Low-level antimicrobial resistance of Enterobacteriaceae isolated from the nares of pig-exposed persons.

Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) have recently emerged in livestock and humans. Therefore, this study assessed the carriage of Enterobacteriaceae in the anterior nares and associated antimicrobial resistance in pig-exposed persons. Nasal swabs were enriched in non-selective broth and then plated on MacConkey and ESBL-selective agars. Species was confirmed by matrix-assisted laser-desorption ionization-time-of-flight mass spectrometry (MALDI-ToF MS). Antimicrobial susceptibility testing was performed according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Of 114 pig-exposed persons tested, Enterobacteriaceae were detected in the nares of 76 (66·7%) participants. The predominant species were Proteus mirabilis (n = 17, 14·9%), Pantoea agglomerans (n = 13, 11·4%), Morganella morganii (n = 9, 7·9%), Citrobacter koseri (n = 9, 7·9%), Klebsiella pneumoniae, Escherichia coli and Proteus vulgaris (each n = 8, 7·0%). ESBL-E were not detected. Of all isolates tested, 3·4% were resistant against ciprofloxacin, 2·3% against gentamicin, 23·9% against trimethoprim-sulfamethoxazole and 44·3% against tigecycline. Despite the high prevalence of ESBL-E in livestock, pig-exposed persons did not carry ESBL-E in their nares. This finding is important, because colonization of the nasal reservoir might cause endogenous infections or facilitate transmission of ESBL-E in the general population.

Owner-collected swabs of pets: a method fit for the purpose of zoonoses research.

As part of the preparation of a large cohort study in the entire German population, this study examined the feasibility of cat and dog owners collecting nasal and oral swabs of their animals at home as a method of assessing exposure to zoonoses. In veterinary clinics in Hannover, Germany, 100 pet owners were recruited. Nasal and oral swabs of pets were taken by a veterinarian at the clinic and owners took swabs at home. Swabs were analysed regarding bacterial growth and compared (owner vs. vet) using Cohen's kappa and McNemar's test. The return rate of kits was 92%, and 77% of owners thought it unnecessary to have veterinarian assistance to swab the mouth. McNemar's test results: oral swabs 78% agreement with Gram-positive bacterial growth, 87% agreement with Gram-negative bacterial growth; with similar results for nasal swabs. Although sample quality differed, this method allowed the receipt of swabs from pets in order to obtain information about colonization with zoonotic pathogens.

Years of potential life lost for six major enteric pathogens, Germany, 2004-2008.

In industrialized countries, acute infectious enteric diseases are usually mild, but they can also cause death. They do so, however, at different ages. Using 2004-2008 German notification data, we computed and compared crude and premature mortality [three different measures of years of potential life lost (YPLL)] of illnesses caused by Campylobacter spp., Listeria monocytogenes, norovirus, rotavirus, non-typhoidal Salmonella spp., and Shiga toxin-producing E. coli (STEC). Among ~1.5 million notified illnesses, those caused by norovirus were the most frequent. The highest annual mortality was registered for salmonellosis (0.55/1 000 000 population), but listeriosis accounted for the highest number of YPLL (n=4245). Disregarding death at advanced age (i.e. >70 years), STEC illness (n=757) and rotavirus gastroenteritis (n=648) ranked second and third, following listeriosis (n=2306). Routine surveillance captures only a fraction of all incident cases and deaths, under-ascertaining the true burden of disease. Weighting death by age permits a different view on the disease burden individual enteric pathogens cause and particularly underscores the public health importance of listeriosis prevention.

[Comparison of pars plana vitrectomy with ILM peeling and intravitreal triamcinolone in diffuse diabetic macular oedema]. / Pars-plana-Vitrektomie mit ILM-Peeling versus intravitreale Triamcinolon-Injektion bei diffusem diabetischem Makulaödem.

