[Ophthalmologic diagnostic procedures and imaging of retinal vein occlusions]. / Ophthalmologische Diagnostik und Bildgebung bei venösen retinalen Gefässverschlüssen.

Retinal vein occlusions are a common vascular disease of the eye. Ophthalmological diagnostic procedures and imaging are important for the prognosis of the disease, as are the systemic work-up and therapy. Besides routine ophthalmic tests (visual acuity, slit lamp examination, funduscopy) a work-up for glaucoma such as intraocular pressure, visual field or 24 h IOP profile is useful as a diagnostic procedure. Furthermore, new diagnostic and imaging tests such as central corneal thickness and optic nerve head imaging by Heidelberg retina tomography or optical coherence tomography (OCT) should be considered for glaucoma evaluation. Optical coherence tomography also plays a major role in treatment monitoring of macular edema secondary to retinal vein occlusions. Fluorescein angiography is well established and can provide information with regard to size and extent of the occlusion, degree of ischemia, areas of non-perfusion and neovascularization, as well as macular edema.

[Idiopathic macular telangiectasia - follow-up with and without laser photocoagulation]. / Idiopathische makuläre Teleangiektasie (IMT) - Verlaufsbeobachtung mit und ohne Laserphotokoagulation.

PURPOSE: The aim of this study was to evaluate the effectiveness of laser photocoagulation for idiopathic macular telangiectasia (IMT) by using the revised and simplified classification of Yannuzzi 2006. PATIENTS AND METHODS: The Yannuzzi classification was used for a retrospective analysis of the medical records of all patients with idiopathic macular telangiectasia as diagnosed consecutively in the University Eye Clinic of Mainz in the time period from 1 / 02 to 12 / 06. Laser treatment was indicated only in those eyes which presented with a visual acuity below 10 / 20 (follow-up interval in median 37 months, minimum 13 months). RESULTS: 12 patients with unilateral macular telangiectasia (IMT type I) and 30 patients with bilateral macular telangiectasia (IMT type II) were recruited. In type I disease 9 / 12 patients were male with an average age of 41 years (range: 28 to 47). 10 / 12 eyes showed macular oedema. After focal laser photocoagulation in 6 / 10 eyes the macular oedema decreased in 4 / 6 eyes and visual acuity improved in 3 / 6 eyes. In type II disease 17 / 30 patients were male and the average age was 56 years (range: 45 to 63). All 60 eyes showed macular oedema. In 40 eyes, which did not receive a laser photocoagulation, the ocular findings did not change during the follow-up examinations. In 16 / 20 eyes the macular oedema has successfully been reduced by laser photocoagulation, however without significant visual improvement. In 2 of these 16 treated eyes the development of a subfoveal choroidal neovascularisation with central loss of vision was noted. CONCLUSIONS: In IMT type I laser photocoagulation was able to achieve a visual improvement. In IMT type II, however, a laser photocoagulation indication should be considered very carefully because in this group no visual improvement was reached and a secondary induction of subretinal neovascular membranes seems likely.

[Eales' disease--10 years experience with a rare disease]. / Morbus Eales--10 Jahre Erfahrung mit einem seltenen Krankheitsbild.

BACKGROUND: Eales' disease is an uncommon vasoproliferative retinal disease affecting otherwise healthy young men. We report on our treatment results in a large patients group with long-term follow-up. PATIENTS AND METHODS: The treatment results in 50 eyes (35 patients) with Eales' disease, that were consecutively treated from May 1995 to August 2005, were analysed retrospectively. Recorded data included age, sex, race, association of systemic disease, medications, laboratory evaluation and the surgical treatment. Mean follow-up was 5.8 years (minimum: 3.2, maximum: 8.6 years). RESULTS: Systemic and laboratory evaluations detected a factor V Leiden mutation (4x), vestibuloauditory problems (1x) and migraine (1x). 10 eyes with peripheral non-perfusion, teleangiectasia and mild neovascularisations were treated by scatter laser photocoagulation alone. 18 eyes with advanced neovascularisations/vitreous haemorrhages received cryocoagulation too. 14 eyes with persistent or recurrent bleedings despite coagulation therapy and/or development of tractional retinal detachment were treated by vitrectomy. 5 of them received a silicone oil endotamponade. All eyes could be stabilised without further bleedings. Visual acuity increased in 25 eyes. Only 5 eyes showed a visual loss. The visual results (rate of improvements and the stages of visual acuity as well) were the best in those eyes that received vitrectomy. CONCLUSIONS: These results suggest that early retinal laser and cryocoagulation and - if necessary - vitrectomy in due time may led to a stabilised retina without further bleedings and visual improvement too. Coagulopathy could play a role in the pathogenesis of Eales' disease.

