Mean retinal autofluorescence lifetimes in AMD patients are significantly prolonged. Intraretinal deposits cause prolonged lifetimes, whereas deposits in the area of the outer photoreceptor segments lead to short fluorescence lifetimes.

Background: In an open pilot study we tested a program of reduced combined radio-chemotherapy in Hodgkin’s disease in limited stages with risk factors and in advanced stages. Aim of the study was to reduce the delayed complications of full-dose combined modality treatment while preserving its effectiveness. Material and Methods: From May 1985 to December 1988 43 previously untreated consecutive patients entered the study. Treatment consisted of CVPP/ABVCy hybrid chemotherapy and low-dose (25 Gy) involved-field radiotherapy. Results: All patients could be evaluated for response to treatment. Primary complete remission (CR) reached 35/43, partial remission 5/43 (12%), and 3/43 (7%) did not respond. After a median observation period of 64 months 28/35 (80%) are in first CR. The survival data are as follows: relapse-free survival 3 years 86%, 5 years 78%, overall survival 3 years 91%, 5 years 83% (Kaplan-Meier estimation). So far 7 patients relapsed and 7 patients died. The acute toxicity of the treatment program was acceptable and up to now we have not observed secondary neoplasms. Conclusions: We regard our treatment approach as useful; it matches the reports of other groups using similar treatment policies.

Objectives/Hypothesis Head and neck squamous cell carcinoma (HNSCC) has a high tendency for regional lymphatic spreading. Nevertheless, isolated regional lymph node recurrences are rare, and only limited data regarding its management are available. The aim of this study was to describe treatment modalities and outcomes, and to identify prognostic factors. Study Design Retrospective cohort study. Methods The records of all patients (n = 498) with tumor persistence or recurrence after curatively intended treatment for HNSCC were retrospectively reviewed. Patients with synchronous secondary tumors at initial presentation, tumor persistence, local or locoregional recurrence, and systemic metastases were excluded. Results A total of 76 patients were included. The rate of occult additional metastasis in radiologically uninvolved neck compartments during salvage neck dissection was 25%. The salvaged patients showed a 37.5% 5‐year recurrence‐free survival (RFS). Multivariate analysis revealed initial stage IVA‐B (hazard ratio [HR]: 4.16, P < .01), extracapsular spread (HR: 3.71, P = .04), higher involved/total lymph node ratio (HR: 6.79, P < .01), and soft‐tissue infiltration (HR: 3.27, P < .01) as independent adverse prognostic factors for RFS. Moreover, univariate data analysis identified recurrent stage rcN2‐3; clinical involvement of the neck levels IV, V and/or VI; and smoking as adverse risk factors for RFS. Conclusions This study identifies initial stage IVA‐B, extracapsular spread, higher involved/total lymph node ratio, and soft‐tissue infiltration as independent adverse prognostic factors for RFS following isolated regional recurrences. The incidence of occult additional metastasis of radiologically uninvolved levels during salvage neck dissections was high (25%). Therefore, superselective or selective neck dissection would not have been the adequate type of salvage surgery. Level of Evidence 4 Laryngoscope, 131:67–72, 2021

Purpose To investigate the influence of lens opacifications on fluorescence lifetime imaging ophthalmoscopy (FLIO). Methods Forty-seven eyes of 45 patients were included. Mean fluorescence lifetimes ( Tm ) were recorded with a fluorescence lifetime imaging ophthalmoscope in a short spectral channel (SSC) and a long spectral channel (LSC). Retinal and lens autofluorescence lifetimes were measured in subjects before and after cataract surgery. Lens opacification was graded using the Lens Opacities Classification System III (LOCS III) classification. Results The retinal Tm decreased significantly after cataract surgery in both spectral channels (SSC: –53%, P < 0.0001; LSC: –26%, P = 0.0041). The lens Tm differed significantly between the crystalline and the artificial lens in both spectral channels ( P < 0.0001). The “nuclear opacity” and “nuclear color” score of the LOCS III classification correlated significantly with the mean Tm difference in both spectral channels ( P < 0.0001). Conclusions Lens opacification results in significantly longer retinal Tm . Therefore the lens status has to be considered when performing cross-sectional fluorescence lifetime analysis. Cataract-formation and cataract-surgery needs to be considered when conducting longitudinal studies. Grading of nuclear opacity following the LOCS III classification provides an approximate conversion formula for the mean change of lifetimes, which can be helpful in the interpretation of data in patients with lens opacities. Translational Relevance FLIO is significantly influenced by lens opacities. Using a lens opacity grading scheme and measuring fluorescence lifetimes before and after cataract surgery, an approximative conversion formula can be calculated, which enables the comparison of lifetimes after cataract surgery or over the course of time.

