[Histopathology of retrocorneal membranes after keratoplasty]. / Histopathologische Untersuchung von retrokornealen Membranen bei irreversiblem Transplantatversagen.

BACKGROUND: This retrospective study examines the histopathological changes, especially the occurrence of retrocorneal membranes, in irreversible graft failure after penetrating keratoplasty. PATIENTS/MATERIALS AND METHODS: 371 corneas of 308 patients were examined. The examination was carried out using a light microscope. RESULTS: 45% of the corneas (167/371) showed a retrocorneal membrane with a thickness of 2-520 micrometers. Re-endothelialisation was detected in 75 cases. In 74% (124/167) cellular infiltration into the stroma could be observed. In 32% (119/371) the graft-host border was visible. CONCLUSIONS: Retrocorneal membranes are a frequent finding in irreversible graft failure after penetrating keratoplasty. Aetiologically the graft-host border as well as the formation of connective tissue seem to play a key role.

Analysis of immune deviation elicited by antigens injected into the subretinal space.

PURPOSE: To determine whether the subretinal space supports the induction of deviant immune responses to cell-associated and soluble antigens and to elucidate factors influencing the immunologic properties of the subretinal space. METHODS: P815 mastocytoma cells were used as cell-associated antigens and were inoculated into the anterior chamber (AC), the vitreous cavity (VC), the subretinal space, and subconjunctivally in H2-compatible, but minor H-incompatible, BALB/c mice. Ovalbumin, as a soluble antigen, was similarly injected into eyes, after which recipient animals were immunized with ovalbumin and complete Freund's adjuvant. Delayed-type hypersensitivity (DTH) was assessed by ear challenge. To alter the conditions in the subretinal space, the outer blood-retinal barrier was disrupted by compromising retinal pigment epithelial (RPE) cells with a systemic injection of sodium iodate. Immune privilege in the AC was abolished by mild corneal cauterization. RESULTS: Antigen-specific DTH did not develop in mice in which alloantigenic tumor cells or ovalbumin was injected into the AC, the VC, or the subretinal space, and the mice's spleens contained lymphocytes capable of suppressing DTH when adoptively transferred into naive mice. When RPE cells were compromised with sodium iodate, tumor cells or ovalbumin injected into the subretinal space or the VC did not induce immune deviation, although the AC of these eyes still promoted AC-associated immune deviation. By contrast, when immune privilege in the AC was abolished by corneal cauterization, neither tumor cells nor ovalbumin injected into the subretinal space or the VC of eyes elicited immune deviation. CONCLUSIONS: The subretinal space supports immune deviation for histoincompatible tumor cells and soluble protein antigens by actively suppressing antigen-specific DTH. Acute loss of immune privilege in the subretinal space and the VC does not cause loss of privilege in the AC, but abolition of immune privilege in the AC eliminates the capacity of the subretinal space and the VC to support immune deviation to antigens injected locally.

Evidence that retinal pigment epithelium functions as an immune-privileged tissue.

PURPOSE: Tissues derived from immune-privileged sites sometimes possess special characteristics that promote their own survival when transplanted to a nonprivileged site. This study was undertaken to evaluate whether retinal pigment epithelium (RPE) behaves as an immune-privileged tissue when transplanted extraocularly. METHODS: RPE grafts were prepared from eyes of neonatal C57BL/6 or C57BL/6 gld/gld (deficient in CD95 ligand expression) mice. These grafts (or conjunctival grafts as positive controls) were transplanted into the anterior chamber, the subretinal space, the subconjunctival space, and underneath the kidney capsule of histoincompatible BALB/c mice. Transplant survival was evaluated by histology at selected time points after engraftment. Recipients were tested for acquisition of C57BL/6-specific delayed-type hypersensitivity (DH) and for the ability to suppress DH. RESULTS: Allogeneic neonatal RPE grafts from normal donors showed significantly enhanced survival at all graft sites compared with conjunctival grafts. However, allogeneic RPE cell grafts from gld/gld mice were rapidly rejected after transplantation beneath the kidney capsule. Allogeneic RPE grafts placed in extraocular sites induced systemic DH directed at donor alloantigens, whereas RPE allografts placed intraocularly induced suppression of systemic DH. CONCLUSIONS: Allogeneic neonatal RPE grafts, through constitutive expression of CD95 ligand, promote their own survival at heterotopic sites. Paradoxically, these grafts also display immunogenicity. Thus, neonatal RPE tissue owes its immune privilege to the capacity to prevent immune rejection rather than to inhibit sensitization.

