[Immunotherapy of uveal melanoma: vaccination against cancer. Multicenter adjuvant phase 3 vaccination study using dendritic cells laden with tumor RNA for large newly diagnosed uveal melanoma]. / Immuntherapie beim Aderhautmelanom: Vakzination gegen Krebs. Multizentrische adjuvante Phase-III-Impfstudie mit Tumor-RNA-beladenen dendritischen Zellen bei neu diagnostizierten, großen Uveamelanomen.

Uveal melanomas are the most common malignant tumors of the eye. With modern molecular biological diagnostic methods, such as chromosome 3 typing and gene expression analysis, these tumors can be categorized into highly aggressive (monosomy 3, class II) and less aggressive forms. This molecular biological stratification is primarily important for determining the risk of these tumors as no therapy is currently available that is able to prevent or delay metastases. A randomized study of patients with a poor prognosis (monosomy 3) is currently being carried out in order to determine whether a cancer vaccine prepared from autologous (patient's own) dendritic cells and uveal melanoma RNA can prevent or delay progression and further metastases of this extremely aggressive form of cancer. Inclusion in the uveal melanoma study, which hopes to provide a potential therapeutic option for patients, is only possible if patients are referred to an institution that is able to manufacture and provide this vaccination before the patient is operated on or treated with radiation. Untreated tumor material is necessary for producing the vaccine on an individualized patient basis.

A simple clinical model to estimate the probability of Marfan syndrome.

BACKGROUND: Marfan syndrome is a heritable connective tissue disease. Definitive diagnosis is complex, and requires sequencing of a large gene, FBN1. AIM: We aimed to develop a simple model to estimate the pre-test probability of Marfan syndrome. DESIGN: Prospective cross-sectional study. METHODS: We applied diagnostic standards for definitive diagnosis or exclusion of Marfan syndrome in 329 consecutive persons. In 208 persons with random assignment to our derivation group, we performed multivariate logistic regression to assess 14 clinical variables for inclusion in a prediction model with derivation of score points from the estimated coefficients. We created cut-offs to classify low, moderate and high probability of Marfan syndrome. For validation, we applied the model to the remaining 121 persons. RESULTS: We identified seven variables for inclusion in the final model, where we assigned four score points to ectopia lentis, two points to a family history of Marfan syndrome, and one point to previous thoracic aortic surgery, to pectus excavatum, to a wrist and thumb sign, to previous pneumothorax, and to skin striae. In the derivation group 12, 42 and 92% of persons with low (≤1 point), moderate (>1-3.5 points) or high pre-test probability (>3.5 points) had Marfan syndrome, compared to 12, 57 and 91%, respectively, in the validation group. Positive likelihood ratios were 13.96 and 8.54 in the high probability group of the derivation and validation group, respectively. CONCLUSION: A simple prediction model provides evidence for Marfan syndrome. This model can be used to identify patients who require definitive diagnostic work-up.

[Status of TTT in the therapy for CNV]. / Stand der TTT bei der Therapie der CNV.

Transpupillary thermotherapy (TTT) and photodynamic therapy (PDT) are recent treatment options for choroidal neovascularisation (CNV). In PDT a photochemical reaction is induced by the injection of a photosensitising substance. In contrast to this, TTT is a non-invasive photothermal treatment option for CNV and choroidal tumours. It leads to a low-grade-hyperthermia with consecutive induction of metabolic processes and production of heat-shock proteins in order to restore cellular homeostasis. Classical laser coagulation as recommended by the Macular Photocoagulation Study Group produces a photocoagulative effect with significant tissue hyperthermia and prompt visual loss. For classic CNV, PDT represents an established therapy option. Positive results of the treatment of occult CNV by PDT have enlarged the use of PDT to this kind of CNV. TTT represents an economic therapy modality for (mainly) occult CNV. The effect for visual outcome varies in different studies. The results are shown in a .

