[Therapy of malignant glaucoma]. / Therapie des malignen Glaukoms.

Malignant glaucoma is a rare and complex eye disease but the exact cause has not yet been clarified with certainty. Malignant glaucoma can be treated with medication or by means of laser surgery or open incisional surgery. In this article the possible procedures for the treatment of malignant glaucoma (medicinal and surgical) are presented together and justifications for the procedures described are given.

Saccade testing to distinguish between non-organic and organic visual-field restriction.

AIM: The authors described and tested a simple bedside procedure to detect non-organic visual-field loss. METHODS: Prospective comparative observational case series of 16 patients with non-organic visual-field loss and 15 patients with organic visual-field loss were examined. Saccade patterns provoked by a stimulus outside the claimed visual field were assessed by a masked observer. RESULTS: Whereas, in organic visual-field defects, eye movements as noted by the observer were in small and erratic searching patterns towards the visual-field defect in all patients (15/15), most patients with non-organic visual-field loss (14/16) were able to jump directly to the presented red cap in one directional large saccade, although the stimulus was outside their stated visual field. The sensitivity of the saccade test in detection of non-organic visual-field loss by a masked observer was 87% (95% CI 60% to 97%) and the specificity was 100% (95% CI 75% to 100%). The positive predictive value for non-organic visual-field loss of the saccade test was 100%, and the negative predictive value was 90%. CONCLUSIONS: The saccade test is a quick and reproducible examination to use and is largely independent of the patient's willingness for cooperation. The authors believe that the test will be of value to clinicians on bedside evaluation when non-organic visual-field loss is suspected.

Non-invasive biometric assessment of ocular rigidity in glaucoma patients and controls.

PURPOSE: To determine in vivo whether a pharmacologically induced change in intraocular pressure (IOP) leads to measurable changes in axial eye length and whether there is a difference between glaucoma patients and control subjects. METHODS: 42 subjects (19 patients with primary open angle glaucoma and 23 control patients matched for age and gender) underwent axial eye length measurement using partial coherence laser interferometry and measurement of IOP using dynamic contour tonometry before and 2 h after oral intake of 500 mg acetazolamide. Student's t-test was used to compare differences in the means. RESULTS: An identical drop in IOP was induced in both the glaucoma (mean+/-SEM: 2.90+/-0.44 mmHg, n=19) and the control group (mean+/-SEM: 3.17+/-0.32 mmHg, n=23). The change in axial eye length was significantly smaller (P=0.026) in the glaucoma group (mean+/-SEM: -14.2+/-3.2 microm, n=19) compared with the control group (mean+/-SEM: -23.0+/-2.98 microm, n=23). CONCLUSIONS: Our results strongly suggest that the ocular rigidity is increased in patients with established glaucoma in comparison to control subjects. Ocular rigidity could play a role in the pathogenesis and pathophysiology of glaucoma. Determination of ocular rigidity could be helpful in detection of glaucoma.

Significance of Staphylococcus lugdunensis bacteremia: report of 28 cases and review of the literature.

BACKGROUND: Staphylococcus lugdunensis endocarditis has been associated with an aggressive course. The aim of this study was to determine factors associated with the development of endocarditis in patients with S. lugdunensis bacteremia. METHODS: A retrospective analysis of all patients with S. lugdunensis bacteremia in three tertiary care centers in Switzerland was performed. Data regarding medical history, symptoms, and susceptibility of S. lugdunensis isolates were collected. Our results were reviewed in the context of the current literature. RESULTS: A total of 28 patients with S. lugdunensis bacteremia were identified. Of the 13 patients with endocarditis, all were community acquired. Cardiac surgery was performed in 85% of these patients; mortality was 23%, reflecting the aggressive course of this disease. In contrast, in the 15 patients without endocarditis, no complications associated with S. lugdunensis bacteremia were observed. In 73%, a probable source was identified in the form of a venous catheter or other foreign device. Only three of these episodes were community acquired. No difference was observed in susceptibility of the S. lugdunensis isolates to penicillin, which was 77% in endocarditis isolates, and 87% in isolates of bacteremia without endocarditis, respectively. CONCLUSION: S. lugdunensis bacteremia is associated with endocarditis in up to 50% of patients. Every patient with community-acquired S. lugdunensis bacteremia should be carefully examined for signs of endocarditis. Once S. lugdunensis endocarditis is diagnosed, close monitoring is essential and surgical treatment should be considered early. In the nosocomial setting, endocarditis is far less frequent, and S. lugdunensis bacteremia is usually associated with a catheter or other foreign materials.

Fibrosing alopecia in a pattern distribution: patterned lichen planopilaris or androgenetic alopecia with a lichenoid tissue reaction pattern?

BACKGROUND: Androgenetic alopecia is characterized by a defined area of progressive nonscarring alopecia. The clinical and histological findings in 15 women and 4 men with progressive scarring alopecia in a pattern distribution were studied. The results were evaluated and compared with clinicopathologic entities that feature scarring of the central scalp area, specifically, lichen planopilaris, pseudopelade, and follicular degeneration syndrome. OBSERVATIONS: Patients developed progressive fibrosing alopecia of the central scalp, without the multifocal areas of involvement typical of lichen planopilaris and pseudopelade. Perifollicular erythema, follicular keratosis, and loss of follicular orifices were limited to a patterned area of involvement. Biopsy specimens of early lesions demonstrated hair follicle miniaturization and a lichenoid inflammatory infiltrate targeting the upper follicle region. Advanced lesions showed perifollicular lamellar fibrosis and completely fibrosed follicular tracts indistinguishable from end-stage lichen planopilaris, pseudopelade, or follicular degeneration syndrome. CONCLUSIONS: Some patients with androgenetic alopecia might have additional clinical and histological features of inflammation and fibrosis limited to the area of androgenetic hair loss. In these patients, the histological findings of early lesions are identical to those seen in lichen planopilaris. The lichenoid tissue reaction leading to follicular destruction in these patients might be pathogenetically related to the events underlying androgenetic alopecia.