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Negative symptoms in schizophrenia remain a clinical challenge with small effect sizes and evidence for pharmacological or psychotherapeutic treatment approaches. Studies suggest that electroconvulsive therapy (ECT) holds some promise as a treatment option of often persistent negative symptoms with clinically meaningful effects. This review summarizes the existing evidence on the efficacy of ECT on negative symptoms in patients with schizophrenia. Thirty-five publications were included in this literature review comprising 21 studies, two meta-analyses, eight reviews and four case reports. Conclusions should be interpreted cautiously, given the small number and methodological shortcomings of the included publications with a variation of study designs and missing standardized protocols. Implications for future research and practice are critically discussed. Recommendations are given to provide more evidence that will meet the clinical challenge of reducing the negative symptoms in schizophrenia. Study designs that focus explicitly on negative symptoms and assess patients over longer follow up periods could be helpful. Future research should include control groups, and possibly establish international multicentered studies to get a sufficient study population. Findings suggest that patients with schizophrenia resistant to pharmacological treatment might benefit from ECT. A risk and benefit assessment speaks in favour of the ECT treatment. Future practice of ECT should include a combination treatment with antipsychotics. Whereas the use of anaesthetics and electrode placement does not seem to play a role, the recommendation regarding frequency of ECT treatments is currently three times a week, For the assessment of negative symptoms the assessment tool should be chosen carefully.

ObjectivesGenome-Wide Association Studies (GWAS) of Schizophrenia (SCZ) have provided new biological insights; however, most cohorts are of European ancestry. As a result, derived polygenic risk scores (PRS) show decreased predictive power when applied to populations of different ancestries. We aimed to assess the feasibility of a large-scale data collection in Hanoi, Vietnam, contribute to international efforts to diversify ancestry in SCZ genetic research and examine the transferability of SCZ-PRS to individuals of Vietnamese Kinh ancestry.MethodsIn a pilot study, 368 individuals (including 190 SCZ cases) were recruited at the Hanoi Medical University’s associated psychiatric hospitals and outpatient facilities. Data collection included sociodemographic data, baseline clinical data, clinical interviews assessing symptom severity and genome-wide SNP genotyping. SCZ-PRS were generated using different training data sets: i) European, ii) East-Asian and iii) trans-ancestry GWAS summary statistics from the latest SCZ GWAS meta-analysis.ResultsSCZ-PRS significantly predicted case status in Vietnamese individuals using mixed-ancestry (R2 liability=4.9%, p=6.83*10−8), East-Asian (R2 liability=4.5%, p=2.73*10−7) and European (R2 liability=3.8%, p = 1.79*10−6) discovery samples.DiscussionOur results corroborate previous findings of reduced PRS predictive power across populations, highlighting the importance of ancestral diversity in GWA studies.

Two children from the same neighbourhood presented with concomitant granuloma annulare (GA) and intermediate uveitis (IU) at an interval of 2 weeks. A coincidence seemed unlikely, as IU is very rare in children and even more so in connection with GA. Thorough diagnosis was performed to exclude other associated diseases. No systemic disease, no special features of vaccination or medication, no history of infection, and no toxic cause could be found. An association between GA and IU based on other, as yet undiagnosed factors, is still possible. Therefore, when evaluating patients with newly diagnosed IU, clinical work-up should also include medical history and examination to rule out GA.

Glomerular permeability and subsequent albuminuria are early clinical markers for glomerular injury in hypertensive nephropathy. Albuminuria predicts mortality and cardiovascular morbidity. AT1 receptor blockers protect from albuminuria, cardiovascular morbidity and mortality. A blood pressure independent, molecular mechanism for angiotensin II (Ang II) dependent albuminuria has long been postulated. Albuminuria results from a defective glomerular filter. Nephrin is a major structural component of the glomerular slit diaphragm and its endocytosis is mediated by β-arrestin2. Ang II stimulation increases nephrin-β-arrestin2 binding, nephrin endocytosis and glomerular permeability in mice. This Ang II effect is mediated by AT1-receptors. AT1-receptor mutants identified G-protein signaling to be essential for this Ang II effect. Gαq knockdown and phospholipase C inhibition block Ang II mediated enhanced nephrin endocytosis. Nephrin Y1217 is the critical residue controlling nephrin binding to β-arrestin under Ang II stimulation. Nephrin Y1217 also mediates cytoskeletal anchoring to actin via nck2. Ang II stimulation decreases nephrin nck2 binding. We conclude that Ang II weakens the structural integrity of the slit diaphragm by increased nephrin endocytosis and decreased nephrin binding to nck2, which leads to increased glomerular permeability. This novel molecular mechanism of Ang II supports the use of AT1-receptor blockers to prevent albuminuria even in normotensives.