BackgroundVideo learning of surgical procedures helps trainees gain an initial understanding of the complex anatomy and the surgical procedure. Because no comparative studies have yet examined which microsurgical approach to the middle ear is most suitable for video learning, the authors investigated objective and subjective outcomes for medical trainees observing microscopic, 2-dimensional (2D) endoscopic, and 3- dimensional (3D) endoscopic ear surgeries.MethodsSixty-two medical students (min. 3rd year) from the University Hospital of Bern watched three standardized videos of a type I tympanoplasty surgery recording, conducted with a microscope, a 2D endoscope, and a 3D endoscope, respectively. The authors measured participants’ learning outcome, eye movements, cognitive load, and subjective preferences.ResultsOf the 62 participants included in the study, 14 were male (22.58%), and mean age was 24.44 years (range: 21–29). Learning outcome was highest after watching the 3D endoscopic video (mean [SD], 59.48% [20.57%]). Differences in score were statistically significant: 2D endoscopic video (mean difference: –6.56%, 95% CI: –13.02 to –0.10%), microscopic video (mean difference: –13.82%, 95% CI: –20.27 to –7.36%). Participants showed lowest average eye fixation duration when watching the 3D endoscopic video (mean [SD], 307 ms [109 ms]), with statistically significant differences to the 2D endoscopic video (mean difference: –139 ms, 95% CI: –185 to –93 ms), and the microscopic video (mean difference: –264 ms, 95% CI: –310 to –218 ms). Participants reported lowest cognitive load for the 2D and 3D endoscopic videos. Ratings on discomfort, usability, naturalness, depth perception, and image quality were in favor of the 3D endoscopic video.ConclusionThe 3D endoscopic technique offers many advantages for video learning in terms of knowledge gain, visual field exploration, and subjective evaluation. To optimize learning effects in trainees, the authors recommend the use of endoscopes in middle ear surgery and, if available, using 3D technology.

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PURPOSE. The purpose of this study was to characterize fundus autofluorescence lifetimes of retinal drusen in patients with AMD. METHODS.Patients with AMD and retinal drusen and healthy controls of similar age were examined. A fluorescence lifetime imaging ophthalmoscope was used. Retinal autofluorescence was excited using a 473-nm pulsed laser, and fundus autofluorescence lifetimes of the central retina (308) were measured in two distinct spectral channels (short: 498 to 560 nm [SSC]; long: 560 to 720 nm [LSC]). Mean retinal autofluorescence lifetimes, corresponding fundus autofluorescence intensity images, spectral domain optical coherence tomography, color fundus images, and clinical data were investigated. Patients were analyzed in two distinct groups (soft drusen and reticular pseudodrusen) and compared with control subjects.RESULTS. Sixty-four eyes of 64 patients with AMD and retinal drusen (age: mean 6 SD, 78 6 8.5 years; range, 59 to 94 years) were investigated and compared with a control group of 20 age-matched healthy subjects. Mean retinal autofluorescence lifetimes in patients with AMD was significantly prolonged compared with the healthy control eyes (mean 6 SEM: SSC, 486 6 18 vs. 332 6 11 ps, P < 0.0001; LSC: 493 6 9 vs. 382 6 17 ps, P < 0.0001). Areas of drusen featured a wide range of fluorescence lifetime values. Long lifetimes were identified in areas of atrophy and in areas of intraretinal hyperreflective deposits. Short lifetimes corresponded to deposits within the photoreceptor outer segment band.CONCLUSIONS. Mean retinal autofluorescence lifetimes in AMD patients are significantly prolonged. Intraretinal deposits cause prolonged lifetimes, whereas deposits in the area of the outer photoreceptor segments lead to short fluorescence lifetimes.Keywords: fluorescence lifetimes, fundus autofluorescence, retinal imaging, FLIO, age-related macular degeneration, AMD, deposits, drusen A MD is caused by age-related metabolic disorders in the retina, which leads to thickening of the Bruch membrane with calcifications, basal laminar deposits, and appearance of drusen. The predominant symptom is progressive central vision loss. The prevalence of advanced AMD is estimated to increase from 2.2% in 65-year-old patients to more than 21% in patients older than 90 years.1 Various risk factors have been identified, including age, sex, arterial hypertension, arteriosclerosis, elevated serum lipids, smoking, alcohol abuse, exposure to UV light, and various genetic factors. 2-6The hallmark of early AMD is the presence of retinal drusen, which can be classified into soft drusen of various sizes (small, medium, large), hard drusen, cuticular drusen, crystalline drusen, and reticular pseudodrusen. 4,7 In the biomicroscopic fundus examination, drusen are seen as discrete, yellow-white punctuate elevations. Retinal drusen are focal deposits of extracellular debris located between the basal lamina of the RPE and the inner collagenous layer of the Bruch membrane and are mainly concentrated within the posterior pole. The ...