Torsten Schlote

Mesopic vision in myopia corrected by photorefractive keratectomy, soft contact lenses, and spectacles

Purpose: To evaluate contrast vision and glare sensitivity under mesopic conditions in eyes having uncomplicated excimer laser photorefractive keratectomy (PRK) for myopia and in eyes corrected by disposable soft contact lenses, soft contact lenses, and spectacles. Setting: Division of Experimental Ophthalmic Surgery, University of Tübingen, Germany. Methods: The Mesoptometer II test was used to evaluate mesopic vision (glare sensitivity and contrast vision) in 28 eyes of 14 patients wearing disposable soft contact lenses, 20 eyes of 10 patients wearing soft contact lenses, 39 eyes of 20 patients wearing spectacles, 30 eyes of 15 emmetropic patients, and 33 eyes of 22 patients after PRK with a 5.0 mm optical zone. Follow‐up was between 15 and 60 months after PRK (mean 34.5 months). Results: The guidelines of the German Ophthalmologic Society state that patients must recognize Mesoptometer II contrast levels of 1:5 or better with and without glare to meet the minimum legal night‐driving standards for private cars. All eyes with disposable soft contact lenses and soft contact lenses, all emmetropic eyes, and 38 eyes corrected by spectacles recognized contrast levels of 1:5 or better without glare. In contrast, 18 eyes in the PRK group were unable to recognize contrast level 1:5 without glare. With glare, 1 eye in the disposable soft contact lens group, 1 in the soft contact lens group, and 7 with spectacles were unable to recognize the 1:5 contrast level. All emmetropic eyes recognized contrast levels of 1:5 or better; 22 PRK eyes were unable to recognize contrast level 1:5 with glare. Conclusion: Myopic PRK may lead to long‐term impairment of mesopic vision, while soft contact lens use does not seem to markedly influence mesopic vision in eyes with low to moderate myopia.

[Optical coherence tomography in the diagnosis and follow-up of patients with uveitic macular edema].

BACKGROUND Optical coherence tomography (OCT) is a relatively new, noninvasive method and has been well established as an effective diagnostic procedure for the investigation of several macular diseases. Knowledge about the efficacy of OCT in the diagnosis and follow-up of macular edema in uveitis patients is still limited. PATIENTS AND METHODS In the first part of the study, OCT was performed in 22 eyes of 18 patients with anterior or intermediate uveitis who showed angiographic and fundoscopic evidence of macular edema. The OCT results were compared with the visual acuity and fundoscopic and angiographic appearance of macular edema. In the second part of the study, the same patients were followed over a period of approximately 5 months (+/-2 months) and OCT was repeated at different time points during treatment of uveitic macula edema. RESULTS OCT investigation also showed clear evidence of macular edema in all eyes and was not compromised by a low or medium degree of optical haze. Furthermore, OCT investigation revealed marked differences in the individual degree of macular edema (foveal heights 168-810 microm). Diffuse macular edema ( n = 4 ) and different types of cystoid macular edema (several distinguished cysts n = 6, partially or completely confluent cysts n = 11, one marked cyst n = 1) were observed. During the follow-up of the patients, OCT results, visual acuity, and fundoscopic appearance of the macula showed a comparable behavior. In some eyes, a stable visual acuity was accompanied by changes of foveal edema demonstrated by OCT. CONCLUSION Optical coherence tomography is a safe and highly effective method in the diagnosis of macular edema in uveitis associated with low or medium haze of the optical media. Furthermore, OCT investigation seems to be useful in the follow-up of uveitic macular edema under treatment.

Choroidal metastases and choroidal melanomas: comparison of ultrasonographic findings

AIMS The purpose of the study was to analyse, whether the shape and the height to base ratio in B-scan ultrasonography are appropriate to differentiate choroidal melanomas from metastases. METHODS Between 1991 and 1996 16 eyes of 16 patients with choroidal metastases from breast carcinomas and 66 eyes of 66 patients with choroidal melanomas were evaluated ultrasonographically. The diagnosis of choroidal melanoma has been confirmed histologically in all eyes. Irradiated tumours were excluded from the study. Fisher’s exact test and χ2 test were used for statistical analysis. RESULTS Choroidal metastases demonstrated a significantly lower height to base ratio in B-scan (mean 0.18, SD 0.08) than melanomas (mean 0.6 (0.16); p < 0.001). A polygonal tumour surface was significantly more frequent in metastases (13 out of 16 metastases and in six out of 66 melanomas, p < 0.001). A choroidal excavation could be demonstrated in 38 melanomas and in no metastatic tumour (p < 0.001). The reflectivity was significantly higher in metastases than in melanomas. CONCLUSION The combined use of height to base ratio and reflectivity enables a highly significant discrimination between choroidal melanomas and metastases from the breast, thus probably constituting appropriate variables for the clinical differentiation.

