Zoonotic intravitreal Onchocerca in Hungary

OBJECTIVE

To report the case of a 65-year-old male patient from western Hungary who presented with rapidly progressive peripheral visual field (VF) loss and the sensation of an actively moving object in his central VF.

DESIGN

Interventional case report. METHOD/INTERVENTION: A live nematode was removed from the anterior vitreous cavity by pars plana vitrectomy.

RESULTS

The worm was successfully removed surgically, and the patient had an uneventful recovery. The nematode was identified as an immature filaria, most likely a member of the genus Onchocerca.

CONCLUSIONS

Only 3 previous reports exist of human infection of the eye caused by zoonotic Onchocerca, 2 involving the subconjunctiva and 1 the cornea. Although rare, zoonotic onchocercal infection of the eye must be considered a differential diagnostic entity even in temperate climates.

Recurring transitory blindness caused by primary marginal pigment epithelial iris cysts

PURPOSE

To report four cases of primary pupillary pigment epithelial iris cysts, all members of one family, in which two of the patients had recurring transitory visual impairment.

METHODS

Observational case series. History was taken, the patients were examined with slit-lamp and ultrasound biomicroscopy, and surgically removed cyst tissue was examined with transmission electron microscopy.

RESULTS

Pupillary pigment epithelial cysts of the iris generally show an autosomal dominant heredity pattern, with occasional lack of penetrance. In two of our cases, the size and location of the cysts caused visual symptoms, necessitating surgical removal. The cyst wall consists entirely of pigment epithelial cells.

CONCLUSION

The origin of pupillary pigment epithelial cysts is unclear, and a hereditary background is very likely. Their clinical significance is in their similarity to pigmented tumors of the iris. They may also be indicative of coexisting systemic disease. In symptomatic cases, treatment is indicated.

A catheter technique in ophthalmic regional anaesthesia. Clinical investigations

BACKGROUND

Usually general anaesthesia is chosen if ophthalmic surgery of longer duration is expected. Our goal was to introduce a flexible catheter preoperatively into the extra- or intraconal space and to provide sufficient anaesthesia by continuous administration of a local anaesthetic via the catheter.

METHODS

The continuous anaesthetic technique was applied in 28 patients undergoing vitreoretinal surgery. An indwelling catheter was introduced in 20 patients into the intraconal and in 8 patients into the extraconal space. In 6 patients, the position of the catheter was controlled by ultrasound examination prior to the injection of the local anaesthetic agent.

RESULTS

For all patients adequate anaesthesia could be achieved and maintained with continuous retrobulbar administration (CRA) of a local anaesthetic by catheter. There were two patients who experienced moderate pain intraoperatively during continuous peribulbar administration (CPA). No complications occurred with the placement of the catheters. The catheter did not disturb the surgeon or the process of the ophthalmic surgery.

CONCLUSIONS

Continuous administration of a local anaesthetic agent via an indwelling catheter into the intraconal space allowed ophthalmic anaesthesia without time restriction. Thus, CRA is a good alternative to general anaesthesia for patients undergoing long-lasting ophthalmic surgery.

A catheter technique in ophthalmic regional anaesthesia. Cadaver experiments

BACKGROUND

Regional anaesthesia for ophthalmic surgery is generally accomplished by peri- or retrobulbar techniques. Depending on the duration of ophthalmic surgery, reblock might become necessary. Our goal was to invent a catheter technique for ophthalmic regional anaesthesia that enables the user to administer local anaesthetics intraoperatively into the peri- or retrobulbar space continuously.

METHODS

Twenty-five adult cadaver orbits of normal size and anatomy were used for the experiments. A flexible catheter was introduced transcutaneously or transconjunctivally into the extra- or intraconal space. Methylene blue solution was injected through the catheter.

RESULTS

Using the same transcutaneous retro- and peribulbar technique, it was possible to introduce flexible catheters into a proper position of the cadaver orbits. The injected dye was found intra- or extraconally.

CONCLUSION

Examining the spread of the dye in the orbit, we concluded that it is possible to provide ophthalmic anaesthesia for surgery through an indwelling catheter. We proved that continuous or intermittent administration of a local anaesthetic agent into the extra- or inraconal space can be achieved and this technique may allow us to maintain anaesthesia as long as it is necessary.

[Growth inhibition of intraocular proliferative explants under in vitro conditions by verapamil]

BACKGROUND

For the treatment of non neoplastic proliferations in the fundus, a nontoxic, proliferation-inhibiting long-term therapy would be desirable in addition to vitreoretinal surgery. In theory, the use of calcium channel blockers as a means of prevention appears promising.

METHODS

In order to test the action of Verapamil in the above application, 42 preretinal, epiretinal and subretinal membranes were removed during pars plana vitrectomy between May, 1991 and June, 1992. Following crushing, these were cultured under cell culture conditions.

RESULTS

Cell division outside the membranes was seen in 27 cases. In 13 cases the minimum cell count was approximately 1000 per primary culture. Subcultures were prepared from each of the latter, the cells having been divided into four portions. Two of the samples were diluted with Verapamil in a concentration of 0.25 microgram/ml. When cell fusion began, the number of intact cells in each sample was determined. Verapamil inhibited growth significantly (significance level of 0.93, P < 0.01).

CONCLUSIONS

A larger number of cases would have to be studied to permit more comprehensive conclusions.

[Isolated leukemic iritis in childhood]

Case report on a child with acute lymphogenous leukemia. Although there was constant hematological remission she developed an isolated leukemic iritis and secondary glaucoma. The clinical picture showed a characteristic stratification of the hyphema. After the patient had remained seated for a prolonged period of time the leukemic cells settled above the erythrocytes, forming a so-called pseudohypopyon, which diagnostically important. Cytologic examination after anterior chamber paracentesis is indispensable in order to establish the etiology of the disease. Isolated leukemic iritis may be the first sign of a relapse and therefore indicate a need to reinstitute induction therapy.

Age-related difference in radioprotective effect of D-penicillamine

D-Penicillamine, previously suspected to have a beneficial effect on the occurrence of severe retrolental fibroplasia among very low birth weight infants, was tested to determine the extent to which this drug modifies acute radiosensitivity on 3- to 4-day-old mice in comparison with adult animals. It was found that the radioprotective effect of penicillamine, given in doses of 3,000 mg/kg i.p. 60 min before whole-body exposure to 6-10 Gy of 60Co gamma rays, was greater in 3- to 4-day-old mice than in adult animals. These data seem to be compatible with the view that D-penicillamine, by virtue of its antioxidant action, may reduce the toxic effects associated with exposure of the newborn infant to hyperoxia, specifically retrolental fibroplasia and bronchopulmonary dysplasia.

Local lymphokine production in ocular inflammatory diseases

We took samples of the aqueous humour and subretinal fluid from 12 patients suffering from various types of ocular inflammation. The presence of leucocyte migration inhibition factor in these fluids was determined using the leucocyte migration inhibition test. Our results indicated that this test differentiated ocular inflammatory reactions due to cell mediated immunity from those due to other mechanisms.

[Conjunctivitis caused by fly larvae (author's transl)]

The author presents a case of ophthalmomyiasis externa which caused conjunctivitis. The larvae which were visible in photomicrographs were immobilised in paraffin oil.