[Preservative-free glaucoma treatment : Selection of the correct treatment in 1 min]. / Unkonservierte Glaukomtherapie : Wahl der richtigen Therapie in 1 min.

BACKGROUND: The presence of preservatives in topical glaucoma treatments may impact ocular surface function and structure. For treatment to be effective, side effects need to be minimized, in order to promote compliance and allow continuation of therapy. Therefore, in daily clinical practice, it needs to be decided on an individual basis whether a preservative-free treatment is required. OBJECTIVE: This study aimed to develop a questionnaire which helps to quickly and easily identify patients who require preservative-free treatment. MATERIALS AND METHODS: A questionnaire was prepared to collect relevant clinical findings needed to make a therapeutic decision (preservative-free required? Yes/No). Moreover, a rating scheme was developed to enable efficient final assessment of the collected data. To check their practicability in daily clinical practice, both instruments were tested in 11 ophthalmological centers in Germany. RESULTS: The questionnaire and rating scheme were easy to use, integrated efficiently into everyday routine, and performed in about 1 min. Data of 1150 glaucoma patients were collected and preservative-free eyedrops recommended for 586 (51 %). Parameters most frequently associated with such a recommendation were a reduced tear film break-up time of < 10 s (87.5 %) or marked corneal staining (65.5 %). CONCLUSION: The presented approach helps to decide within 1 min, in daily clinical practice, whether preservative-free glaucoma threatment should be recommended. Individualized therapy decisions can thus be made, allowing goal-oriented use of preservative-free antiglaucomatosa. This might help to promote compliance and lead to reduced progression of glaucoma.

Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report.

OBJECTIVE: Pathologic lacrimation (crocodile tears) is a rare but stigmatizing symptom after facial nerve paralysis. The aim of this pilot study was to examine whether botulinum toxin injection into the lacrimal gland is effective in reducing pathologic tear secretion. DESIGN: Case report. INTERVENTION: One patient who had crocodile tears after a zoster oticus infection received a botulinum toxin injection (2.5 mouse units) into the lacrimal gland. TESTING: Before injection, 1 week, 1 month, and 6 months after injection, patient's lacrimation was assessed by a Schirmer test. RESULTS: The lacrimation of the injected eye was reduced after 1 week and equal after 1 month when compared to the healthy side. After 6 months, hyperlacrimation reoccurred. No side effects were observed. CONCLUSION: Intraglandular injection of botulinum toxin into the lacrimal gland may serve as a sufficient therapy for crocodile tears.

[Papular xanthoma of the eyelids]. / Papulöse Xanthome der Lider.

BACKGROUND: Xanthomatous tumors are common tumors of the eyelid. We report the rare case of a patient with a papular xanthoma of the eyelid. CASE REPORT: The 87-year old patient suffered from multiple xanthomatous lesion in the face and the trunk. The tumors were painless and elastic. A biopsy of the largest tumor was performed. RESULTS: The histologic examination revealed multiple histiocytes and giant cells of the Touton type. Immunohistochemistry showed a positive stain for CD68. CONCLUSIONS: The clinical, histologic and immunohistochemical findings are typical for a papular xanthoma and help to differentiate from other xanthomatous lesions such as xanthelasma, xanthoma disseminatum, necrobiotic xanthogranuloma and fibrous histiocytoma.

[Trochlear paralysis within the scope of acute herpes hominis virus (HHV) 6 subtype B infection]. / Trochlearisparese im Rahmen einer akuten Herpeshominis-Virus-(HHV)-6-Subtyp-B-Infektion.

PATIENT: A 33-year-old woman developed progressive trochlear palsy without further neurological disorders. HHV-6 subtype B viremia was found in serological examination. TREATMENT: To prevent necrotizing encephalitis, a dangerous complication of untreated symptomatic acute HHV 6 subtype B infection, intravenous antiviral treatment consisting of initially ganciclovir, then ganciclovir and foscarnet in alternating combination and finally solitary foscarnet was performed. The result was complete eradication of viremia and restitution of the palsy. CONCLUSION: Bearing the risk of necrotizing encephalitis, acute HHV-6 subtype B infection should be taken into consideration as a possible cause for progressive neuroophthalmological disturbances of unknown etiology.

Photoreactive flow changes in the posterior cerebral artery in control subjects and patients with occipital lobe infarction.

BACKGROUND AND PURPOSE: Photoreactive flow changes of the posterior cerebral artery (PCA) in control subjects and patients with unilateral occipital lobe infarction were investigated to study the hypothesis that occipital lobe infarction of varying extent leads to a reduced visually activated flow increase in the ipsilateral PCA. METHODS: Maximum mean flow velocity (MFV) of the PCA was investigated by transcranial Doppler sonography after photic stimulation of the retina. RESULTS: In 25 control subjects MFV was increased by 30.6 +/- 9.7%. In 13 patients with unilateral occipital lobe infarction the ipsilateral MFV increase was significantly lower than in control subjects. Nine patients with homonymous hemianopsia showed an ipsilateral MFV increase of 3.4 +/- 4.1% (P < .001) and four patients with incomplete occipital lobe infarction and homonymous quadrantanopsia had an MFV increase of 16.0 +/- 12.8% (P < .05). CONCLUSIONS: We conclude that photoreactive flow changes of the PCA represent a noninvasive and reliable measure of functional impairment due to occipital infarction.

On the mechanism of action of phenylephrine in rat atrial heart muscle.

Both in rat left atrial heart and in aortic smooth muscle preparations, phenylephrine (PE) caused a concentration-dependent increase in force of contraction (FC) in the presence of atenolol (10 mumol/l), which was antagonized by phentolamine, prazosin and WB 4101 in a competitive manner. The pA2 values of the antagonists in the cardiac tissue were 10-20fold lower than those in the rat thoracic aorta. In the spontaneously beating right atrium, PE exerted a positive chronotropic action, which was not significantly antagonized by phentolamine or prazosin. It is therefore assumed that the effects of phenylephrine in the left atrium and in the aorta are mediated by different subtypes of alpha 1-adrenoceptors, whereas the effects in the sino-atrial node are probably unrelated to alpha 1-adrenoceptors. To further elucidate the mechanisms of the positive inotropic effect of PE, action potential configuration and 45Ca2+ fluxes were monitored in the rat left atrium. The increase in FC by PE was associated with an increase in action potential duration (APD) and a reduction in resting membrane potential (RP). In the presence of (-)-devapamil (D888), the effects of PE on APD and RP persisted, whereas the increase in FC was antagonized in a non-competitive manner. Forskolin (300 nmol/l) enhanced the positive inotropic effect of PE. PE exerted a significant increase in 45CA2+ uptake in beating preparations, which was abolished in the presence of (-)D888 (1 mumol/l). In addition to the PE-induced increase in 45Ca2+ uptake, a decrease in 45Ca2+ efflux was observed.(ABSTRACT TRUNCATED AT 250 WORDS)