[LASIK - a new treatment or the standard]. / LASIK - Neulandbehandlung oder medizinischer Standard.

Classification of LASIK in refractive surgery and treatment by health insurance, and education by the physician. Results in clinical studies and case law in Germany 2010.

[Unilateral papilledema with contralateral loss of vision]. / Einseitiges Papillenödem und kontralateraler Visusverlust.

A 46-year-old woman presented with a 4-day history of headache, dizziness and blurred vision in the left eye and a 1-year history of neck pain. Fundoscopy revealed a pale optic disc in the left eye and a swollen optic disc in the right eye. Furthermore a bilateral anosmia was evident. Cranial magnetic resonance imaging (MRI) showed a mass in the anterior cranial fossa, which was classified as a WHO grade I endotheliomatous meningeoma. A Foster Kennedy syndrome was diagnosed.

[Scanning electron microscopic characteristics of lamellar keratotomies using the Femtec femtosecond laser and the Zyoptix XP microkeratome. A comparison of quality]. / Vergleich des Femtec Femtosekundenlasers und des Zyoptix XP Mikrokeratoms. Rasterelektronenmikroskopische Gegenüberstellung lamellärer Keratotomien.

OBJECTIVE: To demonstrate the qualities and compare the typical features of cut surfaces and cut edges created by the Femtec femtosecond laser and the Zyoptix XP microkeratome, using scanning electron microscope (SEM) pictures. METHODS: Lamellar keratotomies were performed using a femtosecond laser (40 kHz) or a microkeratome on freshly enucleated porcine eyes (n=16, eight each per technique). After special preparation, SEM images were taken to evaluate the qualities of the cut surfaces and cut edges. Therefore, special criteria were involved, including relief and homogeneity of the surface and sharpness of the cut edges. RESULTS: Surfaces created by microkeratome cuts were very homogenous. Concerning surface relief, nearly no irregularities occurred. Cut edges showed a flat, serrated course from the epithelial layer to the stroma of the cornea. The edges were sharp and easily visible. After preparation using the femtolaser, the surface showed many rips in the tissue, leading to irregularities. Nevertheless, the cut edges were very sharp and entered the corneal layer straight at 90 degrees . CONCLUSIONS: A comparison of the two systems shows that the microkeratome creates a more homogenous cut surface. The need for preparation after automated cutting with the femtosecond laser leads to irregularities on the cut surface. The cut edges of both systems tested here differ concerning their angles on entering the tissue. With regard to the sharpness of the cuts, the qualitative aspect is nearly similar, although the cut edges of the microkeratome are serrated. Because the microkeratome-cut edge has a flatter course, the wound area might be bigger. Cut edges with the steepness produced by the femtosecond laser could be an advantage for repositioning the flap after LASIK. If excimer laser ablation is performed later, the flap bed created by the femtosecond laser could be disadvantageous.

[Clinical course of a solitary retinal astrocytoma]. / Klinisch-zeitlicher Verlauf eines solitären retinalen Astrozytoms.

Retinal astrocytomas are benign tumors of the retina. Their localization can be solitary, multiple, or bilateral in both eyes. It is also known that they can be part of a phakomatosis syndrome (i.e., tuberous sclerosis or neurofibromatosis). Because retinal astrocytomas have a slow growth rate, yearly controls by an ophthalmologist with interdisciplinary consultation are adequate. Some uncommon cases have been reported in which the tumor has grown more aggressively. These tumors may require therapeutic interventions (e.g., vitreoretinal surgery, brachytherapy, photodynamic therapy, or cryotherapy).

[Unusual myopic fundus alteration]. / Ungewöhnliche myope Fundusveränderung.

A 44-year-old female patient reported a "black dot" which had been in front of the right eye for more than 4 days and which moved together with eye movements. The optical coherence tomography (OCT) image of the right macula showed large cystic cavities and thickening within the retinal pigment epithelium (RPE) near the fovea centralis as well as small bore cystic alterations, which indicated an event in the region of the choroid. Fluorescein angiography and indocyanine green angiography excluded choroidal neovascularization (CNV). The diagnosis revealed a broad superficial choroidal blood vessel mimicking a subretinal hemorrhage.