[Arteriovenous crossing sheathotomy in branch retinal vein occlusion]. / Arteriovenöse Dissektion (AVD) bei retinalen Venolenastverschlüssen.

BACKGROUND: The aim of this study is to report on arteriovenous sheathotomy in branch retinal vein occlusion (BRVO) with a long-term follow-up and examine the visual field effects of this surgical approach. PATIENTS AND METHODS: In a clinical trial 36 eyes with branch retinal vein occlusion (22 eyes with ischaemia, 14 eyes with chronic macular oedema) underwent surgical decompression accompanied by peeling of the membrana limitans interna after prior isovolemic haemodilution for 3 months had been unsuccessful. RESULTS: All eyes showed a significant reduction of macular oedema 3 months after surgery. During follow-up (median: 26.4 months) visual acuity increased in 24/36 eyes and was stabilised in 8/36 eyes. We observed haemorrhages at the dissection site (5x), vitreous haemorrhages (12x) and retinal holes at the vitreous base (2x). Goldmann perimetry revealed paracentral scotomas in 3 eyes, which had been treated by arteriovenous dissection relatively close to the optic disc. In 16/22 eyes with ischaemic thromboses the visual field was narrowed in the affected quadrant. CONCLUSIONS: The results of arteriovenous sheathotomy in BRVO are encouraging because we observed increase of visual acuity in 67% of the eyes in spite of an unsuccessful haemodilution during 3 months before. However, whether its benefits outweigh potential surgical complications as visual field defects remains to be determined.

[Central serous chorioretinopathy (CSC) and corticosteroids]. / Chorioretinopathia serosa centralis (CSC) und Kortikosteroide.

BACKGROUND: Corticosteroids are under suspicion of playing an important role in the development of central serous chorioretinopathy (CSC). PATIENTS AND METHODS: In a prospective study the course of CSC was evaluated in a consecutive series of 46 patients, who received the diagnosis of CSC in the period 4 / 2004 - 12 / 2005. Data analysis was focused on the complete medical and ocular history and the ocular course of this disease. RESULTS: 27 patients had been taking exogenous corticosteroids (oral, intravenous, inhalative, cutaneous and intraarticular) within 4 weeks before onset of symptoms. Additionally, one case with Cushing's disease and 2 pregnant women were included. These 30 / 46 patients with steroid association presented bilateral involvement in 21 cases (70 %) and angiographically more than one leakage point in 10 cases (33 %). In 16 / 46 patients without history of taking exogenous corticosteroids bilateral involvement was seen in 2 / 16 cases (13 %) and multiple leakages in only one case (6 %). CSC resolved spontaneously in 25 / 46 patients within 2 - 6 months. In 21 / 46 patients recurrences were documented either in the eye, which was primarily affected or in the other one. In this group of recurrent CSC all 8 patients were included who did not discontinue the use of systemic corticosteroids. CONCLUSIONS: These results strongly support the association of steroid use with CSC. Unter systemic treatment with corticosteroids bilateral involvement and multilocular leakages seem to be more likely than without use of steroids. All patients in need of corticosteroids by any systemic route of administration should be informed of the associated risk.

[Laser photocoagulation and photodynamic therapy (PDT) with verteporfin for retinal angiomatous proliferation (RAP) in age-related macular degeneration (AMD)]. / Laserfotokoagulation und photodynamische Therapie (PDT) zur Behandlung der retinalen angiomatösen Proliferation (RAP) bei feuchter altersabhängiger Makuladegeneration (AMD).