BACKGROUND: Visual outcome and anatomic results in patients with diffuse diabetic macular oedema (DDME) were evaluated after vitrectomy with internal limiting membrane (ILM) peeling versus intravitreal triamcinolone acetonide (TA). MATERIALS AND METHODS: A prospective, non-randomised pilot study included 41 eyes (35 patients) with clinically significant DDME. In 24 eyes (group A) we performed pars plana vitrectomy with ILM peeling. Seventeen eyes (group B) received an injection of 10 mg TA. Best corrected visual acuity and central macular thickness (measured with OCT) were determined preoperatively as well as 1 and 4 months postoperatively. RESULTS: In group A, OCT showed a macular thickness of 403 +/- 142 microm preoperatively. Best corrected visual acuity was 0.24 +/- 0.18. One month after surgery, macular thickness decreased to 311 +/- 62 microm (p = 0.06 ns) and visual acuity was 0.17 +/- 0.14 (ns). Four months after surgery, macular thickness remained significantly lower compared with preoperative values, at 307 +/- 161 microm (p = 0.012). There was a tendency towards a higher visual acuity of 0.30 +/- 0.26 (p = 0.32 ns). Before TA injection, macular thickness in group B was 551 +/- 180 microm and visual acuity was 0.19 +/- 0.14. One month after TA, macular thickness decreased to 242 +/- 82 (p = 0.001) microm while visual acuity increased to 0.31 +/- 0.21 (p = 0.005). At 4 months follow-up, group B showed recurrence of macular oedema. Compared with the preoperative findings macular thickness was significantly lower (368 +/- 159 microm; p = 0,001). Best corrected visual acuity after 4 months was 0.27 +/- 0.17 and did not differ significantly from the preoperative visual acuity (p = 0.033 ns). CONCLUSIONS: Intravitreal TA as a single treatment reduces the extent of DDME within a short time after surgery. These promising results may not be stable during long-term follow-up, necessitating in many cases a re-injection of TA. Macular oedema reduction after vitrectomy with ILM peeling, however, remains stable for more than 4 months and, therefore, offers more permanent results. However, none of these treatments facilitated a significant visual acuity restoration 4 months postoperatively.

[Femtosecond laser ablation and scanning microscopy of the internal retinal limiting membrane: an experimental study].

The investigation was undertaken to study whether femtosecond laser ablation and microscopy might be used in the internal retinal borderline membrane. Ablation of internal limiting membrane preparations removed using or not using indocyanine green was made by a low-energy femtosecond laser. Examination of the preparations by laser and electron microscopy revealed precision laser cuts of the internal retinal borderline membrane. The use of indocyanine green during laser ablation reduced laser irradiation parameters as compared to the dye not being applied. Low-energy femtosecond lasers enable precision contactless ablation of the internal borderline membrane to be carried out without collateral damage to the adjacent tissue. The parameters of laser impulses, particularly low ones used in the ablation of indocyanine green-stained preparations, prove the photosensitizing effect of the dye.

[Long-term outcome of keratoprosthesis with biological support]. / Langzeitverlauf nach Keratoprothesen mit biologischer Haptik.

BACKGROUND: In severe Sicca syndrome and limbal stem cell deficiency, vision can be restored by an artificial optical implant into the cornea (keratoprosthesis, KPro). After multiple efforts to achieve long-lasting corneal fixation of such an optical implant, two methods have become established: KPro with biological support, such as osteo-odonto-keratoprosthesis (OOKP) made from the root of patient's own tooth or osteo-keratoprosthesis (OKP), made from cortical bone of the patient's tibia; and the Boston KPro. MATERIALS AND METHODS: We examined the long-term outcome of a total of 93 patients with biological support, 59 with OOKP and 34 with OKP, and compared the results with the latest literature on Boston KPro. RESULTS: Medium follow-up was 7.5 years (max. 20.6 years) in OOKP and 4.5 years (max. 13.2 years) in OKP. The percentage of anatomic survival in Kaplan-Meier analysis was 95 and 89% after 2 years, 92 and 81% after 5 years, and 89 and 81% after 10 years, for OOKP and OKP, respectively; and 84% after 15 years and 56% after 20 years for OOKP. In the case of an autoimmunologic process underlying the corneal disease, long-term results are slightly worse than for non-autoimmunologic cases, but a literature comparison revealed that they are still better than with the Boston KPro. CONCLUSION: OOKP has a slightly better anatomic survival rate than OKP. Comparison with the literature reveals the medium anatomic survival rate to be better for KPro with biological support than for Boston KPro. The OOKP is still the gold standard in KPro.

[Health-related quality of life after implantation of a keratoprosthesis with biological haptic]. / Gesundheitsbezogene Lebensqualität nach Implantation einer Keratoprothese mit biologischer Haptik.

