[Hypertensive changes of the fundus]. / Hypertone Veränderungen des Fundus.

Systemic hypertension affects approximately 25 % of the population worldwide and is the most important preventable risk factor for cardiovascular diseases. Hypertension-related fundus abnormalities can be classified into hypertensive retinopathy, choroidopathy, and optic neuropathy. Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer. The use of a detailed grading system based on the severity of vascular constriction is not practicable as arteriosclerotic changes are common among elderly people. Therefore, early stages with pure vascular pathology should be differentiated from severe forms of hypertensive retinopathy with parenchymal changes of the fundus. Screening the retina for hypertensive changes is essential in cases of severe systemic hypertension, acute visual impairment, diabetes mellitus and pregnancy.

[Macular pathology as a cause of visual impairment?]. / Makulapathologie als Ursache einer Visusminderung?

This article reports a case of a pituitary adenoma as the cause of unilateral visual impairment and concomitant unilateral macular pathology. Pituitary adenomas can be classified into hormone-secreting and inactive tumors of the adenohypophysis and lead to typical symptoms in cases of hypersecretion of hormones or hypopituitarism. A pituitary adenoma classically presents with bitemporal hemianopia when compression occurs at the optic chiasm. Imaging is crucial in diagnosing pituitary adenomas. Microsurgical or endoscopic transsphenoidal surgery, hormone therapy and radiotherapy are the treatment options.

[Retinal vein occlusion. Diagnosis or symptom?]. / Venenverschluss. Diagnose oder Symptom?

Behçet's disease is a chronic recurrent systemic vasculitis and can affect nearly all organ systems. Eye involvement is characterized by uveitis with occlusive retinal vasculitis. Oral aphthous ulcers are the major primary symptom and arthritis, genital ulcerations and skin lesions are common extraocular manifestations. Gastrointestinal and vascular symptoms or manifestations of the central nervous system are less frequently seen. Biologic agents are used alone or in combination with immunosuppressive or cytotoxic drugs to prevent relapse as the prognosis is poor in patients with retinal vasculitis.

[Papilledema of unknown cause]. / Unklare Papillenschwellung.

Orbital metastases occur in 2-5 % of cancer patients. Common primary sites that cause orbital metastases are breast, lung and prostate cancer. In up to 25 % of patients orbital metastasis is the initial sign of an unknown primary tumor. Clinical symptoms are proptosis, ocular motility disorder and visual impairment. Imaging procedures may be useful in diagnosing orbital metastases but are not specific. Treatment is palliative. Radiotherapy, chemotherapy and surgical debulkment in selected patients are treatment options.

[Prognostic factors for visual outcome after intravitreal drug therapy for chronic diabetic macular oedema]. / Prognostische Faktoren beim chronisch-diabetischen Makulaödem nach intravitrealer Therapie.

BACKGROUND: In recent years, intravitreal bevacizumab and triamcinolone acetonide (TA) have been widely used to treat diabetic macular oedema (DMO). However, the indication criteria are not clear. The purpose of this study was to evaluate factors which are decisive for long-term visual outcome after intravitreal drug treatment for eyes with DMO. MATERIALS AND METHODS: Fifty eyes (37 patients) treated with intravitreal bevacizumab, TA, or sequentially with both for DMO with a minimum follow-up period of 6 months were analysed retrospectively. The eyes with an increase of best-corrected visual acuity (BCVA) at the last visit were classified as gainers, and eyes with stable or decreased BCVA as non-gainers. Clinical and imaging findings were evaluated. RESULTS: BCVA significantly increased in 22 eyes and decreased in 28 eyes after a mean follow-up period of 14.6 ± 6 months after initial intravitreal intervention. Unfavourable for the long-term visual outcome was the presence of cystoid macular oedema (CMO, p < 0.001), whereas an early response at 5 weeks into therapy indicated a positive outcome (p = 0.016). The initial central macular thickness measured by OCT, the type of agent used in monotherapy, age and gender were without influence on long-term visual acuity. CONCLUSIONS: An initial CMO is unfavourable for the prognosis of long-term visual outcome of DMO. Hence, benefit from intravitreal treatment with bevacizumab and/or TA is more likely in the early stages of chronic DMO before CMO has evolved. In eyes without CMO even a low number of injections is beneficial. An early response following intravitreal bevacizumab or TA is a predictor of long-term benefit.

