[Anticoagulative therapy in patients with exudative age-related macular degeneration: acute angle closure glaucoma after massive intraocular hemorrhage]. / Akutes Winkelblockglaukom nach massiver intraokularer Blutung bei exsudativer altersbedingter Makuladegeneration unter gerinnungshemmender Therapie.

BACKGROUND: Acute secondary angle closure glaucoma after massive vitreous and subretinal hemorrhage from exudative age related macular degeneration is a seldom, but devastating complication of an anticoagulative therapy. PATIENTS: Four patients (age range 70-76 years) developed unilateral acute angle closure glaucoma after massive intraocular bleeding due to exudative age-related macular degeneration and anticoagulative therapy. Three patients received Phenprocomoun and one patient thrombolytic therapy with heparin. One eye had led to blindness at initial investigation. Pars plana vitrectomy was performed in the remaining three eyes. Within a few months, 2 of these 3 eyes were blind, one eye had light perception and all three eyes developed hypotonia. CONCLUSION: Acute angle closure glaucoma after intraocular bleeding may be the initial clinical manifestation of overtreatment with anticoagulants. Early pars plana vitrectomy probably will increase the surveillance rate of the eye but not the visual prognosis.

[Blinking activity during visual display terminal work. Part 1: Ocular discomfort and pathophysiological principles]. / Lidschlagaktivität während der Bildschirmarbeit. Teil 1: Okuläre Beschwerden und pathophysiologische Grundlagen.

Up to three-fourths of visual display operators complain about ocular discomfort after lengthy work at a monitor. The increase of displays at work has resulted in a problem area with growing impact for the economy and healthcare. Symptoms overlapping the complaints of dry eye disease point to the joint pathophysiological origin. In numerous studies the drastic decrease in blinking frequency was shown to be an essential cause of dry eye symptoms. Lid movements not only have the purpose of smoothing the precorneal tear film ("windshield effect"), but also affect the composition and stability of the different layers. Unfortunately, previous work has often been limited by the heterogeneity of measurement settings, leading to inconsistent results.

[Blinking activity during visual display terminal work. 2: reduced blinking and therapeutic approaches]. / Lidschlagaktivität während der Bildschirmarbeit. Teil 2: Reduzierter Lidschlag und therapeutische Ansätze.

New findings based on a noninvasive, automated long-term measurement method revealed interindividual differences in lid movement behavior, existence of blinking patterns, and the dominance of cognitive influence in the regulation of blinking frequency during increased concentration and especially visual attention. The development of an individual blinking animation promises long-lasting increase and harmonization of lid movements during visual display work. Maintenance of the integrity of the ocular surface by preventing surface evaporation and providing sufficient precorneal environment eradicates important pathogenic factors of ocular discomfort. An animation program for stimulation of blinking has been developed. First results showed that an increase in blinking rate initiated by the computer itself is feasible in principle during work at a visual display terminal. Further improvement of this new approach is promising.

[Epidemic keratoconjunctivitis. Detecting adenoviruses]. / Keratoconjunctivitis epidemica. Nachweis von Adenoviren.

OBJECTIVE: The validity of the 15-min adenovirus assay SAS Adenotest was evaluated compared with virus detection by polymerase chain reaction (PCR) from conjunctival swabs. METHODS: In 75 patients with assumed epidemic keratoconjunctivitis, adenovirus detection from conjunctival swabs was performed by the immunochromatographic assay SAS Adenotest and PCR. RESULTS: In 25 patients adenovirus was detected by PCR, 18 of whom were detected by the SAS Adenotest and 7 of whom were not. No false positive results occurred. Sensitivity was 72% and specificity was 100%. CONCLUSIONS: The results indicate that rapid adenovirus detection with the SAS Adenotest is a useful tool in early epidemic keratoconjunctivitis. An additional PCR should be performed when clinical symptoms persist for 5 days or more.

The influence of established and new antiepileptic drugs on visual perception. 1. A placebo-controlled, double-blind, single-dose study in healthy volunteers.

The influence of single oral dosages of carbamazepine (CBZ), valproic acid, vigabatrin (VGB), lamotrigine (LTG), gabapentin (GBP), and losigamone (LSG) on visual perception was investigated in ten healthy volunteers according to a double-blind, placebo-controlled, cross-over study design. The test battery comprised visual acuity, the Lanthony-D-15-désaturé colour perception test, increment, postadaptation and transient tritanopia threshold measurements, perception threshold assessment for monochromatic and chromatic gaussian dots, monochromatic gratings and gratings of differing spatial frequency, and critical flicker fusion tests with various stimuli. The only consistent and partly significant effects were seen after VGB and GBP. After VGB, increment, postadaptation and transient tritanopia thresholds and the critical flicker fusion increased, whereas GBP led to a somewhat converse profile. The other tests were not influenced consistently by any antiepileptic drug (AED). We conclude that: (i) gamma-amino-butyric acid-(GABA)-related properties as under the prototype drug VGB result in specific alterations of the transient tritanopia phenomenon which is consistent with the physiological hypothesis for this retinal paradigm based on extracellular recordings in primates. The possible mechanisms why VGB improved critical flicker fusion as the only AED in this trial are discussed. The profile of GBP indicates a unique mechanism of action. We have not observed specific influences on visual perception under AEDs which act mainly via alterations of ion membrane conductance. The transient tritanopia and flicker fusion paradigms we used appear to be promising to investigate antiepileptic drugs with hitherto unknown modes of actions in human noninvasively.

