Search

We report on the case of a young immunocompetent female patient with parainfectious optic neuritis and macular inflitrate due to Neisseria meningitidis B meningitis.Case report RESULTS: A 22-year-old female patient was admitted to the emergency department for intensive care treatment with a strong suspicion of meningitis. Clinical and serological parameters were indicative of a bacterial genesis of the meningitis. By analysis of the cerebrospinal fluid (CSF) Neisseria meningitidis type B could be detected. Subjective and objective symptoms could be improved by immediate intravenous administration of antibiotics; however, 1 day before discharge the patient complained of a sudden left-sided, painful loss of vision with extreme photophobia. The ophthalmoscopic examination revealed profound ciliary injection with slight anterior uveitis and papilledema with macular infiltration and diffuse petechiae-like retinal hemorrhage. After exclusion of viral proliferation in the CSF systemic steroid therapy was carried out together with continuation of antibiotic therapy and the eye was treated with local steroids and mydriatics. This resulted in healing of the ocular inflammation and partial recovery of vision.The painful loss of vision in this patient is probably due to parainfectious optic neuritis with macular infiltrate from Neisseria meningitidis B meningitis, which is an unusual course. Despite the rarity of this disease the complication of a parainfectious inflammation of the optic nerve should be considered and appropriate steps taken when the corresponding symptoms occur.

This article reports a case of an Epstein-Barr virus (EBV) associated acute retinal necrosis. A 72-year-old male patient presented in the emergency department complaining of progressive loss of vision. During patient management an acute retinal necrosis was suspected and the subsequent diagnostics from a vitreal body biopsy showed positive results only for the EBV genome.The EBV is a rare cause of ocular inflammation. With this report we would like to draw the attention of colleagues to this unusual finding.Although EBV screening is not part of the standard diagnostic procedure, its implementation in relevant clinical situations could possibly assist the differentiation between causal relationship and morbidity.

We report the case of a 67-year-old woman who presented with a persisting corneal erosion after blunt injury. Six years later, a highly prominent corneal tumor had developed at the site of the initial erosion. Histological analysis revealed a malignant melanoma. This case provides evidence that malignant melanoma may be a long-term complication of corneal epithelial disorders.

Transplantation and translocation surgery for the treatment of AMD has been evaluated for over 25 years. More recently injections of inhibitors of vascularisation have been used with some success. Inhibitors of neovascularisation result in the recovery of vision in about 30% of patients; however, we do not understand what criteria can be used to select patients who will respond to or will not respond to treatment with antivascularisation treatment. We have to assume that successful antivascularisation treatment will require first that the retinal pigment epithelial cells be present and functional and second that the photoreceptor cells should not be degenerated. We then hypothesise that if either of these two parameters are not present, antivascular treatment will not result in vision recovery and we must then consider surgical intervention. Surgical intervention for macular degeneration encompasses procedures from simple membrane extraction to macular rotation to cell transplantation or a combination of these procedures, however these procedures must take into account that vision recovery cannot be achieved without reconstruction of the retina-choroid complex. Since in AMD degeneration of the retinal pigment epithelial cells and vascular membranes removal results in damage to the basal lamina and possibly deeper layers of Bruch's membrane, it will be necessary to reconstruct these damaged structures. In fact, transplantation of RPE cells or IPE cells has not resulted in any significant improvement in vision in AMD patients. Long-term follow-up of AMD patients following macular rotation surgery has shown that significant visual recovery is not maintained in most patients. Of the many approaches that could be used to reconstruct the damaged basal lamina and Bruch's membrane the most promising would be the introduction of a monolayer of pigment cells on a "natural" biodegradable substratum. A natural substratum consisting of extracellular matrix proteins would allow the pigment cells to retain their differentiated characteristics and functions, including the degradation the substratum and production of the normal components of the basal lamina and Bruch's membrane. In addition, the cells introduced as a monolayer can be engineered to carry specific genes to aid in the restructuring of the retina-choroid complex, such as growth factors and inhibitors of vascularisation.