Results of radiotherapy of subfoveal neovascularization with 16 and 20 Gy.

PURPOSE: In a nonrandomized, prospective study the efficacy of radiotherapy with 16 and 20 Gray (Gy) for subfoveal neovascularization in age-related macular degeneration (ARMD) was analysed. MATERIAL AND METHODS: From 1996 to 1998, 63 eyes were irradiated with 16 Gy and 38 eyes with 20 Gy for exudative ARMD. A total of 12 eyes had classic ARMD, 89 eyes occult ARMD, median baseline visual acuity (VA) was 6/30 (range: 3/60-6/9.5), median age was 78 years. Risk factors (type of ARMD, baseline VA) were evenly distributed in both groups. Median follow-up was 1.3 years (range: 4 months-4.7 years). VA of +/-1 line or better and unchanged size and activity of the membrane in fluorescein angiography were defined as stable. Actuarial methods were used. RESULTS: Median loss of VA was -3 lines (range: -14 to +5), neovascularization remained unchanged or decreased in size and activity in 35 eyes. At 18 months, the probability of stabilized VA was 0.4 (95% confidence interval (CI): 0.3-0.5), at 24 months 0.3 (95% CI: 0.2-0.4). Radiation dose, type of ARMD or baseline VA had no significant impact on outcome of VA and membrane size and activity (P>0.05). Side effects were mild and transient increased tearing. CONCLUSION: In this study, the results after radiotherapy were comparable to the natural course of the disease. An impact of radiation dose (16 vs 20 Gy) on stabilizing visual acuity and subfoveal neovascularization could not be shown. The results of studies on dose escalation using very small fields and high radiation doses should be awaited.

[Transpupillary thermotherapy for subfoveal choroidal neovascularization. A 9-month follow-up]. / Transpupillare Thermotherapie bei subfovealer choroidaler Neovaskularisation. Ein 9-Monats-Follow-up.

PURPOSE: The purpose of this study was to evaluate the efficiency, stability, and safety of transpupillary thermotherapy as a treatment of subfoveal occult choroidal neovascularizations (CNV) in age-related macular degeneration. METHODS: Transpupillary thermotherapy (TTT) was performed in 40 patients with uni- or bilateral predominantly occult CNV. Laser light derived from an infrared diode laser at 810 nm was used to apply spots for a duration of 60 s. A complete ophthalmic examination was performed prior to and 9 months after the treatment. RESULTS: After 9 months, visual acuity remained stable in 65% (+/-2 lines). In 35% of the patients TTT could not prevent further visual loss. Retinal leakage, assessed by fluorescein angiography, stabilized in 67.5% of the treated patients. CONCLUSIONS: The present data show stabilization of visual acuity in 65% after TTT. Compared to the natural course of occult and mixed subfoveal CNV, these data give some evidence for patient benefit after TTT.

[Ultrasound biomicroscopy in pigmentary glaucoma]. / Ultraschallbiomikroskopie beim Pigmentglaukom.

PURPOSE: To evaluate the anatomical relationships of the iris in pigmentary glaucoma before and after laser iridotomy and to evaluate the effect on intraocular pressure. METHODS: Ultrasound biomicroscopy (UBM, Humphrey-Zeiss) of the anterior segment was performed in 28 eyes of 28 patients (20 male, 8 female, mean age 43 years, mean untreated IOP 24.3 mmHg) with pigmentary glaucoma before and after laser iridotomy. The slope of intraocular pressure was documented. Mean follow-up was 9 months. For statistical analysis the Wilcoxon test was used. RESULTS: Ten out of 28 eyes showed iridozonular contact and concavity of the midperipheral iris. Laser iridotomy resulted in a significant pressure drop (P < 0.05) in these 10 eyes (24.6 mmHg to 18.3 mmHg). Eighteen eyes, however, did not show iridozonular contact and intraocular pressure did not drop sufficiently (P > 0.05; 25.1 mmHg to 23.1 mmHg) after laser iridotomy. CONCLUSION: The results show that iridozonular contact does not exist in every patient with pigmentary glaucoma. Therefore, it seems possible that more than one pathogenic mechanism is involved in pigmentary glaucoma. In patients with iridozonular contact, however, laser iridotomy significantly reduces intraocular pressure.

