[Laser-induced Maculopathy Caused by Strangers]. / Fremdverursachte laserinduzierte Makulopathie.

Background: Laser-induced ocular injuries are of public interest, especially when caused by strangers. Clinical signs and follow-up: Two laser-induced maculopathies were presented which had been caused by strangers. Morphological findings were shown by funduscopy and Spectralis Domain OCT follow-up. Conclusion: Severe retina injuries can be induced by laser pointers of higher classes.

Human case of Onchocerca lupi infection, Germany, August 2014.

Onchocerca lupi, a nematode parasite infecting dogs and cats with a hitherto unknown arthropod vector, is also being recognised as a parasite also responsible for human eye infections. Here we describe a case of human eye infection diagnosed molecularly by nematode 12S rDNA PCR in a German patient who had travelled to Tunisia and Turkey. The patient recovered after treatment with antibiotic and anti-inflammatory therapy.

Objective visual field determination in forensic ophthalmology with an optimized 4-channel multifocal VEP perimetry system: a case report of a patient with retinitis pigmentosa.

We present the case of a 59-year-old male patient with progressive vision impairment and consecutive visual field narrowing ("tunnel view") for 7 years and a known retinitis pigmentosa for 5 years. The remaining Goldmann perimetric visual field at time reported was less than 5°. A request for blindness-related social benefits was rejected because an ophthalmologic expert assessment suggested malingering. This prompted us to assess an objective determination of the visual field using multifocal VEPs. Objective visual field recordings were performed with a four-channel multifocal VEP-perimeter using 58 stimulus fields (pattern reversal dartboard stimulus configuration). The correlated signal data were processed using an off-line method. At each field, the recording from the channel with the maximal signal-to-noise ratio (SNR) was retained, thus resulting in an SNR optimized virtual recording. Analysis of VEP signals was performed for each single field and concentric rings and compared to an average response measured in five healthy subjects. Substantial VEP responses could be identified in three fields within the innermost ring (eccentricity, 1.7°) for both eyes, although SNR was generally low. More eccentric stimuli did not elicit reliable VEP responses. The mfVEP recording was correlated with perimetric visual field data. The current SNR optimization by using the channel with the largest SNR provides a good method to extract useful data from recordings and may be appropriate for the use in forensic ophthalmology.

[Zoledronate-induced panuveitis]. / Zoledronsäure-induzierte Panuveitis.

Zoledronate-induced (Aclasta®) uveitis is a rare iatrogen-induced inflammation of ocular structures, which can result in substantial morphological and functional limitations. This case report describes the clinical course of a female patient with zoledronate-induced panuveitis. Additionally, the diagnostic procedure, therapy and follow-up are presented.

[Self-inflicted laser-induced maculopathy in adolescence]. / Selbst verursachte laserinduzierte Makulopathie im Jugendalter.

Reports of laser-induced ocular injuries have become more frequent in recent years, especially due to high-energy laser pointers. The article presents for the first time in the German literature a case of self-inflicted laser-induced maculopathy in an adolescent. In addition to the clinical findings, the results of funduscopy and spectral domain optical coherence tomography (SD-OCT) follow-up are presented.

Optical clearing of the eye using the See Deep Brain technique.

PurposeTissue clearing has been used in anatomy for the first time in Germany over a century ago. Neuronal tissue, like cortex, was investigated in mice using a water-based optical clearing method termed See Deep Brain (SeeDB). However, although the eye belongs to the central nervous system, this histological technique was not applied in the eye up to date. We applied SeeDB for the visualization of intraocular structures.Patients and methodsFour eyes of cornea donors (two male, two female: 73-84 years) obtained from the Cornea Bank of the Department of Ophthalmology Erlangen, four chicken eyes and two mices' optic nerve were used. Bulbi were fixed in 4% paraformaldehyde in phosphate-buffered saline and treated with increasing concentrations of aqueous fructose solution with 0.5% α-thioglycerol. After SeeDB, transscleral macrophotographs of the choroid were performed.ResultsComplete transparency of the sclera was obtained in enucleated human and chicken eyes after SeeDB treatment. Macroscopical anatomy of the choroid (partially transparent due to the remaining retinal pigment epithelium and melanocytes) showing vessels and other related structures was possible without preparing slides. Mice optic nerves were also transparent after SeeDB treatment.ConclusionThe SeeDB method allows visualization of intraocular structures through a completely translucent sclera. This innovative processing technique could facilitate comprehensive qualitative and quantitative topographical anatomical studies of human and animal eyes, preserving their 3D architecture. Supra- and intrachoroidal ganglionic plexus could potentially be visualized transsclerally. Finally, clinical-pathological correlations of intraocular diseases-for example, retinal tumors-will be possible in non-dissected eyes.

