In this retrospective longitudinal observational study, data from one site of the Fight Retinal Blindness! Registry (University of Zurich, Switzerland) was used to investigate the quantity and ...distribution of recurrent fluid in neovascular age-related macular degeneration (nAMD). Study eye eligibility required treatment-naïve nAMD, receiving at least three anti-vascular endothelial growth factor injections, followed by a treatment discontinuation of at least six months and subsequence fluid recurrence. To quantify fluid, a regulatory approved deep learning algorithm (Vienna Fluid Monitor, RetInSight, Vienna, Austria) was used. Fifty-six eyes of 56 patients with a mean age of 76.29 ± 6.58 years at baseline fulfilled the inclusion criteria. From baseline to the end of the first treatment-free interval, SRF volume had decreased significantly (58.0 nl (IQR 10–257 nl) to 8.73 nl (IQR 1–100 nl), p < 0.01). The quantitative increase in IRF volume from baseline to the end of the first treatment-free interval was not statistically significant (1.35 nl (IQR 0–107 nl) to 5.18 nl (IQR 0–24 nl), p = 0.13). PED also did not reach statistical significance (p = 0.71). At the end of the second treatment discontinuation there was quantitatively more IRF (17.3 nl) than SRF (3.74 nl). In conclusion, discontinuation of treatment with anti-VEGF therapy may change the fluid pattern in nAMD.
Purpose
Infection represents probably the most challenging complication in shoulder arthroplasty and all other surgical procedures of the shoulder. A deep infection of the shoulder is often combined ...with a destruction of the joint and a loss of function. In many cases the arthroplasty is the last resort for these patients to obtain a satisfactory function. The objective of this study was to determine outcome data on microbiota and clinical results of a two-stage shoulder arthroplasty procedure after deep infection of the shoulder.
Methods
Twenty-six patients with a deep shoulder infection after arthroplasty, osteosynthesis, or rotator-cuff repair were included, while two patients had an empyema without prior surgery. All underwent initial surgical debridement with implantation of an antibiotic-loaded spacer, followed by postoperative systemic antibiotics. The patients obtained definitive shoulder arthroplasty in a second surgery. None of the patients had to undergo more than two surgeries before the arthroplasty. The follow-up analysis including microbiota results, complication rates, and functional outcomes could be determined after at least 1 year in 60% of patients (
n
= 16).
Results
The most frequently detected microorganisms were
S. epidermidis (
31%,
n
= 10) and
Cutibacterium acnes (
19%,
n
= 6). In 28% (
n
= 9) of cases multi-drug resistant bacteria were detected and in 35% (
n
= 8) of cases more than one microorganism was found. The overall revision rate was 42%, 11 of 26 patients, in the first 8 weeks after arthroplasty. Reasons for revision were joint dislocations in 23% (
n
= 6), 15% (
n
= 4) postoperative hematomas, one (4%) re-infection and one (4%) periprosthetic fracture. At follow-up after 19.3 ± 5.5 months postoperatively, a mean abduction of 113.4°, anteversion of 122.8° and external rotation of 14° was found, with an average age and gender-adjusted Constant Score of the affected shoulder of 63. The subjects’ pain and impairment in normal life measured by a questionnaire with school grades were significantly reduced (
p
< 0.05) as compared to prior shoulder arthroplasty.
Conclusion
The most relevant bacteria in the study cohort were
Staphylococcus subspecies
and to a lower extent
Cutibacterium acnes
. A high number of multi-drug resistant and mixed microbiota spectra were detected, defining a need to adapt therapeutic regimen targeting these microbiotas. The two-stage shoulder arthroplasty after a deep infection resulted in excellent infection control with however high early postoperative rates for joint dislocation (23%) and hematomas (15%). At follow-up a stable joint was achieved with a sufficient functional outcome and satisfying outcome for activities of daily living and pain.
Clinical trial
Trial registration number: DRKS00016927, date of registration: 2019/03/19.
To evaluate vascular changes in the superficial and deep retinal capillary plexus (SCP, DCP) and their association with drusen volume changes in intermediate age-related macular degeneration (iAMD).
...Patients with iAMD were examined at baseline and 12 months thereafter. Drusen volume was extracted from 20° × 20° OCT scans using a 3-mm ETDRS grid using a customized algorithm with manual correction. Vessel density (VD) and flow area (FA) were extracted from 3 × 3 mm SD-OCT-A scans after manual correction of the segmentation. Associations were investigated using multiple regression models.