[Morphology of macular holes after pars plana vitrectomy with silicone oil endotamponade : a pilot study with high resolution Fourier domain OCT (Cirrus OCT)]. / Morphologie von Makulaforamina nach Pars-plana-Vitrektomie mit Silikonölendotamponade : Pilotstudie mit hochauflösendem Fourier-Domain-OCT (Cirrus-OCT).

OBJECTIVE: After unsuccessful surgery for macular holes re-vitrectomy is often conducted with silicone oil endotamponade. In the postoperative management uncertainty exists whether the macular hole is actually closed. Standard time domain OCT (Stratus OCT and its predecessors, Carl Zeiss Meditec AG) is rarely successful in depicting the central retina under silicone oil. High resolution Fourier domain OCT (Cirrus OCT) may be superior in delineating macular structures under these conditions. METHODS: A total of 10 eyes from 10 patients were examined with the Cirrus OCT (Carl Zeiss Meditec AG) after vitrectomy with silicone oil for persistent macular holes. Sufficiently clear optical media were a prerequisite for the examination. Macular morphology was analyzed under silicone oil and compared with the findings after silicone oil removal. RESULTS: Of the 10 eyes 5 showed macular hole closure under silicone oil with retinal tissue in the center of the fovea. In 3 eyes there was a shallow subretinal cyst in the center of the fovea and the other 5 eyes showed a persisting hole. The macular hole remained closed after oil removal in all 5 eyes with a foveal contour. In 4 of the other 5 eyes the macular hole reopened and for 1 eye the hole remained stable. CONCLUSIONS: This pilot study showed that the aspect of macular holes under silicone oil seems to influence the prognosis after oil removal. Thus, silicone oil removal as well as further surgery may be planned. The reliable analysis of macular holes under silicone oil has only become possible with high resolution Fourier domain OCT.

[White dot syndrome]. / White-Dot-Syndrom.

The white dot syndromes comprise a group of diseases with a suspected immunological background, which show no systemic manifestations. The characteristic inflammatory changes of the choroid and the retinal pigment epithelium are typically yellow-white foci beneath the retina. Diseases belonging to the white dot syndromes which will be discussed in this article are acute multifocal placoid pigment epitheliopathy (AMPPE), multiple evanescent white dot syndrome (MEWDS), birdshot retinochoroidopathy (BSRC), multifocal choroiditis with panuveitis (MFC/MCP), punctuate inner choroidopathy (PIC), acute zonal occult outer retinopathy (AZOOR) and serpiginous choroiditis, Neither the trigger mechanism nor the pathogenetic development is known with certainty for any of these diseases. Immunological reactions to previous viral infections coupled with a genetic predisposition seem to be a common denominator. Transitions between the individual diseases have also been described.

Prospective documentation and analysis of the pre- and early clinical management in severe head injury in southern Bavaria at a population based level.

Treatment of patients suffering from severe head injury is so far restricted to general procedures, whereas specific pharmacological agents of neuroprotection including hypothermia have not been found to improve the outcome in clinical trials. Albeit effective, symptomatic measures of the preclinical rescue of patients (i.e. stabilization or reestablishment of the circulatory and respiratory system) or of the early clinical care (e.g. prompt diagnosis and treatment of an intracranial space occupying mass, maintenance of a competent circulatory and respiratory system, and others) by and large constitute the current treatment based on considerable organizational and logistical efforts. These and other components of the head injury treatment are certainly worthwhile of a systematic analysis as to their efficacy or remaining deficiencies, respectively. Deficits could be associated with delays of providing preclinical rescue procedures (e.g. until intubation of the patient or administration of fluid). Delays could also be associated in the hospital with the diagnostic establishment of intracranial lesions requiring prompt neurosurgical intervention. By support of the Federal Ministry of Education and Research and under the auspices of the Forschungsverbund Neurotraumatology, University of Munich, a prospective system analysis was carried out on major aspects of the pre- and early clinical management at a population based level in patients with traumatic brain injury. Documentation of pertinent data was made from August 1998 to July 1999 covering a catchment area of Southern Bavaria (5.6 mio inhabitants). Altogether 528 cases identified to suffer from severe head injury (GCS < or = 8 or deteriorating to that level within 48 hrs) were enrolled following admission to the hospital and establishment of the diagnosis. Further, patients dying on the scene or during transport to the hospital were also documented, particularly as to the frequency of severe head injury as underlying cause of mortality. The analysis included also cases with additional peripheral trauma (polytrauma). The efficacy of the logistics and organization of the management was studied by documentation of prognosis-relevant time intervals, as for example until arrival of the rescue squad at the scene of an accident, until intubation and administration of fluid, or upon hospital admission until establishment of the CT-diagnosis and commencement of surgery or transfer to the intensive care unit, respectively. The severity of cases studied in the present analysis is evident from a mortality of far above 40% of cases admitted to the hospital, which was increased by about 20% when including prehospital mortality. The outcome data notwithstanding, the emerging results demonstrate a high efficacy of the pre- and early clinical management, as indicated by a prompt arrival of the rescue squad at the scene, a competent prehospital and early clinical management and care, indicative of a low rate of avoidable complications. It is tentatively concluded on the basis of these findings that the patient prognosis is increasingly determined by the manifestations of primary brain damage vs. the development of secondary complications.

