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Purpose: To determine a novel vital dye (patent blue; Blueron®) for vitreoretinal surgery in a prospective consecutive case series. Methods: Five patients with either idiopathic epiretinal membrane (ERM; n = 2), proliferative vitreoretinopathy (n = 2), or a macular hole (n = 1) underwent a three-port pars plana vitrectomy. Patent blue assisted staining of the retinal surface followed by a consecutive peeling of the ERM (n = 4) or of the internal limiting membrane (ILM; n = 1) was performed. The main outcome measures were quality of intraoperative visualization of preretinal structures and postoperative visual acuity. Results: The dye induced a moderate staining (++) of the ERM and a mild staining (+) of the ILM. Complete ERM and ILM removal was successfully achieved in all cases. A mean visual improvement of three Snellen lines was observed 6 months postoperatively. No visual field defects or visible retinal pigment epithelial changes were present 6 months postoperatively. Conclusion: Patent blue, a novel dye for intraocular applications, may be added as an alternative dye in chromovitrectomy.

Problemstellung Zur Korrektur der Aphakie stehen verschiedene Techniken und Intraokularlinsen zur Auswahl. Bis vor einem Jahr erfolgte an unserer Klinik die Korrektur der Aphakie durch eine skleranahtfixierte Hinterkammerlinse. Neuerdings verwenden wir eine Irisklauenlinse, welche ebenfalls hinter der Iris platziert werden kann. Es stellt sich die Frage, welche Methode geeigneter fur eine Aphakiekorrektur erscheint.

To demonstrate the cross-sectional morphology in crystalline retinopathy.A 24-year-old woman with Bietti's crystalline dystrophy (BCD) and bilaterally decreased vision and nyctalopia was examined by optical coherence tomography (OCT).Fundus examination demonstrated numerous reflective, yellow-white crystalline deposits scattered throughout the posterior pole and midperipheral retina. Optical coherence tomography disclosed an abnormally level of high reflectivity in red to orange colours throughout the entire neuroretina, retinal pigment epithelium (RPE) and choroid. The RPE-choriocapillaris complex was thickened and hyper-reflective, corresponding with dense crystalline deposits.The observed uncommon hyper-reflectivity in BCD relates to the deposition of numerous infiltrates. In vivo investigations by OCT confirmed histological studies that a crystalline retinopathy corresponds with numerous infiltrates in the retina, RPE and choroid. The RPE and choroid have intensive hyper-reflection and may be the primary location of the disease.

Purpose To determine whether sectorial-oriented grouped pigmentations of the retina follow developmental patterns of pigmentary mosaicism. Design Systematic literature review. Participants Fundus images from patients with grouped congenital hypertrophy of the retinal pigment epithelium (CHRPE). Methods An extensive Internet and library search was performed to obtain articles dealing with grouped CHRPE. Each article was carefully screened for fundus images and inclusion criteria. Fundus images of sufficient quality were scanned, digitized, and matched in size using Adobe Photo Shop to compare the pattern location and extension of the pigmented lesion. These obtained patterns of grouped CHRPE were than mapped and superimposed. Results Forty-five images were retrieved from 32 articles with grouped CHRPE. The lesions extended from the margin of the optic disc and radiated in sectors to the fundus periphery. The stream of growth did not follow the pattern of the retinal nerve fiber layer, because the clusters of pigmented cells crossed the midline raphe not sparing the macular area. Smaller lesion clusters were mainly located near the optic disc, whereas larger lesions were found in the periphery. Conclusions The growth pattern of grouped CHRPE is similar to cutaneous sectorial pigmentations. We speculate that pigmentary mosaicisms may be a modified wild-type allele in a somatic cell clone during early embryogenesis following developmental lines analogous to the cutaneous lines of Blaschko. The sectorial pigmentations on the ocular fundus may reflect the stream, outgrowth, and migration of retinal pigment epithelium cells during embryogenesis.

Idiopathic epiretinal membranes (ERM) grow on the surface of the internal limiting membrane (ILM) and are a very uncommon condition in young subjects. We report six young subjects with ERM and describe the spontaneous separation of the membranes. The functional and anatomical recovery was assessed by Snellen visual acuity, Amsler grid and funduscopy. Selected cases were additionally assessed by optical coherence tomography (OCT). All subjects initially claimed a sudden, unilateral, reduction in visual acuity (VA) with severe distortion at the age of 15–30 years. No ocular trauma or disease was ascertained in any case. Initial fundus examination demonstrated a gray–whitish ERM with translucent stress lines over the macula. Visual recovery occurred in all cases after resolution of the ERM. Sequential OCT demonstrated the successive peeling of an ERM accompanied by normalization of foveal thickness. Young subjects should be counseled about the favorable prognosis for maintaining good vision and possible spontaneous membrane separation. Conservative observation is advocated if the visual disturbance is located temporally, as functional recovery and spontaneous membrane separation may occur. When the contracting forces of the immature ERM are stronger than its adhesions to the retina, the membrane may separate spontaneously.