The use of vital dyes in "chromovitrectomy" allows the easier removal of less recognizable structures like epiretinal membranes (EM) or the inner limiting membrane (ILM). In recent years numerous studies demonstrated the use of indocyanine green (ICG), trypan blue (TB) and patent blue (PB) for this indication. Reports of the possible risk of these dyes, i. e. especially ICG, in respect of reduced visual acuity results, possible visual field defects or alterations of the retinal pigment epithelium (RPE) resulted in limitations in their application.Human RPE cells and choroidal endothelial cells were cultured in monolayers on semipermeable membranes representing an in vitro model of the outer blood-retinal barrier. By measurement of the transepithelial electrical resistance (TER) the stable barrier function was determined. Two different models representing an air-filled and a fluid-filled eye were tested on the one hand by addition of the dye to the culture medium and, on the other, by direct application on the cell monolayer. In these two models ICG (5 mg/ml, 0.5 mg/ml, 0.125 mg/ml), TB (1.5 mg/ml, 0.15 mg/ml) and PB (2.4 mg/ml, 0.24 mg/ml) were applied for three minutes and the influence on the barrier function was determined. RPE cell growth was also tested in these two models after the application of ICG, TB and PB. Finally, monolayers of RPE cells were evaluated by transmission electron microscopy (TEM).After application of TB, PB and the lowest concentration of ICG of 0.125 mg/ml, the TER remained stable in both models. In contrast, ICG in a concentration of 5 mg/ml and 0.5 mg/ml caused a significant TER decrease in the model of the air-filled eye, whereas no influence on the function of the outer blood-retinal barrier was noted in the model of the fluid-filled eye. RPE cell growth rates were not influenced by the addition of the vital dyes, with the exception of ICG in a concentration of 5 mg/ml in the model of the air-filled eye, resulting in a temporary reduction of the cell count. In good correspondence to these results also in TEM intercellular blisters were noted after application of 5 mg/mL ICG for 3 minutes in the model of the air-filled eye. However, damage to the RPE cells themselves was not obvious. No pathological changes in the TEM were noted after application of TB and PB.The use of PB and TB at the posterior eye segment seems to be safe concerning damage to the PRE and its barrier function. In contrast, ICG in higher concentrations and with longer application times may cause a toxic effect on RPE morphology and function.

The goal of this study is the characterization of the strong yellow fluorescence of oxidized melanin in the retinal pigment epithelium (RPE) and the choroid.Naturally occurring melanin in the human retina and choroid was oxidized by exposing fixed and plastic-embedded sections of a human eye to light and hydrogen peroxide. Synthetic melanin was also oxidized in vitro by exposure to light and hydrogen peroxide. The fluorescence of oxidized melanin was examined by absorption spectroscopy, fluorescence spectroscopy, and fluorescence microscopy.Naturally occurring melanin oxidized in situ exhibited a lipofuscin-like yellow fluorescence. Oxidation of melanin in vitro degraded the melanin polymer, resulting in a fluorescent solution. Fluorescence spectroscopy gave an excitation maximum at approximately 470 nm and an emission maximum at approximately 540 nm for both natural and synthetic melanin. Increasing the time of exposure to light or hydrogen peroxide increased melanin fluorescence.The results indicate that the strong yellow fluorescence of melanin in the RPE and choroid in situ is a property of oxidized melanin and is not due to contamination of the melanin by proteinaceous or lipid materials. The data presented allow a reinterpretation of the results obtained from fluorescence investigations of melanin-containing tissue and suggest a link between melanin degradation and lipofuscin formation.

Neovascular glaucoma develops on a background of ischemic ocular pathologies, such as diabetic eye diseases or central retinal vein occlusion. Development of neovascular membranes in the chamber angle leads to elevated intraocular pressure. Since treatment by cyclodestructive therapy or drainage surgery often fails, we have examined intense antiproliferative surgery as a treatment for advanced neovascular glaucoma.Thirty-two patients with neovascular glaucoma subsequent to central vein occlusion or advanced diabetic retinopathy underwent antiproliferative surgery, which comprised vitrectomy, panretinal laser treatment and direct laser coagulation of the ciliary processes, followed by silicone oil tamponade. Patients were followed for a minimum of 1 year and as long as 3 years.After one week following surgery the intraocular pressure (IOP) was normal, ranging from 8 to 21 mm#Hg, in 52% (15/29 eyes), after 3 months the IOP was normal in 50% (16/32 eyes), after 6 months the IOP was normal in 59% (16/27 eyes) and after 1 year the IOP was normal in 72% (18/25 eyes). Of the 10 eyes that lost all sight after the surgery, 7 eyes had a history of central vein occlusion. Hypotony was observed in 6% (2/32) of the eyes 3 months following surgery; after 6 months hypotony was present in 15% (4/27) of the eyes and after 1 year hypotony was present in 12% (3/25) of the eyes.The theoretical premise of our surgical intervention (antiproliferative surgery) is based on the assumption that laser treatment interrupts the self enhancing pathway of retinal ischemia, release of proliferative factors and increase in intraocular pressure. The silicone oil endotamponade prevents postoperative complications and supports the rapid regression of rubeosis iridis by separating the anterior from the posterior segment.