[Diagnosis and follow-up of non-diabetic macular edema with optical coherence tomography (OCT)]. / Diagnostik und Verlaufskontrolle des nichtdiabetischen Makulaödems mithilfe der optischen Kohärenztomographie (OCT).

INTRODUCTION: Objective and quantitative follow-up of macular edema with present clinical methods is limited. We studied to what extent optical coherence tomography (OCT) may be clinically useful in diagnosis and follow-up of non-diabetic macular edema. PATIENTS AND METHODS: We evaluated 106 eyes with non-diabetic macular edema retrospectively considering diagnosis, foveal retinal thickness in OCT, fluorescein angiographic findings and visual acuity. RESULTS: In 60 of 61 eyes (98%) the diagnosis of macular edema was confirmed by fluorescein angiography. There was only a minor correlation between visual acuity and foveal retinal thickness (r=0.32, p=0.001). Follow-up of 24 eyes showed a statistically significant decrease of foveal retinal thickness under therapy from 420+/-165 microm to 354+/-165 microm (p=0,035) as well as a small improvement in visual acuity from 0.30 to 0.38 (p=0.025). CONCLUSION: OCT can diagnose macular edema non-invasively and thus may replace fluorescein angiography as an invasive method. The reduction of macular edema in the course of therapeutic measures can be documented objectively with OCT.

The assessment of the frequency of chews during rumination enables an estimation of rumination activity in hay-fed sheep.

The objective was to assess rumination behaviour and, more specifically, the intra-individual and inter-individual variation of the frequency of chews during rumination (per min) in five Blackhead sheep fed hay at a level of 100% maintenance (experimental period [EP] I), 50% maintenance (EP II) and ad libitum (EP III). Animals ruminated in EP II less (416 min/day) than in EP I and III (558 and 592 min/day, respectively). Mean inter-individual coefficients of variation (CV) of frequency (defined as number of chews/duration of chewing per cycle) were 12.5%, mean intra-individual CV were 2.5%. The respective CVs for the duration of rumination per day were 8.1 and 9.7%, respectively. The level of intake influenced the frequency of chews significantly. It is concluded that the frequency of chews has to be considered in studies investigating chewing behaviour of ruminants. Under the experimental conditions investigated, number of chews during rumination per day could be estimated by the frequency of chewing with nearly the same precision as by using the duration of rumination per day.

[Determination of retinal thickness in relation to the age and axial length using optical coherence tomography]. / Bestimmung der Netzhautdicke in Abhängigkeit von Alter und Achsenlänge mit Hilfe der optischen Kohärenztomographie.

PURPOSE: It is unknown whether the thickness of the retina depends on axial length or on age. We therefore used optical coherence tomography (OCT) to study this relationship. METHODS AND MATERIALS: We recruited 159 subjects aged 13-92 years (205 eyes) without macular pathology. OCT measurements included three horizontal scans and one vertical scan through the fovea. Axial length was determined by an analog high-resolution biometric unit. RESULTS: There was no correlation between retinal thickness and either axial length or age. Mean retinal thickness in the fovea was 142 +/- 18 microns. In the nasal retina thickness was significantly increased to 266 +/- 17 microns, compared to 249 +/- 18 microns in the temporal retina. Retinal thickness in subjects' two eyes was significantly correlated. CONCLUSIONS: Since retinal thickness does not depend upon age or length of the eye, no corrections are necessary when analyzing pathological retinal thickening, such as in diabetic retinal disease.

