Chorioideremie - Konduktorin und phanotypische auspragung: Eine kasuistik

Choroideremia is a X-linked disease with nyctalopia, visual field constriction und visual acuity reduction in male patient starting in the first decade of life. Female carriers often have no complaints. A 15-year-old male patient complained about loss in night vision and photophobia since 10 years. His best corrected visual acuity was 1.0 on both eyes. Fundus examination revealed a salt-and-pepper pigmentation, multiple islands of retinal pigment epithelium (RPE) and choriocapillaris atrophy as well as pigment clumps in the midperiphery and a central RPE granularity. In the electroretinogramm rods were non-recordable and cone answers decreased. The electrooculogramm was reduced and the visual fields were slightly constricted temporarily. Funduscopy of his mother showed RPE granularity in the midperiphery whereas all other function tests were normal. As the differential diagnose of choroideremia to other diseases like gyrate atrophy or diffuse choriocapillaris atrophy is sometimes a challenge, examination of family members, particularily noting the appearance of the mother's fundus, should help decide the issue.</p

Panretinale photokoagulation mit dem mikrogepulsten diodenlaser bei proliferativer diabetischer retinopathie

Repetitive, short-pulse laser can coagulate the retinal pigment epithelium selectively, while sparing the adjacent outer neuroretina and the choroid. Therefore the functional defects caused by panretinal photocoagulation with conventional laser delivery systems may be reduced or even avoided using a micropulsed diode laser. A panretinal laser treatment was performed in 6 patients with proliferative diabetic retinopathy using an argon laser on one and a micropulsed diode laser on the fellow eye. Pre- and posttreatment examination consisted besides of a complete ophthalmological status, a fluorescein angiography, visual fields and of electrophysiological tests. The argon laser eyes showed a profound loss of response in the scotopic ERG and more absolut scotomas in the peripheral visual fields compared to the micropulsed eyes. Most of the laser burns caused by the micropulsed diode laser could not be detected neither ophthalmoscopically nor angiographically. Some lesions were visible as small laser scars. No regression of the proliferations could be achieved with the diode laser after a follow-up of at least 5 months. The functional damage after panretinal photocoagulation can be reduced using a micropulsed diode laser, but no stabilisation of the proliferative retinopathy could be obtained at the energy levels used.</p

H.E.L.P.- Therapie bei okularen durchblutungsstorungen

By way of an extracorporeal circulation, the HELP-system (Heparin- induced extracorporeal LDL-precipitation) selectively eliminates fibrinogen, LDL-cholesterol, cholesterol, triglycerides and LP(a) from the blood plasma achieving, an immediate improvement of the hemorheological situation. HELP- treatment were administered to 56 (mean age 65.3 ± 9.5 years) with retinal artery or vein occlusions or with nonarteritic anterior ischemic optic neuropathy (AION). The patients received 8 single treatments over a period of 7 weeks. A 40-50% reduction of fibrinogen and LDL after the first procedure significantly lowered whole blood and plasma viscosity as well as RCTT of about 15-20%. Visual acuity increased by two or more Snellen lines in all 4 patients with retinal artery occlusion, in 73.9% of the patients with nonischemic retinal vein occlusion and in 52.6% in the patients with AION after 3 months. Compared to a hemodiluted control group, patients with AION treated with HELP obained a statistically significant improvement of the mean sensitivity of the visual fields. The development of iris neovascularization in ischemic central retinal vein occlusion, was not influenced by HELP- therapy compared to the untreated group. Our studies showed a beneficial influence of HELP-treatment on the hemorheological situation, significant functional improvements were achieved only in patients with nonarteritic AION.</p

Fraktionierte teletherapie mit 25,2 Gy bei subfovealer altersabhangiger makuladegeneration

No beneficial effect was obtained on neither functional nor on morphological results in patients with age-related macular degeneration after radiation treatment with 14.4 Gy in our previous study. In the present prospective study 40 patients - 8 males and 32 females - with a mean age of 75 years and exudative AMD with involvement of the fovea were radiated with a dosage of 25.2 Gy. Visual acuity, visual fields, fluorescein (FA) and indocyaningreen angiography (ICGA) were investigated prior to treatment and 3, 6, 9 and 12 months after treatment. Radiation was administered to the posterior pole with a 8 MV-photon beam from a linear accelerator A dose of 25.5 Gy, 1.8 Gy per day, 5 fractions per week was delivered through a single lateral port. Five patients had classic, well-defined CNV, 35 had occult lesions. After the follow-up period (6 months all patients, 9 months 21, 12 months 12 patients) the visual acuity improved in 1 patient, was stable in 13 and deteriorated three or more lines in 26 patients. A stabilisation or regression of the neovascular complex was not observed in any of the patients. Although the follow-up period of this study is to short to make a final conclusion, the functional results are no different compared to those of our previous study with 14.4 Gy.</p

Die Vulvovaginalkandidose (außer chronisch mukokutaner Kandidose). Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (AWMF-Registernummer 015/072, S2k-Level, Dezember 2013)

Mendling W, Friese K, Mylonas I, et al. Vulvovaginal Candidosis (excluding chronic mucocutaneous candidosis). Guideline of the German Society of Gynecology and Obstetrics (AWMF Registry No. 015/072, S2k Level, December 2013). Geburtshilfe und Frauenheilkunde. 2015;75(4):342-354

Corrigendum: Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis) (vol 58, pg 1, 2015)

Mendling W, Brasch J, Cornely OA, et al. Corrigendum: Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis) (vol 58, pg 1, 2015). Mycoses . 2015;58(5):324