[Reduction of astigmatism by arcuate incisions using the femtosecond laser after corneal transplantation]. / Korrektur des Astigmatismus nach Hornhauttransplantation durch bogenförmige Inzisionen mit dem Femtosekundenlaser.

AIM: We examined the effectiveness of arcuate incisions by femtosecond laser treatment for high astigmatism in corneal transplants. BACKGROUND: High astigmatism is a well known complication after corneal transplantation and is difficult to treat. At present, there are many surgical procedures for the correction of high astigmatism after PKP in case of an unsuccessful contact lens therapy. PATIENTS AND METHODS: Ten patients with a high postoperative astigmatism underwent arcuate keratotomy with the Femtec laser. We performed two arcuate incisions on each transplant. With the femtosecond laser technology it is possible to perform precise incisions where the depth and length of the arcus can be programmed. RESULTS: The best corrected visual acuity was improved in eight out of ten patients. The visual acuity of two patients did not change. The average corneal astigmatism was reduced by three dioptres. The average refractive astigmatism was reduced by four dioptres. CONCLUSION: Arcuate incisions with the femtosecond laser on patients with high astigmatism subsequent to corneal transplantation are an effective and safe treatment.

[Hazeformation (corneal scarring) after cross-linking therapy in keratoconus]. / Haze-Bildung nach Vernetzungstherapie bei Keratokonus.

The aim of cross-linking therapy is to prevent keratoconus progression and stabilize the present refractive situation. A 41-year-old man was treated with collagen cross-linking in one eye. Postoperatively there were a diffuse subepithelial opacification and a paracentral corneal thinning. This superficial scarring in the sense of a "haze" disappeared only gradually despite intensive therapy.

[Molecular genetic and histopathological examinations for genotype-phenotype analysis in patients with TGFBI-linked corneal dystrophy]. / Molekulargenetische und histopathologische Untersuchungen zur Genotyp-Phänotyp-Analyse bei Patienten mit TGFBI-gekoppelten Hornhautdystrophien.

PURPOSE: Different missense mutations in the TGFBI gene cause granular (Groenouw CDGG1, Avellino CDA, Reis-Bücklers CDB1) and lattice (Type I; Biber-Haab-Dimmer; CDL1) corneal dystrophies and, in some reports, corneal dystrophy Thiel-Behnke (CDB2). We report on the mutation spectrum and the genotype-phenotype correlations on the basis of clinical and histopathological examinations of 13 German families with TGFBI-linked corneal dystrophies. METHODS: In 31 patients with different corneal dystrophies, DNA was extracted from leukocytes of the peripheral blood and mutation analysis was performed by direct sequencing of the TGFBI gene. Clinical and histopathological findings were compared with the molecular genetic findings for genotype-phenotype correlations. RESULTS: In 6 patients (2 families/one single person) with clinical and histopathological CDL1 we found a Missense mutation Arg124Cys and in 7 patients (3 families/one single person) with clinical and histopathological CDA we found a Missense mutation Arg124His in the exon 4 of the TGFBI gene. In 12 patients (4 families/2 single persons) with clinical and histopathological CDGG1 we found a Missense mutation Arg555Trypt in the codon 12 of the TGFBI gene. In all five patients (1 family/4 single persons) with clinical and histopathological CDB2 we could not find any mutation in the TGFBI gene. In one patient with exceptional clinical and histopathological findings we found a Missense mutation Ala546Asp, which was reported before only twice in connection with polymorphous corneal amyloidosis. CONCLUSIONS: In comparison of our clinical and histopathological findings and the molecular genetic results we found a strong genotype-phenotype correlation in patients with TGFBI-linked corneal dystrophies. Rare mutations can lead to exceptional clinical and histopathological findings which cannot be classified into the different groups of corneal dystrophies. In our patients with CDB2 we could not find any molecular genetic correlation to the TGFBI gene.

[Idiopathic orbital inflammatory syndrome (orbital pseudotumors): diagnosis and therapy]. / Idiopathische entzündliche intraorbitale Fibrosklerose: Diagnostik und therapeutische Möglichkeiten.