BACKGROUND: Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (AMD) with particularly bad prognosis. Diverse treatment modalities are performed. PATIENTS AND METHODS: This is a retrospective review on the treatment results of 41 consecutive patients from 1/2003 to 12/2005 with RAP stage 1-3 (Yannuzzi classification), who were treated with laser photocoagulation, photodynamic therapy (PDT) and intravitreal injection of triamcinolone acetonide (IVT). Follow-up was 12 months minimally. RESULTS: In RAP stage I complete closure of the vascular lesion in 14 / 22 eyes was achieved by 1.2 +/- 0.5 sessions of laser photocoagulation (4 x combined with IVT) and in 3/14 eyes with photodynamic therapy (2 +/- 0.5 sessions). In RAP stage II closure of the lesion was achieved by 3.2 +/- 0.6 sessions of photodynamic therapy in 6/14 eyes (4 x combined with IVT). In RAP stage III closure of the lesion was achieved by 3.2 +/- 0.4 sessions of photodynamic therapy in 0 / 5 eyes (3 x combined with IVT). A rip of the retinal pigment epithelium was observed in 2/14 eyes of RAP stage II and 2/5 eyes of RAP stage III. Visual acuity improved in 9/17 eyes with occlusion of RAP stage I. Without closure of the vascular lesion all eyes got legally blind (visual acuity 1/50 or less). CONCLUSIONS: Early detection and subsequent direct treatment of RAP stage I in AMD is recommended. In advanced stages anatomical closure of the vascular complex is rarely achieved and the risk is improved for development of tears in the retinal pigment epithelium and getting legally blind.

[Pseudomelanomas of the choroid]. / Pseudomelanome der Aderhaut.

BACKGROUND: The aim of this study was to evaluate what are the most frequent ocular diseases that were suspected for choroidal melanoma ("pseudo melanoma"). PATIENTS AND METHODS: The data of all patients who were seen in the University Hospital of Mainz under the suspicion of choroidal melanoma between 1.1.1994 and 1.1.2004 and underwent ultrasound examination, fluorescein angiography or fundus photography, were analysed retrospectively. Among 458 examined eyes a choroidal melanoma was diagnosed in 212 cases. In 246 cases the diagnosis was "pseudomelanoma". RESULTS: The most frequent ocular diseases suspected for choroidal melanoma were "suspicious nevi" in 31 % of the cases and "disciforme macula degeneration" in 34 %. Less frequently we found hyperplasty of pigment epithelium (5 %), melanocytoma (10 %), choroidal haemangioma (6 %), choroidal detachment (7 %) and retinal macroaneurysma with epi-/subretinal haemorrhages (3 %). Rare diagnoses were orbital tumour, scleritis posterior and a combined hamartoma of retina and pigment epithelium (4 % at all). In 58 eyes without a fundus view, ultrasound revealed an intraocular tumour. In these cases vitrectomy/cataract extraction was performed and we found a choroidal melanoma in 5 eyes, a disciforme macula degeneration in 48 eyes and in 5 eyes a retinal macroaneurysma. CONCLUSIONS: Age-related macula degeneration (AMD) is the cause for one third of all pseudomelanomas. Because of its increasing incidence in the future, more attention must be paid to AMD in the differential diagnosis of chorioretinal lesions suspicious of melanoma.

[Radial optic neurotomy (RON) for central retinal vein occlusion]. / Radiäre Optikusneurotomie (RON) bei retinalen Zentralvenenverschlüssen.

BACKGROUND: Compression in the lamina cribrosa is discussed as a reason for central retinal vein occlusion. Radial optic neurotomy should release the pressure and increase venous blood outflow. PATIENTS AND METHODS: In a clinical trial 27 eyes with central retinal vein occlusion (22 eyes with clinical ischaemia, 5 eyes with continuous disc oedema and visual acuity below 4/10) underwent surgical decompression by vitrectomy and radial optic neurotomy. During surgery the intravenous pressure in the central vein was tested by infusion dynamometry before and right next to the incision. Follow up-time minimally was 1.5 years. RESULTS: Infusion dynamometry demonstrated a decrease of the central vein pressure right next to the incision in all eyes. In 17/22 eyes with ischaemic type of occlusion 6 weeks after surgery the relative afferent pupillary defect was lowered significantly and no growth of neovascularisations occurred. 5 eyes with persistence of the afferent pupillary defect received laser/cryocoagulation because of neovascularisations. After surgery visual acuity improved in 20/27 eyes and remained unchanged in 4/27 eyes. As complications we saw small subretinal haemorrhages at the neurotomy site (5/27), vitreous haemorrhages (7/27), hypotonia and choroidal detachment (1/27) and segmental visual field loss (14/27). CONCLUSIONS: The results of infusion dynamometry strongly support the hypothesis of a postulated compression of the central retinal vein in the lamina cribrosa. Functional results of radial optic neurotomy are superior to those of the natural course of ischaemic retinal vein occlusion in the literature, but visual field defects in association with the neurotomy site seem to be a serious side-effect of this therapeutic approach.

