Biomedical subjects

G E Lang

Publications and source records attributed to G E Lang.

At least 37 records · Page 2Linked to original sources

PubMed2001

[Iris metastases in breast carcinoma].

BACKGROUND: Metastatic cancer of the iris is rare. We report a case of breast carcinoma which metastasized to the iris and a review of the literature. METHOD: A 60-year-old woman with a history of breast carcinoma presented with lesions of the iris 5 years after diagnosis and tumor excision. In addition to slit-lamp examination including gonioscopy, ultrasound biomicroscopy, positron-emission tomography and fluorescein angiography of the iris were used for diagnosis. Furthermore, the literature was searched using the medline database. RESULTS: The iris metastasis exhibited multiple whitish to pink nodules on the inferior half of the iris and infiltration of the chamber angle. The main tumor mass was prominent and highly vascularized. Best corrected visual acuity was 20/40 and the intraocular pressure was 7 mmHg. Ultrasound biomicroscopy showed lobular masses characterized by mid to low reflectivity and there was no distinct border to the surrounding tissue. Fluorescein angiography of the iris showed tumor vessels with dye leakage. The positron-emission tomography displayed metastatic lesions to the liver, lung, bones and lymph nodules in addition to the lesion of the iris. The review of the literature revealed that breast carcinoma leads to choroidal metastases in 5% of cases and iris metastases are even rarer. In twothirds of these cases the lesions form unilateral whitish to red clumps at the horizontal meridian and in the inferior quadrants of the iris. The preferred treatment is chemotherapy and/or radiation therapy. CONCLUSIONS: Breast carcinoma is rarely associated with iris metastasis. Positron-emission tomography is a sensitive diagnostic tool to identify metastatic lesions and is a useful method for planning therapeutic approaches. Radiation therapy, argon laser treatment and block excision are therapeutic options with an isolated metastasis of the iris.

Breast Neoplasms↗

PubMed2001

[Prospective randomized comparative study of frequency doubling perimetry vs standard automated perimetry in patients with glaucoma].

AIM: To compare frequency doubling perimetry (FDP) versus standard automated perimetry in glaucoma. To evaluate the reproducibility of both methods. PATIENTS AND METHODS: All the patients were tested (full threshold test) twice with both FDP (N-30) and Humphrey Field Analyzer II model 750 (HFA) (30-2 procedures) in random sequence, within one day. The parameters mean deviation (MD), pattern standard deviation (PSD) and measured thresholds per quadrant and center areas were evaluated for FDP/HFA comparison in 45 glaucoma patients. The same parameters were used for testing the reproducibility of FDP (n = 46) and HFA (N = 39). Additionally, the center and each quadrant area were checked for any deviation in the total deviation probability plots. For statistical analysis Kappa coefficients and Bland/Altman plots were used. RESULTS: An average MD (FDP vs HFA) of -7.3 +/- 5.8 dB vs -8.9 +/- 7.6 dB and PSD of 6.9 +/- 2.4 dB vs 6.5 +/- 3.6 dB were found. Kappa coefficients denote marginal accordance (kappa: 0.11-0.38) for area deviations. In a total of 225 areas HFA detected 191 deviations and FDP 165. HFA measured more negative deviation compared with FDP in the case of MD < -15 dB. The reproducibility was 0.98 (MD) and 0.92 (PSD) for FDP and 0.98 (MD) and 0.95 (PSD) for HFA (95% confidence interval). CONCLUSIONS: There was great conformity between FDP and HFA in glaucoma patients. HFA detected more deviations in the total deviation probability plots than FDP. There was a high reproducibility of both methods. FDP is an appropriate tool for detecting visual field loss in glaucoma patients.

Adult↗

PubMed2001

Octreotide reduces vitreous hemorrhage and loss of visual acuity risk in patients with high-risk proliferative diabetic retinopathy.

