Cantonal Hospital of Lucerne

Luzern, Switzerland

Cantonal Hospital of Lucerne

Luzern, Switzerland
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Schmid M.K.,Cantonal Hospital of Lucerne | Bachmann L.M.,INC Research | Fas L.,INC Research | Kessels A.G.,Maastricht University | And 2 more authors.
British Journal of Ophthalmology | Year: 2015

Topic: To quantify the gain in visual acuity and serious side effects of ranibizumab, bevacizumab and aflibercept in age-related macular degeneration (AMD). Clinical relevance: There is an ongoing debate about the optimal treatment of AMD with these three antivascular endothelial growth factor (anti-VEGF) treatments. Methods: Network meta-analyses. (Pre)Medline, EMBASE, SCOPUS, Cochrane Library (until April 2013), Science Citation Index and reference lists were searched for placebo-controlled randomised trials or head-to-head comparisons. Outcomes were 1-year follow-up data of visual acuity (letters gained) and serious (vascular death, any death, stroke, myocardial infarction, transient ischaemic attack) and thrombotic events. Two investigators independently assessed eligibility and quality of included studies and extracted data. Results: 11 trials (enrolling 8341 patients) assessing five active treatments were included. Compared with placebo, all anti-VEGF treatments had a significantly higher percentage of letters gained: ranibizumab 0.3 mg 2.39% (95% CI 1.59 to 3.19; p<0.001), ranibizumab 0.5 mg 3.56% (95% CI 2.58 to 4.13; p<0.001), bevacizumab 1.25 mg 2.14% (95% CI 0.47 to 3.82; p=0.012), aflibercept 0.5 mg 2.91% (95% CI 0.99 to 4.82; p=0.003) and aflibercept 2 mg 3.44% (95% CI 1.73 to 5.14; p<0.001). Compared with placebo, serious side effects were higher in all other treatments: ranibizumab 0.3 mg 4.41% (95% CI 3.42 to 5.40; p<0.001), ranibizumab 0.5 mg 5.33% (95% CI 4.37 to 6.30; p<0.001), bevacizumab 1.25 mg 5.58% (95% CI 3.567 to 7.60; p<0.001), aflibercept 0.5 mg 5.65% (95% CI (3.28 to 8.02; p<0.001) and aflibercept 2 mg 5.29% (95% CI 3.18 to 7.39; p<0.001). Compared with placebo, systemic thrombotic events also occurred more often in all other treatments. Conclusions: The study revealed only a modest superiority of aflibercept 2 mg and ranibizumab 0.5 mg over other formulations and dosages. © 2015, BMJ Publishing Group. All rights reserved.


OBJECTIVE: To clarify the screening potential of the Amsler grid and preferential hyperacuity perimetry (PHP) in detecting or ruling out wet age-related macular degeneration (AMD).EVIDENCE ACQUISITION: Medline, Scopus and Web of Science (by citation of reference) were searched. Checking of reference lists of review articles and of included articles complemented electronic searches. Papers were selected, assessed, and extracted in duplicate.EVIDENCE SYNTHESIS: Systematic review and meta-analysis. Twelve included studies enrolled 903 patients and allowed constructing 27 two-by-two tables. Twelve tables reported on the Amsler grid and its modifications, twelve tables reported on the PHP, one table assessed the MCPT and two tables assessed the M-charts. All but two studies had a case-control design. The pooled sensitivity of studies assessing the Amsler grid was 0.78 (95% confidence intervals; 0.64-0.87), and the pooled specificity was 0.97 (95% confidence intervals; 0.91-0.99). The corresponding positive and negative likelihood ratios were 23.1 (95% confidence intervals; 8.4-64.0) and 0.23 (95% confidence intervals; 0.14-0.39), respectively. The pooled sensitivity of studies assessing the PHP was 0.85 (95% confidence intervals; 0.80-0.89), and specificity was 0.87 (95% confidence intervals; 0.82-0.91). The corresponding positive and negative likelihood ratios were 6.7 (95% confidence intervals; 4.6-9.8) and 0.17 (95% confidence intervals; 0.13-0.23). No pooling was possible for MCPT and M-charts.CONCLUSION: Results from small preliminary studies show promising test performance characteristics both for the Amsler grid and PHP to rule out wet AMD in the screening setting. To what extent these findings can be transferred to a real clinic practice still needs to be established.


