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Bacterial infections can affect all structures of the eye. In most cases, infections of the ocular surface are treatable with topical antibiotics, whereas intraocular infections need a combined treatment with intraocular and systemic antibiotics. Localisation, severity, expected microorganisms, and possible consequences of the infection lead to the appropriate therapy. Unwarranted use of antibiotic substances for prophylaxis or treatment of nonbacterial infection should be avoided, especially because of possible selection of multiresistant microorganisms.

Diagnosis of fungal keratitis is only straightforward if it presents in its typical form with pyramidal-shaped hypopyon, prominent geographical corneal infiltration and satellites. However, in contact-lens wearers clinical presentation is untypical at early infection. Corneal debridement is therefore necessary, which simultaneously facilitates penetration of the antimycotic into the corneal stroma. At present, voriconazole is the medication of choice, if not changed after microbiological diagnosis to a specifically more potent substance - e.g. posaconazole or caspofungin. Amphotericin B may be used for repeated intracameral or intravitreal injection. Simultaneous application of steroids is useful.

BACKGROUND: Contact allergies (CA) against active agents of topical ophthalmological therapeutics, causing inflammation of the conjunctiva and/or the lid, are usually not life-threatening, but occur not infrequently. As yet, the assessment of the CA-eliciting risk has been based on clinical data alone, while a valid epidemiological risk assessment is lacking. MATERIALS AND METHODS: The Information Network of Departments of Dermatology supplied information on diagnostic results obtained in 4,102 patients patch-tested for suspected CA to ophthalmic drugs between 1995 and 2004. Clinical prevalences were extrapolated to incidences at the German population level. These estimates served as numerator for a relative incidence (RI), which included the nationwide frequency of prescriptions collected by the WIdO, Bonn, in terms of a standardised defined daily dose (DDD) as denominator. RESULTS: The estimated annual incidence of CA ranges from 155 (atropine sulphate) to 2077 (gentamicin sulphate) and can thus be regarded as moderate. If incidence estimates are related to prescription frequencies, the highest risk was found for kanamycin and neomycin sulphate (RI > 8 / 100,000 DDD). In contrast, the RI of pilocarpine-HCl (0.3) was virtually negligible. CONCLUSIONS: The substance-specific risk of CA has been evaluated for the first time and found to differ between therapeutics (with a similar spectrum of application). CA risk should be considered in differential therapeutic decision-making.

A 24-year-old woman had been in full remission of an acute myeloid leukaemia since 1988, but she required regular erythrocyte and platelet transfusions for pancytopenia. To counteract a progressive siderophilia due to the transfusions (ferritin levels of about 10,000 ng/ml) deferoxamine was intermittently given intravenously (5 g after each transfusion). Seven months after the start of this treatment the patient was hospitalized because of severe left-sided facial pain as well as reddening and swelling in the periorbital region. As maxillary and frontal sinusitis was suspected, antibiotics were administered (at first three times daily 2.2 g amoxicillin and clavulanic acid, then two times daily 300 mg rifampicin and 200 mg ciprofloxacin). Nonetheless, orbital phlegmon developed within a few days with protrusion and blindness of the left eye necessitating a decompression operation. Material obtained at operation revealed rhinocerebral mucormycosis. After 3 weeks of antimycotic treatment with both amphotericin B (1 mg/kg.d) and flucytosine (150 mg/kg.d) the mucormycosis healed without the necessity of extensive and disfiguring removal of necrotic tissue. But the blindness in the left eye, caused by occlusion of the central artery, was irreversible.

In this short review, new data on the taxonomy of Chlamydia and the association of these pathogens with various ocular diseases are presented. Clinical diagnosis and laboratory tests for ocular C. trachomatis infection are discussed. The actual therapy consists in oral azithromycin.

Mycotic keratitis is a comparatively rare but serious ophthalmological disease, that can possibly lead to a severe loss of vision up to blindness. Over the last two decades an increase of cases with mycotic keratitis has been noticed, which is possibly caused by an increased use of soft contact lenses. This article gives an overview of the typical clinical signs and symptoms of keratomycosis, tried and tested diagnostics and therapy as well as new diagnostic and therapeutic developments and findings.

