[MALT Lymphoma of the Conjunctiva in a 13-year old Child--5-Year Relapse-free Follow-up Following Antibiotic Treatment]. / MALT-Lymphom der Bindehaut bei einem 13-jährigen Kind--fünf Jahre Rezidivfreiheit nach ausschließlich antibiotischer Behandlung.

MEDICAL HISTORY: In February 2007, a 13-year old boy presented with a livid tumour in the lower conjunctival fornix of the left eye. OPHTHALMOLOGICAL FINDINGS: The tumor was salmon-coloured, bulging and elastic and filled the whole lower conjunctival fornix of the left eye. There was no other pathological finding in the left eye. Uncorrected visual acuity was 20/20. Intraocular pressure was 12 mmHg. The eye was fully motile. TREATMENT: Incisional biopsy was performed in February 2007. The tumor was histologically an extranodal MALT lymphoma. DNA testing for Chlamydophila trachomatis and Chlamydophila pneumonia was negative. Systemic treatment was started with doxycycline (200 mg daily). After six weeks, the tumour was slightly smaller. Azithromycin 500 mg once a week was added. 18 months after initiation of the treatment, the tumour had completely regressed. A second sample taking in the former tumor area showed tumor-free conjunctiva and subconjunctival tissue. As a precaution, the combined antibiotic therapy was continued for 10 months and the patient was followed for five more years. The lymphoma did not relapse in the conjunctiva and orbit or in the whole body. CONCLUSION: We showed that extranodal MALT lymphomas of the conjunctiva can be successfully treated with antibiotics alone. At the start of therapy, the child was 13 years old. To our knowledge, this patient is the first child in Germany and one of the first in the world with ocular adnexal lymphoma who could be successfully treated with combined antibiotic therapy and who could be followed up for 5 years without relapse. Thus, we could avoid radiotherapy or chemotherapy in childhood and eliminate the risk of a therapy-induced secondary malignancy.

[Change of Intraocular Pressure 10 Days Following Radical Prostatectomy for Prostate Cancer]. / Augeninnendrucksenkung 10 Tage nach radikaler Prostatektomie bei Patienten mit diagnostiziertem Prostatakarzinom.

BACKGROUND: Results of a retrospective study of perioperative changes in intraocular pressure (IOP) following radical prostatectomy (RPE) for prostate cancer. PATIENTS AND METHODS: In 25 consecutive patients, PSA (prostate specific antigen) and IOP were measured with Goldmann tonometry before and after a mean of 10 days following RPE. The data of three patients with proven glaucoma were evaluated separately. The data of 22 patients without glaucoma were analysed with non-parametric statistical methods. The primary objective of the investigation was the statistical analysis of the changes in the IOP of the right eyes. The results for the left eyes are presented as secondary objective. RESULTS: The mean IOP in the right eye decreased from 13.95 ± 2.95 mmHg (n = 22) preoperatively to 12.18 ± 1.99 mmHg postoperatively; the average reduction in pressure was 1.77 ± 2.44 mmHg. In the left eyes, the IOP of 14.45 ± 3.16 mmHg preoperatively decreased to 12.05 ± 2.21 mmHg postoperatively. The average reduction in pressure was 2.41 ± 3.53 mmHg. The PSA level decreased from 18.70 ± 21.66 ng/ml preoperatively (median: 11.3 ng/ml) to 2.21 ± 3.13 ng/ml postoperatively (median: 1.25 ng/ml). The decline in IOP and the difference in PSA are highly statistically significant (Wilcoxon test for paired samples, n = 22, p < 0.01). There was no linear relationship between the reductions in IOP and PSA (Pearson correlation coefficient: r = 0.137, p = 0.542 for right eyes, r = 0.062, p = 0.784 for left eyes). CONCLUSION: Our case series shows that there is a statistically significant decrease in IOP following RPE, and to a clinically relevant extent. The changes in PSA and IOP might be linked by changes in prostaglandin metabolism in the prostate and/or the seminal vesicles. This theory remains to be confirmed by further studies. The increase in IOP during the development of prostate cancer might also be linked to changes in prostaglandin metabolism and composition. It is conceivable that prostaglandin analogues could be developed to reduce IOP.

Two-year clinical experience with the CyPass micro-stent: safety and surgical outcomes of a novel supraciliary micro-stent.