The influence of established and new antiepileptic drugs on visual perception. II. A controlled study in patients with epilepsy under long-term antiepileptic medication.

In this study, we investigated visual performance under chronic antiepileptic drug treatment. Patients were under carbamazepine (CBZ) (n = 18), valproic acid (VPA) (n = 9), CBZ and vigabatrin (VGB) (n = 4), CBZ and gabapentin (GBP) (n = 8), and under CBZ and topiramate (TPR) (n = 6), respectively. Seven untreated patients with epilepsy and 42 healthy volunteers served as controls. The test battery comprised the Lanthony-D15-désaturé colour perception test, increment, postadaptation and transient tritanopia (TT) threshold measurements, visual perception threshold assessments for monochromatic and chromatic gratings and gaussian dots, and critical flicker fusion (CFF) tests. No differences were seen between naive patients and healthy controls. Patients under drug treatment always showed alterations of visual perception. Postadaptation and TT thresholds were altered under each drug regimen after short delays between switching off the adaptation light and switching on the blue test light. Threshold elevations were maximum under the combination of CBZ and TPR and lowest under CBZ and GBP. Consistent impairment of the CFF was seen under combined CBZ and TPR whereas VPA as well as combined CBZ and VGB led to ameliorations the mechanisms of which are discussed. The other tests were less sensitive. In conclusion, alterations of visual function were apparent under chronic antiepileptic drug treatment both with established and new agents. However, it may be difficult to distinguish between effects based on specific modes of action and nonspecific retino- and neurotoxicity.

Colour discrimination thresholds in Parkinson's disease: results obtained with a rapid computer-controlled colour vision test.

A dysfunction of dopaminergic retinal neurons is thought to occur in Parkinson's disease, manifesting itself in impaired performance on various visual discrimination tasks. We have investigated whether differences in colour discrimination could readily be detected between a normal group and a Parkinsonian group, using a computer-controlled test of colour vision. Although some individual Parkinsonian patients showed an abnormal elevation of colour discrimination thresholds, there was no significant difference between the normal group and the Parkinsonian group.

Binocular function after bilateral implantation of monofocal and refractive multifocal intraocular lenses.

PURPOSE: To evaluate binocular function after bilateral implantation of a refractive multifocal intraocular lens (IOL). METHODS: Contrast sensitivity, glare, depth discrimination, and distance and near visual acuity were examined in 21 patients with a multifocal IOL and 15 patients with a monofocal IOL. RESULTS: There was no significant difference in binocular distance visual acuity between the 2 groups. In near visual acuity with distance correction, the multifocal group had a significant advantage in monocular and binocular vision (P < .05). High contrast with Regan contrast letter acuity charts did not differ significantly between the groups. However, at a contrast of 11%, sensitivity was significantly lower monocularly in the multifocal group. Contrast sensitivity in this group was not significantly lower binocularly. The brightness acuity tester revealed no between-group difference in glare. With the Titmus stereotest, depth discrimination was significantly better with the multifocal IOL with distance correction. CONCLUSION: Bilateral implantation of a refractive multifocal IOL provided good binocular function and alleviated the well-known disadvantage of reduced contrast sensitivity at low contrast levels.

[Optical coherence tomography in the diagnosis and follow-up of patients with uveitic macular edema]. / Die optische Kohärenztomographie (OCT) als Diagnose- und Verlaufsparameter bei uveitisbedingtem Makulaödem.