Age-related macular degeneration (AMD) is a frequent cause of an irreversible loss of the ability to read. The non-exudative form of AMD has not been therapeutically approached in the past in contrast to the exudative form with choroidal neovascularizations (CNVs). Parafoveal laser coagulation can be applied, and in cases of subfoveal location a pars plana vitrectomy with subretinal resection of the CNV is possible.Since 1995, we have operated 46 eyes of 45 patients with CNV developing from AMD. Patient ages ranged from 63 to 85 years (mean 71.8 years). Pre- and postoperatively we performed vision tests, fluorescence angiographies with sodium fluorescein and indocyanine green. Follow-up times ranged from 3 to 28 months (mean 12.3 months).Pre-operative vision was 0.10 (range: hand movements to 0.4). Postoperative vision at the end of the follow-up period was 0.12 (range: hand movements to 0.4). Vision at the end of the follow-up was lower in 41%, unchanged in 20% and improved in 39%. In 43 eyes, a non-exudative form of AMD developed. Two eyes had a recurrent CNV, which was removed successfully with a second pars plana vitrectomy. Three patients developed a retinal detachment, which was successfully treated by pars plana vitrectomy, encircling buckle and gas tamponade.We still have to wait for the results of the photodynamic study trials and a randomized study of macular dislocation. Subretinal removal of the CNV by pars plana vitrectomy allows a stabilization of the visual function in most of our cases of AMD. This method inhibits the development of large pseudotumour-like scars. Postoperatively remaining pigment epithelial defects with choroidal atrophies however limit a visual rehabilitation so that reading vision can only be achieved in cases with good pre-operative vision. Long-term results of photodynamic therapy are still lacking and have to show its effectiveness over greater time spans.

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) can be associated with Gardner's syndrome (GS). During childhood multiple adenomatose polyps develop in the colon ascendens (familiar-autosomal Polyposis coli [FAP]), and always become malignant until the age of 35. The tumour-suppressive FAP-gen was identified at the long arm of chromosome 5 (5q21). Ophthalmic funduscopy is very important. Patients with more than 3 CHRPE in one eye or a bilateral CHRPE, as well as patients with a positive family history and one unilateral solid CHRPE require further gastroenterological evaluation.

It was the aim of this study to compare postoperative pigment epithelium defects after submacular surgery for well-defined choroidal neovascularization (CNV) with preoperative fluorescein angiogram (FAG), indocyanine green angiogram (ICG), and intraoperative findings of the excised neovacularization. Surgical removal of the CNV was videotaped. By means of a gauge the absolute size of an anatomic structure was determined which was visible on video, FAG, and ICG as well. Postoperatively another FAG was performed to further examine the funduscopically visible pigment epithelium defect. By comparison with the above-mentioned anatomic structure it was thus possible to determine the exact size of CNV and pigment epithelium defect. The extent of the pigment epithelium defect as determined on postoperative FAG after submacular surgery surpasses the size of CNV as measured in FAG, ICG, and anatomical preparation.

· Purpose: To assess the effects of intravitreal injection of recombinant tissue plasminogen activator (rTPA) and gas on submacular hemorrhage in age-related macular degeneration (ARMD). · Methods: Eleven consecutive patients (11 eyes) with subretinal hemorrhage due to ARMD involving the fovea with elevation of the neurosensory retina were included in this study. Subretinal hemorrhage occured 12 h to 14 days before onset of therapy. Injection of rTPA through the pars plana in a dose of 50 or 100 μg was performed. Gas instillation (0.2–0.4 ml) followed rTPA injection, either immediately after injection (7 patients) or during the following day (4 patients). · Results: After intravitreal injection of rTPA, subretinal clots were totally or partially liquefied when treatment started up to 3 days after onset of bleeding. In all patients treated with 100 μg rTPA a large exudative retinal detachment of the inferior retina resulted, which reabsorbed spontaneously within 2 weeks. After reattachment of the exudative retinal detachment hyperpigmentation of the retinal pigment epithelium was noted. Temporary opacification of the vitreous was observed between the 2nd and 7th postoperative day in 5 eyes (45.5%). Postoperative visual acuity increased in 5 patients (45.5%). · Conclusion: Intravitreal application of rTPA followed by gas injection is a sufficient and convenient technique for effective removal of freshly formed submacular hemorrhage. Removal is mediated through combined enzymatic (rTPA) and mechanical (gas) effects. This technique offers a quick recovery of vision in eyes with less severe ARMD.

