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AUGENHEILKUNDE
212/1998 – ISSUE
6
Abstracts:
S. 419-427 (Art. 362)
Ocular manifestation of hematological
diseases
Unknown Autor
Ocular manifestations can be the presenting symptom of hematological diseases.
Ocular changes can be found in up to 90% of the patients depending on the
underlying disease. Most patients with ocular manifestations however are
asymptomatic.
Hematological disorders can manifest in all structures and adnexa of the
eye. The most common manifestations are conjunctival pallor and hemorrhages,
intraretinal hemorrhages and cotton wool spots. Retinal infiltrates,
manifestations in the lids, anterior segment, optic nerve, orbit and adnexa
are rare.
Different ocular manifestations in anemia, leukemia, malignant Non-Hodgkin
lymphoma, Hodgkin's disease, chronic myeloproliferative diseases, plasmocytoma,
myelodysplastic syndromes, coagulopathies, and reticulo-histiocytic diseases
are described.
Not only the underlying disease but also chemotherapy, bone marrow
transplantation can lead to ocular complications.
Key words Bone-marrow transplantation - Graft-versus-Host disease
- hematologic disease - leukemia - lymphoma - myelodysplastic syndromes -
ocular involvement
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S. 428-432 (Art. 351)
Astigmatic reduction by 4 mm selfsealing
corneal incision (stretch incision) with phacoemulsification and 5 mm PMMA
lens implantation
Unknown Autor
Aim Refractive cataract surgery using corneal incisions is aiming
at neutralization of preoperative astigmatism.
Patients and methods 61 patients with preoperative astigmatism of
2.25 B0.98 were included in the treatment. A selfsealing corneal tunnel incision
measuring 4.0 to 4.1 mm in external diameter and 6.5 to 7.0 mm in internal
diameter (stretch incision) was performed on the steeper axis. After
capsulorhexis and phacoemulsification a 5 mm PMMA lens was implanted without
suturing. Keratometry and corneal topography were performed preoperatively,
3 days and 1 year respectively following surgery. The statistical analysis
was based on the Wilcoxon signed ranks test.
Results Surgical induced astigmatism (IA) following superior incisions
in cases of astigmatism with the rule (np29) amounted to 1.93 B0.97, while
lateral incisions in cases of astigmatism against the rule (np29) led to
an IA of 1.35 B0.73. Axial shifts by more than 30° were 23% following
superior incisions and 17% after lateral incisions. We observed astigmatic
reduction of 1.3 D after superior incisions and 0.7 D following lateral
incisions.
Conclusion By 4 mm corneal cataract incisions on the steeper axis
a high preoperative astigmatism can be reduced significantly without additional
keratotomies.
Key words Refractive cataract surgery - selfsealing corneal tunnel
incision - PMMA lens implantation - high astigmatism - astigmatic reduction
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S. 433-443 (Art. 353)
Interpretation of corneal topography
with wave-front parameters after penetrating keratoplasty - Comparison between
nonmechanical trephination with the excimer laser and motor
trephination
Unknown Autor
Background Besides irregular astigmatism characterized by the asymmetric
components of the corneal surface, the aberration of the cornea from an ideal
sphere degrades the optical performance of the "optical system eye".
Best-corrected visual acuity may be markedly decreased with an increasing
aperture diameter. The purpose of this study was to evaluate the time course
of the symmetrical part of the aberration from an ideal sphere and to correlate
it with functional results after penetrating keratoplasty (PK).
Patients and methods Fifty patients each (20 primary dystrophies,
30 keratoconus) underwent nonmechanical trephination (NMT) (excimer laser
MEL60, Aesculap-Meditec, Heroldsberg, Germany) or mechanical motor trephination
(MT) in penetrating keratoplasty. All procedures (7.5 mm in dystrophies,
8.0 mm in keratoconus, 8 orientation teeth in NMT, double-running 10-0 nylon
suture) were performed by one surgeon (GOHN). At a postoperative gate of
6 weeks, 6 months, before partial suture removal and after complete suture
removal, corneal topography analysis (TMS-1, Tomey, Tennenlohe, Germany)
was performed. After a Gram-Schmidt-orthogonalization, corneal topography
height data of 25 noncentric rings in 256 hemimeridians were decomposed into
Zernike components of radial order np16 in the sense of minimizing the root
mean square error. The symmetrical part of the deviation from an ideal spherical
surface was calculated from the Zernike components Z04, Z06,..., Z016. From
the Zernike components, the longitudinal focus distribution and its standard
deviation (SDF) was determined. SDF was correlated with the surface asymmetry
index (SAI), the surface regularity index (SRI), the potential visual acuity
(PVA) of the TMS-1 and the spectacle-corrected visual acuity .
