[Ocular blood flow in patients with asymmetric glaucoma]. / Okulärer Blutfluss bei Patienten mit asymmetrischem Glaukom.

BACKGROUND: Hemodynamic factors are gaining increasing importance in the pathogenesis of glaucoma. This study was designed to investigate ocular blood flow in patients with asymmetric glaucoma. METHODS: The more affected and the contra-lateral eyes of 15 glaucoma patients with asymmetric scotomas (difference in mean deviation >/=8 dB) despite equal IOP were compared with reference to IOP, optic nerve head excavation, mean deviation in scotomas and ocular blood flow (OBF). Exclusion criteria were defined as follows: operated eyes, secondary glaucomas, differences in IOP and in antiglaucoma therapy, differences in visual acuity >2 steps and other ophthalmological diseases. For statistical analysis the Wilcoxon test for paired samples was used. RESULTS: A comparison of IOP's of the more affected eyes with the contralateral eyes showed no differences. Vertical and horizontal excavation differed significantly ( p=0.027 and p=0.01, respectively) and also the mean deviation in scotomas showed a statistically significant difference ( p=0.001). The pulse amplitude and the pulse volume showed only a slight tendency, but the pulsatile ocular blood flow was significantly lower in the more affected eyes ( p=0.047). CONCLUSION: The lower pulsatile ocular blood flow in the more affected eye in patients with asymmetric glaucoma could be the lateralizing factor in these patients, and suggests an influence of hemodynamic factors in the pathogenesis of glaucoma.

[Follow-up of proliferation of juxtapapillary retinal pigment epithelium]. / Verlaufsbeobachtung einer Proliferation des juxtapapillären retinalen Pigmentepithels.

PURPOSE: Bengin proliferation of the juxtapapillary retinal pigment epithelium is a rare but important tumor because it may be mistaken for a malignant lesion such as choroidal melanoma. CASE REPORT: A 9-year-old male patient consulted our clinic first in 1991 because of a reduction in visual acuity due to a tumor of the optic nerve head in the left eye. Visual acuity was 1.0 in the right eye and 0.2 in the left eye. Slit lamp examination and intraocular pressure were regular in both eyes. Kinetic perimetry showed a enlarged blind spot besides regular isopters. Funduscopy revealed a pigmented, ill-defined prominence of the optic nerve head with a mossy surface. In annual examinations were found a slowly progredient reduction in visual acuity up to 0.04 durning the last visit in January 2000 as well as a enlargement of the blind spot due to an increasing prominence and pigmentation of the optic nerve head. Because of the clincal aspect, the slowly progressive course, the enlargement of the blind spot with deterioration of vision and especially the florescein angiography, which revealed peripapillary capillary alterations with leakage, we diagnosed a proliferation of the juxtapapillary retinal pigment epithelium. CONCLUSION: The proliferation of the juxtapapillary retinal pigment epithelium can be differentiated from other pigmented tumors of the optic nerve head by its typical clinical aspect and course and especially by using flourescein angiography.

[Complications following eyebrow piercing]. / Komplikationen nach Brauenpiercing. Patientendarstellung.

BACKGROUND: Piercing as a new form of "body art" is becoming more frequent in western industrialised countries and has achieved a certain social acceptance. Materials used are mainly surgical steel and, less frequently due to higher costs, titanium, gold, silver and niobium. The current literature reports complications such as infections, swellings, allergies, wound healing problems, dental damage and hepatitis following piercing in oral and facial regions. PATIENT: A 22-year-old nurse underwent piercing of her right eyebrow 4 months previously. While piercing of her tongue and nipples had not caused any problems, she first complained of a local inflammation about 3 months after the piercing procedure, which healed spontaneously. Now she complained again about pain, pressure, redness and swelling of her right cheek and face. A dermatologist had recommended tea compresses. On her first visit she presented with a solid, movable, tender, cherry-size swelling of the lateral third of the right eyebrow, a redness of the eyelid and a large swelling of the cheek. Following a systemic antibiotic therapy she underwent surgery and the inflammatory tissue was removed. Histologically, muscle tissue and a piercing canal were visible as well as histiolymphocytotic infiltrates with epitheloid and solitary giant cells. CONCLUSIONS: With an increasing frequency of piercing, the number of complications in the field of ophthalmology is also likely to increase. Considerable costs may arise for the social health care system depending on the severity of the complications.

