[Detection of hepatitis C virus RNA in tear film of a patient with recurrent peripheral corneal ulcers]. / Nachweis von Hepatitis-C-Virus-RNA im Tränenfilm eines Patienten mit rezidivierenden peripheren Hornhautulzera.

BACKGROUND: There are conflicting reports on the role of hepatitis C virus in corneal pathology. PATIENT: A 58-year-old male patient presented with recurrent peripheral corneal ulcers and corneal thinning in the left eye. There was a bilateral vascular pannus formation and a decreased ocular wetting measured by Schirmer testing. The posterior ocular segment was normal. There was no sign of any systemic rheumatic disease. Serological testing detected antibodies against hepatitis C virus. Hepatitis C virus RNA testing using a quantitative polymerase chain reaction method revealed hepatitis C virus RNA in serum (> 3.2 million copies/ml) and in tear samples (18,000 copies/ml) of the patient. In a control group of 7 consecutive patients with hepatitis C virus RNA detection in the serum but without ocular pathology, no hepatitis C virus RNA was detected in tear samples (detection limit: 1000 copies/ml). CONCLUSIONS: Detection of hepatitis C virus RNA in lacrimal fluid of a patient with recurrent peripheral corneal ulcers may indicate a pathogenic role of hepatitis C virus in corneal pathology. Especially, since our patients with systemic hepatitis C virus infection but without ocular changes did not show hepatitis C virus RNA in their tears. Therefore, patients with recurrent corneal ulcers of unknown origin should be tested for systemic hepatitis C virus infection.

[Transitory intrathoracic and -abdominal pressure elevation in the history of 64 patients with normal pressure glaucoma]. / Transitorische intrathorakale und -abdominale Druckerhöhung in der Anamnese von 64 Patienten mit Normaldruckglaukomen.

BACKGROUND: As one pathogenetic factor in normal-tension glaucoma an individually elevated sensitivity of lamina cribrosa regarding intraocular pressure fluctuations is postulated. Aim of this study was to evaluate patients with normal-tension glaucoma for the exposure to potential, clinically undetected transient elevations of intraocular tension due to increased intrathoracic and -abdominal pressure. PATIENTS AND METHODS: A survey of 64 patients of the "Erlanger Glaucoma registry" with normal-tension glaucoma (NTG) and 64 patients with primary open angle glaucoma (pOAG) as control group were performed with regard to activities respectively diseases causing intrathoracic or -abdominal pressure elevation (1. weight lifting, 2. playing high resistance wind instruments, 3. chronic asthma/cough, 4. obstruction of the urinary system, 5. constipation). Both groups were matched regarding age (median: 61 years), sex (24 male, 40 female), visual field defects (mean defect: NTG 4.4; pOAG 4.7), visual acuity (median 1.0 +/- 0.2) and systemic diseases (diabetes mellitus, hypertension, cardiac disease). RESULTS: Among patients with NTG there were 45% (29/64 patients) with activities respectively diseases causing intrathoracic or intraabdominal pressure elevation in their medical history compared to 11% (7/64) among patients with pOAG. Male patients with normal-tension glaucoma showed with 62% the highest frequency of such activities (among them 4/24 high resistance wind instrument playing, 5/24 urinary system obstructions, 4/24 long time weight lifting). Female patients with normal-tension glaucoma most frequently presented with a history of weight lifting (11/40). CONCLUSION: Patients with glaucomatous optic nerve atrophy without evident intraocular pressure elevation compared to patients with pOWG more frequently report activities or diseases causing intrathoracic/-abdominal pressure elevation in their medical history. This may suggest an additional pathomechanism in normal-tension glaucoma. Therefore patients may be adviced on these potential risk factors.

[Adamantiadis-Behçet syndrome: fluorescein angiography and choroid ischemia]. / Das Adamantiadis-Behçet-Syndrom: Fluoreszenzangiographie und choroidale Minderperfusion.

