Susac's syndrome: improvement with combined antiplatelet and calcium antagonist therapy.
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Adult↗
Biomedical subjects
S Dithmar
Publications and source records attributed to S Dithmar.
[Confocal scanning laser indocyanine green angiography with the Heidelberg retinal angiograph].
PURPOSE: Indocyanine-green angiography (ICG) has been shown to be a valuable adjunctive technique to fluorescein angiography including further delineation of choroidal neovascularization in age-related macular degeneration. We report on initial clinical experiences with a newly developed infrared confocal scanning laser ophthalmoscope. MATERIALS AND METHODS: Fundus and fluorescein angiography photographs were obtained in 20 patients with various fundus changes. Confocal laser scanning ICG-angiography using the Heidelberg Retina Angiograph (Heidelberg Engineering GmbH, Germany) was performed after injection of 25 mg ICG. The confocal principle ensures that only light reflected from a defined focal plane is detected by the integrated photomultiplier. Excitation wave-length was 795 nm, and emission was recorded above 810 nm. About 60% of the emission is detected. An additional built-in diode laser (830 nm) allowed fundus visualization prior to dye injection. RESULTS: ICG angiography using the scanning laser angiograph showed typical findings as previously reported with other systems. The images were characterized by high contrast. In addition, the retinal vessels were readily visualized in the late phase. By means of the confocal mode different layers of the circulation could be visualized. CONCLUSIONS: The findings indicate that the confocal scanning angiograph is a useful alternative tool for ICG angiography and that it offers similar information obtained by other imaging systems. Advantages compared with previous techniques may include high image contrast, visualization of retinal vessels in the late phase, lower amount of light exposure, direct digital image acquisition and easy practical operation.
Adult↗
[Covered rupture of periocular dermoid cysts. Clinico-histologic study].
BACKGROUND: Dermoid cysts are common periocular tumours that occur in childhood and can, in case of rupture, result in persistent granulomatous inflammation. Histologically signs of chronical inflammation of the wall of the dermoid cyst are occasionally found in dermoid cysts that show no clinical symptoms. The aim of this study is to analyze frequency and etiology of this inflammation. PATIENTS AND METHODS: The charts of 21 patients that were operated on because of a dermoid cyst at Heidelberg University Eye Hospital between 1986 and 1993 have been examined concerning anamnesis, clinical symptoms, localisation of the cyst and incidents during operation. The dermoid cysts were assessed macroscopically, and histologically by means of serial sections (three cuts every 200 microns). RESULTS: Histologically 8 patients (38%), of which only one had clinical symptoms, showed an inflammation of the wall of the cyst. The serial histological sections revealed a hidden rupture, that is a damage of the epithelium with a remaining pseudo-capsule of connective tissue, in these 8 patients. Hidden ruptures occurred proportionately most often at the age of 20 to 40. All cysts with a volume of more than 2197 mm3 showed a hidden rupture. CONCLUSIONS: Hidden ruptures seem to be the reason for inflammations of the wall of a dermoid cyst. By way of the rupture, the content of the cyst gets into contact with the surrounding tissue, which results in a granulomatous reaction to the foreign body with remaining pseudo-capsule, to begin with. Etiologically a hidden rupture is promoted by the growth of the dermoid cyst and the pubertal enlargement of the sebaceous glands in the wall of the cyst. As a hidden rupture may result in a complete one with corresponding clinical symptoms, and as the risk to rupture a cyst during operation is higher in case of a cyst with hidden rupture, we recommend an early operative removal of dermoid cysts, if possible at the age of 3 or 4, but at least within the first 10 years.
Adolescent↗
[Fuchs' heterochromic cyclitis. Clinico-histopathologic findings of nodular iritis].
BACKGROUND: Despite the fact that in 1906 Fuchs described the first case of Fuchs' heterochromic cyclitis histopathologic reports of this disease are still rare. PATIENT AND METHODS: A clinicopathologic correlation of findings in Fuchs' heterochromic cyclitis is presented. In a patient with a history of Fuchs' heterochromic cyclitis for 15 years a secondary open-angle glaucoma developed. Several operations were performed including intracapsular cataract extraction, goniotrephanation (Elliot) and repeated cyclocryotherapy. The eye finally had to be enucleated because of a painful absolute glaucoma. RESULTS: Clinical hallmarks of Fuchs' heterochromic cyclitis in this patient include cataract formation and secondary open-angle glaucoma. Histology revealed accumulations of mononuclear cells on the surface of the iris and the corneal endothelium, as well as sparse inflammatory cells within the anterior chamber. The trabecular meshwork showed an infiltration of mononuclear inflammatory cells, chiefly lymphocytes and plasma cells. DISCUSSION: Accumulations of mononuclear cells on the surface of the iris, which histopathologically have not been described before, could represent the clinicopathologic correlate of Koeppe and Busacca nodules. Histologically, the cell deposits on the iris were similar to those in the anterior chamber and to larger corneal precipitates. It is supposed that the cells, which originally emigrated from the iris vessels, may form primary cell deposits on the iris surface or endothelium. Such iris precipitates may also be secondarily attracted by the endothelium in whole. An autoimmune-reaction against the corneal endothelium may be the underlying reason.
Adult↗