Gibt es eine Pseudo-Tapetoretinale Degeneration auch bei der Toxoplasmosis acquisita?

Zusammenfassung An Hand von vier Fällen wird aufgezeigt, daß aller Wahrscheinlichkeit nach auch die Toxoplasmosis acquisita zu pfeffer-und-salz-fundusartigen und zu Retinitis pigmentosa-ähnlichen Veränderungen der Augenhintergrundsperipherie zu führen vermag. Das Zustandsbild der Pseudo-Degeneratio tapetoretinalis toxoplasmotica acquisita wird eingehend geschildert. Gelegentlich sind mit diesem auch zentrale Veränderungen vergesellschaftet. Da die bisherigen klinischen Erfahrungen noch nicht ausreichen, für die toxoplasmotische Erkrankung der Augenhintergrundsperipherie ein ähnlich kennzeichnendes Zustandsbild aufzustellen, wie es die Retinitis exsudativa externa centralis (Rieger) für die toxoplasmotische Erkrankung der Netzhautmitte zu sein scheint, sind derartige Fälle gegen die senile Pigmententartung der Netzhaut (Pillat), gegen die peripheren Formen der Tapetoretinalen Degeneration und schließlich gegen die Chorioretinitis syphilitica diffusa (JacobsonFörster) abzugrenzen. Nach Mitteilung einer Sippe mit anscheinend unvollständig-geschlechtsgebunden-rezessiv erblicher feinkörniger Form der Tapetoretinalen Degeneration und mit gleichzeitig positivem Ausfalle der Toxoplasmoseteste werden an Hand zweier Beobachtungen von gleichzeitiger Infektion mit Lues und mit Toxoplasmose die hier obwaltenden diagnostischen Schwierigkeiten dargelegt. Unter Schilderung des tragischen Schicksals eines dieser beiden Fälle wird eindringlichst betont, daß bei Fehlen der elterlichen Blutsverwandtschaft und des Sippenbeweises die Diagnose einer Tapetoretinalen Degeneration nur mit größter Vorsicht gestellt werden darf.Mit 1 Textabbildung     

Analysis of the causes of enucleations performed at the Department of Ophthalmology of the Medical University of Lódź

PURPOSE: To gather and analyse the data about causes of enucleations, which were performed in the Department of Ophthalmology, Medical University of Lód?. MATERIAL AND METHODS: The data were based on case histories. The whole examined group consisted of 57 patients, who had an enucleation surgery done in the period from June 1999 to June 2003. The analyzed data included: clinical diagnosis, visual acuity, intraocular pressure, results of histopathology examination and results of diagnostic imaging examinations. RESULTS: The most frequent causes of enucleations were: intraocular tumors (fraction 0.51 of the whole group), painful blind eyes (fraction 0.33), endophthalmitis (fraction 0.12) and ocular traumas (fraction 0.04). CONCLUSIONS: Despite significant advances in ophthalmology in recent years, enucleation remains a method of treatment. The main indications for this type of surgery are: intraocular tumors, painful blind eyes, severe endophthalmitis and some cases of ocular trauma.     

Is the partial pressure of carbon dioxide in the blood related to the development of retinopathy of prematurity?

AIMS: To determine the role of carbon dioxide in the development of retinopathy of prematurity (ROP). METHODS: This was a retrospective cohort study of 25 consecutive infants admitted to the neonatal unit with continuously recorded physiological data. The daily mean and standard deviation (SD) of transcutaneous carbon dioxide partial pressure (tcPCO(2)) was compared between infants who had stage 1 or 2 ROP and stage 3 ROP. The time spent hypocarbic (<3 kPa) and/or hypercarbic (>10 kPa and >12 kPa) was also compared between these groups. Intermittent arterial carbon dioxide tension was also measured and compared with the simultaneous tcPCO(2) data. RESULTS: There were no significant differences in carbon dioxide variability or time spent hypocarbic and/or hypercarbic between the ROP groups on any day. 86% of transcutaneous values were within 1.5 kPa of the simultaneous arterial value. CONCLUSION: TcPCO(2) measurement can be a very useful management technique. However, in this cohort neither variable blood carbon dioxide tension nor duration of hypercarbia or hypocarbia in the first 2 weeks of life was associated with the development or severity of ROP.     

