Presentation of Meibomian Acini Compared to Dermal Papillae of the Eyelid Margin, Using Confocal Laser Scanning Microscopy and Corresponding Histology.

BACKGROUND: Numerous studies have investigated the eyelid margin using confocal laser scanning microscopy (CLSM) and have presented morphological alterations of the examined structures, which were presumed to be Meibomian acini. However, recent data confirm that these structures are the cross-sections of dermal papillae of the dermoepidermal junction. This study aims to present the morphological appearance of Meibomian acini examined by confocal laser scanning microscopy in comparison to dermal papillae, and to reveal the corresponding patterns with specific histological sections. METHODS AND MATERIAL: Twenty healthy patients were examined with a CLSM device in vivo at the marginal edge of the eyelid. Twenty-two samples of full-thickness eyelid wedges from 22 patients treated surgically with ectropion were collected, of which 11 freshly excised samples were imaged on the incision surface with CLSM ex vivo and 11 eyelids underwent conventional histological preparation. The represented structures on CLSM images were compared to Meibomian acini on histological sections in terms of area, longest and shortest diameter, as well as depth and density. RESULTS: On in vivo CLSM images, Meibomian orifices, epidermal cells, and dermal connective tissue could be identified, the latter in a cross-sectional view of the dermal papillae surrounded by basal cells of the epidermis, forming reflective ring-like structures. All morphological parameters of these structures differed from Meibomian acini measured on histological sections. In contrast, the CLSM images of the incision surface showed acinar units with the same morphology as the Meibomian acini seen in the histological images and no statistically significant difference was found between the corresponding parameters. CONCLUSION: The morphological appearance of Meibomian acini differs from the structures that were previously presumed as Meibomian glands on CLSM images. In vivo imaging of Meibomian glands by commonly used in vivo CLSM cannot be performed.

[Two cases of phototherapeutic keratectomy treatment of the recurrent corneal erosion caused by alkali burn]. / Behandlung zweier Patienten mit einer zeitgleichen, arbeitsbedingten Augenlaugenverätzung und konsekutiver rezidivierender Erosio corneae mittels phototherapeutischer Keratektomie.

BACKGROUND: Four eyes of two patients were injured simultaneously by industrial alkali while working. One eye of both patients healed without later consequences. PATIENTS AND METHODS: Two eyes were treated with phototherapeutic keratectomy (PTK) because of recurrent corneal erosion syndrome caused by alkali burn. RESULTS: In both cases reepithelisation of the cornea was completed by the end of the 1st postoperative week, the injured persons were able to work again. No recurrence was experienced in the next 6 months of follow-up. CONCLUSION: With these cases the authors would like to draw attention to the possible complications, as well as the importance of careful balancing and adequate management.

[Atypical acute syphilitic posterior placoid chorioretinitis]. / Atypische akute syphilitische posteriore plakoide Chorioretinopathie.

Syphilis is an infectious disease that can cause a wide variety of ocular signs. One of the rarest manifestations of ocular syphilis is acute syphilitic posterior placoid chorioretinitis (ASPPC). We report the case of an immunocompetent 38-year-old woman diagnosed with unilateral, atypical, acute syphilitic posterior placoid chorioretinitis. Fundoscopic examination revealed a yellow-white, subretinal, placoid lesion at the posterior pole, which is typical sign of ASPPC. In the periphery of the retina, multifocal choroiditis was also found. Fundus and angiographic changes in ASPPC may mimic other chorioretinal diseases. Accurate diagnosis of ASPPC as a presenting sign of syphilis is important for the prompt initiation of systemic antibiotic treatment.

Corneal topography parameters after superior clear corneal incision cataract surgery in arcus lipoides.