Gezielte Anamneseerhebung und Spaltlampenmikroskopie erlauben in aller Regel die Diagnose einer Akanthamobenkeratitis bereits im Fruhstadium. In Zweifelsfallen konnen konfokale Mikroskopie, mikrobiologische und histopathologische Untersuchungen zur Sicherung der Diagnose beitragen. Mit konservativen Masnahmen (lokale Kombinationstherapie mit Aminoglykosiden, Polyhexamethylenbiguanid 0,02 %, Propamidinisoethionat 0,1 %) kann im Fruhstadium eine vollstandige Visusrehabilitierung erreicht werden. Im Spatstadium ist jedoch eine perforierende Keratoplastik oft unumganglich. An early diagnosis of an acanthamoeba keratitis can usually be made on the basis of the patient’s history and slit-lamp examination. Further helpful diagnostic steps are confocal microscopy, microbiological, and histopathological examination. In the early stages topical application of antimicrobials (combined application of aminoglycosides, polyhexamethylene biguanide 0.02 %, propamidine isoethionate 0.1 %) is effective. In the late stages a penetrating keratoplasty is often necessary.

After preoperative conjunctival and periorbital antisepsis with povidone-iodine (PVP-I), the systemic absorption of iodine after cataract surgery was measured to evaluate the risk of thyroid side effects. Five different combinations of PVP-I alone or in combination with PVP-I-free antiseptics were applied to the conjunctiva and periorbital skin. An iodine-free product served as control. Iodide and creatinine in urine were analyzed before intervention and 24 and 48 h postoperatively. Depending on the concentration and application site, 0.3–4.5% of the total applied iodine or 3.6–45.4% of the free iodine were absorbed. The range of urine iodine excretion was between 11.7 and 71.0 µg iodine/g creatinine, depending on the PVP-I concentration and the site of application. The increase in iodine excretion was significant at 24 h postoperatively in trials receiving PVP-I both periorbitally and conjunctivally, depending of the concentration used. Because the iodine absorption is only slight and of doubtful clinical relevance, presurgical conjunctival antisepsis can be achieved with 1.25% PVP-I; so far clinically manifest anamnestic thyroid disorders are excluded. Presently, periorbital skin antisepsis with PVP-I cannot be recommended until data on thyroid metabolism in the population have been collected and evaluated, especially in a region currently or previously deficient in iodine.

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.

In this review ophthalmological diseases caused by herpes simplex virus, varicella zoster virus, Epstein-Barr virus, cytomegaly virus or adenovirus are described briefly. The main therapeutic options are discussed placingemphasis especially on prospective randomised trials.

Das wichtigste Dokumentationsobjekt in der klinischen Medizin ist die Patientenakte in papiergebundener oder elektronischer Form. Die elektronische Patientenakte (EPA) besitzt im Vergleich zur Papierkrankenakte (PKA) viele Vorteile. Am Beispiel der Universitatsaugenklinik Magdeburg wird der Einsatz einer elektronischen Patientenakte mit klinikumsweiter Kommunikation dargestellt. Um eine klinikumsweite Bild- und Befunddokumentation, z. B. mit der Radiologie und Pathologie, zu gewahrleisten, wird das System der Fa. MEDOS an der Universitatsaugenklinik Magdeburg verwendet. Verschiedene Untersuchungsgerate, wie z. B. Funduskamera, Spaltlampe und Ultraschall, sind mit der Moglichkeit der Bildspeicherung und -ubergabe uber eine DICOM-Schnittstelle an das „MEDOS“-System ausgestattet. Fur die Bildubergabe wird die Software „AnalySIS“ als Gateway benutzt. Das System MEDOS unterstutzt ebenfalls den Workflow in der Klinik. Der Einsatz einer elektronischen Patientenakte in einer Augenklinik ist heute bereits moglich. Allerdings befindet sich diese Entwicklung erst am Anfang und bedarf noch vieler Optimierungen.

Twenty patients with dendritic keratitis were treated in a double-blind analysis study with either phosphonoformate 3% or trifluorthymidine 1% drops. Nineteen cases were virologically confirmed. Follow-up was performed until closure of the corneal lesion was registered and a pair comparison between both substances was made. Healing time was longer for phosphonoformate (7.16 days) than for trifluorthymidine (5.83 days). There was no significant difference between phosphonoformate and trifluorthymidine. One drug failure was registered in each series. No side effects were observed.