BACKGROUND: Many studies report comparatively good long-term results among patients with keratoprostheses with biological haptic. However, overall costs are correspondingly high. A clear cost-benefit relationship is therefore desirable. OBJECTIVE: This study investigates health-related quality of life after implantation of a keratoprosthesis with biological haptic. MATERIALS AND METHODS: We present a retrospective analysis of medical data of 25 patients treated between 1996 and 2006 at the Department of Ophthalmology, University Hospital Homburg/Saar and the Klinikum Offenburg. Health-related quality of life was assessed by means of a questionnaire based on validated instruments, with particular emphasis on physical symptoms, mental health, functional limitations, and social interactions. RESULTS: At a patient age of 49.8 ± 15.7 years (minimum-maximum: 19-78 years; 6 female, 19 male), the mean duration of corneal blindness was 13.8 ± 13.1 years (minimum-maximum: 1-47 years). Changes in visual acuity and subjective satisfaction were statistically significant (p <0.001). Quality of life (on a scale of 1 to 6: median 2) at the time "before the onset of eye disease" and ≥15 months after surgery were identical. Patients with a postoperative visual acuity ≤0.1 (n =11) also showed a statistically significant (p =0.016) benefit in this context. CONCLUSION: The expenditures and costs of keratoprosthetics can be justified by an improvement in the health-related quality of life of the persons concerned. Even a postoperative visual acuity of ≤0.1 correlates with a statistically significant improvement in the subjective quality of life of these patients.

[The Ahmed glaucoma valve. Medium term results]. / Die "Ahmed glaucoma valve" Mittelfristige Ergebnisse.

BACKGROUND: In complicated glaucoma, when classical filtrating surgery would be ineffective, aqueous shunts may be used. Complications due to hypotonia are reduced by valved systems, such as the Ahmed glaucoma valve (AGV). METHOD: In a retrospective case control study, 28 patients with complicated glaucoma were included. In addition to the clinical examination, we examined the size and function of the filtering area using ultrasound. RESULTS: The medium term follow-up was 25+/-16 months, the preoperative intraocular pressure (IOP) 35.5 mmHg+/-10.3 while 17 eyes were pseudophakic and nine aphakic. In the first weeks after AGV implantation, the mean IOP was 6.3+/-2.5 mmHg. In nine eyes, the pressure was less than 5 mmHg and five developed a temporary choroidal detachment. At the last visit, IOP was regulated in 22 eyes (82.1%). There was no correlation between IOP regulation and the size of the filtering bleb or the increase in the latter by digital pressure. CONCLUSION: In the management of complicated glaucoma, if there is a high risk of failure due to conjunctival scarring, AGV implantation can be used as a save procedure with a success rate comparable to other glaucoma implants.

Risk factors for anatomical success and visual outcome in patients undergoing silicone oil removal.

PURPOSE: To define risk factors for anatomical success and visual outcome in patients undergoing removal of silicone oil. METHODS: This retrospective study included patients who had silicone oil removed at this hospital between 1996 and 2000. All were followed for at least six months. Patients with recurrent retinal detachment after silicone oil removal were compared with patients without this complication. We also compared patients whose vision improved or stabilized with patients whose vision deteriorated. Risk factors for anatomical success and visual outcome were identified. RESULTS: We analysed 94 eyes of 92 patients with silicone oil removal. Nineteen eyes (20%) had recurrent retinal detachment, and in 30 eyes (32%), the vision deteriorated after removal of the oil. Initial vision less than ambulatory vision, initial pathology of giant retinal tears and recurrent retinal detachment, postoperative hypotony and postoperative epiretinal membrane occurred more frequently in eyes with than without recurrent retinal detachment. Pre- and postoperative hypotony, postoperative epiretinal membranes and postoperative recurrent retinal detachment were also more frequent in eyes with deteriorated vision. CONCLUSIONS: When treating giant retinal tears or recurrent retinal detachments with silicone oil tamponade, surgeons and their patients need to be aware of the higher possibility of unfavorable results, particularly when the initial vision is less than ambulatory vision. The presence of risk factors before and after silicone oil removal should remind surgeons of the higher risk profile of this particular surgery.

[Keratoprostheses. Historical overview, materials and status of current research]. / Keratoprothesen. Historischer Uberblick, Materialien und Stand der gegenwärtigen Forschung.

