[Bilateral 4MRGN Pseudomonas aeruginosa-associated choroidal abscesses in cystic fibrosis : Bilateral enucleation of the eyes as a last resort in a life-threatening situation]. / Bilaterale 4MRGN-Pseudomonas-aeruginosa-assoziierte choroidale Abszesse bei Mukoviszidose : Die bilaterale Enucleatio bulbi als Ultima Ratio bei vitaler Bedrohung.

We present a case of bilateral choroidal abscesses due to a multidrug-resistant gram negative (4MRGN) Pseudomonas aeruginosa lung colonization in a patient with cystic fibrosis under immunosuppression after lung transplantation. Bilateral choroidal and subretinal abscesses were detected by funduscopy, ultrasound, magnetic resonance imaging (MRI) and phacovitrectomy and were accompanied by bilateral acute vision loss. The diagnosis was confirmed by intraoperative subretinal biopsy. Due to therapy resistance a bilateral enucleation for life-saving purposes was performed.

[Postoperative care and options for scar treatment in eyelid surgery]. / Postoperative Nachsorge und Möglichkeiten der Narbenbehandlung in der Lidchirurgie.

Oculoplastic surgery places special demands on postoperative care because of the functional importance of the eyelids for the ocular surface. We present an overview of postoperative care after surgical eyelid interventions. All options, limits and the scientific evidence are discussed with a special focus on the treatment of postoperative edema, analgesia, infection prophylaxis and scar treatment.

[Vismodegib Therapy for Periocular Basal Cell Carcinoma]. / Die Behandlung periokulärer Basalzellkarzinome mit Vismodegib.

Background Basal cell carcinoma (BCC) is the commonest periorbital tumour. Mohs' micrographic surgery and secondary reconstruction is the therapeutic gold standard for periorbital BCC. In cases of inoperability for any reason, therapeutic alternatives are needed. Since the approval of vismodegib, an orally administered, targeted BCC therapy is available. Nevertheless there is little information on the use of vismodegib for periorbital BCC. Patients and Methods In a retrospective study, we analysed the data of 4 patients treated with vismodegib since 2014. The patients' mean age before starting therapy was 87 years. The mean maximum tumour diameter was 22.0 mm. Results The median follow-up was 17 months. The median treatment duration was 7.5 months. In 75 % of patients, complete clinical remission of BCC was achieved. In 25 % of patients, interim stabilisation of tumour growth was possible. The most common side effect of therapy was muscle spasm. Conclusion Vismodegib is an effective treatment option for patients with periorbital BCC, in whom surgical treatment is not possible for any reason.

[Immunotherapy of uveal melanoma: vaccination against cancer. Multicenter adjuvant phase 3 vaccination study using dendritic cells laden with tumor RNA for large newly diagnosed uveal melanoma]. / Immuntherapie beim Aderhautmelanom: Vakzination gegen Krebs. Multizentrische adjuvante Phase-III-Impfstudie mit Tumor-RNA-beladenen dendritischen Zellen bei neu diagnostizierten, großen Uveamelanomen.

Uveal melanomas are the most common malignant tumors of the eye. With modern molecular biological diagnostic methods, such as chromosome 3 typing and gene expression analysis, these tumors can be categorized into highly aggressive (monosomy 3, class II) and less aggressive forms. This molecular biological stratification is primarily important for determining the risk of these tumors as no therapy is currently available that is able to prevent or delay metastases. A randomized study of patients with a poor prognosis (monosomy 3) is currently being carried out in order to determine whether a cancer vaccine prepared from autologous (patient's own) dendritic cells and uveal melanoma RNA can prevent or delay progression and further metastases of this extremely aggressive form of cancer. Inclusion in the uveal melanoma study, which hopes to provide a potential therapeutic option for patients, is only possible if patients are referred to an institution that is able to manufacture and provide this vaccination before the patient is operated on or treated with radiation. Untreated tumor material is necessary for producing the vaccine on an individualized patient basis.

[Lateral canthopexy - a simple addition to lower lid blepharoplasty]. / Die laterale Kanthopexie - eine wenig aufwendige, wertvolle Ergänzung der Unterlidblepharoplastik.

Rejuvination of the lower lid is a challenging procedure. Lower lid malposition and ectropion are serious postoperative complications. Therefore presurgical assessment of the lower lid function and laxity are a must before performing a blepharoplasty. Lateral canthopexy is an effective procedure to minimise the risk of postsurgical ectropion. Its necessity increases with rising age of the patients. The canthopexy supports the lower lid postion in the case of increasing vertical tension.

[Post enucleation socket syndrome - new and established surgical solutions]. / Das Syndrom der anophthalmischen Höhle oder das "post enucleation socket syndrome" - neue und bewährte chirurgische Konzepte.