PURPOSE: To compare changes in corneal topographic parameters after cataract surgery in eyes with different severities of arcus lipoides. METHODS: Fourty eyes of 40 patients (23 women, 17 men, age 71.3+/-20.4 years, range 40 to 89 years) were studied prospectively in a consecutive, non-interventional, comparative series of cases. Eyes were classed in three groups (0 to 2) according to the assessed grade of arcus lipoides (none, <180 degrees, >180 degrees). Corneal topography (Tomey TMS-2) was performed preoperatively and at 1 and 10 days and 1 and 3 months following cataract surgery (superior 4.0 mm clear corneal incision, no suture). Keratometric astigmatism (Dcyl), surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) were evaluated for the different groups and time-points, using the Kruskal-Wallis, Wilcoxon, and Mann-Whitney statistical tests. RESULTS: No significant preoperative difference was found in mean Dcyl, SRI, or PVA; preoperative SAI was lower in Group 1. Postoperatively Dcyl was increased at day 1 in Groups 1 and 2, and remained higher in Group 2 until month 1. At month 3 significant differences among Groups 0, 1, and 2 disappeared. CONCLUSIONS: The 4.0 mm superior clear corneal incision is a safe method for cataract surgery in the presence of arcus lipoides. This procedure induces greater corneal astigmatism, surface irregularity, and lower PVA in the early postoperative period in cases with arcus lipoides than in normal corneas. Concerning final results, wound healing was not affected by greater severity of arcus lipoides, although stabilization of the corneal surface tended to be slower.

[Bilateral simultaneous central retinal vein occlusion in protein S deficiency]. / Bilateraler simultaner retinaler Zentralvenenverschluss bei Protein-S-Mangel.

CASE REPORT: This article reports a case of bilateral simultaneous central retinal vein occlusion (CRVO) and protein S deficiency. The 27-year-old male patient presented with a sudden decrease in vision in both eyes. The patient's medical history documented the death of his father at the age of 33 years due to pulmonary embolism. Thrombophilia screening revealed protein S deficiency. OBJECTIVES: We report this case to emphasize that in any case of young onset retinal vein occlusion, protein S deficiency should be suspected. CONCLUSIONS: Thrombophilia assays and taking a thorough medical history should be performed.

Clinical and morphological response to UV-B irradiation after excimer laser photorefractive keratectomy.

This paper represents an update on a study that has been reported elsewhere (Nagy ZZ et al: Ophthalmology 104:375-380, 1997). The aim of the study was to evaluate the clinical and light- and electron-microscopic effects of ultraviolet-B (UV-B) exposure on the outcome of photorefractive keratectomy (PRK). A total of 42 pigmented rabbits were used in the study. One eye from each of 12 rabbits received a 193 nm 45-microm deep (-5.0 diopters [D]) excimer laser PRK, one eye from each of 12 rabbits received a 135-microm deep (-15.0 D) excimer laser PRK, and one eye from each of 12 rabbits received a 270 microm deep (-30.0 D) excimer laser PRK. Twenty-one days after PRK, six of the laser-treated eyes from each group were exposed to 100 mJ/cm2 UV-B (280-320 nm). The other six rabbits from the PRK groups received no further treatment. One eye from each of six rabbits received only UV-B irradiation, serving as control. Subepithelial haze was evaluated before and after UV-B irradiation. Clinical changes were followed by laser tyndallometry, confocal corneal biomicroscopy, ultrasound biomicroscopy, and endothelial specular microscopy. Corneal morphology was assessed 4, 8, and 12 weeks after UV-B exposure, employing light microscopic and transmission electron-microscopic techniques (TEM). Eyes only exposed to 100 mJ/cm2 UV-B exhibited keratitis for 2 days, but showed no haze and were histologically normal at all time intervals. The PRK-UV-B-irradiated rabbit eyes exhibited a significant increase of stromal haze compared to the eyes receiving PRK alone; this phenomenon correlated with the depth of photoablation. The severity of clinical findings also correlated with the previously attempted photoablation depth; in PRK-UV-B-irradiated eyes the symptoms were much more serious than in eyes treated with PRK alone. Histologically, the main difference between the UV-B-irradiated and nonirradiated-post-PRK eyes was the presence of anterior stromal extracellular vacuolization in the UV-B-exposed eyes. The vacuolated foci were confined to the PRK treatment area, contained increased numbers of keratocytes and showed a disorganization of normal collagen lamellae. Transmission electron microscopy revealed activated keratocytes containing abundant rough endoplasmic reticulum, prominent Golgi zones, and extracellular vacuoles filled with amorphous material. The haze and morphological changes showed a tendency to incomplete resolution over a period of 12 weeks. Ultraviolet-B exposure during post-PRK stromal healing exacerbates and prolongs clinical symptoms and the stromal healing response, which is manifest biomicroscopically by augmentation of subepithelial haze. The findings suggest that excessive ocular UV-B exposure should be avoided during the period of post-PRK stromal repair and that UV-B may modulate the response of tissues to excimer 193 nm, and perhaps, other laser energy in general.

Central bump-like opacity as a complication of high hyperopic photorefractive keratectomy.

