Topical retinoic acid treatment of drug-induced pseudopemphigoid

A case of drug-induced ocular cicatricial pemphigoid with pronounced keratinizing squamous epithelium metaplasia was treated for 5 months with all-trans retinoic acid ointment. Keratinization reversed completely and the cicatricial process was stabilized in one eye and slowed down in the other eye. The treatment was well tolerated.     

Habitual and goal-directed factors in (everyday) object handling

A habitual and a goal-directed system contribute to action selection in the human CNS. We examined to which extent both systems interact when selecting grasps for handling everyday objects. In Experiment 1, an upright or inverted cup had to be rotated or moved. To-be-rotated upright cups were more frequently grasped with a thumb-up grasp, which is habitually used to hold an upright cup, than inverted cups, which are not associated with a specific grasp. Additionally, grasp selection depended on the overarching goal of the movement sequence (rotation vs. transport) according to the end-state comfort principle. This shows that the habitual system and the goal-directed system both contribute to grasp selection. Experiment 2 revealed that this object-orientation-dependent grasp selection was present for movements of the dominant- and non-dominant hand. In Experiment 3, different everyday objects had to be moved or rotated. Only if different orientations of an object were associated with different habitual grasps, the grasp selection depended on the object orientation. Additionally, grasp selection was affected by the horizontal direction of the forthcoming movement. In sum, the experiments provide evidence that the interaction between the habitual and the goal-directed system determines grasp selection for the interaction with every-day objects.     

Biomechanical evaluation of different fixation methods for tibial eminence fractures

BACKGROUND: Tibial eminence fractures have become more common, but the best method of fixing these fractures arthroscopically has not been elucidated. OBJECTIVE: The objective of this study is to assess the stability of different fixation methods for tibial eminence fractures. STUDY DESIGN: Controlled laboratory study. METHODS: The authors evaluated the initial fixation strength of 4 different fixation techniques for tibial eminence fractures (2 screws, 1 screw, suture fixation with 1 mm Ethibond, and suture fixation with No. 5 FiberWire) using single cycle and cyclic loading tests. The tests were performed by loading the knee with an anterior tibial shear force. RESULTS: Suture cerclage with the FiberWire showed significantly higher maximum load (599.6 N) and stiffness (36.99 N/mm) than all other fixation methods tested. The lowest maximum load in the single cycle loading test was observed in the group with 2 screws (1 screw, 371.2 N; 2 screws, 249.8 N). The lowest stiffness was found in the Ethibond group (14.5 N/mm). After 1000 cycles of loading, the maximum load of the FiberWire fixation was significantly higher than the maximum load of the Ethibond fixation (399.4 N), the fixation with 1 screw (354.2 N), and the fixation with 2 screws (301.5 N). CONCLUSION: These biomechanical data suggest that under cyclic loading conditions, suture fixation of tibial eminence fractures provides more fixation strength than screw fixation. CLINICAL RELEVANCE: A second screw has no positive effect on the biomechanical characteristics of screw fixation.     

“White dot syndromes”, an inappropriate and outdated misnomer

International Ophthalmology -     

Detection of Toxoplasma gondii DNA in primary intraocular B-cell lymphoma.

Primary intraocular lymphoma, a variant of primary central nervous system lymphoma with ocular involvement, is a large B-cell non-Hodgkin's lymphoma. Some cases of primary intraocular lymphoma have been reported to be associated with microorganisms including Epstein-Barr virus (EBV) and human herpes virus-8 (HHV-8), but not parasites. We analyzed 10 cases of primary intraocular lymphoma using microdissection and PCR. Tumor and normal cells were microdissected from ocular tissue on slides and subjected to PCR for genes from Toxoplasma gondii, EBV, and HHV-8. We detected Toxoplasma gondii, not HHV-8 or EBV, DNA in the lymphoma but not in normal cells of two cases that resembled ocular toxoplasmosis clinically. We speculate that Toxoplasma gondii may play a role in some forms of primary intraocular B-cell lymphoma.     

Sensitivity of indocyanine green angiography for the follow-up of active inflammatory choriocapillaropathies