Ocular findings can be very typical for general disorders associated with rheumatological diseases. Of these ocular diseases, scleritis and uveitis are of particular significance. The present article discusses and attempts to solve the problems which can be seen when ocular inflammation is associated with rheumatological disorders. The identification of "uveitis" should not be sufficient to initiate diagnosis and therapy, but rather its localisation and, where possible, also its etiology should be known. These can usually be found with good clinical investigation and careful patient history. Only rarely are ocular and rheumatological inflammation active at the same time, as will be discussed later using HLA-B27-associated uveitis and juvenile idiopathic arthritis-associated uveitis as examples. It is important in the case of ocular inflammation that the indication for treatment be made by an ophthalmologist. Finally, the role of the rheumatologist in the treatment of this patient group will be described in detail.

Das klinische Bild der okularen Allergien ist typisch. Von der am haufigsten auftretenden Form, der saisonalen Konjunktivitis (Heuschnupfen), mussen v. a. die Keratokonjunktivitis atopica und die Keratokonjunktivitis vernalis, die beide einen schwerwiegenden Verlauf nehmen und zur Hornhautinfiltrationen fuhren konnen, abgegrenzt werden. Typisch fur alle diese Formen ist der Juckreiz. Okulare Allergien mussen konsequent therapiert werden, was mit den heute verfugbaren Medikamenten (Antihistaminika, Mastzellstabilisatoren, evtl. des Weiteren Glukokortikoide und Cyclosporin A) mit guter Prognose gelingen sollte.

Choroidal lymphoma is a rare disease and can be classified into primary and secondary choroidal lymphomas. Primary choroidal lymphoma is a low-grade extranodal marginal zone B-cell lymphoma and secondary choroidal lymphomas present ocular manifestations of disseminated systemic lymphomas. Typical clinical features of choroidal lymphoma are multifocal, yellow-whitish choroidal infiltrates. The vitreous body is usually clear and cell-free. Choroidal lymphoma has a tendency to extend through the sclera. In contrast to primary choroidal lymphoma, which is more often unilateral, does not show signs of anterior segment involvement and has a slow progression, secondary choroidal lymphoma is more often bilateral, has a rapidly progressive course with anterior segment and vitreous involvement and belongs to the high-grade lymphomas. The definitive diagnosis of choroidal lymphoma can only be confirmed by histopathological examination of biopsy tissue. The choroidal biopsy is the gold standard in the diagnostics of choroidal lymphoma. To date, no standardized treatment for choroidal lymphoma has been established. The treatment modalities include external beam radiotherapy, immunotherapy with rituximab and chemotherapy. The prognosis for survival of primary choroidal lymphoma is usually good. The prognosis of secondary choroidal lymphoma depends on the malignancy grade of systemic lymphoma.

Fuchs uveitis syndrome (FUS) is typically a unilateral, chronic, low-grade inflammation of the anterior segment which manifests in young adulthood. It is underdiagnosed because of its variable clinical spectrum. Although it can mimic various forms of anterior uveitis, it is important to make the correct diagnosis, based on clinical grounds, because both the management and prognosis differ from those of other uveitides. While its etiology remains unknown, it is possible that the disease has multiple causes that lead through different pathogenic mechanisms to the same clinical entity. Although many patients do not require treatment, it is not a benign condition, as often perceived. The high incidence of glaucoma makes it mandatory that all patients with FUS should be screened at regular intervals, even if they are not being actively treated and are relatively asymptomatic.

