MALT lymphoma in patients with autoimmune diseases: a comparative analysis of characteristics and clinical course.

MALT lymphoma, especially of extragastric origin, is thought to be associated with an underlying autoimmune disease (AD) in a significant proportion of patients. No systematic assessment of the clinical characteristics of MALT lymphoma arising in AD as opposed to patients without AD has been performed so far. Therefore, all patients diagnosed and treated for MALT lymphoma at our institution have prospectively undergone routine clinical and serological assessment for AD since 1997. In total, 158 patients were available for analysis, and 61 out of 158 patients (39%) were diagnosed with an underlying AD. Patients with AD were predominantly women and significantly younger at lymphoma diagnosis (56 versus 67 years, P=0.004), with a significantly higher rate of extragastric lymphomas (P=0.012). Furthermore, lymphomas in these patients showed a lower frequency of trisomy 3 (P=0.04) and a significantly lower response rate to Helicobacter pylori eradication therapy in the case of gastric lymphomas (P=0.03). All other parameters including estimated median time to relapse were comparable between both groups. Our data suggest that patients with AD develop MALT lymphoma significantly earlier in life. The clinical course, however, does not appear to be adversely influenced by the presence of AD, as neither rate of relapse nor times to relapse or survival are significantly different.

'Blind' antibiotic treatment targeting Chlamydia is not effective in patients with MALT lymphoma of the ocular adnexa.

BACKGROUND: Recent results have implicated Chlamydia, especially Chlamydia psittaci, in the development of ocular adnexal lymphoma in the large majority of patients. We present our experience with ex-juvantibus antibiotic treatment in patients diagnosed with MALT lymphoma of the ocular adnexa. PATIENTS AND METHODS: A retrospective analysis identified a total of 11 patients (six female, five male) with MALT-lymphoma of the ocular adnexa who were given doxycyclin 200 mg p.o. daily over 3 weeks. Patients were tested also for autoimmune conditions, Helicobacter status and hepatitis along with assessment of MALT-lymphoma specific genetic changes. RESULTS: After a median follow-up of 9 months, none of the patients responded to 'blind' antibiotic treatment with doxycyclin. Only one patient with bilateral conjunctival lymphoma related a short lasting subjective improvement, but was referred to alternative therapy due to progression and worsening symptoms after 6 months. CONCLUSIONS: In this uncontrolled series, no effect of 'blind' antibiotic treatment with doxycyclin could be found in our patients with MALT lymphoma of the ocular adnexa. These results are in contrast to other series and suggest a potential geographic difference in the role of Chlamydia in ocular adnexal lymphoma. Thus, antibiotic therapy without prior testing for Chlamydia should be discouraged.

Semicircular tumor of the iris and uveitis as unilocal manifestation of sarcoidosis.

PURPOSE: To describe an unusual manifestation of sarcoidosis as a large tumor of the iris and ciliary body without any other involvement of the body. METHODS: We describe a 20-year-old female presenting with a granulomatous tumor of the right iris and ciliary body and concomitant uveitis. RESULTS: Extensive ocular and systemic workup revealed the tumor to be a large solitary sarcoid granuloma. As systemic steroids were not able to control the activity of the uveitis and granuloma, only the initiation of immunosuppressive therapy with cyclosporine A achieved a lasting remission. CONCLUSION: The possibility of an exclusively ocular sarcoidosis should always be kept in mind despite negative regular screening tests. In these cases, a biopsy should be considered and immunosuppressive agents like cyclosporine A should be evaluated in cases not responding to first-line treatment with systemic steroids.

Treatment of ocular toxocariasis with albendazole.

The purpose of this study was to evaluate the efficacy of combined albendazole and steroid treatment for uveitis caused by Toxocara canis in immunocompetent patients. Five patients (7 eyes) with ocular larva migrans syndrome (OLM) were used in this study. Toxocariasis was suspected based on clinical manifestations and confirmed by anti-toxocara IgG and Western blot analysis. Systemic albendazole (adults: 800 mg b.i.d.; children: 400 mg b.i.d.) was given in conjunction with steroids. Visual acuity before and after therapy, inflammatory response, side effects and toxicity were evaluated. Treatment resulted in an improved visual acuity in all patients. Mean initial Snellen visual acuity was 20/40, and mean final acuity was 20/20. There were no recurrences of uveitis throughout the observation period (average: 13.8 months; range: 3 days to 24 months). These findings suggest that albendazole, in combination with systemic steroids, is a useful regimen to treat ocular larva migrans syndrome.