OBJECTIVE: Growth hormone and insulin-like growth factor-I have been implicated as strong promoters of proliferative diabetic retinopathy. We studied reduction of bleeding and preservation of visual acuity by treatment with the long-acting somatostatin analogue, octreotide, in diabetic patients at an advanced stage of proliferative diabetic retinopathy. RESEARCH DESIGN AND METHODS: Randomized trial in a University hospital setting. Reading ophthalmologists were masked for octreotide use, diabetologists were aware of that treatment. Nine patients received 100 microg tid octreotide (verum) subcutaneously for a maximum of 36 months. Nine diabetics served as controls, no placebo treatment was used. Episodes of vitreous hemorrhages were counted, measurement of visual acuity, estimation of neovascularization by stereoscopic fundus photography and fluorescein angiography were carried out. RESULTS: After 3 years of treatment, the incidence of vitreous hemorrhages and the need for vitreoretinal surgery was significantly lower (log rank test p = 0.002) in the octreotide-treated patients. Visual acuity was preserved and significantly better in the octreotide treated group compared to controls (p = 0.05). CONCLUSIONS: In diabetics with high-risk proliferative retinopathy after full scatter laser coagulation, octreotide reduced the number of vitreous hemorrhages, preserving visual acuity.

Adult↗

PubMed2000

[Age-related maculopathy. Comparative studies of patients, their children and healthy controls].

BACKGROUND: The aim of this study was to evaluate prospectively whether there are differences in spectrometrically measurable parameters of the fundus between patients with early and late age-related maculopathy (ARM), the children of the ARM patients (F1 generation) and normals. METHOD: Using the "Jenaer Imaging Spectrometer", retinal oxygen saturation, xanthophyll, and intrinsic fluorescence were measured; the spatial distribution of xanthophyll was determined using the Rodenstock SLO 101 model. RESULTS: Xanthophyll is reduced in late ARM as compared to the F1 generation and the control group (alpha < 0.01). The different fluorescence spectra, measured at shortwave and at longwave excitation, suggest the presence of more than one fluorophore. Furthermore, the components of the fluorophores seem to be different between patients with ARM and their F1 generation. The longwave autofluorescence is age-dependent only in late ARM (r2 = 0.81). For the first time, we found an alteration in oxygen saturation in retinal vessels in patients with ARM. CONCLUSIONS: Xanthophyll is reduced only in late ARM. Autofluorescence and oxygen saturation are different between ARM patients, the F1 generation and normals, however, we were not able to identify a genetically based predisposition concerning the parameters studied.

Adult↗

PubMed2000

[Effect of octreotide combined with growth factors on proliferation of RPE cells in vitro].

BACKGROUND: The long-acting somatostatin analogue octreotide is used as a therapeutic option for patients with diabetic retinopathy and age-related macular degeneration. Growth factors, such as EGF, bFGF, VEGF, and PDGF, have been implicated in the pathogenesis of these diseases. The aim of this study was to investigate the effect of octreotide on the growth-factor-induced proliferation of bovine retinal pigment epithelial (RPE) cells in vitro. METHODS: RPE cells were assayed for proliferation as measured by (3H)-thymidine uptake (ccpm). Bovine RPE cells at passage 3-8 were seeded in a 96-well plate and incubated for a 24-h period with a minimum medium followed by a 24-h incubation with the different growth factors at a concentration of 10 ng/ml with and without 5 x 10(-5) M octreotide. In a different assay the cells were incubated with octreotide at 5 x 10(-10)-5 x 10(-4) M. Afterwards the cells were pulsed with 5 microCi/ml (3H)-thymidine for 12 h, and the incorporated radioactivity was measured on glass fiber filters in a beta-counter (mean +/- SEM ccpm). The Wilcoxon Signed Rank test and the student's t-test were used for statistical analyses. RESULTS: There was a biphasic effect of octreotide on RPE cell proliferation. Exposure of RPE cells to PDGF (20,225 +/- 3304 ccpm) and bFGF (3441 +/- 539 ccpm) resulted in a significantly higher proliferation compared to control medium (1543 +/- 352 ccpm) (p < 0.05). No difference was found for EGF (2385 +/- 383 ccpm). For VEGF (776 +/- 83 ccpm) a significant reduction in RPE cell proliferation was found (P < 0.05). There was a significant reduction in proliferation of RPE cells with PDGF, bFGF, and EGF in combination with octreotide versus growth factors alone (octreotide in combination with PDGF 308 +/- 82 ccpm, with bFGF 229 +/- 88 ccpm, with EGF 2362 +/- 91 ccpm) (p < 0.005). VEGF in combination with octreotide resulted in a significant inhibition of RPE cell proliferation compared to VEGF alone (p < 0.0005). CONCLUSION: The data suggest that there is an inhibitory effect of octreotide on RPE cell proliferation of bovine RPE cells and on the increased proliferation of bovine RPE cells induced by PDGF and bFGF. An enhanced inhibitory effect is found for the combination of octreotide and VEGF.