Die optische Kohärenztomographie (OCT) als Diagnose- und Verlaufsparameter bei uveitisbedingtem Makulaödem

BACKGROUND Optical coherence tomography (OCT) is a relatively new, noninvasive method and has been well established as an effective diagnostic procedure for the investigation of several macular diseases. Knowledge about the efficacy of OCT in the diagnosis and follow-up of macular edema in uveitis patients is still limited. PATIENTS AND METHODS In the first part of the study, OCT was performed in 22 eyes of 18 patients with anterior or intermediate uveitis who showed angiographic and fundoscopic evidence of macular edema. The OCT results were compared with the visual acuity and fundoscopic and angiographic appearance of macular edema. In the second part of the study, the same patients were followed over a period of approximately 5 months (+/-2 months) and OCT was repeated at different time points during treatment of uveitic macula edema. RESULTS OCT investigation also showed clear evidence of macular edema in all eyes and was not compromised by a low or medium degree of optical haze. Furthermore, OCT investigation revealed marked differences in the individual degree of macular edema (foveal heights 168-810 microm). Diffuse macular edema ( n = 4 ) and different types of cystoid macular edema (several distinguished cysts n = 6, partially or completely confluent cysts n = 11, one marked cyst n = 1) were observed. During the follow-up of the patients, OCT results, visual acuity, and fundoscopic appearance of the macula showed a comparable behavior. In some eyes, a stable visual acuity was accompanied by changes of foveal edema demonstrated by OCT. CONCLUSION Optical coherence tomography is a safe and highly effective method in the diagnosis of macular edema in uveitis associated with low or medium haze of the optical media. Furthermore, OCT investigation seems to be useful in the follow-up of uveitic macular edema under treatment.

Cyclosporin A in der Therapie der chronischen Uveitis im Kindesalter

Es wurden 4 Kinder (Alter 4 – 10 Jahre) mit einer chronischen Uveitis mit einer Kombinationstherapie aus Cyclosporin A (CsA; Initialdosis 2 mg/kg und Tag) und Prednisolon behandelt. Zuvor blieben eine alleinige systemische Kortikosteroidtherapie oder die Kombinationstherapie aus Kortikosteroiden und Immunsuppressiva erfolglos. Bei 1 Kind mit Uveitis anterior bei juveniler chronischer Arthritis (JCA) gelang die dauerhafte Kontrolle des intraokularen Reizzustands bei Erhalt der Sehschärfe unter niedrig dosierter, alternierender Kortikosteroidtherapie. Bei 1 weiteren Kind konnten wir eine bis dahin nicht erreichbare Reduzierung der Entzündungsaktivität beobachten, waren jedoch mehrfach zu einer vorübergehenden Erhöhung der Kortikosteroiddosis gezwungen. Bei den beiden übrigen Kindern konnte keine dauerhafte Reduzierung des intraokularen Reizzustands erreicht werden, so daß die Therapie mit CsA abgebrochen werden mußte. Ernsthafte Komplikationen wurden bei einem Therapiezeitraum von 11 bis zu 26 Monaten nicht beobachtet, jedoch kam es bei allen 4 Kindern zur Ausbildung einer moderaten Hypertrichose, bei einem Kind zu einer Gingivahyperplasie. Unseren bisherigen Erfahrungen zufolge stellt bei schweren Verlaufsfällen einer chronischen Uveitis im Kindesalter die Kombinationstherapie aus Cyclosporin A und systemischen Kortikosteroiden, niedrig dosiert, eine Alternative gegenüber einer alleinigen Kortikosteroidtherapie oder anderen Immunsuppressiva dar.Four children, 4 to 10 years old, with chronic uveitis were treated with cyclosporin A (CsA; starting dosage 2 mg/kg per day) and prednisolone. All children had previously received systemic steroids and/or cytotoxic agents, which resulted either in a poor therapeutic effect or in intolerable side effects. In one child, suffering from uveitis in combination with juvenile rheumatoid arthritis, a complete reduction of intraocular inflammation was achieved. In a second child treatment resulted in a marked reduction of inflammatory activity with stabilization of visual function, although a temporary increase in the steroid dosage was necessary at one stage. In the remaining two cases therapy failed to improve the intraocular inflammation. During the time of treatment, ranging from 11 to 26 months, no serious side effects were observed. All patients developed moderate hypertrichosis and one child gingival hyperplasia. In our <\d> experience, cyclosporin A (CsA) combined with low-dose systemic steroids is useful as a therapeutic alternative to steroids alone and to other immunosuppressive agents in severe cases of chronic uveitis in childhood.