[Idiopathic sclero-choroid calcification]. / Idiopathische sklerochoroidale Kalzifikation.

BACKGROUND: Idiopathic sclerochoroidal calcification (ISC) is an unusual, benign disorder occurring at the level of the posterior choroidea and sclera. Clinical differential diagnosis includes choroidal osteoma, choroidal metastasis, choroidal melanoma, choroidal amelanotic naevus and choroiditis. PATIENT: A 61-year old man was referred with the diagnosis of multifocal choroidal tumor in both eyes. Fundoscopy showed bilateral yellow lesions located near the superotemporal arcade. RESULTS: Fluorescein angiography shows the late staining of the choroidal lesions. Ultrasonographically highly reflective lesions (sclerochoroidal placoid lesions at the sclero-choroidal interface in the CT) confirms the clinical diagnosis. The serum calcium and phosphate metabolism is normal. CONCLUSION: The Idiopathic Sclerochoroidal Calcification (ISC) is a rare echographical differential diagnosis to the choroidal osteoma. ISC is a heterotopic calcification of the posterior pole in both eyes, usually located near the superotemporal arcade.

A new sponge profile for retinal detachment surgery: design and in vitro-effectiveness.

PURPOSE: To develop a new, calculated design for episcleral sponges to achieve sufficient indentation under avoidance of form related side effects. DESIGN AND METHODS: The new sponge profile consists of two convex halves with different radii, with a calculated optimum relation between inner and outer radius. It was tested on pig eyes and compared with round and half cut sponges. The height of the intraocular buckle was determined by ultrasound (A-Scan, Biovision V Plus), the extraocular height using ultrasound biomicroscopy (Humphrey Biomicroscope System Model 840). RESULTS: The buckle height achieved with the new design showed no significant difference to round sponges, whereas the extrascleral height was significantly lower compared to round sponges (p<0.001). Half cut sponges showed significantly less buckle height compared to round sponges (p<0.001) and to the new design (p<0.02). CONCLUSION: The new design produces sufficient indentation combined with minor change of the outer globe contour. It has the potential to be as efficient as conventional round sponges, but more tolerable for the patient by reduction of form related side effects.

Ultrasound biomicroscopy of tangential keratotomy incision depth after penetrating keratoplasty.

PURPOSE: To assess the accuracy and reproducibility of using ultrasound biomicroscopy to measure corneal refractive incisions in vivo. SETTINGS: Department of Ophthalmology, University of Vienna, Austria. METHODS: Ultrasound biomicroscopy was performed in five eyes of five patients who had previous tangential keratotomy for high postkeratoplasty astigmatism. Depth of the incision scar was documented, and the measurements were compared with those obtained preoperatively by ultrasound pachymetry readings of the corneal thickness and with the settings of the diamond knife blade. RESULTS: The measured depths reached 84.7% +/- 12.9 (SD) of corneal thickness compared with the intended 89.1 +/- 6.7% depth of incision. The relation between knife setting and achieved depth was 95.3 +/- 15.9%. CONCLUSION: Ultrasound biomicroscopy provided high-quality images of the incision scars, accurately measuring actual incision depth in vivo. It may become a clinically useful tool for the refractive surgeon as it contributes to the predictability and accuracy of keratorefractive procedures.

[Combined therapy with cyclosporin A and cortisone in endocrine Basedow endocrine orbitopathy: successful use in compressive optic neuropathy]. / Kombinierte Therapie mit Cyclosporin A und Kortison bei der endokrinen Orbitopathie des Morbus Basedow: erfolgreicher Einsatz bei der kompressiven Optikusneuropathie.