PURPOSE: The aim of this study was to evaluate through 2 postoperative years the clinical outcomes associated with a novel supraciliary micro-stent for the surgical treatment of open-angle glaucoma (OAG) when implanted in conjunction with cataract surgery. PATIENTS AND METHOD: In a multicenter, prospective, consecutive case series, 136 subjects (136 eyes) with OAG and requiring cataract surgery with 24-month postoperative data were included. A combined phacoemulsification procedure, with intraocular lens insertion and CyPass Micro-Stent implantation into the supraciliary space of the study eye, was performed. At baseline, all subjects were on glaucoma medication with either uncontrolled intraocular pressure (IOP; ≥ 21 mmHg, Cohort 1, n=51) or controlled IOP (<21 mmHg, Cohort 2, n=85). Glaucoma medications were stopped postoperatively, but could be restarted if needed, at the investigator's discretion. Device-related adverse events, postoperative IOP, best corrected distance visual acuity (BCDVA), and number of IOP-lowering medications were recorded. RESULTS: The micro-stent was successfully implanted in all eyes. At 24 months, 82 subjects remained in the study. No sight-threatening adverse events occurred. The most common adverse events were transient hypotony (15.4%) and micro-stent obstruction (8.8%), typically due to iris tissue overgrowth. Fifteen subjects (11%) required secondary incisional glaucoma surgery. For Cohort 1 (n=23), mean ± SD IOP was 15.8 ± 3.8 mmHg after 24 months (change, -37% ± 19%). Mean IOP decrease from baseline was statistically significant (p<0.0001) at months 6, 12, and 24. For Cohort 2 (n=59), mean ± SD IOP at 24 months was 16.1 ± 3.2 mmHg (change, 0% ± 28%). Mean decrease from baseline was statistically significant at months 6 (p=0.0188) and 12 (p=0.0356). At 24 months, the mean ± SD number of medications was 1.0 ± 1.1 in Cohort 1 and 1.1 ± 1.1 in Cohort 2. Mean decrease from baseline medication use was statistically significant at months 6 (p<0.001), 12 (p<0.001), and 24 (p=0.0265) in Cohort 1, and at months 6, 12, and 24 (all p<0.0001) in Cohort 2. CONCLUSIONS: CyPass Micro-Stent implantation, in combination with cataract surgery, was associated with minimal complications while substantially lowering IOP and/or use of IOP-lowering medications.

[The relationship between the temperature increase caused by phacoemulsification and the damage to the corneal endothelium]. / Zusammenhang zwischen der Temperatursteigerung bei der Phakoemulsifikation und den auftretenden Zellschäden am Hornhautendothel.

PURPOSE: Endothelial cell damage can be found after a phacoemulsification. The reason for this cell damage is not yet known. The temperature rise inside the anterior chamber during the emulsification of the lens is considered as a potential damage mechanism. The aim of this study was to investigate the relationship between the temperature increase and the cell damage. MATERIALS AND METHODS: This study was performed with 86 enucleated porcine eyes, which were divided into six groups A-F. Group A served as control group. Phacoemulsification was simulated in the groups B-E with different surgically relevant system settings. The temperature change was measured simultaneously with temperature sensors inside the anterior chamber. Inside the eyes of group F, the instruments were positioned and irrigation and aspiration were activated, but no ultrasound was applied. For all 86 corneas, the endothelial cell damage was quantified with a standardised evaluation protocol using scanning electron microscopy (SEM). A potential correlation was checked between the observed cell damage and the measured temperature rise. RESULTS: The highest temperature increase in group E with an obstructed aspiration line and an output power setting of 50 % was 17.77 °C. The temperature increase in group D with an output power setting of 100 % and unblocked fluid flow was significantly lower (p = 0.006). The highest temperature increase in group D was 8.89 °C. In contrast, the cells in group D were rated with a significantly lower score value than the cells in group E (p < 0.001). No significant correlation between the temperature rise and the cell damage could be obtained in due consideration of all measured data. However, an increase of the output power setting was connected with a non-linear increase of the cell loss. CONCLUSION: The temperature rise was not the main reason for the endothelial cell damage in the performed experiments. Therefore, there seems to be no causal relationship between the temperature increase inside the anterior chamber during a common phacoemulsification and the endothelial cell damage. Due to the strong dependence between the output power setting and the cell damage, the lowest output power setting should be used during surgery which ensures the emulsification of the nucleus.