The orbital volume after enucleation or evisceration might shrink over time due to atrophy of the orbital fat and connective tissue. This can lead to prosthesis misfit and an unsatisfactory cosmetic result. This so-called post enucleation socket syndrome (PESS) needs a secondary orbital volume augmentation. The techniques for orbital volume augmentation are secondary orbital implants or implant exchange, orbital floor implants or injectable augmentation. The surgical possibilities are described and discussed with special attention to indications and chances.

[Long-term follow-up after deep sclerectomy]. / Langzeitverlauf nach tiefer Sklerektomie.

BACKGROUND: The aim of this study was to evaluate the long-term outcome of deep sclerectomy (DS) with a follow-up of up to 8 years. PATIENTS AND METHODS: All patients who underwent a deep sclerectomy between February 2004 and October 2005 and who attended a follow-up visit between August 2009 and October 2011 were included in this study. RESULTS: This study evaluated 74 eyes of 65 patients with a mean postoperative follow-up of 76.28 ± 10.6 (53.65-92.02) months. Preoperative IOP was 18.37 ± 6.36 mmHg, postoperative IOP at the last follow-up was 12.85 ± 3.5 mmHg, corresponding a 30 % reduction. The number of IOP-lowering eye drops was reduced from 2.36 ± 1.24 to 1.66 ± 1.21 after more than 6 years (p < 0.05). The visual fields showed a mean deviation of - 9.16 ± 8.48 dB initially and - 9.43 ± 8.07 dB at the last follow-up (p > 0.05). Complete success (IOP ≤ 15 mmHg without eye drops or additional surgery) was achieved in 5 % of patients. Qualified success (IOP ≤ 15 mmHg with eye drops or additional surgery) was achieved in 81 %. 53 % (n = 39) underwent cyclophotocoagulation and 20 % (n = 15) needed revision surgery during the follow-up period. CONCLUSION: DS is an effective long-term IOP-lowering procedure leading to visual field stabilisation.

[Artificial sight: recent developments]. / Künstliches Sehen: Stand der Entwicklung.

The implantation of electronic retina stimulators appears to be a future possibility to restore vision, at least partially in patients with retinal degeneration. The idea of such visual prostheses is not new but due to the general technical progress it has become more likely that a functioning implant will be on the market soon. Visual prosthesis may be integrated in the visual system in various places. Thus there are subretinal and epiretinal implants, as well as implants that are connected directly to the optic nerve or the visual cortex. The epiretinal approach is the most promising at the moment, but the problem of appropriate modulation of the image information is unsolved so far. This will be necessary to provide a interpretable visual information to the brain. The present article summarises the concepts and includes some latest information from recent conferences.

[Pressure-related analysis of compression therapy after burn injuries in childhood]. / Analyse des Kompressionsdruckes in der Kompressionstherapie von Verbrennungen und Verbrühungen im Kindesalter.

BACKGROUND: Burns and scalds are among the most common traumas in childhood and more than often lead to hypertrophic scarring. Compression therapy is one of the main concepts in the prophylaxis and therapy for hypertrophic scars. However, the mode of action and the optimum value for pressure are still unknown. In this study, we evaluated the possibility of measuring the pressure under compression garments with a simple pressure measuring device. MATERIAL AND METHODS: Pressure generation occurred by an air-filled balloon connected to a piezoresistive pressure sensor, which showed the pressure as a value of voltage. Calibration was possible with p

Kallikrein-kinin activation by altered vitreous pH: New perspectives for treatment and pathogenesis of diabetic macular edema? : Comment on: Gao BB et al. Extracellular carbonic anhydrase mediates hemorrhagic retinal and cerebral vascular permeability through prekallikrein activation. Nat Med. 2007 Feb;13(2):181-8.

Recently, Gao et al. published an experimental study based on the pathophysiology of diabetic macular edema in Nature Medicine (Nat Med. 2007 Feb;13(2):181-8). They found an increased amount of carbonic anhydrase in the vitreous, which causes a pH shift. This activates the kallikrein-kinin system and leads to increased retinal vascular permeability. In this comment the clinical implications of this article are discussed.

Toxicity of a pendimethalin containing herbicide formulation and three heavy metals in chicken embryos.

The toxic effects of a widely used herbicide (Stomp 330 containing 33% pendimethalin as active ingredient) applied alone or in combination with three heavy elements (copper sulphate, cadmium sulphate and lead acetate) modelling the heavy metal load of the environment were studied on chicken embryos with injection treatment. The treatment was done on day 0 of incubation. Solutions and emulsions of different concentrations were made from the test materials and injected in 0.1 ml volume into the air space of eggs. The macroscopical evaluations were done on day 19 of the incubation. Summarizing the findings, it can be established that the individual administration of the 33% pendimethalin containing herbicide formulation was less toxic compared to the control group than the simultaneous administration of the pesticide and heavy elements. As compared with each other the results from the combined administrations of the 33% pendimethalin containing herbicide formulation and heavy elements the simultaneous administration of cadmium and the herbicide caused the highest embryomortality while the incidence of developmental anomalies were the highest in the interaction study of the copper and the pesticide.