Immune privilege is extended, then withdrawn, from allogeneic tumor cell grafts placed in the subretinal space.

PURPOSE: To determine whether the subretinal space can extend immune privilege to allogeneic tumor cell grafts that do not possess their own inherent immune privilege. METHODS: P815 tumor cells were injected into the anterior chamber (AC), the subretinal (SR) space, or subconjunctivally in eyes of BALB/c (allogeneic), SCID (immune incompetent), normal DBA/2 (syngeneic), or DBA/2 mice presensitized with P815 cells transfected with interleukin-12 and B7.1. Tumor growth was observed clinically and histologically for up to 50 days. BALB/c recipients were tested for suppression of DBA/2-specific delayed hypersensitivity and concomitant immunity. The SR space of tumor-containing eyes was assessed for its capacity to support ovalbumin (OVA)-specific anterior chamber associated immune deviation (ACAID). RESULTS: P815 cells injected into the SR space of presensitized and normal DBA/2 and SCID mice grew progressively, resulting eventually in recipient death. Tumor cells injected into the SR space of eyes of BALB/c mice grew progressively until day 14, followed by tumor regression resulting in phthisis bulbi (14/35) or tumor elimination (19/35) with preserved ocular anatomy by day 35. Despite elimination of tumors from the SR space, BALB/c recipients exhibited DBA/2-specific ACAID and concomitant immunity. In addition, OVA injected into the SR space of eyes from which tumor has been eliminated induced ACAID. CONCLUSIONS: Various parameters of immune privilege, originally described for the AC, are characteristic of immune privilege within the SR space. However, because P815 cells placed in the AC prove lethal for BALB/c recipients, but P815 cells placed in the SR space resolve without jeopardizing the host's life, immune privilege in the SR space can be distinguished from immune privilege in the AC, and this may have implications for grafts of retinal tissue placed within the SR space.

Modulation of retinal pigment epithelial cell behavior by Agaricus bisporus lectin.

PURPOSE: To determine whether Agaricus bisporus lectin (ABL) binds retinal pigment epithelial cells (RPEs), to conduct a preliminary viability study of RPEs exposed to ABL, and to evaluate the effects of ABL on RPE proliferation and RPE-mediated matrix contraction in vitro. METHODS: Using cultured bovine RPEs, immunohistochemistry was used to study ABL binding. Morphologic and trypan blue exclusion techniques were used for toxicity studies. The effect of ABL on RPE proliferation was investigated by [methyl-3H]-thymidine incorporation. The effect of ABL on RPE-mediated matrix contraction was evaluated with RPE-populated three-dimensional collagen matrices. RESULTS: ABL bound to RPE cells. This binding was inhibited by asialomucin. No change in RPE morphology or trypan blue exclusion compared with controls was observed in RPEs incubated with 5 to 60 microg/ml ABL for 3 days. Twenty-four-hour incubations of RPEs with ABL significantly inhibited RPE proliferation in a dose-dependent way, 40 microg/ml ABL inhibited proliferation by 83% (SE 14, P<0.05). ABL showed a dose-dependent significant inhibition of RPE-mediated collagen matrix contraction over 3 days, with 93% inhibition compared with controls by 40 microg/ml lectin (P<0.05). The inhibitory effect of ABL on proliferation and gel contraction was partly reversible after eliminating ABL from the culture medium. CONCLUSIONS: Bovine RPE cells bind ABL, and preliminary evaluations suggest that levels of ABL that are nontoxic to the cells potently inhibit RPE proliferation and RPE-mediated matrix contraction. ABL deserves further investigation as a potential inhibitor of RPE proliferation and cell-mediated matrix contraction in anomalous reparative processes such as proliferative vitreoretinopathy and as a laboratory tool for RPE behavioral studies.

