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The purpose was to compare systematically the legibility of a font without serifs (Helvetica) and one with serifs (Times New Roman).Three paragraphs that were equal in the number of words, syllables, characters, difficulty and reading length were printed at equal size, with equal spacing between the lines and equal layout (paperback style), in either the sans serif typeface Helvetica Neue T1 55 Roman (Adobe) or the serif typeface Times New Roman PS Roman (Adobe). They were also printed in newspaper format in the serif font. The paragraphs were presented in random order (Latin square design) to 36 participants between 18 and 38 years of age (wearing their best-corrected visual acuity). Reading duration was measured with a stopwatch. Reading time, reading speed and the number of reading errors were compared.For the paperback layout, no significant difference in reading time (p = 0.50) or reading speed (p = 0.56) was found between the two fonts. The correlation between the two fonts was high for both reading time and speed (r = 0.93). The mean number of reading errors was the same (0.31 ± 0.58 errors/text) for both fonts. There was a significant difference in reading time and speed between the paperback and the newspaper layout.The legibility of Helvetica and Times New Roman is similar when investigated under equivalent conditions. Thus, these two font types can be used as interchangeable standard typefaces.

Purpose To investigate the effect of font choice on reading parameters by using the RADNER Reading Charts printed in two fonts (Helvetica vs. Times Roman) equalized in terms of x-height. Methods This is a cross-sectional study of 40 participants with healthy eyes (18 to 60 years of age; mean: 42.13 ± 12.28 years). Reading performance was evaluated binocularly with RADNER Reading Charts printed in either Helvetica Neue (T1) Roman sans serif (Adobe) or Times New Roman PS Roman serif (Adobe). The test distance was 40 cm. Reading charts were presented in random order. Reading acuity (RA), mean reading speed of all sentences read (MEAN-ALL RS), mean reading speed from 0.8 logRAD to 0.3 logRAD (MEAN-RS), maximum reading speed (MAX-RS), and critical print size (CPS) were compared. Results The RA values obtained for the Helvetica and Times Roman fonts (in full logarithmic units of 0.1 logRAD) did not differ between the two fonts (mean for both fonts: − 0.128 ± 0.064 logRAD; 95% CI for both: − 0.148; − 0.107 logRAD). The differences in all other reading parameters between the two fonts were small and not statistically significant. The analyses revealed narrow confidence intervals and good coefficients of reliability. Except for the CPS (r = 0.49) and RA (equal for Helvetica and Times Roman), the correlations for all parameters were high, ranging from r = 0.92 to r = 0.98. Conclusion The equivalent reading performance obtained with Helvetica and Times Roman (when equalized in x-height and layout) makes these font types interchangeable as standards for reading charts.

Objective Navigated computer-assisted total knee arthroplasty (TKA) shows inconclusive mid- to long-term outcome results and is limited by increased costs, surgery-time and an additional learning curve. We introduced a treatment algorithm preserving computer-assisted TKA for patients with adipositas-per-magna, posttraumatic leg-deformities, osteosynthetic material in-situ or reduced preoperative X-ray quality. Methods 237 primary unilateral TKA were allocated based on the treatment concept described above. A retrospective pre- and postoperative radiological analysis was performed. Results 222 TKA (93.7%) were within 3° varus/valgus of mechanical-lower-limb axis (mean absolute deviation: 1.8° ± 1.3°). Conclusion This algorithm showed an excellent postoperative implantation-accuracy based on an accurate preoperative surgery-planning.

