The differentiation of individual-specific, stimulus-specific, and motivation-specific response patterns in activation processes: an inquiry investigating their stability and possible importance in psychophysiology

The role of specific response patterns obtained by means of psychophysiological activation and their temporal stability are meeting with an increasing interest in the literature because of a low correlation between psychophysiological variables and of possible implications with regard to pathogenetic mechanisms in psychosomatic disease. Two empirical studies are presented that were conducted under similar stress conditions (mental arithmetic, free speech, cold-pressor test, blood-taking) and have been monitoring similar activation variables (seven physiological and four or five psychological variables) - one of which using a large sample of 125 students, the other one consisting of 47 students, who were tested three times week- by-week. Findings reveal that substantial proportions of variance in the three-factorial ANOVA (subjects, situations, variables) may be considered on the basis of individual-specific (23-29% for physiological variables, 6-11% for psychological variables), stimulus-specific (5-19% for physiological variables, 1-11% for psychological variables), and motivation-specific (21% for physiological variables, 10% for psychological variables) response patterns. Five evaluation procedures on nominal, ordinal, and interval data levels as well as various definitions of similarity found in the reaction patterns are used in a comprehensive approach to the analysis of specificities. Estimation of variance components, global tests, and individual tests are applied. The results prove to be reliable and rather stable, at least over a period of several weeks. In total, about one fourth of the subjects show a stable individual-specific response pattern on physiological variables. The results are discussed with respect to data and sampling problems as well as to various methods of data analysis.     

Molekulargenetische Ergebnisse bei Patienten mit kongenitalen Zapfenfunktionsstörungen

PURPOSE: This study compares clinical and molecular genetic findings in patients with congenital cone dysfunction. METHODS: In this study 28 patients underwent a basic ophthalmologic examination. Except for a 1-year-old boy, color vision, perimetry, and full-field ERG (ISCEV standard) were evaluated in all patients. Blood samples were taken for molecular genetic analysis of the CNGA3, CNGB3, or GNAT2 genes. RESULTS: Two patient groups could be distinguished: patients without and with residual cone function in the ERG. In 14 of 17 patients without cone function, mutations in one of the three genes were detected, and except for one patient mutations in both alleles could be determined. In these patients, visual acuity was reduced to 20/400 and color discrimination was absent. In 2 of 11 patients with residual cone function, mutations in one allele of the CNGB3 gene were detected. It is of interest that 6 of 16 patients with mutations perceived their disease as progressive; in three of them we could determine a progression. Only in 4 of 16 patients was the ocular fundus normal. The other patients with mutations presented with central pigment irregularities, attenuated vessels, or pale optic disk. CONCLUSION: In patients with congenital cone dysfunction without cone function in the ERG, an analysis of the CNGA3, CNGB3, or GNAT2 gene is advisable. In contrast, patients with residual cone function did not show clear association with mutations in one of the three genes. In patients with mutations, retinal alterations and nystagmus are frequent. In contrast to the designation of these disorders as stationary, in some patients with mutations in the CNGA3 and CNGB3 gene slow progression was observed.     

Retinopathy of prematurity

This review summarizes the knowledge and highlights recent advances in clinical research of retinopathy of prematurity (ROP). This disease is still important, because improvements in neonatal intensive care during the last years have increased the survival of the most immature newborns, but did not diminish the ROP frequency. Ophthalmologic screening and, if applicable, laser treatment at the optimal time for advanced ROP prevents blindness in most cases. The history, classification and the modern concepts of ROP pathophysiology are described. The results of various multicenter treatment trials are summarized. The current German screening guidelines are discussed with the guidelines of other nations. The therapeutic treatment strategies and the treatment results are discussed. The ophthalmologic disorders of former preterm infants, as higher rates of amblyopia, strabismus, and refractive error, are mentioned. Possible future therapies, e. g. anti-angiogenic factors are discussed.     

Translocation of iris pigment epithelium in patients with exudative age-related macular degeneration: long-term results

Purpose To report the practicability and efficacy of autologous iris pigment epithelium (IPE) translocation in exudative age-related macular degeneration (ARMD) over 1 year.Methods The consecutive interventional case series included 56 patients with exudative ARMD. During vitrectomy the submacular neovascular membrane (CNV) was removed and IPE cells, harvested from a peripheral iridectomy, were injected into the submacular space. Included were patients with subfoveal occult CNV (11 eyes), classic CNV (10 eyes), mixed CNV (17 eyes), CNV with a pigment epithelial detachment (13 eyes) or CNV with a hemorrhage (5 eyes). Outcome measures were visual acuity, foveal fixation, size of CNV and rate of recurrence based on fluorescence angiographic imaging.Results All patients underwent successful surgical removal of the CNV with consecutive subretinal IPE injection. Visual acuity was better than 20/100 in 19 patients preoperatively and in 18 patients postoperatively. A visual acuity of 20/100 or less was found in 37 patients preoperatively and in 38 patients postoperatively. Mean preoperative visual acuity (1.0±0.3 logMAR units) did not change significantly after 1 year (1.0±0.3 logMAR units). Ten eyes (18%) developed a recurrence. Fixation within the surgically denuded area could be demonstrated in 25 eyes (45%).Conclusions Autologous IPE translocation for ARMD over one year can preserve foveal function on a low level, but cannot improve visual acuity. IPE translocation is technically feasible with a low rate of complications. Continued research seems justified to improve functional outcome.     

