Atypical severe Puumala hantavirus infection and virus sequence analysis of the patient and regional reservoir host.

Nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) is a mild variant of haemorrhagic fever with renal syndrome, which is endemic in Germany. We describe the case of a 67-year-old man initially presenting with acute bilateral angle-closure glaucoma, an atypical clinical presentation of PUUV infection. Subsequently, the patient developed a severe course of disease additionally complicated by profound hepatitis and interstitial nephritis, both phenomena which are rarely described in association with hantavirus infection. Serologic diagnosis was complicated by delayed antibody production until the 10th day of illness; however, PUUV RNA was detectable early in disease. To further analyse this unusual case, sequencing of the PUUV S segment was performed from the patient and regional reservoir host which showed a close relation.

[Ocular signs of a mitochondrial trifunctional protein defect. A long-term follow-up]. / Okuläre Zeichen eines mitochondrialen trifunktionalen Proteindefekts. Eine Langzeitbeobachtung.

A 13-year-old boy presented with a defect of the mitochondrial trifunctional protein (MTP). The MTP complex catalyses ß-oxidation of long chain fatty acids. Disorders of this multienzyme complex result in accumulation of hydroxylated long chain fatty acids which leads to chorioretinopathy. Ophthalmoscopic findings in these patients include fine hyperpigmentation while autofluorescence reveals hyperfluorescent granules at the posterior pole. Visual acuity, visual fields and electroretinography are within the normal range. A special long chain fatty acid-reduced diet seems to delay the progression of chorioretinopathy.

[Accuracy of two autorefractors--Pediatric Autorefractor plusoptiX and Retinomax--in cycloplegic children in comparison to retinoscopy]. / Zur Messung der objektiven Refraktion in Zykloplegie im Kindesalter mit Skiaskopie und automatischer Refraktometrie mit dem Pediatric Autorefractor und dem Retinomax.

HISTORY: In children, measuring refraction is of interest particularly with regard to the risk of amblyopia. Cycloplegic retinoscopy is the gold standard method for this age group. In a prospective study we compared readings from two hand-held photorefractors, the Pediatric Autorefractor and the Retinomax, to those from retinoscopy. PATIENTS AND METHODS: 74 patients were recruited consecutively at the outpatient department of Heidelberg University Eye Hospital's Section for Strabismology and Neuroophthalmology. All patients underwent standardised cycloplegia measurements first by the Pediatric Autorefractor plusoptiX A 08 in 1 metre working distance, then adding an infrared filter to reduce interferences, followed by the Retinomax K-plus 3 in 5 cm working distance and retinoscopy as reference on the right eye. RESULTS: Spherical equivalents measured by the Pediatric Autorefractor plusoptiX A 08 coincided in 51.2% with retinoscopy (± 0.5 D). Adding an infrared filter increased this to 60.0%. However, the success rate of measurement decreased to 47% on adding an infrared filter as compared to 55.4% in cycloplegia alone. Children showed no cooperation in 11% and 16% with the infrared filter, respectively. The remaining children were not measurable by means of the device. With regard to spherical equivalents, the measurements done with Retinomax K-plus 3 coincide in 57% with those done in retinoscopy. The success rate of measurements with the Retinomax was 91%. The remaining children showed no cooperation. CONCLUSION: Retinoscopy in cycloplegia is still the method of choice when determining refraction in children. Autorefractors quickly provide results for comparison which coincide with retinoscopy in 50-60% in spherical equivalent and in 80-90% in cylindrical values. The Pediatric Autorefractor is not suited for everyday clinical routine due to a low success rate of 50% and tight measuring range of + 5.0 to -7.0 D in spherical equivalents.

[Pilot study of the Heidelberg diplopia questionnaire]. / Pilotstudie zu einem Heidelberger Doppelbildfragebogen.