Results In the time course after PK, SDF decreased from the 6 weeks
follow-up examination to the end of the follow-up from 1.27 mm to 0.77 mm
in NMT (pp0.01) and from 1.29 mm to 1.20 mm following MT (pp0.24) within
the central corneal region of 3 mm in diameter. The SAI did not depend on
SDF, whereas the SRI correlated significantly inversely with the SDF within
the 3 mm zone immediately before (pp0.01 and pp0.02) and after suture removal
(pp0.01 each) after NMT. After MT, only a mild inverse correlation was observed
before (pp0.05) and after suture removal (pp0.04). In the time course after
the 6 months follow-up the SDF within the 3 mm central area correlated inversly
with the best-corrected visual acuity, more with NMT than with MT (pp0.005
and pp0.04 after suture removal). Best-corrected visual acuity was approximately
2 decimal lines better following NMT.
Conclusions Zernike decomposition of corneal topography height data
allows a separation and quantification of aberration of corneal graft surface
from an ideal sphere. Although corneal surfaces with a high degree of local
irregularities can be decomposed due to the orthogonality condition. Following
NMT, SDF was markedly lower after suture removal.
Key words Corneal topography - Zernike decomposition - penetrating
keratoplasty - excimer laser - nonmechanical trephination - motor trephination
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S. 444-448 (Art. 345)
Color doppler sonography of the retrobulbar
arteries in normal tension- and open angle glaucoma
Unknown Autor
Background Various authors report that the glaucomatous loss of function
is due to a chronic anterior ischemic optic neuropathy, being caused by a
disturbed relationship between intraocular pressure and perfusion pressure
in the posterior short ciliary arteries, which possibly leads to increased
resistance in the ciliary vascular system. The authors attempt to test this
hypothesis by measuring the vascular resistance (Resistance Index) in the
ciliary vessel system by means of color Doppler sonography.
Patients and methods 35 eyes of 35 patients, suffering from open angle
glaucoma (OAG), with a mean age of 65,3 years, were examined as well as 35
eyes of 35 patients with normal tension glaucoma (NTG), whose mean age was
65,8 years. Both glaucoma groups were compared to an age- and sexmatched
control group of healthy volunteers. The color-Doppler measurements were
performed with an Acuson 128 XP/10, which allows imaging of all retrobulbar
arteries, the ophthalmic artery, the central retinal artery and the short
posterior ciliary arteries, and also guarantees the precise calculation of
blood flow velocity and resistive index (RI). The RI was statistically
evaluated.
Results The resistance index of all retrobulbar arteries showed a
statistically significant increase (p < 0.05) according to Wilcoxon´s
test in the OAG group as well as the NTG group.
Conclusions Increased vascular resistance was found in all retrobulbar
arteries in OAG and in NTG. These findings point out the pathognomonic importance
of perfusion disturbance in glaucoma.
Key words Color Doppler sonography - normal tension glaucoma - open
angle glaucoma - resistance index
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S. 449-453 (Art. 342)
Confrontation visual field test using
Bagolini striated glasses - a new screening method for detecting quadrantanopia
and hemianopia
Unknown Autor
Backround To propose a quick test using striated lens according to
Bagolini for detecting quadrantanopic and hemianopic visual field defects.
Patients and methods The results of this test are presented and compared
with Goldmann perimetry in five patients suffering from quadrantanopic and
hemianopic visual field defects in hypophyseal adenoma (2! quadrantanopia,
1! bitemporal hemianopia) and occipital process (2! homonymous hemianopia).
To examine the visual field the patient has to fixate a light at 50 cm distance.
Due to the striated glasses two light stripes are generated along the 45°
diagonal, crossing in the fixated light in normal binocular vision. The temporal
lower and nasal upper quadrants of both eyes, and after switch the striated
glasses around the horizontal axis, the nasal lower and temporal upper quadrant
of both eyes can be tested along the 45° axis. While fixating the lamp
the patient is asked (in normal binocularity identical with the crossing
point), if one or more of the four light stripes, beginning at the crossing
point is shorter or weaker than the others, or interrupted or missing
totally.