Teratogenicity testing of a 2,4-D containing herbicide formulation and three heavy metals in chicken embryos.

The toxic effects of a widely used herbicide (Dikamin D containing 72% 2,4-D-amine Na as active ingredient) applied alone or in combination with three heavy elements (copper sulphate, cadmium sulphate and lead acetate) modelling the heavy metal load of the environment were studied on chicken embryos with injection treatment. The treatment was done on day 0 of incubation. Solutions and emulsions of different concentrations were made from the test materials and injected in 0.1 ml volume into the air space of eggs. The macroscopical evaluations were done on day 19 of the incubation. Summarizing the findings, it can be established that the individual administration of the 72% 2,4-D containing herbicide formulation was less toxic compared to the control group than the simultaneous administration of the pesticide and heavy elements. As compared with each other the results from the combined administrations of the 72% 2,4-D containing herbicide formulation and heavy elements the simultaneous administration of cadmium and the herbicide caused the highest embryomortality while the incidence of developmental anomalies were the highest in the interaction study of the copper and the pesticide.

Early embryogenesis study on a dimethoate containing formulation and Cd-sulphate in chicken embryos.

The toxic effects of a widely used organophosphate insecticide (BI 58 EC containing 38% dimethoate as active ingredient) applied alone or in combination with cadmium sulphate modelling the heavy metal load of the environment were studied on chicken embryos in the early phase of development. Solutions and emulsions of different concentrations were made from the test materials and injected in 0.1 ml volume into the air space of eggs on the first day (day 0) of incubation. Subsequently, on days 2 and 3 of incubation permanent preparations were made from the embryos in order to study the early developmental stage. Embryos fixed on slides and stained with osmium tetroxide solution were studied under light microscope. Summarising the findings, it can be established that the embryotoxicity increased after the simultaneous administration of Cd-sulphate and 38% dimethoate containing insecticide formulation compared to the control or the individually treated groups.

Teratogenicity study of some pesticides in chicken embryos.

The use of pesticides involves the risk of poisoning on wild animals. Teratological tests carried out on avian embryos provide useful data for environmental protection and facilitate the development of environment-friendly chemical plant protection techniques. A 30% dimethoate containing insecticide formulation (BI 58 EC) and a 20% benfluralin containing herbicide formulation (Flubalex) and a 960 g/l S-metolachlor containing herbicide formulation (Dual Gold 960 EC) were studied in chicken embryos after single administration by immersion and injection technique. Treatment was done on day 0 of incubation. Applied concentration of pesticides were 0.1% (dimethoate) and 2.05% (S-metolachlor) and 0.375% (benfluralin) corresponding to that used in plant protection practice. Test materials were injected into the air chamber in a volume of 0.1 ml/egg, or eggs were treated by the immersion technique for 30 min. at 37 degrees C. Evaluation was done on day 19 of incubation. Injection treatment: the administration of S-metolachlor and benfluralin did not result a significant decrease in the average body weight of embryos. At the same time the body weight of embryos significantly decreased because of single administration of dimethoate. The embryomortality increased markedly after the administration of test materials (S-metolachlor, benfluralin, dimethoate). Immersion treatment: the administration of S-metolachlor and benfluralin and dimethoate did not result a significant decrease in the average body weight of embryos. The rate of embryomortality was low after the administration of S-metolachlor, benfluralin and dimethoate. After the immersion and the injection treatment the incidences of developmental anomalies were sporadic. In summary it can be established that the injection treatment was more toxic than immersion technique of the test materials in our study.

Toxicity of a dichlorvos containing insecticide formulation and an atrazine containing herbicide formulation in chicken embryos after individual administration.

A 50% dichlorvos containing insecticide formulation (Unifosz 50 EC) and a 50% atrazine containing herbicide formulation (Hungazin PK 50 WP) were studied in chicken embryos after administration as single compounds. Applied concentrations of dichlorvos were 0.1% (corresponding to the plant protection practice), 0.05%, 0.02%, 0.01%. Applied concentrations of atrazine were 0.66% (corresponding to the plant protection practice), 0.33%, 0.132%, 0.066%. The test materials were injected directly into the air-chamber of eggs on day 0 of the hatching period and evaulation was carried out on day 19 of incubation. The chicken embryos were examined for the following: rate of embryo mortality, body mass, type of developmental anomalies. After the single administrations of dichlorvos containing insecticide formulation and atrazine containing herbicide formulation on day 0 of incubation, the average body weight of chicken embryos significantly did not decrease as compared to the control. After the individual administrations of pesticides the incidence of developmental anomalies was sporadic. The embryonic mortality markedly increased at the highest concentrations of pesticides. The rate of embrio mortality were 61% (dichlorvos insecticide containing formulation) and 52% (atrazine containing herbicide formulation). In summary, the 50% dichlorvos containing insecide formulation (Unifosz 50 EC) and the 50% atrazine containing herbicide formulation (Hungazin PK 50 WP) were toxic to the developing chicken embryos at the highest concentration in our study. The toxic effect was expressed in the high rate of embrio mortality.