BACKGROUND: Inflammatory choriocapillaropathies (choriocapillaritis) correspond to the clinical spectrum of lesions of the fundus, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis (MC), and other rarer entities caused by inflammatory disturbances of choriocapillaris perfusion. The aim here was to study the sensitivity of indocyanine green (ICG) angiography in investigating and following inflammatory choriocapillaropathies. PATIENTS AND METHODS: Patients with inflammatory choriocapillaropthies were included who had had a dual fluorescein and ICG angiography as well as visual field testing (Goldman or computerized perimetry) at presentation and on follow-up visits. ICG angiography was performed according to a routine angiographic protocol used for inflammatory diseases and was correlated with fundus examination, fluorescein angiography, and visual field testing. RESULTS: Three patients with MEWDS, two with APMPPE, and two with MC were included. The visual field alterations in all seven patients were well correlated with the extent of the hypofluorescent areas seen on ICG angiography, whereas they were badly correlated with fluorescein angiographic signs and their evolution. The visual field in MEWDS was particularly well correlated with the importance of peripapillary hypofluorescence seen on ICG angiography. In MC, the evolution of new lesions was well demonstrated by ICG angiography and well correlated with visual symptoms and visual fields, but was barely detected on fundus examination and by fluorescein angiography. CONCLUSIONS: ICG angiographic signs were shown to be closely correlated with visual function (visual field testing). This was not the case for either fundus examination or fluorescein angiography. ICG angiography appears as a very sensitive follow-up parameter in inflammatory choriocapillaropathies, giving morphological information on the evolution of the disease and on the response to treatment when therapy is indicated.     

Acute retinal necrosis: a new pathophysiological hypothesis.

A 76-year-old woman with unilateral acute retinal necrosis had an elevated titer of cytomegalovirus (CMV) antibodies with both in the aqueous humor and serum. The serological pattern indicated recent CMV infection, and the Goldmann-Witmer coefficient comparing aqueous and serum titers was above 4 indicating intraocular production of specific antibodies. The clinical characteristics and results as well as a new possible etiopathogenic hypothesis are presented.     

Tuberculosis-related choriocapillaritis (multifocal–serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography

To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop the progression of the retinal disease. In each case of choriocapillaritis such as APMPPE an infectious cause including TB has to be excluded making IGRA tests unavoidable. As the main structure involved is the choriocapillaris the most precise follow-up or monitoring is obtained with ICGA.     

Comparison of the effects of trabeculoplasty using the Nd-YAG laser and the argon laser]

We compared the effect of Argon Laser trabeculoplasty (ALT) and Nd-YAG-Laser trabeculoplasty (YLT) on inflammation and intraocular pressure (IOP). Twenty-two patients scheduled for bilateral trabeculoplasty were treated with an Argon laser in one eye and with Nd-YAG laser in the controlateral eye. Visual acuity, IOP and anterior chamber inflammation (measured with the laser flare-cell meter) were controlled at 0, 3, 6, 18 hours, 2, 4, 7, 14, 30, 90 and 180 days after trabeculoplasty. Our results showed a similar pressure lowering effect in both groups (-24.5 +/- 23% after YLT versus -32.9 +/- 16.3% after ALT at 90 days post-laser; p = 0.26). The anterior chamber inflammation was delayed and more important in the ALT-group (inflammation peaked at 24.8 hours after YLT versus 44.5 hours after ALT; p = 0.034) (maximal mean flare increase: 19.4 +/- 12 pH/msec. after ALT, versus 16.1 +/- 11.4 ph/msec. after YLT). All eyes with inflammation were successfully treated with topical diclofenac QID (Voltaren Ophtha), a nonsteroidal anti-inflammatory agent. YLT is a safe and effective alternative technique to perform laser trabeculoplasty, which is especially useful in poorly pigmented angles where ALT is known to be less effective.     

Differential treatment of postoperative and uveitis-induced inflammatory cystoid macular edema]

Twenty-five eyes (23 patients) with inflammatory cystoid macular edema (CME) (11 after cataract surgery and 14 eyes (12 patients) with uveitis) were followed in a prospective open study. The aim was to determine the efficiency of a combined treatment of Diamox (acetazolamide), Voltaren Ophtha (diclofenac, a NSAID) and Ultracortenol (prednisolone acetate) and in the case of treatment failure, the usefulness of posterior subtenon's injections of corticosteroids (Kenacort 40 mg (triamcinolone)). Seven eyes (all pseudophakic CMEs) responded successfully to the initial therapy. Their mean visual acuity improved from 0.31 +/- 0.13 to 0.93 +/- 0.08 after 18 +/- 5 days (p less than or equal to 0.001). Of the sixteen of 18 evaluable eyes that were additionally treated with a mean of 3.28 +/- 1.07 three-weekly posterior subtenon's injections, 15 eyes including all uveitis CME responded to treatment. Their mean visual acuity improved from 0.49 +/- 0.20 to 0.96 +/- 0.31 (p less than or equal to 0.001). Two patients were excluded; in 22/23 eyes the sequential treatment was successful with an overall success rate of 95% of cases (improvement of five lines on the Snellen chart or final visual acuity of 0.8 or better). Initial angiographic cystoid macular edema was comparable and significantly improved after therapy in the two treatment groups. No mean intraocular pressure rise was noted after steroid injections. Measurement of anterior chamber inflammation with the laser flare-cell meter (Kowa FC-1000) showed elevated flare in all cases which significantly decreased in both treatment groups and represented a good follow-up parameter for the effect of antiinflammatory treatment and restoration of blood-ocular barrier.(ABSTRACT TRUNCATED AT 250 WORDS)