Okuläres vernarbendes Pemphigoid

Als Pemphigoide wird eine Gruppe bull?ser Dermatosen mit St?rung der Koh?sion zwischen Basalschicht der Epidermis und Dermis bezeichnet. Klinisch liegen csubepidermale Blasen vor. Dies unterscheidet die Pemphigoidgruppe vom echten Pemphigus mit intraepidermal gelegener Blasenbildung. Zu den Pemphigoiden werden heute das vernarbende und das bull?se Pemphigoid gez?hlt. Insbesondere die erste Form ist sehr h?ufig von einer Augenbeteiligung begleitet bzw. kann sich als isolierte schwerwiegende okul?re Erkrankung pr?sentieren.     

Okul?res vernarbendes Pemphigoid Retrospektive Analyse von Risikofaktoren und Komplikationen Retrospektive Analyse von Risikofaktoren und Komplikationen

Das vernarbende Pemphigoid (cicatricial pemphigoid, CP) ist eine seltene, mit subepidermaler Blasenbildung und Vernarbung einhergehende Autoimmunerkrankung, die sich an Haut und Schleimhaut manifestiert. Eine Augenbeteiligung liegt bei etwa 70% der Patienten vor. Methode: Retrospektiv wurden Krankheitsverlauf, klinische Komplikationen und m?gliche Risikofaktoren von Patienten der Augen- und Hautklinik mit vernarbendem Pemphigoid von 1986–1998 untersucht.     

Okuläres Risiko bei obstruktivem Schlafapnoesyndrom

Purpose

A prospective controlled cohort study examined the effects of obstructive sleep apnea syndrome (OSAS) on the visual field, including morphological and physiological aspects.

Methods

Thirty-two patients with newly discovered and previously untreated moderate to severe OSAS (apnea–hypopnea index >20) were compared with a control group of 32 healthy individuals. Global visual field indices [mean deviation (MD), corrected pattern standard deviation (CPSD)] were compared, and optic disc changes, intraocular pressure, correlations between MD and polysomnography, and the frequency of local defects (using the Humphrey Field Analyzer) were examined.

Results

The MD was significantly reduced (R –1.66/L –1.62 dB; p<0.001) in OSAS patients, whereas there was no difference in CPSD. Diffuse local defects in the middle periphery of the 30° visual field were increased in OSAS patients (p<0.003). Normal intraocular tension values were found in all persons, with no correlation to MD. The incidence of pathological optic disc changes was increased in the apnea group (6.25%).

Conclusions

OSAS seems to lead to reduced sensitivity in the visual field by diffuse rarefaction of nerve tissue in the retina, optic nerve, or both. An increased incidence of development of a low-tension glaucoma is assumed.     

Okuläre Manifestationen und chirurgische Ergebnisse beim Marfan-Syndrom

AIM: This retrospective study should examine and judge the surgical indications and the therapeutic possibilities as well as their complications in patients with ocular manifestations of Marfan syndrome (MFS) diagnosed according to the criteria of the Ghent nosology. PATIENTS AND METHODS: The study included 17 patients. Operative indications were increasing subluxation of the lens, retinal detachments and secondary glaucoma. The operative procedure depended on patient age and findings. Eleven MFS patients were operated in both eyes and six MFS patients in one eye. RESULTS: Stabilization or functional improvement of visual acuity could be achieved in all patients in whom no disorders limiting visual acuity or amblyopia were present preoperatively. In six eyes of five patients, lens insertion was accomplished via a pars plana approach. Lens removal without implantation of an intraocular lens was performed in 16 eyes of 10 patients. Pars plana vitrectomy was accomplished in 12 eyes. Complications were well controlled by pars plana vitrectomy. CONCLUSIONS: Difficult preoperative situations and postoperative complications are not rare in MFS patients. However, they can be controlled well by means of modern vitreous surgery.     

