Clinical picture of intermediate uveitis.
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Biomedical subjects
Publications and source records attributed to W Böke.
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We found a multifocal retinochoroiditis in 16 patients (13 female, 3 male). Patients also showed vitreous cells, in some cases pronounced retinal vasculitis, cystoid macular edema and papilledema. The patients ranged in age from 62 to 77 years. The anterior segment was involved in 13 cases. One patient demonstrated subretinal neovascularisation in both eyes. Fluorescein angiograms showed leakage from the retinal vessels, papilledema, macular edema and subretinal neovascularisation. A convincing classification of the described changes within any known disease entity was impossible. The findings most closely resembled a disease described by Dreyer and Gass in 1984 as 'multifocal choroiditis and panuveitis'.
Improved by both technology and new surgical procedures, phacoemulsification of the nucleus has become increasingly important in extracapsular cataract surgery. Phacoemulsification within the capsular bag has proved to be a valuable surgical technique, yielding predominantly good results. In the hands of a carefully trained, critical surgeon, this procedure results in safe in-the-bag fixation of an intraocular lens. In intravitreal surgery it is almost indispensable. In special cases, such as congenital coloboma, hydrophthalmia in adults, pseudoexfoliation syndrome, risk of expulsive hemorrhage, or in cataract surgery following penetrating keratoplasty, phacoemulsification of the nucleus may be surgically safer than expression of the nucleus through a large corneoscleral incision.
Multifocal retinochoroiditis was diagnosed in 16 patients (13 female, 3 male). The patients also had cells in the vitreous, and in some cases pronounced retinal vasculitis, cystoid macular edema and papilledema. The patients' ages ranged from 62 to 77 years. There was anterior segment involvement in 13 cases. One patient had subretinal neovascularization in both eyes. Fluorescein angiograms revealed leaks from the retinal vessels, papilledema, and macular edema. So far, the authors have not succeeded in classifying the changes described as belonging to a known disease entity. The findings most closely resembled a disease described by Dreyer and Gass in 1984 as "multifocal choroiditis and panuveitis". Similar changes were seen by Tiedemann in 1987, in patients with Epstein-Barr viral antibodies.
The present paper describes the results of angiographic examinations of 48 eyes (29 patients) with intermediate uveitis. More than 50% of the cases displayed pathologic changes of the retinal blood vessels, such as increased fluorescein staining of the vessel walls and leakages of the retinal veins or venules, respectively. Some 20% of the eyes manifested cystoid macular edema and/or edema of the optic disk which had gone undetected by ophthalmoscopy. These findings suggest that vascular changes may play a role in the pathogenesis of intermediate uveitis. The question as to whether this disease might be caused rather by retinal vasculitis than by uveitis is discussed.
The implantation of an artificial lens into the retropupillary space, be it the sulcus ciliaris or the capsular bag, has proved to be a safe procedure in the vast majority of cases. However, posterior chamber lens implantation invariable provokes some intraocular inflammatory reaction, though in general only a clinically insignificant one. Occasionally, serious reactions may occur, such as fibrinous exsudates, "toxic lens syndrome", UGH syndrome, and the "intermittent white-out" syndrome. Lens-induced, IOL-induced, or even microbe-induced uveitis or endophthalmitis have also been seen. The clinical pictures of such complications are described. Prophylaxis and appropriate therapeutic measures are outlined. With regard to postoperative inflammatory reactions whose etiology is unclear, the potential role of the following factors is discussed: lens material, lens manufacturing technology, sterilization, and sulcus fixation vs. capsule fixation. Presently, there is no evidence of any obvious relationship between these factors and major inflammatory responses. However, patients suffering from glaucoma, diabetes, or uveitis seem to be more prone to significant postoperative reactions than others. Generally, in cases of unusual intraocular inflammation following posterior chamber lens implantation, the various clinical pictures described here should be taken into consideration. The possibility of a slowly developing microbe-induced endophthalmitis should not be overlooked.
Eyes suffering from cataract and glaucoma often present particular situations which require particular surgical approaches. The technique to be chosen mainly depends on the depth of the anterior chamber, on the state of the pupil, and on whether or not a fistulizing operation has already been performed. According to the given situation, different surgical options need to be considered. Five such different situations are presented and relevant surgical procedures are described. Although lens implantation in glaucoma usually proves to be more difficult than in normal cataractous eyes, careful selection of an appropriate surgical technique usually provides a good surgical result.
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A total of 301 posterior chamber lenses implanted consecutively by one surgeon were examined on postoperative days 3-7 with special regard to both centering and the position of the haptics. It was possible to evaluate 296 eyes. In these, 83.1% of the lenses were ideally centered, while 16.9% were found to be slightly eccentric. There was one serious lens dislocation. The position of the haptics was evaluated in 245 eyes. The attempt to fix both haptics in the sulcus was achieved in 74.7% of the cases. Of the implants fixed in the sulcus, 96.2% were ideally centered. In the remaining cases 11 lenses were fixed entirely in the capsule but in 51 one loop was in the sulcus and the other in the capsule. While the lens is usually centered well when both loops are in the capsule (81.8%), it is significantly less well centered if one loop is fixed in the sulcus and the other in the capsule (41.2%). The data are discussed.
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Regarding immunopathogenesis of the Vogt-Koyanagi-Harada syndrome (VKHS), peripheral blood lymphocytes of a female patient with this disease were tested for sensitization against several antigens such as myelinic basic protein (BP) and uveoretinal, brain and spleen tissue homogenates. For comparison, cells of seven patients with chorioretinitis only and cells of six patients with encephalitis of unknown etiology were also tested. Cells of healthy donors served as controls. The electromobility test and the leucocyte migration test were used as in vitro test systems for cell-mediated immunological reactivity. The results show a strong sensitivity against BP and uveoretinal and brain tissue homogenates in VKHS. In the patients suffering from chorioretinitis, a strong reactivity against uveoretinal homogenate only was found, while in patients with encephalitis, responses to brain antigens only were observed. Reactions towards spleen tissue homogenate were negative in all experiments. The extent to which this tissue-specific immunological reactivity, which is different from the monoreactivity in chorioretinitis or encephalitis, might be a characteristic phenomenon of the VKHS is discussed.
The release of 35S labeled corneal glycoprotein from an allogenic interlamellar corneal graft was studied in randomly selected rabbits. Simultaneously, the uptake of 35S by the recipient animal was investigated. These changes followed for a period of 80 h indicate that there is a constant 35S release fromthe donor cornea and that it is the recipient cornea which takes up the major part of the 35S from the donor. The iris, choroid, and sclera of the recipient also take up a certain percentage of the donor's 35S while the aqueous humor, the optic nerve, and the local lymph nodes take up only minimal amounts.
Report on the clinical and fluorescein-angiographic appearance of leiomyoma of the ciliary body in a 23-year-old woman, the surgical technique and histopathological findings. The tumor was wholly excised and histologically verified, preserving the bulb and a useful degree of vision. The histological differential diagnosis is discussed.