Treatment of primary intraocular lymphoma with oral trofosfamide: report of two cases and review of the literature

Background The prognosis of primary intraocular lymphoma (PIOL) is poor. Due to frequent ocular and/or CNS relapses, the optimal treatment for PIOL has not yet been defined. This is the first report of PIOL treatment with trofosfamide.Methods The first patient with a newly diagnosed PIOL was not considered eligible for high-dose methotrexate-based systemic chemotherapy due to comorbidities. The second patient had a primary central nervous system lymphoma, which was resistant to three chemotherapy regimens and responded to whole-brain irradiation. A tumor relapse in the eye was treated with local radiotherapy with initial success; however, the tumor subsequently recurred. The first patient received oral trofosfamide 150 mg daily, the second 400 mg daily (reduced after 5 months of therapy to 300 mg daily) over 5 consecutive days, followed by a 5-day drug-free interval.Results In both patients, complete remission was achieved, which lasted for 8+ and 18 months, respectively. Except for a temporary asymptomatic decrease in hemoglobin in the first patient, no toxicity was observed.Conclusions Trofosfamide may offer an alternative treatment option for PIOL with a very favorable side effect profile. The exact role of trofosfamide in the treatment of PIOL remains to be defined.     

Long-term results following pars plana vitrectomy with platelet concentrate in pediatric patients with traumatic macular hole

PURPOSE: To describe the long-term clinical course in children with a traumatic macular hole after vitrectomy with platelet concentrate. DESIGN: Interventional case series. METHODS: Four pediatric patients with a mean age of 13.2 years (range, 10-15 years) underwent pars plana vitrectomy with platelet concentrate, internal limiting membrane peeling, and SF6 gas tamponade for stage 3 traumatic macular hole repair. RESULTS: Primary closure was achieved by a single intervention in all patients with a marked visual improvement of three to seven lines after surgery. The surgically achieved visual improvement remained stable and no vision-threatening complications occurred during the mean follow up of 35.2 months (range, 27-51 months). CONCLUSION: We regard pars plana vitrectomy with platelet concentrate and SF6 gas instillation as safe and effective and, therefore, as the therapy of choice for traumatic macular holes particularly in children after a period of observation no longer than 3 to 4 months.     

Clinical characteristics of choroidal metastasis

ZusammenfassungHintergrund Die Aderhautmetastase ist der häufigste maligne intraokulare Tumor. Ziel dieser Untersuchung ist die Charakterisierung des klinischen Erscheinungsbildes, der zugrunde liegenden Tumorerkrankung sowie des differenzialdiagnostischen Vorgehens bei Aderhautmetastasierung (AM).Patienten und Methode Es wurden 71 konsekutive Patienten mit AM ausgewertet. Besondere Beachtung fanden die okulären Symptome, das ophthalmoskopische und sonographische Erscheinungsbild der AM sowie die Charakterisierung der zugrunde liegenden Tumorerkrankung. Bei allen Patienten erfolgte ein vollständiges Screening (CT Kopf, Thorax und Abdomen; Knochenszintigraphie) zur Primärtumorsuche bzw. bei bereits bekanntem Primärtumor zur Suche nach weiteren Organmetastasen.Ergebnisse Eine symptomatische AM zeigten 95% der Patienten, bei 5% handelte es sich um einen Zufallsbefund. Bei 60% der Patienten bestand eine solitäre AM, bei 40% multiple AM (2–14). Bei Erstvorstellung war bei 18% der Patienten (n=13) keine Tumorerkrankung bekannt. Bei 12 dieser Patienten konnte ein Bronchialkarzinom diagnostiziert werden. Insgesamt bestand bei 53% der Patienten ein Mammakarzinom, bei 26% ein Bronchialkarzinom, bei je 3% ein Nieren- oder Darmkarzinom, ein Aderhautmelanom oder ein kutanes Melanom, sowie bei einzelnen Patienten ein Zervix-, Ovarial-, Thymus- oder Prostatakarzinom sowie in einem Fall ein unbekannter Primärtumor. Weitere Fernmetastasen zeigten 96% der Patienten. Beim Bronchialkarzinom trat die AM im Mittel 9 Monate, beim Mammakarzinom 68 Monate nach Diagnose der Tumorerkrankung auf. Bei 58% der Patienten mit Bronchialkarzinom war die AM die Erstmanifestation der Grunderkrankung, beim Mammakarzinom bei 28% das erste Zeichen der Metastasierung.Schlussfolgerung Aderhautmetastasen finden sich fast nur bei einer generalisierten Tumorerkrankung. Beim Mammakarzinom treten sie typischerweise Jahre nach Diagnose auf und können das erste Zeichen einer Generalisierung sein. Beim Bronchialkarzinom kann die Aderhautmetastase das erste klinische Zeichen der Erkrankung sein.Teile des Beitrags wurden auf der 98. Tagung der Deutschen Opthalmologischen Gesellschaft präsentiert.