Ultrastructure of the rabbit corneal stroma after experimental keratomileusis.

Experimental keratomileusis operations were performed on 13 rabbit eyes. The corneas of the rabbits, in particular the stroma, were investigated up to 24 months after the operation by light and electron microscopy. The most striking features of the corneal ultrastructure following experimental keratomileusis were the presence of abnormal collagen fibrils and electron-translucent vacuoles in the interface.

Keratitis from abuse of corneal anaesthetics.

Topically applied anaesthetics are potentially dangerous, as frequent and continuous application may lead to anaesthetic-induced keratitis. Three patients with serious corneal lesions are described.

[Pterygium excision with intra-operative administration of low dosage mitomycin C]. / Pterygiumexzision mit intraoperativer Applikation von niedrig dosiertem Mitomycin C.

Pterygium excision with postoperative instillation of mitoymcin C (MMC, 0.4 mg/ml) is encouraging because of the technical simplicity and low recurrence rates, but serious postoperative complications have been described (scleral necrosis, corneal perforation, glaucoma, cataract). The authors studied the efficacy and safety of pterygium excisions with a single intraoperative application of low-dose MMC (0.2 mg/ml). Pterygium excision (bare sclera technique) was performed in 18 patients with primary or recurrent pterygia. MMC (0.2 mg/ml) was applied intraoperatively (5 min) to the exposed sclera. Patients were followed up for signs of recurrence and complications. There were four recurrences (mean follow-up 13.8 months). Postoperative complications consisted of granuloma formation (n = 2). Delayed conjunctival healing was observed in all cases. Scleral necrosis, corneal complications, cataract, or glaucoma were not seen. Intraoperative application of MMC apparently reduces the recurrence rate after pterygium excision. The use of a 0.2 mg/ml concentration of MMC appears to be safe.

[The pterygium, Autologous conjunctiva-limbus transplantation as treatment]. / Das Pterygium. Die autologe Konjunktiva-Limbus-Transplantation zur Behandlung.

Based on a new concept of the limbus as a junctional zone for separating the vascularized conjunctiva from the avascular cornea, this study presents conjunctival/limbal autograft transplantation for 22 cases of pterygium. The pterygia were primary in 17 eyes, cicatricial in 1 and recurrent in 4. In all cases a free transplant of the superotemperal limbus with an adjacent piece of thin conjunctiva was placed in the excision area. Postoperative follow-up ranged from 1 1/2 to 17 months, with a mean of 8.7 months. Only two pterygia recurred. In all other cases ideal anatomic reconstruction was achieved without any side effects. The authors believe that conjunctival/limbal transplantation is an encouraging technique for treating a pterygium surgically.

[Diagnosis and and differentiation of dry eye disorders]. / Diagnostik und Differenzierung von Benetzungsstörungen.

Artificial tears often fail in dry eye patients. Our goal was to establish a diagnostic approach that involves alternatives that are more effective for the treatment. We examined 110 patients with dry eyes not stabilized by artificial tears: medical history, visual acuity, slit lamp examination, rose bengal stains and fluorescein stains, Schirmer test, break-up time (BUT), dye tests, impression cytology, and lid transillumination. This allowed disturbances of the three layers of the tear film (lipid, aqueous, mucin) to be differentiated. Cellular damage of the ocular surface was evaluated and scored by slit lamp examination, rose bengal staining, and impression cytology. Only 8% of the patients with "sicca syndrome" had exclusive aqueous deficiencies amenable to artificial tears. In contrast, lipid deficiencies (chronic blepharitis) were determined most frequently (78%). Twenty-six percent had disturbances in two or more layers of the tear film. The diagnostic strategy of differentiating disturbances of the layers of the tear film offers a more specific approach to the treatment of dry eyes.

[Corneal transplantation]. / Hornhauttransplantationen.

After a brief review of the history of corneal grafting, consideration is given to the topics immunology, and the harvesting and preservation of donor material. The surgical techniques of lamellar and penetrating keratoplasty are briefly discussed. The indications for perforating and lamellar keratoplasty are listed, and the prognosis associated with the individual indications considered. Current problems of corneal grafting are the increasing numbers of operations, the question of the significance of HLA typing, and the evaluation of postoperative immunosuppression with cyclosporine A.

[Therapy of acute keratoconus]. / Zur Therapie des akuten Keratokonus.

The incidence of acute keratoconus has increased in recent years. A defect of the endothelium and Descemet's membrane allows the aqueous to flow into the stroma. The therapy of choice is penetrating keratoplasty. The discussion concerning the best time for the operation is still going on. The present authors have performed penetrating keratoplasties on 9 patients at the acute stage during the last 2 years. The results show that early surgery can prevent progression of the symptoms, with corneal edema and pannus, and subsequent complications.

[Acute corneal endothelial cell loss]. / Der akute Hornhautendothelzellverlust.

Corneal endothelial cell loss may result from endogenic causes, such as acute angle-closure glaucoma, or exogenic causes, such as corneal contusion, corneal perforation or surgery involving the anterior chamber. The extent of endothelial cell loss varies with the severity of trauma. Despite the different causes the response of the corneal endothelium is always an endothelial cell loss. Corneal endothelial decomposition may result from an acute endothelial cell loss.

[Surgery on the eye under anticoagulative therapy (author's transl)]. / Operation am Auge unter Therapie mit Anti-koagulantien.

Surgery on the eye of patients on long term anticoagulation therapy is possible. To avoid bleeding suprarenin solution 1:1000, coagulation of conjunctival and scleral blood vessels, incision into the cornea when removing cataracts and iridectomy under the operating microscope are recommended. Local anaesthesia is advisable, has however the risk of a retrobulbar hematoma. Thromboplastin time (Quick) under 15% of the norm should be avoided, and only raised in cooperation with the responsible internist.

