Ocular findings in familial adenomatous polyposis

Background: Retinal pigment epithelium (RPE)lesions are predictive congenital phenotypic markersfor familial adenomatous polyposis (FAP). Thisprospective screening study aims at assessing theincidence and significance of these lesions in FAPpatients and their family members.Methods: Sixty-two members from three familiesincluding five patients with the diagnosis of FAP havebeen ophthalmologically surveyed. All RPE lesions weredocumented with fundus photography and fluoresceinangiography was performed in 13 subjects.Sigmoidoscopy and/or radiological examination wereperformed annually in 9 family members with typicalRPE lesions during 4 years to allow early diagnosis ofFAP.Results: Typical RPE lesions were present infive FAP patients and 15 family members.Telangiectatic dilatations in the retinal peripherywith small dot-like hemorrhages were detected in 6subjects from 3 families These lesions wereparticularly evident on fluorescein angiography.Annual colon analysis showed polyps in 3 out of 9subjects who were positive for RPE lesions.Conclusion: RPE lesions are valuable as aclinical marker in predicting FAP. The co-existingperipheral vascular alterations which have not beenreported before, are probably related to FAP.     

Horseshoe-like macular tear following recurrent branch retinal vein occlusion

Background A macular hole can develop as a late complication secondary to a branch retinal vein occlusion (BRVO). We report about an atypical horseshoe-like tear occurring in the fovea after recurrent BRVO. Methods An interventional case report. Results In 1997, a 53-year-old man was seen with an occlusion of macular part of inferior temporal vein of the retina on the left eye. After experiencing several recurrent BRVO in this eye, 6 years later he presented with a horseshoe-like tear in the fovea. Visual acuity was 20/200. The patient underwent standard three-port vitrectomy and installation of C3F8 16%. Intraoperatively, massive traction of the vitreous was detected on the edges of the tear. Six months after the operation, the tear remained attached. The visual acuity was 20/200. Conclusions The uniqueness of the presented case is the occurrence of a macular tear following recurrent BRVO, its horseshoe-like shape and foveal location. To the best of our knowledge, this is the first report on a horseshoe-like tear seen in the fovea secondary to BRVO. We assume that chronic macular edema and retinal ischemia following BRVO were additional factors beside the vitreous traction, contributing to the formation of the macular tear. Anatomical closure of the tear and stabilisation of visual acuity can be achieved by vitreoretinal surgery. There is no financial interest to declare. No grant has been received in relation to this case. Presented as a poster at the 102nd meeting of the German Ophthalmologic Society, 2004 Berlin.     

Visusprognose und Patientenselektion

Choroidal neovascularization (CNV) is one of the leading causes of central vision loss. Laser photocoagulation and photodynamic therapy may reduce the risk of severe loss of visual acuity in subfoveal CNV secondary to age-related macular degeneration. However, the most favorable effect of these therapies is the slowing of the vision loss. Macular translocation surgery, removing the neurosensory retina away from the area of choroidal neovascularization to a healthier underlying tissue, may improve or stabilize the visual acuity. Several pilot studies of this surgery reported visual recovery in selected patients. Well-designed, controlled randomized studies are needed to clarify the role of the macular translocation surgery in treatment of choroidal neovascularization. Given the severe complications of this surgery, it is of utmost importance to discuss the potential risks and advantages of this procedure with the patient.     

Histological findings in experimental macular surgery with indocyanine green

PURPOSE: To analyze the effect of different concentrations and application intervals of indocyanine green (ICG) on the retina in an experimental setting of macular surgery. METHODS: Twenty-one porcine eyes were used within 5 hours after enucleation. The eyes were hemisected and the vitreous removed. Different doses of ICG (up to 1 mg) were applied over the trephined macula, and the remainder of the eyecup was filled with a balanced salt solution (BSS). Both the ICG solution and the BSS were drained after 30 or 60 seconds and the complete eyecup irrigated and filled with fresh BSS. The posterior pole was then illuminated with a standard surgical light pipe and light source at maximum power for 3 minutes. Both the ICG-treated retina and the nontreated surrounding retina were processed for histology. RESULTS: Exposure of the retina at different concentrations of ICG either for 30 or 60 seconds, followed by illumination, caused no histologically detectable damage compared with the controls. No microarchitectural disorganization or cellular disruption was detected. The vitreoretinal interface seemed unaffected. CONCLUSIONS: Previously described severe damage to the inner retina of human donor eyes could not be found with even higher doses of ICG in this porcine model. Although differences within the species may contribute to these contradictory results, it is conceivable that the postmortem time and the vitality of the tissue influence the outcome in this ex vivo system.     