Dear Editor, We have read with interest the article of Alpeter et al. We appreciate the fact that they compared their reading speed determination with sentences derived from the RADNER Reading Charts [1, 2]. However, our reading charts were never designed to determine reading speed based on just a single sentence; this limited use is methodologically incorrect, and the comparison is therefore not appropriate. Further remarks regarding their analysis are provided below. The RADNER Reading Charts were designed for clinical and research use, providing a number of different reading parameters from a single examination in patients with normal to low vision [e.g., 1–3]. These reading charts offer standardized “sentence optotypes” [e.g., 1] that logarithmically progress in print size (Fig. 1). The sentence optotypes, developed in 11 different languages, have been standardized by reliability and validity analyses in 1,253 individuals involving over 42,000 measurements. The reliability of the RADNER Reading Charts has been analyzed by a test–retest protocol (interval, 3–4 weeks), interchart reliability analysis, and variant component analysis (randomized, orthogonal Latin square design) [2, 3]. Fig. 1 The RADNER Reading Charts, currently available in German, English, French, Spanish, Portuguese, Dutch, Italian, Danish, Swedish, Hungarian, and Turkish The sentences optotypes have consistently given correlations of r ≈ 0.9 with long paragraphs. Analyzing different reading parameters (such as reading acuity, mean and maximum reading speed, and critical print size, among others, has proven advantageous in evaluating specific alterations of reading performance in different eye diseases [e.g., 4–8]. The RADNER Reading Charts have been used incorrectly in the study of Alpeter et al. All RADNER Reading Charts come with clear instructions included in the booklet, informing an examiner how to use them and how to reduce inaccuracies. The unusually high number of outliers among the 30 patients (who read only three sentences each) in the paper of Alpeter et al. suggests that the readers had not been instructed correctly. It is inappropriate that the participants recruited were friends and relatives of co-workers. In addition, there was no randomization. There is incongruence between the results and our data. Using the data from a recent study (Radner et al., publication submitted) we calculated the correlations among seven sentence optotypes (font: Times Roman, 12 Pt), as measured in 60 normally sighted persons (Table ​(Table1).1). Our results offer a higher correlation (r = 0.775 to r = 0.909; p

FOCUS (“Foresight Security Scenarios – Mapping Research to a Comprehensive Approach to Exogenous EU Roles”) aims namely to define the most plausible threat scenarios that affect the “borderline” between the EU’s external and internal dimensions to security. This article presents scenarios about alternative futures of security research to support a comprehensive approach of the “EU 2035” as a civil security provider. Three scenarios were selected as context scenarios for alternative futures of security research afterwards they have been lined up with drivers identified in a matrix procedure. From these three context scenarios six alternative futures for security research were evaluated using the portfolio-cluster-method. The weighting was done from a dual and interdependent perspective: a) nation/ member state vs. EU-level/international approach to civil security and b) position of the scenario on the continuum of internal/external security. Finally, the article introduces each scenario for alternative future of security research in detail.

Background and Purpose— Purpose of the present study is to evaluate the clinical outcome of endovascular treatment of unruptured intracranial aneurysms and to address the question of long-term stability and protection against future subarachnoid hemorrhage. Methods— Retrospective analysis of all patients treated in a 12-year period (173 patients: age 26 to 76 yr, mean 52.2±10.8/202 aneurysms: size 3 to 50 mm, mean 10.0±8.3). Results— The mortality was 0.5%; the overall morbidity was 3.5%. The most frequent complications were thromboembolic events (10.9%). Of these, 3.0% of patients suffered a stroke, leading to severe disability in 1 patient (0.5%). In 1 patient, the aneurysm ruptured during treatment, resulting in relevant neurological disability. Another patient suffered a fatal aneurysm rupture hours after treatment. The occlusion rate depended on aneurysm and neck size. Follow-up angiography revealed a decrease of the occlusion rate over time. This trend was obvious in all size categories and was most pronounced in giant aneurysms. In 3 patients (1.5%) with partially thrombosed giant aneurysms of the posterior circulation, embolization could not prevent later aneurysm rupture. There were no ruptures of any other aneurysms in the follow-up period (3.7±3.4 yr). Conclusion— Endovascular treatment is a highly safe procedure with low intervention-related morbidity and mortality. Long-term data for nongiant aneurysms showed good protection against rupture in the observation period. In contrast, the risk of rupture for giant aneurysms of the posterior circulation was as high as expected in observational studies.

