[Postoperative ultrasound biomicroscopic evaluation of the tangible position of black diaphragm posterior chamber lenses in congenital and traumatic aniridia in comparison with gonioscopy]. / Postoperative ultraschallbiomikroskopische Bestimmung der Haptiklage von Irisblendenlinsen bei kongenitaler und traumatischer Aniridie im Vergleich zu Gonioskopie.

BACKGROUND: Ultrasound biomicroscopy (UBM) allows to determine the haptic position of posterior chamber lenses (PCL) in relation to adjacent structures. In transsclerally sutured PCLs, the comparison between intraoperatively endoscopically and postoperatively localized haptic positions via UBM showed a correspondence of only 81%. The different localisation of 19% of the examined haptic positions was explained with postoperative dislocation without any proof for this assumption. The purpose of this study therefore was the correlation of UBM results with simultaneously determined haptic positions via gonioscopy in aniridia after black diaphragm PCL implantation. PATIENTS AND METHODS: The haptic positions of black diaphragm PCL implants in 20 patients with congenital and 13 patients with traumatic aniridia were determined via UBM (50-MHz-probe) and gonioscopy 44.4 (6-75) months postoperatively. RESULTS: 39/66 haptic positions could be localized in gonioscopy as well as in UBM. 38 haptics (97.4%) showed the same position in both examination techniques. Determination of the haptic position through one of the two examination techniques was impossible in 27/66 haptics (11 haptics in gonioscopy, 16 haptics in UBM). Reasons for this were primarily haptic position behind iris remnants and corneal opacities in gonioscopy and scarring of the ciliary body in UBM. CONCLUSIONS: The validity of UBM in localization of PCLs was confirmed gonioscopically, which also confirms our prior assumption of postoperative displacement of IOL-haptics after transscleral suturing in about 20% of cases. Scarring of the ciliary body was the most important obstacle in the determination of PCL haptic positions in relation to adjacent structures.

[Intravitreal injection of cidofovir in cytomegalovirus retinitis]. / Intravitreale Injektion von Cidofovir bei CMV-Retinitis.

BACKGROUND: CMV retinitis is the most common opportunistic ocular infection and the main cause of blindness in AIDS patients with a T-helper cell count < or = 50/microliter. Cidofovir is a nucleotide analogue with a long half-life time after phosphorylation intracellularly. It is effective against CMV and can be given intravenously and intravitreally. The aim was to offer an alternative therapy for CMV retinitis to patients who could not receive standard treatment because of contraindications or refused it. The efficacy and tolerance of intravitreal injections of cidofovir should be evaluated. PATIENTS AND METHODS: We treated 16 eyes of 12 patients. The total number of injections with 15 micrograms of cidofovir each was 49, with an average of 3 injections per eye. The duration of follow-up was 75-295 days (median 170 days). Probenecid was given concomitantly. Injections were repeated after 6-10 weeks. Secondary prophylaxis of CMV organ infection was done with oral ganciclovir. RESULTS: Within a few days all areas with active retinitis turned into scars following the first injection. Under consequent treatment no reactivation was observed. Four eyes developed a mild iritis with hypotony within a mean time of 12 days after injection. All responded rapidly to topical steroids. None had a persisting loss of vision. Two eyes developed cystoid macular edema (CME). Two patients stopped anti-CMV treatment (ganciclovir orally and injections), followed by a recurrence after an average of 64-days. CONCLUSIONS: Intravitreal injection therapy with 15 micrograms cidofovir and concomitant oral probenecid is a valuable and safe alternative treatment for CMV retinitis in AIDS patients. Its main complication is iritis with hypotony, which is effectively treatable with topical steroids. No complications caused by the injection technique itself were noted. The occasional observation of CME in otherwise quiet eyes, however, is probably drug-related.

[Local therapy in treatment of cytomegalovirus (CMV) retinitis in AIDS. The ganciclovir implant (pellet)]. / Lokaltherapie zur Behandlung der Zytomegalievirus(CMV)-Retinitis bei AIDS. Das Ganciclovirimplantat (Pellet).

BACKGROUND: Cytomegalovirus (CMV) retinitis with AIDS has been treated either systemically or locally by weekly intravitreous injections. An intraocular device now offers a new therapeutic approach. We investigated its efficacy in preventing progression of CMV retinitis without additional systemic therapy. Conversely, we also studied the risks and disadvantages of this method of drug administration. PATIENTS AND METHODS: In our study 46 devices were implanted in 28 patients. All patients were pretreated with systemic medication. Systemic treatment was stopped on the day of surgery. RESULTS: Severe perioperative complications occurred in one patient, who developed retinal detachment after surgery. Most patients showed no relapse of retinitis with the implant, though they did not receive systemic treatment for 8.1 months on average. Only 20% of our patients presented with extraocular CMV disease. Thirty-five percent (n = 17) of patients with unilateral retinitis developed CMV retinitis in the primary uninvolved fellow eye. After implantation of a device into this eye also progression could be stopped without additional systemic treatment. Two patients showed progression of retinitis due to an empty ganciclovir reservoir. A second device was implanted without removal of the first. CONCLUSIONS: The intraocular ganciclovir device appears to be an effective treatment for CMV retinitis with few disadvantages. Time to progression of retinitis tends to be prolonged compared to systemic treatment.