Tissue plasminogen activator for the treatment of postoperative intraocular fibrinous membranes following cataract surgery.

We report on our first two patients treated by intracameral application of tissue plasminogen activator (tPA) for dissolving fibrinous exsudates. Both patients had developed fibrin membranes in the pupillary plane and in the anterior chamber several days after cataract surgery. Injection of 25 micrograms tPA into the anterior chamber resulted in complete dissolution of the fibrin within 1 h of its application.

[Lens epithelium necrosis factor for prevention lens opacity]. / Linsen-Epithel-Nekrose-Faktor (LENF) zur Nachstarverhütung.

Posterior capsule opacification is a common postoperative complication after extracapsular cataract extraction and lens implantation. If the patient's visual acuity is reduced markedly, a capsulotomy with a Nd-YAG laser may become necessary. Various attempts have been made with the aim of developing an injectable solution capable of damaging the epithelial cells of the capsule bag irreversibly and thereby avoiding posterior capsule opacification. This solution should be applied for a short time during the operation. In tissue culture we tested the influence of two injectable solutions [lens epithelial necrosis factor (LENF)] and aqua bidest. on cellular growth. Balanced salt solution served as control. We used human epithelial carcinoma cells, type HEp-2. The results were evaluated by vital staining (ethidium bromide and acridin orange), hemotoxylin staining, autoradiography and measurement of protein and DNA synthesis. The results showed that LENF is capable of damaging 100% of the epithelial cells irreversibly if it is applied for 20 s or longer. The influence of each of these solutions was tested on 20 human capsular flaps, which were excised during the operation. The flaps were immersed for 30 s in the different solutions. Vital staining of these flaps led to the following results: LENF causes a 100% cell damage of all epithelial cells of the capsular flaps. No vital cells remained. On the other hand Aqua bidest. cannot guarantee 100% cell damage of the capsular flap epithelia. Sixty percent of the capsular flaps treated with aqua bidest, showed differing amounts of remaining vital cells.

[Incidence and pathogenesis of ocular symptoms in HIV infection]. / Zur Inzidenz und Pathogenese okulärer Symptome bei HIV-Infektion.

202 patients with HIV infections of different stages [1 (n = 59): symptomless HIV seropositivity, 2 (n = 64): pre-AIDS (LAS = Lymphadenopathy syndrome, ARC = AIDS related complex), 3 (n = 79): AIDS] were prospectively examined. The findings of the first examination were analyzed statistically in a cross-section-study. In 15 AIDS autopsy cases the eyes were examined histopathologically and with immunohistochemical techniques. Patients with stage 1 had only some Sicca syndromes (3%) and neuroophthalmological signs (dyscoria with neurosyphilis) (2%). 14% of the patients with stage 2 had a microvascular retinal syndrome, 11% a Sicca syndrome and 2% neuroophthalmological signs. Among the AIDS patients (stage 3), however, 61% had a microvascular syndrome of the retina, 24% a retinitis resp. choroiditis as an opportunistic infection (in 15% Cytomegalovirus was the causative organism), 16% had neuroophthalmological symptoms, 14% a Sicca syndrome and 5% Kaposi's sarcoma of the eyelids or conjunctiva. The microvascular retinal syndrome was found to be the most sensitive ocular indicator for an advanced stage of HIV infection. Further changes of the anterior eye segments (especially conjunctival vessel abnormalities and precipitates of the corneal endothelium in Cytomegalovirus retinitis) are demonstrated.

[Eye involvement in AIDS]. / Augenbeteiligung bei AIDS.

Between 1984 and 1987 (over two-and-a-half years) 30 hospitalized patients with HIV infections of different degrees of severity were ophthalmologically examined. Ocular involvement was found in 17 patients (approx. 57%). In 16 of these 17 patients with pathologic ophthalmologic findings (approx. 94%), AIDS was already fully developed. Ocular involvement is therefore a sign of poor prognosis. Fourteen patients had a microvascular retinal syndrome and four patients had infectious (chorio-)retinitis (causative organisms: cytomegalovirus in three cases, Cryptococcus neoformans in one). Further findings included sicca syndrome with superficial punctate keratitis in two cases, keratitis in one patient with generalized mucocutaneous candidiasis, Kaposi's sarcoma of the eyelids in two cases, Kaposi's sarcoma of the conjunctiva in one case, papilledema with cryptococcal meningitis in one case, and atypical hordeolum in one case. Morphologic and pathogenetic aspects of the ophthalmologic findings, their importance and course in AIDS patients, and therapeutic problems are discussed.

[High altitude retinal hemorrhages in mountain climbers (author's transl)]. / Netzhautblutungen bei Teilnehmern an Hochgebirgs-Expeditionen.

A report is given on three patients who noticed an acute deterioration of visual acuity after a sojourn at 5000 altitude caused by retinal hemorrhages. We documented both the ophthalmological examinations such as visual acuity, fundus, perimetry and fluorescence-angiography and the systemic results. During the period of about half a year after the incidence of deterioration of visual acuity we followed the course of illness. The pathophysiological mechanism, and therapeutical and prophylactical possibilities are discussed in consideration of the results of other authors.

Low intensity argon laser coagulation in central serous retinopathy (csr).

Mechanisms of light coagulation effects in RPE and detached retina are discussed. 25 cases of CSR are presented in which the leaking point in the RPE was coagulated with an argon laser coagulator, the exposure parameters being set to avoid a whitening of the retina. The results suggest that the retinal whitening and consequently retinal damage does not constitute a criterium for coagulation effectiveness in CSR.