Pars plana vitrectomy and removal of the internal limiting membrane in the treatment of chronic macular oedema

Background To evaluate the results of pars plana vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic macular oedema.Methods PPV with indocyanine green (ICG) assisted peeling of the ILM was performed in 33 eyes with diabetic (21 eyes) or non-diabetic (12 eyes) macular oedema. Postoperatively, resolution of macular oedema, improvement of visual acuity (VA) and complications were documented. The peeled membranes were submitted for light and transmission electron microscopic evaluation.Results The mean follow-up time was 12.2 months. The macular oedema decreased or was resolved in 17 (81%) eyes in the diabetic group and in 11 (92%) eyes in the non-diabetic group. VA improved by at least 2 lines in 11 (52%) eyes in the diabetic group and in 7 (58%) eyes in the non-diabetic group. The difference between visual acuity improvements of the two groups was not statistically significant (P>0.05). However, in the diabetic group the difference of visual improvement between cystoid and diffuse type of macular oedema eyes was statistically significant (14% versus 71%, P=0.02). Light and transmission electron microscopy showed the presence of ILM in all specimens. During the follow-up period no recurrence of macular oedema or epiretinal membrane formation was observed.Conclusion Pars plana vitrectomy with peeling of the ILM and epiretinal membrane leads to the resolution of macular oedema in the majority of eyes. This however, is not always associated with VA improvement. In diabetic eyes, cystoid type of macular oedema appears to be a poor prognostic factor for improved VA.     

Visusprognose und Patientenselektion

Die choroidale Neovaskularisation ist eine der wichtigsten Ursachen des zentralen Sehverlustes. Die Laserkoagulation und die photodynamische Therapie k?nnen das Risiko des schweren Sehverlustes bei der subfovealen choroidalen Neovaskularisation verringern. Trotzdem kann im günstigsten Fall für die Patienten nur eine Verz?gerung der Sehverschlechterung erreicht werden. Die Makulatranslokation, mit Verlagerung der neurosensorischen Netzhaut auf eine gesündere Unterlage, bietet eine Perspektive zur Verbesserung des Sehens bzw. zu dem Erhalt vorhandener Sehfunktionen. Pilotstudien zur Makulatranslokation mit unterschiedlichen operativen Techniken berichteten über positive Ergebnisse. Andererseits sind auch schwere Komplikationen nach diesem Verfahren bekannt. Bis eine prospektive kontrollierte Studie zur Makulatranslokation aussagekr?ftige Daten liefert, kann dieses Verfahren als Therapieversuch nach ausführlicher Aufkl?rung geeigneten Patienten angeboten werden. Die gegenw?rtigen Indikationen auf Basis der vorliegenden Daten zur Makulatranslokation werden diskutiert.     

Über die oto- und rhinogene Erysipelas,insbesondere deren postoperative Formen

Ohne ZusammenfassungMit 2 AbbildungenAus einem Vortrage gehalten am 4. April 1930 auf der Jahresversammlung der Japanischen Otorhinolaryngologischen Gesellschaft zu Osaka.     

Acetylsalicylic acid and misoprostol combination in adjuvant arthritis of rats

The combined effect of acetylsalicylic acid (ASA) and misoprostol (MISO) on adjuvant arthritis was investigated on rats. Alteration by various doses of MISO and fixed dose of ASA was studied. Drugs were given by the nasogastric route each day beginning from the day of adjuvant injection (day 0) and continued until the 16th day. Paw swelling was measured on days 4, 17, and 29, and secondary lesions were assessed on days 17 and 29. Pathological examination of tibiodorsal junction was also evaluated on the 29th day. The results clearly showed that the combination of MISO with ASA did not inhibit the antiinflammatory effect of ASA. Unexpectedly, MISO increased the antiinflammatory effect of ASA at some dosage regimens.     

A clinical review of Stargardt's disease and/or Fundus Flavimaculatus with follow-up

Out of 49 patients diagnosed as having Stargardt's disease that have been clinically reviewed, 22 of these cases have been followed for a period up to 13 years. The cases have been studied in three subgroups, according to their fundus appearance. Patients from group I were those whose lesions were confined to the macula, showing no flecks in the retina. In group II the macular lesion was surrounded by perimacular flecks and in group III fundus flavimaculatus flecks were seen, diffusely scattered in the posterior pole. It appears that the prognosis of group I is better than the other groups, where surrounding flecks are seen in addition to the macular lesion.The follow-up indicates that the disease evolves with a rather large spectrum of expressivity. Assessment of a predictive factor for the evolution of the disease is not yet possible. However, the observation of a dark choroid appears to be strongly suggestive for a further centrifugal progression of the disease.