This study reports our experience with a combined treatment with cyclosporin A (Cy A) and cortisone in patients with Graves' ophthalmopathy (GO), all of whom had compressive optic nerve disease (CON). The therapy was performed in 8 patients (6 females, age range: 40 to 76 years) with normal liver and kidney function and classical Graves' disease, except for 1 male, who had normal thyroid function and no detectable thyroid antibodies. 5 patients were euthyroid on methimazole, 2 patients were off thyrostatic treatment for 5 and 2 years. 3 patients have had high-dose cortisone (100 mg/die) treatment for GO before the study. Visual field defects were reported by the patients 1 week before start of therapy and evaluated by computerized visual field measurements (CVFM). The treatment consisted of Cy A in a dose which aimed at through levels between 100 and 300 ng/ml (RIA method) for 2 to 6 months and of methylprednisolone in a starting dose of 1 mg/kg body weight, tapered gradually to a maintenance dose of 10 mg/day for 6 to 12 months. CON disappeared completely in all patients. The thickening of affected eye muscles decreased in 5 patients, disappeared in 1 and remained unchanged in 2 patients. The shortest period for a measurable effect (either by echography or by CVFM, performed every week the first month and then every 3 months) was 1 week; the longest 1 month. The follow-up of the patients (range 6 months to 2.5 years) showed a relapse only in 1 patient. 2 patients were lost to follow-up 1 year after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Calculating the diameter of the anterior chamber before implanting an artificial lens]. / Die Berechnung des Vorderkammerdurchmessers vor Implantation eines Pseudophakos.

Anterior chamber lenses sized correctly and positioned properly yield excellent results. Problems reported with anterior chamber implants are related to improper length/or lens placement to the scleral spur. In clinical routine examinations the "white to white data plus one mm" determine the overall length of an anterior chamber lens. However, variability of limbal anatomy causes great variations in estimations of corneal diameter. Approximation of corneal profile can be achieved by using ellipsoid or paraboloid functions. These data together with ultrasound measurements and keratometer readings serve as prerequisites for computations. For biometry an Ocuscan DBR 400-ST unit is used; the corneal refraction (r0) is measured with an automatic keratometer (Humphrey). The peripheral measurements are performed 13.5 degrees nasally and temporally (r1, r2). Using Euler's formula the horizontal radius is calculated (R0, R1, R2). Taking the constant epsilon 2 (epsilon 2 = r2-r0(2)/r2sin2 phi) the diameter can be calculated with the formula h = square root of (2ap-p2)(1-epsilon 2). Model A: two asymmetric halves are computed, the addition gives the corneal diameter (H = h1 + h2). Model B and C: only one symmetric half is computed, the double distance gives the corneal diameter (H = 2 h). The distance p is taken from biometry data; the distance from the anterior corneal surface to the posterior lens surface (ACD + LE) should be multiplied with the factor 0.32: p = (ACD + LE) 0.32. 250 eyes were examined comparing the optical data with the calculated results of our corneal model; the mean value for p was 2.4811 millimeter. Based on a control system the computer eliminated 35 eyes (14%). In the rest group of 215 eyes (100%) the difference to the optical measurements was not greater than +/- 0.25 mm in 181 calculations (84.2%). We noticed a tendency to predict too short internal diameters with external methods. Using optical measurements 1.25 millimeters should be added assuring correct position of the haptics. Using our computer-program for calculations of corneal diameter new anatomic conditions in eyes with abnormal dimensions may be detected.

[A simplified ultrasonographic measuring technic in combination with a computer program for calculating the power of intraocular lenses]. / Vereinfachte ultrasonographische Messtechnik in Kombination mit einem Computerprogramm zur Berechnung der Stärke intraokularer Linsen.

In the last few years intraocular lens implantations have gained in popularity. In biometry new electronic methods have been introduced. For measuring the axial length by ultrasound we use the Ocuscan DBR 400 ST unit in combination with the digital storage system and an immersion technique. For lens power calculation we have developed a new computer program for a Commodore CBM 4032 using R.D. Binkhorst's formulae. In a series of 50 Kelman S-Flex anterior chamber lenses we found a mean error of +0.250 D and a standard deviation of +/- 0.662 D. Sixty-four percent of predictions were within the +/- 0.5 D range, and in 88% of these patients we predicted within the +/- 1.0 D range. The maximum errors of prediction were -1.0 D and +/- 1.75 D. Using an immersion technique an accurate axial length measurement can be obtained.