[Early and late findings with optical coherence tomography (OCT) in patients with postoperative hypotonia]. / Frühe und späte Befunde der optischen Kohärenztomographie (OCT) bei Patienten mit postoperativer Hypotonie.

PURPOSE: To study early and late findings of macular retinal thickness in patients with hypotony following filtering procedures. PATIENTS AND METHODS: 13 patients who had undergone trabeculectomy (9 with antimetabolites) developed ocular hypotony. The macular region appeared normal during biomicroscopy in 8 patients. In the hypotensive phase, macular thickness was measured using optical coherence tomography (OCT). Directly after attempted and successful normalization of intraocular pressure (7 spontaneous, 5 operative, 1 failure) as well as 6 months later, OCT measurements were repeated. Foveal thickness in the hypotonous eye was correlated with visual acuity and foveal thickness in the fellow eye. RESULTS: Intraocular pressure could be raised from a mean of 2.5 +/- 1.3 mmHg to 11.5 +/- 5.5 mmHg and later on to 13 +/- 3.7 mmHg (follow-up). Mean foveal thickness was reduced from 211 +/- 73 microns during hypotony to 170 +/- 44 microns after normalization of intraocular pressure and to 171 +/- 38 microns at late follow-up. Mean visual acuity improved from 0.17 to 0.33 and finally to 0.6. CONCLUSIONS: Despite normal appearance of the macula (8 patients) using biomicroscopy in patients with hypotony, retinal thickness in the fovea is increased. Apart from refractive changes, this retinal thickening can be held responsible for the deterioration of visual acuity in eyes with hypotony. OCT analysis and measurements may be useful to distinguish between retinal thickening that is reversible after normalization of intraocular pressure and cystoid macular edema that leads to permanent visual impairment.

[Findings of optical coherence tomography (OPT) before and after macular hole surgery]. / Befunde der optischen Kohärenz-Tomographie (OCT) vor und nach Makulalochchirurgie.

PURPOSE: We used optical coherence tomography (OCT) for the staging of macular holes and compared our results with clinical and intraoperative findings. PATIENTS: Between 1 January 1997 and 15 October 1998, 80 patients underwent vitrectomy for idiopathic macular holes. In 36 cases we could record an OCT preoperatively and in 24 cases also postoperatively. OCT measurements were analyzed in a blind fashion independent of the clinical pre- and intraoperative findings. RESULTS: Preoperative OCT staging was in agreement with the intraoperative findings in 24 of 36 cases. However, in 8 cases, the macular hole was judged as stage 3 intraoperatively, while OCT revealed a stage 4 hole. Postoperatively, OCT results were consistent with the clinical findings in all 24 cases. CONCLUSION: OCT scans are a valuable adjunct for the pre- and postoperative analysis of idiopathic macular holes. As the posterior hyaloid surface cannot always be reliably identified in OCT, discrimination between stage 3 and 4 is difficult.

[Quantitative and objective follow-up of papilledema with the Heidelberg Retina Tomograph]. / Quantitative und objektive Verlaufskontrolle der Papillenschwellung mit dem Heidelberg-Retina-Tomographen.

UNLABELLED: The Heidelberg retina tomograph (HRT) is a new instrument to analyze the three-dimensional structure of the retina. It is based on confocal laser scanning technology. Scientific interest has so far focused on the follow-up of glaucomatous optic nerve head damage. As parameters such as cup depth and cup volume can be reproduced with a high degree of accuracy, this new instrument may prove to be an excellent tool to follow up swelling of the optic disk. PATIENTS AND METHOD: A total of 21 patients suffering from optic disk swelling of various etiologies were included in a pilot study. Measurements were taken at six different time points. The maximum optic disk elevation and the volume of swelling were evaluated. Visual acuity and the visual field were determined, and fundus photographs were taken. RESULTS: A reduction in optic disk swelling over time may be demonstrated by both morphological parameters and correlates with improvement in fundus changes. The change in the volume of swelling is greater than the change in maximum disk elevation. The course of optic disk swelling differs between patients with anterior ischemic optic neuropathy and those with pseudotumor cerebri. No correlation was found between our measurements with the HRT and functional parameters (visual acuity and visual field). CONCLUSION: The HRT is a good tool for the follow-up of optic disk swelling, particularly optic disk elevation due to increased intracranial pressure.

