[Orbital firearm injuries]. / Orbitale Schussverletzungen.

BACKGROUND: Injuries caused by firearms are fortunately rare in the field of ophthalmology. The treatment of an affected patient is a special challenge both ophthalmologically and emotionally. METHODS: We report on seven consecutive cases of patients with an orbital gunshot injury who presented in a university hospital over a period of 11 years. The course of events leading to the injury with the weapon involved, the type of projectile, the injury pattern, cranial imaging, treatment and course were evaluated. RESULTS: A total of seven cases of injuries caused by firearms could be documented and evaluated in the period 2007-2018. All seven patients were male. The average age was 44 ± 27.5 years. Of the injuries five were caused by a suicide attempt and two by an accident. Firearms were used except for one injury caused by a crossbow. There was a retained projectile in four of the cases, the bullet went through the body in two cases and one of the cases presented with a ricochet shot. The final visual acuity was unilateral amaurosis in 1 case and bilateral amaurosis in another case, 1/35 (measured at 1 m) in 1 case, while it varied between 0.2 and 0.7 in the other 4 cases. No patient died as a direct consequence of the firearm injury. CONCLUSION: Injuries caused by firearms are relatively rare in Germany and mostly have a suicidal background. The pattern of the injury of the ocular structures is very variable. A reconstruction attempt is principally recommended. In the care of patients interdisciplinary cooperation between ophthalmologists and neurosurgeons, orofacial surgeons, ear nose and throat (ENT) surgeons and psychiatrists is necessary.

[Familial exsudative vitreoretinopathy (FEVR) in childhood]. / Familiäre exsudative Vitreoretinopathie (FEVR) im Kindesalter.

A case of secondary neovascularization of the optic disc in familial exsudative vitreoretinopathy (FEVR) is reported. A 12-year-old girl presented with decreased visual acuity of the right eye to 0.05. Funduscopy showed a prominent fibrovascular neovascularization of the optic disc covering the macula. Fluorescein angiography demonstrated circular peripheral ischemia as well as vascular anomalies in both eyes. Peripheral laser coagulation of the ischemic retina of the right eye was conducted with the patient under general anesthesia. The central neovascularization regressed and visual acuity increased up to 0.4. Molecular genetic examination detected the LRP5 gene for FEVR.

[Primary enucleation in an avulsion injury : A high-risk procedure under phenprocoumon]. / Primäre Enukleation bei direkter Avulsio bulbi : Ein Risikoeingriff unter Markumartherapie.

The case of a 77-year-old woman with trauma after a fall is reported. On clinical examination, an avulsion injury was found in the left eye with dual optic nerve dissection. An INR of 3.3 was determined in a perioperative blood sample. The given conditions forced the rare but urgent indication for primary enucleation with hemostasis. Oral anticoagulation presented perioperative high risk, especially due to the potential risk of bleeding from the ophthalmic artery.

[Bilateral papilledema, unilateral loss of vision and abducens nerve palsy]. / Beidseitige Stauungspapillen, einseitiger Visusverlust und Abduzensparese.

A 35-year-old woman complained of headache, reduced visual acuity, restricted visual field in the right eye and blindness in the left eye. The examination of the retina showed papilledema and peripapillary hemorrhages in both eyes. Magnetic resonance imaging (MRI) revealed a sinus thrombosis. Despite modern imaging technologies sinus thrombosis is an often overlooked, life-threatening disease and needs immediate treatment in order to avoid long-term consequences. An ophthalmological examination can be pioneering as it leads to further imaging.

[Ocular motility disorders in a patient with Fabry's disease]. / Augenbewegungsstörungen bei einem Patienten mit Morbus Fabry.

Fabry's disease (FD) is a rare lysosomal storage disorder. Early cerebral manifestations are a major and often life-threatening burden of the disease. We present a 38-year-old male FD patient with a prior history of six different episodes of stroke and newly developing ocular disorders. He presented with nystagmus with different wave forms and directions and blepharospasm as well as cornea verticillata.

[Anisocoria and nausea]. / Anisokorie und Ubelkeit.

We present the case of a 40-year-old female patient with sudden onset of anisocoria and unilateral ptosis of the left eye. With the exception of several previous episodes of nausea and vomiting, mild headache and tiredness, combined with the early death of the patient's mother following aortic rupture, patient history and clinical condition showed no pathological findings. Following indicative findings on duplex sonography, a dissection of the left internal carotid artery from its origin to its distal section was detected on CT angiography of the brain vessels and the diagnosis of Horner syndrome due to internal carotid artery dissection was made. Since this condition is associated with serious embolic complications, prompt treatment following diagnosis is of utmost importance. Our patient was treated conservatively using PTT (partial thromboplastin time)-effective heparinisation. Regular checks including kidney ultrasound, blood pressure measurement, imaging and continuous therapy with acetylsalicylic acid are recommended.