[Painless acanthamoeba keratitis]. / Schmerzlose Akanthamöbenkeratitis.

A 37-year-old contact lens wearer was treated for herpes simplex keratitis. After an initial improvement the keratitis became much worse. An annular infiltrate gave rise to the suspicion of acanthamoeba keratitis even though the patient was not in pain. This diagnosis was confirmed by histological and microbiological examination of the corneal disc after keratoplasty. Acanthamoeba keratitis should be considered even in the absence of pain, especially when the patients are contact lens wearers.

Effects of multipurpose contact lens solutions on the protein composition of the tear film.

OBJECTIVES: To analyze the influence of multipurpose contact lens cleaning solutions on tear proteins. Changes in tear film protein profiles of contact lens wearers who used several marketed brands of multipurpose contact lens care solutions, were assessed by ProteinChip analysis. METHODS: Three studies were conducted. Study I was a comparison of Complete and OptiFree multipurpose solutions. Study II was a study with Complete Moisture Plus solution, Study II was a comparison of Renu and Solocare contact lens solutions. Wearers of soft contact lenses were assigned to use the contact lens care solutions for 4 weeks. Non-contact lens wearing patients were used as controls. Tear samples of each participant were analyzed with the ProteinChip (SELDI-TOF) system. Multivariate statistical analysis and artificial neural networks were used to determine the tear protein profiles of each study group. RESULTS: Before starting the use of the solutions, the tear protein composition in all contact lens wearers deviated from the tear composition of the non-contact lens wearing controls. After 4 weeks of using the different care regimens, the tear protein composition of the patients using Complete or Complete Moisture Plus solutions tended to move toward that of the non-contact lens wearing controls. The tear protein composition of patients using the OptiFree, Renu or Solocare solutions did not undergo a measureable change in the protein level. CONCLUSIONS: The ProteinChip system can analyze protein profiles for large-scale applications as in clinical studies. Two multipurpose solutions, Complete and Complete Moisture Plus, demonstrated a beneficial effect on the tear proteins in contact lens wearers.

Effects of intraocular cefotaxime on the human corneal endothelium.

PURPOSE: To ascertain whether 0.4 mL of cefotaxime 0.25% applied intracamerally causes toxic alteration of the human corneal endothelium. METHODS: In this prospective randomized masked study, 66 patients had cataract extraction using phacoemulsification, a frown incision, and implantation of a poly(methyl methacrylate) intraocular lens. This was followed by intraocular injection of 0.4 mL of cefotaxime 0.25% or balanced salt solution (BSS(R)). Contact specular microscopy and photography were performed preoperatively and 1 to 4 days and 3 months postoperatively. RESULTS: In the cefotaxime group, the mean endothelial cell count was 2729 cells/mm(2) +/- 474 (SD) preoperatively, 2520 +/- 462 cells/mm(2) 1 to 4 days postoperatively, and 2560 +/- 495 cells/mm(2) 3 months postoperatively. The mean endothelial cell count in the BSS (control) group was 2657 +/- 413 cells/mm(2), 2475 +/- 384 cells/mm(2), and 2486 +/- 427 cells/mm(2), respectively. There was no significant difference in cell count or morphology between groups (P <.05). CONCLUSIONS: Intraocular application of cefotaxime produced no significant changes in endothelial cell count or morphology when compared with application of a control substance. With its broad spectrum of antibiotic activity, cefotaxime might be an appropriate alternative to other intraocularly administered antibiotics in anterior segment surgery for prophylaxis and management of infection.