Background: The causes of recurrent choroidal neovascularisation (CNV) after photodynamic therapy (PDT) remain controversial. Subretinal surgery was carried out after unsuccessful PDT. Aims: To determine intraoperatively the status of the posterior vitreous interface. Design: Interventional case series. Methods: Conventional three-port vitrectomy was carried out in 10 eyes with CNV that had undergone 1–4 PDT sessions. The vitreous cutter was held close to the edge of the optic nerve to evaluate the status of the posterior vitreous. Results: Lesion size showed an increase from 1.5 (standard deviation (SD) 0.53) to 2.3 (SD 0.83) macular photocoagulation study disc diameters, between the first and the last PDT. Intraoperative findings during vitrectomy showed little liquefaction of the vitreous gel and an incomplete posterior-vitreous detachment, with remarkably firm attachments at the macula in all cases (10/10). Conclusion: We determined an abnormally high incidence of vitreous attachments in eyes with recurrent CNV. Vitreomacular attachments may trigger the progression or recurrence of CNV.

itreopapillary traction (VPT)appears as a pseudopapilloede-ma with strong adhesions at the mar-gin of the optic disc and plays animportant role in a number of differ-ent diseases, including diabetic retin-opathy, central retinal vein occlusionor toxocara (de Bustros et al. 1987;Kroll et al. 1995; Karatas et al. 2005).Its surgical release by vitrectomy hasbeen debated in the past (Small et al.1989). We present a young patientwho developed serious VPT afterchronic panuveitis.A 21-year-old man complained ofdecreased visual acuity (VA) andmetamorphopsia in the left eye. Hismedical history was unremarkable,with no persistent hyaloid artery orprevious ocular blunt trauma.The eye was initially treated atanother university hospital with atro-pine ointments twice daily and withprednisolone acetate eight times daily.His best corrected Snellen VA was20⁄20 OD and 20⁄200 OS. Fundus-copy OS revealed a severe uveitisintermedia with numerous cells andvenous sheathing. After a sub-Tenon’sinjection of 20 mg triamcinolone, thesubject’s VA improved to 20⁄60 tem-porarily. A second opinion wasobtained 3 months later at anotheruniversity hospital specializing in uvei-tis disease. This examination revealedno signs of herpes infection (HIV, her-pes simplex virus [HSV], herpes zostervirus [HZV], varicella zoster virus[VZV]), other infections (Toxocaracanis, lyme borreliosis, Treponemapallidum, To. gondii) or rheumatoidinfections (antineutrophil cytoplasmicantibody [ANCA], antinuclear anti-body [ANA]).Due to increasing VMT, the sub-ject’s VA declined to 20⁄80 OS4 months later and he attended ourinstitution. The anterior segmentappeared normal with a clear view tothe fundus and no synechia. Biomicro-scopic examination disclosed strongepipapillary adhesions and elevationof the optic disc (Figs 1A and 2A).Optical coherence tomography (OCT)revealed persistent traction of densevitreous strands on the optic disc(Fig. 3A) and moderate thickening ofthe central retina.A pars plana vitrectomy withseparation of the posterior hyaloidand release of the vitreal traction onthe optic nerve head was performed(Fig. 1B). Examinations of the vitre-ous specimens obtained revealed nosigns of bacterial or viral infection.On careful examination we noted amarkedly improved retinal vascula-ture immediately after surgery(Fig. 2B). Three weeks later the sub-ject’s VA improved to 20⁄25 with novisible traction on OCT (Fig. 3B),while the foveal thickness remainedconstant during a follow-up of8 months.Vitreopapillary traction has beenproposed as a possible cause of tem-porary or chronic functional impair-ment (Katz & Hoyt 2005). Our casegives further evidence of visualimpairment due to VPT and immedi-ate functional improvement after sur-gical release. Tractional forceselongate the retinal nerve fibres andbend the central retinal vessels. Physi-cal deformation via stretching andthinning of the ganglion cell axons(neurogenic) reduces the anterogradelyor retrogradely axoplasmatic flow andaccounts for a sensory blockade ofneuroretinal signals by altering thevisual evoked potentials. Mechanicalrestriction and nourishing of the

150 patients suffering from primary hypercholesterolemia were divided into three different groups receiving (1) lovastatin, (2) simvastatin, or (3) fenofibrate as controls. The aim of the study was to detect possible drug-induced ocular side effects, especially in the lens. The study period was 2 years. Ophthalmological examination and Scheimpflug photography were performed at the beginning and every 6 months. Increases or decreases in the visual acuity were distributed very similarly in the three groups. Definite evidence of side effects was not found, nor was there evidence of deleterious effects on refraction. The intraocular pressure revealed intraindividual fluctuations without clinical significance. Many changes were observed in the lens, all were minimal, including those of the extreme lens periphery which had no effect on visual acuity. The present study shows the great value of Scheimpflug photography with densitometric image analyses because of its objectivity when compared with other methods. Our observations provide good evidence that lovastatin and simvastatin have no undesirable toxic effects on the lens and other ocular tissues, compared with fenofibrate.