Malignant melanoma of the conjunctiva with intraocular extension.

Intraocular extension of a malignant melanoma of the conjunctiva is a rare entity. A 75-year-old woman underwent repeated surgery after receiving the diagnosis of a multilocular recurrent malignant melanoma arising from a primary acquired melanosis. Treatment included 2 lamellar sclerokeratectomies and percutaneous radiotherapy. Five years after initial surgery, intraocular extension of the melanoma was observed, and enucleation was performed. Findings from histopathological examination revealed a malignant melanoma occupying part of the ciliary body, the trabecular meshwork, and the iris. Eyes with recurrent malignant melanoma of the conjunctiva should be carefully monitored for intraocular extension. Deep excision of conjunctival melanoma, including lamellar sclerokeratectomy, may abolish the natural barrier against intraocular extension of malignant melanomas of the conjunctiva.

Detection of varicella zoster virus DNA and viral antigen in the late stage of bilateral acute retinal necrosis syndrome.

We describe the clinicopathologic and virologic findings in the right, blind eye of an immunocompetent 61-year-old woman. The eye was enucleated 32 months after the clinical onset of a bilateral acute retinal necrosis syndrome. Histopathologic study showed a diffuse, full-thickness, necrotizing retinitis with replacement of sensory retinal structures by glial tissue, occlusive retinal arteritis, granulomatous choroiditis, and optic neuritis with ischemic optic atrophy. Varicella zoster virus could be identified as the causative agent by DNA in situ hybridization and by immunohistochemical stains in mononuclear cells with eosinophilic intracytoplasmic inclusions. Virus was detected only within the choroid and the choriocapillaris. We conclude that these histopathologic and virologic features are consistent with a "burned-out phase" of a varicella zoster virus-induced acute retinal necrosis syndrome.

Long term results after autologous nasal mucosal transplantation in severe mucus deficiency syndromes.

AIM: Severe mucus deficiency syndromes may require substitution of mucous membrane for re-establishment of the ocular surfaces. The long term results after autologous nasal mucosal transplantation were investigated. METHODS: 55 eyes of 50 patients with severe mucus deficiency syndromes were followed retrospectively after free autologous nasal mucosal transplantation-group A: patients after severe lye, acid, heat burns, or radiation (n=38 eyes), group B: patients with systemic mucosal disease (n=17 eyes). The results of routine clinical examination were recorded and patients were followed for a median of 37 months. 17 biopsies of transplanted nasal mucosa were studied by light microscopy and 22 patients by impression cytology before and at several intervals after mucosal transplantation. RESULTS: All nasal mucosal grafts healed well and no intraoperative complications occurred. During follow up 107 additional surgical procedures were performed including 16 lamellar and 21 penetrating keratoplasties. Subjective complaints improved in 44/47 patients with preoperative symptoms. Best corrected visual acuity at the end of follow up was increased in 23 eyes, 10 eyes (18. 2%) reached a final visual acuity equal to or greater than 20/200. Histopathologically, all (n=17) biopsies showed vital intraepithelial mucin producing goblet cells in the nasal mucosal graft (median 25 cells/field (400x magnification)). The mean density of goblet cells before transplantation was 48/mm(2) and after nasal mucosal grafting 432/mm(2) measured by impression cytology (p<0. 0001). CONCLUSIONS: Functional goblet cells persist in autologous nasal mucosa for up to 10 years after transplantation. In patients with severe mucus deficiency syndromes of different origin nasal mucosal transplantation can re-establish the ocular surface, substitute the mucus components of the tear film, improve symptoms of the patients, and facilitate a moderate increase in visual acuity.

Detection of varicella zoster virus DNA and viral antigen in human cornea after herpes zoster ophthalmicus.

