Measurement of the axial length of cataract eyes by laser Doppler interferometry.

PURPOSE: To examine the applicability of the recently developed laser Doppler interferometry technique for measuring the axial length of cataract eyes in a realistic clinical situation. To determine the performance of the instrument as a function of cataract grade. To compare the results to those of ultrasound methods. METHODS: A total of 196 cataract eyes of 100 patients were examined. The axial eye length was determined by laser Doppler interferometry and by two different ultrasound techniques, the applanation technique and the immersion technique. The cataract grade was determined by a commercial instrument that measures backscattered light. RESULTS: Laser Doppler interferometry worked very well except in the cases of the highest cataract grades (4% of the eyes of this study were not measurable because of a too-high lens density). Only 3.5% of the other eyes were not measurable because of fixation problems of the patients. The precision of laser Doppler interferometry is not influenced by the cataract grade (except the highest grade). The standard deviation of the geometric eye length is approximately 20 microns. Linear regression analysis revealed a very good correlation of laser Doppler interferometry and ultrasonic measurements, but a systematic difference was found. The eye lengths measured by laser Doppler interferometry were about 0.18 mm longer than those measured by the immersion technique and about 0.47 mm longer than those measured by the applanation technique. CONCLUSION: These differences are attributed to the laser Doppler interferometry results including the retinal thickness and indentation of the cornea by the applanation technique. The main advantages of the laser Doppler interferometry technique are high precision, high accuracy, and more comfort for the patient because it is a noncontact method, anesthesia is unnecessary, and the risk of corneal infection is avoided.

Silicone oil implantation in penetrating injuries complicated by PVR. Results from 1982 to 1986.

Between 1982 and 1986, the authors implanted silicone oil in 34 eyes with retinal detachment and proliferative vitreoretinopathy (PVR) stages C-3 to D-3 caused by penetrating injuries. The retina had failed to reattach after initial vitrectomy, membrane peeling, and scleral buckling. Complete anatomic reattachment was achieved in 62%, partial reattachment in an additional 9%. Useful functional results were achieved in 68% of cases (visual acuity of 1/60 to 20/20). Postoperative complications included elevated intraocular pressure in 38% and progress of PVR with membrane formation under the silicone oil in 21% of the cases. Sixty-eight percent of the aphakic eyes developed band-shaped keratopathy. Because most of the eyes were aphakic, the authors do not report cataract incidence. In 15 eyes (44%) the silicone oil was removed. In 14 of these eyes the retina remains attached, in one eye silicone oil removal was followed by phthisis bulbi.

Assessment of echographic regression criteria in ruthenium-irradiated melanoma.

Steady flattening of the tumor, increasing reflectivity and decreasing vascularity are echographic signs of successful irradiation treatment. The specific example of an irradiated choroidal melanoma shows that the absence of echographic changes by no means excludes tumor destruction. Because of a dense vitreous body hemorrhage, the melanoma could only be evaluated echographically. Since the echogram lacked evidence of regression, the tumor was locally resected 5 months later. Histology, however, revealed an amorphous mass of dead tissue pervaded by intact vessels. Apparently a successfully irradiated melanoma may generate an echo typical of vital melanoma tissue. The authors therefore draw the conclusion that only a steady tumor growth, as substantiated by an echogram, may be considered an unambiguous sign of tumor vitality.

The triple procedure--results in cataract patients with corneal opacity.

Beginning in May 1984, we performed penetrating keratoplasties in combination with extracapsular cataract extractions and implantations of posterior chamber lenses in 21 patients. In addition to cataracts, 15 of these elderly patients presented Fuchs' dystrophy and 6 had corneal scars due to infectious or inflammatory corneal diseases. In 2 of the 21 eyes, keratoplasty was a repeat operation because of graft rejection or graft dystrophy. With a mean follow-up of 22 months, visual rehabilitation was satisfactory: 15 patients (71%) achieved a postoperative corrected visual acuity of 6/12 or better. Postoperative deviation from preoperatively calculated refractive lens power--the only major problem--remained within +/- 2 dptr in 95% (20 eyes), with an error of + 4 dptr in 1 eye (5%). In all 21 eyes, clear corneal grafts were obtained. Thus we consider the triple procedure to be the treatment of choice in cataract patients with corneas opacities.

Evaluation of 50 silicone posterior chamber lens implantations.

This study presents our experience with 50 silicone intraocular lens (IOL) implants (STAAR Surgical Company, model AA-4004) in the posterior chamber. In the relatively short-term mean postoperative follow-up of seven months, the following complications were observed: iris chafing - pigmentary dispersion, 15 (30%); IOL tilt and decentration, 7 (14%); pseudophakodonesis, 6 (12%); fibrinous exudate, 3 (6%); luxation of one haptic in the anterior chamber, 1 (2%); IOL tears, 5 (10%). Visual acuity of 20/20 to 20/40 was obtained in 40 patients (80%). Although no severe consequences were noted, the long-term effects of the complications are unpredictable at present.