BACKGROUND: Pseudotumors of the orbit comprise a group of idiopathic inflammatory processes and are, except for endocrine orbitopathy, the most common reason for exophthalmos in adults. Orbital pseudotumors, also called idiopathic orbital inflammatory syndrome (IOIS), can be determined from orbital involvement in systemic fibrosing diseases. Finding the correct diagnosis can be challenging. Due to the topographic relations of the orbit to neighbouring structures, a multidisciplinary cooperation is highly recommended. CASE REPORT: We report a case of a 42-year-old woman with unilateral exophthalmos. Additionally we found impaired motility of the affected bulbus, ptosis and reduction of visual acuity. Orbital MR imaging demonstrated dense fibrotic masses filling the whole orbita including the extraocular muscles as well as the optic nerve. Tissue specimens were extracted while performing orbital decompression via a lateral orbitotomy. Histological examination revealed a lymphatic infiltration and fibrotically destroyed tissue containing the lacrimal gland. After surgical decompression, oral steroid therapy and immunotherapy, a recovery of the visual loss could be seen. CONCLUSIONS: Intraorbital fibrosclerosing pseudotumors often require a difficult long-term treatment. Therapeutic options are steroid therapy, immunotherapy, radiotherapy and surgery. The diagnostic steps include blood tests, ultrasound, CT and/or MRI as well as histological differentiation. Solid tumors and orbital involvement in diseases of the hematopoetic system have to be excluded. Since intraorbital fibrosis can be accompanied by manifestations in various other organs, a complete investigation of the body and thorough follow up are crucial.

[Corneal wound healing after hyperopic PRK and LASIK]. / Korneale Wundheilungsreaktionen nach hyperoper PRK und LASIK.

BACKGROUND: The purpose of this study was to investigate the influence of different postoperative treatments on the wound healing reaction in the anterior stroma after PRK and in the interface area after LASIK. METHODS: Seventy-two corneal buttons of refractively treated rabbit eyes underwent different postoperative eyedrop regimens with antibiotics and/or steroids or additional UV-B irradiation. Morphological and immunohistological investigations were performed 6 months postoperatively by light and transmission electron microscopy. RESULTS: PRK eyes showed interdigitations between the epithelia and the anterior stroma. LASIK-treated eyes showed only minor changes between epithelia and stroma in the incisional region. Only a slight increase in deposits of fibrillar extracellular matrix components were detectable in the interface region. CONCLUSIONS: The clinically important problem of haze after PRK is caused by the interdigitations between epithelia and anterior stroma. The delicate wound healing reactions in the interface region in LASIK eyes corresponded to the clinically visible minor changes in these corneas.

[Radiotherapy for Graves' ophthalmopathy]. / Radiotherapie der endokrinen Orbitopathie.

Graves' ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease, an autoimmune disorder of the thyroid, whereas the precise pathogenesis still remains unclear. In Hashimoto's thyroiditis the occurrence of proptosis is an extremely rare event. The therapy for middle and severe courses of GO shows in partly disappointing results, although several therapy modalities are possible (glucocorticoid therapy, radiotherapy, antithyroid drug treatment, surgery). All these therapies lead in only 40 - 70 % to an improvement of the pathogenic symptoms. An intensive interdisciplinary cooperation is necessary to satisfy the requirements for the treatment of Graves' ophthalmopathy. As a consequence of the very different results of the few of clinical studies that were accomplished with reference to this topic, treatment by radiotherapy in the management of the disease is presently controversially discussed. In the German-speaking countries the radiotherapy is, however, firmly established as a therapy option in the treatment of the moderate disease classes (class 2-5 according to NO SPECS), especially if diplopia is present. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. Altogether, radiotherapy is assessed as an effective and sure method. The administration of glucocorticoids can take place before the beginning of or during the radiotherapy. For the success of treatment the correct selection of patients who may possibly profit from a radiotherapy is absolutely essential. By realising that GO proceeds normally over a period of 2-5 years, which is followed by a period of fibrotic alteration, the application of the radiotherapy in the early, active phase is indispensable. A precise explanation for the effects of radiotherapy in treatment of the GO does not exist at present. The determination of the most effective irradiation doses was made from retrospectively evaluated collectives. Recently the results of a national survey of all German RT departments were published, initiated by the working group of the DEGRO (German Society of Radiooncology). In the most of the German radiooncology departments irradiation with 8 to 10 x 1.8-2.0 Gy 5 x weekly to 16 or 20 Gy is standard. Two recently published prospective German studies pointed out the equivalence of the effectiveness of a short therapy in low dose ranges up to 2.4 Gy as well as of a low proportioned irradiation during a longer period in relation to a standard therapy with 20 Gy. That is why at the moment it is not possible to give a definite recommendation with reference to dosages or the fractionation schemes. In 2003 the first European group (European Group on Graves ' Orbitopathy Experience -- EUGOGO) was founded for pursuing investigations of GO in multi-centric studies, mainly to improve therapy results.