The idea to substitute optically clear material in an opaque cornea is two centuries old and in that time experiments have been carried out in animals and patients without much success. The historical development of and the clinical experiences with keratoprostheses are described. Especially in the last 40 years there have been great efforts concerning design, fixation, material and surgical technique to create a device with long-term success. The best long-term survival rates are achieved with the osteo-odontokeratoprosthesis, as it is the only model with a biological haptic. Due to some disadvantages of this procedure the present research is looking for new, soft materials and surface modifications to create a biointegrable artificial cornea.

[Keratoprostheses. Clinical aspects]. / Keratoprothesen. Klinische Aspekte.

In patients with dry eye, like pemphigoid, Fuchs-Stevens-Johnson syndrome and xerophthalmia, in eyes with severe vascularisation of the cornea due to severe burns, in a leucoma adherens or following recurrent transplant rejections as well as in cloudy corneas of silicone-filled eyes, restoration of visual acuity can often only be achieved by a keratoprosthesis. In the case of an intact posterior segment and retinal function a normal visual acuity can be anticipated but mostly with a restricted visual field. Complications vary from glaucoma, retroprosthetic membranes, necrosis of the recipient tissue at the rim of the prosthesis, endophthalmitis, loosening and loss of the prosthesis even to the loss of visual acuity. With some types of prostheses the visual acuity will be reduced again within a short time, but in osteo-odonto-keratoprostheses, using the root of a patients tooth as haptic material for the optical cylinder, good long-term results even for several decades are possible. In patients without suitable teeth, prostheses with biointegrable materials such as Pintucci keratoprostheses can be used. A basic rule is that a secondary glaucoma, which in this patient group frequently develops even preoperatively, must be treated adequately.

[The Ahmed glaucoma valve - a new implant for high intraocular pressure]. / Die Ahmed Glaucoma Valve.Ein neues Implantat zur operativen Drucksenkung.

UNLABELLED: In incurable glaucoma the implantation of traditional drainage systems (such as the Molteno implant) usually leads to extreme hypotension in the eye in the first postoperative period. The Ahmed Glaucoma Valve presents an alternative method to avoid this problem. PATIENTS AND METHOD: Ten patients with incurable glaucoma received an Ahmed Glaucoma Valve. The average age was 59 years (22-81) and the follow-up period was an average of 8 months (4-20). RESULTS: In the early postoperative period the average IOP was 5.5 mm Hg (range 4-8.5). We saw chorioidal detachments in two patients but no shallow anterior chamber. In six patients the pressure rose over 22 mm Hg, but we induced filtration by massaging the eye or rinsing the system in three and two patients, respectively. In nine of the ten patients, tension was definitively regulated, in one with an additional topical medication against glaucoma. CONCLUSIONS: Unlike the classic glaucoma drainage systems, the Ahmed Glaucoma Valve reduces intraocular pressure in the first postoperative period without the problems of excessive hypotension.

[Drainage systems in glaucoma surgery]. / Drainagesysteme in der Glaukomchirurgie.

Glaucoma drainage devices, also known as aqueous shunts (AS) are widely used in the USA. They consist of a silicone tube that is inserted into the anterior chamber and connected to a plate made of silicone or polypropylene, the explant. The latter is positioned between the recti muscles and over several weeks the surrounding tissue forms a fibrous bleb around the plate. This serves as a permanent filtration reservoir.Recurrent failure of filtrating surgery is the main indication for the use of AS. Other indications include situations in which the formation of a filtering bleb seems to be unpromising because of extensive conjunctival scarring. Qualified success has been achieved for many years in 50-100% of the eyes treated depending on patient selection. The most serious complication is postoperative hypotonia that can lead to serious chorioidal detachment, suprachorioidal hemorrhage, flat anterior chamber and corneal decompensation. To avoid this complication some devices, i.e.the Ahmed Glaucoma and the Krupin valve have integrated mechanisms to sustain a residual intraocular pressure. With other devices i.e. the Molteno and the Baerveldt devices, the tube has to be temporarily ligated until bleb formation has started. On the other hand fibrous infiltration of the bleb 1-4 months after the surgery often leads to a reversible rise in introcular pressure, which can be treated by massaging the bulbus, needling the bleb or injection of antimetabolites. There are no obvious differences between the various forms of AS with regard to the success of pressure regulation. In summary,by close scrutiny of indications and management of complications,drainage systems are a useful option in the management of complicated glaucoma that carry a high risk of failure from conventional filtering surgery.

