The aim of this project was to explore new ways of knowledge engineering that are examplified on liver diseases (hepatology) [1]. Special emphasis was laid on the determination of the strength of confirmation of a present symptom for establishing a disease as diagnostic hypothesis. Variants of the positive predictive value are calculated for this purpose. Other topics of interest were disease hierarchies, cooperating knowledge bases, and systemic interrelationships among symptoms, signs, test results, and diagnoses.

Über die letzten 9 Jahre sind insgesamt 4 verschieden Femtosekundenlaser-Systeme (ein amerikanisches, drei europäische) auf dem Markt der refraktiven Chirurgie in die klinische Anwendung gekommen, wobei die Anzahl der Applikationen (und damit der praktischen Erfahrung) mit den einzelnen Geräten – weltweit gesehen – hoch signifikant differieren.

Das Pseudoexfoliationssyndrom (PEX-Syndrom) zählt heute zu den am häufigsten diagnostizierten Ursachen des Offenwinkelglaukoms, wobei auch eine Assoziation mit einem erhöhten Risiko für Gefäßerkrankungen (z.B. Hypertonie, Angina pectoris, Myokardinfarkt, apoplektischem Insult, retinale Thrombosen) beschrieben worden ist. Ziel dieser Studie war es zu untersuchen, ob mit Hilfe des pulsatilen okulären Blutflusses (POBF) bei diesem Syndrom eine veränderte okuläre Durchblutungssituation zu verifizieren ist.

Excimer Laser Corneal Shaping using an 193 nm Excimer Laser (ArF) provides a possibility for the fabrication of corneal transplants of various forms for various clinical applications such as (epi-)keratoplasty. Another area of application envisioned is the production of 'living contact lenses' for epikeratophakia. A device for lathing and perforating corneal donor tissue with a scanning laser beam is presented. A new ablation algorithm (Optimized Scanning Laser Ablation) was recently developed and increased the quality of lenticules and donor buttons considerably.

Flow cytometric analysis employing MRC OX 6 and MRC OX 17 monoclonal antibodies recognizing determinants on RT1.B or RT1.D molecules, equivalent to murine I-A and I-E, respectively, was used to detect rat MHC class II antigen (Ag) expression. Approximately 5 % of freshly isolated rat bone marrow cells (BMC) expressed RT1.B and over 30 % displayed RT1.D molecules. The RT1.D+ cells were W3/13(+), OX 7(+), OX 19(-) and OX 22(-). After one week culture of BMC with murine recombinant granulocyte/macrophage colony-stimulating factor (GM-CSF), regardless of concentrations, 90 to 95 % of the cells were scored as bone marrow-derived macrophages (BMDM Phi), and over 30% expressed both RT1.B and RT1.D Ag. GM-CSF increases the percentage of BMDM Phi bearing MHC class II Ag in a concentration-dependent manner. This effect seems to be specific because antibodies to interferon-gamma, tumor necrosis factor-alpha or interleukin-4 did not reduce the number of cells expressing RT1.B and RT1.D Ag. Furthermore, GM-CSF was able to trigger expression of class II molecules on rat peritoneal macrophages (M Phi) and BMDM Phi resulted from cultures of BMC with mouse M Phi-CSF (M-CSF), and the RT1.B and RT1.D inducing effect of GM-CSF was opposed by M-CSF, and by anti-GM-CSF antibodies. The induction of MHC class II Ag synthesis by GM-CSF on rat BMDM Phi was confirmed at the mRNA level by Northern blot analysis employing cDNA probes encoding the RT1.B-alpha.

Eine der gefürchtetsten Komplikationen von Kataraktoperationen stellt die postoperative Endophthalmitis dar, deren Prognose leider immer noch in vielen Fällen sehr schlecht ist. Die Inzidenz postoperativer Endophthalmitiden liegt derzeit durchschnittlich unter 0.1%. Der Zweck unserer Studie bestand darin, die Effizienz des an der 2. Universitäts-Augenklinik angewendeten Regimes zur Vermeidung intraoperativer Infektionen zu evaluieren. Es wurden daher einerseits vor der Operation Bindehautabstriche abgenommen, andererseits aber auch intraoperativ gewonnene Kammerwasserproben untersucht, um den Grad der Kontamination festzustellen. Alle Operationen wurden von demselben Operateur (G. G.) durchgeführt. Obwohl 75% der präoperativen Abstriche und 25,5% der intraoperativen Proben kontaminiert waren, kam es in keinem Fall zum Auftreten einer postoperativen Endophthalmitis. Dieses, sowie weitere Ergebnisse der Studie werden diskutiert, die verschiedenen Prophylaxe-Maßnahmen werden präsentiert.