[Comparison of four MICS intraocular lenses regarding their rates of neodymium:YAG laser capsulotomy]. / Vergleich von 4 MICS-Intraokularlinsen im Hinblick auf ihre Neodym:YAG-Laser-Kapsulotomieraten.

BACKGROUND: The aim of this study was to evaluate the incidence of posterior capsule opacification up to 50 months following 1.7-mm bimanual MICS-cataract surgery. METHODS: Bimanual MICS cataract surgery was performed in 197 eyes (135 patients) via two 1.7-mm corneal incisions. Four MICS acrylic foldable IOLs were implanted: AcriSmart 48S-5, n = 54 (Acritec GmbH, Hennigsdorf, now AT.Smart 48S Carl-Zeiss-Meditec, AG, Jena, Germany), ThinLens UltraChoice 1.0, n = 53 (Technomed GmbH, Baesweiler, Germany), AcriFlex 46, n = 41 und AcriFlex 48 CSE, n = 7 (Acrimed GmbH, Berlin, now: Lentis L-303, Oculentis GmbH, Berlin, Germany) and CareFlex, n = 43 (w2o Medizintechnik AG, Bruchsal, Germany). Statistical analysis was performed using the Kaplan-Meier technique. RESULTS: High levels of completeness of follow-up rates were: ThinLens 96%, CareFlex 100%, AcriSmart 93%, AcriFlex 92%. The capsulotomy rate was 43.13% for ThinLens within a mean/max. follow-up period of 801/1131 days, 34.88% for CareFlex (565/872 days), 40% for AcriSmart (988/1506 days) and 15.91% for AcriFlex (728/975 days). By limiting the follow-up period to a comparable maximum of 850 days for all four IOLs, our capsulotomy rates were as follows: ThinLens 33.33%, CareFlex 32.56 %, AcriSmart 20.0% and AcriFlex 11.36%. MICS IOLs have higher capsulotomy rates than hydrophobic acrylic lenses and sharp-edged silicone lenses. In literature comparisons MICS-IOLs do not exceed the variance levels of capsulotomy rates of PMMA, hydrophilic acrylic and silicone lenses without sharp edges. Cases of decentration or luxation of MICS-IOLs following Neodym:YAG laser capsulotomy were not detected. Capsulotomy frequency with the CareFlex was statistically significantly higher in comparison to the AcriSmart (Log Rank Mantel Cox Test, p = 0.007) and AcriFlex (log rank Mantel Cox test, p = 0.002). CONCLUSIONS: Capsulotomy rates observed varied for the four MICS-IOL-types tested. The posterior capsule opacification frequency of the two best MICS-IOLs (AcriFlex, AcriSmart) did not exceed the higher variance levels of posterior capsule opacification rates of the round-edged "conventional" non-MICS IOLs of PMMA, silicone or hydrophilic acryl material. Sharp-edged silicone or hydrophobic acrylic "conventional" lenses have shown lower posterior capsule opacification rates.

[Treatment reality with ranibizumab in clinical routine use for patients with diabetic macular edema : 1­year results of the German POLARIS cohort]. / Behandlungsrealität mit Ranibizumab in der klinischen Routineanwendung bei Patienten mit diabetischem Makulaödem : 1-Jahres-Ergebnisse der deutschen POLARIS-Kohorte.

BACKGROUND: Currently only few data are available on the treatment reality with ranibizumab in patients with diabetic macular edema (DME). MATERIAL AND METHODS: POLARIS is an international observational study which included 983 patients who were treated with ranibizumab due to DME. The primary objective of the study was to investigate the influence of treatment and control intervals as well as resource utilization on the mean change in visual acuity. Secondary endpoints included the collation of disease activity monitoring in the clinical practice. This article describes the results of the German POLARIS population. The study was conducted in 8 European countries from October 2012 to January 2015. RESULTS: In Germany 220 patients were included in the study. Visual acuity improved by 4.3 letters within the first 3 months of treatment. At 12 months, visual acuity increased on average by 4.1 (SD ± 12.4) letters (approximately 1 line) for 168 patients enrolled in the efficacy analysis. Patients received an average of 4.5 (SD ± 1.9) injections, 10.3 (SD ± 6.3) visual acuity tests and 3.3 (SD ± 3.1) optical coherence tomography (OCT) examinations during the first year. Patients with ≤3 injections showed an average improvement in visual acuity by 2.7 letters which was less improvement compared to patients with >3 injections, who achieved an average improvement of 5.4 letters. There was a correlation between the number of injections and the visual acuity achieved. DISCUSSION: For Germany, the results of the POLARIS study indicate that despite a high number of visits, patients with DME are undertreated in clinical routine practice. The injection frequency in Germany was lower than in randomized clinical trials. Almost half of the patients received less than 4 injections in the first year of treatment and thus showed an undertreatment compared to the recommendations of German and international medical societies.