PURPOSE: A new complication is reported in association with high hyperopic excimer laser photorefractive keratectomy. METHODS: One thousand consecutive eyes were treated with a Meditec MEL-60 excimer laser (Meditec Inc, Heroldsberg, Germany) for hyperopic refractive error between +1 diopters and +7 diopters. RESULTS: Three eyes with high hyperopic corrections between +5 and +6 diopters had a central, round bump-like subepithelial scar develop 1 month after hyperopic photorefractive keratectomy, which reduced the uncorrected and spectacle-corrected visual acuity. CONCLUSION: Central bump-like opacity is a new, visually significant complication of unknown origin associated with high hyperopic photorefractive keratectomy. Possible causes of this complication include drying and edema of the cornea as a result of prolonged exposure, interruption of the peripheral superficial nerve plexus affecting the central anterior stroma, and abnormal epithelial or tear film function resulting from excessive central steeping.

Photorefractive keratectomy for astigmatism with the Meditec MEL 60 laser.

PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) in eyes treated with astigmatic refractive errors. METHODS: Nine hundred forty eyes were treated with the Aesculap Meditec MEL 60 ArF excimer laser. Treatment groups were: Group 1 (n=746) eyes with compound myopic astigmatism, Group 2 (n=104) eyes with compound hyperopic astigmatism, Group 3 (n=75) eyes treated for mixed astigmatism, and Group 4 (n=15) eyes with simple myopic astigmatism (negative cylinder). RESULTS: In Group 1, the preoperative spherical equivalent refraction of -6.10 D with an average of -1.50 D cylinder decreased to -0.95 D with -0.13 D cylinder; uncorrected visual acuity (UCVA) of 20/40 or better was achieved in 86% (642/746 eyes); 20/20 or better in 58% (433/746 eyes); 0.8% (6/746 eyes) lost two lines of spectacle-corrected visual acuity (SCVA); 74% (552/746 eyes) were within +/-0.50 D and 93% (694/746 eyes) were within +/-1.00 D of target refraction. In Group 2, preoperative mean +4.57 D spherical equivalent refraction with an average of +1.57 D cylinder decreased to +1.13 D with +0.38 D cylinder; UCVA of 20/40 or better was achieved in 84% (87/104 eyes); 20/20 or better in 46% (48/104 eyes); 14,4% (15/104 eyes) lost two or more lines of SCVA; 52% (54/104 eyes) were within +/-0.50 D and 82% (85/104 eyes) were within +/-1.00 D of target refraction. In Group 3, mean preoperative -4.20 D cylinder and +3.00 D spherical equivalent refraction decreased to -0.50 D cylinder and -0.50 D spherical equivalent refraction; UCVA of 20/40 or better was achieved in 83% (62/75 eyes); 20/20 or better in 32% (24/75 eyes); 13.3% (10/75 eyes) lost two or more lines of SCVA. In Group 4, mean preoperative -3.98 D cylinder decreased to -0.62 D cylinder; UCVA of 20/40 or better was achieved in 60% (9/15 eyes); none of the eyes achieved 20/20 or better; SCVA remained stable in 6.6% (1/15 eyes) and decreased two or more lines in 20.0% (3/15 eyes); 20% (3/15 eyes) were within +/-0.50 D and 53.3% (8/15 eyes) were within +/-1.00 D of target refraction. CONCLUSION: PRK with the Meditec MEL 60 laser produced the best results in eyes with compound myopic astigmatism (Group 1). In all other groups, results were less predictable.

Photorefractive keratectomy for myopia with the Meditec MEL 70G-Scan flying spot laser.