Review of the treatment of Graves’ ophthalmopathy: The role of the new radiation techniques

Graves ophthalmopathy (GO) is an autoimmune disorder and the most frequent extrathyroidal manifestation of Graves’ disease. GO is an inflammatory process leading to an increased volume of the extraocular muscles and orbital connective and adipose tissues associated with multiple histopathological changes. Despite recent progress in the understanding of its pathogenesis, GO often remains a major diagnostic and therapeutic challenge. It has become increasingly important to classify patients into categories based on disease severity and activity. Low doses of radiotherapy (RT) have demonstrated a benefit in the treatment of moderate-to-severe GO with very few side effects. New RT techniques deliver a more conformal dose distribution to the target and decrease the dose to normal healthy tissue minimizing the risk of side effects. In this review we briefly analyzed the pathogenesis of GO and discussed the most relevant therapeutic approaches, with particular emphasis in the new RT technics. Appropriately designed and powered clinical studies are necessary to determine the most effective treatment with the lowest risk of side effects.     

Does identification of the causal organism of corneal ulcers influence the outcome?

PURPOSE: To investigate whether identification of the causal organism in corneal ulcers influences their outcome. METHODS: We retrospectively studied 114 patients, 72 males and 42 females aged 6-89 years, admitted to this eye clinic during the years 1994-2000 on account of an infectious corneal ulcer. Their examination included a detailed history, visual acuity measurement, and biomicroscopy in everyday follow-up. The ulcers were classified according to their severity and outcome. We assessed the cases where cultures had been done, reviewed the results, and searched for a possible correlation between the outcome and the fact of culturing the ulcer and identifying the causal organism. RESULTS: Of the 114 corneal ulcers studied, 23 were mild, 49 moderate, and 42 severe. Fifty (44%) had not been cultured, but 64 ulcers (56%) had been cultured, with a positive result in 37 cases (58%), Staphylococcus and Pseudomonas species being the most common organisms found. In moderate and severe ulcers, there was a tendency to a higher proportion of successful outcome for cultured ulcers, but with no significant correlation. CONCLUSIONS: Despite a tendency towards favorable results in culture-positive corneal ulcers, the influence of the detection of the organism on their outcome has not been proved. The role of the initial broad-spectrum antibiotic therapy remains important.     

Topographical Evaluation of the Decentration of Orthokeratology Lenses

Purpose: To evaluate the amount of lens decentration and various factors affecting decentration after orthokeratology lens wear and to observe the effect of decentration on the visual functions. Methods: Two kinds of orthokeratology lenses were fitted to 270 eyes of 135 patients [initial mean refractive error: (-3.98±1.51 )D]. Humphery Instruments ATLAS 990 was used for the computer-assisted analysis of corneal topographical maps. The examination of corneal topography was performed on patients before and after 6 months of wearing orthokeratology lenses. The amount of decentration of orthokeratology lenses was measured by finding the distance between center of optic zone and the pupil center. The factors influencing the amount of decentration were analyzed, including the initial refraction error, astigmatism, keratometry values, corneal eccentricity, and the diameter of lens. Visual symptoms including monocular diplopia, glare around lights were recorded to evaluate the effects of decentration on visual functions. Results: The mean amount of decentration was (0.49±0.34) mm after one night's wear. The mean amount of decentration after 1 month, 3 months and 6 months was (0.57±0.41) mm, (0.55±0.48) mm and (0.59±0.39) mm, respectively. After one month, the amount of decentration was less than 0.50 mm in 51.1% eyes, 0.50-1.0 mm in 35.6% eyes and more than 1.00 mm in 13.3% eyes. The direction of decentration of more than 0.50 mm was mainly in the temporal quadrant (48.5%). Patients with greater initial astigmatism and smaller lenses showed greater decentration (P<0.05). There was no statistically significant difference in decentration between the two groups with different corneal eccentricities and keratometry values (P>0.05). The amount of decentration was greater in patients who complained of monocular diplopia and glare. Conclusions: The amount of decentration of orthokeratology depends on the initial refractive error, astigmatism and the design of orthokeratology lenses. Improvement in fitting technology and lens design can lead to reduced incidence of decentration and visual symptoms. Eye Science 2005;21:132-135.     

How good is the match between the plane of the text and the plane of focus during reading?1

Because results from animal models demonstrate that retinal image defocus is a crucial factor in the visual control of eye growth, we have measured the precision of accommodation during reading at 1 m and at 30 cm distance. A newly developed photorefractor was used to sample both the refraction in the vertical meridian and direction of gaze at 25 Hz. Using these two parameters, a three-dimensional "refraction map" of the visual field was plotted. It showed the optic disc as an area with more myopic refractions and the course of refractions across a visual field of about +/- 25 deg. A special calibration scheme was employed to ensure that the precision of the refractions was 0.2 dpt or better (as estimated from the standard deviations of repeated measurements and the noise in the calibration curve). Twelve young adults (students from the lab) served as subjects. We found considerable inter-individual variability in the off-axis refractions but little variability among repeated measurements in the same subjects. Inter-individual variability reached a minimum in the foveal region. Both myopes wearing their spectacle corrections (n = 6) and emmetropes (n = 6) under-accommodated by about 0.3 D during reading at 30 cm distance but, at 1 m distance, only the emmetropes under-accommodated. Since both refraction groups under-accommodated similarly during reading at close distance, it remains unclear whether the small amount of defocus is critical for their future myopia development. Either accommodation errors differ at earlier times when myopia first appears (as suggested by the literature), or the subjects' eye growth was differently sensitive to defocus, or our simple protocol did not pick up existent differences in accommodation among the two groups.     