The triple classification of dry eye for practical clinical use.

PURPOSE: "Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. METHODS: To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions. CONCLUSIONS: The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).

[Glaucoma diagnostics and corneal thickness]. / Glaukomdiagnostik und Hornhautdicke.

In recent years the role of pachymetry in the correction of applanation tonometry values was controversially disputed. At the present time it is undoubtedly proven that central corneal thickness affects the accuracy of applanation tonometry. The dimension of this influence is 1 mmHg of pressure per 25 microm of change in corneal thickness. It is important to remember that Goldmann and Schmidt calibrated the applanation tonometer according to the central corneal thickness of their population by using the optical method. Therefore, it is first necessary to determine the corneal thickness for each examiner and his methods. The linear correction formula should be used only in the range of corneal thickness in which the formula was determined. The correction according to Orssengo and Pye and further developments in tonometry may offer alternatives for better estimation of intraocular pressure.

Role of ocular matrix metalloproteinases in peripheral ulcerative keratitis.

AIM: Peripheral ulcerative keratitis (PUK) is an ocular manifestation of rheumatoid arthritis and other similar systemic diseases. The purpose of this inquiry was to investigate the involvement of matrix metalloproteinases (MMPs) in the induction and/or maintenance of PUK. METHODS: Substrate gel electrophoresis was used to characterise the MMP activities secreted by primary cultures of keratocytes derived from normal and perforated pathological corneal specimens, and those present in tears of normal subjects and patients with PUK. Substrate specificity and the in vivo activity status of the secreted MMPs was assessed by SDS-polyacrylamide gel electrophoresis of standard collagens incubated in the presence or absence of the various enzyme preparations. RESULTS: In addition to MMP-2 of M(r) 66,000, cultured keratocytes derived from perforated corneas of patients with PUK abnormally produce the MMP-2 of apparent M(r) 62,000. Other MMPs and in particular MMP-9 of M(r) 92,000, also occur in the tears of these patients. Their visualisation on substrate polyacrylamide gels correlated with clinical manifestations of disease activity; during periods of disease quiescence they were barely detectable. The steroid prednisolone, frequently used in systemic therapy, had no effect on the in vitro activity of MMP-2, or on its production by cultured corneal keratocytes. Although the in vitro activity of MMP-2 was inhibited by both Cu(2+) and Zn(2+), Cu(2+) apparently induced the keratocytes to produce activated enzyme and Zn(2+) irreversibly inhibited their production of MMP-2. CONCLUSION: Overexpression of corneal MMP-2 and tear film MMP-9 are characteristic features of patients with PUK and their activation may be a crucial facet of disease initiation or progression. Although effective in systemic therapy for PUK, prednisolone had no direct control over corneal MMP-2 production or activity. Zn(2+) on the other hand inhibited both MMP-2 production and MMP-2 activity and may, therefore, be of therapeutic value if suitably formulated and used in conjunction with systemic steroid treatment.

Ocular penetration of topical ciprofloxacin and norfloxacin drops and their effect upon eyelid flora.

A double blind, prospective study was undertaken to compare aqueous humour penetration of topical 0.3% norfloxacin and 0.3% ciprofloxacin and their effect upon normal eyelid flora in 39 patients undergoing cataract surgery. Lid swabs were taken before and after six 1 hourly applications of single drops of ciprofloxacin or norfloxacin given before surgery. Aqueous humour was aspirated at surgery and antibiotic concentration assayed using high performance liquid chromatography. The mean aqueous humour concentrations were: ciprofloxacin 220 ng ml-1, norfloxacin 140 ng ml-1. Although this difference was not statistically significant (p = 0.112) the trend demonstrated may be relevant clinically, especially considering the greater activity of ciprofloxacin. Both coagulase negative staphylococcal (p = 0.004) and total bacterial (p = 0.019) lid counts dropped sixfold after ciprofloxacin treatment but the smaller reductions noted after norfloxacin application did not achieve statistical significance (p > 0.1). The reduction of external eye flora experienced with ciprofloxacin suggests that this may be a useful presurgical prophylactic agent.

