A randomized controlled clinical trial comparing 20 gauge and 23 gauge vitrectomy for patients with macular hole or macular pucker

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A Randomized Controlled Clinical Trial Comparing 20 Gauge and 23 Gauge Vitrectomy for Patients with Macular Hole or Macular Pucker

IntroductionTo compare the transconjunctival sutureless 23 gauge (G) pars plana vitrectomy (PPV) with 20 G PPV regarding inflammation, safety, visual outcome and patient comfort.MethodsWe included 103 patients with symptomatic macular hole or macular pucker, scheduled for vitrectomy in this prospective, randomized, controlled, mono-center clinical trial. Patients were randomized 1:1 to either 20G PPV (n=51) or 23G PPV (n=52). All eyes underwent standard 20G or 23G PPV with membrane peeling. Primary outcome measure was change in aqueous humor flare 3weeks after surgery compared with baseline. Secondary outcome measures were flare values 2days and 26weeks after surgery, subjective discomforts measured with a visual analog scale, best-corrected visual acuity, duration of surgery, intraocular pressure (IOP) and adverse events.ResultsThere was no significant difference in change of flare 3weeks after PPV [- 1.7, 95% CI (- 6.3 to 2.9), p=0.466]. Both groups showed a significant increase in flare 2 days after surgery (20G: p<0.001, 23G: p=0.002), but only the 20G group after 3weeks (p=0.011). The gain in visual acuity after 3 weeks was higher after 23G PPV (4.2 95% CI (0.4-8.0, p=0.029), but without a difference after 6months. The duration of surgery was shorter in the 23G group (p<0.001). Patient comfort 3weeks after surgery was greater after 23G PPV (foreign body sensation p=0.002; itching: p=0.021). However, the rate of complications did not differ between the groups.ConclusionThe primary aim, showing the superiority of the 23G group regarding the change of flare value from baseline to 3weeks after surgery, was not met, but the level of inflammation decreased faster after 23G PPV. Clear advantages of the 23G PPV were a lower risk of postoperative IOP elevation, a shorter surgery time, faster visual recovery and greater patient comfort in the early postoperative phase.Clinical Trial Registration NumberClinicalTrials.gov NCT01969929

Effects of a 6-Month, Group-Based, Therapeutic Exercise Program for Childhood Cancer Outpatients on Motor Performance, Level of Activity, and Quality of Life

BackgroundExercise interventions in pediatric oncology are feasible and safe. However, scarce data are available with regard to the effectiveness of outpatient, group-based exercise interventions. As well, the potential role of exercise to improve motor performance has not been adequately explored despite being a meaningful outcome during childhood with important implications for physical activity behavior. No study has yet demonstrated significant changes in motor performance after an exercise intervention. ProceduresThis explorative, prospective study was designed to evaluate the effects of a 6-month, group-based, therapeutic exercise program for a mixed childhood cancer population on motor performance, level of activity, and quality of life. After cessation of inpatient medical treatment, childhood cancer outpatients aged 4-17 years exercised once a week during a 6-month period (IG). Comparison groups included childhood cancer outpatients receiving care as usual (CG(1)), as well as healthy peers (matched to IG by age and gender) (CG(2)). ResultsOverall motor performance, various motor dimensions, activity in sport clubs and school sports, as well as physical and emotional well-being were significantly reduced in the IG at baseline. Significant differences between the IG and CG(1) and/or CG(2) were identified in the change of overall motor performance, single motor dimensions, overall level of activity, and emotional well-being from baseline to post-intervention. ConclusionsThe exercise intervention was beneficial in terms of motor performance, level of activity, and emotional well-being. As such, this study provides support for group-based exercise as a potential strategy to improve these outcomes after inpatient medical treatment. Pediatr Blood Cancer (c) 2015 Wiley Periodicals, Inc

Is there a difference between active opening of the Eustachian tube in a hypobaric surrounding compared to a hyperbaric surrounding?

Introduction: The Eustachian tube (ET) is the key to pressure equalization between the middle ear and ambient pressure. To date, little is known about differences of the opening mechanisms under hyper- or hypobaric conditions. Aim of this study was to compare standard ET opening parameters during standardized hypo- and hyperbaric exposures. Methods: Thirty healthy participants were exposed to a standardized profile of decompression and compression (SPDC) in a hypo-/hyperbaric pressure chamber. Impedance, expressed as tympanic membrane compliance, was recorded at intervals during the excursions from 1 atmosphere absolute (atm abs) to 0.8 and 1.2 atm abs respectively. Parameters for tubal opening were obtained during SPDC: ET opening pressure (ETOP), ET opening duration (ETOD) and ET opening frequency (ETOF), hypobaric (Phase 1) and hyperbaric (Phase 2) data were compared. Results: Mean value for Valsalva maneuver ETOP was 40.10 +/- 19.02 mbar in Phase 2 vs. 42.82 +/- 21.75 mbar in Phase 1. For ETOD it was 2.80 +/- 2.09 seconds in Phase 2 vs. 2.51 +/- 1.90 seconds in Phase 1. For swallowing, mean value for ETOP was 33.47 +/- 14.50 mbar in Phase 2 vs. 28.44 +/- 14.04 in Phase 1. ETOD was 0.82 +/- 0.60 seconds in Phase 2 vs. 0.76 +/- 0.55 seconds in Phase 1. There was no statistical significance for ETOP, ETOD and ETOF between the two phases. Conclusion: No statistical significant difference was evident for active pressure equalization (Valsalva and swallowing) between a hyperbaric setting (dive) and a hypobaric setting (flight) in healthy subjects