Gunthert A.R.,Cantonal Hospital of Lucerne | Gunthert A.R.,University of Bern | Christmann C.,Cantonal Hospital of Lucerne | Kostov P.,Cantonal Hospital of Lucerne | And 2 more authors.
American Journal of Obstetrics and Gynecology | Year: 2015

The minimally invasive approach for hysterectomy with proven benefits and lower morbidity has become the gold standard, even in women with large uterine masses. Most women with a malignant condition present with abnormal vaginal bleeding and/or suspicious imaging such that few are diagnosed by final histopathology after surgery. However, if a malignancy is not diagnosed preoperatively, intraabdominal morcellation for uterus extraction has an increased risk for potential tumor spread and peritoneal metastases, especially in cases of unexpected leiomyosarcoma. We describe a simple method to wrap the uterus in a contained environment with a plastic bag through the posterior vaginal fornix prior to conventional coring morcellation for vaginal extraction in total laparoscopic hysterectomy. We further describe our experience with a risk stratification and treatment algorithm to implement this procedure in daily routine. A video and an illustrating sketch demonstrate the simplicity and safety of the procedure. © 2015 Elsevier Inc.


Gunthert A.R.,Cantonal Hospital of Lucerne | Christmann C.,Cantonal Hospital of Lucerne | Kostov P.,Cantonal Hospital of Lucerne | Mueller M.D.,University of Bern
American journal of obstetrics and gynecology | Year: 2015

The minimally invasive approach for hysterectomy with proven benefits and lower morbidity has become the gold standard, even in women with large uterine masses. Most women with a malignant condition present with abnormal vaginal bleeding and/or suspicious imaging such that few are diagnosed by final histopathology after surgery. However, if a malignancy is not diagnosed preoperatively, intraabdominal morcellation for uterus extraction has an increased risk for potential tumor spread and peritoneal metastases, especially in cases of unexpected leiomyosarcoma. We describe a simple method to wrap the uterus in a contained environment with a plastic bag through the posterior vaginal fornix prior to conventional coring morcellation for vaginal extraction in total laparoscopic hysterectomy. We further describe our experience with a risk stratification and treatment algorithm to implement this procedure in daily routine. A video and an illustrating sketch demonstrate the simplicity and safety of the procedure. Copyright © 2015 Elsevier Inc. All rights reserved.


Baenninger P.B.,Cantonal Hospital of Lucerne | Baenninger P.B.,University of Zürich
Eye (London, England) | Year: 2014

PURPOSE: To compare the effect, failure rate and the risks of corneal cross-linking (CXL) in keratoconus patients aged ≥35 years to patients <35 years.METHODS: In 141 eyes of 116 keratoconus patients we compared the changes in best phoropter-corrected visual acuity (BCVA) and maximum keratometry values (Kmax) before and 12 months after CLX in patients aged ≥35 years (n=34, 38 eyes) to the cohort of patients below 35 years of age.RESULTS: Overall, CXL significantly improved BCVA from 0.487 logMAR (95% confidence interval (CI) 0.426-0.548) by -0.197 logMAR (95% CI -0.243 to -0.150; P<0.001) and reduced Kmax from 48.96 diopter (Dpt) by -1.33 Dpt (95% CI -1.85 to -0.81: P<0.001). Age ≥35 years had no effect on the changes of BCVA (-0.02 (95% CI -0.13 to 0.09); P=0.757) or Kmax (0.58 (95%CI -0.51 to 1.68); P=0.294) as compared with younger patients. In 54 patients (55 eyes, 38.5%) aged <35 years and in 18 patients (18 eyes, 47.4%) aged ≥35 years, BCVA increased by ≥2 Snellen lines. Failure (increase in Kmax ≥1 Dpt) was observed in 17 eyes (16.5%) of patients aged <35 years and in 3 eyes (7.9%) of patients aged ≥35 years during the 12-month follow-up period. Adverse outcomes (loss of ≥2 Snellen lines) occurred in 4 (3.9%) eyes of patients aged <35 years and 1 (2.6%) eye of a patient aged ≥35 years.CONCLUSION: Effects and adverse events of CXL treatment do not seem to differ between subjects younger or older than 35 years.