[Sympathetic ophthalmia following repeated pars plana vitrectomy : Clinical findings and spectral domain OCT follow-up]. / Sympathische Ophthalmie nach zweimaliger Pars-plana-Vitrektomie : Klinische Befunde und Spectralis-OCT-Verlauf.

Sympathetic ophthalmia is a rare form of bilateral granulomatous panuveitis, occurring after penetrating trauma. Hitherto, sympathetic ophthalmia after vitrectomy has only occasionally been described in the literature. This case report presents a female patient with sympathetic ophthalmia after repeated pars plana vitrectomy on the basis of clinical findings and follow-up with fluorescein angiography, spectral domain OCT, and histopathology.

[Therapy options for malignant eyelid tumors]. / Therapie bei malignen Lidtumoren.

Basal cell carcinomas are the most common malignant tumors of the eyelids. Patient history, clinical symptoms and signs, inspection, palpation and slit-lamp examination usually allow a working diagnosis; however, the clinical diagnosis requires histopathological confirmation and determination of the histopathological type. Squamous cell carcinomas, sebaceous gland carcinomas, melanomas and Merkel cell carcinomas can metastasize usually via the lymph vessels into the regional lymph nodes. Microscopically controlled excision of the primary tumor into healthy tissue is most commonly the first goal. Palpation and ultrasonography of the regional lymph nodes and also computed tomography (CT) with contrast enhancement and magnetic resonance imaging (MRI) for tumors with perineural sheath cell invasion are necessary to define the TNM stage. Non-surgical treatment options are becoming more popular in the further management of malignant eyelid tumors.

[Frosted branch angiitis : Clinical findings and Spectralis OCT follow-up]. / Frosted-Branch-Angiitis : Klinische Befunde und Spectralis-OCT-Verlauf.

Frosted branch angiitis is a special form of retinal vasculitis, which has only rarely been reported in the literature. Although the majority of cases of frosted branch angiitis are idiopathic, a systematic clinical work-up should be done in order to exclude other causes, such as infectious and autoimmune diseases. The aim of this study was to correlate the clinical findings with the images obtained during follow-up by spectral domain optical coherence tomography (OCT).

Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability.

Vascular dementia is the second most common type of dementia after Alzheimer's disease (AD). Subcortical ischemic vascular disease refers to a form of vascular cognitive impairment characterized by the presence of diffuse white matter hyperintensities (WMHs) and multiple lacunar infarcts. These neuroimaging findings are mainly caused by cerebral small-vessel disease (cSVD) and relate to aging and cognitive impairment, but they can also be silent and highly prevalent in otherwise healthy individuals. We aimed to review studies on blood and cerebrospinal fluid (CSF) markers related to the presence of WMHs and lacunar infarcts that have been conducted in the past in large population-based studies and in high-risk selected patients (such as those with vascular risk factors, vascular cognitive impairment, or AD). Relevant associations with the presence and progression of cSVD have been described in the blood for markers related to inflammatory processes, endothelial damage and coagulation/fibrinolysis processes, etc. Also, different combinations of CSF markers might help to differentiate between etiologic types of dementia. In the future, to translate these findings into clinical practice and use biomarkers to early diagnosis and monitoring vascular cognitive impairment would require the replication of candidate markers in large-scale, multicenter, and prospectively designed studies.

Ranking of optic disc variables for detection of glaucomatous optic nerve damage.

PURPOSE: To describe optic disc variables assessed by evaluation of clinical optic disc photographs and to compare sensitivity and specificity of these optic disc parameters in identifying patients with ocular hypertension who have nerve fiber layer defects and normal visual fields and patients with visual field defects. METHODS: The study included 500 normal subjects, 132 patients with ocular hypertension with retinal nerve fiber layer defects and normal visual fields (preperimetric glaucoma), and 840 patients with glaucomatous visual field defects. Color stereo optic disc photographs were morphometrically evaluated. RESULTS: Highest diagnostic power for the separation between the normal group and the preperimetric glaucoma group had the vertical cup-to-disc diameter ratio corrected for its dependence on the optic disc size, total neuroretinal rim area, rim-to-disc area ratio corrected for disc size, and cup-to-disc area ratio corrected for disc size. Diagnostic power was lower for rim area in the temporal inferior and temporal superior disc sector, cup area corrected for disc size, and horizontal cup-to-disc diameter ratio corrected for disc size. Less useful for the differentiation between the normal subjects and the preperimetric glaucoma group were size of zones alpha and beta of parapapillary chorioretinal atrophy, and ratios of neuroretinal rim width and rim area comparing various optic disc sectors with each other. CONCLUSIONS: In subjects with ocular hypertension with retinal nerve fiber layer defects and normal conventional achromatic visual fields, the vertical cup-to-disc diameter ratio corrected for optic disc size, total neuroretinal rim area, rim-to-disc area ratio, and cup-to-disc area ratio corrected for disc size are the most valuable optic disc variables for early detection of glaucomatous optic nerve damage. Correction for optic disc size is necessary for optic disc variables directly or indirectly derived from the optic cup. Parapapillary atrophy is less important in the early detection of glaucoma.

