RI in central retinal artery as assessed by CDI does not correspond to retinal vascular resistance.

The aim of the present study was to investigate the association between ultrasound Doppler measurements of resistive index (RI) in the central retinal artery and retinal vascular resistance (R) assessed with laser Doppler velocimetry, vessel size measurement, and calculation of ocular perfusion pressure (PP) in healthy subjects. An increase in vascular resistance was induced by inhalation of 100% O(2). During hyperoxia no significant changes in PP were observed. Mean flow velocity in main retinal veins was reduced by -27.5 +/- 2.0%. The average decrease in diameter was -11.5 +/- 1.0%. R, which was calculated as the ratio of PP to flow rate, increased by 97.6 +/- 7.7%. RI increased as well, but the effect was much smaller (6.6 +/- 2.2%). In addition, a negative correlation was found between baseline values of R and RI (r = -0.83). During hyperoxia R and RI were not associated. In conclusion, our data indicate that RI as assessed with color Doppler imaging in the central retinal artery is not an adequate measure of R.

Immunohistochemical detection of estrogen and progesterone receptor in human cornea.

OBJECTIVE: For treatment of postmenopausal keratoconjunctivitis sicca hormone therapy is favored by some clinicians. The likely morphological basis assessing the hormone receptor status in the human cornea has not been performed. Immunohistochemical staining methods provide the opportunity to evaluate the hormone receptor content within the histologic compartments of the cornea. The aim of our study was to assess and localize immunohistochemical hormone receptor staining in the human cornea. METHODS: Formalin-fixed and paraffin-embedded specimens of three pre- and three postmenopausal women were assessed for localization of estrogen receptor (ER) and progesterone receptor (PR) expression with established immunohistochemical hormone receptor staining methods. RESULTS: No nuclear staining reaction was found in the epi- and endothelial layers of the corneas. The stroma of the corneas showed no immunohistochemical staining reaction in all cases. We found cytoplasmatic PR staining of the endothelial layer in two cases. CONCLUSIONS: We found no morphological basis in the human cornea for the use of topical steroid hormone treatment in postmenopausal keratoconjunctivitis sicca. Hormone receptor expression in the conjunctiva or in the lacrimal gland may have an impact in some patients showing relief of symptoms in postmenopausal dry eye syndrome.

Normalization of orbital arterial blood flow in non-ischemic central retinal vein occlusion after 6 months.

INTRODUCTION: Central retinal vein occlusion (CRVO) is a common vascular disorder and may lead to blindness. The aim of the study was to obtain information about the possible imbalance and recovery of orbital arterial blood flow in non-ischemic CRVO. METHODS: Vascular resistance (pulsatility index-PI) in the orbital arteries of 14 patients with non-ischemic CRVO was examined within 3 weeks after onset of CRVO and 6 months later. The control group consisted of 14 age- and sex-matched healthy control eyes. RESULTS: PI was increased in all orbital arteries of CRVO eyes measured within 3 weeks after the onset. Normal PI values were recorded in the same retrobulbar arteries, and re-measured 6 months later. DISCUSSION: There is an increase in vascular resistance in all orbital arteries at the onset of non-ischemic CRVO, followed by a recovery of vascular resistance to normal levels 6 months later. The increase at the onset may be caused by arterial vasospasm or by intraocular hemostasis affecting the afferent arteries.

Ocular arterial blood flow of choroidal melanoma eyes before and after stereotactic radiotherapy using Leksell gamma knife: 2 year follow up.

AIMS: To evaluate the effect of high dose stereotactic radiotherapy on the ocular blood flow of patients with uveal melanoma. METHODS: Colour Doppler imaging (CDI) was used to measure blood flow velocity and vascular resistance in the ophthalmic, short posterior, and central retinal arteries of nine patients suffering from uveal melanoma. The measurements were taken before, 6 months, 1 year, and 2 years after stereotactic radiotherapy. Irradiation was performed with the Leksell gamma knife with the 59 (41-66.5) Gy total marginal dose divided in two equal fractions. CDI results were compared with age and sex matched healthy control eyes. RESULTS: At each time of measurement, blood flow velocity in the central retinal artery of the affected eyes was significantly reduced whereas vascular resistance was only increased at the 2 year follow up. Blood flow velocity and vascular resistance in the short posterior arteries of melanoma eyes were also only significantly altered at the 2 year follow up. Blood flow velocity and vascular resistance in the ophthalmic artery of melanoma eyes were not changed at all follow ups. CONCLUSIONS: In the melanoma eyes, blood flow velocity in the central retinal artery is reduced. High dose stereotactic radiotherapy with the Leksell gamma knife and a 59 (41-66.5) Gy total marginal dose in two fractions leads to a significant reduction of blood flow and a significant increase in resistance variables in the small ocular arteries within 2 years.

