[Successful treatment of Fusarium-associated keratitis with multiresistant pathogen and multimorbid patient]. / Erfolgreiche Therapie einer Fusarium-assoziierten Keratitis bei multiresistentem Erreger und multimorbidem Patienten.

A 75-year-old man (not a contact lens wearer) presented with Fusarium-associated hypopyon keratitis. After several weeks of empirical and subsequently targeted antimycotic treatment, no considerable improvement was observed. However, after sclerokeratoplasty (11.2 × 11.2 mm) combined with prolonged antimycotic therapy a good local result with relapse-free long-term follow-up was achieved.

[Examination of preschool children for refractive errors. First experience using a handheld autorefractor]. / Untersuchung von Kindergartenkindern auf Refraktionsanomalien. Erste Erfahrungen mit einem handgehaltenen Autorefraktometer.

BACKGROUND: Since ametropia is a leading cause of amblyopia refractive screening of preschool children is recommended. Measurement of refraction using tabletop autorefractors can be difficult or impossible due to lack of cooperation in this age group. The intention of the present study is to evaluate the use of a new handheld autorefractor for screening in kindergartens. METHODS: A total of 216 children aged 3.5-4.5 years were examined without cycloplegia using the handheld autorefractor (SureSight, Welch Allyn) in their kindergartens. RESULTS: Using the test device the majority of the examined eyes showed mild hyperopia (on average +1.18+/-0.87 dpt spherical equivalent) and mild astigmatism (on average 0.60+/-0.46 dpt cylinder power). The reproducibility of repeated autorefractor readings was higher for cylinder power and axis than for the spherical equivalent. Autorefractor readings of 55 eyes could be compared with the results of cycloplegic retinoscopy. The results were similar between the two measurements with differences of no more than 0.5 dpt in 18.2% for the spherical equivalent, in 82.1% for cylinder power, and in 66.6% for axis (weighted axis difference). There was adequate cooperation in 99.5% of the children. CONCLUSION: The handheld autorefractor proved an accuracy of measurement comparable to that of conventional tabletop autorefractors for cylinder power and axis with limitations in accuracy for the spherical equivalent. Validity and threshold values for relevant abnormalities are to be evaluated in further studies. By the high cooperation rate the instrument proved useful for screening examinations in preschool children.

[Unilateral eyelid swelling as an initial manifestation of angiosarcoma]. / Einseitige Lidschwellung als Erstmanifestation eines Angiosarkoms.

Cutaneous angiosarcomas mainly arise on the scalp and face of older patients. They present with reddish nodules or plaques and tend to bleed and ulcerate. Angiosarcomas show an aggressive and recurrent course and have a high potential for metastasis. We report on a 48-year-old patient with unilateral eyelid edema as the first manifestation of an angiosarcoma. The clinical presentation, the history of contact allergy, the presence of antinuclear antibodies, and abnormal thyroid function tests favoured a non-neoplastic disease. However, multiple biopsies confirmed the diagnosis of a highly differentiated angiosarcoma. Staging of the patient revealed no metastasis. After radical surgery including orbital exenteration and postoperative radiation therapy, no recurrence was observed with a follow up of 26 months. This case underlines the importance of including angiosarcoma in the differential diagnosis of unilateral eyelid edema.

Endophthalmitis induced by atypical mycobacterial infection.

Granulomatous uveitis induced by Mycobacterium tuberculosis infection has been less frequently encountered over the last 20 years. Differential diagnosis of M. tuberculosis and other atypical mycobacteria is nevertheless of particular interest in patients with acquired immune deficiency syndromes. We present the case of a 60-year-old man who was referred to our clinic because of therapy-refractive endophthalmitis. Diagnostic vitrectomy including microbiological examination as well as further extensive serological examinations did not reveal any further information on the etiology. Despite intensive anti-inflammatory treatment, the eye became blind and developed secondary glaucoma. Evisceration of the globe had to be performed. Histopathological examination showed a granulomatous inflammation without the tuberculosis-typical development of central caseous necrosis. Further molecular pathological investigations had to be performed with regard to differential diagnostic aspects. By means of the polymerase chain reaction we could detect mycobacterial gene sequences that corresponded to atypical mycobacteria. The diagnosis of atypical mycobacterial infection was confirmed Molecular-genetics examination techniques, especially those involving the polymerase chain reaction, will become more important in routine histopathological examination. These techniques can be performed on paraffin-fixed or formalin-embedded material for further differential diagnostic considerations.

[Detection of atypical mycobacterial endophthalmitis by PCR]. / Nachweis einer atypischen mykobakteriellen Endophthalmitis durch PCR.

We report a case of a 60 year old male who presented with a therapy resistant endophthalmitis which led to an evisceratio bulbi. Histologically, a granulomatous inflammation was present, in which acid-fast bacilli could not be detected. Molecular genetic examination by means of polymerase-chain-reaction technique (PCR) of the routinely processed tissue material revealed the diagnosis of an atypical mycobacterial infection, because DNA specific for atypical mycobacteria was detected. This example shows that PCR technique provides a useful tool in the diagnosis of mycobacterial infections as an adjunct to surgical pathology.

[Early vitrectomy in endogenous juvenile uveitis intermedia--a long-term study]. / Frühvitrektomie bei endogener juveniler Uveitis intermedia--Eine Langzeitstudie.

BACKGROUND: The intermediate uveitis is one of the most common intraocular manifestations of inflammation during infancy and adolescence. The success of intensive pharmacological treatment is rather limited and often associated with heavy side effects. PATIENTS AND METHODS: In 25 eyes with juvenile uveitis intermedia (age of the patients between 5 and 18 years, mean 13.5 years) and visual acuities between 0.02 and 0.4 (mean 0.19) an early vitrectomy was performed after failure of conservative treatment and peripheral cryocoagulation. RESULTS: Almost all patients (22 out of 25) showed an improvement of visual acuity within the first 6 months of the surgery. Among the patients with a remarkable improvement of visual acuity 7 eyes had a chronic cystoid macular oedema which showed a regression postoperatively. Additionally, the number and the course of inflammatory periods could be reduced postoperatively. An increase of preexisting lens opacities, however, has not been noticed even after a follow-up period of 10 years. CONCLUSIONS: The results show that an early vitrectomy in cases of juvenile uveitis intermedia often leads to a stabilization or an improvement of visual acuity and a regression of the inflammatory attacks (episodes). Therefore, in children and adolescents with endogenous uveitis intermedia a pars plana vitrectomy instead of a long-term systemic immunosuppression associated with heavy side-effects should be considered.