Okuläre Hämodynamik und Gesichtsfeld beim Glaukom unter Dorzolamid-Therapie

Objective. It has been shown that oral carbonic anhydrase inhibitors improve visual function in glaucoma. Furthermore topical dorzolamide might improve ocular hemodynamics, as was demonstrated previously. This study was undertaken to evaluate whether topical dorzolamide affects visual function and ocular hemodynamics in glaucoma. Methods. In a retrospective, open clinical trial, dorzolamide eye drops were administered to 28 patients with confirmed primary open angle glaucoma (POAG) in both eyes, 3 times daily for a mean follow up of 9 months. One eye was randomly chosen for evaluation. IOP, blood pressure, heart rate, pulsatile ocular blood flow (POBF) and Humphrey 30–2 visual fields were measured at baseline and after the start of the therapy. POBF was determined by pneumotonography. For statistical analysis the Wilcoxon-matched-paired test and the Bonferoni-Holm adjustment were used. Results. In dorzolamide-treated patients the IOP dropped from 18 mmHg to 15.5 mmHg after 9 months therapy (p<0.01) and the visual field improved significantly by 18% (p<0.05). A statistically significant change was found for POBF from 543 μl/min to 675 μl/min (p<0.05). Conclusions. The results showed the expected drop in intraocular pressure. Visual function and pulsatile ocular blood flow improved significantly which might be explained by an analogous, vasodilatory effect as was observed in orally applied carbonic anhydrase inhibitors.     

Okuläre Toxoplasmose-Antikörper in Kammerwasser und Serum

BACKGROUND: The diagnosis of ocular toxoplasmosis is mainly based on ophthalmological examination but might be difficult to establish in some cases. The purpose of our study was to evaluate the value of aqueous humor and serum analysis in ocular toxoplasmosis. PATIENTS AND METHODS: We analyzed the avidity of toxoplasma-specific IgG in aqueous humor and serum samples from 50 patients with toxoplasmic retinochoroiditis, with 25 patients with uveitis posterior or panuveitis serving as controls. RESULTS: Specific intraocular antibody synthesis could be confirmed in 49 patients (98%). In two patients (8%) of the control group, antibody synthesis was detected (false positive). Forty-nine patients with diagnoses of ocular toxoplasmosis were positive for serum anti-T. gondii IgG, but only three patients had increased IgM levels. CONCLUSIONS: Analysis of local antibody production is a reliable method for confirming or excluding a suspected clinical diagnosis of toxoplasma retinochoroiditis. The determination of toxoplasma antibodies in the patients' serum is of limited value.     

Makuläres Pigment und altersabhängige Makuladegeneration

The present concepts of the pathogenesis of AMD include cummulative light damage by oxidative processes in the macular photoreceptors as enviromental co-factor for the developement of AMD. The direct causative connection of this hypothesis has still to be established but wide circumstantial evidence from epidemiological and basic scientific investigations are strongly supportive. Macular pigment consisting of lutein and zeaxanthin through there ability to filter light and by direct antioxidative properties, has been proposed as the most effective protective factor in the central retina (“natural sun glasses”) and could be important to reduce light induced oxidative retinal damage. The observation, that with age and especially in eyes with AMD lower concentrations of macular pigment could be found, can be interpreted that low macular pigment concentrations may be associated with higher risk for AMD. Through dietary intake and eventually with supplementation the concentration of macular pigment can be increased, and analysis of the correlation between macular pigment and AMD may be important to characterise a possible influencable AMD risk factor.     