Results Shortened or absent light stripe indicating quadrantanopic
visual field defect agrees with the location of visual field defect in kinetic
Goldmann Perimetry. An absent light stripe indicates a complete quadrantanopia,
a shortened light stripe an incomplete quadrantanopia. Fixation is warranted
easily by the crossing light stripes.
Conclusion The dissociation with the aid of striated glasses allows
a simultaneous test of both eyes in the 45°-axis of all four quadrants
in combination with the location of the visual field defect in this axis.
The proposed confrontation test is a simple and quick test without extensive
equipment. This test seems to be a useful tool in detecting homonymous or
heteronymous quadrantanopic and hemianopic viusal field defects for quick
screening purposes, especially in immobile patients.
Key words Bagolini - striated glasses - quadrantanopia - hemianopia
- visual field testing - perimetry - confrontation visual field - glaucoma
- nerve fiber bundle defects - simulation test
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S. 454-464 (Art. 361)
Family history of glaucoma and risk
factors in pigmentary glaucoma. A clinical study
Unknown Autor
Background Whether a family history of glaucoma (FHG) in patients
with pigmentary glaucoma (PG) is a prognostical indicator, is unknown. Therefore
the aim of this study was to evaluate the influence of FHG on the severity
of the disease in PG and pigment dispersion syndrome (PDS). Furthermore risk
factors in PG and PDS were evaluated.
Methods The findings of 207 patients with PG and PDS, who were able
to give information about FHG, were evaluated (149 PG, 43 PDS with ocular
hypertension (OH), 15 PDS without OH).
Results Significance of FHG: FHG was found in 39.1%, and in one third
of the patients more than one relative had the disease. FHG was found in
PG not more frequent than in PDS. Pigmentary glaucomas in advanced stages
of the disease did not have a higher incidence of FHG than patients in beginning
stages. Out of 207 patients with PG and PDS 71% were male and 29% female
(p [ka] 0.001). In patients with FHG the share of men was 64.2% and not
significantly different to the group without FHG with 75.4%. The sex distribution
in parents and grandparents having a glaucomatous disease was 1 : 1. Risk
factors: The patients with and without FHG in PDS with and without OH, PG,
and within the different stages of visual field loss, showed no significant
differences in risk factors, for example in maximum intraocular pressure,
refraction and cup-disc ratio. Myopia: Patients with PG had a significantly
higher myopia than patients with PDS (p [ka] 0.01). The higher the myopia,
the earlier the disease was diagnosed (pp0.008). Krukenberg spindle: During
miotic therapy the Krukenberg spindle decreased in the upper half of the
cornea. Time of diagnosis: PG was diagnosed at a higher age compared to
PDS.
Conclusion FHG does not influence the severity of the disease in PG.
Family history of glaucoma is a risk factor in patients with PG, but no
prognostical indicator. Patients with FHG do not have primarily larger cup-disc
ratios than patients without FHG. Myopia is a risk factor.
Key words pigmentary glaucoma - pigment dispersion syndrome - family
history of glaucoma - genetic predisposition - risk factors
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S. 465-468 (Art. 360)
Mitomycin C in the treatment of conjunctival
melanoma and primary acquired melanosis
Unknown Autor
Background Since 1995 we have used Mitomycin C additionally in the
treatment of conjunctival melanoma and primary acquired melanosis.
Methods We report on the therapy results of 14 patients suffering
from pigmented conjunctival lesions (malignant melanoma 9 and primary aquired
melanosis 5). After local excision, cryotherapy or irradiation all patients
received one eye drop Mitomycin C (0.02%) four times daily for four to six
weeks.
Results We observed regression of the pigmentations in 11 cases after
median follow up of 13.1 months. In one patient there was no change. Two
cases showed progression with tumefaction. There were no adverse reactions
except conjunctival hyperemia during therapy.
Conclusions Topical administration of Mitomycin C may be useful in
the treatment of pigmented conjunctival lesions. Longer follow-up periods
are necessary.
Key words conjunctival melanoma - primary acquired melanosis of the
conjunctiva - Mitomycin C
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S. 469-472 (Art. 337)
HPETE, an arachidonic acid metabolite,
induces apoptosis in the rat retina in vitro
Unknown Autor
Background Apoptosis is a gene-regulated mode of cell death which
gains increasing importance in retinal pathologies such as retinitis pigmentosa,
retinal detachment and proliverative vitreoretinopathy. A better understanding
of the regulation of apoptosis could imply the means to reduce photoreceptor
cell death and thereby provide therapeutic strategies to influene the time
course of retinal diseases. Previous studies in our laboratory demonstrated
that light induces apoptosis in the rat retina in vivo as a function of light
dose. In several cell systems, oxidative stress including oxygenated metabolites
of arachidonic acid (AA) was found to evoke apoptosis. We have observed a
light-elicited release of AA and the subsequent formation of its metabolites
in the rat retina. Therefore, AA and its metabolites appeared to be suitable
candidates for the induction of apoptosis during light exposure.
