Argyrios Chronopoulos

Okuläre Beteiligung bei Stevens-Johnson-Syndrom und Toxisch epidermaler Nekrolyse

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe reactions of skin and mucous membranes. They are considered as a single disease entity with differing severities and are mainly induced by drugs, less frequently by infections. In 50% of the patients ocular complications occur, which can lead to blindness in the absence of immediate ophthalmological treatment. The acute pattern, the unpredictable course and extreme variations in the manifestation of complications require an interdisciplinary treatment. Early diagnosis and initiation of an intensive lubricating and anti-inflammatory surface care are of utmost importance for the best visual outcome. This article is intended to help ophthalmologists towards a better understanding and interpretation of clinical signs of these conditions with the goal to achieve substantial improvements in visual outcome and of course the patients quality of life.

Traumatic retinal detachment-the difficulty and importance of correct diagnosis

Accurate characterization of a retinal detachment as traumatic is often difficult, but is important because it may instigate a careful search for occult coexistent traumatic pathology, affect the prognosis and the treatment of both eyes, influence insurance coverage benefits and medical-legal determinations, and is essential for epidemiologic studies. We review the epidemiology and pathophysiology of traumatic retinal detachment, common obstacles to correct diagnosis, diagnostic guidelines, and outline categories of traumatic causal relationships. Because there is no generally accepted definition of traumatic retinal detachment, we offer a practical one. Categorization as traumatic should be based on the particular history and physical examination rather than epidemiologic criteria.

Ungewöhnliche Kalzifikation intraokularer Kunstlinsen nach vitreoretinalem Eingriff mit Silikonölendotamponade

PURPOSE Calcification of intraocular lenses (IOL), although nowadays less frequent than in the past, is a well-documented complication that can still necessitate their explantation. Although mostly noted in hydrophilic materials it has been rarely reported in hydrophobic intraocular lenses. We wish to report on two unusual cases of intraocular lense (one hydrophobic and one hydrophilic with hydrophobic surface) calcification following vitrectomy and silicon oil endotamponade. METHODS In the course of treatment both patients underwent multiple ocular interventions due to re-detachment/persistent macular hole including local rt-PA or triamcinolone injection due to persistent postoperative anterior chamber inflammation/macular oedema. Finally and after thorough patient examination with characteristic visual complaints and difficulty in the retinal assessment the extraction of the calcified lenses was considered necessary. The configuration as well as the elemental analysis of the opacified surface of the IOLs was performed by means of high magnification microscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy (EDX). Intraocular and systemic histories of both patients were summarised. RESULTS The scanning electron microscopy and EDX analysis demonstrated massive calcium-based deposits on the surface of the hydrophilic and a diffuse vacuolation and calcification consisting of oxygen (O), silicon (Si), magnesium (Mg), aluminium (Al), sulphur (S) and phosphorus (P) on the surface of the hydrophobic IOL. CONCLUSION The explantation of an IOL due to calcification represents an unusual event. The careful consideration of systemic and ocular factors that promote calcification processes can help reduce the incidence of calcification. Despite all efforts in material production and risk factor analysis, it is not always possible to define or even predict the exact cause of this phenomenon and in the presence of corresponding clinical symptoms IOL exchange remains as the sole option.

Diagnostic Dilemma in Sequential Branch Retinal Vein and Artery Occlusion.

Purpose To report on an unusual case of a branch retinal vein occlusion followed by occlusion of the respective branch retinal artery of the same eye 7 years later, in a young, otherwise healthy man with marginal elevation of antiphospholipid antibodies. Case Report On first presentation, a 30-year-old male patient was diagnosed as having a branch retinal vein occlusion with the sole risk factor of slightly increased diastolic pressure. On second presentation, 7 years later, a transient occlusion of the respective branch retinal artery was diagnosed on the same patient. Extensive ophthalmologic and general medical evaluations were performed including cardiovascular, coagulation, and immunology testing. Coagulopathy screening revealed slightly elevated titers of anticardiolipin IgM and anti–beta 2 glycoprotein-I IgM antibodies, and aspirin prophylaxis was initiated. Conclusions Retinal vascular occlusions are typically associated with well-defined, classical risk factors in older people. In younger, otherwise healthy patients, further autoimmune hypercoagulable disorders are often causal. Our case suggests the contribution of slightly elevated antiphospholipid IgM antibodies, although this remains to be proven.