Assoziation zwischen klassischen kardiovaskulären Risikofaktoren und altersabhängiger Makulopathie (ARM)

BACKGROUND: Epidemiological studies have reported inconsistent associations between cardiovascular risk factors and the occurrence of age-related maculopathy (ARM). METHODS: In the baseline examination of the Muenster Aging and Retina Study (MARS), we assessed this potential relationship in 1060 subjects who underwent clinical and ophthalmologic examinations. The ARM status was graded according to international standardized classifications. RESULTS: There were 974 eye pairs available for analysis. Smoking, hypertension, hypercholesterolemia, and a history of myocardial infarction or stroke were found significantly more often in patients with ARM. There were no statistically significant multivariate associations between overweight, diabetes, or a history of myocardial infarction or stroke. CONCLUSIONS: Our results confirm previous epidemiological studies pointing to a potential role of atherosclerotic processes in the development of ARM.     

Retrospektive Fallanalyse zum ophthalmologischen und internistischen Risikoprofil von retinalen Gefäßverschlüssen

Objective

The aim was to determine systemic risk factors for acute central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) and to evaluate the usefulness of systemic diagnostics in CRAO and CRVO.

Methods

The study consisted of a retrospective chart review including 80 patients (CRAO 38, CRVO 42). All patients underwent systemic diagnostics including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, transthoracic echocardiography (TTE), intraocular pressure measurement, glaucoma history and presence of thrombophilic factors. A systemic medical history was obtained.

Results

Systemic hypertension was found in 76.3% CRAO and 75.6% CRVO patients. Abnormal cardiac findings were detected in 61% (CRAO) and 22% (CRVO). Abnormal carotid findings were detected in 44.1% for CRAO and 9.5% for CRVO. Pathological thrombophilic factors were found in boths groups for approximately 15%.

Conclusions

TTE and carotid Doppler are important tools in the diagnosis of sources of emboli in patients with CRAO, while for CRVO abnormal findings are revealed by TTE and carotid Doppler less often. Thrombophilia should be ruled out in the absence of common risk factors, especially in younger patients and systemic hypertension should be adequately controlled.     

Über familiäres Vorkommen von spontanem pulsierenden Exophthalmus

Ohne Zusammenfassung     

Hygiene von Phakoemulsifikations- und Vitrektomiegeräten Kontaminierung und Bewertung

BACKGROUND: Contamination of automated surgical equipment is widely disregarded as a potential source of perioperative infection. We investigated the possibility of contamination of the aspiration fluid by the vacuum control manifold (VCM). The normal, unsterile internal VCM was compared with a modified external VCM that was regularly disinfected. MATERIALS AND METHODS: We investigated 37 aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. There were 25 specimens from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 specimens from one system equipped with a modified external VCM (control group). No hygiene procedures were used with the hidden internal VCM, but the modified external VCM was regularly rinsed and filled with 70% isopropanol overnight. Specimens were collected under sterile conditions, centrifuged, cultured for bacterial growth on blood agar and MacConkey agar for 24-48 h at 37 degrees C, and analyzed microbiologically. RESULTS: Aspiration fluids of irrigation/aspiration systems used for intraocular surgery were found to be severely contaminated with bacteria originating from the VCM. In all aspiration fluid specimens from internal VCM systems, 2(+)-4+ bacterial growth was found. Stenotrophomonas maltophilia (17), Comamonas acidovorans (8), and Agrobacterium radiobacter (13) were found most frequently. All specimens from the modified external VCM system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between experimental and control groups (P = 0.0001, chi 2). CONCLUSIONS: We found that the aspiration fluid of common phaco- and vitrectomy systems was strongly contaminated by bacteria originating from the internal VCM. The technical modification of an external VCM allows easy disinfection and prevents contamination of the aspiration fluid.     