Electromagnetic radiation is involved in the generation of several different diseases especially those of the skin. Even the eye is subjected to the influence of electromagnetic radiation, which first reaches the cornea and the conjunctiva. These structures being superficial eye tissues, are naturally the first to be subjected to actinic influences. Additionally all other eye structures can be reached and possibly damaged by ultraviolet radiation being dependent on wavelength and intensity. In this respect, it is of crucial importance whether the damage in question is due to acute radiation or is to be considered a consequence of chronic exposure.

The effect of an aldose reductase inhibitor, AL-1576, on the development of UV-B and X-ray-induced cataract was studied with 100 female Brown-Norway rats. Histological studies were made with 32 eyes. A new histological procedure enabled detailed information on UV or X-ray-induced impairment on the lens, as well as on the potential efficiency of anticataract drugs. No definite effect of the aldose reductase inhibitor, AL-1576, on the development of UV or X-ray-induced cataract could be found. It may be concluded that AL-1576 cannot prevent damage caused by irradiation, like that of other oxidative influences. Disadvantageous effects of AL-1576 on the lens could be excluded.

RNA-dependent DNA polymerases of intracisternal A particles from the mouse plasma cell tumor MOPC 104E and of Abelson murine leukemia virus (A-MuLV) were isolated from particle preparations by Nonidet P40 and ultrasonic treatment and purified by column chromatography on DEAE-cellulose and phosphocellulose, followed by centrifugation in linear sucrose gradients. Both DNA polymerases were very similar in their elution patterns from phospho and DEAE-cellulose, template specificities, requirements for optimum activity and inactivation by anti-(reverse transcriptase) antiserum. They are associated with ribonuclease H activity. For molecular weight determinations, antibody-precipitated enzymes were bound to staphylococcal-protein-A-Sepharose, solubilized and run on dodecylsulfate/polyacrylamide gels. Their apparent molecular weight was estimated to be 80000.

Intracisternal A particles from mouse plasma cell tumours were isolated from microsomal vesicles by detergent treatment and separated in linear sucrose gradients. Four peaks of DNA polymerase activities banding at densities of 1.30, 1.24, 1.20–1.22 and 1.13 g/cm3 were observed assaying on poly(rA) · oligo(dT). Solubolized DNA polymerases of the 1.30 g/cm3 fraction were eluted from phosphocellulose at salt concentrations around 0.30 M, 0.5 M and 0.65 M KCl. They could be distinguished by their different responses towards poly(rA) · oligo(dT), poly(rC) · oligo(dG) and poly(dA-dT). Serological experiments on the three DNA polymerases with antisera directed against Rauscher leukaemia virus reverse transcriptase showed that only enzymes responding to poly(rA) · oligo(dT) and poly(rC) · oligo(dG) could be inhibited.

A RNA-dependent DNA polymerase was isolated from a human cell line derived from the bone marrow of a patient with polycythemia vera. The purification procedure included chromatography on phosphocellulose and oligo(dT)-cellulose, and glycerol gradient centrifugation. The enzyme could be distinguished from polymerase A by salt elution from phosphocellulose, utilization of poly(rC) · oligo(dG) and its molecular size of about 70 000, as determined by centrifugation. Throughout the purification procedure ribonuclease H activity was co-purified. Upon dodecyl-sulfate-polyacrylamide electrophoresis on microgradient gels two main bands with molecular weights of 68 000 and 66 000 and three minor bands were detected. The enzyme preferentially used poly(rA) · oligo(dT) as template-primer compared with poly-(dA) · oligo(dT). It incorporated dGMP into polymer on poly(rC) · oligo(dG).

Thirteen monoclonal antibodies to human leukocyte interferon have been obtained. They exhibit different patterns of binding to purified leukocyte interferon species that are consistent with the structural multiplicity of the human leukocyte interferons. These antibodies will be useful as probes into the structure of the human leukocyte interferons, for their purification, and for rapid assay of leukocyte interferon.