Recurrent corneal ulcerations with perforation in keratosis follicularis (Darier-White disease)

Darier-White disease, also known as keratosis follicularis, is a relatively common genodermatosis (frequency between 1 in 36 000 and 1 in 100 000) with autosomal dominant inheritance and late age of onset.1 Clinical features consist of disseminated warty papules and plaques with an affinity to the seborrhoeic areas of the body. The disease may be exacerbated by sun exposure or sweating and never remits. Ocular involvement in keratosis follicularis is relatively uncommon. Most of the affected patients have dry eye syndrome with and without Sjogren’s syndrome. Possible corneal manifestations are peripheral arcus lipoides-like opacifications, asymptomatic nebular dot-like opacities of the peripheral corneal epithelium, and central epithelial surface irregularities.2–4 Involvement of the eyelids and association with retinitis pigmentosa, subnormal dark adaption, and post-cataract extraction staphylococcal endophthalmitis may also occur.4,5 We describe the first case of recurrent severe bilateral corneal ulcerations with perforation in a female patient with keratosis follicularis. A 74 year old woman was referred to the university eye hospital with complaints of redness and reduced visual acuity in the left eye. She had no significant ocular history. …

[Blinking activity during visual display terminal work. 2: reduced blinking and therapeutic approaches].

ZusammenfassungAktuelle Untersuchungen, die auf der Basis einer nichtinvasiven und automatisierten Messmethode über ein längeres Zeitintervall durchgeführt wurden, zeigen neben einer massiven Reduktion der Lidschlaghäufigkeit auch starke interindividuelle Unterschiede im Lidschlagverhalten während der Bildschirmarbeit. Die Ausprägung von Lidschlagmustern unterliegt besonders unter erhöhter Konzentration starken kognitiven regulativen Einflüssen auf die Lidschlaghäufigkeit.Die Entwicklung einer individuell ausgerichteten Animation zur dauerhaften Steigerung und Harmonisierung des Lidschlags während der Bildschirmarbeit verfolgt den therapeutischen Ansatz, über eine Verkürzung der verlängerten Expositionsintervalle die drohende Austrocknung und Oberflächenbelastung der Hornhaut und Bindehaut zu vermeiden. Durch ein erstes Computerprogramm konnte die prinzipielle Steigerung der Lidschlaghäufigkeit während der Bildschirmarbeit gezeigt werden. Eine Weiterentwicklung dieses neuen therapeutischen Ansatzes ist vielversprechend.AbstractNew findings based on a noninvasive, automated long-term measurement method revealed interindividual differences in lid movement behavior, existence of blinking patterns, and the dominance of cognitive influence in the regulation of blinking frequency during increased concentration and especially visual attention.The development of an individual blinking animation promises long-lasting increase and harmonization of lid movements during visual display work. Maintenance of the integrity of the ocular surface by preventing surface evaporation and providing sufficient precorneal environment eradicates important pathogenic factors of ocular discomfort. An animation program for stimulation of blinking has been developed. First results showed that an increase in blinking rate initiated by the computer itself is feasible in principle during work at a visual display terminal. Further improvement of this new approach is promising.

