[Ocular toxocariasis. From biology to therapy]. / Okuläre Toxokariasis. Von der Biologie zur Therapie.

Ocular toxocariasis represents an organ manifestation of the systemic infection with the Nematode larva Toxocara canis. The infection can provoke very different changes in the eye. Especially posterior uveitis, vitreous body infiltrates, epiretinal membranes and suberetinal granulomas can occur. The diagnosis of these changes can be difficult due to the variety of the symptoms and on the other side by the absence of characteristic specific changes. Moreover unclear findings can occur when only serological examinations are performed. In unclear cases the antibody-detection by means of ELISA from the vitreous body fluid can be useful. The examination of vitreous body material can prove toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Besides the systemic anti-helminthic therapy with Albendazol the pars plana vitrectomy is a substantial therapeutic option in ocular toxocariasis when vitreo-retinal complications are present. A well timed adequate therapy can stabilize the visual acuity in many cases.

[Ocular toxocariasis. Diagnostic and therapeutic options]. / Okuläre Toxocariasis. Diagnostische und therapeutische Optionen.

BACKGROUND: The diagnosis of ocular toxocariasis can be difficult and the aim of this study was to evaluate the benefit of ELISA testing of vitreous body fluid. PATIENTS AND METHODS: We present five consecutively treated patients with ocular symptoms of toxocariasis, three of these patients presenting with epiretinal membranes and subretinal granulomas were vitrectomized. Vitreous and body fluid and serum were tested for toxocara antibodies by ELISA. Moreover vitreous body fluid of 10 patients with epiretinal membranes of other origins were examined by the same ELISA. RESULTS: In all three operated patients toxocara antibodies were detected in the vitreous fluid but ELISA testing of serum samples was negative in two of the three patients. Visual acuity increased or remained stable in the operated patients. The ELISA test was negative in all vitreous fluid samples of the control group. CONCLUSIONS: ELISA testing of vitreous body fluid can prove the presence of toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Well-timed vitrectomy is a suitable therapy for vitreo-retinal complications in ocular toxocariasis to improve prognosis and to confirm the diagnosis.

[Acute retinal necrosis syndrome: analysis, therapy and long-term follow up of 14 eyes]. / Akute Retinanekrose: Analyse, Therapie und Langzeitbeobachtung an 14 Augen.

PURPOSE: Acute retinal necrosis syndrome (ARN) might be complicated by retinal detachment, vasculopathy and optic neuropathy and has a poor prognosis despite intensive medical and surgical therapy. PATIENTS AND METHODS: A series of 10 consecutive patients (14 eyes) with ARN were followed for 36 months (average of 20 months +/- 10). We present the results of the clinical evaluation for diagnostic and therapeutic modalities. RESULTS: Viral etiology was confirmed in 9 of 10 aqueous-humor samples. Intraocular antibody synthesis against Varicella-Zoster Virus was found in 7, against Herpes-Simplex Virus in 5 and against Cytomegalovirus in 2 samples. Three eyes had a mild clinical course with a visual acuity of 0.6 or better. Vitrectomy and silicone-oil tamponade preserved visual acuity from 0.3 to 0.1. ARN lead to blindness in 5 eyes due to vasculopathy, optic neuropathy or retinal detachment. An arterial branch occlusion was successfully overcome with i.v. heparin treatment in one patient. CONCLUSION: Aqueous-humor analysis supports clinical diagnosis. Early vitrectomy and silicone oil tamponade stabilizes retinal structure and preserves visual acuity. Occlusive vasculopathy and optic neuropathy are the main causes leading to blindness.

[Proliferation and wound healing of retinal pigment epithelium cells in vitro. Effect of human thrombocyte concentrate, serum and PDGF]. / Proliferation und Wundheilung von RPE-Zellen in vitro. Einfluss von humanem Thrombozytenkonzentrat, Serum und PDGF.

PURPOSE: Biological agents like human serum or autologous platelets have recently been employed as adjuvants for macular hole surgery. However, the role of these agents on the retinal cellular level remains unclear. In the present study, we investigated the effect of human platelets, serum and PDGF on RPE migration and proliferation in cell culture. METHODS: Human RPE were cultured in DMEM + 2% FCS and experiments performed at passages 2-4. Human platelet concentrate (PC) and serum (HS) were isolated from blood of patients previewed for macular hole surgery; human PDGF-BB was from Pepro Tech. PC and HS at protein concentrations ranging from 50-1000 micrograms/ml and PDGF at 1 and 10 ng/ml were added to 5000 cells/well in the proliferation assay and to a confluent RPE monolayer on which a central mechanical "wound" (5 mm diameter) was made. Incubation times ranged from 1 h to 5 days. Cell numbers at D 5 were indirectly determined by protein measurements. In the wound model, the cells inside the wound area were counted and results compared to the control cultures that received no supplements. RESULTS: Cell proliferation was significantly stimulated over controls by all concentrations of PC, HS and PDGF with any incubation time. Compared to PC and PDGF, HS revealed less proliferation after 1-6 h of incubation; there was no significant difference from PC with other incubation times. In the wound model, both PC and PDGF significantly increased the number of cells migrating into the denuded area after 1 h incubation with the culture medium; longer incubation times had no further effect compared to controls. CONCLUSION: The present study is the first to demonstrate that human platelet concentrate induces proliferation and migration of RPE cells in vitro. However, PDGF, a growth factor which is abundantly present in platelets, was found to be at least equally effective. We assume that the majority of the mitogenic effect of platelet concentrate is due to PDGF.

