium group (n = 8) and two patients in the placebo group (n = 11) presented a suicide attempt throughout the course of the study. No differences related to suicidal behavior could be detected between the placebo group and the group with lithium intervention., Conclusions: On the basis of the small sample size, among patients with comorbid PD, lithium does not seem to have an effect on suicidal behavior in contrast to patients with affective disorders without comorbid PD.

Objective: Low-dose doxepin has produced favorable results in healthy adults and elderly persons with chronic or transient insomnia, while exhibiting an amenable adverse event profile. The aim of this article is to investigate the efficacy and safety of low-dose doxepin for insomnia in depressed patients., Method: In this retrospective case series analysis, the files of 17 inpatients diagnosed with major depressive disorder (MDD) and comorbid insomnia between January 1, 2011, and October 1, 2012 who had received a course of off-label doxepin (< 25 mg/d) were analyzed with regard to dose, efficacy, and safety for up to 4 weeks of treatment. Hamilton Depression Rating Scale (HDRS) sleep item scores were used to estimate efficacy., Results: Our results showed no improvement in sleep onset and sleep maintenance insomnia in patients with MDD during the 4 weeks of treatment. We found a significant improvement in insomnia between baseline and week 3 when considering all 3 HDRS sleep items (P = .058)., Conclusion: Contrasting previous results in healthy subjects, low-dose doxepin does not seem to improve sleep onset or maintenance in patients with MDD. Further research, preferably placebo-controlled, double-blind sleep laboratory trials, is necessary to determine whether low-dose doxepin may be beneficial in this important patient subgroup.

Purpose: To compare and correlate imaging of classic subfoveal choroidal neovascularization (CNV) with noninvasive 3-dimensional imaging by the retinal thickness analyzer (RTA) to conventional fluorescein angiography (FA)., Methods: A total of 29 eyes of 29 consecutive patients with predominantly classic CNV eligible for photodynamic therapy underwent FA and RTA imaging. The FA dimensions of the CNV were measured independently by two graders. With the RTA, masked to FA the size of the CNV itself as imaged in 3-dimensional reconstruction, the size of significantly thickened retina overlying the CNV and the maximum retinal thickness were measured., Results: The mean diameter of the CNV determined from 3-dimensional RTA reconstructions showed an excellent correlation with measurements from FA (r = 0.91, p < 0.001). The area of retinal thickening was by a mean of 0.7 mm in diameter larger and correlated moderately well with the size of the CNV on FA (r = 0.65, p < 0.001). In contrast, there was no correlation between the absolute retinal thickness and the CNV size on FA., Conclusions: Noninvasive quantitative mapping of predominantly classic CNV by RTA is feasible and also allows 3-dimensional measurement of the lesion itself. The results correlate well with FA assessment but visualize different properties of the disease.

Purpose: To date, the increase of visual acuity and morphological parameters have been used to assess the benefit of a surgical intervention. The aim of this prospective study was to evaluate changes in patients' visual quality of life due to vitreoretinal surgery for epiretinal membranes., Patients and Methods: Twenty patients with unilateral epiretinal membrane and good visual acuity of the fellow eye were included. Best corrected visual acuity and visual quality of life assessed by the visual function index (VF-14) were obtained preoperatively and 3 months after pars plana vitrectomy and peeling., Results: Median visual acuity increased from 0.28 to 0.4 postoperatively. Visual quality of life (VF-14 values) rose from 72.8+/-4.7 (SEM) to 83.3+/-2.9 (p<0.05). Analysis revealed that patients with preoperatively low VF-14 values and preoperatively low visual acuity notably profited from surgery. The increase of visual quality of life can be predicted better than increase of visual acuity. Combined cataract surgery had no significant influence., Conclusion: In addition to best corrected visual acuity, quality of life measurements are important predictive and outcome parameters to estimate the value of vitreoretinal surgery.

Purpose: The aim of this study was to evaluate patients' acceptance and intraocular pressure (IOP) readings of a new digital mobile tonometer (TGDc-01) and compare it to Goldmann applanation tonometry., Method: Measurements repeated five times with the TGDc-01 and three times with Goldmann tonometry were performed in 100 eyes of 100 patients by two independent investigators. Patients' acceptance of both techniques was evaluated by a visual analogue scale (VAS)., Results: The mean IOP with the TGDc-01 yielded 15.4 mmHg for investigator 1 and 12.7 mmHg for investigator 2 (range: 4-43 mmHg). Results of the measurements with Goldmann tonometry showed 17.6 mmHg for investigator 1 and 17.3 mmHg for investigator 2 (9-42 mmHg). The IOP difference of the two tonometry methods was highly significant (p<0.001). The intraobserver variability was 29% for investigator 1 and 8% for investigator 2. Mean IOP values of the two investigators taken with the TGDc-01 differed significantly (p<0.01) from each other by a mean of 2.6 mmHg., Conclusions: The new mobile tonometer TGDc-01 is better accepted by patients but IOP values are significantly lower compared to Goldmann tonometry and variability is high. Regarding glaucoma diagnostics it seems to be less suitable than Goldmann tonometry.