Immunosuppressive treatment has shown to be effective in various ocular inflammatory disorders. Factors limiting their use are the individual response and the rate of side effects. This report summarizes our knowledge about the use of mycophenolate mofetil (MMF) in the treatment of ocular cicatricial pemphigoid (OCP), uveitis, atopic keratoconjunctivitis (AKC), prevention of graft rejection after penetrating keratoplasty (PK) and scleritis. Controlled studies have been performed for prevention of graft rejection after PK, showing MMF as effective in the prevention of graft rejection as cyclosporine A. In experimental uveitis, MMF has been demonstrated to be highly effective in prevention of retinal destruction. A number of studies have now shown that MMF also seems effective in uveitis. There are also studies with smaller patient groups which point out the effectiveness of MMF in OCP, AKC, and scleritis. In most of the studies, the spectrum of side effects was small, compared to other immunosuppressives.

Die Halfte aller Rosazeapatienten leidet unter einer Augenbeteiligung. Die Augenbeschwerden sind oft unspezifisch. Der Augenbefund stellt meist eine Blepharokonjunktivitis mit nachfolgendem trockenem Auge dar, und nur selten kann eine Rosazeakeratitis zu einem Hornhautulkus fuhren, das dann eine dringende ophthalmologische Vorstellung erfordert. Eine topische Therapie mit konservierungsmittelfreien Tranenersatzmitteln und Lidrandhygiene wird primar zur Behandlung der Ophthalmorosazea empfohlen. Sekundar sind systemische Medikamente, abhangig vom Schweregrad des ophthalmologischen und dermatologischen Befundes, indiziert.

The electronic structure of trans-1-naphthol solvated with H2O, Ar and N2 was investigated using multiphoton ionization spectroscopy and spectral hole burning. The hole burning spectra aided in the identification of several new intermolecular vibrations in the cluster with one water molecule, and showed that in the REMPI spectrum of the cluster with a single Ar only one isomer was present. Several low-frequency vibrational bands were observed and assigned. The red-shifts of the S1 ← S0 transition are surprisingly different from those measured for phenol and 2-naphthol clusters. The experiments were supported by electronic structure calculations, yielding geometries and binding energies of the clusters. The results obtained for the 1-naphthol/N2 cluster were particularly surprising. Computations indicate a π-bound structure that is more stable than the H-bound structure. The experimentally observed small red-shift upon excitation seems to support this picture.

We report results on the photodissociation dynamics of the tert-butyl radical, C4H9. A beam of internally cold radicals is generated by supersonic jet flash pyrolysis of azo-t-butane. Upon optical excitation, the radical dissociates into 2-methylpropene (iso-butene) and a hydrogen atom that is detected by time-resolved photoionization. By varying the excitation wavelength between 355 and 266 nm, unimolecular dissociation rates are obtained as a function of excitation energy. Whereas at low excitation energies, the rates are on the order of 108 s-1, in agreement with simple RRKM calculations. However, the reaction slows down at excitation wavelengths shorter than 329 nm. The data are discussed in light of previous results on the ethyl radical.

The trans -1-naphthol/H 2 O cluster was investigated by [1 + 1] resonantly enhanced multiphoton ionization and by [1+1 ′ ] zero kinetic energy photoelectron (ZEKE-) spectroscopy. In the electronically excited state of the cluster a bending vibration of 57 cm −1 appears with considerable intensity and is also present in combination with several intramolecular bands. Some other intermolecular vibrations in the electronically excited S 1 state are tentatively assigned. The ZEKE-spectrum reveals a progression in the intermolecular stretch with a harmonic frequency of 190.5 cm −1 . An ionization energy of 59133 cm −1 was determined from the ZEKE-spectrum.