Vitrectomy serves as an important treatment modality in uveitis, removing inflamed vitreous body and eliminating secondary complications. The aim of our retrospective study was to evaluate the value of vitrectomy in the treatment of complications in uveitis.We included 50 eyes of 50 patients suffering from chronic uveitis, which underwent vitrectomy surgery during the period of 1990 to 1993. The study only included patients who had vitrectomy for uveitis for the first time. Indications leading to surgery were density of optic media, retinal detachment, cyclitic or preretinal membranes. The mean follow-up was 455 (range 48-1420) days.Vitrectomy was performed at a mean delay of 452 days after initial presentation. The mean visual acuity at the time of surgery was 0.05. The best visual acuity postoperatively was measured at a mean time of 118 days after vitrectomy. Overall, at the last control, eyes with preoperative retinal detachment presented a much worse final functional result (visual acuity of 0.02) than eyes without detachment (visual acuity of 0.5). Ten eyes resulted in hypotonia after surgery (7 eyes with persisting hypotonia). Most frequent complications in the postoperative course were macular pucker (11 eyes), secondary glaucoma (10 eyes), macular edema (6 eyes) and retinal detachment (6 eyes). Fifty percent of all complications occurred within the first 3 months following surgery.Vitrectomy leads to a permanent increase in visual acuity through the treatment of complications, on the condition that a stable retinal situation was present preoperatively.

Dural arteriovenous fistula of the Arteria carotis externa and the sinus cavernosus are rare vascular malformations. In the literature the prognosis and necessity of treatment is described very variable.A 90 year old female presents in our outpatient clinic with acute exophthalmus, dilated episcleral veins, cerebral bruits and beginning orbital apex syndrome. After normal computerized axial tomography (CAT) without and with contrast medium, we were able to diagnose a dural AV-fistula by angiography. Shortly after dismission the patient had a spontaneous subarachnoidal haemorrhage with severe neurological symptoms.The suspect of an intracranial AV-malformation implies a detailed diagnostic search with precise localisation of the process. In any patient with intracerebral and intracranial fistula there has to be an individual check of possible and necessary treatment. It is impossible to classify dural AV-fistula as a benign disease with harmless clinical course.

Significance of topometric follow-up examinations of the optic nerve head in glaucomatous eyes depends on the reproducibility of the calculated parameters. Since the definition of the standard reference plane in software version 1.11 of the Heidelberg Retina Tomograph has been changed, intrapapillary parameters depend directly on the position of the contourline in the sector between -10 degrees to -4 degrees, and therefore on the observer variability to determine the disc border. We evaluated intra- and interobserver variability and present a simple approach to increase reproducibility.The disc border of 4 glaucomatous eyes, 3 ocular hypertensive eyes and 3 eyes of healthy subjects were traced by two observers, 5 times using the free draw mode and 5 times by the addition of contourline circles.We found a median variability of the mean disc radius in sector -10 degrees to -4 degrees of 51 microns, which defines the position of the standard reference plane, resulting in a median variability of the position of the standard reference plane of 33 microns which caused a variability of 81 microns2 of the cup area. Addition of contourline circles smoothing the final contourline along the border of the optic disc resulted in a decrease of the coefficient of variation of the standard reference plane of 3.76% (6.76% vs. 3.0%), of the cup area of 2.34% (3.87% vs. 1.53%) and of the rim volume of 3.41% (9.75% vs. 6.34%).The calculation of the cup area using software version 1.11 of the Heidelberg Retina Tomograph depends on observer variability. The addition of contourline circles to define the final contourline along the disc border increases reproducibility. However, in follow-up of topometric examinations of the optic nerve head the software supported transfer mode should be used. Comparing topometric data of an individual optic disc in follow-up suppose the same definition of the contourline. Therefore, topometric data evaluated using software version 1.10 or earlier needs to be recalculated.