[Congenital syphilis: late diagnosis in spite of screening]. / Lues connata: Späte Diagnose trotz Screening.

We report the case of an infant in whom congenital syphilis was diagnosed at the age of 5 weeks. The case is remarkable because of (a) the negative venereal disease laboratory test from the cord blood, (b) the incidental diagnosis of the disease in the fifth week of life, (c) pneumonia alba being one of the symptoms, (d) the occurrence of a mild Jarisch-Herxheimer reaction after initiation of penicillin therapy and (e) the successful treatment of infection related anaemia with recombinant human erythropoietin.

Retrobulbar hemodynamics in amaurosis fugax; investigation by color Doppler velocity.

PURPOSE: The aim of the study is to determine blood flow and resistance parameters (Resistance Index-RI, Pulsatility Index-PI) in the retrobulbar arteries of patients suffering from amaurosis fugax. METHODS: Color Doppler velocity was used to measure blood flow velocity and vascular resistance in the ophthalmic artery, central retinal artery and lateral short posterior ciliary artery of 32 involved eyes in their afflictless interval. The patients' mean age was 60.1 years (range 29-85). The age- and sexmatched control group comprised 32 healthy volunteers (32 eyes). RESULTS: There was no significant difference neither in RI nor in PI of amaurosis fugax patients compared to the control group. CONCLUSIONS: We conclude that in almost all cases of amaurosis fugax no local disturbance of blood flow in the afflictless interval is noted. However, increased vessel resistance is noticed in some cases of amaurosis fugax: Giant cell arteritis, intraorbital vascular anomalies, intraorbital tumors. In these cases color Doppler velocity is able to give information on the extent of blood flow disorder and, in particular by the B-mode, the etiology can be assumed.

[Conjunctival cysts of the orbits: clinical aspects and histology in 4 patients]. / Konjunktivale Zysten der Orbita: Klinik und Histologie bei vier Patienten.

BACKGROUND: Only a few reports concerning congenital conjunctival cysts of the orbit (primary nonkeratinized epithelial cysts) have been published. PATIENTS: We describe four further cases of conjunctival cysts of the orbit, which were observed between 1995 and 1997 in Tübingen and Vienna. Histologically, all cysts were lined by nonkeratinizing epithelium with goblet cells. Epidermal appendages were found in the wall of one cyst. The patients' age was between 1 and 32 years. Clinically, the prominent symptom was swelling of the upper eyelid, persisting in three patients for more than several years. In one patients diplopia and restriction of eye movements developed within several weeks. CONCLUSIONS: The cases we described are in accordance with the cases reported in the literature. Often a swelling of the upper eyelid persisted for several years, before the cyst has become symptomatic predominantly in an adult patient. In contrast to dermoid or epidermoid cysts, there is no bony erosion and the cysts are located in the superior to nasal orbit. These cysts are probably more common as it is represented in the literature.

[Color duplex of retrobulbar arteries in normal pressure and open angle glaucoma]. / Farbduplex der retrobulbären Arterien bei Normaldruck- und Offenwinkelglaukom.