[Severe ocular injuries caused by fishing equipment]. / Schwerste Sklera-Aderhaut-Netzhautverletzungen durch Unfälle mit Angelgerät: Bericht und Operationen von 3 Patienten.

BACKGROUND: Severe ocular injuries due to fishing equipment are rare, almost exclusively involve the anterior segments of men, and bear a bad prognosis. We report on two men and one woman with different etiologies of accidents. PATIENTS: In two men (53 and 39 yrs. OD and OS) and one woman (27 yrs., OD) a choroidal rupture due to a lead weight and subsequent choroidal neovascularisation (1x), temporal and nasal scleral and retinal lacerations (2x) due to a fish pick and a fish hook were noted. A laceration of the m. rectus int. (1x), uveal and retinal prolapse (1x), traumatic aniridia and aphakia (1x), a 12 and a 15 mm corneoscleral perforation temporal and nasal resp. including a retinal incarceration, a giant retinal tear 270 degrees, and vitreous and subretinal hemorrhage were seen. SURGERY: Interventions included 2x tight wound closure, 3x ppv, retinotomies (1x) endolasercoagulation (3x), silicone oil instillation (3x), muscel refixation (1x), and posterior lens implantation (1x). Subsequent surgery were silicone oil removal (2x) and membrane peeling (1x). RESULTS: An anatomical reconstruction was achieved in all of the patients, and the best postoperative visual acuity was gained after 4-6 months (+6.0 sph (2x) = 0.5, and +4.0 sph (1x) = 0.3). Silicone oil was removed after 4 and 13 months resp. followed by hypotony and redetachments, in one patient with silicone oil in place vision remained stable for > 2 years up to now at 0.5. CONCLUSIONS: Accidents due to fishing equipment may result in lacerations and contusions and involve women as well as. Surgery for extensive lacerations and complications of choroidal ruptures may not be hopeless, however, the prognosis for subsequent interventions is not good. Indications to remove silicone oil in eyes bearing a relative ciliary body insufficiency due to a long-standing insufficient wound closure should be done very cautiously.

[Discrimination difficulties--expression of disordered relative localization?]. / Trennschwierigkeiten--Ausdruck gestörter relativer Lokalisation?

Spatial uncertainty was examined according to a procedure suggested by Bedell and Flom (1981) ("triangle procedure") and additionally with a line-division test designed by Kundt. A horizontal line of a length of about 20 degrees and a shorter one of 4.3 degrees was divided into two equal parts. Strabismic amblyopes mark the middle of such a line with less precision and greater uncertainty than visually normal subjects do. Visual acuity was measured by single optotypes (Landolt rings), as well as by line optotypes with spaces of 2.6 min of arc between each other (C-test). Surprisingly, there was little correlation between visual acuity--even line acuity--and localization tasks.

Platelet monoamine oxidase activity and schizophrenia--a myth that refuses to die?

Platelet monoamine oxidase (MAO) activity was determined using kynuramine as a substrate in a group of schizophrenic patients (n = 107), a group of healthy individuals (n = 100), and a group of psychiatric patients who were neither schizophrenics nor alcoholics (n = 110). No significant difference emerged between the schizophrenics and the other two groups, while a significant reduction in platelet MAO activity in a group of alcoholics (n = 60) was confirmed. Breaking down the schizophrenic group according to course of illness, phenomenology (paranoid-hallucinatory or not) and drug use did not lead to a significant deviation in platelet MAO activity in any of these subgroups. It can also be demonstrated from the literature that the results reached by most research teams question the usefulness of platelet MAO activity as a genetic marker for psychiatric illness.