Background and Purpose— Acute ischemic stroke in humans is associated with profound alterations in the immune system. Hallmarks of this stroke-induced immunodepression syndrome are: lymphocytopenia, impairment of T helper cell and monocyte function. We studied which stroke-specific factors predict these immunologic alterations and subsequent infections. Methods— Leukocyte/lymphocyte subsets were assessed serially by white blood cell count and fluorescence-activated cell sorter analysis in ischemic stroke patients (n=50) at baseline, day 1, and day 4 after stroke onset and compared to an age-matched control group (n=40). Concomitantly, monocytic human leukocyte antigen-DR expression and the in vitro function of blood monocytes measured by the production of tumor necrosis factor-α upon stimulation with lipopolysaccharide were assessed. Associations of these immunologic parameters with stroke specific factors (National Institutes of Health Stroke Scale, infarct size) were explored. Multivariable logistic regression analysis was applied to identify early predictors for poststroke respiratory and urinary tract infections. Results— Infarct volume was the main factor associated with lymphocytopenia on day 1 and day 4 poststroke. Particularly, blood natural killer cell counts were reduced after stroke. Monocyte counts increased after ischemia paralleled by a profound deactivation predominantly after extensive infarcts. Reduced T helper cell counts, monocytic human leukocyte antigen-DR expression, and monocytic in vitro production of tumor necrosis factor-α were associated with infections in univariate analyses. However, only stroke volume prevailed as independent early predictor for respiratory infections (OR 1.03; CI 1.01 to 1.04). Conclusions— Infarct volume determines the extent of lymphocytopenia, monocyte dysfunction, and is a main predictor for subsequent infections.

To investigate the mean values and standard deviations according to age, reliability, and correlation between different parameters of anterior chamber measurements using the Pentacam rotating Scheimpflug camera. Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. This prospective clinical study comprised 76 healthy volunteers (mean age 46.6 years +/- 16.8 [SD]). Three consecutive measurements were made of only 1 eye and anterior chamber depth (ACD), mean and minimum anterior chamber angle (ACA), and anterior chamber volume (ACV) were evaluated. Mean ACD was 2.93 +/- 0.36 mm, mean ACA was 34.81 +/- 5.05 degrees, minimum ACA was 29.99 +/- 5.53 degrees, and mean ACV was 160.3 +/- 36.81 mm3. Increasing age was associated with reduced ACD and ACV; however, mean and minimum ACAs were lowest in patients aged 40 to 59 years. Excellent correlation was found between ACD and ACV (R = 0.92). Anterior chamber depth and mean ACA correlated only moderately (R = 0.65). The correlation coefficient between ACD and minimum ACA was smaller (R = 0.58). There was no correlation between ACV and ACA (R = 0.37). Minor standard deviations were noted (ACD 0.02 +/- 0.02 mm, mean ACA 1.12 +/- 0.94 degrees, minimum ACA 2.04 +/- 2.67 degrees, and ACV 2.48 +/- 1.65 mm3). Using the Pentacam, it was possible to examine different parameters of the anterior chamber within a short period and with good reliability. The evaluation of the ACA in different positions can help to classify the potential risk for angle-closure glaucoma.

Purpose: To evaluate the effectiveness and safety of 2 enhanced monofocal intraocular lenses (IOLs). The TECNIS Eyhance IOL (Model ICB00) was compared with a standard monofocal IOL (TECNIS Monofocal, Model ZCB00). Setting: European multicenter study. Design: Prospective, bilateral, randomized, comparative/evaluator-masked, controlled study. Methods: Adult subjects scheduled to undergo bilateral, primary phacoemulsification cataract extraction and posterior IOL implantation were randomized to receive the enhanced monofocal ICB00 IOL or the monofocal ZCB00 IOL in both eyes. Monocular endpoints at 6 months included distance-corrected intermediate visual acuity (DCIVA), photopic corrected distance visual acuity, and uncorrected intermediate visual acuity (UIVA). Binocular visual acuities, monocular corrected distance contrast sensitivity (first eyes), patient-reported outcomes, and safety were assessed at 6 months. Results: Overall, 139 patients were bilaterally implanted with the enhanced monofocal IOL (n = 67) or standard monofocal IOL (n = 72) and available for the 6-month visit. The enhanced monofocal IOL significantly improved mean monocular and binocular DCIVA and UIVA by at least 1-line logarithm of the minimum angle of resolution vs the standard monofocal IOL (all P ≤ .0001). Distance vision for the enhanced monofocal IOL was 20/20 or better and comparable with that of the standard monofocal lens at 6 months. Contrast sensitivity, photic phenomena outcomes, and rates of adverse events were similar between the 2 groups. Conclusions: In patients undergoing cataract surgery, TECNIS Eyhance IOL Model ICB00 provided enhanced intermediate vision and similar distance performance and photic phenomena compared with a standard monofocal IOL, along with improved functional performance in daily life.

To describe a morphological scoring system of posterior capsule opacification (PCO) that is not based on visual acuity testing. Department of Ophthalmology, University of Heidelberg, Germany. Following dilation of the pupil, standardized photographs of the pseudophakic anterior segments were obtained using a photo slitlamp. Posterior capsule opacification was scored by evaluating retroillumination photographs. The individual PCO score was calculated by multiplying the density of the opacification (graded from 0 to 4) by the fraction of capsule area involved behind the intraocular lens (IOL) optic. To evaluate the reliability of the morphological scoring system, six observers examined photographs of five eyes each (Experiment A, interindividual reliability). The same observer scored the PCO in three eyes on five different days (Experiment B, intraindividual reliability). Morphological PCO scores were very reliable. With PCO scoring from 0 to 4, the interindividual reliability showed standard deviations between 0.08 and 0.25. The intraindividual reliability showed standard deviations between 0.06 and 0.19 of the mean individual PCO scores. Standard deviation was 0.12 when different photographs of the same eye were scored. The morphological scoring system evaluates the entire area behind the IOL optic and thus includes a larger area of the posterior capsule than does visual acuity testing. The method revealed high reliability and insignificant investigator-dependent variations. When using a standardized photographic setup, systematic errors by the photographic technique were not relevant. This method may be an important tool to accurately test for differences in PCO formation with various IOL styles and surgical methods.

To evaluate corneal topography in a series of keratoconus patients using the Orbscan Topography System. Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. Seventy-one eyes of 38 patients with keratoconus were evaluated. Quantitative topographic parameters were analyzed with special reference to the central point of the cornea, the apex (the point with maximum reading on the anterior elevation best-fit sphere map), and the thinnest point. Evaluation included location, elevation (compared to a best-fit sphere), pachymetry, tangential curvature, and composite curvature. The mirror-image symmetry between the right and left eyes of a patient was also investigated. Mean patient age was 31.2 years +/- 12.2 (SD). Thirty-three patients (86.8%) had bilateral keratoconus and 5 (13.2%), unilateral keratoconus. Most cones (68/71) were located in the inferior temporal quadrant; 3 were above the horizontal meridian. Mean distance between the apex and the thinnest point was 0.917 +/- 0.729 mm (P < .001). The correlations between apex elevation and apex composite curvature and apex tangential curvature were high (r = 0.94 and r = 0.91, respectively; P < .001). In right and left eyes, there was a correlation between the apex and the thinnest point semi-meridians (r = 0.47 and r = 0.65, respectively; P < .05) but not between the radii of the apex and the thinnest point (r = 0.21 and r = 0.24, respectively). The Orbscan system can provide useful and accurate information in defining the morphology of keratoconus and detecting subtle topographic changes present in early keratoconus. It may also improve the results of contact lens fitting and surgical management.