Pigmentary dispersion syndrome. A biometric study.

A-Scan biometry was performed on both eyes of 5 patients suffering from unilateral pigmentary dispersion syndrome, partly with glaucoma. The anterior chamber was significantly deeper and the lens significantly flatter in the eyes with pigmentary dispersion syndrome.

[Scleral disks--silicone implants in the orbit following enucleation]. / Skleraschalen--Silikonimplantate der Orbita nach Enukleation.

A surgical technique for primary or secondary insertion of an orbital implant is described. A silicone implant encased in a scleral homograft is placed within the muscle cone after enucleation. The implant fills up the volume deficit of the orbit and connects fairly tightly with the extraocular muscles, providing good mobility of the prosthesis. This prevents exophthalmus, which frequently follows enucleation if no intraorbital implant is fitted.

[Significance of echographic tissue differentiation for orbital surgery]. / Die Bedeutung der echographischen Gewebsdifferenzierung für die Orbitachirurgie.

The high degree of accuracy of standardized echography in tissue differentiation of orbital tumors enables the ophthalmic surgeon to determine exactly whether or not orbitotomy is indicated. As a result of the echographic examination the ophthalmologist is optimally informed as to the location, extent, delimitation and nature of the tissue of the tumor, and therefore better able to perform the orbitotomy. Standardized A-scan echography is capable of demonstrating an orbital tumor with 99% accuracy. Its location, limits, and tissue differentiation decide whether conservative or surgical treatment is to be preferred. Orbital tumors in any location can be removed by Krönlein's temporal orbitotomy: the wide temporal approach enables even large tumors to be excised in toto. With appropriate care much of the orbital contents can be spared and an optimal functional and cosmetic result achieved.

[Biometry--an exact method for the measurement of the axial length of the eye]. / Die Biometrie--eine exakte Methode zur Messung der Achsenlänge des Auges.

High-frequency ultrasound, using a 10 MHz sound probe and an immersion technique, enables the measurement of the axial length of the eye to within an accuracy of 0.1 mm. The total axial length of the anterior surface of the cornea to the vitreoretinal interface is measured by ultrasound. Many authors add a retinal thickness factor to the echographic data. Addition of this retinal factor lowers the accuracy of axial length measurements. Biometry of both eyes can detect unilateral high-grade myopia as the only reason for unilateral exophthalmos. Accurate measurements of anterior chamber depth, lens thickness and axial length are of great diagnostic importance in glaucoma and are useful in the therapeutic management of this condition. Accurate biometry and preoperative calculation of intraocular lens power are indispensable procedures in obtaining optimal post-operative results in patients subjected to intraocular lens implantation.

[The value of preoperative calculation of intraocular lenses]. / Die Bedeutung der präoperativen Berechnung intraokularer Linsen.

In 82 cataract patients the power of the pseudophakos to be implanted was determined. Axial length and anterior chamber depth were measured by ultrasound. The results of keratometry and the echographic data were used for lens power calculation. For the accuracy of prediction the estimated post-operative anterior chamber depth is of importance. Using R. D. Binkhorst's formula in a series of 32 four-loop iris clip lenses a mean of +0.16 D and a standard deviation of 0.81 D were obtained. In a group of 50 Kelman Quadraflex anterior chamber lenses the mean was +0.17 D and the standard deviation 0.66 D. No error greater than +/- 2.0 D was observed.

[Malignant melanoma of the choroid or metastasis? An echographic differential diagnosis (author's transl)]. / Malignes Melanom oder Aderhautmetastase? Eine echographische Differentialdiagnose.

The echografic criteria for a differential diagnosis between malignant melanoma of the choroid and a metastasis are described. In particular, the reflectivity of these lesions differs, so that malignant melanoma can be diagnosed with a high degree of accuracy, even in cases with primary tumors where a metastasis in the choroid is suspected.