BACKGROUND: Adamantiadis-Behçet's disease is a chronically progressing multisystemic disorder. The underlying disease mechanism is an obliterative vasculitis of unknown etiology. Main clinical symptoms are oral and genital aphthous ulcers and intraocular inflammations. Additionally, cutaneous, rheumatoid, neural, gastrointestinal, or cardiovascular manifestations may be observed. Diagnosis is based on clinical features since currently no specific laboratory tests or pathognomonic histopathological features are available. Ocular changes may provide important diagnostic clues to the systemic disease. PATIENTS AND METHODS: In a retrospective fashion 196 patients of the Department of Ophthalmology of the University of Erlangen-Nürnberg between 1988 and 1998 with retinal vasculitis seen by fluorescence angiography were evaluated according to the diagnostic criteria of the "Behçet's Disease Research Committee of Japan". RESULTS: Among 196 patients there were 12 patients with Adamantiadis-Behçet's disease. Apart from retinal vasculitis, angiographic features included capillary dropout in 64% (9/14), swelling of the optic disc in 79% (11/14) and irregularly delayed areolar filling of choriocapillaris in the early phase of fluorescence angiography in 43% (6/14) of eyes. There was no statistically significant relationship between severity of the systemic disorder and the activity of the ocular disease. CONCLUSION: Apart from retinal vasculitis, 43% of eyes in patients with Adamantiadis-Behçet's disease presented a delayed choroidal filling in fluorescence angiography as a sign of choroidal involvement of occlusive vasculitis. We observed leakage of fluorescein from the optic disc, which could be due to a secondary inflammation of the ciliary circulation. Inflammatory involvement predominantly of choroidal vessels, as visualized in fluorescence angiography, may be a diagnostic lead in Adamantiadis-Behçet's disease.

[Bilateral papillary edema in cerebrospinal syphilis]. / Bilaterale Papillenschwellung bei Lues cerebrospinalis.

BACKGROUND: Nowadays luetic infections are rarely seen by ophthalmologists. We report on an immunocompetent ophthalmologically asymptomatic patient with bilateral papilledema due to perineuritis optici in lues cerebrospinalis. PATIENT: A 47-year old female patient presented with presbyopic complaints. Additionally she reported occasional dizziness with nausea and hearing loss with tinnitus. Visual acuity measured 16/20. There was a bilateral prominent optic disc with indistinct margins and papillary hemorrhagies on the right side and corresponding enlargement of the blind spot in the visual field. Echography revealed bilateral optic drusen. Serological examination suggested lues (TPHA 1:5120, IgM-FTA-Abs-Test 1:320, Cardiolipin 1:640). Cerebrospinal fluid examination indicated an inflammatory process in the CNS without proof of an autochthonous antibody production. CONCLUSION: Even nowadays lues cerebrospinalis must be suspected in patients with bilateral papilledema without visual loss. The ophthalmologist holds an important diagnostic position, because adequate treatment is able to prevent disease progression.

[Lipaemia retinalis due to metabolic syndrome--case report]. / Lipaemia retinalis bei metabolischem Syndrom--Kasuistik.

BACKGROUND: Lipaemia retinalis is a rarely described ocular manifestation of hyperlipidemia. We report on a female patient with visual loss and visual field defects associated with lipaemia retinalis due to a metabolic syndrome. PATIENT: A 45-year-old female patient presented with bilateral slowly progressing visual loss. Additionally, there were eruptive xanthomatas all over the body. Visual acuity measured 0.2 in both eyes. There was a bilateral creamy discoloration of retinal vessels with a salmon-colored fundus. The peripheral visual field was reduced. Laboratory findings indicated a severe mixed hyperlipidemia (triglyceride 11,694 mg/dl, cholesterol 1724 mg/dl). Immediately initiated therapy to normalize the metabolism resulted in improvement of clinical symptoms. CONCLUSION: Lipaemia retinalis is an useful clinical indicator for triglyceridemia. Persistent lipaemia retinalis may lead to visual loss and visual field defects and may be a sign of severe metabolic disturbances. To prevent cardiovascular complications immediate treatment is necessary.

Catecholamine cell groups innervating infant rat somatosensory cortex.

HRP was injected into somatosensory cortex of rats 2-8 days of age. In locus coeruleus, ipsilateral to the injection, neuronal somata were retrogradely labeled. A few neurons located in the region of cranial nerve VII, ipsilaterally, were also labeled and may represent neurons from cell group A5. No other cell groups in mid- and hindbrain contain labeled cells. The labeled cell bodies are likely to represent a major source of brainstem afferents to infant neocortex, demonstrated by other workers. Since these cell bodies are located amidst known catecholaminergic neurons, it is proposed that these neurons give rise to the monoaminergic (MA) pre-synaptic cortical inputs that have been described using ultrastructural cytochemical techniques.