Behçet's disease (BD) is a multisystemic inflammatory disorder. Although the cause and pathogenesis of BD are still unclear, there is evidence for genetic, immunologic and infectious factors at the onset or in the course of BD. This review focuses on the functional genomics and immunology of BD. HLA-B51 is the major disease susceptibility gene locus in BD. An increased number of gammadelta T cells in the peripheral blood and in the involved tissues have been reported. However, the T cells at the sites of inflammation appear to be a phenotypically distinct subset. There is also a significant gammadelta T cell proliferative response to mycobacterial 65-kDa heat shock protein peptides. Homologous peptides derived from the human 60-kDa heat shock protein were observed in BD patients. There is evidence that natural killer T cells may also play a role in BD.

Intermediate uveitis is a form of intraocular inflammation in which the vitreous body is the major site of inflammation. Intermediate uveitis is primarily treated medicinally and systemic corticosteroids are the mainstay of therapy. When recurrence of uveitis or side effects occur during corticosteroid therapy an immunosuppressive treatment is required. Cyclosporine A is the only immunosuppressive agent that is approved for therapy of uveitis in Germany; however, other immunosuppressive drugs have also been shown to be effective and well-tolerated in patients with intermediate uveitis. In severe therapy-refractory cases when conventional immunosuppressive therapy has failed, biologics can be used. In patients with unilateral uveitis or when the systemic therapy is contraindicated because of side effects, an intravitreal steroid treatment can be carried out. In certain cases a vitrectomy may be used.

An efficient control of chemical waves is desirable in various fields of science and engineering. We present a novel method to control the motion of the spiral tip using an electric field perpendicular to the plane of wave propagation. An alternating field may lead to complex spatio-temporal patterns. Shown in the picture is an example of the destabilising effect of an alternating electric field, in which the wavefront displays fluctuating wrinkles.

With an incidence of 2.5 - 5/100 000 persons, uveitis in childhood can be associated with various disorders. Anterior uveitis is mostly associated with juvenile idiopathic arthritis (JIA), most often with oligoarthritis, for which antinuclear antibodies are detectable in ca. 70 %, but is also not uncommonly found in seronegative polyarthritis. This report gives an update about the various forms of uveitis associated with JIA, with the major emphasis on the differentiation of the various forms and therapy. While the prognosis in ca. 25 % of all JIA-associated uveitis patients who develop a severe course, has been poor in the past, the more rapid induction of immunosuppressives has improved the prognosis by reducing the complications. It seems that patients who were previously termed “therapy-refractive” are now responding in a high percentage to TNF-alpha blocking agents, especially to Infliximab and Adalimumab. In additional, the adequate control period, depending on the underlying disorder, is presented.

Half of patients with rosacea develop ocular involvement. The complaints are often nonspecific. The most common ocular manifestation is blepharoconjunctivitis with dry eye, while on rare occasion rosacea keratitis can lead to corneal ulcer, which then requires urgent ophthalmologic consultation. Topical therapy with preservative-free artificial lubricants and lid hygiene is recommended for the primary treatment of ocular rosacea. Secondarily, systemic medications are indicated depending on severity of the ocular and skin findings.

This presentation will summarize how the DUAG (Deutsche Uveitis Arbeitsgemienschaft) was founded and developed. The reasons for the group, having an umbrella position over the local patient groups, will become explained, and how this concept may become adapted to other ocular diseases.

Uveitis due to Behçet's disease belongs to those types of intraocular inflammation with a poor visual prognosis. Despite early treatment with corticosteroids and immunosuppressants, patients often become blind. With the so-called biologicals, highly effective drugs are now available which very rapidly lead to quiescence of intraocular inflammation and which successfully avoid further uveitis relapse. Recently, an interdisciplinary group of experts on behalf of the EULAR developed nine recommendations for the treatment of Behçet's disease. Two of these address ocular involvement. Compared with TNF alpha antagonists, interferon alpha offers the advantage that even after cessation of treatment a high percentage of patients remain in remission. This article provides an overview on current medical treatment of ocular Behçet's disease.