Comparing two methods of examination in the interaction study of a pesticide and a heavy metal.

The use of pesticides in field application involves the risk of poisoning wild animals. The reproduction period of pheasant takes place at the same time as the spraying time of pesticides, which justifies, that we evaluate in a point of the ecotoxicologic view the influence of the pesticide on progressive avian embryo. The most frequent technical way is injecting the exam stuffs to the some part of the embryonated eggs under the bird teratological trials. The advantage of this method is that it can be injected in a correct measured dose into the optional part of eggs. The disadvantage of this method is that it can't model properly the influence on the environment. If adverse effect of the embraced chemical substance on the embryo is experienced under the study, it will be necessary to use an immersion treatment. This procedure shows only the possible indirect influence of the pesticide on the embryo but it can suitably model its influence in plant protection practice. Treatment was done on day 12 of incubation. Applied concentration of heavy element (Cd sulphate) was 0.01% and the concentration of pesticide (Dithane M-45) was 0.2%. Evaluation was done on day 19 of incubation. Injection treatment: the simultaneous administration of Cd sulphate and the 80% mancozeb containing fungicide formulation on day 12 of incubation did not result in a significant decrease in the average body weight of embryos compared to neither the control nor the pesticide individually treated group. At the same time the body weight of embryos significantly decreased because of combined administration as compared to the Cd sulphate treated group. The embryo mortality and the incidence of developmental anomalies markedly increased after the simultaneous administration. Immersion treatment: the combined administration of Cd sulphate and the mancozeb containing fungicide formulation on day 12 of incubation did not result in a significant decrease in the average body mass of embryos compared to neither the control nor the individually treated groups. The number of embryo mortality was very high after the simultaneous administration. The incidence of developmental anomalies was sporadic.

Embryonic toxicity of a mancozeb containing fungicide formulation and Cu-sulphate in pheasant after individual or combined administration.

Cu-sulphate and a 80% mancozeb containing fungicide formulation (Dithane M-45) were studied in pheasants after administration as single compounds or in combination. The test materials were injected directly into the air-chamber of eggs on day 12 of the hatching period and evaulation was carried out on day 23 of incubation. The pheasant embryos were examined for the following: rate of embryo mortality, body mass, type of developmental anomalies, light microscopic examination. After the administration of copper-sulphate on day 12 of incubation, the average body weight of pheasant embryos significantly did not decrease as compared to the control. The embryonic mortality was 68%. After the administration of a mancozeb containing fungicide formulation (Dithane M-45) on day 12 of incubation, the average body weight of embryos did not decrease as compared to the control. The embryonic mortality was 50%. After the individual administration of pesticide, the incidence of developmental anomalies was very high. After the combined administration of copper-sulphate and the 80% mancozeb containing fungicide formulation (Dithane M-45) on day 12 of incubation the embryonic mortality markedly increased. The rate of embryo mortality was 93%. We did not find any degenerative change in the liver tissue in either the control group or the treated groups by light microscopic examination. In summary, it can be established that the simultaneous administration of Cu-sulphate and mancozeb containing fungicide formulation caused high toxicity compared with the individual toxicity of test materials.

Toxicity and degradation of metolachlor (Dual Gold 960 EC) in chicken embryos.

The herbicide formulation Dual Gold 960 EC (960 g/l metolachlor) was applied, ROSS 308 embryonated hen eggs were treated on day 12 of incubation period. The pesticide was diluted in water to a concentration level 0.3% and the emulsion was injected into the air space in a volume of 0.1 ml/egg, or hen's eggs were treated by the immersion technique (30 min). Residues of metolachlor were measured by GC in 14 collected embryo samples on days 13, 15 and 19 of the incubation of chicken embryos, and macro- and microscopic morphological examinations of 49 embryos were performed simultaneously on day 19. Body mass of embryos was weighed on 13th, 15th and 19th day of incubation. After the both treatments the mortality rate of embryos was similar. The average data of body mass showed a significant decrease compared to the control in the immersion study on day 15 and 19 of the hatching period. This phenomenon may only be in connection with the presence of metolachlor over the limit of quantification (LOQ) on day 13 of incubation period. The macroscopic deformations were sporadic in the embryos. No histologically detected alterations were seen.