The present study reports the application of a modified commercially available automated digital image analysis system (DIA) for the evaluation of organ culture preserved donor corneas. The central corneal endothelium was viewed and photographed under an inverted phase-contrast microscope. The images were then analyzed with the help of DIA. The results of DIA were compared to the findings obtained with a conventional 'fixed-frame analysis' for the same corneas. 100 human donor corneas have been evaluated. DIA, with interactive picture enhancement, was found to be practicable, and to yield reproducible results. The mean number of cells analyzed per photograph was 250 (range 95-395); this, on the average, was four times higher than with conventional fixed-frame analysis (mean 54, range 37-70). The correlation of the cell densities obtained with both methods was highly significant (p < 0.0001). Since additional information, like variation in cell size and shape (circularity form factor), was automatically computed by the program, more data on the homogeneity of the donor endothelial cell pattern were available. Futhermore, this computerized technique does not require an experienced investigator and thereby helps to eliminate bias.

Die früher als Retikulumzellsarkome bezeichneten, hochmalignen Non-Hodgkin Lymphome befallen in ihrer okulozerebralen Form Auge und Zentralnervensystem älterer Patienten. Immunoblastische Lymphome sind selten, meist sind beide Augen, wenn auch in unterschiedlichem Zeitabstand und Ausmaß betroffen. Der okuläre Befall geht der Generalisierung der Erkrankung in Form der ZNS-Beteiligung um Monate bis Jahre voraus. Wir berichten über einen 62jährigen Patienten, der von Sept. 88 bis Sept. 89 bei unauffälligem internen Status eine langsam progrediente Panuveitis des rechten Auges entwickelte. Über Monate bildeten sich disseminierte Pigmentepithelabhebungen, zunehmende Glaskörpertrübungen, ein solides Pseudohypopyon mit schlammartiger Ansammlung von Tumorzellen in der Vorderkammer und ein Sekundärglaukom. Im Nov. 89 kam es zu einer massiven Papillenschwellung links, die Durchführung einer diagnostischen Vitrektomie wurde jedoch vom Patienten zu wiederholten Malen abgelehnt. Die immunhistochemische Aufarbeitung des enukleierten rechten Bulbus ergab ein hochmalignes, polymorphes, zentroblastisches Lymphom mit vielen Immunoblasten. Der Patient unterzog sich einer Radiatio des Neurocraniums und des Spinalkanales, eine intrathekale und intravenöse Chemotherapie wurde durchgeführt. Innerhalb der Nachbeobachtungszeit von über 2 Jahren traten keinerlei okuläre oder zerebrale Lymphom-Rezidive auf, am linken Auge konnte bei klar gebliebener Linse der volle Visus erhalten werden.

Bei der Spaltlampenuntersuchung eines 15jährigen Mädchens, das wegen einer Iritis zugewiesen worden war, fand sich in der Vorderkammer des rechten Auges ein zwei Millimeter langer Wurm, der sich bei Lichteinfall kontrahierte. Die Patientin war sonst völlig gesund, anamnestisch berichtete sie über auffallend engen Kontakt mit ihrem Hund. Die chirurgische Entfernung des Parasiten gelang durch Anwendung einer viskoelastischen Substanz komplikationslos. Bei der Untersuchung des lebend entfernten Organismus wurde von den Parasitologen eine sehr junge Bandwurmlarve festgestellt, auf Grund des fehlenden Hakenkranzes war die Artzuordnung schwierig. Die serologische Untersuchung mittels Western-Immunoblot erhärtete den Verdacht auf eine Infektion mit Taenia crassiceps. Ein weiterer Augenoder ein systemischer Befall konnte innerhalb der zwei-jährigen Beobachtungszeit ausgeschlossen werden.

A total of 52 nonrelated Caucasian patients (21 male, 31 female, age at onset of the disease: 7-74 years, average: 31.6 years) suffering from intermediate uveitis were tissue typed for 56 different HLA-A, -B, -C and -DR-antigens.No significant association between any specific HLA-antigen and the disease, both when comparing the total patient group with a large, healthy control population, or any of the different subgroups (male vs. female, early vs. late onset, mild vs. severe course) could be demonstrated.