The effect of oral anticoagulation on clotting during hemodialysis. Background Between 5% and 10% of hemodialysis patients are treated with oral anticoagulants. It is currently unknown whether additional anticoagulation with heparin or low-molecular-weight heparin (LMWH) is needed to prevent clotting during hemodialysis. Methods In this prospective, randomized, cross-over study 10 patients treated with oral anticoagulants (phenprocoumon) received either no additional anticoagulation or low dose dalteparin (bolus of 40 IU/kg body weight) before dialysis. Efficacy of hemodialysis was measured by normalized weekly Kt/V and urea reduction rate (URR). Thrombus formation was evaluated by measurement of D-dimer and inspection of air traps and dialyser. Results The median international normalized ratio (INR) did not differ between both observation periods (phenprocoumon 2.2(2 to 3) vs. dalteparin 2.1(2 to 2.9). The anti-Xa level in dalteparin patients was 0.33 (0.27 to 0.38) IU/mL after 2 hours and 0.16 (0.03 to 0.23) IU/mL after 4 hours of hemodialysis. The median increase of D-dimer was significantly higher in patients without additional dalteparin therapy during hemodialysis (ΔD-dimer 0.23 μg/mL vs. 0.03 μg/mL) ( P = 0.0004). Complete thrombosis of the dialyser membrane occurred in one patient in the phenprocoumon group but in none with combined treatment. The extent of thrombosis in the arterial and venous air trap and dialyser was significantly less in patients with additional dalteparin therapy ( P = 0.0014, P = 0.0002, and P = 0.0005, respectively). Weekly Kt/V and URR was similar in both groups. Conclusion Standard oral anticoagulation with an INR between 2 and 3 is insufficient to prevent clotting during hemodialysis. Additional low dose anticoagulation with a LMWH or heparin is necessary to facilitate treatment.

Purpose: To assess satisfaction with photocoagulation treatment in diabetes patients and to investigate how it relates to patient-related characteristics and patients' visual ability. Further, to observe the interaction between physician and patient and suggest ways to improve the patient−provider relationship and, thereby, treatment satisfaction. Methods: This open longitudinal study included 123 diabetes patients undergoing first photocoagulation treatment for diabetic maculopathy or proliferative retinopathy. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was completed by all patients. Communication, scheduling and adherence scores were defined for each physician−patient pair. Outcome measures were: the patient's overall satisfaction with laser treatment; the patient's degree of satisfaction in relation to visual results; communication, scheduling and adherence scores, and visual acuity results. Results: The level of satisfaction after initial photocoagulation treatment was high; 46.4% of patients with proliferative retinopathy and 53.1% with maculopathy scored 31 or higher. Although 69.5% of all patients reported that their expectations of treatment corresponded to their final 9-month visual results, only 8.7% of these patients reported an improvement in visual acuity after 9 months. The number of unwanted actions performed by the patients during treatment were significantly related to the number of unclear instructions given by the physician (Fisher's exact test P

Introduction: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer’s disease (AD) and behavioral variant of frontotemporal dementia (bvFTD). Methods: Patients were recruited in a prospective pilot study. A structured history was taken and QSART was recorded. Results: In all, 15 patients with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%) patients with AD and 0 (0%) patients with bvFTD ( P = .037). The upper extremity was only involved in 1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ between both groups. Patients’ history correlated with severe autonomic symptoms as assessed with QSART. Conclusion: Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the disease.

