Szemészet, 2006 (143. évfolyam, 1-4. szám)
2006-12-01 / 4. szám
143. évfolyam (2006) Supplementum I. 75 Methods: A 37-year-old man presented in our Department complaining of blurred vision in the left eye of 3 days duration. Apart from paleness he had no other symptoms. He had no significant ocular or medical history. On examination, visual acuity was 1.0 in the right eye and 1/60 (< 0.02) in the left, with a left afferent pupillary defect. The right fundus was normal, but the left fundus showed signs of central retinal vein occlusion including disc oedema with disc haemorrhages, multiple haemorrhages along the vascular arcades, venous tortuosity and macular oedema. Laboratory examination showed severe anaemia (haemoglobin 3.5 g/dl). Results: Because of this severe anaemia the patient was referred to the Department of Internal Medicine, where he received blood transfusions. A gastroscopy revealed gastrointestinal bleedings caused by a paraesophageal hernia. Cross-sectional spiral computed tomography (CT) showed a large hiatus hernia with intrathoracic stomach. Due to the possibility of life threatening complications laparoscopic surgery was performed to reposition and fixate the stomach. Three months later the haematological state was normal. Ophthalmological follow up investigations showed a decreasing of the macular edema and the haemorrhages. The visual acuity improved from 1/60 to 0.1 during a 6 months follow-up. Conclusions: Central retinal vein occlusion may be a rare complication of anaemia caused by gastrointestinal bleeding. In our case it was the first symptom of the anaemia. There are only a few case reports about central retinal vein occlusion in aplastic and pernicious anaemia. The exact pathophysiological pathway in this case remains unknown. Should we treat suspicious choroidal nevi? Monika Mayer, Dietmar Mattes, Mona Schmutzer, Gerald Langmann Medical University of Graz (Austria), Department of Ophthalmology Background: According to the COMBS study, 37% of suspicious choroidal nevi transform to malignant melanoma. Aim: To present preliminary data of tumour regression and side effects of treatment of small choroidal nevi with a maximum prominence of 2 mm after 1 session of transpupillary thermotherapy (TTT) as an alternative to close follow-up. Methods: A single session of TTT using a diode laser with the slit-lamp adapter (power 390-600 mW, exposure time 1 min., spot size 2 and 3 mm) was performed on a series of patients. Results: 5 patients (6 eyes) with choroidal nevi located outside the macula with a median diameter of 4.8 mm (range 3.5-8.8 mm) and a median prominence of 1.6 mm (range 1.4-2 mm) were treated with a single session of TTT. The best-corrected visual acuity was 20/20 (range 20/200 to 20/20). After a follow-up longer than 12 months a total regression with scar formation occurred in 4 of the 6 eyes. In 2 patients macular pucker developed, in one patient additional vitreous haemorrhage occurred, and consequently a vitrectomy with membrane peeling had to be performed. Conclusions: In our series, the likelihood of side effects increased with the size and the central location of the lesion. Patients offered TTT as an alternative therapy to close follow-up evaluation should be informed about the possibility of side effects like macular pucker and vitreous haemorrhage. Voriconazole as primary treatment for fungal keratitis: Report of 2 cases Monika Mayer, Navid Ardjomand Medical Unversity of Graz (Austria), Department of Ophthalmology Background: Voriconazole is a novel antifungal agent which has been well-established in the treatment of systemic mycosis. The use of voriconazole in the treatment of ocular fungal infection was first described by Reis et al. Several experimental and clinical studies have shown its efficacy against yeasts and moulds. We present two cases of fungal keratitis which were successfully treated with voriconazole as primary treatment. Reports: Case 1: A 38-year-old man with a history of ocular trauma and contact-lens wear was originally misdiagnosed with herpes keratitis and treated with gentamicin/dexamethason and acyclovir ointment. In the follow-up
