Reliability and reproducibility of the German version of the European Society of Cataract and Refractive Surgeons reading charts.

PURPOSE: To create a validated, standardized, logarithmic European Society of Cataract and Refractive Surgeons (ESCRS) reading chart in German and to use this reading chart as a template for comparable reading charts in other languages. SETTING: Hanusch Hospital, Vienna, and Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria. DESIGN: Prospective multicenter validation study. METHODS: Thirty-nine short standardized German sentences were developed and tested on healthy volunteers and pseudophakic patients. On the first visit, corrected distance visual acuity was assessed in each eye using autorefraction (KR8000) and subjective refraction using Early Treatment Diabetic Retinopathy Study charts at 4 m. Reading speed, when reading the new ESCRS reading charts, was tested under photopic conditions (85 to 100 candelas/m(2)) and high contrast (≥95% Michelson contrast). RESULTS: The study assessed 120 subjects. Sixty subjects were young healthy volunteers and 60 were pseudophakic patients. Reliability of the sentences was tested using Cronbach's α and was found to be high (α = 0.994). Furthermore, reproducibility was high in most cases and the absolute mean difference between the first measurement and second measurement for all sentences was 0.56 seconds ± 0.07 (SD) (range 0.43 to 0.72 seconds). CONCLUSION: The German version of the ESCRS reading charts, a standardized logarithmic and validated reading test, was reliable in healthy volunteers as well as in pseudophakic patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Aqueous humor ferritin in hereditary hyperferritinemia cataract syndrome.

PURPOSE: Hereditary hyperferritinemia cataract syndrome (HHCS) is a rare autosomal dominant hereditary disease, characterized by hyperferritinemia but with absence of body iron excess and early onset of bilateral cataracts. Although 5- to 20-fold increased serum ferritin concentrations have been reported in HHCS patients, data of ferritin levels in aqueous humor have not been obtained. We therefore aimed to investigate the ferritin levels in aqueous humor and serum and further present histological and ultrastructural data of the lens. METHODS: During cataract extraction and intraocular lens implantation, aqueous humor and lens aspirate of a 37-year-old HHCS patient were obtained from both eyes. Ferritin levels in serum and aqueous humor were quantitatively analyzed via immunoassays in the HHCS patient and healthy control subjects (n = 6). Lens aspirate in HHCS was analyzed histologically and at the ultrastructural level. Further, genetic mutation screening by polymerase chain reaction and DNA sequencing in blood was performed. RESULTS: Serum ferritin levels in the control group were 142.2 ± 38.7 µg/L, whereas in the HHCS patient, this parameter was excessively increased (1086 µg/L). Analysis of ferritin in aqueous humor revealed 6.4 ± 3.8 µg/L in normal control subjects and 146.3 µg/L (OD) and 160.4 µg/L (OS) in the HHCS patient. DNA analysis detected a C>A mutation on position +18, a T>G mutation on position +22, a T>C mutation on position +24, and a T>G polymorphism on position +26 in the iron-responsive element of the light-chain ferritin (L-ferritin) gene. CONCLUSIONS: In the HHCS patient, a 23-fold (OD) to 25-fold (OS) increased aqueous humor ferritin level was detected. Therefore, the formation of bilateral cataract in HHCS is most likely a result of elevated aqueous humor ferritin. In addition, a novel mutation in this rare disease in the iron-responsive element of L-ferritin gene is reported.

Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results.

OBJECTIVES: To test the feasibility and accuracy of MR-guided soft tissue tumour biopsy at 3T, using the dynamic contrast-enhanced (DCE) information from staging MRI for intralesional targeting. METHODS: After obtaining written informed consent for this institutional review board-approved study, 53 patients with suspected soft tissue tumours prospectively underwent preoperative staging MRI at 3T, including DCE, and subsequent MR-guided core needle biopsy. In 44/53 cases, DCE was heterogeneous and was used for intralesional biopsy targeting. Surgical, whole-specimen histology was used as the gold standard in 43/44 patients and revealed 42 soft tissue tumours (24 men; 18 women; mean age, 52 years; range, 19 - 84). RESULTS: Final surgical histology revealed eight benign lesions, six tumours of intermediate dignity, and 28 malignancies. All malignancies had shown heterogeneous DCE. The diagnostic yield of the biopsies was 100% (42/42). Histological accuracy rates of biopsy were 100% in predicting the dignity (42/42; 95% CI [0.916 - 1.000]), 95.2% for the tissue-specific entity (40/42; 95% CI [0.847 - 0.987]), and 90.5% for the tumour grade (38/42; 95% CI [0.779 - 0.962]). CONCLUSIONS: Our preliminary study indicates that biopsy of soft tissue tumours can be performed accurately and safely with DCE targeted MR-guidance at 3T, using a combined staging/biopsy MRI protocol. KEY POINTS: • MR-guided soft tissue tumour biopsy using DCE for intralesional targeting is feasible. • Targeting by staging-MRI allows reliable planning of the biopsy approach. • The method seems accurate and safe as a combined staging/biopsy procedure in outpatients. • DCE-targeted biopsy seems useful in challenging large and heterogeneous tumours.