[Osteo-odonto-keratoprosthesis. A summary of 6 years surgical experience]. / Die Osteo-Odonto-Keratoprothese. Ein Resümee nach sechs Jahren operativer Erfahrung.

PURPOSE: In patients with severe corneal scarring and vascularisation, corneal grafts have a high risk of failure. In those patients an osteo-odonto-keratoprosthesis (OOKP) can be performed. METHOD: We performed OOKP in eight patients in all with ocular pemphigoid, severe alkali burns, or repulsion of a corneal graft. Each of the patients had finger-counting visual acuity or less. The OOKP consisted of a PMMA cylinder 8 mm long, with a diameter of 3-4 mm, and from a root of the patient's tooth. This was implanted in the cornea and covered with buccal mucosa. RESULTS: The medium follow-up was 3 years. The implants are now well incorporated. The best visual acuity was between 0.6 and 0.9 in four patients with intact retinas. In the remaining patients, visual acuity was dependent on the posterior segment findings. The visual field was centred. Five of the eight patients had vitreous bleeding after the operation that was spontaneously absorbed. Revision of the mucous coverage was necessary in four patients, and one of them had a severe inflammation with partial absorption of the bone and tooth implant. One patient developed a secondary angle-closure glaucoma and was treated successfully by implantation of an Ahmed valve. Two patients developed membranes behind the cylinder that were successfully removed. There was no loss of any prosthesis during follow-up. CONCLUSIONS: In impasse in severe corneal scars, the osteo-odonto-keratoprosthesis is still indicated and shows good results in visual rehabilitation of patients.

[The effectiveness of limbus epithelium transplantation]. / Untersuchung zur Effektivität der Limbusepitheltransplantation.

BACKGROUND: The transplantation of the limbus is based on the theory that limbal stem cells are necessary for epithelialisation and maintenance of a clear cornea. We used a genetic analysis procedure to demonstrate the survival of transplanted limbus stem cells. PATIENT AND METHODS: A lamellary corneal graft and limbus transplantation from donor material was carried out on a patient with severe alkali burns and destroyed Bowmann's membrane to prepare the cornea for perforating keratoplasty. Subsequently, perforating corneal graft was carried out and the epithelium and endothelium of the removed cornea were analysed with a gene analytical procedure. For the cellular typing we used the SGM kit, well known in forensic analysis, that allows simultaneous detection of alleles at 11 loci. The genetic analysis was performed using an ABI PRISM 310 Genetic Analyser (Perkin Elmer Applied Biosystems) after DNA amplification by the polymerase chain reaction. RESULTS: The cornea-limbus transplant was integrated without vascularisation from the limbus under treatment with cyclosporin A. The epithelium cells of the corneal tissue gained by keratoplasty had the same genetic pattern as the primary donor in all loci, but no congruence with the recipient (except for the amelogenin marker because both the donor and the recipient were males). Therefore the epithelium cells must have originated from the transplanted stem cells of the donor. CONCLUSIONS: The identical genetic pattern found for the donor and the epithelium of the corneal-limbal transplant demonstrate the survival of the transplanted stem cells in a patient with adequate cytostatic therapy.

[Prospective study of surgical therapy of pterygium: bare sclera technique vs. free conjunctiva-limbus transplant]. / Prospektive Studie zur operativen Therapie des Pterygiums: Bare-Sklera-Technik vs. freies Bindehaut-Limbus-Transplantat.

Many techniques of pterygium surgery with various rates of recurrence are described in the literature. We report on the outcome after pterygium excision with bare-sclera technique compared with free transplantation of limbal conjunctiva. We used the bare-sclera technique in 21 eyes and performed free transplantation of conjunctiva in 34 eyes. The duration of follow-up was 14 months. In patients operated with the bare-sclera technique there were significantly more recurrences (eight vs four, P < 0.025) and cases of development of pyogenic granuloma (four eyes vs no eyes, P < 0.01). In patients with primary surgery and free limbal transplant we found no case of recurrence, but the bare-sclera technique was associated with a recurrence rate of 35.5% (P < 0.01). We recommend free limbal conjunctival transplantation even in patients with primary surgery of a pterygium.

[Perioperative follow-up of physiologic and cognitive functions after oral premedication with midazolam 3.75 mg in women for retrobulbar anesthesia]. / Perioperativer Verlauf von physiologischen und kognitiven Funktionen nach oraler Prämedikation mit Midazolam 3.75 mg bei Frauen in Retrobulbäranästhesie.