Lidschlagaktivität während der Bildschirmarbeit

ZusammenfassungBei bis zu 3/4 aller Bildschirmbenutzer treten okuläre Beschwerden nach längerer Bildschirmarbeit auf. Diese Problematik hat wegen der starken Zunahme von Bildschirmarbeitsplätzen eine hohe ökonomischen Relevanz und gesundheitspolitische Bedeutung. Ein großer Anteil der Beschwerden am Bildschirmarbeitsplatz ist im Sinne eines Oberflächenproblems zu interpretieren und entspricht der Symptomatik eines Sicca-Syndroms.In zahlreichen Untersuchungen konnte die massive Reduktion der Lidschlaghäufigkeit als eine wesentliche Ursache der Beschwerden gefunden werden. Der Lidschlag dient nicht nur der gleichmäßigen Verteilung des Tränenfilms („Scheibenwischer“-Funktion), sondern trägt auch zu dessen Zusammensetzung und Stabilität bei. Bisherige Untersuchungen sind allerdings häufig durch eine große Heterogenität der Messbedingungen gekennzeichnet und deshalb nicht selten zu widersprüchlichen Ergebnissen gekommen.AbstractUp to three-fourths of visual display operators complain about ocular discomfort after lengthy work at a monitor. The increase of displays at work has resulted in a problem area with growing impact for the economy and healthcare. Symptoms overlapping the complaints of dry eye disease point to the joint pathophysiological origin.In numerous studies the drastic decrease in blinking frequency was shown to be an essential cause of dry eye symptoms. Lid movements not only have the purpose of smoothing the precorneal tear film (“windshield effect”), but also affect the composition and stability of the different layers. Unfortunately, previous work has often been limited by the heterogeneity of measurement settings, leading to inconsistent results.

[Blinking activity during visual display terminal work. Part 1: Ocular discomfort and pathophysiological principles].

ZusammenfassungBei bis zu 3/4 aller Bildschirmbenutzer treten okuläre Beschwerden nach längerer Bildschirmarbeit auf. Diese Problematik hat wegen der starken Zunahme von Bildschirmarbeitsplätzen eine hohe ökonomischen Relevanz und gesundheitspolitische Bedeutung. Ein großer Anteil der Beschwerden am Bildschirmarbeitsplatz ist im Sinne eines Oberflächenproblems zu interpretieren und entspricht der Symptomatik eines Sicca-Syndroms.In zahlreichen Untersuchungen konnte die massive Reduktion der Lidschlaghäufigkeit als eine wesentliche Ursache der Beschwerden gefunden werden. Der Lidschlag dient nicht nur der gleichmäßigen Verteilung des Tränenfilms („Scheibenwischer“-Funktion), sondern trägt auch zu dessen Zusammensetzung und Stabilität bei. Bisherige Untersuchungen sind allerdings häufig durch eine große Heterogenität der Messbedingungen gekennzeichnet und deshalb nicht selten zu widersprüchlichen Ergebnissen gekommen.AbstractUp to three-fourths of visual display operators complain about ocular discomfort after lengthy work at a monitor. The increase of displays at work has resulted in a problem area with growing impact for the economy and healthcare. Symptoms overlapping the complaints of dry eye disease point to the joint pathophysiological origin.In numerous studies the drastic decrease in blinking frequency was shown to be an essential cause of dry eye symptoms. Lid movements not only have the purpose of smoothing the precorneal tear film (“windshield effect”), but also affect the composition and stability of the different layers. Unfortunately, previous work has often been limited by the heterogeneity of measurement settings, leading to inconsistent results.

Dopaminrezeptoren des Hornhautepithels und -endothels

BACKGROUND Dopamine is a major neurotransmitter and its two receptor subgroups, termed D1-like and D2-like receptors, are found both in the central and peripheral nervous systems. D1-like receptors signal through increases, D2-like receptors through decreases in cAMP production. Reports about the presence of dopamine receptors in the cornea are rare and inconsistant. The aim of this study was to examine if native bovine corneal epithelial and endothelial cells express dopamine receptors and whether these receptors belong to the D1-like or D2-like group. MATERIALS AND METHODS Dopamine receptors were studied using polyclonal antibodies. The cAMP concentration after receptor stimulation with dopamine was determined by means of an enzyme immunoassay. RESULTS In bovine corneal epithelium and endothelium immunohistochemical staining was positive for D1-like receptors but not for D2-like receptors. Stimulation of corneal D1-like receptors with dopamine revealed a dose-dependent increase of the intracellular cAMP concentration which was blocked by SCH23 390 (a selective D1-like antagonist). CONCLUSION Our data demonstrate that bovine corneal epithelium and endothelium express a functional D1-like receptor positively coupled to adenylyl cyclase and cAMP production. However, at the present time the physiological role of this receptor remains a matter of speculation.