Topical 0.3% ciprofloxacin, norfloxacin, and ofloxacin in treatment of bacterial keratitis: a new method for comparative evaluation of ocular drug penetration.

AIMS: This study was designed to assess the relative corneal penetration of topical drops of three antibiotics and to relate those levels to minimum inhibitory concentrations for organisms associated with bacterial keratitis. METHODS: Four drops of each of ciprofloxacin, norfloxacin, and ofloxacin (0.3% topical ophthalmic preparations) were given to 12 patients undergoing corneal transplantation. After the recipient tissue was removed, corneal drug penetration was measured using high performance liquid chromatography. RESULTS: Intracorneal concentrations of ofloxacin (geometric mean 0.81 mg kg-1) were significantly higher than both ciprofloxacin (0.60 mg kg-1; p = 0.048) and norfloxacin (0.54 mg kg-1; p = 0.012). Ciprofloxacin and norfloxacin concentrations did not differ significantly (p = 0.33). CONCLUSIONS: Review of the minimum inhibitory concentrations of the fluoroquinolones against ocular pathogens reveals that ciprofloxacin is more potent than ofloxacin against many bacteria; ofloxacin is in turn more potent than norfloxacin. These data favour the selection of ciprofloxacin and ofloxacin rather than norfloxacin for the empirical treatment of corneal infection. The greater potency of ciprofloxacin offsets the superior penetration of ofloxacin. There is a need for improved clinical trial data concerning the use of fluoroquinolone eyedrops in ulcerative keratitis; some encouraging data are available for ciprofloxacin but not (in humans) for norfloxacin or ofloxacin.

Randomised trial of ganciclovir and acyclovir in the treatment of herpes simplex dendritic keratitis: a multicentre study.

AIMS: This study was designed to assess the relative efficacy of topical ganciclovir 0.15% gel and acyclovir 3% ointment in the treatment of herpes simplex dendritic keratitis. METHODS: Both treatment modalities were administered on a five times daily basis to patients suffering from herpes simplex keratitis. Patients were assigned randomly to one of the two treatment groups for the purpose of the trial. They were then examined on days 2, 7, 10, and 14 to assess the rate of healing of the dendritic ulceration. RESULTS: There was no statistically significant difference detected in the rate of healing between the two treatment groups over the course of the trial. CONCLUSIONS: Review of the relative efficacy of topical ganciclovir and acyclovir in the treatment of herpes simplex dendritic keratitis showed that both treatment modalities were equally effective in their ability to heal the viral induced corneal ulceration. There were no significant side effects or adverse effects reported for either treatment modality.

Visual recovery after phacoemulsification using topical anesthesia.

PURPOSE: To assess the speed of visual function recovery after phacoemulsification using topical anesthesia. SETTING: Department of Ophthalmology, Royal United Hospital, Bath, United Kingdom. METHODS: Twenty consecutive patients having routine sutureless clear corneal phacoemulsification with implantation of a Staar foldable intraocular lens were recruited in a prospective study. Visual acuity was assessed using a LogMAR chart and contrast sensitivity using a Pelli-Robson chart 1, 2, 4, and 16 hours postoperatively. A final examination and refraction were performed at 1 week. RESULTS: Although return of visual acuity was slow during the first 2 hours, the mean LogMAR acuity had improved to 0.425 (Snellen equivalent 6/15) by 4 hours and 0.165 (Snellen equivalent of 6/9.5) by 16 hours. There was no postoperative ptosis or diplopia. CONCLUSION: The absence of diplopia and rapid return of visual function with a mean acuity of 6/15 by 4 hours suggest that early patient discharge is relatively safe.

Material properties of ophthalmic sutures after sterilization and disinfection.