This article describes the histopathology, immunohistochemistry, and varicella zoster virus DNA in situ hybridization of 14 corneal buttons obtained from 14 patients (average age 69.0 years) after perforating keratoplasty (four patients) or surgical enucleation (10 patients) at different times after the clinical onset of herpes zoster ophthalmicus (average 58.7 months). The main histopathologic features were intense stromal vascular scarring (12 patients) and granulomatous reaction to Descemet's membrane (nine patients). Using the peroxidase-antiperoxidase method, varicella zoster virus (VZV) antigen could be detected by immunohistochemistry in two patients within epithelial cells of the cornea and in the limbal episclera during the active phase of herpes zoster ophthalmicus. For in situ hybridization we used the 35S-labeled HindIII A and C fragment of VZV and identified viral DNA in five corneal buttons obtained 1 day to 8 years after the clinical onset of infection. Viral DNA was mainly found in mononuclear cells with eosinophilic intracytoplasmic inclusions within vascular stromal scars, in keratocytes, and in epithelial cells of the cornea. Our results show that VZV DNA is detectable in human cornea even 8 years after the clinical onset of herpes zoster ophthalmicus and may indicate VZV persistence in a latent form in corneal tissue or reactivation of the virus from an endogenous or exogenous source causing a severe and often recurrent keratitis in the progress of herpes zoster ophthalmicus.

[Autologous early transplantation of nasal mucosa after the most severe eye chemical burns]. / Autologe Nasenschleimhauttransplantation frühzeitig nach schwersten okularen Verätzungen.

UNLABELLED: The treatment of severe eye burns is still complicated. Since 1984 we have performed autologous nasal mucosa transplantation for the severe mucus deficiency syndromes often occurring during follow-up. Now we report on our initial experience using nasal mucosa transplantation shortly after severe burns. PATIENTS: Prospectively, nine patients (eight male, one female) were examined after autologous nasal mucosa grafting within 14 days after eye burns. In all patients there was an almost complete defect of limbal vascularization, large areas of necrotic conjunctiva and prolonged epithelialization problems. The patients were followed for an average of 38 months. RESULTS: In all patients the subjective complaints lessened and sufficient ocular wetting led to rapid reepithelialization. During the follow-up period two patients showed light symblephara. In five patients visual acuity improved to > or = 20/200. CONCLUSION: Early nasal mucosa transplantation is an additional tool in the treatment of severe ocular burns.

[Value of conjunctival biopsy in diagnosis of sarcoidosis]. / Wertigkeit der Bindehautbiopsie bei der Diagnosestellung der Sarkoidose.

PURPOSE: Retrospective study concerning the value of conjunctival biopsy in the diagnosis of sarcoidosis. PATIENTS AND METHODS: Between 1990 and 1996 we performed conjunctival biopsy in 11 patients (mean age 42.7 +/- 16.4 years) with suspect of sarcoidosis. RESULTS: In 8 of the 11 patients the diagnosis of sarcoidosis was established during the clinical course. In four of these eight patients conjunctival biopsy was positive. Five of the eight were under systemic steroids at the time of biopsy. Of the four patients with clinically established sarcoidosis and negative biopsy, three were under systemic steroids at the time of biopsy. In two patients diagnosis of sarcoidosis was established primarily by conjunctival biopsy. CONCLUSION: Conjunctival biopsy is a simple tool in the diagnostic of sarcoidosis. If possible, biopsy should be undertaken before systemic steroid treatment. We consider conjunctival biopsy to be useful as the first diagnostic tool before other invasive methods.

[Bilateral amaurosis in 11 patients with giant cell arteritis confirmed by arterial biopsy]. / Bilaterale Amaurose bei 11 Patienten mit histologisch gesicherter Riesenzellarteriitis.