Zusammenfassung: Kammerwasser von Kaninchen stimuliert das filamentose Wachstum von Candida albicans in stammabhangiger Weise. Die Zugabe von Kammerwasser zu Blastosporen des Stammes DSM 70010 in Nahrbouillon und Inkubation bei 37°C fur 18–24 h fuhrt ebenso zur Filamentbildung wie die Inkubation der Blastosporen mit Blutse-rum. Bei Stamm CBS 2730 ergibt nur Serum Filamentwachstum, nicht aber Kammerwasser. Falls im Verlauf einer Candida-Keratitis die Descement'sche Membran durchwachsen wird, konnte die Filamentstimulation durch Kammerwasser klinische Relevanz erlangen. Summary: Aqueous humor of rabbit eyes stimulates the filamentous growth of Candida albicans in a strain-dependent manner. Addition of aqueous humor to blastospores of strain DSM 70010 in nutrient broth and incubation at 37°C for 18–24 h yields filaments which are comparable to filaments after incubation of blastospores with blood serum. In strain CBS 2730 serum promotes the formation of filaments but not aqueous humor. If in the course of Candida keratitis the fungus penetrates Descement's membrane, the filamentation in aqueous humor may influence the outcome of the mycosis.

The prophylactic use of topical anti-infectives is indicated on the eye (1) prior to any surgery on the eye, by periorbital and conjunctival administration and, if required, intraoperatively as well; (2) in the form of the Credé prophylaxis against ophthalmia neonatorum; (3) with accidental pathogenic contamination of the eye; (4) to prevent conjunctivitis by intensive care surgical patients; (5) for the antiseptic irrigation of donor bulbi prior to keratoplasty, and (6) if required, to prevent ocular infection in a given epidemiological situation. The drug of first choice is polyvinylpyrrolidone-iodine at a concentration ranging from 1.5 to 5%. Another topical anti-infective is a 0.02 or 0.01% solution of polyhexanide, a promising medication, currently in the process of being approved.

In recent years, liposomes have been increasingly explored as novel drug delivery systems, and several liposome-based drug products have been approved in Europe, the USA and Japan. Depending on size, composition and surface characteristics, liposomes interact sepcifically with biological structures. Liposomal drug products provide a topical activity at the desired locus of action and are deemed more effective and less toxic than conventional drug formulations. The combination of povidone-iodine (PVP-I) and liposomes unites the exceptional microbicidal activity of the antiseptic substance with the excellent tolerability and lack of immunogenicity of liposomes; in addition, liposomes provide a moist molecular film for the wound environment. The multilamellar vesicles act as microreservoirs hence prolonging the release of the active ingredient. Although no commercial product for repeated application on the eye is currently available, PVP-I has been used in ophthalmology not only for pre- and postoperative antisepsis, but also for the treatment of bacterial and viral conjunctivitis and for prophylaxis against ophthalmia neonatorum. For these indications, liposomal formulations with 2.5 and 5.0% PVP-I were developed. These eye drops are isotonic with tear fluid at pH 6. First in vitro tests demonstrated an excellent antimicrobial efficacy, and a placebo-controlled clinical study on volunteers showed a very good local tolerability. A study on rabbits demonstrated positive results of the PVP-I liposome eye drops compared to placebo and the broad-spectrum antibiotic Polyspectran in a standardized model of Staphylococcus aureus deep eye infection. The other aim is a well-tolerated liposomal PVP-I hydrogel for improved antiseptic wound treatment with moisturizer. It has been reported that liposomes are enriched at the wound bottom for direct action against infection and support of wound healing. An animal study on the efficacy and tolerability of different formulations of a hydrogel with PVP-I liposomes in deep dermal burn wounds has indicated an outstanding quality of wound healing with smooth granulation tissue, less inflammation, less wound contraction and no hyperkeratotic reactivity, especially with the 3% PVP-I liposome formulation.

Postoperative endophthalmitis often leads to a substantial loss of vision and sometimes to loss of the eye. Occasionally this results in legal disputes during which medical studies will be consulted for reaching a verdict. Both the European Society of Cataract and Refractive Surgeons (ESCRS) study on prophylaxis and the Early Vitrectomy study on the therapy of postoperative endophthalmitis suffer from substantial deficits in essential areas. These studies cannot therefore be utilized as standard operating procedures and guidelines as well as in legal disputes.