[Value of Doppler carotid artery sonography in ophthalmologic diagnosis]. / Stellenwert der Karotis-Doppler-Sonographie in der ophthalmologischen Diagnostik.

We report the clinical and Doppler sonographic findings on the internal carotid artery in 230 patients with various purely ocular vascular symptoms. For evaluation, the patients were subdivided into four groups: group I (107): central retinal artery obstruction (CRAO) (13), branch retinal artery obstruction (BRAO) (31), amaurosis fugax (AF) (13), anterior ischemic optic neuropathy (AION) (50); group II: retinal vein occlusion (25); group III: "low-tension glaucoma" (55); group IV: chronic open-angle glaucoma with a possible vascular co-factor (43). In group I with signs of arterial ocular mal-perfusion; 29.5% of cases with CRAO and BRAO revealed significant stenosis or complete obstruction of the ipsilateral internal carotid artery. Only 4 of 50 cases (8.0%) with AION showed positive findings. A remarkable result of this evaluation is the coincidence that nearly all high-grade obliterations and obstructions of the internal carotid arteries diagnosed in this study were exclusively confined to eyes with very severe ischemic changes in both anterior and posterior segments. In no other case was localization or extent of the obstructive process in the internal carotid artery predictive. Venous retinal obstructions with only 16% positive findings did not show any correlation with arterial occlusive disease of extracranial vessels based on demographic aspects and clinicopathological studies. Also no etiological correlation could be detected in either of the glaucoma groups (III and IV).

[Modification of Mackensen's and Corydon's technique for reattaching the ciliary body (author's transl)]. / Modifikation des Operationsverfahrens zur Anheftung des Ziliarkörpers nach Mackensen und Corydon.

The weakness of Mackensen's and Corydon's method of reattaching the ciliary body in hypotonic syndrome lies in the closure of the scleral wound. We therefore recommend additional fibrinous cementing of the scleral suture with lyophilized dura mater. Since we adopted this technique we have observed no cases of wound dehiscence.

[Prognosis of functional healing of infantile strabismus]. / Die Prognose der funktionellen Heilung des frühkindlichen Schielsyndroms.

One hundred and forth-three patients suffering from infantile strabismus, who had undergone surgery on the horizontal eye muscles between the ages of 0 and 6 years were re-examined with the aim of establishing a correlation between the date of operation and functional healing (binocular single vision in space). In 89 patients (62%) a cosmetically satisfactory result (alignment) was achieved. The number of operations and functional healing (binocular single vision in space). In 89 patients (62%) a cosmetically satisfactory result (alignment) was achieved. The number of operations needed decreased with increasing age. Of the 89 patients with alignment, 61 (69%) were found to have binocular single vision in space, while 13 (15%) patients presented with stereopsis. Impairment of functional results was found to correlate with higher age at the first operation or on the date when alignment was reached for the first time, respectively. In cases with amblyopia or vertical divergences which had received insufficient postoperative treatment, attainment of binocular single vision or, respectively, the stability thereof was impaired. Therefore, with respect to functional healing, early surgical correction of strabismus is only recommended if adequate postoperative conservative and/or surgical after-treatment is assured. The postulate that successful functional healing can only be achieved by operations up to the second year (early surgery) is not supported by our data.

Leiomyoma of the ciliary body.

Clinical, histological, and electron-microscopic study of a leiomyoma of the ciliary body, which was removed by cyclectomy from the right eye of a 55-year-old female patient. This is the second case in the literature in which an excision has been performed and the diagnosis been confirmed by electron microscopy. The differential diagnosis between amelanotic malignant melanoma, schwannoma, and neurofibroma is discussed, and the electron-microscopic characteristics of a leiomyoma are demonstrated.

Cataract operations in a retina centre.

The position of the cataract surgeon in a retinal surgical centre is a particular one. Close collaboration with the retinal specialist obliges him never to lose sight of the judgement of the latter. The retinal surgeon does not judge the success of a cataract operation by the consequent visual acuteness obtained, but must wait to see the fundus of the eye, and in particular the retinal periphery. This is a problem with which we are occupied. We have studied from the point of view of the cataract specialist the modifications and retinal complications occurring in 2000 cataract operations. In addition, we have tried to make, from the point of view of the retina specialist, an analysis of detachments of the aphakia which occurred in relation to the cataract operations during the same period of time.

[Initial experience with autologous conjunctiva/limbus transplantation in pterygium]. / Erste Erfahrungen mit der autologen Conjunctiva-/Limbus-Transplantation beim Pterygium.

The present paper reports on the technique and results of conjunctiva/limbus transplantation in 13 eyes with primary or cicatricial pterygium (12 cases and 1 case, respectively). In all cases the pterygia were located nasally. The operation was performed by bare sclera excision, covered with a free graft from the superotemporal conjunctiva and limbus. After a mean follow-up time of 5 months there was only one recurrence. On the basis of a new understanding of limbal diseases the authors believe that conjunctiva/limbus transplantation is an encouraging and appropriate technique for ideal anatomic reconstruction and low recurrence rates in pterygia.

[Cataract operations and glaucoma - a study (author's transl)]. / Kataraktoperationen und Glaukom (Eine Studie).

This study reports on the favourable influence of lens extraction alone on intraocular pressure levels in different kinds of glaucoma (wide angle, angleclosure, secondary). Out of 2000 eyes undergoing cataract surgery 162 had medically treated glaucoma prior to surgery. Follow-up examinations of the intraocular pressure could be carried out in 118 eyes over a year. There resulted from this study no certain indications for a combined operation, whose value is discussed.