[Diagnostic and therapeutic recommendations for mucous membrane pemphigoid of the eye]. / Empfehlungen zu Diagnostik und Therapie beim Schleimhautpemphigoid.

Mucous membrane pemphigoid (MMP) is often accompanied with a chronic cicatrizing conjunctivitis that may eventually lead to loss of vision. The study is intended to investigate the current scientific knowledge on the diagnosis of and therapy for MMP involving the eye. Previous studies published before December 2004 have been systematically reviewed for their level of evidence. Consequently, recommendations for patient management are provided.

[Additive retrobulbar anesthesia in surgery of retinal detachment with general anesthesia. Reduced postoperative pain and stress response]. / Additive Retrobulbäranästhesie bei Operationen von Netzhautablösungen in Allgemeinanästhesie. Postoperative Schmerzreduktion und Unterdrückung der endogenen Stressantwort.

BACKGROUND: It has recently been shown that the pain occurring after retinal detachment surgery can be reduced by combined general and retrobulbar anesthesia. This study investigated the effect of retrobulbar anesthesia on the intra- and postoperative stress response and on postoperative pain, vigilance, nausea and vomiting. PATIENTS AND METHODS: In this prospective randomized study, 45 patients were enrolled where scleral buckling surgery for retinal detachment had been performed under general anesthesia. Bupivacain 0.5% (4 ml) was injected retrobulbarly in group I (n = 15) before surgery (preoperative) and in group II (n = 15) after surgery (postoperative), group III did not receive retrobulbar anesthesia. At different times during and after surgery, blood pressure, cortisol and glucose levels, time in the recovery unit, vigilance score, nausea and vomiting were measured and the pain score was determined. The dosages of intraoperative opioid analgetics and of postoperative pain medication were documented. RESULTS: Retrobulbar anesthesia reduces postoperative pain. Intra- and postoperative endogenous stress responses in groups I and II were reduced and the plasma levels of cortisol and glucose in group I were lower than in group II. In group I, nausea, dosages of intraoperative opioid analgetics and postoperative pain medication were reduced, the vigilance was increased and time in the recovery unit was shortened. CONCLUSIONS: The data show that combined local and general anesthesia has several advantages over general anesthesia alone, especially when the retrobulbar injection is given before retinal detachment surgery.

[Argon laser trabeculoplasty in chronic simple glaucoma with visual field defects and papillary damage]. / Argon-Laser-Trabekuloplastik bei Glaucoma chronicum simplex mit Gesichtsfeldausfällen und Papillenschaden.

It has been recently demonstrated that the intraocular pressure (IOP) after argon laser trabeculoplasty (ALT) in primary open-angle glaucoma rises in the long term. The present study analysed the effect of the postoperative rise in IOP in 36 patients (group A) with glaucomatous optic nerve damage or visual field defects. The results were compared with those in 37 patients without such glaucomatous damage (group B). The IOP, the cup-disk ratios and the visual fields (Goldmann) were retrospectively studied. All patients were under topical glaucoma medication. At the end of the follow-up (group A 20.2 +/- 3.39 months, group B 17.4 +/- 3.59 months), the IOP was uncontrolled in both study groups, and visual fields and disc cupping had worsened in both groups. The results indicate that ALT should not be considered in patients with optic disc damage or glaucomatous visual field defects.

[Therapy of dry eye disorders]. / Therapie von Benetzungsstörungen.

BACKGROUND: The treatment of dry eyes with artificial tears often fails. We differentiated the disturbances of the three layers of the tear film in 90 such patients. This showed that only 11.1% had aqueous deficiency, while 42.3% had combined disturbances of different layers of the tear film, and 76.7% had lipid deficiencies. PATIENTS AND METHODS: We now studied the efficacy of a therapeutic approach, which intended to stabilize each individual deficiency of the three layers of the tear film (follow-up > or = 6 months). The 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 were analyzed. RESULTS: Therapy was beneficial in all patients (n = 90) with regard to the symptoms and the objective parameters. Artificial tears applied strictly were without preservatives. Patients with toxic conjunctivitis induced by high dosages of eye drops were often stabilized through withdrawing the medication. The frequency of applying artificial tears was significantly tapered by punctum plugs and -coagulation. Tarsorrhapies were helpful in the most severe cases. Topical retinoids significantly reduced the symptoms and increased the goblet cell density. Treating chronic blepharitis was very sufficient, when initiated by topical steroids and Tetracycline, and systemical Doxycycline. CONCLUSIONS: Differentiating the disturbances of the three tear film layers in "sicca syndrome", and stabilizing each component is more effective than artificial tears alone.