BACKGROUND Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements. QUESTIONS/PURPOSES We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT. METHODS In a prospective, randomized, controlled study, we enrolled 151 patients undergoing TKA. In Group A (n=76 patients), the autotransfusion system was used for a total of 6 hours (intraoperatively and postoperatively) and the WSB was retransfused after processing. In Control Group B (n=75 patients), a regular drain without suction was used. We used signs of anemia and/or a hemoglobin value less than 8 g/dL as indications for transfusion. If necessary, we administered one or two units of allogenic blood. RESULTS Twenty-three patients (33%) in Group A, who received an average of 283 mL (range, 160-406 mL) of salvaged blood, needed a mean of 2.1 units of allogenic blood, compared with 23 patients (33%) in Control Group B who needed a mean of 2.1 units of allogenic blood. CONCLUSIONS We found the use of an autotransfusion system did not reduce the rate of postoperative ABTs. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Soil sampling and analysis for radionuclides after an accidental or routine release is a key factor for the dose calculation to members of the public, and for the establishment of possible countermeasures. The IAEA organized for selected laboratories of the ALMERA (Analytical Laboratories for the Measurement of Environmental Radioactivity) network a Soil Sampling Intercomparison Exercise (IAEA/SIE/01) with the objective of comparing soil sampling procedures used by different laboratories. The ALMERA network is a world-wide network of analytical laboratories located in IAEA member states capable of providing reliable and timely analysis of environmental samples in the event of an accidental or intentional release of radioactivity. Ten ALMERA laboratories were selected to participate in the sampling exercise. The soil sampling intercomparison exercise took place in November 2005 in an agricultural area qualified as a "reference site", aimed at assessing the uncertainties associated with soil sampling in agricultural, semi-natural, urban and contaminated environments and suitable for performing sampling intercomparison. In this paper, the laboratories sampling performance were evaluated.

Aims Progressive right ventricular (RV) dilation due to pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) may impair left ventricular (LV) filling. Our aim was to analyse long-term time courses of M-mode LV and RV measurements and to relate these to the degree of PR. Methods and results Retrospective longitudinal cohort of children ( n = 88) after repair of TOF followed by serial echocardiography over 9 years. LV and RV diameters were expressed by z -scores based on normal paediatric reference values. Time courses of LV and RV diameter z -scores, degree of PR, and influence of co-variables were analysed using mixed regression models. LV diameter z -scores were significantly lowered before repair, increased after surgery, but fell again over time; thus, mean LV diameters were significantly lower than normal population means at all times. LV diameter z -scores correlated negatively with RV dilation and degree of PR. Notably, they were significantly higher in patients with previous shunts. After pulmonary valve replacement, LV diameter z -scores recovered to normal, whereas RV diameter z -scores remained abnormal. Conclusion Our results confirm progressive adverse RV–LV interaction in the long-term post-operative follow-up of TOF. The use of z -scores facilitated the analysis of time courses of LV and RV diameters.

Objective: Patients in intensive care exhibit a high degree of loss of muscle mass. Appropriate instruments are needed to document muscle wasting in these patients. The aim of this pilot study was to describe muscle wasting in patients in the intensive care unit. Design: Two-fold study setting: prospective longitudinal and cross-sectional single-blind. Patients: A total of 118 patients in the intensive care unit (length of stay 1–98 days; male:female ratio 88:30; age 55 ± 17 years) were included in a two-fold study setting. Methods: Muscle layer thickness of the M. quadriceps femoris was documented using ultrasound measurement at well-defined points. Seventeen pilot-patients were measured twice; at baseline and after 28 days. In another group of 101 patients, muscle layer thickness was determined once after a random length of stay. The results of both groups were compared and correlated. Results: In both groups, M. quadriceps femoris thickness showed a significant negative correlation with length of stay in the intensive care unit (p < 0.01). Furthermore, muscle wasting in intensive care patients could be described using a logarithmic function. Conclusion: Loss of muscle mass shows a negative correlation with length of stay, and seems to be higher during the first 2–3 weeks of immobilization/intensive care unit stay. Ultrasound is a valid and practical measurement tool for documenting muscle mass (e.g. muscle layer thickness) as part of the daily routine at an intensive care unit.