[Assessing refraction in children with cerebral damage]. / Zur Refraktionsbestimmung zerebralgeschädigter Kinder.

In children with brain damage or multiple disabilities ophthalmological care may involve a variety of problems if it extends beyond mere diagnosis. Above all, difficulties can occur if a patient does not tolerate a trial spectacle frame and/or trial glasses in front of his/her eyes, so that it is impossible to perform retinoscopy in the usual way. If refraction has to be measured as a prerequisite for further treatment (in cases of squint, anisometropia etc.), close range retinoscopy and other modified refraction methods may be useful. The potential and limitations of these methods are described on the basis of the patient collective of a special outpatient department for children with brain damage.

[Initial experiences with primary silicone oil administration into the vitreous cavity in complicated eye injuries]. / Erste Erfahrungen mit primärer Silikonölfüllung des Glaskörperraumes bei komplizierten Augenverletzungen.

The authors report on five cases of severe perforating injury of the posterior segment which were initially treated by vitrectomy and subsequent filling of the vitreous cavity with silicone oil. The results so far have been satisfactory in all eyes. The advantages of the method (e.g., tamponade of retinal tears, facilitation of postoperative laser treatment) are emphasized and possible side effects are discussed.

Effect of indomethacin on aqueous PGE2 levels in rabbits following ocular trauma.

Using a highly specific radioimmunoassay, post-traumatic aqueous PGE2 levels were measured in rabbit eyes treated with topical indomethacin aqueous solution, as well as in untreated eyes. In two groups of ten rabbits each, the surgical trauma consisted of corneoscleral incision (without injury to the iris); one of the two groups received prophylactic treatment (3 days) and therapeutic (21 days) indomethacin treatment. In two other groups of ten rabbits each, corneoscleral incision and iridectomy were performed. One group received indomethacin treatment as described above, while the other group was not treated. Surgery was performed in all 40 right eyes, the left eyes serving as controls. In 20 of the 40 left eyes, indomethacin therapy was applied. In all right and left eyes, aqueous samples were withdrawn 3 days and 21 days postoperatively, and PGE2 concentrations were determined. The results indicate that 3 days after corneal trauma and 3 days after corneal trauma plus iridectomy, there was a highly significant reduction in the elevated PGE2 concentrations as a result of indomethacin therapy. On postoperative day 21, indomethacin reduced even further the still slightly elevated aqueous PGE2 concentrations without, however, completely blocking prostaglandin activity. The latter was observed even in the control animals that were not operated upon; they showed minimal PGE2 levels in response to corneal puncture on postoperative day 3 for the purpose of drawing aqueous samples. Our study demonstrated that short-term indomethacin therapy has a significant inhibitory effect, but no unequivocal answers were found as to the value of long-term treatment.

Trabeculectomy and intraocular lens implantation: a combined procedure.

We present the results achieved in 26 cases of trabeculectomy combined with intraocular lens implantation after extracapsular surgery in eyes with open-angle glaucoma. Phacoemulsification was performed in nine cases, planned extracapsular cataract extraction in 17. In 23 eyes, a posterior chamber lens was implanted; in three eyes an anterior chamber lens was used because of a ruptured posterior capsule. After a follow-up period ranging from four to 29 months, the postoperative results were satisfactory in all eyes treated. The patients achieved postoperative intraocular pressure of 20 mm Hg or less. In 28% of the cases, however, additional antiglaucomatous medication is required. Given proper indications and present-day surgical techniques, this combined procedure provides effective one-time treatment for cataract and glaucoma patients as well as optimal visual rehabilitation.

Recent advances in preservation of viable corneal tissue.

Increasing numbers of preserved corneas are being transplanted as the demand for optimal bioavailability for donor corneas increases. McCarey-Kaufman (MK) short-term storage provides a sufficient endothelial cell viability for a maximum of only 4 days. Organ culture of corneoscleral discs extends post mortem storage times up to 4 weeks. K-Sol, a new cornea storage medium with 2.5% chondroitin sulfate, containing no calf serum as source of foreign protein and no dextran as artificial dehydrating agent, permits tissue to be used for at least 2 weeks after enucleation stored at 4 degrees C. The corneal endothelium was intact, as demonstrated by subsequent vital staining and phase microscope evaluation. Pachymetric measurements showed regular thinning profiles in 31 K-Sol preserved corneas for corneal transplantation, with a clear outcome after a preliminary average observation time of six months.

[Cyanoacrylate tissue gluing in corneal perforations]. / Cyanoacrylat-Gewebeklebung bei Hornhautperforationen.

