Vitreoretinales Traktionssyndrom bei multipler Sklerose

Retinal periphlebitis in patients with multiple sclerosis

Background/Aim. Multiple sclerosis (MS) is an immunemediated disorder of the central nervous system (CNS), characterized by inflammation, demyelination and axonal loss. Retinal periphlebitis (RP) is often present in MS patients with similar evolution and histopathological changes as MS lesions. The aim of this study was to analyze the presence of RP in MS patients during different clinical phases, and its connection with impairment of blood-brain barrier. Methods. The study included 45 patients (26 females and 19 males) with MS. Their average age was 33.2 ? 8.1 years. There were 28 patients with relapsing-remitting (RR) form, 7 with primary progresive (PP) and 10 with secondary progressive (SP) form of MS. There were 27 patients in the relapse and 18 patients in the remission phase. The average MS duration was 7.48 ? 1.3 years. Ophthalmological, neurological and MRI examination were performed in all the patients, as well as cerebrospinal fluid sampling. Albumin ratio and IgG index were calculated in all the patients. Results. There were 9 patients with RP, and 36 without it. MS duration was significantly longer in the RP group. RP was much more common in the progressive form and was not present in the remission phase of MS. Albumin ratio values were increased in the group with RP. IgG index and IgG synthesis according to Tourtellotte formula, were statistically higher in the group of patients with RP. The values of visual evoked potentials (VEP's) latency were significantly higher in the group of patients with RP. Conclusion. The presence of RP is a reliable indicator of MS activity and might be considered as a parameter for monitoring the disease activity and effects of the treatment.

Vitreous Hemorrhage in Multiple Sclerosis-Associated Uveitis

PURPOSE

To report on six patients who developed vitreous hemorrhage (VH) in the course of intermediate uveitis (IU) associated with multiple sclerosis (MS).

METHODS

Observational case series.

RESULTS

Six out of 25 patients (24%) with IU and MS seen at two tertiary centers developed VH. Average age at onset of MS was 26 years and average age at the onset of IU was 25 years. IU developed before the onset of MS in four of the six patients (67%). All patients had IU associated with peripheral phlebitis. The average interval between the onset of IU and the occurrence of VH was five years (range: 0-11 years; VH was the initial sign of uveitis in 2 patients). VH cleared spontaneously in all cases; however, subsequent retinal detachment developed in two eyes. All six patients had ischemic retinal areas and four had subretinal neovascularizations. Optimal visual acuity five years after VH varied from no light perception to full visual acuity. The causes of diminished acuity included optic neuritis, cystoid macular edema (CME), and retinal detachment.

CONCLUSION

The possibility of MS-associated uveitis should be considered in patients with IU and VH.

Klassifikation biomedizinischer Forschungsberichte als Grundlage evidenzbasierter Medizin in der Augenheilkunde

BACKGROUND

Evidence-based medicine requires careful appraisal of published data derived from experimental and clinical studies. Based on classification of biomedical research reports, evidence levels can be determined and recommendations for therapeutic decisions can be made.

METHODS

A classification system for clinical studies was developed. It was evaluated in classifying the reports published in Der Ophthalmologe during 2003-2004 (study design: descriptive cross-sectional study, case series).

RESULTS

In the 2-year interval, 70 longitudinal and 95 cross-sectional studies were published. The vast majority of the longitudinal studies were interventional cohort studies. Not considering case reports, 73% of the original articles were longitudinal prospective studies, 1% were retrospective (case-control) studies, and 26% were cross-sectional studies.

CONCLUSIONS

The study design of all published articles could be classified using the classification system. This classification system proves to be applicable in the context of clinical studies in ophthalmology and may be helpful in the process of critical appraisal of the literature and synthesis of clinical evidence and an evidence-based recommendation.