To report a series of 3 patients with soft contact lens-related Fusarium keratitis. Two of them were treated with the antiamoebic polyhexamethylene biguanide 0.02% (PHMB) in combination with antifungal drugs, and 1 patient was treated with PHMB as sole antifungal regimen.Chart review of 3 patients treated with PHMB in Fusarium keratitis. Two of them were refractory to the commonly used therapy. The antifungal power of PHMB and propamidine isethionate was tested against the patients' isolates as well as against the clinical isolates from another 9 patients with ocular mould infections.An excellent outcome could be achieved in 2 patients with Fusarium solani keratitis refractory to common antifungal treatment by the additional use of PHMB 0.02%. In another patient PHMB alone was sufficient to resolve Fusarium proliferatum infection. The drug was well tolerated. In all patients repeated abrasion was done for better penetration of the drugs. PHMB revealed a marked in vitro antifungal activity for the three Fusarium isolates as well as for another 9 isolates of ocular infections from other patients including also the genera Scedosporium, Aspergillus and Rhizopus giving minimal inhibitory concentrations ranging from 1.56 to 3.12 µg/ml.Fusarium keratitis is a severe ocular infection. We report on the use of PHMB in 3 patients given additionally or as sole antifungal drug. We emphasize the benefit of PHMB 0.02% in Fusarium keratitis which might be considered as a therapeutic option especially in cases refractory to common antifungal therapy and possibly in keratitis due to other fungi.

Giant cell arteritis can cause diagnostic difficulties due to its heterogeneous symptomatology. Characteristic ophthalmic and systemic symptoms of Horton's disease are discussed. The clinical course is described on the basis of typical patients, which shows that generic symptoms do not have to coexist. The Horton's arteritis potentially represents a systemic vasculitis that requires early diagnosis and treatment in order to avoid dramatic ophthalmic consequences, in worst cases blindness. The erythrocyte sedimentation rate (ESR) represents the most important laboratory parameter. Although temporal artery biopsy remains the only confirmatory procedure for a definite diagnosis, imaging procedures such as sonography, magnetic resonance imaging, ultrasound biomicroscopy are useful in supporting the clinical diagnosis. Highly dosed corticosteroid therapy should always be indicated when suspicious clinical symptoms are present, even without any dramatic laboratory parameter changes. Initial high dosages are indicated up to 1 gram daily depending on the severity of the disease. Subsequently a slow ESR titrated reduction of the dose is necessary under control of inflammation values, symptomatology and side effects. Occasionally a lifelong immunsuppressive therapy is indispensable. The long-term treatment should take place in close cooperation with the general practitioner, rheumatologist, neurologist and if necessary further specialists.

To test the efficiency of antimicrobial substances on bacterial conjunctivitis under standardized conditions a reproducible model is needed. As there are no data in the literature concerning this topi

Hintergrund: Eine wichtige Differenzialdiagnose des akuten Exophthalmus ist die Carotis-Sinus-Cavernosus-Fistel. Diese erworbene Gefasanomalie zeigt ein vielfaltiges Erscheinungsbild, was die Diagnosefindung oft erschwert. Carotis-Sinus-Cavernosus-Fisteln konnen neben einem ausgepragten Visusverlust auch weitreichende intracerebrale Komplikationen verursachen. Methode: Anhand einer Falldarstellung einer 77-jahrigen Patientin werden Diagnostik, Therapie und Verlauf des Krankheitsbildes der Carotis-Sinus-Cavernosus-Fistel erlautert. Ergebnisse: Die Patientin stellte sich in unserer Klinik mit einer seit einer Woche bestehenden ausgepragten, zunehmenden Rotung und Schwellung beider Augen vor. Weiter bestand ein beidseitiger Visusabfall auf rechts 1/6 und links 0,6 (korrigiert) sowie Tensionsanstieg. Zusatzlich gab sie erhebliche Kopfschmerzen und Drehschwindel seit mehreren Wochen an. Anamnestisch war ein Sturz mit Schadelbasisfraktur eruierbar. Der Vorderabschnittsbefund ergab beidseits einen deutlichen Exophthalmus mit Chemosis der Bindehaut und Stauung der episkleralen Gefase. Der Fundus zeigte keine Auffalligkeiten. Diagnostisch wegweisend waren das am Kopf auskultierbare Stromungsgerausch sowie die MRT-Untersuchung vom Schadel. Der klinische Verdacht auf eine Carotis-Sinus-Cavernosus-Fistel konnte mit einer Angiografie bestatigt werden. Gleichzeitig erfolgte eine selektive Embolisation (interventionelle Radiologie). Darunter kam es zu einer subjektiven Beschwerdebesserung mit Visusanstieg auf 1,0 am rechten Auge und 0,8 am linken Auge (korrigiert). Schlussfolgerung: Bei einem akuten Exophthalmus mit gestauten episkleralen Gefasen sowie Sehverschlechterung und Tensionsanstieg ist an eine lebensbedrohliche Carotis-Sinus-Cavernosus-Fistel zu denken, welche oft eine diagnostische Herausforderung darstellt. Oft sind neben einem Stromungsgerausch okulare Symptome wegweisend fur die Diagnosefindung. Ein fruhzeitiger Nachweis der Fistel mit zeitnaher Embolisation ist entscheidend fur den Verlauf der Erkrankung und kann eine vollstandige Ruckbildung der Symptome erzielen.