Hypercalcemia in persistent secondary hyperparathyroidism after kidney transplantation is considered to result from increased bone resorption. Bone biopsies' studies, however, have never been performed in these patients. Bone biopsies after double tetracycline labeling were obtained from 17 patients with hypercalcemic hyperparathyroidism and an estimated glomerular filtration rate > 30 mL/min/1.73 m2. Serologic bone markers, calcitriol, intact fibroblast growth factor-23 (iFGF-23), and serum and 24h urine concentration of calcium and phosphate were measured in all patients. Tubular maximum for phosphate corrected for GFR (TmP/GFR), and the fractional excretion of calcium (FeCa) were calculated. High-turnover renal osteodystrophy (ROD) was present in nine and low-turnover ROD in eight patients. The bone formation rate was significantly associated with bone alkaline phosphatase, c-telopeptide and osteocalcin. In patients with high turnover ROD, osteocalcin was also significantly higher than in patients with decreased bone formation. The FeCa was normal or below normal in 14/17 patients. TmP/GFR was below normal in all patients. Neither intact PTH nor iFGF-23 was associated with TmP/GFR, FeCa or any histomorphometric bone parameter. We conclude that hypercalcemia of posttransplant hyperparathyroidism can be associated with high or low turnover bone disease. Decreased calcium excretion suggests an additive tubular effect on hypercalcemia.

Deep venous thrombosis (DVT) and pulmonary embolism (PE) may be significant complications following spinal surgery. The incidence rate ranges from 0.5% to 2.5% in patients with symptomatic thromboembolic disease and up to 15% in patients with non-symptomatic thrombotic complications. We determined the incidence of symptomatic thromboembolism after spinal surgery in patients with postoperative systemic prophylaxis and investigated general and specific risk factors for development of this disease.We analyzed the clinical records of 978 patients who had undergone surgery of the spine because of trauma and who had been admitted to our level-I trauma center between 1980 and 2004. Spinal procedures included anterior and/or posterior spinal fusion, video-assisted thoracoscopic fusion, and spinal decompression. Symptomatic thromboembolic disease was diagnosed when patients showed significant clinical signs or symptoms of DVT or PE. In cases of DVT, diagnosis was confirmed by duplex scan of the lower limbs; in cases of PE, diagnosis was confirmed by CT-scanning of the thorax or at post mortem.The incidence rate of symptomatic thromboembolic complications was 2.2% (n 22). 17 patients showed clinical signs of deep venous thrombosis, with 4 of them developing pulmonary embolism subsequently. The other 5 patients developed pulmonary embolism without prior clinical signs of deep venous thrombosis. 6 patients died because of thromboembolic disease. Thromboembolic complications were more frequent in older patients and among males, as well as in patients with regular tobacco consumption and obesity. Thromboembolic complications were also seen more frequently in patients with surgical procedures at the lumbar spine, in patients with anterior spinal fusion, and in those with motor deficits in the lower extremities.We found a rather low rate of clinically significant thromboembolic complications after spinal surgery because of trauma, compared to the results reported in the literature. Level of spinal surgery, surgical approach, and motor deficits in the lower extremities were identified as specific risk factors for DVT or PE. Age, sex, obesity and regular smoking were identified as general risk factors.

Neutrophil granulocytes (Gs) represent highly abundant and short-lived leukocytes that are constantly regenerated from a small pool of myeloid committed progenitors. Nuclear receptor (NR) family members are ligand-activated transcription factors that play key roles in cellular proliferation and differentiation processes including myelopoiesis. Retinoid X receptor alpha (RXRα) represents the predominant NR types I and II homo- and heterodimerization partner in myeloid cells. Here we show that human myeloid progenitors express RXRα protein at sustained high levels during macrophage colony-stimulating factor (M-CSF)–induced monopoiesis. In sharp contrast, RXRα is down-regulated during G-CSF–dependent late-stage neutrophil differentiation from myeloid progenitors. Down-regulation of RXRα is critically required for neutrophil development since ectopic RXRα inhibited granulopoiesis by impairing proliferation and differentiation. Moreover, ectopic RXRα was sufficient to redirect G-CSF–dependent granulocyte differentiation to the monocyte lineage and to promote M-CSF–induced monopoiesis. Functional genetic interference with RXRα signaling in hematopoietic progenitor/stem cells using a dominant-negative RXRα promoted the generation of late-stage granulocytes in human cultures in vitro and in reconstituted mice in vivo. Therefore, our data suggest that RXRα down-regulation is a critical requirement for the generation of neutrophil granulocytes.