PURPOSE: To evaluate the efficacy, predictability, stability, and safety of the Meditec MEL 70G-Scan flying spot excimer laser. METHODS: One hundred thirty myopic eyes were treated with the Aesculap Meditec Mel 70G-Scan ArF flying spot excimer laser with photorefractive keratectomy (PRK). Patient groups: low myopia (Group 1) from -1.50 to -6.00 D (90 eyes), medium myopia (Group 2) from -6.10 to -9.00 D (31 eyes), high myopia (Group 3) from -9.10 to -14.00 D (9 eyes). RESULTS: At 12 months in the low myopia group, uncorrected visual acuity (UCVA) of 20/40 or better was achieved in 95.5% (86 eyes), 20/20 or better in 77.7% (70 eyes); 2.2% (two eyes) lost two or more lines of best spectacle-corrected visual acuity (BSCVA); 73.3% (66 eyes) were within +/-0.50 D of the target correction and 98.8% (89 eyes) were within +/-1.00 D. In the medium myopia group, UCVA of 20/40 or better was achieved in 74.2% (23 eyes), 20/20 or better in 25.8% (eight eyes); 3.2% (one eye) lost two lines, 61% (19 eyes) were within +/-0.50 D of desired correction and 83.8% (26 eyes) were within +/-1.00 D. In the high myopia group, UCVA of 20/40 or better was achieved in 22.2% (two eyes); 20/25 or better in 11.1% (one eye); none of the eyes achieved 20/20 UCVA; 22.2% (two eyes) lost two lines of BSCVA; 44.4% (four eyes) were within +/-0.50 D and 66.6% (six eyes) were within +/-1.00 D of the target correction. Refractive stability was achieved between 3 and 6 months. Increased intraocular pressure was detected overall in 7.69%. CONCLUSIONS: The results of predictability, safety, and efficacy in low and medium myopia with the Meditec MEL 70G-Scan flying spot excimer laser were good, but poorer predictability, regression, and a significant loss of BSCVA were observed in the high myopia group.

Photorefractive keratectomy for hyperopia in 800 eyes with the Meditec MEL 60 laser.

PURPOSE: To evaluate the refractive results of 800 hyperopic eyes undergoing PRK treatment. METHODS: Eight hundred hyperopic eyes were treated with PRK. An Aesculap-Meditec MEL 60 scanning ArF excimer laser used. Treatment Group 1 consisted of eyes with a preoperative refractive error of +3.50 D or less (n = 482) and Group 2, of +3.75 D or more (n = 318). RESULTS: Preoperatively, Group 1 required an average correction of +2.88+/-1.34 D and Group 2 required +5.64+/-2.96 D. One year after PRK, average residual correction was +1.26+/-1.24 D in Group 1, and in Group 2, +2.46+/-1.84 D. In Group 1, uncorrected visual acuity (UCVA) was 20/40 or better in 88.4% (426/482); 20/20 or better in 75.7% (365); 2.1% (10/482) of eyes lost 2 lines, 2.1% (10/482) gained 2 lines; 3.1% (15/482) gained 2 or more lines of BSCVA; 74.4% (359/482) of eyes were within +/-0.50 D of target correction and 84.8% (408/482) were within +/-1.00 D. In Group 2, 47.5% (151/318) had UCVA of 20/40 or better; 34.2% (109/318) saw 20/20 or better uncorrected; 19.1% (61/318) lost 2 lines; 11.6% (37/318) lost 3 lines; none of the eyes gained 2 or more lines of BSCVA; 22.3% (71/318) were within +/-0.50 D and 46.8% (149/318) were within +/-1.00 D of target correction. Refractive stability was achieved after 6 months; a slight regression after 6 months was still observed. In Group 1, 10.5% (42/482) and in Group 2, 21.6% (69/318) complained of problems with daytime vision (glare and ghost image); during night-driving in Group 1, 17.6% (85/482) and in Group 2, 40.5% (129/318) had problems. CONCLUSION: PRK with the Aesculap-Meditec MEL 60 scanning ArF excimer laser offered the best long-term results with +3.50 D or less preoperative refractive error. With higher corrections, regression, decrease in BSCVA, and daytime visual problems were encountered.

Influence of post-LASIK corneal healing on scanning laser polarimetric measurement of the retinal nerve fibre layer thickness.