A rare form of malignant large-cell non-Hodgkin's lymphoma or reticulum cell sarcoma is confined to the eye and central nervous system (CNS). We report the case of a 62-year-old man, who presented with recalcitrant progressive uveitis in his right eye. Although lymphoma was suspected, the patient refused to undergo vitrectomy. Over one year he developed large blister-like solid scattered lesions of the retinal pigment epithelium (RPE) in the same eye. Repetitive neuroimaging detected no CNS involvement. After developing optic disc-swelling and discrete RPE-changes in the left eye also, the patient agreed to enucleation of his right eye. Histopathology and Immuno-histochemistry revealed malignant intraocular large cell-lymphoma invading all eye-tissues. Liquor cytology showed lymphomatous cells. Suffering from high grade malignant lymphoma with CNS involvement, the patient had to undergo radiation therapy of the orbits and neuroaxsis as well as intravenous and intrathecal chemotherapy. Papilledema of the left eye resolved quickly and completely, RPE-infiltrations disappeared and led to discrete punched out lesions with no scarring, the lens remained transparent over the whole observation period of 25 months. the patieht has been surviving for more than 52 months after first suspicion of malignant lymphoma, he has retained full vision in his left eye until now.

A rare form of malignant large-cell non-Hodgkin's lymphoma or reticulum cell sarcoma is confined to the eye and central nervous system (CNS). We report the case of a 62-year-old man, who presented with recalcitrant progressive uveitis in his right eye. Although lymphoma was suspected, the patient refused to undergo vitrectomy. Over one year he developed large blister-like solid scattered lesions of the retinal pigment epithelium (RPE) in the same eye. Repetitive neuroimaging detected no CNS involvement. After developing optic disc-swelling and discrete RPE-changes in the left eye also, the patient agreed to enucleation of his right eye. Histopathology and Immuno-histochemistry revealed malignant intraocular large cell-lymphoma invading all eye-tissues. Liquor cytology showed lymphomatous cells. Suffering from high grade malignant lymphoma with CNS ivolvement, the patient had to undergo radiation therapy of the orbits and neuroaxsis as well as intravenous and intrathecal chemotherapy. Papilledema of the left eye resolved quickly and completely, RPE-infiltrations disappeared and led to discrete punched out lesions with no scarring, the lens remained transparent over the whole observation period of 25 months. the patient has been surviving for more than 52 months after first suspicion of malignant lymphoma, he has retained full vision in his left eye until now.

Forty six patients received a topical application of a 0.3% norfloxacin (Zoroxin; MSD, Austria) solution into the lower fornix at different time intervals and frequencies before undergoing planned extracapsular cataract extraction. Aqueous humor was sampled at the beginning of surgery and assayed for the level of the antibiotic with high performance liquid chromatography. The highest aqueous humor level observed 30 min after the administration of the last drop in four patients who received five drops of norfloxacin into the lower fornix was 660.25 +/- 378.2 ng/ml. These concentrations are above the minimum inhibitory concentration of norfloxacin for 90% (MIC90) of most of the gram-negative microorganisms, but below the MIC90 of most of the staphylococci (coagulase negative Staph. and Staphylococcus aureus range between 0.25-1 mg/ml).

An otherwise healthy 15-year-old girl developed an iridocyclitis in her right eye. A contractable living parasite measuring two millimeter could be detected in the anterior chamber, the other parts of the eye remained uninvolved. The patient had close contact with the young dog of the family. By using a viscoelastic substance the parasite could be removed alive without any complications. The tapeworm was found to be too young for having developed the characteristic scolex. Western-immunoblotting gave indirect evidence for infection with Taenia crassiceps, a dog's tapeworm. During an observation period of two years no evidence for any other ocular or general Taenia crassiceps infestations could be found.

A review of 115 cases of ulcerative keratitis that were diagnosed and treated at the specialized ambulatory care center for infectious eye diseases at the 2. Department of Ophthalmology over a period of eight years (January 1983 - April 1991) is presented. In the analysis of the etiology nearly half (47.7%) were observed following a trauma to the epithelium, 38 (= 33,0%) were associated with contact lens wear and the third largest group (10.4%) was associated with lid problems. It is apparent that over the course of the last years the spectrum of microorganisms associated with this localized inflammation has shifted: the prevalence of Staphylococci (1983-1986 = 65%) has decreased, whereas the incidence of gram-negative rods increased (1987-1990 = 49%). In 19% Pseudomonas aeruginosa could be isolated, mostly associated with soft contactlens wear. A total of 37.5% of the sphapylococci isolates were found to be resistent to gentamicin, most probably as a consequence of the widespread, indiscriminate use of this antibiotic. An updated treatment schedule is presented.

50 Patienten, die das typische klinische Bild einer Chlamydien-Keratokonjunktivitis zeigten, wurden in diese Studie einbezogen. Im Direktabstrich wurden bei allen mittels direkter Immunfluoreszenz zahlreiche Elementarkörperchen nachgewiesen, welche für Chlamydia trachomatis spezifisch sind. Alle Proben wurden zusätzlich mittels der Standard-Giemsa-Färbung und einer Züchtung auf der McCoy-Zellkultur untersucht.