[Effect of latanoprost on ocular hemodynamics and contrast sensitivity]. / Einfluss von Latanoprost auf okuläre Hämodynamik und Kontrastsensitivität.

BACKGROUND: Latanoprost effectively lowers intraocular pressure. Because ischemia has gained increasing importance in the pathogenesis of glaucoma, an antiglaucomatous drug should also be investigated with regard to the influence on ocular hemodynamics. METHODS: In a double masked, randomized, clinical trial, Latanoprost eye drops were administered to 15 volunteers once daily for 8 days and 15 further volunteers received placebo eye drops according to the same protocol. IOP, blood pressure, heart rate, ocular pulse amplitudes, pulse volume, pulsatile ocular blood flow and contrast sensitivity were measured before (1T0), 120 min after drop administration (1T120), after 7 days of therapy (8T0) and again 120 min after an acute administration (8T120). For statistical analysis a two-way variance-analysis and the t-test for paired samples were used. RESULTS: IOP was found to be statistically significantly different comparing both groups over the test period (p = 0.036). In Latanoprost-treated subjects the t-test revealed a significant drop in IOP between 1T0 and 8T0 (p = 0.009) and between 1T0 and 8T120 (p < 0.0001). All other above mentioned parameters remained constant. CONCLUSION: In Latanoprost-treated subjects, a significant drop in intraocular pressure was observed after 1 week. However, ocular perfusion and contrast sensitivity did not change during therapy. This might be due to an effective autoregulation in healthy volunteers.

[Reduction of ocular pulse amplitude by apraclonidine--prospective double-blind, randomized clinical trial with 10 subjects]. / Reduktion der okulären Pulsamplitude unter Apraclonidin--prospektive doppelt maskierte Studie an 10 Probanden.

BACKGROUND: The alpha-agonist Apraclonidin lowers effective intraocular pressure. Ischemia gains increasing importance in the pathogenesis of glaucoma. Therefore, an antiglaucomatous drug should also be investigated in regard of its influence on ocular hemodynamics. METHODS: In a double masked, randomized, clinical trial 0.5% Apraclonidin eye drops were applied in 10 health subjects twice daily for 8 days. The control group (10 healty volunteers) received a placebo medication (0.9% NaCI) according to the same protocol. IOP, heart rate, blood pressure and ocular pulse amplitudes (OBF Labs, UK) were measured at baseline (1T0), 90 minutes after instillation of one eye drop (1T90), after 7 days of therapy (8T0) and again 90 minutes after an acute instillation (8T90). For statistical analysis the wilcoxon test for paried samples was used. RESULTS: In Apraclonindin treated subjects IOP dropped significantly (P<0.01) from 15.6 mm Hg to 11.4/12.4/10.3 mm Hg (1T0/1T90/8T0/8T90. The control group showed a significant reduction at 1T90 (p + 0.01)and at 8T90 (p = 0.005) from 3.22 mm Hg to 2.48/31/2.35 mm Hg (1T0/1T90/8T0/8T90), in the control group the pulse amplitude remained constant. CONCLUSION: After one week of therapy with 0.5% Apralonidin, intraocular pressure dropped as expected in health volunteers. The observed reduction in pulse amplitudes in pulse amplitudes however could have a negative effect on long-term therapy in patients with chronic open-angle glaucoma .

[Retinal nerve fiber layer thickness and peripapillary blood flow in glaucoma patients and healthy probands]. / Retinale Nervenfaserschichtdicke und peripapillärer Blutfluss bei Glaukompatienten und Gesunden.