BACKGROUND: Various authors report that the glaucomatous loss of function is due to a chronic anterior ischemic optic neuropathy, being caused by a disturbed relationship between intraocular pressure and perfusion pressure in the posterior short ciliary arteries, which possibly leads to increased resistance in the ciliary vascular system. The authors attempt to test this hypothesis by measuring the vascular resistance (Resistance Index) in the ciliary vessel system by means of color Doppler sonography. PATIENTS AND METHODS: 35 eyes of 35 patients, suffering from open angle glaucoma (OAG), with a mean age of 65.3 years, were examined as well as 35 eyes of 35 patients with normal tension glaucoma (NTG), whose mean age was 65.8 years. Both glaucoma groups were compared to an age- and sex-matched control group of healthy volunteers. The color-Doppler measurements were performed with an Acuson 128 XP/10, which allows imaging of all retrobulbar arteries, the ophthalmic artery, the central retinal artery and the short posterior ciliary arteries, and also guarantees the precise calculation of blood flow velocity and resistive index (RI). The RI was statistically evaluated. RESULTS: The resistance index of all retrobulbar arteries showed a statistically significant increase (p < 0.05) according to Wilcoxon's test in the OAG group as well as the NTG group. CONCLUSIONS: Increased vascular resistance was found in all retrobulbar arteries in OAG and in NTG. These findings point out the pathognomonic importance of perfusion disturbance in glaucoma.

[Bilateral acute retrobulbar space-occupying lesion within the scope of thrombolytic therapy in myocardial infarct--a case report]. / Beidseitige akute retrobulbäre Raumforderung im Rahmen einer Thrombolysetherapie bei Myokardinfarkt--ein Fallbericht.

A 51-year-old male patient with circulatory arrest and ventricular fibrillation was brought to the emergency department after restoration of spontaneous circulation. ECG presented signs of acute anterolateral myocardial infarction. Thrombolytic therapy according to the Neuhaus scheme was initiated. After administration of 60 mg rt-PA continuously increasing protrusion and hyposphagma of both eyes (left > right) and left-sided monocle-hematoma was observed. CCT showed shadowing of sinus ethmoidales frontales, broadening of the left lateral rectus muscle and retrobulbar volume increase without any signs of recent bleeding. The ophthalmologist had to answer the question if there was, in spite of the massive retrobulbar volume increase, a sufficient blood supply for both eyes. Ophthalmoscopically there were no signs of intraretinal bleeding or retinal ischemia. Intraocular circulation was checked by color Doppler sonography: Ophthalmic artery, the short posterior ciliary arteries and central retinal artery of both eyes showed very low, but definitely positive bloodflow. Further course showed a constant trend towards higher systolic bloodflow velocities in all eye vessels, verified by color Doppler sonography. Computer perimetry, performed after the recovery of the patient, revealed a visual field defect, which was related to a breakdown of the flow in a ciliary artery rather than to damage due to compression of the optic nerve. Possible reasons of the retrobulbar volume increase under thrombolytic therapy are discussed.

Color Doppler ultrasound investigation of the therapeutic effect of plasmapheresis on a lymphoplasmocytoid lymphoma (immunocytoma): a case of central retinal artery occlusion.

The lymphoplasmocytoid immunocytoma (Waldenström's disease) is a non-Hodgkin's lymphoma of low malignancy. The disease is defined by the production of monoclonal IgM-globulins in the bone marrow. These macroglobulins affect the aggregation of thrombocytes and bind the coagulation factors, which leads not only to hemorrhagical diathesis, but also to hyperviscosity syndrome. We present the rare case of a 79-year-old woman suffering from an immunocytoma with sudden painless loss of vision in her right eye. Ophthalmoscopic examination revealed an occlusion of the central retinal artery. The immediately performed blood examination showed the following results: IgM serum level was 6610 mg/dl (normal range: 60-370 mg/ dl), kappa-paraproteinemia showed values of 702 mg/dl (normal range: 200-440 mg/dl), and the plasma viscosity was 3.4 mPa/s (normal range: 1.5-1.72 mPa/s). Plasmapheresis was promptly initiated. Subsequently, the highly pathological serum levels were markedly lower and sight improved from complete amaurosis to qualitative vision. Blood-flow velocity and vascular resistance parameters (resistive index) in all nutritious vessels [ophthalmic artery (OA), posterior ciliar arteries (PCA) and central retinal artery (CRA)] were recorded before and after each of the six cycles of plasmapheresis, using color Doppler velocity (CDV). It was proven that even after the first plasmapheresis, circulation in the central retinal artery was restored. After each further cycle of plasmapheresis, an improvement in blood-flow velocity in OA, PCA, and CRA was recorded by CDV. CDV verifies variations in circulation of the eye vessels and gives an objective assessment of the influence of therapy.