Three cases of corneal perforation which were treated with tissue adhesive (Histoacryl) are reported. The first case showed free fistulation after perforating keratoplasty, whilst the second had a trophic ulcer and the third had a traumatic corneal laceration with loss of corneal tissue. Treatment was successful in all three cases. The surgical technique, results and possible complications are mentioned.

[Argon laser trabeculoplasty in simple glaucoma]. / Argonlasertrabekuloplastik bei Glaucoma simplex.

In June 1984 the authors started a prospective study on the treatment of open-angle glaucoma with argon laser trabeculoplasty. The technique used was to treat 180 degrees of the anterior nonpigmented part of the trabecular meshwork with 80 to 100 burns. For retreatment the posterior pigmented part of the trabecular meshwork was coagulated with 80 to 100 burns. The burns were always applied to the pretreated half of the meshwork. At present the study includes 47 eyes treated posteriorly. Of these cases 12 eyes required retreatment. Five eyes had previously undergone an unsuccessful trabeculectomy. The preliminary results are satisfactory. The average reduction in intraocular pressure was 5.9 mm Hg; the mean intraocular pressure before therapy was 23 mm Hg. In 8 cases the trabeculoplasty failed, making a fistulating procedure necessary. The treatment was always well tolerated and there were only minor side effects which never led to any lasting damage.

[Treatment of recurrent conjunctival melanoma by lamellar resection and contact irradiation]. / Behandlung rezidivierender Bindehautmelanome durch lamellierende Resektion und Kontaktbestrahlung.

The author reports on a 43-year-old patient who, having been treated for a conjunctival melanoma by local resection, presented 6 years later with a recurrent melanoma of a superficial spreading type, having a nodular and a flat component. While lamellar corneal excision was performed on the nodular component, the flat portion was treated with beta-contact radiation. The results are described and the argument for this therapy discussed.

[Surface atypia following recurrent corneal lesions (light and electron microscopy findings)]. / Oberflächenatypien nach rezidivierenden Kornealläsionen (Licht- und elektronenmikroskopische Befunde).

A case of recurrent herpetic keratitis was followed by therapy-resistant corneal opacities. Histological sections revealed epithelial ectopias in superficial stromal layers of the cornea; their formal pathogenesis appears to be due to defects in Bowman's membrane. Another patient developed several intraocular complications after a penetrating corneal injury, and each surgical intervention resulted in increasing corneal decompensation. Semithin and ultrathin sections of the explant revealed endothelial metaplasia with fibroblastic activity.

[Extracapsular cataract operation with implantation of posterior chamber lenses following fistulating glaucoma operations]. / Extrakapsuläre Kataraktoperation mit Implantation von Hinterkammerlinsen nach fistulierenden Glaukomoperationen.

In 78 eyes treated by different fistulizing procedures (57 by goniotrepanation or trabeculectomy, 13 by Elliot trepanation and 8 by iridencleisis) extracapsular cataract extraction with implantation of posterior chamber lenses was performed. A sector iridectomy had to be performed in about 40% of the eyes because of difficulties in dilatation of the pupils and posterior synechiae. Postoperatively the IOP was regulated in 83% of all eyes without additional topical medication; a second fistulizing procedure was only necessary in one eye. Complications such as keratopathies, posterior capsule fibrosis, and dislocations of the posterior chamber lenses were not found to be more frequent compared with nonglaucomatous eyes treated by extracapsular cataract extraction with implantation of posterior chamber lenses.

[Use of the neodymium YAG laser following posterior chamber lens implantation]. / Neodymium-YAG-Laser Anwendung nach Hinterkammerlinsen-implantation.

The authors report on the neodymium-YAG laser used after extracapsular cataract extraction with the implantation of a posterior chamber lens in 1726 patients. The most common indication was capsular fibrosis necessitating posterior capsulotomy. The alternative to the YAG laser would be a bulbus-opening procedure via pars plana using a Sato knife. The advantage of the YAG laser in comparison with capsulotomy with a Sato knife is that there is no danger of intraocular infection or bleeding (which may result from tension on the fibers with the first method). A disadvantage of the YAG laser method is a possible transitory increase in intraocular pressure and an endothelial cell loss. In 1726 cases with posterior chamber lenses 45 capsulotomies using the YAG laser were necessary. A further indication for the YAG laser are posterior chamber lenses decentered by capsular fibrosis (3 cases). A third indication is chorepraxia after posterior chamber lens implantation. In three cases with posterior chamber lenses a flattening of the pupil occurred because remnants of the anterior capsule had shifted into the anterior chamber. In two cases a pupil became decentered for no apparent reason. In these cases YAG laser therapy is indicated. In at least three cases pupillary membranes were cut with the YAG laser. The authors treated their patients with the Lasertec model 135 YAG laser (Q-switched mode).