Abstracts of the presentations of the 193rd meeting of the Dutch Ophthalmological Society,Amsterdam, 17–19 March 1999

1. NM Jansonius, AM van der Vliet,FW Cornelissen, AC Kooijman:An achiasmatic girl with a horizontal nystagmus2. CAB Webers: Brimonidine 0.2%3. AF Deutman: Vitreomacular surgery, a new subspecialism4. MMA Scbreurs, EC La Heij, F Hendrikse: Evaluation ofscleral buckling procedure in primary retinal detachment; a sequel5. F Hendrikse, A Liem, E la Heij: Vitrectomies and persistentdiabetic macular oedema6. EC La Heij, PJFM Derhaag, TA Liem, F Hendrikse: Results ofsurgery for complex retinal detachments after removing silicone-oil7. JMM Hooymans, VW Renardel de Lavalette, AG Oey: Formationof proliferative vitreoretinopathy in primary rhegmatogenous retinaldetachment8. JS Stilma, PR van den Biesen, PAWJF Schellekens: Primaryvitrectomy in pseudophakic retinal detachment9. RJW de Keizer, D de Wolff-Rouendaal, PCW Hogendoorn, M Nooy: Angiosarcomain ophthalmology10. H Brink, C Smulders, G Weers-Pothoff, G Wanten,C Vandenbroucke-Gauls: Ocular colonization by Pseudomonasaeruginosa in mechanically ventilated patients     

Methylglyoxal induces hyperpermeability of the blood–retinal barrier via the loss of tight junction proteins and the activation of matrix metalloproteinases

Background  

One of the early signs of diabetic retinopathy is the alteration of the blood–retinal barrier (BRB), which may involve the breakdown of endothelial cell tight junctions. Methylglyoxal (MGO) is a cytotoxic metabolite that is produced from glycolysis in vivo. Elevated levels of MGO are observed in a number of pathological conditions, including neurodegenerative disorders and diabetic complications. Herein, we hypothesize that increased levels of MGO disrupt the tight junction protein known as occludin protein by matrix metalloproteinases (MMPs), leading to breakage of the BRB.     

Abstracts of the presentations of the 192nd meeting of the Dutch Ophthalmological Society,Maastricht, 18–20 March 1998

Background: Iris arteriovenous communication (IAVC) represents a quite rare congenital anomaly, consisting of abnormal vascular connection bypassing the iris capillary bed. The aim of the present study is to describe clinical and angiographic pattern of IAVC on iris fluorescein angiography (IFA) and on indocyanine green videoangiography (IICGV). Methods: During a mean follow-up period of 33.5 months, eight patients affected by IAVC underwent at least three ophthalmological examinations completed by IFA and IICGV. Results: IFA allows the detection of IAVC vascular structures, evidencing afferent and efferent branches, which show a rapid filling, without any evidence of leakage or iris hypoperfusion. IICGV shows more precisely the entire vascular pattern of IAVC, revealing also the presence of iris hypoperfusion in the sector in which the IAVC lay. One patient underwent cataract surgery; three months later, two neovascular tufts appeared in the hypoperfused area related to IAVC. In all other patients, periodical examinations did not reveal any clinical or angiographic changes. Conclusion: In IAVC, the clinical picture appears stable throughout the follow-up; both angiographic techniques seem able to precisely delineate the vascular pattern. Nevertheless, IICGV is superior in showing iris hypoperfusion surrounding the vascular abnormality. Particular care must be drawn to patients affected by IAVC who need cataract surgery.     

Study on Application of the Silicone Oil in the Reattachment of Complicated Retinal Detachment

Sixty eyes with complicated retinal detachment were treatedby vitrectomy combined with silicone oil tamponade (27 eyes of PMR gradeD,15 eyes of giant retinal tears with posterior flat folded-over,13 eyes ofposterior or macular hole,5 eyes of traumatic PVR).After 3-24 monthsfollow-up,the study showed retinal anatomic reattachment in 48 eyes inwhich the visual acuity of 32 eyes was 0.05 or better.The authorsconsider that vitrectomy and peeling make the silicone oil tamponadeperfect the vitreous surgery and improve the successful rate.The theoryof silicone oil tamponade,the indications,advantages and disadvantagesof silicone oil tamponade are discussed in this paper.Eye Science1993,9:146-148.