Kavvadias T.,Cantonal Hospital of Lucerne | Baessler K.,TU Berlin | Schuessler B.,Cantonal Hospital of Lucerne
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2011

Aim of this review is to summarise the available literature on the definitions and assessment of pelvic pain in the urogynaecological patient. A MEDLINE search and a hand search of conference proceedings of the International Continence Society and International Urogynecological Association were performed. Sixty-nine articles were reviewed. The site of pain was specified in 45% of the articles, 20% used the digital examination of pelvic myofascial trigger points for the diagnosis; 20%, the Pelvic Pain and Urgency/Frequency Symptom Scale; 26%, the Interstitial Cystitis Symptom and Problem Index and 39%, a simple visual analogue scale. The diagnosis was interstitial cystitis in 67% and chronic pelvic pain in 19% of the articles. Consensus on the diagnostic procedures and definition of pelvic pain in the urogynaecological patient should be achieved in order to provide exact diagnostic information which will lead to more satisfying treatment options. © The International Urogynecological Association 2010.


Kavvadias T.,Cantonal Hospital of Lucerne
International urogynecology journal and pelvic floor dysfunction | Year: 2011

Aim of this review is to summarise the available literature on the definitions and assessment of pelvic pain in the urogynaecological patient. A MEDLINE search and a hand search of conference proceedings of the International Continence Society and International Urogynecological Association were performed. Sixty-nine articles were reviewed. The site of pain was specified in 45% of the articles, 20% used the digital examination of pelvic myofascial trigger points for the diagnosis; 20%, the Pelvic Pain and Urgency/Frequency Symptom Scale; 26%, the Interstitial Cystitis Symptom and Problem Index and 39%, a simple visual analogue scale. The diagnosis was interstitial cystitis in 67% and chronic pelvic pain in 19% of the articles. Consensus on the diagnostic procedures and definition of pelvic pain in the urogynaecological patient should be achieved in order to provide exact diagnostic information which will lead to more satisfying treatment options.


Bochmann F.,Cantonal Hospital of Lucerne
Cochrane database of systematic reviews (Online) | Year: 2012

Late trabeculectomy bleb leaks are a common complication after filtering glaucoma surgery. Although asymptomatic, late bleb leaks may lead to hypotony and are associated with bleb related infections. To assess the effects of interventions for late trabeculectomy bleb leak. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), MEDLINE (January 1946 to July 2012), EMBASE (January 1980 to July 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 18 July 2012. We included randomised and quasi-randomised trials in which any treatments for eyes with late bleb leak (interventional and non-interventional) were compared with each other. Two authors independently assessed trial quality and extracted data. We contacted study authors when additional information was needed. The review included one multicentre trial based in the USA with 30 eyes of 30 participants. The trial compared two surgical procedures (conjunctival advancement and amniotic membrane transplant) to cover a filtering bleb leak. Conjunctival advancement has been shown to be more effective in sealing filtering bleb leaks. Although a variety of treatments have been proposed for bleb leaks, there is no evidence of their comparative effectiveness.The evidence in this review was provided by a single trial that compared two surgical procedures (conjunctival advancement and amniotic membrane transplant). The trial did show a superiority of conjunctival advancement, which was regarded as standard treatment, to amniotic membrane transplantation. There is a need for more randomised trials to validate the findings of this single trial and provide more information on the different types of interventions, especially non-surgical treatments compared to surgical procedures. We recommend that any intervention should be compared to a standard procedure, which is to date conjunctival advancement.