Animals↗

PubMed2000

[Dilatation of large retinal vessels after increased intraocular pressure].

PURPOSE: To measure dilation of large retinal branch vessels. METHODS: Diameters of a vessel section of a branch artery and vein were examined by the retinal vessel analyzer. Intraocular pressure (IOP) was increased briefly by an oculo-oscillo-dynamograph. The examination was repeated after 2 weeks. RESULTS: A vessel reaction was found in all volunteers. The mean venous diameter decreased 9.9 +/- 9.4% during the suprasystolic phase of intraocular pressure. A maximal dilation was found in arteries (7.0 +/- 6.2%) and veins (9.3 +/- 5.2%) 1 min after lowering of IOP. The results were reproduced in the second examination for veins in all phases of the examination and for arteries in the middle phase after lowering IOP (4 min). Various changes in mean systolic blood pressure did not significantly affect reproducibility of the vessel reaction. CONCLUSION: The vessel reaction caused by rise in IOP can be measured for single vessel sections. The venous reaction is well reproducible in healthy volunteers. Further research should examine the benefit of this method in the diagnosis and follow-up of glaucoma.

Adult↗

PubMed2000

[Morphometric changes in the choriocapillaris and choroid in eyes with advanced glaucoma damage].

BACKGROUND: In addition to elevated intraocular pressure, a compromised ocular blood supply has been implicated in the pathogenesis of primary open-angle glaucoma (PCOG). METHODS AND MATERIALS: We analyzed 20 eyebank eyes with end-stage PCOG and compared these with 20 age-matched controls. The following variables were measured: density and diameter of large choroidal vessels in the macular and equatorial choroid; thickness of the choroid in the macular and equatorial region; and density and thickness of choriocapillaris in the macular, peripapillary, and equatorial choroid. RESULTS: Eyes with glaucoma displayed a lower density of the capillaries of the choriocapillaris than control eyes in the macular, temporal peripapillary, and equatorial choroid, with 0.50 vs. 0.55 (P = 0.018), 0.46 vs. 0.51 (P = 0.016), and 0.50 vs. 0.55 (P = 0.038), respectively. Assessment of large choroidal vessels in the macular choroid showed that eyes with glaucoma had less density of veins (11.7 vs. 38.9/mm2; P < 0.001) and arteries (7.7 vs. 12.4/mm2; P = 0.005) and arteries with a higher diameter (45.6 vs. 28.2 microns; P < 0.001) than control eyes. The large vessels in the equatorial choroid displayed no significant difference in diameter but a lower density (21.2 vs. 44.1/mm2; P = 0.017) in eyes with glaucomatous damage than controls. CONCLUSION: Eyes with advanced glaucomatous damage after long-standing PCOG exhibit many changes in the choroidal vasculature. We cannot conclude from our study whether the observed vascular changes in the choroid are primary pathogenic factors or secondary phenomena.

Capillaries↗

PubMed2000

[Effects of carotid artery thrombendarterectomy on pulsatile ocular blood flow].

UNLABELLED: Successful operations of clinically significant carotid artery stenosis by carotid endarterectomy (CEA) are leading to a better perfusion in the region of this artery. It still creates problems to make a statement about cerebral and ocular perfusion during the operation. METHODS: In 10 patients who underwent a CEA the pulse amplitude (PA) of the intraocular pressure (IOP) was measured intraoperatively by a pneumotomography (OBF-Systems, U.K.) and the so called pulsatile ocular blood flow (pOBF) was determined. The middle arterial blood pressure (MAP) was taken invasively during the operation. RESULTS: During the clamping phases no PA could be recorded. PA (p = 0.04) and pOBF (p = 0.028) increased on the side which had been operated on. No correlations of PA and pOBF to MAP were found. CONCLUSION: This method can prove an increased pulsatile ocular blood flow after successful CEA.

Aged↗

PubMed2000

Changes of retinal capillary blood flow in age-related maculopathy.