Objective The purpose of this retrospective study was to present 7 years of data from operations of currently active, chronic venous leg ulcers (CEAP: C6), focusing on the short- and long-term effects of healing and recurrence and considering concomitant risk factors. Methods Between January 1997 and March 2004, 173 patients (239 legs) with a currently active, chronic venous leg ulcer were surgically treated. The surgical procedures included two main steps: (1) the surgical interruption of reflux in the superficial and perforating veins to reduce venous hypertension in the entire leg and/or the affected area and (2) the surgical procedure involving the ulcer. A total of 123 patients (173 legs) who came to the follow-up were examined. The follow-up period ranged from 3 months to 7 years. The data collection integrated a preoperative examination that included medical history and clinical diagnoses and incorporated measurements such as body mass index, ankle-brachial pressure index, and the neutral position method at the follow-up. The function of the veins was measured with duplex ultrasonography. Finally, the data were analyzed by using various statistical methods, including Kaplan-Meier analysis, Cox regression analysis, and paired t tests. Results Initially, ulcer healing occurred in 87% of the cases (151 legs). A total of 13% (22 legs) of the venous ulcers never healed, and recurrent venous ulcers occurred in 5% (9 legs). The Kaplan-Meier analyses of ulcer healing showed a healing rate of 85% in 6 months for all legs. The mean time of healing was 1.5 months. Furthermore, the Kaplan-Meier analyses of ulcer recurrence showed a 1.7% rate of recurrence in 6 months for all legs. The 5-year ulcer recurrence rate was 4.6%. The mean time of recurrence was 70.4 months. Conclusions On the basis of the results from the 7 years of data from functional surgery of venous leg ulcers and as a result of the outcomes of our study, we recommend surgical treatment of venous leg ulcers at any stage. We therefore conclude that surgery is indicated before an ulcer is intractable to treatment. In general, our findings are based on the understanding and identification of the causes and symptoms of venous ulceration and illustrate that standard surgical methods can be applied for the therapy of venous leg ulcers at any stage.

To assess satisfaction with photocoagulation treatment in diabetes patients and to investigate how it relates to patient-related characteristics and patients' visual ability. Further, to observe the interaction between physician and patient and suggest ways to improve the patient-provider relationship and, thereby, treatment satisfaction.This open longitudinal study included 123 diabetes patients undergoing first photocoagulation treatment for diabetic maculopathy or proliferative retinopathy. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was completed by all patients. Communication, scheduling and adherence scores were defined for each physician-patient pair. Outcome measures were: the patient's overall satisfaction with laser treatment; the patient's degree of satisfaction in relation to visual results; communication, scheduling and adherence scores, and visual acuity results.The level of satisfaction after initial photocoagulation treatment was high; 46.4% of patients with proliferative retinopathy and 53.1% with maculopathy scored 31 or higher. Although 69.5% of all patients reported that their expectations of treatment corresponded to their final 9-month visual results, only 8.7% of these patients reported an improvement in visual acuity after 9 months. The number of unwanted actions performed by the patients during treatment were significantly related to the number of unclear instructions given by the physician (Fisher's exact test P0.01).A high level of satisfaction was observed, despite the minimal improvements in visual acuity. Attempts to further improve patient satisfaction might focus on improved education of patients on the possible benefits of laser treatment, greater care in communicating information during treatment, additional nursing support, and additional clerical time to communicate with patients before each appointment.