Evaluation of an electronic reading desk to measure reading acuity in pseudophakic patients.

PURPOSE: To compare a new electronic reading desk (Salzburg-Advanced) with conventional measurements of reading acuity. SETTING: Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN: Evaluation of diagnostic test. METHODS: In study 1, the electronic reading desk was compared with the same version of a printed reading chart. All patients were measured twice with autorefraction (Topcon KR8800) and subjective refraction. In study 2, patients were measured once. In addition, electronic reading desk measurements were obtained under different contrast and luminance levels. RESULTS: Study 1 evaluated 100 eyes of 50 pseudophakic patients. Differences between the electronic reading desk and the printed version were small and not significant for reading speed (131.1 words per minute [wpm]±28.7 [SD] versus 134.9±20.7 wpm), reading distance (44.7±14.4 cm versus 39.6±7.6 cm), and smallest possible read print size (1.95±0.58 mm versus 2.02±0.70 mm), respectively. Study 2 evaluated 40 eyes of 20 pseudophakic patients. Reading acuity and the smallest possible read print size decreased with lower contrast and reduced luminance, whereas reading distance and reading speed did not change significantly. CONCLUSIONS: Measurements performed with the electronic reading desk can be used interchangeably with those performed using a printed chart. The opportunity to preset standardized luminance and contrast settings could be useful for measurements in clinical trials. FINANCIAL DISCLOSURES: Drs. Dexl and Grabner have a proprietary interest in the Salzburg Reading Desk technology as patent assignees. No other author has a financial or proprietary interest in any material or method mentioned.

Three-dimensional proton MR spectroscopic imaging at 3 T for the differentiation of benign and malignant breast lesions.

PURPOSE: To evaluate the diagnostic accuracy of quantitative, three-dimensional (3D) magnetic resonance (MR) spectroscopic imaging at 3 T for the differentiation of benign and malignant breast lesions, on the basis of choline (Cho) signal-to-noise ratio (SNR) threshold levels, in a clinically feasible measurement time. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained from all subjects. Fifty female patients (mean age, 50 years; age range, 25-82 years) with mammographic or ultrasonographic (US) abnormalities were successfully examined in the prone position with a 3-T MR system by using a dedicated breast coil. Lesions were verified by either histopathologic examination or follow-up of at least 24 months. For 3D MR spectroscopic imaging, a point-resolved spectroscopic sequence (repetition time msec/echo time msec, 750/145; field of view, 12 × 12 × 12 cm(3); matrix size, 12 × 12 × 12, interpolated to 16 × 16 × 16; acquisition time, 11 minutes 17 seconds) was used. The maximum Cho SNR was assessed in all lesions and correlated with the histopathologic results. RESULTS: Thirty-two malignant and 12 benign lesions were confirmed in 43 patients with histopathologic examination. Seven patients without biopsy underwent imaging follow-up. In 31 of 32 (97%) malignant and 10 of 19 (53%) benign lesions, Cho was detected. The median Cho SNR in malignant lesions was 5.7, compared with 2.0 in benign lesions. With a Cho SNR threshold level of 2.6, 3D MR spectroscopic imaging provided a sensitivity of 97% and a specificity of 84% for the differentiation of benign and malignant breast lesions. CONCLUSION: At 3T, 3D MR spectroscopic imaging yields high diagnostic sensitivity and specificity for discrimination of benign and malignant breast lesions within reasonable measurement times. This technique allows the study of heterogeneous and multicentric breast tumors and simplifies acquisition planning.