BACKGROUND: To investigate retinal capillary blood flow characteristics in patients with age-related maculopathy (ARM). METHODS: Retinal capillary blood volume (VOL), blood flow (FLOW), and velocity (VEL) were measured in four macular sectors (I, II, III, IV) and in two areas beyond the temporal superior and inferior major vessel arcades (V and VI) in: 10 eyes with early ARM (drusen > or = 63 microns and/or atrophy of the retinal pigment epithelium, RPE, < 175 microns and/or proliferation of RPE), 13 with late ARM (exudative), 10 with late ARM (fibrotic), 14 normal eyes of 14 children of patients with ARM, and in 4 age- and sex-matched control groups using the Heidelberg retinal flowmeter (HRF). Statistical analysis was performed with the exact Wilcoxon test using an additional adjustment procedure by Bonferroni-Holm. RESULTS: As compared to the control group, there was no significant change of VOL, FLOW, and VEL in patients with early ARM. In patients with late ARM (exudative), there was a significant higher FLOW in sectors I, II, and IV and a higher VOL and VEL in sectors III and IV. The group with late ARM (fibrotic) showed a reduction of VOL and FLOW in sectors I-IV and of VEL in sectors II and IV. In children of ARM patients, VOL, FLOW, and VEL of sectors I-VI did not differ from the control group. CONCLUSION: HRF measurements in patients with ARM indicate an increased macular retinal capillary blood flow in patients with the exudative form of late ARM and a decreased macular perfusion in those with the fibrotic form.

Aged↗

PubMed2000

Diabetic retinopathy is associated with decreased serum levels of free IGF-I and changes of IGF-binding proteins.

In patients with diabetic retinopathy, elevated serum levels of total circulating insulin-like growth factor-I (IGF-I) have been implicated as an important mediator of the disease. There is no study, however, measuring free IGF-I levels in patients with diabetic retinopathy which mediate the biological effects of IGF-I and are modulated by a complex system of six specific IGF binding proteins (IGFBPs) and several IGFBP proteases.

Aged↗

PubMed2000

[Cone dystrophy associated with Alport syndrome].

BACKGROUND: Alport's syndrome is a hereditary disease with renal, cochlear, and ocular involvement. We report a patient with Alport's syndrome who exhibited morphologic macular changes similar to cone dystrophy. HISTORY AND SIGNS: A 46-year-old man was evaluated for peculiar macular changes, which have caused a significant decrease in visual acuity over the last years. His general history was remarkable for the presence of sensorineural hearing impairment since infancy as well as end stage renal failure followed by renal transplantation. The ophthalmological findings in this patient included circumscribed macular lesions consisting of atrophy of the retinal pigment epithelium and bilateral anterior lenticonus. CONCLUSION: Alport's syndrome is a characteristic prototype of a genetic basement membrane disease with ocular, renal, and cochlear involvement. Common ocular findings are the dot-and-fleck retinopathy and the anterior lenticonus. In contrary to the anterior lenticonus retinal changes are rarely associated with visual impairment. An association with a macular lesion similar to the cone dystrophy has only infrequently been reported.

Electroretinography↗

PubMed2000

[Diffuse retinal pigmented epitheliopathy associated with systemic corticosteroid therapy].

BACKGROUND: It is well known that topical as well as systemic treatment with corticosteroids may have ocular side effects. The most common are the development of cataract and increase of intraocular pressure, however, alteration of the retinal pigment epithelium may also occur. PATIENT: A 64-year old male experienced a progressive decrease of visual acuity over a time period of 6 weeks. Ophthalmologic examination revealed a severe diffuse retinal pigment epitheliopathy with serous detachment of the neurosensory retina. This patient was treated with systemic methylprednisolone for chronic glomerulonephritis. After cessation of the treatment with systemic corticosteroids visual acuity improved and the serous retinal detachment resolved. CONCLUSION: Ophthalmologic examination including biomicroscopy of the retina is recommended on a regular basis for patients treated with systemic corticosteroids. With development of pigment epithelial changes steroids should be reduced or discontinued if possible.

Anti-Inflammatory Agents↗

PubMed2000

Growth factor combinations modulate human retinal pigment epithelial cell proliferation.