[Vertebral replacement in palliative tumor therapy. Possible surgical procedures--significant improvement in quality of life]. / Wirbelkörperersatz in der palliativen Tumortherapie. Mögliche Operationsverfahren--erhebliche Verbesserung der Lebensqualität.

Complications associated with spinal metastases encompass not only pain, but often neurological deficits and possibly even paralysis due to transverse lesions. The differential indication for dorsal, ventral and combined surgical procedures depends on the nature and extent of the tumor, and the life expectancy and general state of health of the patient. Surgery must be carried out in good time, before additional damage to the spinal cord occurs. In recent years, 20 patients have been treated by GHG-vertebral body replacement. In 19 of these patients, pain was considerably improved. All patients were able to walk following surgery. Preoperative neurological deficits disappeared, in 9 of 13 patients resulting in a major improvement in the patients' quality of life.

[Changes in orbital hemodynamics caused by nitroglycerin and nifedipine. A study using color duplex ultrasound]. / Veränderungen der orbitalen Hämodynamik durch Glyzerintrinitrat und Nifedipin. Eine Studie mit Hilfe der Farb-Duplex-Sonographie.

Color Doppler imaging has demonstrated orbital hemodynamic changes in diseases such as central vein occlusion, the ocular ischemic syndrome and diabetic retinopathy. Reports of pharmacologically induced changes are, however, rare and inconsistent. In order to verify the sensitivity of color Doppler imaging to demonstrate pharmacologically induced changes in orbital hemodynamics, nitroglycerin and nifedipine served as vasoactive agents with a clear pharmacological spectrum. Twelve healthy volunteers were examined before and after drug application. After the administration of 0.8 mg nitroglycerin, the end diastolic bloodflow velocity was increased in the central retinal artery (before: Vdiastolic 2.2 +/- 1.0 cm/s, after: Vdiastolic 3.1 +/- 1.1 cm/s) as well as the ophthalmic artery (before: Vdiastolic 5.8 +/- 1.7 cm/s, after: Vdiastolic 7.4 +/- 1.8 cm/s). The resistance index of orbital blood flow decreased in all three vessels. After sublingual administration of 10 mg nifedipine, peak systolic blood flow velocity was slightly higher in the ciliary arteries and in the ophthalmic artery (before: Vsystolic 34.7 +/- 4.6 cm/s, after: Vsystolic 37.8 +/- 3.6 cm/s). Blood-flow velocity in the central retinal vein was elevated as well (before: Vmax 3.81 +/- 0.66 cm/s, after: Vmax 4.66 +/- 0.83 cm/s). Those slightly divergent results may be due to the different pharmacological spectrum of the two drugs investigated While nitroglycerin leads to dilatation of venous vessels, nifedipine acts primarily on small arteries. As nifedipine and other calcium channel blockers have been tested in patients with low-tension glaucoma, future color Doppler studies of such a population seem to be promising.

[Color duplex ultrasound. A new procedure in the study of orbital blood vessels in diabetic retinopathy]. / Die Farbduplexsonographie. Ein neues Verfahren zur Untersuchung der orbitalen Gefässe bei Retinopathia diabetica.

Color Doppler imaging is a new noninvasive technique that allows the measurement of flow velocity in small orbital vessels (both arteries and veins). We compared 59 eyes with proliferative, 47 eyes with nonproliferative and 24 eyes with preproliferative diabetic fundus changes with a control group of non-diabetic patients. The central retinal artery, short ciliary artery and ophthalmic artery of each patient were examined. The systolic, diastolic and mean velocity was obtained for each vessel. Differences between the groups were most prominent in the central retinal artery. The perfusion velocity was significantly lower (P < 0.01) in proliferative eyes (Vsyst 5.7 +/- 1.9 cm/s) than in the control group (Vsyst 9.4 +/- 1.4 cm/s) or the nonproliferative eyes (Vsyst 8.3 +/- 1.9 cm/s). In the preproliferative group the velocity distribution varied widely. Consequently, no statistically significant difference could be deduced in relation to either the control group or the group with proliferative diabetic changes. In the ophthalmic artery and ciliary artery no group showed significant differences from normal. Our measurements indicate a definite correlation between the severity of diabetic retinopathy and a decreased flow velocity, particularly in the central retinal artery. Thus, color Doppler imaging may help to identify those diabetic patients who are at high risk of developing severe diabetic retinopathy so that early photocoagulation treatment can be initiated.