BACKGROUND: Even in the times of corticosteroids giant cell arteritis may lead to complete bilateral blindness. AIM: To assess the frequency of complete irreversible blindness in giant cell arteritis. PATIENTS AND METHODS: Among all 218 patients with the diagnosis of giant cell arteritis confirmed by arterial biopsy between 1980 and 2000, clinical data of patients with bilateral amaurosis were further investigated. The main interest was focussed on the kind of ocular manifestation, the interval between first symptoms and therapy and the interval between involvement of the first and second eye. RESULTS: In 11 patients (9 women, 2 men, mean age: 79 years) giant cell arteritis led to complete bilateral blindness. Morphological ocular changes were anterior ischemic optic neuropathy (15 eyes), optic atrophy (4 eyes), posterior ischemic optic neuropathy (2 eyes), and central artery occlusion (1 eye). The median interval between involvement of the first eye and initiation of therapy was 4 days (1/2 day to 8 weeks). The median interval between visual loss in the first and second eye measured 4 days (simultaneously to 30 days). In 2 patients visual loss occurred 1 and 2 days after initiation of treatment (500 mg methylprednisolone/daily), respectively. Treatment with corticosteroids (100 - 1000 mg) did not result in visual improvement in any patient. CONCLUSIONS: Complete bilateral blindness occurred in 5 % of patients with giant cell arteritis, up to 2 days after initiation of treatment with corticosteroids. This number can only be further reduced by immediate therapy after clinical suspicion of giant cell arteritis.

[Lipaemia retinalis due to metabolic syndrome--case report]. / Lipaemia retinalis bei metabolischem Syndrom--Kasuistik.

BACKGROUND: Lipaemia retinalis is a rarely described ocular manifestation of hyperlipidemia. We report on a female patient with visual loss and visual field defects associated with lipaemia retinalis due to a metabolic syndrome. PATIENT: A 45-year-old female patient presented with bilateral slowly progressing visual loss. Additionally, there were eruptive xanthomatas all over the body. Visual acuity measured 0.2 in both eyes. There was a bilateral creamy discoloration of retinal vessels with a salmon-colored fundus. The peripheral visual field was reduced. Laboratory findings indicated a severe mixed hyperlipidemia (triglyceride 11,694 mg/dl, cholesterol 1724 mg/dl). Immediately initiated therapy to normalize the metabolism resulted in improvement of clinical symptoms. CONCLUSION: Lipaemia retinalis is an useful clinical indicator for triglyceridemia. Persistent lipaemia retinalis may lead to visual loss and visual field defects and may be a sign of severe metabolic disturbances. To prevent cardiovascular complications immediate treatment is necessary.

[Correlation of ultrasound biomicroscopy with histological findings in diagnosis of giant cell arteritis]. / Korrelation der Ultraschallbiomikroskopie mit histologischen Befunden in der Diagnostik der Riesenzellarteriitis.

BACKGROUND: A biopsy of the temporal arteries is still the appropriate method to prove the diagnosis of giant cell arteritis. We evaluated the potential use of high-resolution ultrasound-biomicroscopy in the diagnosis of giant cell arteritis. PATIENTS AND METHODS: In a prospective study we examined 16 patients (8 women and 8 men) with a mean age of 71 years with the clinical suspicion of a giant cell arteritis. Additionally to the clinical examination the temporal arteries were imaged in all patients using the ultrasound-biomicroscopy (Zeiss-Humphrey Instruments). The results were correlated to the histopathologic changes of the temporal arteries excised bilaterally at the same location. RESULTS: Histopathological evaluation revealed a granulomatous arteritis in 4 out of 16 examined patients. The temporal arteries of these patients also showed characteristic changes using ultrasound biomicroscopy like middle-reflective shadowing of the arterial lumen and a condensation and enlargement of the muscularis media. Ultrasound-biomicroscopy allowed a precise evaluation of the temporal arteries due to a high-resolution sonographic image. The morphological differentiation between a normal and an affected artery was possible. A positive correlation between histopathological and clinical findings was seen in all patients. CONCLUSION: In this preliminary study the ultrasound-biomicroscopy seemed to be an appropriate non-invasive tool for the morphological imaging and evaluation of temporal arteries.