PURPOSE: To test the visual-function-related quality of life in patients with diplopia, we designed a new questionnaire: the Heidelberg diplopia questionnaire. PATIENTS AND METHODS: In a prospective study, 51 patients with different ocular motility diseases (congenital and acquired) were asked about their everyday life impairment. The questionnaire encompasses the following subscales: duration of diplopia, spatial perception, motion in space, driving difficulties, difficulties at work, near vision, social function, and subjective complaints. RESULTS: The median composite questionnaire score correlated well with the patients' subjective complaints (Spearman's rho 0.70, p=0.000001) and their driving difficulties. There was a weak correlation with the clinical assessment of diplopia in the field of binocular vision based on the suggestions of Haase and Steinhorst and of Kolling. CONCLUSION: The Heidelberg diplopia questionnaire records patients' subjective complaints concerning diplopia. This study serves as the starting point for further studies in this field.

Reliability of three different visual acuity testing procedures in school children.

AIM: To evaluate the usability and reliability of three different visual acuity (VA) testing procedures using Landolt C's in 8 positions with a semi-automated computer program in school children. METHODS: 100 school children (median 7 years, 59 boys and 41 girls) were included; only the better eye was tested. We used the semi-automated computer program CORVIS.VT in a forced choice method. Three different test strategies were employed, each two times: A) DIN, B) Standard-Staircase and C) Best-PEST procedure with sequences A, B, C or A, C, B. RESULTS: Average testing time was 100 s +/- 45 (DIN), 59 s +/- 36 (Staircase) and 77 s +/- 25 (Best-PEST). The mean VA estimated with DIN was equivalent to that with the Best-PEST procedure. However, the mean VA with Standard-Staircase was one line less. In DIN, 76% of the retest scores were within 0.1 logMAR unit of the initial test score (Staircase: 72%, Best-PEST 73%). The 95% confidence interval of test-retest reliability was calculated to be -0.05 +/- 0.24 logMAR in DIN, +0.02 +/- 0.32 logMAR in Staircase, and 0.00 +/- 0.29 logMAR in Best-PEST. CONCLUSION: A high percentage of children aged 6 to 9 years (98%) can be tested with Landolt C's (8 positions). We found a decreasing test-retest reliability starting from DIN via Best-PEST to Staircase in this configuration.

[Management of consecutive exotropia -- operative therapy and diplopia testing]. / Zur Therapie des konsekutiven Strabismus divergens.

PURPOSE: The aim of this study was to investigate the diagnostic value of preoperative sensory testing on postoperative diplopia and to evaluate the dose-effect relations of medial rectus muscle or unilateral recess/resect advancement procedures and their constancy. METHODS: A retrospective evaluation of 62 operative cases of consecutive exotropia performed from 2001 to 2003 was carried out. Diplopia after prismatic correction and after converging by minus glasses was tested. In 47 cases a unilateral recess/resect procedure and in 15 cases an advancement of the medial rectus muscle were performed. The postoperative results were controlled one week and three months after operation by measuring the angle of squint by a prism cover test looking in five metres and in 33 cm. RESULTS: 22 patients (36 %) had neither diplopia after prismatic correction of angle of squint nor after operation. The other 40 patients (64 %) experienced diplopia, but were not troubled by it. In all patients the whole amount of angle of squint was operated. Immediately after operation, 14 patients (23 %) experienced diplopia temporarily, which remained after 3 months in 9 patients, but all of them were not disturbed by it. In all patients the mean preoperative angle of - 19 degrees was corrected by a mean operative amount of 11 mm, the mean postoperative angles were + 1.5 degrees after one week and - 2.6 degrees after three months with considerable variations of the results (standard deviations were about 5 degrees ). In 15 cases with advancement of the medial rectus muscle the dose-effect relation was 2 degrees per mm operative amount. After three months these patients become more divergent, the mean value was - 6 degrees , the dose-effect relation was reduced to 1.4 degrees /mm. The unilateral recess/resect operations were more constant: these became more divergent of 2.5 degrees only and their dose-effect relation remained more constant (after one week: 1.9 degrees /mm, after 3 months: 1.7 degrees /mm). CONCLUSIONS: The diagnostic value of preoperative prismatic correction of the deviation is very limited. Even if diplopia can be provoked, the chance of disturbing diplopia is very low. Nevertheless, some guidelines for pre- and postoperative care are necessary to prevent double vision. The postoperative outcome is favourable for the patient after one operation. In cases of relapsing divergence a second operation is easily possible.