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Zusammmenfassung: Hintergrund: Wir berichten über einen 52-jährigen Patienten — Kettenraucher, welcher im Zusammenhang mit der Entstehung eines chronischen totalen infrarenalen Aortenverschlusses — Leriche Syndrome, eine ischämische proliferative Retinopathie in beiden Augen erlitt. Methoden: Zahlreiche klinische und Laboruntersuchungen wurden durchgeführt, Blutdruckkontrollen, Farb-Duplex-Sonographie von extrakraniellen Carotiden und Orbiten, Echokardiographie, neurologische Untersuchungen, Bluttests und postoperative Scanning Laser Ophthalmoskopie (SLO) eingeschlossen, um die Ursache der vasoproliferativen retinalen Veränderungen aufzuklären. Ergebnisse: Neben arterieller Hypertonie, arteriosklerotischen Gefäßalterationen und Veränderungen, welche die Blutviskosität steigern, wurde auch eine systemische arterielle Hypoxamie/Normokapnie infolge von chronischer obstruktiver pulmonaler Erkrankung (COPD) festgestellt. Andererseits konnten keine Thrombi oder Emboli in orbitalen oder retinalen Gefäßen, sowie keine schwere Okklusion im Gebiet der extrakraniellen Carotiden gefunden werden. Andere Erkrankungen, welche mit der Entstehung von retinalen Neovaskularisationen einhergehen wie Diabetes mellitus, rheumatische oder entzündliche Erkrankungen, Hämoglobinopathien und andere Prozesse konnten ausgeschlossen werden. Fazit: Die Ergebnisse lassen vermuten, dass entweder ein „rheologischer“ oder passagerer venöser retinaler Verschluss mit Kapillarobstruktionen in der mittleren Peripherie der Ausgang von bilateralen retinalen Neovaskularisationen war. Der zugrundeliegende Prozess dieser Verschlüsse bleibt allerdings unklar. Als Ursache wird der Effekt von oxidativem Stress und freien Radikalen und/oder Homozysteinämie möglicherweise in Kombination mit systeinischer arterieller Hypoxämie diskutiert. Summary: Backround: We present an observational study report of a single case of a 52-year-old male patient, a chainsmoker who experienced ischemie proliferative retinopathy in both eyes in association with chronic development of total infrarenal aortoiliac occlusion — Leriche syndrome. Methods: The whole spectrum of clinical and laboratory tests including blood pressure measurements, color-coded duplex sonography of extracranial carotids and orbits, echocardiography, neurological check-up, blood examinations, as well as postoperative scanning laser ophthalmoscope (SLO) angiography were performed to determine the cause of the vasoproliferative retinal changes. Results: Hypertension, atherosclerotic alterations, changes contributing to the elevated blood viscosity and systemic arterial hypoxemia/normocapnia due to the chronic obstructive pulmonary disease (COPD) were detected. In contrast, thrombi or emboli in retinal or orbital vessels as well as a severe occlusion in the area of extracranial carotids were absent. Other possible diseases known to cause retinal neovascularizations including diabetes mellitus rheumatic or inflammatory diseases, hemoglobinpathies and other pathologies were ruled out. Conclusion: The data suggest “rheologic” or temporary venous retinal occlusions with retinal capillary obstructions in the middle periphery to be the trigger for the development of bilateral retinal neovascularizations. However, the main condition underlying the bilateral occlusions remain unclear. The effects of oxidative stress and free radicals as well as hyperhomocysteinemia possibly in combination with systemic arterial hypoxemia are discussed.

In a prospective study performed between June 1992 and March 1994 19 eyes of 19 patients with dense fibrinous pupillary membranes following cataract surgery were treated with intracameral injections of 25μg recombinant tissue plasminogen activator (r-tPA). Injections were performed between the second and twenty-third postoperative day (mean 5.6±6.9 days). Complete fibrinolysis within one to 4 hours (mean: 3.3±0.89 hours) was observed in 18 (94.7%) eyes. In one (5.3%) eye fibrinolysis was incomplete despite a second injection. In 2 (10.5%) eyes recurrence of a distinct fibrinous membrane was noted which then cleared spontaneously with topical treatment. A small hyphema developed in 2 (10.5%) eyes and intraocular pressure exceeded 25 mm Hg in 2 (10.5%) eyes. No increase of keratopathy nor any toxic intraocular side effect of 25μg intracameral r-tPA was observed throughout the study. The intracameral injection of r-tPA clinically proved to safely accelerate the resorption of dense fibrinous membranes following cataract surgery and thus enhance visual recovery minimizing subsequent complications and systemic or subconjunctival anti-inflammatory treatment.

Purpose:To evaluate the efficacy and complications of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous effusion after cataract and combined cataract and glaucoma surgery.