Since its initial introduction in the mid-1990 s, retinotopic mapping of the human visual cortex, based on functional magnetic resonance imaging (fMRI), has contributed greatly to our understanding of the human visual system. Multiple cortical visual field representations have been demonstrated and thus numerous visual areas identified. The organisation of specific areas has been detailed and the impact of pathophysiologies of the visual system on the cortical organisation uncovered. These results are based on investigations at a magnetic field strength of 3 Tesla or less. In a field-strength comparison between 3 and 7 Tesla, it was demonstrated that retinotopic mapping benefits from a magnetic field strength of 7 Tesla. Specifically, the visual areas can be mapped with high spatial resolution for a detailed analysis of the visual field maps. Applications of fMRI-based retinotopic mapping in ophthalmological research hold promise to further our understanding of plasticity in the human visual cortex. This is highlighted by pioneering studies in patients with macular dysfunction or misrouted optic nerves.

Screening tests should be simple, with high acceptance, low costs and offer a high sensitivity and specificity as well as high reliability. The test-retest reliability of a web-based colour vision test was evaluated.The results of 386 subjects, who had performed the web-based colour vision test with 25 colour plates twice (available at http://www.farbsehtest.de), were analysed from an mySQL data base. Retests were performed spontaneously, normally on the same day, or through an email newsletter with a request to repeat the test. Test-retest reliability was assessed by calculating the kappa coefficient and the corresponding confidence interval. The McNemar test was used as a complementary procedure to detect the presence of systematic differences between test results.The kappa coefficient rises with increasing time interval between the first test performance and the test repetition. Thus it was 0.24 when the test was repeated within one hour (confidence interval 0.07 - 0.41, n = 63), it increases to 0.83 (confidence interval 0.75 - 0.92, n = 240) in the subjects who repeated the test at the earliest after two years. While the proportion of failed tests (3 mistakes) in the second test performance markedly decreases when the test is repeated in the short term within one hour (p0.001, McNemar), we were unable to identify any systematic differences (p = 0.602) for a time interval of more than one day.The web-based colour vision test is a reliable screening test with good reproducible results as well under uncontrolled examination conditions. Subjects must perform the test with serious intent and should not aim at a positive test result by training or manipulation because of self-delusion. Test results are reliable if the time interval between test and retest is more than one day.

In this review the current recommendations for the treatment of Herpes simplex keratitis are given - based on the literature, especially from 2000 till 2009. The medical treatment of epithelial, deep stromal keratitis, the prevention of recurrences and metaherpetic keratitis are discussed. Finally, a therapy scheme is presented.

Bacterial infections can affect all structures of the eye. In most cases, infections of the ocular surface are treatable with topical antibiotics, whereas intraocular infections need a combined treatment with intraocular and systemic antibiotics. Localisation, severity, expected microorganisms, and possible consequences of the infection lead to the appropriate therapy. Unwarranted use of antibiotic substances for prophylaxis or treatment of nonbacterial infection should be avoided, especially because of possible selection of multiresistant microorganisms.

We evaluated the effects of a lipid-lowering drug therapy with simvastatin, lovastatin, and pravastatin on the crystalline lens of the hypercholesterolemic rabbit. A threefold therapeutic dose was administered. Ocular examinations in mydriasis prior to treatment and after 14 and 30 weeks, respectively, were performed, including photographic documentation. Some degree of congenital lens opacities prior to treatment was frequently observed. No development of new cataracts could be proved during the study period.

A new technique was developed to study the pathogenesis of retinal arteriolar occlusion in the pig. Using a catheter with its tip in front of the exit of the ophthalmic artery, autologous microparticles could be injected directly into the retinal arterial system. These microparticles were C5a-des-Arg stimulated leukocytes, which were aggregated to pellets of different sizes ranging from 0.26 to 1.0 mm. For better adhesion of the aggregates to the endothelium, endothelial damage was induced by the injection of additional substances, including methomidate and endothelial antibodies. In a further series of experiments systemic hypoxemic conditions were created over several hours prior to injection of the leukocyte aggregates. This resulted in cotton-wool spots and arterial branch occlusions with retinal edema. Furthermore, retinal hemorrhages occurred. This experimental model seems to be appropriate for mimicking retinal arteriolar occlusion syndromes.