PURPOSE: Retinal pigment epithelial (RPE) cell proliferation is an important step in the pathogenesis of ocular diseases such as proliferative retinopathy. Growth factors play a major role in modulating the development and progression of these diseases. The aim of this study was to examine the effects of single growth factors as compared to growth factor combinations on the stimulation of RPE cell proliferation. METHODS: Human RPE cells were treated with 10 ng/ml IGF-1, PDGF, bFGF, EGF, VEGF, and TGFbeta(2), or with the combination of each of the growth factors. RPE cell proliferation was determined by [(3)H]-thymidine incorporation after growth factor stimulation for 24 hr. RESULTS: RPE cell proliferation was significantly increased when PDGF and bFGF were combined as compared to the single growth factor (p<0.005). There was a decrease in DNA synthesis for combined growth factors as compared to the single growth factor for IGF-1 plus TGFbeta(2) (p<0.05), IGF-1 plus VEGF (p<0.005), PDGF plus TGFbeta(2) (p<0.005), VEGF plus TGFbeta(2) (p<0.005 as compared to VEGF), and bFGF plus TGFbeta( 2) (p = 0.01 as compared to bFGF). The remaining growth factor combinations showed no significant synergistic effect on human RPE cell proliferation. CONCLUSIONS: These data lead to the implication that DNA synthesis in human RPE cell culture is synergistically affected by certain growth factor combinations, but not by all of them. This observation may be important for a better understanding of growth factor interactions occuring in proliferative diseases in the eye.

Cell Division↗

PubMed1999

[Decreased serum level of free bioavailable IGF-I in patients with diabetic retinopathy].

BACKGROUND: Growth factors like IGF-I have been implicated in the pathogenesis of diabetic retinopathy. To investigate the role and bioavailability of IGF-I we measured not only total but also free serum levels of IGF-I in diabetic patients. METHODS: A total of 159 patients with and without diabetic retinopathy were investigated (60 diabetic patients without and 99 with clinically and angiographically diagnosed diabetic retinopathy). One hundred ten healthy volunteers served as controls. The data were analyzed by Student's t-test, analysis of variance and correlation; P < 0.05 was considered statistically significant. RESULTS: Diabetic patients with retinopathy showed significantly lower serum levels of free IGF-I than diabetics without retinopathy. Free IGF-I was negatively correlated with glycosylated hemoglobin 1c. IGFBP-3 levels were diminished in type 2 patients with diabetic retinopathy, while type 1 patients with diabetic retinopathy showed higher IGFBP-1 levels. CONCLUSION: Diabetic patients with retinopathy showed significantly reduced serum levels of free IGF-I. Low IGF-I was associated with poor metabolic control.

Biological Availability↗

PubMed1999

[Risk-adapted management of central vein occlusions].

There is no generally accepted therapy for patients with central retinal vein occlusion. Only few of the therapeutic strategies in use demonstrated their effectiveness in studies with large patient populations, others have the disadvantage of unacceptable side effects. The aim of the immediate therapy is the improvement of blood perfusion. Prognostically relevant factors like the activity of components of the blood coagulation system, rheology characteristics and predisposing vascular disease risk factors have to be considered. A risk adapted management includes the immediate anticoagulation with heparin. Haemodilution, fibrinolytic therapy and hyperbaric oxygen therapy represent other therapeutic strategies. The efficacy of new promising therapies has to be thoroughly evaluated in studies with large stratified patient populations.

Fluorescein Angiography↗

PubMed1999

[Photorefractive keratectomy. Free-running vs. q-switched Er:YAG laser (scanning mode)].

BACKGROUND: Examination of morphology in plane corneal ablation (in vitro) induced by an Er:YAG-laser (2.94 microns) in two modes: free-running (50 microseconds) and q-switched (200 ns). METHODS: Sequences of different fluences in each mode were applied to freshly enucleated swine eyes. Parameters of free-running mode: fluences 1.21-4.77 J/cm2, frequency 80 Hz, spot size 500 microns FWHM, hexagonal spot shape. Parameters of q-switched mode: fluences 0.79-2.33 J/cm2, frequency 20 Hz, spot size 500 microns FWHM, round spot shape. RESULTS: Histology showed thermal damage of 10-25 microns in depth caused by the free-running mode compared with 4.5-7.5 microns by the q-switched mode. In both gross photography and scanning electron microscopic examination, the surface was found to be more homogeneous and smoother in the q-switched mode. CONCLUSIONS: Depending on the different application modes, both laser systems could be used for a defined corneal ablation in photorefractive keratectomy. However, at the moment, results using the Er:YAG laser are not as favorable as with the excimer laser.