To evaluate the association between the density of nuclear, cortical, and posterior subcapsular lens opacities and visual impairment in patients with cataract.In 80 patients, visual acuity and reading performance were evaluated 1 day before and 4 weeks after cataract surgery. Cataracts were categorized and graded according to the Lens Opacities Classification System (LOCS) III of nuclear color (NC), nuclear opalescence (NO), cortical (C), and posterior subcapsular cataract (P). A multiple linear regression analysis and partial correlation coefficients were calculated. Data were also checked for significant pre- and postoperative differences in visual performance related to cataract grading.In the multiple linear regression analysis, significant associations were found between the improvement in visual acuity and reading performance after cataract surgery and the NC, NO, and P scores (P0.001); no significant association was found for the C score (P0.05). High partial correlation coefficients were found between the P score and the preoperative visual acuity (r = 0.6; P0.001), reading acuity (r = 0.74; P0.001), and maximum reading speed (MRS; r = -0.77; P0.001). Significant but lower partial correlation coefficients were found for the NO score. No significant partial correlation coefficients were found for the NC and C score. Significant pre- and postoperative differences in MRS were found in patients with P scoresor =3 or NO and NC scoresor =5, representing functionally relevant impairment.A strong association was found between visual impairment in patients with cataract and the severity of posterior subcapsular cataract (PSC) and nuclear opacity. Particularly in patients with PSC, deficits in reading performance significantly increased. The functionally relevant deficits in patients with P scoresor =3 or NO and NC scoresor =5, should be carefully considered for planning cataract surgery or visual rehabilitation.

The aim of this study was to correlate different types of retinal morphologic alterations secondary to diabetic macular disease with their characteristic impact on retinal function.In the present cross-sectional study, 26 eyes of 26 diabetic patients with clinically significant macular edema were examined. All patients underwent complete standardized ophthalmologic examination, including SD-OCT and microperimetry. Microperimetric values were projected over the scanning laser ophthalmoscope image of the OCT device, allowing direct correlation of functional and morphologic parameters. Results over all 1066 individual areas were analyzed using a general linear model.All the characteristic morphologic alterations demonstrated a significant effect on retinal function (P0.0002), except for outer nuclear layer (ONL) hyporeflectivity and small ONL cysts. Large ONL cysts (220 μm) and serous retinal detachment had the greatest estimated negative effect on retinal sensitivity (-3.86 and -3.66 dB), followed by medium-sized ONL cysts, hard exudates associated with an extinction of the scan signal, and inner nuclear layer cysts.In diabetic macular edema, serous retinal detachment and large ONL cysts are the two morphologic changes with the greatest negative impact on retinal function.

Purpose To investigate concentrations of growth factors and inflammatory cytokines in eyes with central (CRVO) and branch (BRVO) retinal vein occlusion before and during therapy with bevacizumab and to identify associations with disease activity. Methods In a prospective clinical trial, 13 eyes of patients with CRVO (n = 5) or BRVO (n = 8) were included. Bevacizumab was administered intravitreously at baseline and months 1 and 2. Retreatments were given at monthly visits if OCT showed edema or when vision loss occurred. Aqueous humor samples were taken each time injections were performed. Follow-up was 15 months. Samples from patients with cataract served as the control. Multiplex bead assays were used for measurement of 28 growth factors and cytokines. Results During therapy with bevacizumab, VEGF levels were reduced to below detection in the first 2 months. Whenever criteria for retreatment were met, VEGF was measurable again. The decrease in VEGF was associated with a decrease in central retinal thickness (CRT) and improvement in visual acuity (VA). Significantly increased concentrations of VEGF, IL-6, IL-8, IP-10, MCP-1, and PDGF-AA were observed in aqueous humor samples of patients with CRVO compared with the control samples. Conclusions VEGF levels were significantly elevated in patients with CRVO compared with control subjects. Intravitreal injections of bevacizumab resulted in a substantial decrease of VEGF under physiologic levels and remained low under the loading dose of three consecutive monthly retreatments. Macular edema was related to VEGF levels in the aqueous humor.