BACKGROUND: In progressive glaucoma there is increasing loss of retinal nerve fibers and therefore decreasing nerve fiber layer thickness. As measurements of capillary blood flow have been reported to depend on nerve fiber layer thickness, this could result in incorrectly high blood flow measurements in patients with advanced glaucoma. METHODS: In 33 healthy controls and 59 glaucoma patients we measured retinal nerve fiber layer thickness by laser polarimetry and relative capillary blood flow by scanning laser doppler flowmetry three times on the nasal and temporal peripapillary retina. For statistical analysis a regression analysis was used. RESULTS: The correlation coefficients for volume, velocity, and flow with nerve fiber layer thickness at the same location were 0.02/-0.03/-0.02 in the temporal retina and -0.22/-0.07/-0.19 in the nasal retina (all correlations nonsignificant). CONCLUSION: No correlation was found between nerve fiber layer thickness and capillary blood flow. Measurement of capillary blood flow in glaucoma patients thus does not appear to be affected by decreasing nerve fiber layer thickness.

[Maculopathy in Curschmann-Steinert myotonic dystrophy]. / Makulopathie bei Myotoner Dystrophie Curschmann Steinert.

BACKGROUND: Maculopathy occurring in young patients is a challenge in differential diagnosis. Besides hereditary macular dystrophies and acquired macular degenerations, rare systemic disorders should be considered. CASE REPORT: A 36 year old female patient complained about a gradually decrease of visual acuity in both eyes and an increasing exotropia of her right eye. Visual acuity was 0.7, the orthoptical status revealed an intermittent exophoria with exclusion of the right eye. Slit lamp examination showed punctate and cristalline lens opacities. In fundus examination and fluorescein angiography clumpy pigment epithelium hypertrophies and atrophies with a reticular character could be observed. Color vision and perimetry were normal; dark visual acuity was reduced. Because of remarkable deformations of jaw and teeth, a high hairline and an uncertain step we arranged a neurological consultation. Clinical observation together with myotonic activities in electromyography and diffuse lesions in the cerebral medular corpus shown in MRT led to the diagnosis of myotonic dystrophy (Curschmann Steinert syndrome). CONCLUSION: Besides hereditary macular dystrophies and acquired macular degenerations the differential diagnosis of maculopathies in young patients also includes systemic disorders. Myotonic dystrophy (Curschmann Steinert syndrome) should be taken into account as a rare cause of a juvenile maculopathy.

[Are there indications for abortion or cesarean section and contraindications for spontaneous delivery in ophthalmologic diseases? Case report and overview]. / Gibt es Indikationen zur Interruptio oder Sectio caesarea bzw. Kontraindikationen gegen eine Spontangeburt bei ophthalmologischen Erkrankungen? Kasuistik und Ubersicht.

Management of labor and indications for abortion in patients with ophthalmologic diseases are discussed controversially in literature and are often overemphasized. We present a case of a pregnant woman with bilateral papilledema due to pseudotumor cerebri, because an abortion was in question. This case lead us to discuss indications for abortions in patients with pseudotumor cerebri, as well as indications for abortions or cesarean sections in patients with high myopia, retinal detachment, retinopathy in EPH-gestosis, uveal melanoma and diabetic retinopathy. In this article these questions will be discussed.

[External trabecular excision--alternative to filtering glaucoma operation in patients with open angle glaucoma]. / Externe Trabekelexzision (ETE)--Alternative zur filtrierenden Glaukomoperation bei Patienten mit Offenwinkelglaukom.