PURPOSE: To assess the effects that sterilization and disinfection have on the tensile properties of commonly used ophthalmic sutures. SETTING: University of Bristol, Bristol, United Kingdom. METHODS: The sutures 10-0 nylon, 10-0 polypropylene (Prolene), 8-0 virgin silk, and 8-0 polyglactin 910 (Vicryl) were subjected to thermal or chemical sterilization/disinfection including autoclaving, boiling, and immersion in alcohol or glutaraldehyde. Measurements of tensile strength, suture extension to the point of failure, and suture stiffness were then performed. RESULTS: Nylon and Prolene were little affected by all sterilization and disinfection methods. Virgin silk and Vicryl were weakened by thermal methods of sterilization and disinfection. Both Vicryl, and to a lesser extent virgin silk, appeared to be strengthened by immersion in alcohol or glutaraldehyde. CONCLUSION: The casual reuse of ophthalmic sutures is not recommended. However, when there is no alternative, nylon and Prolene monofilaments can be autoclaved or immersed in fresh activated glutaraldehyde, and Vicryl and virgin silk can be immersed in fresh activated glutaraldehyde without significant loss of tensile strength.

Epithelial downgrowth following penetrating keratoplasty with a running adjustable suture.

A 78-year-old female patient who had a third penetrating keratoplasty for aphakic bullous keratopathy and iris fixation of a posterior chamber intraocular lens using a single, 10-0 nylon running suture technique developed a suture track leak postoperatively. Attempts to ease the tension on the suture track reduced the astigmatism and stopped the leak temporarily. Eighteen months after the procedure, epithelial downgrowth was noted on the corneal graft on both sides of the leak site and intraocular pressure was elevated. A fourth penetrating keratoplasty combined with a trabeculectomy was performed. To our knowledge, this is the first report of epithelial downgrowth associated with suture adjustment following the single, continuous suture technique.

Ganciclovir ophthalmic gel (Virgan; 0.15%) in the treatment of herpes simplex keratitis.

PURPOSE: Ganciclovir is a broad-spectrum virustatic agent. Its efficacy and safety after ocular application have been demonstrated in studies of herpetic keratitis in rabbits. Two strengths of ganciclovir gel (0.05 and 0.15%) were compared with 3% acyclovir ointment in the treatment of superficial herpes simplex keratitis in humans. METHODS: Two multicenter randomized clinical trials were carried out in Africa (Trial 1) and Europe (Trial 2). Sixty-seven patients (Trial 1) and 37 patients (Trial 2) from herpetic ulceration were recruited. RESULTS: The results showed no statistically significant difference between the treatment groups, although the healing rates tended to be better in the group receiving 0.15% ganciclovir gel, with healing rates of 85% (Trial 1) and 83% (Trial 2) as compared with 72% (Trial 1) and 71% (Trial 2) in the group receiving acyclovir ointment. Local tolerance was found to be superior with the gel formulation of ganciclovir with fewer complaints of discomfort (stinging, burning) or blurred vision after application of the drug. Systemic absorption of the drug was low. No hematologic changes were detected. CONCLUSIONS: These findings support the efficacy of ganciclovir gel in the treatment of ulcerative herpes simplex keratitis and demonstrate its superior local tolerance when compared with acyclovir ointment.

Reactivity profiles of autoantibodies to different phospholipids and the phospholipid-binding protein beta2-glycoprotein I in patients with clinical symptoms related to thromboembolic and/or vasculopathic events with or without connective tissue diseases.

To study the antigenic and epitope specificities of anti-phospholipid Ab in detail, we investigated 177 patients without (62 with APS-related systemic clinical symptoms, 115 with microangiopathies) and 164 patients with connective tissue diseases (CTD). Ab associated with primary APS (pAPS) seem to show a restricted specificity (phospholipid/beta2-GPI-complexes), whereas those in secondary APS (sAPS) react additionaly with pure beta2-GPI. Simultaneously, beta2-GPI-independent Ab were also frequently present in both conditions (50% of all Ab-positive sera). In CTD patients, the reactivity profile "pure beta2-GPI + phospholipid/beta2-GPI-complexes" is significantly associated with clinically manifest sAPS. Comparing cardiolipin and phosphatidylserine as antigenic target, the overall concordance (crossreactivity?) between both assays was lower than expected (52%), being highest in pAPS (87%) and sAPS (65%). Based on these results, a two-step procedure for reliable serological diagnosis of APS could be recommended: Ab-screening using a mix of phospholipids complexed with beta2-GPI (sensitivity > 90% for Ab concentrations above 20 U/ml) followed by an assay allowing the simultaneous detection of all relevant antigenic and epitope specificities.