We used 31 eyes of 31 patients for evaluation. The mean age at baseline was 74.9 ± 5.4 years; 26 patients were female. Baseline visual acuity (VA) was 0.05 ± 0.08 logMAR (Snellen equivalent approximately 20/22). The initial mean 3-mm central drusen volume was 0.144 ± 0.136 mm3. A significant association with the signal strength index was consistently found, therefore all capillary measurements were corrected. VD in the same area was 49.88% ± 7.38% and 55.43% ± 9.31% for the SCP and DCP, respectively. The baseline FA resulted in 3.292 ± 0.218 mm2 and 3.433 ± 0.224 mm2 for the SCP and DCP, respectively. No association was found between changes in drusen volume and FA or VD after 12 months (all P > 0.05). VA worsened (P = 0.013) and the foveal FA of the SCP increased significantly (P = 0.014).
No significant association was found between the increase in drusen volume in iAMD and capillary retinal perfusion over a 12-month follow-up. Although VA decreased statistically over this time period, the foveal FA of the SCP increased.
Previous studies have identified a link between optical coherence tomography (OCT)-derived and OCT angiography (OCTA)-based parameters in patients with neovascular AMD (nAMD); the latter may serve as ...direct biomarkers for macular neovascularization (MNV) activity. The aim of this study was to assess the individual influence of retinal thickness (RT) as well as intra- and sub-retinal fluid (IRF, SRF) presence on the treatment response over time as assessed by previously identified OCTA-derived MNV vascular parameters.
During the first 3 months of anti-VEGF therapy patients were prospectively followed. RT, SRF and IRF were determined from SSOCT/A (PlexElite, Zeiss) images and using the semi-automated AngioTool software, vessel area (VA), total vessel length (TVL), total number of junctions (TNJ), junction density (JD), vessel density (VD) as well as MNV area were exported. IRF and SRF were identified manually on OCT volume scans .The associations between RT, IRF, and SRF and SSOCTA vascular parameters were analyzed using linear mixed models.
31 eyes of 31 patients with treatment-naïve and OCTA-positive nAMD MNV were included in this analysis. VA, TVL, TNJ, and MNV area show a statistically significant change over time in response to anti-VEGF treatment, even after correcting for the presence of SRF, IRF, or RT (all p < 0.05). This is not the case for JD and VD (both p > 0.05).
OCTA-based parameters VA, TVL, TNJ, and MNVarea show a strong response to anti-VEGF therapy over time, independent of the presence of IRF, SRF or RT. We conclude that the above listed OCTA parameters could contribute to our understanding of MNV biology and to guide individualized treatment in the future.
The authors confirm that all ongoing and related trials are registered. ClinicalTrials.gov Number: NCT02521142
The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities.
Retrospective ...study of prospectively collected data.
Level-1 trauma center located in Germany.
Patients who underwent PABST and were at least 1 year postoperatively were included.
Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed.
Fifteen patients 13 male; mean age 51 years (range, 20-75) underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm interquartile range (IQR): 40-125, and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months 95% confidence interval (95% CI), 6-8.5, and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040).
PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
To compare the visibility and accessibility of the outer retina in neovascular age-related macular degeneration (nAMD) between 2 OCT devices.
In this prospective, cross-sectional exploratory study, ...differences in thickness and loss of individual outer retinal layers in eyes with nAMD and in age-matched healthy eyes between a next-level High-Res OCT device and the conventional SPECTRALIS OCT (both Heidelberg Engineering GmbH, Heidelberg, Germany) were analyzed. Eyes with nAMD and at least 250 nL of retinal fluid, quantified by an approved deep-learning algorithm (Fluid Monitor, RetInSight, Vienna, Austria), fulfilled the inclusion criteria. The outer retinal layers were segmented using automated layer segmentation and were corrected manually. Layer loss and thickness were compared between both devices using a linear mixed-effects model and a paired t test.
Nineteen eyes of 17 patients with active nAMD and 17 healthy eyes were included. For nAMD eyes, the thickness of the retinal pigment epithelium (RPE) differed significantly between the devices (25.42 μm 95% CI, 14.24–36.61 and 27.31 μm 95% CI, 16.12–38.50 for high-resolution OCT and conventional OCT, respectively; p = 0.033). Furthermore, a significant difference was found in the mean relative external limiting membrane loss (p = 0.021). However, the thickness of photoreceptors, RPE integrity loss, and photoreceptor integrity loss did not differ significantly between devices in the central 3 mm. In healthy eyes, a significant difference in both RPE and photoreceptor thickness between devices was shown (p < 0.001).