[Pseudophakia in children with juvenile arthritis]. / Pseudophakie bei Kindern mit juveniler Arthritis.

BACKGROUND: Cataract secondary to juvenile rheumatoid arthritis is a severe, vision-threatening complication in early childhood. Intraocular lens implantation is controversial. The follow-up of four pseudophakic eyes of three patients and their perioperative therapeutic regimen were retrospectively analyzed. Early and late postoperative complications are reported. PATIENTS AND METHODS: Both girls had lens aspiration and posterior lens implantation at the ages of 6 and 12 years, the boy at the age of 10 and 14 years. All patients had relapsing anterior uveitis. The follow-up time was 3 years (1-6 years). One girl was diagnosed with sarcoidosis, causing juvenile arthritis. Both girls had perioperative methothrexate and prednisolone therapy. The boy had azathioprine therapy at the time of his first cataract surgery; later he had no systemic therapy. Both girls' intraocular lenses were implanted at different eye hospitals. RESULTS: Both girls had severe inflammatory reactions after surgery. At the hospitals both eyes had surgical revision for iris capture. In one case this was combined with exchanging the intraocular lens. Iris capture persisted for this eye and later vitrectomy with silicone oil filling was necessary to delay phthisis, resulting in amaurosis. For two pseudophakic eyes vitrectomy was necessary later because of severe vitreous opacities, but visual acuity was severely diminished by chronic cystoid macular edema and epiretinal membranes. The boy developed in his second eye intermittent iris bombata and persistent secondary glaucoma, visual acuity was stabilized at 0.5. CONCLUSIONS: Secondary cataract due to juvenile rheumatoid arthritis or sarcoidosis is a difficult situation for phacoemulsification with intraocular lens implantation in children. For severe inflammatory complications intense local and systemic anti-inflammatory therapy is mandatory. Visual prognosis is reduced for the uveitic posterior segment and glaucoma complications. IOL implantation can be recommended for only a very few patients.

[Reposition and suture fixation of dislocated posterior chamber lenses]. / Reposition und Nahtfixation luxierter Hinterkammerlinsen.

We treated 11 patients with posterior chamber intraocular lenses that were dislocated into the vitreous cavity. Using a pars plana approach, vitrectomy was performed and in order to facilitate manipulation, half of the bulbus volume was filled by perfluorodecaline. The IOL was grasped with forceps and repositioned with a special technique. In this way the first haptic is fixed in the ciliary sulcus. Fixation of the second haptic with 9 x 0 polypropylene suture was performed with a similar procedure. Finally, prophylactic cryotherapy of the retina is indicated.

[The oculocardiac reflex during vitrectomy under neuroleptanalgesia]. / Untersuchungen des okulokardialen Reflexes bei Vitrektomien in Neuroleptanalgesie.

Oculocardiac reflex (OCR) is a frequently occurring complication in eye operations. It is a trigemino-vagal reflex characterised by the clinical occurrence of bradycardia and other cardiac rhythm disturbances following manipulations on the eye and its surroundings especially after traction of the external eye muscles. In this paper based on an analysis of 402 anaesthesia records, a bradycardia frequency (f = less than 60/min) of 31.8% was noted while other rhythm disturbances occurred in 5.7%. Predisposition facts were identified as age over 50, hypertension and cardiac diseases requiring medication with cardiac drugs. The frequency of OCR is considerably lowered by diabetes mellitus. Examination of 159 traction measurements made at the lateral rectus muscle revealed that the first manipulation made at the rectus bulbi superior muscle resulted in a statistically significantly stronger reflex activity than at the other muscles. In a further series of investigations in which rectus bulbi superior muscle was tested last, this muscle again showed the biggest frequency deviation. Only determination of the percentage heart rate decrease is suitable for characterising reflex activity. The frequency of the reflex occurring in our study was 71.7%, the result being reduced by the high proportion of diabetics, who are relatively reflex insensitive.

[Changes in the retinal vessels in mandibular nerve anesthesia. A potential for complications]. / Netzhautgefässveränderungen bei Mandibularisanästhesie Eine Möglichkeit für Komplikationen.

Examinations of the eyegrounds were made on thirty subjects after conduction anesthesia with xylocitin of the inferior alveolar nerve as well as on nine subjects after sodium chloride injections in order to determine the effect of mandibular conduction anesthesia on retinal vessels. Retinal vascular widths were measured and arteriovenous indices determined. The subjects were divided into groups according to preexisting general diseases, age, sex, and smoking habits. Retinal vascular changes were determined in dependence on age and smoking habits after injections made into the mandibular foramen, and the manner of origin and the results are discussed with particular reference to data reported in the literature.