[Retinochoroiditis as a diagnostic indication of acute systemic toxoplasmosis in an immunocompetent patient]. / Retinochoroiditis als diagnostischer Hinweis auf eine akute systemische Toxoplasmose bei einem immunkompetenten Patienten.

HISTORY AND GENERAL INVESTIGATIONS: In February 1993 a 53-year-old immunocompetent man presented at our department with blurred vision on the right eye for 6 weeks. Following a journey to Guatemala in November 1992 he had developed undulating fever up to 40 degrees C (later subfebrile temperature) with loss of weight (15 kg), dysesthesia mainly in the feet and general weakness. He was hospitalized at a general hospital and treated with different antibiotics. Various examinations showed normal results, like cranial computer tomography, and serological tests for virus, bacteria or malaria. Only the transaminases and the borrelia serology (IgG: 1:80, IgM:neg.) were slightly elevated, and the abdominal sonography revealed a moderate hepatomegaly. OPHTHALMOLOGICAL FINDINGS: Visual acuity was 1.0 in both eyes. The right eye showed fatty retrocorneal precipitates, cellular infiltration of the anterior chamber and vitreous and a focal retinochoroiditis next to the superior temporal vessels (Fig. 1a), with corresponding defect in visual field and nerve fiber layer (Fig. 1b, c). Serology established the diagnosis of an acute generalized toxoplasmosis (IgM ISAGA i.S.: 1:1,600; IgM-AK IFT i.S.: 1:128, KBR i.S.: 1:320). THERAPY AND CLINICAL COURSE: After adequate chemotherapy ocular symptoms and dysesthesia improved rapidly. The temperature stayed low and the liver parameters returned to normal. CONCLUSION: The ophthalmoscopic finding of an acute focal retinochoroiditis played an important role for the diagnosis of an acute generalized toxoplasmosis in a patient with fever of unknown origin. Ocular manifestation is rare in acute generalized toxoplasmosis.

[Bilateral papillary edema in cerebrospinal syphilis]. / Bilaterale Papillenschwellung bei Lues cerebrospinalis.

BACKGROUND: Nowadays luetic infections are rarely seen by ophthalmologists. We report on an immunocompetent ophthalmologically asymptomatic patient with bilateral papilledema due to perineuritis optici in lues cerebrospinalis. PATIENT: A 47-year old female patient presented with presbyopic complaints. Additionally she reported occasional dizziness with nausea and hearing loss with tinnitus. Visual acuity measured 16/20. There was a bilateral prominent optic disc with indistinct margins and papillary hemorrhagies on the right side and corresponding enlargement of the blind spot in the visual field. Echography revealed bilateral optic drusen. Serological examination suggested lues (TPHA 1:5120, IgM-FTA-Abs-Test 1:320, Cardiolipin 1:640). Cerebrospinal fluid examination indicated an inflammatory process in the CNS without proof of an autochthonous antibody production. CONCLUSION: Even nowadays lues cerebrospinalis must be suspected in patients with bilateral papilledema without visual loss. The ophthalmologist holds an important diagnostic position, because adequate treatment is able to prevent disease progression.

[Detection of hepatitis C virus RNA in tear film of a patient with recurrent peripheral corneal ulcers]. / Nachweis von Hepatitis-C-Virus-RNA im Tränenfilm eines Patienten mit rezidivierenden peripheren Hornhautulzera.

BACKGROUND: There are conflicting reports on the role of hepatitis C virus in corneal pathology. PATIENT: A 58-year-old male patient presented with recurrent peripheral corneal ulcers and corneal thinning in the left eye. There was a bilateral vascular pannus formation and a decreased ocular wetting measured by Schirmer testing. The posterior ocular segment was normal. There was no sign of any systemic rheumatic disease. Serological testing detected antibodies against hepatitis C virus. Hepatitis C virus RNA testing using a quantitative polymerase chain reaction method revealed hepatitis C virus RNA in serum (> 3.2 million copies/ml) and in tear samples (18,000 copies/ml) of the patient. In a control group of 7 consecutive patients with hepatitis C virus RNA detection in the serum but without ocular pathology, no hepatitis C virus RNA was detected in tear samples (detection limit: 1000 copies/ml). CONCLUSIONS: Detection of hepatitis C virus RNA in lacrimal fluid of a patient with recurrent peripheral corneal ulcers may indicate a pathogenic role of hepatitis C virus in corneal pathology. Especially, since our patients with systemic hepatitis C virus infection but without ocular changes did not show hepatitis C virus RNA in their tears. Therefore, patients with recurrent corneal ulcers of unknown origin should be tested for systemic hepatitis C virus infection.