Animals↗

PubMed1999

Histologic and morphometric analysis of the choroid, Bruch's membrane, and retinal pigment epithelium in postmortem eyes with age-related macular degeneration and histologic examination of surgically excised choroidal neovascular membranes.

OBJECTIVE: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in industrialized countries. Different risk factors have been associated with AMD. We performed a histopathologic and morphometric study to compare eyes with different stages of AMD to age-matched eyes. This study aimed to investigate the correlation among morphometric characteristics of choroidal vessels, the retinal pigment epithelium, and Bruch's membrane, to study the association between these characteristics and the presence and type of AMD, and to identify morphologic risk factors for exudative AMD. Furthermore, we histologically analyzed surgically removed choroidal neovascular membranes secondary to underlying diseases other than AMD to discern whether the cellular and extracellular components of the membranes of eyes with AMD are similar to those with diseases other than AMD. METHODS: We analyzed 51 eye bank eyes (Georgia Eye Bank, Atlanta, GA) from 40 donors with different stages of AMD and compared them with 40 age-matched controls. The eyes were processed for light microscopy. The degree of calcification of Bruch's membrane, fragmentation of Bruch's membrane, number and types of drusen, basal laminar deposit, and seven morphometric variables of the choroid were assessed in the macular and extramacular regions. Surgically excised subfoveal membranes were processed and evaluated by light and transmission electron microscopy. RESULTS: There were no statistically significant differences observed between eyes with neovascular and non-neovascular AMD. The single most important difference between eyes with and without AMD was the amount of basal laminar deposit (P < 0.001). Eyes with AMD displayed fewer large choroidal vessels in the submacular choroid than eyes without AMD (mean density values of all choroidal vessels [arteries and veins] were 3.5 +/- 1.5 mm(-1) and 5.7 +/- 1.6 mm(-1), P < 0.001, respectively). The submacular choriocapillaris density was higher in eyes with AMD (mean density, 0.62 +/- 0.06) than in eyes without AMD (mean density, 0.51 +/- 0.08 [P < 0.001]). The diameter of the larger choroidal vessels in the peripheral choroid was higher in eyes with AMD (mean diameter, 30 +/- 8 microm) than in eyes without AMD (mean diameter, 21.4 +/- 6.2 microm [P < 0.001]). The peripheral choriocapillaris density displayed the same pattern as the macular region in eyes with and without AMD. There was a statistically significant difference observed in the degree of calcification and fragmentation of Bruch's membrane in eyes with exudative AMD (mean degree of calcification, 1.6; median number of breaks in Bruch's membrane, five) as compared with controls (mean degree of calcification, 0.8; median number of breaks in Bruch's membrane, zero). The difference for these two variables between eyes with nonexudative AMD (mean degree of calcification, 0.8; median number of breaks in Bruch's membrane, one) and controls (mean degree of calcification, 0.8; median number of breaks in Bruch's membrane, zero) failed to reach statistical significance. Eyes with AMD displayed significantly more soft, diffuse, and large drusen, as well as basal laminar deposit, in the macular area than controls. CONCLUSION: Combining our data with data from the literature, we conclude that AMD can be interpreted as a dynamic process with early proliferation and subsequent atrophy of capillaries of the choriocapillaris. Calcification and fragmentation of Bruch's membrane; soft, diffuse, and large drusen; and basal laminar deposit, but not hard drusen, strongly correlate with the histologic presence of AMD. The degree of calcification and fragmentation of Bruch's membrane is prominent in eyes with exudative AMD. The formation of choroidal neovascular membranes represents a stereotypic, nonspecific wound repair response independent of the underlying disease.

Aged↗

PubMed1999

[Periphlebitis retinae, uveitis and cystoid maculopathy in a patient with multiple sclerosis].

PATIENT: A 44-year-old woman has a history of multiple sclerosis since 20 years. Besides recurrent numbness she had many instances of optic nerve neuritis which has led to a pronounced optic atrophy on her left eye. Additionally, she has developed recurrent iridocyclitis on her right eye. This was the reason why she was referred to our outpatient department for evaluation. Ophthalmic examination revealed an iridocyclitis associated with a multifocal retinal periphlebitis and severe cystoid macular edema in her right eye. CONCLUSION: Patients with multiple sclerosis develop in approximately 30% of cases retinal periphlebitis which may rarely be associated with anterior uveitis or cystoid macular edema as observed in our patient.

Adult↗