Fortschritte der Ophthalmologie : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft最新文献

From 01. 01. 1988 to June 1990, a total of 275 patients with AIDS had been examined in our ophthalmological out-patient clinic. The clinical diagnosis of a cytomegalovirus (CMV) retinitis was recorded in 56 of these patients (= 20.1%). The initial therapy, as usual, took the form of infusions of the virustatic drug ganciclovir at an induction dose of 10 mg/kg body weight per day (3 weeks), with a maintenance dose of 3.5-5 mg/kg body weight per day (5 days per week) thereafter. During maintenance therapy recurrences were observed in 15 cases and herpes simplex retinitis in 3, with progressive retinal destruction. Therefore we began treatment with trisodium phosphonoformate (Foscavir) at a dosage of 60 mg/kg body weight per day (3 weeks), continuing with maintenance therapy at 90 mg/kg body weight per day (7 days a week). After the induction dose 14 patients showed subjective improvement and satisfactory cicatrization of the retinal lesions. We monitored the retina by a standardized method and 50 wide-angle retinal photographs. One case of acute retinal necrosis (ARN) did not show any response to foscavir therapy. Typical side-effects of therapy with trisodium phosphonoformate were seldom seen: adverse events included renal dysfunction, neutropoenia, and asymptomatic hypocalcaemia. We conclude that trisodium phosphonoformate is an effective and well-tolerated agent for the treatment and prevention of relapse of CMW retinitis and can be used as an alternative ganciclovir.

We performed several placebo-controlled, randomized, prospective, parallel, double-masked studies in ophthalmologically healthy people to determine the local anesthetic effect and the topical subjective tolerability of beta blockers with similar potency of action that are available in the Federal Republic of Germany. There are marked differences in the local anesthetic effects of the different beta blockers. Depending on the type of beta blockers the local anesthetic effect ranges from practically none up to anesthesia allowing contact glass examinations and removal of foreign bodies after application of only one drop. The subjective tolerability becomes worse with increasing strength of local anesthetic effect of the beta-blocker. There is a statistically significant correlation between the subjective tolerability and local anesthetic effect and the octanol-water distribution coefficient. Because of the local anesthetic effect, we recommend repeated checks of corneal sensitivity during beta blocker therapy. This should be done more frequently in people with sensitive eyes, "responders," contact lens wearers, and people with reduced corneal sensitivity for other reasons, especially during therapy with beta-blockers with marked local anesthetic effects. In addition to systemic side effects, cardioselectivity, influence on tear film, intrinsic sympathomimetic activity and topical tolerance, etc., the local anesthetic effect of beta blockers is a further important aspect in the "differential indications" of beta-blockers.

We discuss a paraneoplastic retinopathy in a 6-year-old boy who had an embryonal rhabdomyosarcoma of the thorax. Opacities of the vitreous body, optical atrophy, contracted arteries and changes in the structure of the retina--especially the retinal pigment epithelium--characterized the ophthalmological findings. The asymmetrical localization of the changes makes the differential diagnosis of hereditary retinal dystrophies easier. It is probably an immunological disease caused by an antigenic antibody reaction.

In comparison with normal eyes, eyes affected by glaucomatous optic nerve damage are characterized by a decreased neuroretinal rim area and an increased optic cup size. This study was performed to find whether eyes with nonglaucomatous optic nerve atrophy and normal eyes differ with respect to the neuroretinal rim. In all, 143 eyes with nonglaucomatous descending optic nerve atrophy and 563 normal eyes were biomorphometrically examined. The area and form of the neuroretinal rim and optic cup and the horizontal and vertical cup-to-disc ratios did not differ significantly between the two groups. These results are in part not supported by data in the literature. If they are confirmed by further studies, they will indicate that measurement of the neuroretinal rim and estimation of the cup-to-disc ratios will not be useful for the diagnosis of damage to the descending nonglaucomatous optic nerve. It will be helpful for the differentiation of eyes with glaucomatous and nonglaucomatous optic nerve atrophy.

We tested 1002 persons, 572 divers (including 38 who had diving accidents) and 430 nondivers, for defects of the blue-sensitive system during the years 1988 and 1989. Recent research has shown functional disorders of color vision in divers, linked to previously described alterations of the retinal capillary system and pigment epithelium. The desaturated Lanthony-15-HUE test was used as a screening method. No defect of the blue-sensitive system was found, either in divers or in nondivers. Our results are similar to those of other researchers. One exception was that we found no correlation between age and error score. We found no evidence for retinal damage caused by diving.