Autoantibodies to prothrombin and phosphatidylserine/prothrombin-complexes: do they contribute to the serodiagnosis of primary and secondary anti-phospholipid syndrome?

The diagnostic and clinical relevance of Ab to pure and phosphatidylserine-complexed prothrombin for primary and secondary APS was investigated in a total of 357 patients with (n = 169) and without (n = 188) connective tissue diseases. The overall frequency of anti-prothrombin Ab in sAPS, pAPS and patients without APS-related symptoms were found to be 50.0, 37.5 and 22.0%, respectively. From a total of 72 anti-prothrombin-positive samples, 12.5% were specific for pure prothrombin, 31.9% for phosphatidylserine/prothrombin-complexes and 55.6% recognized both antigenic forms. The simultaneous occurrence of other anti-phospholipid Ab was observed in 84% of all sera. Both types of anti-prothrombin Ab are significantly associated with lupus anticoagulant activity, but only Ab to pure prothrombin display such a relationship to clinical manifestations of APS. Based on these results, it cannot be recommended at present to include anti-prothrombin assays in the routine procedure for the serodiagnosis of APS. However, patients negative for lupus anticoagulant and typical APS-related anti-phospholipid Ab should be tested for anti-prothrombin reactivity, favoring, mainly due to its higher specificity, the ELISA containing pure prothrombin as antigen.

[Erbium:YAG laser vitrectomy. Initial clinical results]. / Erbium: YAG-Laser-Vitrektomie. Erste klinische Ergebnisse.

BACKGROUND: Much interest has been expressed in recent years in the use of erbium:YAG lasers in ophthalmology, particularly for vitrectomy and phacoemulsification. PATIENTS AND METHODS: We performed 54 operations (49 primary, 5 secondary) for pars plana vitrectomy on 53 eyes of 53 patients using the Phacolase erbium:YAG laser at a frequency of 10-100 Hz single-pulse energy of 5-50 mJ. RESULTS: The operation was successful in 51 cases,while in three we had to resort to mechanical vitrectomy due to initial technical problems. CONCLUSION: Erbium:YAG laser vitrectomy was generally fast and caused little mechanical stress to the retina. Complications were only those known from mechanical vitrectomy.The handpiece showed good properties for removing vitreous but not for cutting membranes, although new handpieces specifically for the cutting of membranes are under development.

[Therapeutic and prophylactic application of TPA (recombinant tissue plasminogen activator) into the anterior chamber of the eye]. / Zur therapeutischen und prophylaktischen Anwendung von rTPA in der Augenvorderkammer.

BACKGROUND: In therapy-resistant fibrin reactions within the anterior chamber, especially following combined cataract and glaucoma surgery, injection of TPA is indicated. We report our results. PATIENTS AND METHODS: From August 1994 to August 1998 we applied TPA 185 times into anterior chambers. A total of 123 injections were for therapeutic reasons (if local therapy with eyedrops showed no fibrinolytic effect), 32 for prophylactic reasons at the end of operations with intensive manipulation of the iris and following postoperative fibrin risk, and 30 applications for nonfunctional filtering blebs following glaucoma surgery. We applied 10 microg/0.1 ml. RESULTS: On the first day after therapeutic application of TPA, the fibrin was completely dissolved in 61 % of the eyes, and in 36.6 % of the eyes partial fibrinolysis occurred (total 97.6 %). Only 2.4 % of the eyes showed no fibrinolysis. Seventy-five percent of the eyes showed no fibrin reaction within the anterior chamber after prophylactic application of TPA. In all eyes (100 %) we would have expected fibrin reactions. Application of TPA for a filtering blebs disorder after glaucoma surgery resulted in restoration of the filtering bleb function in two-thirds of the eyes. COMPLICATIONS: After 185 applications of TPA into the anterior chamber we saw ten occurrences anterior chamber bleeding (5.4 %). In six eyes (3.2 %) we saw transcient clouding of the corneal endothelium and/or corneal stroma. These complications were reversible, except for irreversible endothelial decompensation in one eye with Fuchs' corneal dystrophy. CONCLUSION: TPA is effective for treating fibrin formation within the anterior chamber and maintaining the function of the filtering bleb. To confirm and quantify the efficiency of prophylactic use, a controlled prospective study is recommended.