[Intraocular pressure difference in Goldmann applanation tonometry versus a transpalpebral tonometer TGDc-01"PRA" in glaucoma patients]. / Augeninnendruckmessung mit dem transpalpebralen Tonometer TGDc-01"PRA" im Vergleich zur Applanationstonometrie nach Goldmann bei Glaukompatienten.

PURPOSE: The object of this study was to compare intraocular pressure measurements obtained with the TGDc-01"PRA", a new, transpalpebral indentation tonometer, with those from Goldmann applanation tonometry in normal and glaucomatous eyes. METHODS AND PATIENTS: Forty healthy eyes and 185 eyes suffering from glaucoma were included in the study. For Goldmann tonometry three measurements and for the TGDc-01 ten measurements were performed in a random order. All participants were placed in an upright position for all measurements. RESULTS: In both groups a systematic increase of intraocular pressure was found within the TGDc-01-measurements. Therefore, the first 3 measurements of each device were used for further statistical analysis. No learning curve could be demonstrated for the TGDc-01-measurement with normal eyes. Within the group of normal eyes the mean IOD obtained with the TGDc-01 was 1.84 mmHg lower than the mean IOD obtained with Goldmann tonometry (two-sided Student's t-test; P = 0.003). In the group of glaucomatous eyes, the mean intraocular pressure obtained with the Goldmann tonometry was 19.7 +/- 10.1 mmHg, with the TGDC-01 18.1 +/- 7.1 mmHg (coefficient of correlation r = 0.64, P < 0.001). The mean standard deviation of intraocular pressure measurements with Goldmann tonometry was 1.2 +/- 0.9 mmHg, with the TGDc-01 3.1 +/- 2.1 mmHg. TGDc-01-measurements overestimated intraocular pressure compared to Goldmann tonometry up to values of 16 mmHg and underestimated intraocular pressure at values over 16 mmHg. The difference increased by 5.5 mmHg per 10 mmHg Goldmann tonometry. The probability of success, defined as TGDc-01-recordings within +/- 3 mmHg of the Goldmann tonometry recordings, was less than 53 % between 5 and 20 mmHg and less than 30 % between 20 and 30 mmHg. Intraocular pressure (Goldmann tonometry) over 30 mmHg was always accompanied by TGDc-01-measurements lower than 3 mmHg. CONCLUSION: In eyes with elevated intraocular pressure, the TGDc-01"PRA" significantly underestimated the intraocular pressure measurement when compared to the gold standard, Goldmann tonometry. At present, measurement of the intraocular pressure with the TGDc-01 should not be used for clinical management of patients with glaucoma.

[Immunosuppressive therapy with mycophenolate mofetil (CellCept) in treatment of uveitis]. / Immunsuppressive Therapie mit Mycophenolat Mofetil (CellCept) in der Behandlung der Uveitis.

BACKGROUND: Severe forms of uveitis can often only be managed sufficiently with systemic immunosuppression. All available drugs are known for their relative high rate of side-effects. Mycophenolate mofetil (MMF), an immunosuppressant successfully used in management after organ transplantation and many autoimmune diseases, has shown remarkably less side-effects when used for various forms of uveitis in monotherapy or in combination with corticosteroids. The aim of this multicenter-study was to investigate if monotherapy with MMF is effective in various forms of uveitis. METHOD AND PATIENTS: Ten patients with anterior uveitis (n = 3), intermediate uveitis (n = 2), panuveitis (n = 4) and retinal vasculitis (n = 1) were treated in a prospective study with 2 x 1 g MMF daily. Previous immunosuppression had been discontinued because of side-effects or ineffectivity in all patients. In these patients MMF was given in addition to the other immunosuppressant at the beginning of treatment. RESULTS: The follow-up time ranged from 1 to 12 months (mean 4.5 months). Under therapy with MMF (monotherapy in 4 patients, additional prednisolone in 5 patients and additional metotrexate in 1 patient) 8 patients remained free of recurrences. In one female patient depression of inflammation activity was only achieved after cessation of therapy with Cyclosporin A in combination with MMF and a switch to methotrexate. Another patient with a bilateral uveitis was free of recurrences in only one eye, the second eye did not develop recurrence due to the additional corticosteroid treatment. Side-effects were diarrhoea in one patient and probably gastrointestinal problems in another (leading to cessation of therapy in both patients) and in another case nausea, vomitus and alopecia 10 months after beginning therapy. CONCLUSIONS: MMF as a new immunosuppressant stopped inflammation or drastically reduced the rate of recurrences in 8 out of 10 patients with uveitis which was previously not brought under control by other immunosuppressants. The side-effects were tolerable in comparison with other immunosuppressive agents. More patients, longer follow-up times and a comparative study with Cyclosporin A are required to assess the long-term therapeutical success.

[Hyperplasia of sebaceous glands (Fordyce's disease) in an oral mucocutaneous graft: 45-year follow-up]. / Talgdrüsenhyperplasie (Fordyce-Erkrankung) in einem konjunktivalen Mundschleimhauttransplantat: Verlauf über 45 Jahre.

BACKGROUND: Diffuse sebaceous gland hyperplasia in transplanted buccal mucosa is a very rare condition. We report on a further patient with this entity. PATIENT: In 1953, a now 68-year-old man suffered a severe alkali burn. Transplantation of oral mucosa was performed that same day in order to prevent perforation of the eye. Over the following 45 years, the patient developed multiple yellowish nodules within the grafts. Histologically, these nodules proved to be normally differentiated sebaceous glands. CONCLUSIONS: Diffuse sebaceous gland hyperplasia originating from within oral mucosa and developing over an extended period of time is a clinical entity known as Fordyce's disease. It is this a late complication of mucocutaneous transplantation, and although it constitutes mainly a problem of cosmesis, functionally it can lead to aberrant secretion of sebum.

[Acute tumor of the lower eyelid caused by spontaneous hemorrhage of an occult vascular anomaly]. / Akuter Unterlidtumor durch spontane Einblutung bei okkulter Gefässanomalie.

PURPOSE: To present an unusual acute tumour of the lid. PATIENT: A 37-year-old female physician presented with a swelling and a slight hematoma of the right lower lid. Palpation revealed two firm painless nodules under an intact epidermis. The patient confirmed that the lesion had developed within only one day without a preceding trauma. Both eyes were morphologically and functionally normal. Motility was free, and there was no exophthalmus. After three weeks the palpable nodules had not changed substantially. Magnetic resonance imaging disclosed a space-occupying lesion resembling an old hemorrhage or an inflammation. Excision was performed which revealed a thrombus-like structure. Histology showed multiple endothelium-lined vessels that were densely filled with erythrocytes, hemorrhages within the connective tissue, and old hemosiderin deposits. However, no thrombus could be found. CONCLUSION: Although thrombosis was the preferred diagnosis on clinical findings, histology led to the diagnosis of a spontaneous hemorrhage most likely caused by an occult vascular malformation.