Purpose To summarize the clinical signs of virus-induced anterior uveitis and to compare our understanding with the results of a Symposium recently hold in Berlin, comparing proven to unproven cases of herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (clinically like Posner-Schlosman Syndrome), and rubella virus (clinically the picture of Fuchs heterochromic uveitis). Methods Presentation of typical signs and symptoms of anterior uveitis which may be viral induced. This will include secondary glaucoma, keratitis, iris color changes, synechiae, complications like cataract and macular edema. Results Typically viral induced anterior uveitis only sometimes leads to posterior synechiae (HSV, VZV), mostly to a mild anterior chamber inflammation, and very rarely to macular edema Conclusion We plan a worldwide prospective trial for reaching more information about the role of virus in anterior uveitis, with tap of the anterior chamber and evaluation of the antigen and the antibody response.

Interferon alpha (IFN-α) and interferon beta (IFN-β) are naturally occurring cytokines, which belong to the type I interferons and share the same receptor leading to very similar therapeutic effects. The immunomodulatory effect of type I interferons includes modulation of antibody production, inhibition of lymphocyte proliferation, inhibition of delayed-type hypersensitivity and enhancement of T-cell and NK-cell cytotoxicity. An increasing number of open clinical studies and case reports have demonstrated the efficacy of IFN-α for severe ocular inflammation in patients with Behçet's disease and of interferon-β, which has been used mainly for the treatment of multiple sclerosis.

Glaucoma and corneal disorders are often associated and are of diagnostic, therapeutic and prognostic relevance for each other. Glaucoma is already present in approximately 15% of eyes prior to keratoplasty, whereas in addition approximately 15% of cases are diagnosed following corneal transplantation. Corneal opacities, surface irregularities and pachymetric deviations from the norm can have a negative impact on tonometry, perimetry and morphological glaucoma diagnosis. Digital and intracameral tonometry as well as flash VEP to determine the visual potential can be helpful in this setting. Increased intraocular pressure (IOP), long-term application of antiglaucomatous medication or the use of antimetabolites in glaucoma surgery can all induce keratopathy. Therefore, intraocular pressure should be regulated prior to corneal transplantation. Risk factors for the evolution of glaucoma following corneal transplantation are the specific indication and surgical technique (e. g. combined corneal and cataract/vitreoretinal surgery), as well as postoperative steroid application and chamber angle synechiae. Unpreserved glaucoma medication without pro-inflammatory effects should be preferred following keratoplasty. In the long term surgery to control IOP is required in approximately 25% of eyes. The wider use of lamellar techniques for corneal transplantation is likely to reduce the incidence of secondary glaucoma.

In the therapeutic approach to complex glaucomas different initial situations were considered: pre-existing glaucoma, induction of glaucoma after vitreoretinal surgery and antiglaucomatous procedures. In pre-existing glaucoma and after filtering surgery maintenance of the filtering bleb requires a vitreoretinal approach for conjunctiva preservation with techniques such as pneumatic retinopexy or small gauge vitrectomy. After vitreoretinal surgery an increase in intraocular pressure (IOP) is common. Secondary glaucoma may occur after scleral buckling and after vitrectomy with or without gas or silicone oil tamponade as well as after application of steroids. Angle closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Vitreous tamponades with expansive or saturated gases may cause angle-closure glaucoma with or without pupillary blockage and may critically shorten ocular perfusion. Postoperative checks, immediate action and a ban on boarding aircraft over the period of intraocular gas tamponade prevent permanent damage to the eye. The majority of secondary glaucomas can effectively be controlled by topical medication and adequate postoperative posture of the patient. Besides the temporary use of systemic antiglaucomatous medication or laser therapy, very rarely in cases of massive swelling or overfill, a direct intervention, such as partial gas or silicone oil removal is required. A prophylactic inferior peripheral iridectomy prevents pupillary blockage in aphakic eyes with intraocular tamponade. In cases of heavy silicone oil use, the peripheral iridectomy is placed in the superior position. Nd:YAG laser application will regulate IOP in cases of occlusion. Secondary glaucoma due to silicone oil emulsification overload is treated by trabecular meshwork aspiration and lavage. In refractory glaucoma repetitive cyclophotocoagulation and drainage implants represent an approved method for long-term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial in nature and may benefit from an exact analysis for an adequate and successful treatment regimen.