Nitrergic and VIPergic neurons in the choroid and ciliary ganglion of the duck Anis carina.

Immunohistochemistry for neuronal nitric oxide synthase (nNOS) and vasoactive intestinal peptide (VIP), and NADPH diaphorase histochemistry, were applied to investigate neurons in the choroid and the ciliary ganglion of the muscovy duck Anis carina. Up to 1000 neurons in the choroid stained for NADPH diaphorase and showed virtually complete colocalization for nNOS immunoreactivity. Almost all of them co-stained for VIP, while about 90% of VIP immunoreactive cell bodies showed colocalization for nNOS. Two-thirds of the neurons were located, mostly singly, at nodes of a wide-meshed nerve plexus in the suprachoroid and were only rarely grouped in ganglia of up to 3 neurons. Numerous varicose nNOS/NADPH-diaphorase-positive nerve fibers were seen around large arterial blood vessels. These fibers derived mainly from paravascular cell bodies that represented about one-third of all choroidal neurons and also displayed costaining for nitrergic markers and VIP. Colocalization of nNOS/NADPH-d and VIP could be demonstrated in most of the perivascular fibers, while slightly more VIP-positive axons in the suprachoroid plexus did not costain for nNOS/NADPH-d. Small-caliber blood vessels and those localized in the choriocapillaris were not endowed with VIP/nNOS/NADPH-diaphorase-positive fibers. A few reactive neuronal cell bodies were also found in ciliary nerves, while most ciliary axons were unstained. In the ciliary ganglion a small subpopulation of neurons showed VIP/nNOS/NADPH-diaphorase colocalization. There were also nNOS/NADPH-d-positive cap-like terminals on ciliary ganglion cells. The presence of VIP/nNOS/NADPH-diaphorase positive neurons and nerve fibers in both the choroid and ciliary ganglion, and in the choroidal perivascular plexus, indicates peripheral nitrergic and VIPergic control of blood flow in the choroid of the duck.

Visual evoked potentials under luminance contrast and color contrast stimulation in glaucoma diagnosis.

PURPOSE: To evaluate the diagnostic value of visual evoked potential (VEP) assessment with luminance-contrast and color-contrast stimulation in the detection of glaucoma. PATIENTS AND METHODS: The study included 59 patients (96 eyes) with glaucomatous changes of the optic disc and visual field defects and 58 control eyes of 29 healthy patients. Four types of pattern VEP stimulation (0.9 cycle/degree) were performed in all patients: achromatic, alternating sine-wave stripe pattern: 6 reversals per second, contrast of 10% (activation of predominantly the magnocellular pathway); isoluminant, red-green stripe pattern: 83.3 milliseconds onset, 83.3 milliseconds offset, contrast of 30% and 80% (activation of predominantly the parvocellular pathway); and blue grating with yellow background adaptation: 200 milliseconds onset, 500 milliseconds offset (activation of the blue-sensitive pathway). RESULTS: The glaucoma group and the control group differed significantly (P < 0.01) in the peak times of all chromatic VEP responses and to a lesser degree in the achromatic VEP. Considering the amplitudes, only the low-contrast red-green stimulus showed a statistically significant reduction in glaucoma. At a predefined specificity of 90%, in separating patients with glaucoma from healthy control subjects, the peak time of the blue-yellow VEP had a high sensitivity (90%), whereas the sensitivity of the achromatic VEP was low (31%). The red-green VEP showed a sensitivity of 73% using low contrast and 71% using high contrast. In a paired correlation analysis with visual field defects, all stimulations showed significant (P < 0.05) results. Correlation coefficients were highest (R = 0.79, P < 0.01) for the peak time of the blue-yellow VEP. CONCLUSIONS: VEP measurements with presumable stimulation of single neuronal pathways can detect glaucomatous optic nerve damage in a considerable fraction of patients with visual field loss. Occipital responses to chromatic stimulation seem to be more sensitive to glaucoma damages than do responses to achromatic pattern reversal stimulation.

An early antecedent to modern random dot stereograms --'the secret stereoscopic writing' of Ramón y Cajal.

The use of computerized random dot stimuli in modern neuroscience was introduced by Julesz in the 1960s. This method made it possible to study exclusively cortical processing of binocular information by disparity-sensitive neurons, and it has attained widespread use among neuroscientists and psychologists. It is now largely forgotten that in the last century, the famous neuroanatomist Ramón y Cajal had worked on random dot stereograms as a means of encoding written information. A brief note was finally published in a Spanish journal on photography in 1901. We present a translation of this text and summarize the early ideas on random dot stereograms, and we also supply a brief historical account on stereoscopic perception.