Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
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Cat scratch disease (CSD) typically manifests as a febrile lymphadenopathy and is caused by a Bartonella henselae infection after contact with cats. This article describes the case of an atypical presentation of CSD in a 52-year-old patient with acute unilateral loss of vision and headache without fever or lymphadenopathy. Funduscopic examination showed an optic disc swelling and macular star exsudates, pathognomonic for infectious neuroretinitis. ⋯ Systemic antibiotic combination therapy was initiated with doxycycline and rifampicin for 6 weeks resulting in good morphological and functional results. A Bartonella neuroretinitis should be considered in the differential diagnosis of patients with loss of vision and papilledema, even in the absence of fever or lymphadenopathy. Immediate serological testing and initiation of antibiotics are important for the outcome.
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Today's slit lamps have been optimized to realise the principle of focal illumination. When doing clinical work the result is that the slit lamp can be operated simply by using intuition; however, other applications are excluded due to the rigid construction principle. These other applications are summarized in the accompanying film (available online). ⋯ By relying on thorough knowledge of the slit lamp's fundamental optics it is possible to suitably document all essential fields of ophthalmology using slit lamp videography. Slit lamp videography opens up a wide range of documentation possibilities, especially for the routine clinical work of general ophthalmologists.
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Aneurysms of the cerebral vessels are relatively common and aneurysms of the ophthalmic segment of the internal carotid artery (ICA) represent approximately 10% of intradural aneurysms. ⋯ The management of paraophthalmic aneurysms is associated with specific risks. Careful consideration of the available techniques is necessary before each invention. Coil-occlusion remains the first choice for ruptured paraophthalmic aneurysms. For unruptured paraophthalmic aneurysms flow diversion offers improved results. The overall complication rates of these procedures are low; however, cerebral ischemia, intracranial hemorrhage and visual complications must be considered in advance and the patient must be informed of the risks.
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Bacterial orbital cellulitis is a life-threatening infection of the postseptal orbital tissue. It can occur in the context of sinusitis, particularly in children and adolescents. ⋯ Rarely, a subperiosteal abscess can occur, and osteomyelitis can lead to spread of the infection to the cerebrum. A rapid diagnosis and targeted therapy are essential for saving the eye as well as the life of the patient.
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Idiopathic and therapy resistant uveitis especially of unclear origin, is a diagnostic challenge for ophthalmologists. Metastases to the anterior chamber or vitreous body can occasionally mimic the clinical picture of uveitis, a variant on the usual lymphomatous masquerade syndrome. The underlying pathological pathways leading to the metastatic spread of tumor cells within the fluid compartments of the eye remain unclear. ⋯ Due to the extent of dissemination of this non-small cell lung cancer (NSCLC), only palliative treatment including external beam irradiation and systemic chemotherapy was possible to reduce pain and to maintain vision as well as an attempt at systemic control of the disease.