BACKGROUND: Optical coherence tomography (OCT) is a relatively new, noninvasive method and has been well established as an effective diagnostic procedure for the investigation of several macular diseases. Knowledge about the efficacy of OCT in the diagnosis and follow-up of macular edema in uveitis patients is still limited. PATIENTS AND METHODS: In the first part of the study, OCT was performed in 22 eyes of 18 patients with anterior or intermediate uveitis who showed angiographic and fundoscopic evidence of macular edema. The OCT results were compared with the visual acuity and fundoscopic and angiographic appearance of macular edema. In the second part of the study, the same patients were followed over a period of approximately 5 months (+/-2 months) and OCT was repeated at different time points during treatment of uveitic macula edema. RESULTS: OCT investigation also showed clear evidence of macular edema in all eyes and was not compromised by a low or medium degree of optical haze. Furthermore, OCT investigation revealed marked differences in the individual degree of macular edema (foveal heights 168-810 microm). Diffuse macular edema ( n = 4 ) and different types of cystoid macular edema (several distinguished cysts n = 6, partially or completely confluent cysts n = 11, one marked cyst n = 1) were observed. During the follow-up of the patients, OCT results, visual acuity, and fundoscopic appearance of the macula showed a comparable behavior. In some eyes, a stable visual acuity was accompanied by changes of foveal edema demonstrated by OCT. CONCLUSION: Optical coherence tomography is a safe and highly effective method in the diagnosis of macular edema in uveitis associated with low or medium haze of the optical media. Furthermore, OCT investigation seems to be useful in the follow-up of uveitic macular edema under treatment.

[Pseudohypopyon of cholesterol crystals occurring 16 years after retinal detachment in x-linked retinoschisis]. / Pseudohypopyon von Cholesterinkristallen 16 Jahre nach Ablatio bei X-chromosomaler Retinoschisis.

BACKGROUND: Cholesterol crystals of the anterior chamber can be found as a marked feature of advanced cholesterosis bulbi; typically following i. o. hemorrhage after severe trauma, retinal detachment or M. Coats. CASE REPORT: A 39-year-old male patient with longstanding (16 years) retinal detachment in his right eye due to x-chromosomal linked retinoschisis presented with a clinical picture of a hypopyon and mature cataract. Ultrasonography showed a retrolental mass. Phacolytic uveitis was suspected and pars plana lentectomy and vitrectomy was performed. Intraoperatively subretinal chrystals could be detected. A specimen of the aqueous humor and subretinal fluid was evaluated biochemically and histologically and revealed cholesterol crystals. CONCLUSIONS: Cholesterosis bulbi may be similar to lentogenic uveitis and should be included in the differential diagnosis of such processes. To our knowledge this is the first case of cholesterol crystals of the anterior chamber sixteen years after retinal detachment in x-linked retinoschisis.

[Transient blindness after subconjunctival anesthesia for diode laser cyclophotocoagulation]. / Transiente Erblindung nach subkonjunktivaler Anästhesie zur Diodenlaser-Zyklophotokoagulation bei fortgeschrittenen Glaukomen.

BACKGROUND: Retro- and parabulbar anaesthesia can be associated with severe sight-threatening and life-threatening complications and may compromise optic nerve function, especially in eyes with advanced optic neuropathy. Subconjunctival anaesthesia usually does not influence optic nerve function. We report on two patients who developed transient amaurosis after subconjunctival anaesthesia. PATIENTS: In two patients (75 and 77 years old) with advanced refractory glaucoma a diode laser cyclophotocoagulation was performed to lower the increased IOP. For local anaesthesia, 2 ml of 2% mepivacaine was placed beneath the conjunctiva. The needle was placed at least 6 mm from the limbus to avoid bleeding at the injection site near the limbus. After 10 minutes, both patients observed a decrease of their vision of the treated eyes. A few minutes later, an amaurosis of the treated eyes was found in both patients, which was fully reversible after 2 to 3 hours. At fundus examination, no vessel occlusion was seen. CONCLUSIONS: Subconjunctival anaesthesia may cause transient blindness in patients with advanced optic neuropathy. The incidence of this side effect seems very low.

Spatial-frequency-related efficacy of visual stabilisation of posture.

The present study investigates the efficacy of visual stabilisation of posture for different spatial frequencies of a visual stimulus. Circular sine wave gratings were used to analyse the correlation between perception of motion in depth and stabilisation of fore-aft sway by the mechanism of detecting changes in target size. Body sway was recorded by a force-measuring platform (series A) and, in addition, by simultaneous tracking of infrared markers fixed to the subject's body (series B). Mean velocity and amplitude (RMS) of body sway were calculated in both sagittal (a-p) and lateral (l-r) planes. Sagittal sway was of least magnitude when viewing contrast gratings with lowest thresholds, whereas higher thresholds resulted in increasing sway parameters. As intended by the design of the stimuli, sagittal sway was correlated closer with the stabilising effect exerted by the different stimuli than was lateral sway. Sway velocity was reduced more efficiently, however, with a lower correlation with the psychophysical transfer function, than was RMS sway. Since sway velocity measured by the platform is suggested to depend to a greater extent on dynamic muscle forces generated at each individual body site the results indicate that visual information can be used to reduce and thereby optimise dynamic muscle action (sway velocity) even though static body sway is either not or less reduced. A comparable economisation of sway velocity but not of RMS sway was also seen at the end of posture investigations, indicative of positive training effects.