The interrelation between sensorimotor abilities, cognitive performance and individual EEG alpha peak frequency in young children

Objective: The aim of this study was to identify the interrelation between sensorimotor abilities, cognitive performance and individual alpha peak frequency (iAPF), an EEG marker of global architectural and functional properties of the human brain, in healthy preschool children. Methods: 25 participants completed a one minute eyes-closed EEG recording, two cognitive tests assessing processing speed and visual working memory and a sensorimotor test battery. Results: We found positive correlations between selective sensorimotor abilities and iAPF; however, no significant correlations were observed between iAPF and cognitive performance. Specifically, locomotor skills correlated with iAPF across all cortical regions, except for the occipital cortex. Furthermore, a close relationship was found between sensorimotor and cognitive performance indicating that children with improved sensorimotor abilities were faster and/or more accurate in cognitive task performance. The cumulative pattern of our results indicates that a close relationship exists between sensorimotor and cognitive performance in young children. However, this relationship is dissociated from the iAPF. Conclusion: In contrast to adults, in young children the iAPF is related to locomotor skills and not to cognitive processing speed or visual working memory function. Significance: The global architectural and functional properties of the brain are closely related to locomotor skills during development. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved

Prevalence of Barotrauma in Recreational Scuba Divers After Repetitive Saltwater Dives

Introduction:The aim was to investigate the prevalence of middle ear barotrauma (MEB) and to establish risk factors of MEB after repeated saltwater dives.Methods:In this prospective observational cohort study 28 divers were examined over 6 consecutive days of diving in the Red Sea, Egypt. Participants underwent an otoscopic examination before the first dive, between each dive and after the last dive. In addition, they performed Valsalva maneuver (VM) and were questioned about dive-related complaints. Otoscopic findings were classified according to TEED classification for MEB (0=normal otoscopy to 4=perforation) separately for each ear. First examination was conducted before the first dive. Final examination, including a questionnaire, was conducted at least 12h after the last dive.Results:In total, 436 dives were performed and 1161 otoscopic findings were analyzed. All participants showed a normal eardrum and a positive VM during initial exam. MEB prevalence (TEED >0) was 36.5% at final examination. Prevalence increased significantly with number of dives per day (p0.05). More experienced divers (>200 dives lifetime) showed significantly less barotrauma (p<0.0001). Despite the high prevalence of MEB, 81.7% (316 of 387) of all dives were reported asymptomatic.Conclusions:After 6 days of repetitive diving, MEB prevalence was high (36.5%). It was the most often cause of otalgia in divers. Cumulative pressure exposure during repetitive dives resulted in significant increase of MEB. Diving experience significantly reduced the MEB prevalence. Interestingly, the severity of MEB did not correlate with subjective complaints

Intensified topical steroids as prophylaxis for macular edema after posterior lamellar keratoplasty combined with cataract surgery

PURPOSE: To analyze the effect of intensified topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK) on the incidence of postoperative cystoid macular edema (CME). DESIGN: Single-center comparative clinical study with historical controls. METHODS: SETTING: Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year. PATIENTS: Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. INCLUSION CRITERION: Triple-DMEK surgery. EXCLUSION CRITERIA: Prior retinal surgery, history of prior CME. INTERVENTIONS: Prednisolone acetate eye drops 1% 5 times daily for the first week after surgery. After an internal change of therapy regimen: Prednisolone acetate eye drops 1% hourly for the first postoperative week. We compared 75 consecutive eyes before with 75 consecutive eyes after the change of therapy regimen. Patients received macular spectral domain optical coherence tomography (SD OCT) preoperatively, as well as 6 weeks and 3 and 6 months post surgery. MAIN OUTCOME MEASURE: Development of CME detected by macular SD OCT during 6 months postoperatively. RESULTS: Both groups were comparable regarding baseline age, sex, central corneal thickness, rebubbling rate, and visual acuity. With topical steroid therapy 5 times per day during the first postoperative week, we observed 9 cases of subsequent CME (12%). With hourly topical steroid therapy none of the patients developed CME subsequently (P=.003). Apart from the topical steroids during the first week, medical treatment was identical in both groups. CONCLUSIONS: Early intensified postoperative topical steroid therapy constitutes an effective prophylactic treatment to reduce incidence of CME after triple-DMEK surgery. (C) 2016 by Elsevier Inc. All rights reserved