[Acute peripheral vestibular lesions. Monocular subjective visual vertical and cyclodeviation]. / Akute periphere vestibuläre Läsionen. Monokulare subjektive visuelle Vertikale und Zykloduktionsstellung.

BACKGROUND: A deviation of the subjective visual vertical (svv) is often found in patients with unilateral peripheral vestibular lesions and in most cases the deviation is transitory and easy to compensate. The purpose of the study was to find out if there is a correlation between deviation of the svv and objective cyclodeviation of the retina. PATIENTS AND METHODS: A total of 20 patients (10 females and 10 males aged between 16 and 78 years) with acute vestibular disease were enrolled. Only patients with a binocular deviation of the svv of more than 2 degrees and/or a difference between the monocular deviation of more than 1.5 degrees were included. The svv was examined monocular in a darkened room and after pupil dilatation, fundus photography was performed on each eye. The angle between papilla and macula was measured manually. RESULTS: We found a good qualitative correlation between svv (mean 7.9 degrees) and objective cyclodeviation (mean 10.6 degrees). CONCLUSION: In contrast to the binocular measurement of the svv, we found good correlation between the monocular svv and the objective cyclorotation measured with fundus photography. It is not yet clear which part of the vestibular system is responsible for cyclodeviation. Because of our results we recommend monocular measurement of the svv in clinical examinations.

[Melanoma-associated retinopathy with night blindness. Case report]. / Melanom-assoziierte Retinopathie (MAR) mit Nachtblindheit. Fallbericht.

BACKGROUND: Night blindness is usually symptomatic of retinal dysfunction. However, apart from congenital forms of night blindness such as congenital stationary night blindness (CSNB) and pigmentary retinopathy without clumping of pigment, the acquired forms of night blindness present a particular diagnostic challenge to the ophthalmologist. CASE REPORT: A 51-year-old patient with formerly healthy eyes presented with malignant skin melanoma and sudden night blindness. Along with reduced acuity, concentric visual field limitation, and a marked decrease in sensitivity of the retinal rods and cones in adaptometrical tests, significantly reduced b waves and intact a waves were registered in the flash-ERG of both eyes with otherwise inconspicuous morphologic findings. Furthermore, serum levels of antibodies (IgG) against retinal bipolar cells were found to be increased. CONCLUSION: Results indicate the presence of melanoma-associated retinopathy (MAR), which-like carcinoma-associated retinopathy (CAR)-ranks among the tumor-associated diseases of the retina. CAR, MAR, and CSNB can be differentiated immunohistochemically by serum autoantibody determination and electrophysiologically by flash-ERG. As opposed to CAR, the immune response in the case of MAR is not to antigens of photoreceptors and ganglion cells, but to retinal so-called ON-depolarizing bipolar cells mainly connected in series to the rods. In addition, a waves are intact and b waves extinct, resembling the situation of CSNB.

Melanoma-associated paraneoplastic retinopathy: case report and review of the literature.

A 51-year-old white male suffering from metastatic malignant melanoma of the skin presented with lymph node metastases and paraneoplastic retinopathy 4 years after resection of the primary tumour. There were no cerebral metastases. Ocular symptoms consisting of night blindness and sensations of 'shimmering lights' persisted after total resection of the inguinal lymph node metastases and administration of dacarbazine and prednisone. Perimetry of both eyes was abnormal with concentric restriction. Electroretinography showed significantly reduced amplitudes in both eyes. Only 11 patients with melanoma-associated retinopathy (MAR) have been described. High titres of autoantibodies against whole retina extract were detected by enzyme-linked immunosorbent assay (ELISA) reactions. Indirect immunohistochemistry showed strong autoantibody activity against retinal bipolar cells.

Compensatory responses of goat mothers to their impaired young.

The behaviour of a mother goat towards her young normally compensates for differences between them in their vigour at birth. Weakening the first-born with drugs still does not prevent its getting equal access to the udder, though weakening the second-born may render it so much less vigorous that maternal compensation does fail. When the mother is unable to distinguish her kids by sight or smell, she is unable to modulate her responses to the kids and then the more vigorous kid always establishes priority of access to the bladder. We conjecture that this is what normally occurs under harsh environmental conditions where the mother's milk supply is occasionally inadequate for two kids.

ATPase and GTPase activities associated with the 5-S RNA-protein complex of Escherichia coli ribosomes.

Specific 5-S RNA-protein complexes were reconstituted from Escherichia coli 5-S RNA and 50-S ribosomal proteins. These complexes consist of 5-S RNA and two major proteins, namely E-L18 and E-L25. Analysis for enzymatic activities shows that ATP and GTP are hydrolyzed and that this hydrolysis is independent of elongation factors.