Schmidlin-Enderli K.,Cantonal Hospital of Lucerne | Schuessler B.,Cantonal Hospital of Lucerne
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2013

Introduction and hypothesis: The aim of this study was to investigate the functional and anatomical outcome after a new rectovaginal fascial plication technique in patients with rectoceles or rectal pockets and obstructed defecation. Methods: In a prospective study 54 of 87 patients were examined pre- and postoperatively using the Pelvic Organ Prolapse Quantification (POP-Q) system of the International Continence Society (ICS). Bowel and protrusion symptoms as well as quality of life (QOL) were evaluated by a standardized questionnaire. Surgical therapy consisted of a posterior vaginal wall incision in the midline, a dissection of the vaginal epithelium from the underlying rectovaginal fascia while the rectocele was brought under tension by the index finger in the rectum. Under rectal digital control the surgically exposed rectovaginal fascia was sutured in a cranio-caudal fashion with sagittally positioned running absorbable sutures followed by a careful reapproximation of the laterally separated perineal body in the midline. Results: Obstructed defecation symptoms were cured or improved in 72.2 % [95 % confidence interval (CI) 59.1-82.4]. Anatomical cure rate was 92.1 % (95 % CI 79.2-97.3) and protrusion symptoms were resolved in 73.6 % (95 % CI 58.0-85.0). Of the patients who had intercourse, 5.2 % reported de novo dyspareunia postoperatively; in none of these patients was an anatomical cause found. There were no major intra- or postoperative complications. Conclusions: Sagittal rectovaginal fascial plication in symptomatic rectoceles or functionally relevant rectal pockets is associated with a satisfactory anatomical and functional cure rate without impacting sexual function. © 2012 The International Urogynecological Association.


Bochmann F.,Cantonal Hospital of Lucerne | Kaufmann C.,Cantonal Hospital of Lucerne | Kipfer A.,Cantonal Hospital of Lucerne | Thiel M.A.,Cantonal Hospital of Lucerne
Journal of Glaucoma | Year: 2014

Purpose: Repair of leaking filtering blebs after trabeculectomy is a surgical challenge, especially when the patient presents with hypotony. Repair of the filtering bleb using only conjunctiva reconstruction often fails when deeper tissue structures do not provide sufficient outflow resistance. Here, we present a technique that uses anterior stromal lamellae left over from donor corneas used for descemet stripping automated endothelial keratoplasty procedures as patch grafts to repair the scleral tissue wound as a way to treat ocular hypotony. Materials and methods: We describe a new surgical technique to reconstruct the outflow resistance of melted trabeculectomy scleral flaps and present the course of 5 cases of severe hypotony treated using this technique. Results: All 5 patients suffered from severe hypotony several years after trabeculectomy with antiproliferative agents. Multiple surgical and nonsurgical attempts to treat hypotony had failed. Lamellar corneal tissue was used as a patch graft to replace the weakened sclera near the site of the earlier trabeculectomy. This procedure successfully reversed hypotony in all cases. During the follow-up periods of at least 9 months, no recurrences of bleb leak or hypotony were observed. Intraocular pressure (IOP) remained controlled with topical IOP-lowering treatment in 4 cases. In 1 case, a glaucoma drainage implant was used to control IOP. Conclusions: The use of lamellar corneal donor tissue to restore scleral outflow resistance is a safe and effective treatment for severe hypotony after mitomycin C-assisted trabeculectomy with or without filtering bleb leaks. Copyright © 2013 by Lippincott Williams & Wilkins.

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