AbstractPurpose: Previous studies have documented good pressure control with combined cataract and filtering surgery. However, relatively high incidences of iridocapsular synechiae (ICS) and cell precipitates on the optic (CPO) were found. Corneal valve incisions preclude intraoperative chamber flattening and iris injury or prolapse. Rigid one-piece PMMA lenses with a small optic maintain a pronounced optic-iris clearance. In a prospective series, the effect of this approach was studied with special regard to the morphological results. Methods: A temporary corneal lip was created in the clear cornea beneath the scleral flap to serve as a temporary valve during cataract extraction. The lip was then widened and a rigid one-piece 5-mm PMMA lens implanted. Lip and trabeculum were finally excised en bloc at a width of 3 mm. Two years’ functional and morphological results were evaluated. Results: Fifty-four eyes were available for evaluation. After the mean follow-up of 21 months, mean IOP had dropped from 21.6±3 mm Hg preoperatively to 13.9±2.4 mm Hg, with a mean pressure reduction of 7.7±3.4 mm Hg. IOP was 18 mm Hg or less in all cases. The mean medication index dropped from 2.7 to 1.0. Eyes with a preoperative IOP of 21 mm Hg or more showed a significantly greater IOP reduction than eyes with an IOP of 20 mm Hg or less (–9.2±3.0 vs. –6.1±2.9 mm Hg, p = 0.0003). Intraoperatively, the temporary valve effectively prevented chamber flattening and iris injury or prolapse. Postoperatively, 9 eyes or 6% showed hyphemas, 1 undergoing lavage. Two eyes developed a capsular hematoma, 1 requiring YAG capsulotomy. Ten eyes or 19% developed mild and 2 eyes severe but transient fibrin exudation following hypotony or iridoplasty. One eye showed grade I anterior chamber flattening, 1 developed a ciliolenticular block requiring surgery. Postoperative pressure spikes of 30–35 mm Hg were noted in 4 eyes. Three eyes showed prolonged hypotony associated with transient choroidal effusion. A pronounced optic-iris clearance was found in 87% of the eyes. Iris-optic touch developed in 1 eye with prolonged postoperative anterior chamber flattening and in 3 of the 4 eyes that had undergone intraoperative iridoplasty. Three of the latter developed extensive ICS followed by CPO. The mean optic-iris distance was 1.2 mm and the anterior chamber depth 4.2 mm. Conclusion: Apart from effectively lowering IOP, the surgical approach used significantly reduced the incidence of ICS and CPO.

Zusammenfassung: Es wird der Einsatz von oralem Ganciclovir als Erhaltungstherapie bei Cytomegalovirus (CMV)-retinitis im Bereich des hinteren Pols diskutiert. Wir berichten über einen 42 Jahre alten HIV-positiven Patienten mit einem makulären CMV-Herd. Nach der intravenösen Induktionstherapie mit Ganciclovir erhielt der Patient eine orale Erhaltungstherapie mit Ganciclovir. Nach 50 Tagen kam es trotz nur minimaler Aktivitätszeichen zu einer Progression des zentralen Herdes mit massivem Visusabfall. Unsere ersten Erfahrungen mit dem Einsatz von oralem Ganciclovir sprechen gegen die Verwendung von oralem Ganciclovir als Erhaltungstherapie bei CMV-Herden nahe der Fovea, bzw. des Sehnerven, da bei CMV-Herden nahe der Fovea und des Optikus schon eine geringe Progression einen massiven Visusabfall bedeutet. Summary: We herein discuss the use of oral ganciclovir for the maintenance-treatment of macular cytomegalovirus (CMV)-lesions. A 42 years old patient with acquired immunodeficiency syndrome (AIDS) with a CMV-retinitis close to the fovea is presented. After induction therapy with intravenous ganciclovir the patient was treated with oral ganciclovir maintenance therapy. After 50 days of oral ganciclovir therapy CMV-retinitis progressed without signs of active borders, causing a severe loss of visual acuity. With oral ganciclovir maintenance therapy progression of retinitis might be more difficult to detect. Therefore oral ganciclovir may not be appropriate for the treatment of lesions at the posterior pole, where minimal degree of progression may have major visual consequences.

Zusammenfassung: Die Bindehaut scheint ein, durch Östrogen beeinflußbares, Gewebe [5] zu sein. In einer randomizierten Doppelblindstudie wurde die Wirkung der lokalen dreiprozentigen Östrogensalbe auf zwanzig Patientinnen in der Menopause untersucht. Folgende Untersuchungen wurden vor Behandlungsbeginn und eine Woche bzw. einen Monat nach Behandlungsbeginn durchgeführt: Schirmer-Test, Tränenfilmaufreißzeit (BUT), Bengalrosa Vielfärbung und subjektive Beurteilung der Sicca-Symptomatik nach einem standardisierten Fragebogen. In der mit Hormonsalbe behandelten Gruppe stieg der Durchschnittswert des Schirmer-Test von 6,1 mm auf 8,9 mm und der BUT verbesserte sich von 11,3 s auf 15,7 s. Die Scorewertung der Vitalfärbung mit Bengalrosa reduzierte sich von 1,7 auf 1,35. Sieben von zehn Patientinnen in beiden Gruppen fühlten eine Besserung bis Gleichbleiben der Symptome nach der Therapie. Die Verbesserung im Schirmer-Test und BUT waren in der hormonbehandelten Gruppe statistisch signifikant (p = 0,01 bzw. p = 0,05). Die Scoreveränderung der Vitalfärbung war jedoch in keiner Gruppe statistisch auffällig. Summary: The conjunctiva seems to be a estrogen-sensitive tissue. In a randomized placebo controlled double blind study we investigated the effect of topically applied 3% estradiol ointment on the conjunctiva. Twenty postmenopausal women were enrolled in our study. Schirmer test, tear film break up time, rose bengal staining score and subjective assessment of dry eye symptoms with a standardized questionnaire were performed before and four weeks after the therapy. After four weeks of treatment the mean value of Schirmer test increased from 6.1 to 8.9 mm in the hormone group. In the same sample the mean value of break-up time also increased from 11.3 to 15.7 sec. The rose bengal score decreased from 1.7 to 1.35 in hormone treated group, and subjectively 7/10 patients of both groups felt better or the same after the therapy. The changes in the results of Schirmer test and BUT were statistically significant (p = 0.01 and p = 0.05, respectively). The change in rose bengal staining were too small to be statistically significant.