[Results of wavefront-guided LASIK]. / Ergebnisse der wellenfrontgestützten LASIK.

BACKGROUND: Wavefront-guided LASIK procedures provide patients with customized corneal treatments. The computer ablation profiles correct both spherical and/or cylindrical errors of refraction and aberrations up to the fifth order. METHODS: We performed wavefront-guided LASIK treatments on 62 patients using the Keracor 217 Z. The spherical equivalent was -6.11 +/-2.29 D on the average. Data collected for 3 months were evaluated to determine the predictability, efficacy, stability, and safety of the refractive procedure. RESULTS: We found good predictability of the refractive result after correcting -1 to -6 D of myopia. Beyond -7 D there were over- and undercorrections of +/-2 D in 10% of the procedures. A UCVA of 0.8 or better was observed in 53% of the patients 3 months postoperatively, and 75% of the patients reached a BCVA of 0.8 or better. After 3 months 6% lost 2 lines, 22% lost 1 line, 22% of the patients gained 1-2 lines, and BCVA remained unchanged in 55%. The fluctuation of the refraction was about -0.23 D during the first 3 postoperative months. CONCLUSIONS: The low and middle range of myopia can be corrected very accurately using the wavefront technology. Higher degrees of myopia face both under- and overcorrections. Postoperative refractions become stable very quickly. However, the visual acuity changes even 6 months postoperatively. From our point of view, wavefront correction by LASIK should be more reliable in terms of centration, accuracy, and standardization to get better results.

[Intraocular non-Hodgkin's lymphoma and its therapy-- a case series of ten patients]. / Das intraokulare Non-Hodgkin-Lymphom und seine Therapie -- eine Fallserie mit 10 Patienten.

BACKGROUND: The timely and correct diagnosis of intraocular non-Hodgkin's lymphoma represents a huge challenge to clinicians. Two thirds of intraocular lymphomas are a manifestation of a primary CNS lymphoma (PCNSL) arising outside the lymphatic system and are localized in the brain, the meninges or the spinal chord. Ten to twenty percent commence as vitreous or retinal infiltrates mimicking uveitis. Ninety five percent of PCNSL are B cell lymphomas. PATIENTS: Three exemplary cases from a group of ten patients treated between 1998 and 2002 are presented. A table provides a summary of the relevant details of all ten patients. RESULTS: The mean age at presentation was 63.5 years with a female to male ratio of 6 to 4. Nine patients were diagnosed as having intermediate or posterior uveitis, in one patient choroidal metastases were suspected. Six patients had a concomitant CNS lesion while four patients showed isolated intraocular lymphoma only. The presence of a highly malignant B cell lymphoma was proven by vitreous biopsy in nine cases and by stereotactic biopsy of a CNS lesion in one patient. All patients were treated by intravenous chemotherapy, however, no binding recommendations with regard to treatment exist to date. CONCLUSIONS: We give an overview of all current treatment regimens and their pitfalls. At present it is recommended that all patients with proven PCNSL be entered in a multicenter randomized study under the auspices of the Department of Internal Medicine III of the Benjamin-Franklin-University-Hospital, Berlin and the Department of Neurology of the University Hospital of Tuebingen.