Recent changes in the medical system have resulted in a significant increase in the number of surgical procedures performed as day surgery. Therefore, a safe and short postoperative recovery period has become increasingly important. In the present study we investigated perioperative cognitive and physiological functions after oral premedication with low-dose midazolam (3.75 mg). The study was carried out on at total of 55 women (age > 60 years, weight 50-90 kg) scheduled for elective cataract surgery under retrobulbar anaesthesia (RBA), who were randomly assigned to either group 1 (n = 35) receiving 3.75 mg midazolam p.o. or group 2 (n = 20) receiving placebo p.o. 30 min prior to RBA. We measured the following parameters: sedation (modified Glasgow Coma Scale); anxiety (visual analogue scale); numerical and verbal memory (digit span and reproduction of previously presented words); concentration (revision test of Stender/Marschner). To identify depression of ventilation, pulse oximetric oxygenation and end-tidal PCO2 (nasal) were monitored intraoperatively. In the midazolam group anxiety was significantly lower and patients were significantly more sedated than in group 2. At a check 30 min after premedication with midazolam the scores for concentration and numerical memory were significantly (P < 0.05) lower. No differences between the groups could be found 2 h after the operations (2.92 +/- 35 min after premedication). Intraoperatively there was no significant difference in end-tital PCO2 and oxygenation between the groups. Oral administration of low-dose midazolam (3.75 mg) seems to be an appropriate form of premedication for ambulatory surgical procedures in elderly patients.

[Laser flare in combined cataract and glaucoma surgery]. / Laser-Flare bei kombinierter Katarakt- und Glaukomchirurgie.

BACKGROUND: We used a laser-flare meter to compare inflammation of the anterior chamber in combined cataract and glaucoma surgery with that in pure filtering surgery. MATERIALS AND METHODS: In 34 consecutive patients with primary chronic open-angle glaucoma (PCOG) we combined glaucoma surgery and cataract extraction with phacoemulsification and implantation of a foldable intraocular lens via the same incision. We compared the results with those in 32 PCOG patients receiving a single goniotrephination and in 45 PCOG patients receiving cataract extraction via clear cornea with implantation of a foldable lens. RESULTS: The increase in the flare in the first 2 days was significant in those receiving combined cataract and glaucoma surgery and in those receiving single goniotrephination but not in those receiving a single cataract extraction. After 3 weeks there was no significant difference to the preoperative value in any of the groups. The highest flare values were in patients after combined surgery, significantly higher than after cataract extraction in the first days and higher than in the goniotrephination patients 3 weeks after the operation. CONCLUSION: The highest flare on the first day was in combined cataract and glaucoma surgery. This may explain the more frequent scarring of the filtering bleb in combined surgery. Postoperatively the intraocular pressure and number of drugs used for glaucoma did not differ in patients with combined and single goniotrephination.

[Eye and general illnesses in the public school for blind and visually handicapped students in Saarland. Developments in the last 20 years]. / Augen- und Allgemeinerkrankungen in der Landesschule für Blinde und Sehbehinderte des Saarlands. Entwicklungen in den letzten 20 Jahren.

BACKGROUND: The aim of the study was the evaluation of how ophthalmological diagnoses and the proportion of multiply handicapped children has changed within the last 20 years at a state school for visually handicapped and blind children. PATIENTS AND METHODS: A profile investigation was conducted on all 105 children at the Landesschule für Blinde und Sehbehinderte des Saarlandes and compared to the results of an examination from 1975. RESULTS: The predominant ophthalmological diagnoses were: optic atrophy (17.5%), ocular albinism (11.9%), scar-stage IV and V of retinopathy of prematurity (11.1%), as well as tapetoretinal dystrophies with related syndromes (8.7%) and myopia magna (7.9%). Blind: 10.3% (1975: 36.4%); visually handicapped: 47.1% (1975: 49.2%); multiply handicapped: 42.5% (1975: 14.4%). CONCLUSIONS: (1) The diseases that dominated in earlier years in schools for the visually handicapped have become rare (cataract, aphakia, buphthalmia, macular dystrophy--all less than 5%); (2) the proportion of completely blind pupils has become much smaller; (3) there is an increasing tendency to educate visually handicapped pupils in regular schools with integrative aids; (4) there is also an increasing proportion of multiply handicapped children (school and kindergarten: 42%, early patronage 74%).