Materials and methods Isolated rat retinas were incubated for 60,
120 and 180 min, respectively, with and without the addition of 30 µmol
5S-hydroperoxyeicosatetraenoic acid (5-HPETE). Retinas were then processed
for light- and electron microscopy and examined for the morphological signs
of apoptosis. The rate of apoptosis in the outer nuclear layer was assessed
quantitatively.
Results 5S-HPETE induces apoptosis of photoreceptors in the rat retina
in vitro. Quantitative analysis revealed a significant increase in the rate
of apoptosis of 5S-HPETE-treated retinas when compared to untreated
controls.
Conclusion Arachidonic acid metabolites released upon light exposure may
represent messenger candidates for apoptosis in the retina.
Key words arachidonic acid - light damage - apoptosis - 5S-HPETE -
rat - retina - photoreceptors
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S. 473-475 (Art. 338)
Primary malignant B-cell lymphoma of
the lacrimal sac
Unknown Autor
Case report on a 44-year-old woman in good health with the symptoms
of epiphora, a plump elastic, not distressing swelling under the medial canthal
tendon of 1 cm size on the right side. In ultrasonography and intraoperatively
a tumour of moderate reflectivity with infiltration of the lacrimal sac was
found. The histological evaluation, including immunohistochemical studies
of the removed lesion, revealed a malignant B-cell lymphoma.
Key words lacrimal sac - orbit - ultrasonography - tu-mour - lymphoma
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S. 476-479 (Art. 350)
Bilateral microsporidial keratitis in
an patient with AIDS
Unknown Autor
Introduction Microsporidia are spore-forming, obligate intracellular
protozoa. Humans seem to be infected only by 4 genera of microsporidia.
Microsporidial keratoconjunctivitis in immunodeficient patients has a
characteristic appearance.
Case report 34 year old woman with AIDS complained of bilateral blurred
vision. The visual acuity was 0.6 on both eyes. She had a mild conjunctivitis
and disseminate, not very prominent intraepithelial corneal opacities. She
was treated with propamidine isethionate 0,1% 5 times daily and artificial
tears under presumptive diagnosis of microsporidial keratoconjunctivitis.
We discontinued this treatment because of no improvement. Within 6 months
the visual acuity decreased to 0,05. A conjunctival smear was positive for
microsporidia. Local Fumagillin-eye-drops 0,07 mg/ml 7 times daily were given.
Within 2 weeks an impressively improvement was seen. Because of an persisting
diarrhea 400 mg Albendazol twice daily was added orally without success.
Discussion The biomicroscopically changes of microsporidial
keratoconjunctivitis are characteristical and lead to the clinical diagnosis.
Fumagillin is in vitro and clinically a potent antimicrosporidian agent with
an extremely broad therapeutic range.
Key words microsporidial keratitis - AIDS - fumagillin
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S. 480-481 (Art. 349)
Retrosellar arachnoidal cyst as unusual
cause of homonymous hemianopia
Unknown Autor
Background Arachnoidal cysts are cystic lesions filled with a
cerebrospinal-fluid-like content within the leptomeninges. Usually arachnoidal
cysts represent a congenital malformation. Clinical signs (increased intracranial
pressure and/or neurological defects) may become apparent in children or
young adults.
Patient A sixteen year old boy was referred to our outpatient clinic
because of blurred vision in both eyes since five days. The patient complained
of cephalgia and of an increased sleep requirement in the last two weeks.
Morphological findings were within the normal range. The visual acuity was
0.7 in the right eye and 0.2 in the left eye. The visual fields showed an
incomplete homonymous hemianopia to the right. The CT and MRI revealed a
retrosellar arachnoidal cyst. Two weeks after fenestration of the cyst the
visual acuity had risen to 1.3 in both eyes and the visual field defects
had disappeared nearly completely.
Conclusion A retrosellar arachnoidal cyst can impair the visual pathway.
Early fenestration prevents permanent damage.
Key words Arachnoidal cyst - homonymous hemianopia
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