Central RPE thickness was significantly thinner on high-resolution OCT compared with conventional OCT images explained by superior optical separation of the RPE and Bruch's membrane.
Die septische Pseudarthrose einer Pilon tibiale Fraktur stellt eine schwerwiegende Komplikation dar. Nur ein konsequentes Vorgehen mit mehrfachen Eingriffen und ein langer Heilungsverlauf versprechen ...einen nachhaltigen Heilungserfolg. Im Folgenden wird ein aktuelles und praktikables Konzept zur Therapie einer septischen Pseudarthrose des Pilon tibiale vorgestellt, dass in unserer Klinik etabliert durchgeführt wird und mit dem bei konsequenter Durchführung viele dieser komplexen Patienten mit einem guten klinischen Ergebnis geheilt werden können. Die Kernpunkte des Konzeptes bilden die Pseudarthrosenresektion, das Erreichen der Infektfreiheit mittels lokaler und systemischer antiinfektiver Therapie und die befundabhängige Rekonstruktion. Abhängig vom Grad des Verlustes der Knochensubstanz beschreiben die Autoren die lokale Defektauffüllung, bei Notwendigkeit in Kombination mit erneuter osteosynthetischer Versorgung oder primärer Arthrodese. Bei langstreckigen Knochenverlusten besteht die Möglichkeiten zum Knochensegmenttransport mittels verschiedener Verfahren zur Defektfüllung oder in die sekundäre Arthrodese.
10.1016/j.fuspru.2024.02.002
Septic non-union of a tibial pilon or plafond fracture is a serious complication. Only a consistent procedure with multiple interventions and a long process promises a sustainable success. In the following, a current and practicable therapeutical concept of a septic non-union of the tibial pilon is presented, which is carried out in an established manner in our clinic and which, if carried out consistently, many of these complex patients can be healed with a good clinical result. The key points of the concept are radical bone and soft-tissue resection followed by local and systemic anti-infective therapy, and reconstruction of bone and soft tissue loss. Depending on the degree of bone loss, the authors describe local defect filling, if necessary, in combination with osteosynthetic treatment or primary arthrodesis. In the case of long-distance bone loss, there is the possibility of bone segment transport. Therefore, different techniques are presented, followed by docking-procedure or secondary arthrodesis depending on the condition of the joint.
Purpose
Quantification of fundus autofluorescence has only recently become available. We report our findings on the evaluation of the repeatability and reliability of quantitative fundus ...autofluorescence (qAF) measurements in patients with early and intermediate age‐related macular degeneration (AMD), using the first approved and commercially available instrument.
Methods
A total of 43 eyes of 22 patients (aged between 52 and 84 years) diagnosed with early and intermediate AMD were included. All eyes were imaged at day 1, 3 months and 6 months using a modified scanning laser ophthalmoscope, equipped with an internal fluorescent reference. Mean qAF values were calculated for the fovea and for each concentric ring of the Delori pattern. Repeatability and reliability were calculated using Bland–Altman analysis and intraclass correlation (ICC).
Results
The mean patient age was 73.5 ± 7.9 years. Sixteen patients (73%) were female. qAF repeatability of the eight segments in the middle ring of the Delori pattern (qAFM8) for between sessions was ±8.2%. Agreement at 3‐ and 6‐month follow‐up in eyes without retinal changes was ±8.3% and ±9.8%, respectively. Reliability of qAFM8 was high for all images acquired ICC = 0.98 (CI: 0.96–0.99), 0.97 (0.93–0.99) and 0.98 (0.92–0.99). Agreement at 3‐ and 6‐month follow‐up in eyes with retinal changes was ±18.1% and ±20.2%, respectively. Intraclass correlation (ICC) was slightly lower in eyes with retinal changes at 0.93 (0.84–0.97) and 0.96 (0.91–0.98), respectively.
Conclusions
Quantitative autofluorescence shows excellent repeatability and reliability as well as follow‐up agreement in patients with early and intermediate AMD without retinal changes. This is relevant when conducting longitudinal studies using qAF.
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