Case Report: Masquerading Large-vessel Giant Cell Arteritis

SIGNIFICANCE Large-vessel giant cell arteritis (GCA) can be a diagnostic dilemma for the eye care provider because it may not involve the typical cranial arteries. When any of its potential ocular complications are diagnosed, it is important to consider this unusual form of GCA. PURPOSE To report an unusual ophthalmic presentation of large-vessel GCA with sequential bilateral anterior ischemic optic neuropathy and branch retinal artery occlusion. METHODS A 65-year-old previously healthy woman experienced sequential bilateral anterior ischemic optic neuropathy with branch retinal artery occlusion in the absence of other signs and symptoms suggestive of cranial GCA. RESULTS Extensive workup, including temporal artery biopsy, failed to demonstrate vascular inflammation suggestive of GCA or vascular abnormalities, such as atheromatous plaques, but coincidentally revealed a breast tumor, which was excised. Positron emission tomography scan was performed revealing distinct hypermetabolism of the thoracic and abdominal aorta consistent with large-vessel GCA, and corticosteroid therapy was initiated. CONCLUSIONS Large-vessel GCA is an underdiagnosed and undertreated type of GCA that does not typically affect the cranial arteries but rather larger proximal aortic branches. When associated with ocular complications, it can be a puzzling diagnostic dilemma for the eye care provider.

Epstein-Barr-Virus-assoziierte akute retinale Nekrose@@@Epstein-Barr virus associated acute retinal necrosis

ZusammenfassungFallberichtEs wird über eine Epstein-Barr-Virus (EBV)-assoziierte akute retinale Nekrose berichtet. Ein 72-jähriger männlicher Patient stellte sich mit einer progredienten Sehverschlechterung in unserer Ambulanz vor. Im Zuge der Patientenversorgung wurde der hochgradige Verdacht auf eine akute retinale Nekrose gestellt; die Glaskörperbiopsie war positiv nur für das EBV-Genom.ZielsetzungEBV ist selten Ursache einer okularen Entzündung. Anhand dieses Fallberichts möchten wir die Aufmerksamkeit der Kollegen auf dieses ungewöhnliche Ereignis lenken.SchlussfolgerungDas EBV-Screening gehört nicht zum Standard, dessen Berücksichtigung könnte aber in relevanten Situationen wichtige Erkenntnisse liefern, die möglicherweise zu einer Differenzierung zwischen Kausalität und Komorbidität führen könnten.AbstractCase reportThis article reports a case of an Epstein-Barr virus (EBV) associated acute retinal necrosis. A 72-year-old male patient presented in the emergency department complaining of progressive loss of vision. During patient management an acute retinal necrosis was suspected and the subsequent diagnostics from a vitreal body biopsy showed positive results only for the EBV genome.ObjectiveThe EBV is a rare cause of ocular inflammation. With this report we would like to draw the attention of colleagues to this unusual finding.ConclusionAlthough EBV screening is not part of the standard diagnostic procedure, its implementation in relevant clinical situations could possibly assist the differentiation between causal relationship and morbidity.

Epstein-Barr-Virus-assoziierte akute retinale Nekrose

ZusammenfassungFallberichtEs wird über eine Epstein-Barr-Virus (EBV)-assoziierte akute retinale Nekrose berichtet. Ein 72-jähriger männlicher Patient stellte sich mit einer progredienten Sehverschlechterung in unserer Ambulanz vor. Im Zuge der Patientenversorgung wurde der hochgradige Verdacht auf eine akute retinale Nekrose gestellt; die Glaskörperbiopsie war positiv nur für das EBV-Genom.ZielsetzungEBV ist selten Ursache einer okularen Entzündung. Anhand dieses Fallberichts möchten wir die Aufmerksamkeit der Kollegen auf dieses ungewöhnliche Ereignis lenken.SchlussfolgerungDas EBV-Screening gehört nicht zum Standard, dessen Berücksichtigung könnte aber in relevanten Situationen wichtige Erkenntnisse liefern, die möglicherweise zu einer Differenzierung zwischen Kausalität und Komorbidität führen könnten.AbstractCase reportThis article reports a case of an Epstein-Barr virus (EBV) associated acute retinal necrosis. A 72-year-old male patient presented in the emergency department complaining of progressive loss of vision. During patient management an acute retinal necrosis was suspected and the subsequent diagnostics from a vitreal body biopsy showed positive results only for the EBV genome.ObjectiveThe EBV is a rare cause of ocular inflammation. With this report we would like to draw the attention of colleagues to this unusual finding.ConclusionAlthough EBV screening is not part of the standard diagnostic procedure, its implementation in relevant clinical situations could possibly assist the differentiation between causal relationship and morbidity.