Epitheliotrophe Kapazität von Serum- und Plasmaaugentropfen

BACKGROUND: Serum eyedrops are a new modality for the treatment of ocular surface disorders. We examined the influence of the preparation of blood products in a cell culture model and compared it with plasma. MATERIAL AND METHODS: Serum and plasma were obtained from full blood of ten healthy volunteers and centrifuged at 500 and 3000 G. EGF, PDGF, TGF-beta1, fibronectin, and vitamin A were quantified by means of ELISA and HPLC. Cultures of human corneal epithelial cells were incubated with the four blood products in dose-response experiments and the intracellular ATP quantified. RESULTS: EGF, PDGF, and vitamin A were present in serum in significantly higher concentrations than in plasma. The concentration of fibronectin was not influenced by the preparation. Support of proliferation was best by 25% platelet-poor serum. Serum supported the differentiation and migration of epithelial cells better than plasma. CONCLUSION: The biochemical character of serum eyedrops is determined by the parameters chosen to produce the blood product. Plasma does not seem to offer an epitheliotrophic capacity equivalent to serum eyedrops. Their production should be optimized before any meaningful randomized controlled clinical trial can be attempted.     

Zuverlässigkeit und Sicherheit von intravitrealen Ozurdex-Injektionen

Background

Since July 2010 Ozurdex® is approved in Germany for treatment of macular edema from retinal vein occlusion (RVO). The objective of this observational study was a systemic summary and analysis of clinical experience regarding complications and side effects of intravitreal administration of dexamethasone.

Patients and methods

In a retrospective, multicenter study conducted at 10 centers, 342 eyes with RVO were treated with intravitreal dexamethasone (Ozurdex®, Allergan). After treatment the patients were followed-up over a period of 8 months and intraoperative, perioperative and postoperative complications, such as elevated intraocular pressure and dislocation of implants were systematically recorded.

Results

No infections, endophthalmitis, perioperative hypotension, intraoperative lens injuries or retinal detachment occurred. Elevated intraocular pressure was the most common complication accounting for nearly 20 %. In 9 % of patients the intraocular pressure increased by more than 10 mmHg compared to baseline and in 6 patients to >?35 mmHg. In cases of known glaucoma intraocular pressure elevation was not significantly more frequent compared to non-glaucoma patients. In four cases a progression of lens opacity led to phacoemulsification and two implant dislocations in the anterior chamber required surgical repositioning in the vitreous cavity. In two cases a postinterventional macular hole was observed.

Conclusions

In the clinical routine Ozurdex treatment has proven to be a therapy method with minimal side effects. In Ozurdex administration intraocular pressure elevation was observed as the most common side effect; however, this generally did not require surgical intervention. Caution is advised in patients with an anterior chamber lens and iridectomy. Macular holes as a rare complication might result from vitreous traction during the administration process. In summary, even in the clinical routine application of Ozurdex the complication rate was not higher than in registration studies.     

Osmotischer Druck und elektrische Leitfähigkeit von intraokularen Flüssigkeiten und Blutserum von Tieren

Ohne Zusammenfassung     

Augeninnendruck während und nach dem Spielen von Hoch- und Niedrigwiderstandblasinstrumenten

Background

A Valsalva maneuver was performed while playing wind instruments during which the intraocular pressure (IOP) increased.

Methods

IOP was assessed by a rebound tonometer while playing 32 high and low resistance wind instruments in a sitting position. The measurements were obtained during normal and laboured playing sequences as well as after cessation.

Results

The highest increase in IOP of 9.2 mmHg (p<0.001) could be observed during laboured playing of high resistance wind instruments. Additionally a negative correlation was detected between the level of the IOP increase and the relative decrease towards the initial value after performance.

Conclusion

IOP changes found in particular during laboured playing with high resistance wind instruments could be a risk factor for glaucomatous optic nerve damage.     

Stäbchen- und Zapfenwirkung von Fischhypophysen-Implantationen bei Retinitis pigmentosa und Maculadegenerationen

Zusammenfassung Durch Fischhypophysen-Implantationen konnte bei Retinitis pigmentosa-Fällen die Dunkeladaptation, bei Maculadegenerationen die Funktion der Netzhautmitte bedeutend verbessert werden. Die auf die Stäbchen und Zapfen ausgeübte Wirkung wird mit einer Sehstoff-Neogenese fördernder Wirkung melanocytenaktiver Stoffe erklärt.Mit 3 Textabbildungen