[Adamantiadis-Behçet syndrome: fluorescein angiography and choroid ischemia]. / Das Adamantiadis-Behçet-Syndrom: Fluoreszenzangiographie und choroidale Minderperfusion.

BACKGROUND: Adamantiadis-Behçet's disease is a chronically progressing multisystemic disorder. The underlying disease mechanism is an obliterative vasculitis of unknown etiology. Main clinical symptoms are oral and genital aphthous ulcers and intraocular inflammations. Additionally, cutaneous, rheumatoid, neural, gastrointestinal, or cardiovascular manifestations may be observed. Diagnosis is based on clinical features since currently no specific laboratory tests or pathognomonic histopathological features are available. Ocular changes may provide important diagnostic clues to the systemic disease. PATIENTS AND METHODS: In a retrospective fashion 196 patients of the Department of Ophthalmology of the University of Erlangen-Nürnberg between 1988 and 1998 with retinal vasculitis seen by fluorescence angiography were evaluated according to the diagnostic criteria of the "Behçet's Disease Research Committee of Japan". RESULTS: Among 196 patients there were 12 patients with Adamantiadis-Behçet's disease. Apart from retinal vasculitis, angiographic features included capillary dropout in 64% (9/14), swelling of the optic disc in 79% (11/14) and irregularly delayed areolar filling of choriocapillaris in the early phase of fluorescence angiography in 43% (6/14) of eyes. There was no statistically significant relationship between severity of the systemic disorder and the activity of the ocular disease. CONCLUSION: Apart from retinal vasculitis, 43% of eyes in patients with Adamantiadis-Behçet's disease presented a delayed choroidal filling in fluorescence angiography as a sign of choroidal involvement of occlusive vasculitis. We observed leakage of fluorescein from the optic disc, which could be due to a secondary inflammation of the ciliary circulation. Inflammatory involvement predominantly of choroidal vessels, as visualized in fluorescence angiography, may be a diagnostic lead in Adamantiadis-Behçet's disease.

[Retrolaminar infiltration of optic nerve with intraocular tamponade following silicone oil instillation]. / Retrolaminäre Infiltration des Nervus opticus durch als intraokulare Tamponade verwendetes Silikonöl.

BACKGROUND: Eyes after intravitreal silicone oil injection may suffer various complications. We report on a patient with deep retrolaminar changes in the optic nerve after silicone oil instillation with secondary angle-closure glaucoma. PATIENT: A 69-year-old female patient with aphakic retinal detachment of the right eye was treated by pars plana vitrectomy with silicone oil injection. After 41 months the patient presented with absolute secondary angle-closure glaucoma with rubeosis iridis. The intraocular pressure was elevated up to 55 mmHg. There was a peripheral retinal detachment and a pale deeply cupped optic disc. Due to increasing pain the blind eye was enucleated. Histology showed a mainly detached retina and silicone oil occupying the vitreous cavity. The optic nerve was deeply cupped and the parenchyma presented multiple cavernous spaces of various sizes. These presumptive silicone oil bubbles reached beyond the line of surgical transection, nine millimeters behind the globe. CONCLUSION: In comparison to Schnabel's cavernous optic atrophy the vacuoles in the optic nerve in this patient were filled with silicone oil instead of acid mucopolysaccharides. A posterior migration of silicone oil into the orbital optic nerve can not be excluded, after long-term silicone oil tamponade and elevated intraocular pressure.