[Immunomodulation and neuroprotection in optic neuritis]. / Immunmodulation und Neuroprotektion bei Neuritis nervi optici.

BACKGROUND: To date, high-dose corticosteroids constitute the only established treatment of acute optic neuritis (ON); however, steroids cannot prevent the loss of retinal nerve fibers. New acute therapeutic drugs are therefore being sought for a reduction of ganglion cell death. METHODS: Literature search comprising clinical studies on treatment of ON with immunomodulatory and neuroprotective drugs. RESULTS: For the immunomodulatory drug simvastatin some evidence for long-term benefits was shown, particularly regarding visual evoked potentials. For the neuroprotective substance memantine a potential positive effect on retinal nerve fiber layer (RNFL) thickness was revealed. Likewise in one publication a reduction in loss of RNFL thickness could be demonstrated for erythropoietin and this drug is currently being extensively investigated in a phase III randomized controlled trial (RCT). The results of studies with phenytoin, amiloride and anti-leucine-rich repeat and immunoglobulin domain containing 1 protein (anti-LINGO-1) antibodies are awaiting publication. CONCLUSION: According to the data from recent treatment trials, there is hope that neuronal loss in ON can be reduced with the help of immunomodulatory substances, such as simvastatin or neuroprotective agents, such as memantine and erythropoietin.

[Non-Arteritic Ischemic Optic Neuropathy (NAION)]. / Die nicht arteriitische anteriore ischämische Optikusneuropathie (NAION).

Non-arteritic ischemic optic neuropathy (NAION) is virtually unknown outside ophthalmology. It is characterised by acute unilateral visual loss, no pain on eye movements and virtually always optic disc swelling. Optic disc oedema resolves within 1 to 2 months, leaving behind optic atrophy. Vision hardly improves. NAION is the product of local abnormalities of the vascular supply to the optic nerve and general vascular risk factors. Of these, diabetes, hypertension and especially sleep apnoea syndrome are the most important. Recurrences in the involved eye are rare; contralateral recurrence occurs in approximately 15 % of patients. There is no clear scientific evidence for any specific therapy. However, there is general agreement that it is reasonable to control risk factors.

[Current recommendations on optic neuritis]. / Aktuelle Empfehlungen zur Neuritis nervi optici.

BACKGROUND: The diagnostics and therapy of optic neuritis are complex and require interdisciplinary cooperation. AIM: Compact, up-to-date recommendations for the clinician appear to be desirable. MATERIAL AND METHODS: A selective literature search including the authors' professional experience was carried out. An algorithm for the practical approach to optic neuritis was derived from the best available evidence. RESULTS: Our recommendation distinguishes between compulsory and optional investigations. Differential diagnostic cues with regard to atypical optic neuritis and other optic neuropathies are shown. Standard therapy patterns and means of escalation are suggested. Indications for referral are presented. CONCLUSION: The algorithm suggested in this article provides ophthalmologists with an effective orientation aid for the complete treatment procedure of optic neuritis.

[Visual field defects after epilepsy surgery: implications for driving license tenure]. / Gesichtsfelddefekte nach epilepsiechirurgischen Eingriffen : Bedeutung für die Fahrerlaubnis.

BACKGROUND: Epilepsy surgery is an effective and established therapy in medically uncontrollable seizure disorders. In the course of such operations lesions of the visual pathway are often unavoidable. The resultant visual field defects can conflict with the legal requirements for a driving license. METHODS: In this single center trial Goldmann perimetric findings in 135 temporal lobe epilepsy surgery procedures were analyzed retrospectively. The data were reviewed with respect to current and former German legal requirements for a driving license. RESULTS: Of the surgical procedures 64 % resulted in visual field defects, 50% of the postoperative visual field findings did not comply with the legal requirements for a driving license and 56% did not comply with those for a heavy goods vehicle driving license. DISCUSSION: A considerable proportion of the epilepsy surgery procedures examined in this study resulted in visual field defects that did not comply with the German legal requirements for driving vehicles. In all cases defects in the center of the visual field proved pivotal.

[Clinical and neuroradiological diagnostics in Graves' orbitopathy]. / Klinische und neuroradiologische Diagnostik bei endokriner Orbitopathie.

Early diagnosis of Graves' orbitopathy (GO) is important for a timely treatment of the disease. The diagnosis is based on clinical as well as radiological findings. Detailed assessment and follow-up mainly rely on standardized clinical examinations which register symptoms and signs including inflammation, upper lid retraction, exophthalmos, eye muscle involvement and diplopia, corneal involvement, raised intraocular pressure and optic nerve involvement, the latter representing a particular challenge. Each case of GO is classified in terms of severity and activity allowing suitable therapeutic strategies to be derived.

[Surgical therapy in Graves' orbitopathy]. / Operative Therapie bei endokriner Orbitopathie.

Surgical therapy of Graves' orbitopathy comprises orbital decompression as well as strabismus and lid surgery. The former is primarily carried out during active disease, the latter during inactive disease. Orbital decompression abates increased intraorbital pressure and is thus applicable against dysthyroid optic neuropathy and also reduces exophthalmos. The choice of a specific procedure depends mainly on the experience of the respective center. In this article, the pterional transcranial, transnasal transethmoidal, transconjunctival and swinging eyelid approaches are presented. Eye muscle recession relieves the abnormal tension of fibrotic muscles and thus corrects diplopia. Compared to normal strabismus surgery, the dose-response relationship is increased. Lid lengthening surgery is applied to counter upper or lower lid retraction. If several of these operations are necessary the order is chosen in such a way that downstream procedures cannot change specific results of upstream operations.

[Drug therapy and radiotherapy in Graves' orbitopathy]. / Medikamentöse Therapie und Strahlentherapie bei endokriner Orbitopathie.

Drug therapy and radiotherapy in Graves' orbitopathy (GO) aim mainly at the inherent soft tissue inflammation. A timely and sustained anti-inflammatory therapy not only alleviates the current symptoms but particularly intends to limit the degree of permanent alterations. It is indicated in active GO of moderate or higher severity. Pharmacologically, glucocorticoids and if appropriate other immunosuppressive agents, such as cyclosporine are given. Adverse effects can complicate the treatment. Retrobulbar irradiation is applied against diplopia due to eye muscle involvement during the active phase.

Electrophysiological effects of progesterone on hepatocytes.

The addition of progesterone (1-100 mumol/l) to the extracellular fluid bathing rat hepatocytes led to a rapid and fully reversible depolarization of the cell membrane. The progesterone-induced depolarization was paralleled by a decrease of potassium selectivity and an increase of cell membrane resistance and was abolished in the presence of the potassium channel blocker barium. Accordingly, in whole cell recordings, progesterone led to a decrease of the cell membrane conductance. 17 alpha-Hydroxyprogesterone and beta-estradiol were less effective by a factor of 10, whereas cholesterol, corticosterone and hydrocortisone did not significantly alter the potential difference across the cell membrane. In conclusion, acute administration of progesterone depolarized rat hepatocytes by decreasing the potassium conductance of the cell membrane.