Removal of a dislocated natural lens into the vitreous cavity is now performed using vitreous surgery techniques combined with intravitreal phacoemulsification via the pars plana. In contrast to the earlier external surgical approach to luxated lenses, postoperative complications, particularly retinal detachment, are rare. However, retinal damage may occur when ultrasound is used at therapeutic intensities. We therefore examined ultrasound-induced retinal lesions produced in rabbit eyes by treating the retina directly with ultrasound using the type of tip conventionally used for pars plana lensectomy (Fragmatom). Histological evaluation showed that acoustic energy at low intensities led primarily to damage of photoreceptor cell outer and inner segments, which correlated with a discrete pigment reaction visible on ophthalmoscopy. More severe lesions were seen in destruction of the inner retina and resulted in retinal blanching or caused a small retinal break. High energy led to a full-thickness retinal defect with rupture of choroidal vessels and heavy bleeding into the vitreous cavity. Within these lesions the retinal pigment epithelium and Bruch's membrane were also disturbed. Our ophthalmoscopical and histological findings indicate that the mechanism of ultrasound-induced chorio-retinal lesions is not exclusively thermal in nature and differs from other coagulation modalities.

Over a period of about 1 year we observed five patients who developed tumors of their eyelids a few days to 3 weeks after surgery on the paranasal sinuses through the nasal passage. One patient noticed a swelling of his ipsilateral eyelid during an irrigation procedure for the maxillary sinus, which was also followed by endonasal surgery. After surgery each patient developed an ipsilateral periorbital hematoma and subsequently solid indolent tumors of the eyelid without a tendency to regress over a period of 3 to 14 months. Therefore, surgical treatment was necessary. The histological examination showed lipogranulomas with giant cells and many lipid vacuoles of different size. Exploring the origin of these lipids, we performed a magnetic-resonance-spectrum analysis of one tumor sample. We predominantly found signals for linear hydrocarbons, which are the main components in paraffin-liquids. We presume that our patients developed lipogranulomas of their eyelids due to the paraffin introduced into the tissue by the ointment used to tampon the paranasal sinus after endonasal surgery.

A total of 44 eyes of patients with suspected glaucoma or ocular hypertension were examined both by ocular pressure tonometry (OPT) according to Ulrich and by tonography according to Leydhecker. The visual fields of these eyes were prospectively followed up for 3 years to compare the prognostic value of the two methods. In 30 of the 44 eyes a worsening visual field loss was observed, while in 14 the visual fields showed no change. Much better correlation was noted between values obtained by OPT and changes in visual field than between values obtained by tonography and visual field loss. Conventional tonography yielded 39% of false-negative values, but only 11% were recorded with OPT. Therefore, according to results of these and further investigations, OPT appears to be a more helpful and reliable method for assessment and decisions on therapy in patients with suspected glaucoma or ocular hypertension.

In 17 ocularly healthy persons the IOP was artificially raised by suction cup oculopression (negative pressure: 65 mmHg [8.67 kPa]) from initially 15.5 +/- 2.2 mmHg (2.07 +/- 0.29 kPa) to 25.2 +/- 4.0 mm Hg (3.36 +/- 0.53 kPa) (mean +/- SD). Continuing the initial refractive correction, visual acuity (Landolt's rings) decreased from initially 1.06 +/- 0.13 to 0.39 +/- 0.22 (P less than 0.001* [*t-test, paired ties each]). A new optical refraction with suction cup in position significantly raised the visual acuity to 0.64 +/- 0.24 (P less than 0.002*). The suction cup itself induced astigmatism of 2.15 +/- 1.46 dpt (Canon Auto-Refractometer RK-1), which significantly differed from the initial astigmatism (0.32 +/- 0.23 dpt) (P less than 0.001*). The minus cylinder axis initially showed no preferential position. During artificial IOP elevation it shifted to 90 degrees...125 degrees (referred to the right eye) and thus ran about perpendicular to the meridian the suction cup was positioned on the eyeball. Effects of such refractive changes on differential light threshold and VEP amplitude are demonstrated. The results presented allow critical interpretation of previous IOP tolerance tests. The influence of suction cup oculopression on the perception of the white-noise field is shown in some glaucoma patients: the speed of the white-noise campimetry allows the increase in field defects during artificial IOP elevation to be followed up directly.