[Epstein-Barr virus associated acute retinal necrosis].

ZusammenfassungFallberichtEs wird über eine Epstein-Barr-Virus (EBV)-assoziierte akute retinale Nekrose berichtet. Ein 72-jähriger männlicher Patient stellte sich mit einer progredienten Sehverschlechterung in unserer Ambulanz vor. Im Zuge der Patientenversorgung wurde der hochgradige Verdacht auf eine akute retinale Nekrose gestellt; die Glaskörperbiopsie war positiv nur für das EBV-Genom.ZielsetzungEBV ist selten Ursache einer okularen Entzündung. Anhand dieses Fallberichts möchten wir die Aufmerksamkeit der Kollegen auf dieses ungewöhnliche Ereignis lenken.SchlussfolgerungDas EBV-Screening gehört nicht zum Standard, dessen Berücksichtigung könnte aber in relevanten Situationen wichtige Erkenntnisse liefern, die möglicherweise zu einer Differenzierung zwischen Kausalität und Komorbidität führen könnten.AbstractCase reportThis article reports a case of an Epstein-Barr virus (EBV) associated acute retinal necrosis. A 72-year-old male patient presented in the emergency department complaining of progressive loss of vision. During patient management an acute retinal necrosis was suspected and the subsequent diagnostics from a vitreal body biopsy showed positive results only for the EBV genome.ObjectiveThe EBV is a rare cause of ocular inflammation. With this report we would like to draw the attention of colleagues to this unusual finding.ConclusionAlthough EBV screening is not part of the standard diagnostic procedure, its implementation in relevant clinical situations could possibly assist the differentiation between causal relationship and morbidity.

Unusual bilateral traumatic maculopathy following whiplash injury

An unusual extensive bilateral macular oedema (MO) with spontaneous resolution occurred following a car crash accident. Qualitative and quantitative analysis of the macular region using spectral domain optical coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG) was performed daily during the first 7 days, as well as at 3 and 6 months following the accident. SD-OCT examination demonstrated extensive MO accompanied by neurosensory detachment and subretinal fluid. During the 7 days following the accident there was gradual resolution of the oedema accompanied by visual recovery. One year later no anatomical changes were observed, the mfERG showed complete recovery and visual acuity returned to normal level. Although whiplash is a common injury in motor vehicle accidents, whiplash maculopathy (WMP) is rarely reported, most likely due to underdiagnosis. Here we describe the spontaneous resolution of a severe MO after whiplash injury in a car crash accident.

Small incision iris tumour biopsy using a cavernous sampling forceps

Background The aim of this retrospective report is to describe our experience with the Essen-23G biopsy forceps (Akgül forceps) for biopsies of pigmented iris tumours. Methods In this retrospective study of cases between October 2012 and September 2013, patients with iris tumours and clinical signs for malignancy underwent biopsy to secure the diagnosis. The Essen-23G-forceps was used to grasp and extract tissue through a clear corneal incision. Eventual entry and bimanual manipulation with a 23G mini-scissors was achieved through a second incision. Tissue samples were fixed in a sterile tube for further histopathological and immunohistochemical evaluation. Results Seven eyes of seven patients underwent biopsy using the forceps. The average thickness of the iris tumours was 1.07±0.79 mm. A second corneal incision for scissoring in a bimanual technique was necessary in 5 cases (71%). In 6 cases (85%), a precise histological and immunohistochemical diagnosis was achieved. Complications were limited to minute bleeding at the biopsy site and one case of relative pupil enlargement (anisocoria) without further refractive issues. Conclusions Iris tumour biopsies can be successfully approached using a cavernous 23G intraocular forceps with a low risk for procedure-related complications. The conical interior design allows for removal of whole tissue pieces with minimal manipulative artefacts. An optional bimanual access through a second corneal incision and use of a 23G scissors provides better efficacy.