[Three cases--one diagnosis: ocular manifestations of sarcoidosis]. / Drei Fälle--eine Diagnose: okuläre Manifestationsformen der Sarkoidose.

INTRODUCTION: Sarcoidosis can manifest itself in a variety of affection patterns in the eye. Early diagnosis and treatment are of crucial importance. Therefore the following three cases present occular symptoms associated with sarcoidosis. METHODS: Three case reports are described. RESULTS: We report three cases with panuveitis but different anamneses. A 14-year-old boy suffered initially from a medically refractory sinusitis, followed by panuveitis with a distinct pattern of chorioretinal involvement. Furthermore, there was a facial palsy, swelling of the parotid glands, fever, and a deterioration of his general condition. The histological examination of a turbinectomy revealed a granulomatous inflammation with non-caseating granulomas. The second patient, a 66-year-old female, presented with the suspected diagnosis of paraneoplastic syndrome and positive anamnesis for sigma carcinoma. One of her main symptoms was significant uveitis with a pronounced inflammation in the anterior chamber. The suspicious lesions in thoracic CT yielded to the diagnosis of sarcoidosis. The third patient, a 51-year-old male, seemed to be generally healthy. He described a loss of visual acuity, which was explained by vitritis and a pronounced macular oedema. As part of the search for underlying diseases the chest radiography showed abnormal structures. DISCUSSION: In all patients the diagnosis was sarcoidosis. Moreover, in the first case Heerfordt syndrome, a special form of sarcoidosis, was diagnosed. In all three patients a significant improvement of visual acuity occurred under systemic prednisolone therapy. These cases demonstrate the broad spectrum of manifestations of sarcoidosis in ophthalmology. Moreover, the early diagnosis and implementation of therapy were decisive for the prognosis.

[A rare manifestation of sarcoidosis]. / Seltene Manifestation einer Sarkoidose.

This article reports the case of a 14-year-old boy who was presented in the case conference with symptoms of decreased visual acuity, scintillating scotomas and photophobia. Physical examination revealed right facial paralysis, parotid gland swelling, high fever and poor general condition. Ophthalmoscopy revealed anterior and posterior uveitis including macular edema and chorioretinal infiltrates. Angiography revealed a dense pattern of hyperfluorescent lesions and these observations resulted in the diagnosis of Heerfordt syndrome. Under systemic prednisolone therapy, symptoms were reduced and visual acuity recovered.

Comparison of anterior chamber depth measurements using Orbscan II and IOLMaster.

PURPOSE: To evaluate and compare anterior chamber depth (ACD) measurements using Orbscan II (Bausch & Lomb, Rochester, NY) and IOLMaster (Carl Zeiss Meditec AG, Jena, Germany). METHODS: In this prospective clinical study, the authors measured ACD of 145 phakic eyes of 30 healthy volunteers and 115 patients using Orbscan II and IOLMaster. Average patient age was 52.9+/-19.4 (range 16 to 87) years. ACD was evaluated from corneal epithelium to anterior lens surface. Additionally, axial length (AL) was measured using the Zeiss IOLMaster to calculate the regression coefficient between AL and ACD. RESULTS: Mean ACD was 3.35+/-0.43 mm (range 2.01 mm to 4.37 mm) using Orbscan II and 3.36+/-0.41 mm (range 2.09 mm to 4.24 mm) using IOLMaster. Mean total axial length was 24.04 mm +/- 2.1 mm (range 20.7 mm to 31.41 mm). The linear regression coefficient of ACD between both methods was R=0.95. ACD and AL correlated only slightly (R=0.57). The Spearman coefficients of rank correlation were 0.94 and 0.61, respectively. A p value less than 0.01 (paired Wilcoxon test) was considered statistically significant. However, a significant difference was not calculated comparing ACD measurements using both systems and the Bland-Altman-Plot showed 95% of the differences ranging between 0.25 and -0.27 mm. CONCLUSIONS: Regarding clinical application, both systems seem to be equally good and interchangeable in clinical practice in terms of ACD evaluation.

[Severe course and contingent risk factors in optic neuropathy and myelopathy after tuberculostatics]. / Schwerwiegender Verlauf und belastende Faktoren bei Optikusneuropathie und Myelopathie durch Tuberkulostatika.

A male patient with tuberculous lymphadenopathy was treated with a four-fold therapy of ethambutol, isoniacide, rifampicin and pyracinamide. After 10 weeks the patient suffered from photophobia. Although ethambutol was discontinued vision decreased and visual field defects occurred as well as signs of myelopathy. Isoniacide was then discontinued and in the subsequent phase the vision was slowly restored over a period of 36 months. The combined toxicity of ethambutol and isoniacide seems to have been the main cause of the severe and protracted optic neuropathy.

[Progressive peripunctal nevus in an adult]. / Progredienter Nävuszellnävus des Punctum lacrimale im Erwachsenenalter.

Nevi arise from migration of melanocytes into the epithelium. Over the years they experience a typical maturation, with the possibility of an increased thickness due to accompanying inflammation or fibrosis but actual growth of nevi is rare in adults. A 70-year-old patient presented with a growing tumour around the punctum lacrimale. The histological examination revealed a conjunctival nevus without any transformation. Peripunctal nevi are rare. The localisation of a nevus in the area of the punctum lacrimale was first published in 1931 and only 10 other patients with such a nevus have been reported. If at all, an enlargement of a peripunctal nevus has been described in younger patients. The patient presented here showed significant growth of the nevus at an atypically high age without any histological signs of malignancy or proliferation. The reason for this uncommon nevus enlargement remains unclear.