BACKGROUND: Postoperative complications concerning glaucoma filtering surgery (trabeculectomy, goniotrepanation) often include hypotonia that may lead to athalamia or choroidal detachment, which are difficult to handle. Cystic non filtering blebs are due to postinflammatory reactions, and may limit the success of filtering surgery. Aim of the study was to compare the success and the complications of a new operating technique, which will be described, with those of usual glaucoma filtering surgery. PATIENTS AND METHODS: In 24 open angle glaucoma patients with mean intraocular pressure of 28.12 mm Hg (+/- 8.6) we performed external trabecular excision in 25 eyes since June 1997. Preoperative visual acuity and peak intraocular pressure were compared retrospectively in all eyes with the values of the first postoperative day, in 22 eyes after one month and in 17 eyes after 3 months. RESULTS: Intraocular pressure measured between 0 mm Hg and 16 mm Hg on the first postoperative day (7.64 mm Hg +/- 4.3), after one month between 10 mm Hg and 30 mm Hg (17.81 mm Hg +/- 5.5) and after 3 months between 9 mm Hg and 26 mm Hg (15.29 mm Hg +/- 4.2). After 1 month 10 of 22 (45%) and after 3 months 7 of 17 eyes (42%) required antiglaucomatous drugs; 3 eyes needed gonitrepanation (2 weeks, 1 month, 3 months after ETE). Concerning postoperative complications, we observed 6 choroidal detachments, once erythrocoytes in the anterior chamber, twice hyphemata, twice inflammatory reaction in the anterior chamber, two flat anterior chambers and twice a positive seidel test. CONCLUSION: Complications after ETE are similar to those after filtering surgery. Postoperative intraocular pressure dip after ETE in most eyes was not as pronounced as after goniotrepanation or trabeculectomy, and postoperative complications were all reversible. 45% of the eyes again needed antiglaucomatous drugs after one month and 42% after 3 months. A prospective long-term study has to verify the success respectively the complications of ETE.

High-altitude retinopathy.

PURPOSE: To report a patient with high-altitude retinopathy. METHODS: A 30-year-old man with high-altitude retinopathy was examined and treated. RESULTS: After spending 2 weeks at an altitude of 7,000 meters and then descending to sea level, the patient's visual acuity was RE, 20/20 and LE, 20/50. Intraretinal hemorrhages in both eyes and a scotoma in the left eye were found. Blood cell count was normal, but hematocrit had increased to 53%. The patient was treated with isovolemic hemodilution, pentoxifylline, and aspirin, which reduced hematocrit to 41%. Visual acuity and visual field returned to normal, and intraretinal hemorrhages resolved. CONCLUSIONS: High-altitude hemoconcentration should be treated in patients with high-altitude retinopathy.

[Labor monitoring and indications for abortion and cesarean section in eye diseases--an overview]. / Geburtsleitung und Indikationen zur Interruptio und Sectio caesarea bei Augenerkrankungen--eine Ubersicht.

BACKGROUND: Management of labor and indications for abortion in ophthalmologic diseases are discussed controversially in literature. Overtreatment is still frequent. In diseases like pseudotumor cerebri, high myopia, retinal detachment, retinopathy in EPH-gestosis, uveal melanoma and diabetic retinopathy, the question for optimal management of labor or interruption rises mainly from gynaecologists. METHODS: In this review these conditions will be discussed with the literature--obtained by a medline-research. CONCLUSIONS: In the ophthalmologist's point of view--there are no indications for interruption or section caesarean in patients with above mentioned ophthalmologic diseases.

[Pseudotumor cerebri and pregnancy--a case report]. / Pseudotumor cerebri und Schwangerschaft--Kasuistik.

BACKGROUND: Indications for section caesarean or interruption in ophthalmologic diseases are discussed controversially in the literature and are often overemphasized. CASE REPORT: A 34-year-old VII-gravida VI-para consulted our clinic for the first time in her 14th week of pregnancy because of bilateral papilledema. There was no indication for EPH-gestosis, neurological examination als well as MRT were normal. In control examinations--first every 3 weeks, then with the beginning of the 30th week of pregnancy every week--the clinical course was uneventful: visual acuity remained on both sides 1.0, on the right eye more than on the left eye the discs appeared prominent with hazy margins, the blind spot was enlarged on the right eye more than on the left eye. Furthermore there was intermittent myopia. In the 37th week of pregnancy section caesarean was performed because of gynecological indications. At the last examination, 4 weeks later, there was a nearly complete restitution ad integrum. CONCLUSION: Indications for section caesarean or interruption in patients with papilledema due to pseudotumor cerebri will be discussed with the literature.