Secondary glaucoma represents a frequent complication especially in chronic forms of uveitis. Different immunological and mechanical alterations can be responsible for the elevation of intraocular pressure (IOP). To enable a tailored treatment strategy the diagnostic process has to include the search for characteristic findings which can be indicative for the underlying uveitis entity. Sometimes it can be difficult to distinguish inflammatory glaucoma from primary non-inflammatory forms of glaucoma as well as from steroid-induced elevation of IOP. Treatment of secondary glaucoma due to uveitis has to include not only medicinal and surgical lowering of IOP but also control of the inflammation, e.g. by immunosuppressive or antiviral drugs. Under normal conditions, beta-receptor antagonists and carbonic anhydrase inhibitors will represent first-line topical treatment. Besides cyclodestructive and filtrating procedures, the use of drainage implants has gained importance in the surgical treatment of secondary glaucoma due to intraocular inflammation.

In einer Ubersicht wird auf die diversen Interaktionen von Auge, Korper und Tumor eingegangen. Besondere Berucksichtigung finden dabei paraneoplastische okulare Neuropathien, tumorbedingte Veranderungen des Immunsystems und die Metastasierung vom und zum Auge. Die Problematik der Zweittumorentwicklung wird angesprochen. A review of the different interactions between eye, body and tumor is given. Special regard is put on paraneoplastic ocular neuropathies, tumor-induced changes of the immune system and metastases. The problem of developing second tumors is discussed.

Objective. To report the successful treatment with recombinant human IFN- 2a (rhIFN-2a) in two male adolescents suffering from severe treatment-resistant Behcet's disease (BD) with central nervous system (CNS) involvement. Methods. The patients were 14- and 15-yrs old. Both met the International Study Group for Behcet's disease, O'Duffy and the Japanese criteria for the classification or diagnosis of BD. Signs of CNS involvement were impaired sensorimotor function of the left arm, hemiparesis of right arm and leg, dizziness and walking instability in Patient 1, weakness of both legs, impaired bladder-, bowel- and sexual function in Patient 2 and vasculitic lesions on cranial MRI in both patients. RhIFN-2a was administered initially at 3 million IU/day for 4 weeks followed by 33 million IU/week. Results. Complete remission was achieved in Patient 1 (reduction in BD activity score from 17 to 2). Patient 2 experienced remarkable improvement (reduction of BD activity score from 23 to 15). In both patients the MRI lesions improved. Patient 2 had mild flu-like symptoms as adverse effect. Conclusion. RhIFN-2a was effective and well tolerated in these juvenile patients with severe neurological BD. Regarding the serious consequences following ocular and CNS affection and adverse effects of steroid dependency, administration of rhIFN-2a at an earlier time point needs to be considered.

Systemic and topical corticosteroids constitute an important part in the treatment of children with uveitis, because of their rapid therapeutic onset. Patients with anterior uveitis receive eye drops initially every 30 minutes or every hour. Children will experience the same side effects as adults but, in addition, there will be a growth retardation. Therefore, if treatment is required for extended periods of time it is important to avoid steroid quantities above the Cushing level and to initiate an additional systemic immunosuppressive treatment regimen early.

Chronic uveitis in childhood is a common complication of juvenile idiopathic arthritis (JIA) that frequently leads to loss of vision. Besides from corticosteroids and immunosuppressive drugs, Tumour necrosis factor-alpha (TNF-alpha) inhibitors are used frequently.The literature published before September 2006 was evaluated for the usefulness of TNF-alpha inhibitors (etanercept, infliximab, adalimumab) for the treatment of JIA-associated uveitis.TNF-alpha inhibitors are effective drugs for the treatment of chronic uveitis in childhood. The response rate of uveitis in childhood to etanercept was approximately 50%. However, disease recurrence, first manifestations of uveitis and new complications occurred during the treatment. Infliximab and adalimumab appear to be more effective for the treatment of uveitis in childhood than etanercept.The therapy with TNF-alpha inhibitors is expensive and increases the long-term risk for secondary diseases, such as tuberculosis and probably malignant lymphoma. Their use should be restricted to uveitis patients not responding to corticosteroids and at least one of established immunosuppressive drugs.