This study demonstrates 12 patients with "tilted disc syndrome" which includes an inferior conus and inversion of the optic disc, sectorial ectasia of the fundus, and refractive scotoma. Knowledge of the anomaly can help to prevent the patient from repeated neurologic and neuroradiologic examinations to exclude a cerebral tumor.

Bei der Prophylaxe der postoperativen Endophthalmitis muss sowohl zwischen prä-, intra- und postoperativen Maßnahmen als auch zwischen medikamentösen und chirurgischen differenziert werden. Derzeit wird die prospektive, randomisierte ESCRS-Studie an 16.603 Patienten intensiv diskutiert.[for full text, please go to the a.m. URL], 22. Internationaler Kongress der Deutschen Ophthalmochirurgen

Diagnosis of fungal keratitis is only straightforward if it presents in its typical form with pyramidal-shaped hypopyon, prominent geographical corneal infiltration and satellites. However, in contact-lens wearers clinical presentation is untypical at early infection. Corneal debridement is therefore necessary, which simultaneously facilitates penetration of the antimycotic into the corneal stroma. At present, voriconazole is the medication of choice, if not changed after microbiological diagnosis to a specifically more potent substance - e.g. posaconazole or caspofungin. Amphotericin B may be used for repeated intracameral or intravitreal injection. Simultaneous application of steroids is useful.

Contact allergies (CA) against active agents of topical ophthalmological therapeutics, causing inflammation of the conjunctiva and/or the lid, are usually not life-threatening, but occur not infrequently. As yet, the assessment of the CA-eliciting risk has been based on clinical data alone, while a valid epidemiological risk assessment is lacking.The Information Network of Departments of Dermatology supplied information on diagnostic results obtained in 4,102 patients patch-tested for suspected CA to ophthalmic drugs between 1995 and 2004. Clinical prevalences were extrapolated to incidences at the German population level. These estimates served as numerator for a relative incidence (RI), which included the nationwide frequency of prescriptions collected by the WIdO, Bonn, in terms of a standardised defined daily dose (DDD) as denominator.The estimated annual incidence of CA ranges from 155 (atropine sulphate) to 2077 (gentamicin sulphate) and can thus be regarded as moderate. If incidence estimates are related to prescription frequencies, the highest risk was found for kanamycin and neomycin sulphate (RI8 / 100,000 DDD). In contrast, the RI of pilocarpine-HCl (0.3) was virtually negligible.The substance-specific risk of CA has been evaluated for the first time and found to differ between therapeutics (with a similar spectrum of application). CA risk should be considered in differential therapeutic decision-making.

A 28 years old butcher contracted a systemic trichinosis after fasting sausage. Twelve days after onset of systemic symptoms he developed a hemorrhagic maculopathy in his left eye. In addition, on both eyes there were focal atrophies of the retinal pigment epithelium in the mid-periphery. We believe a causal connection of the maculopathy with his serologically proven trichinosis as a retinal involvement is well known in trichinosis and histologically demonstrated by Herrenschwand (1928). To our knowledge this is the first case of hemorrhagic maculopathy in trichinosis.

Eleven patients with M. Purtscher are presented with different manifestations of the retinopathy. The main characteristics are (1) yellowish-white "Purtscher-Flecken", which have a polygonal margin and are lying in the inner nuclear layer between the arterioles, (2) white typical cotton-wool-spots located in the nerve-fiber-layer covering the vessels and hemorrhages, which are (3) spot-like or (4) flame-shaped due to their location in the different retinal layers. All of these four manifestations may be isolated or combined, as we have observed in bilateral cases. Ten cases were caused by trauma of the thorax or the skull and one by pancreatitis. The pathogenesis of M. Purtscher can be explained by microembolization. An intravasal coagulation and/or aggregation of leukocytes resp. thrombocytes may develop after trauma as well as in pancreatitis. This may lead to microinfarcts and hemorrhages. The "microinfarct-hypothesis" has been experimentally proved and is able to explain the rarity of M. Purtscher, the range of variation, the monolateral and bilateral manifestation and identical ophthalmoscopic pictures despite different etiology.