The best experience in the use of DMARDs/immunosuppressive drugs for treatment of juvenile idiopathic arthritis (JIA) and JIA-associated uveitis has been obtained with MTX. Controlled studies on the treatment of uveitis in JIA, however, are still lacking; this is also true for other DMARDs/immunosuppressive drugs. Thus, the grading of the evidence level for these substances only reaches evidence level III (expert opinion, clinical experience or descriptive studies). For the treatment of uveitis in JIA the utility of MTX in comparison to the new biological substance classes (e. g., tumor necrosis factor-alpha, blockers, interleukin-1 receptor antagonist) will have to be examined. Experience with Mycophenolate mofetil (MMF) in JIA uveitis is limited to single cases. According to data from a retrospective analysis cyclosporin A (CsA) appears to have a limited efficacy in JIA uveitis. The results with azathioprine are not consistent. Controlled studies which led to the approval of drugs for JIA are also mandatory for uveitis to offer the most effective and safe therapy for children.

Intraocular inflammation in children differs considerably from that found in adults. Therefore the diagnostic work-up has to be adapted to the age and specific diseases.The published literature was reviewed for results of clinical trials and consensus meetings. In addition, the authors have incorporated their own experience.Recommendations for a systematic and complete diagnostic work-up are given using tables where possible.A close cooperation between ophthalmologists and paediatricians is very important.

Scleromalacia usually appears following vasculitis in systemic rheumatoid diseases, especially as a late symptom of rheumatoid arthritis.A 67-year-old woman was referred to our hospital for further evaluation with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago she had suffered from herpes zoster ophthalmicus-associated keratouveitis and trabeculitis in the same eye. Scleromalacia associated with varicella-zoster virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of the eye was completed and a systemic disease had been ruled out. One week after beginning systemic application of acyclovir (5 x 800 mg daily) and prednisolone (30 mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to appear in the atrophic scleral area.Although scleral atrophy mostly appears as a late sign of systemic rheumatoid diseases, it might also develop secondary to infectious diseases. Scleromalacia associated with varicella-zoster virus has been previously described only in a few cases. Scleromalacia is a vision-threatening complication of zoster ophthalmicus which responds well to combination therapy with systemic antiviral and anti-inflammatory agents.

The prevalence of glaucoma in patients with intra- or extraocular inflammation is five to twenty percent. The etiopathogenesis is manifold, including classical secondary open and closed angle mechanisms as well as specific inflammatory elements. Diagnosis and follow-up studies of inflammatory glaucomas are often difficult. The therapeutic options are limited or are poorly evaluated. The development of a secondary glaucoma is a severe complication of intra- or extraocular inflammation and may even lead to blindness. Further investigations, especially with regard to the treatment of inflammatory glaucomas, are necessary to improve the prognosis.

Mucous membrane pemphigoid (MMP) is often accompanied with a chronic cicatrizing conjunctivitis that may eventually lead to loss of vision. The study is intended to investigate the current scientific knowledge on the diagnosis of and therapy for MMP involving the eye. Previous studies published before December 2004 have been systematically reviewed for their level of evidence. Consequently, recommendations for patient management are provided.

Fuchs uveitis syndrome (FUS) is typically a unilateral, chronic, low-grade inflammation of the anterior segment which manifests in young adulthood. It is underdiagnosed because of its variable clinical spectrum. Although it can mimic various forms of anterior uveitis, it is important to make the correct diagnosis, based on clinical grounds, because both the management and prognosis differ from those of other uveitides. While its etiology remains unknown, it is possible that the disease has multiple causes that lead through different pathogenic mechanisms to the same clinical entity. Although many patients do not require treatment, it is not a benign condition, as often perceived. The high incidence of glaucoma makes it mandatory that all patients with FUS should be screened at regular intervals, even if they are not being actively treated and are relatively asymptomatic.