AIM: To investigate the influence of laser assisted in situ keratomileusis (LASIK) on the values for retinal nerve fibre layer thickness (RNFLT) as measured with scanning laser polarimetry (SLP) during the healing process of the cornea after LASIK. METHODS: SLP with the GDx instrument was performed on 20 consecutive healthy subjects without any eye disease undergoing LASIK for ametropia correction. The SLP measurements were performed before the surgery, and at 1 and 3 days, as well as at 3 months, after LASIK. Thickness data from images of one randomly selected eye per subject were analysed using the ANOVA and Duncan multiple comparison tests. Correlation coefficients between RNFLT data and the treatment parameters were also calculated. RESULTS: Somewhat similar results were found for the different retinal areas. The measured values for superior average RNFLT decreased significantly at all time points compared to the preoperative baseline (p<0.003, Duncan test), but increased significantly between postoperative day 1 and the final visit at 3 months (p=0.025, Duncan test). Inferior average RNFLT in the early postoperative days was significantly smaller than at 3 months after LASIK (p<0.05, Duncan test), and tended to be smaller than at baseline. The thickness values before surgery and at the final visit, however, showed no significant difference (p=0.698, Duncan test) in this region. Ellipse average RNFLT was significantly smaller in the early postoperative days than the baseline value before LASIK. However, the measured value had significantly increased again by the time of the final visit (p<0.02, Duncan test). This value at the final visit showed no difference from the baseline value (p=0.46, Duncan test). The changes in the nasal average and temporal average RNFLT were not statistically significant. No correlation was found between the change in the SLP measured thickness values and central corneal thickness at baseline and its change after surgery, nor with the change in cylindrical correction due to LASIK, or the length of the suction time during surgery (p>0.05 for all correlations). CONCLUSION: The SLP technique is sensitive to the corneal optical properties, and RNFLT as measured with SLP shows changes after LASIK. Most of these changes, however, diminish with time after surgery, and the values tend to return to the preoperative results during the first 3 months of corneal healing following uncomplicated LASIK. It appears that in uncomplicated cases the transient RNFLT changes are artefacts and do not imply pathological thickness alterations due to LASIK.

Treatment of intraocular pressure elevation after photorefractive keratectomy.

PURPOSE: To study the effect of timolol maleate, dorzolamide, or a combination of both in post photorefractive keratectomy (PRK) eyes with an elevated intraocular pressure (IOP) after topical steroid administration. SETTING: Refractive Surgery Outpatient Department, 1st Department of Ophthalmology, Semmelweis University, Budapest, Hungary. METHODS: Forty-five patients with elevated IOP were randomly enrolled in 3 groups: Group 1 received timolol maleate 0.5% twice a day; Group 2 received timolol maleate 0.5% twice a day and dorzolamide 2% 3 times a day; and Group 3 received only topical dorzolamide 2% 3 times a day. Intraocular pressure was measured 3 days and 1, 3, and 6 weeks after the antiglaucoma medication was started. RESULTS: The mean preoperative IOP was 15.25 mm Hg +/- 1.28 (SD). Following administration of topical fluorometholone, the IOP increased a mean of 27.39 +/- 2.88 mm Hg. Six weeks after the antiglaucoma therapy was started, the mean IOP reduction was 6.6 mm Hg in Group 1, 8.86 mm Hg in Group 2, and 4.64 mm Hg in Group 3. CONCLUSIONS: A combination therapy of timolol 0.5% and dorzolamide 2% was most effective in treating secondary IOP elevation after PRK. Dorzolamide alone did not adequately control secondary post-PRK IOP elevation.

A case of paradoxical worsening of dural-sinus arteriovenous malformation syndrome after neurosurgery.

The authors present a case of a patient with the syndrome of paradoxical worsening of dural-sinus cavernous arteriovenous malformation which was a iatrogenic consequence of embolization of the basal branches of a dural shunt with Yvalon. It is presumed that the thrombogenous Yvalon reached the basal branches of the medial meningeal artery to the superior ophthalmic vein, where it caused complete thrombosis. The impaired ocular and orbital venous outflow caused a dramatic worsening of the ocular congestive symptoms: venous stasis retinopathy with dilated veins, flame-and dot-shaped hemorrhages and a secondary increase in intraocular pressure. The diagnosis of thrombosis of the entire superior ophthalmic vein was confirmed by color Doppler imaging. The mechanism is discussed. Although the ocular pathology is usually self-limiting following the establishment of collateral venous outflow channels, in view of the patient's serious congestive ocular symptoms argon laser photocoagulation and conservative antiglaucomatous local therapy were applied. Once orbital collateral venous drainage was established, the ocular symptoms improved. In the one-year follow-up there was no other complication.

Changes in tear protein pattern after photorefractive keratectomy.

PURPOSE: Changes in tear protein composition of patients who underwent photorefractive keratectomy (PRK) were analyzed. METHODS: Tear samples were obtained from 23 eyes of 23 patients immediately before PRK and on the fourth postoperative day with glass capillaries. Tear proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Digital image analysis and evaluation of the densitometric data of the electrophoretic separations were done with BioDoc-Analyze. RESULTS: Analysis of discriminance found a significant difference in the protein patterns (p < 0.001). This type of analysis of the electrophoretic densitographs uses all peak information simultaneously. A significant decrease (p < 0.005) in three of the main protein peaks--lactoferrin, immunoglobulin A heavy chain, and lysozyme--was also found after PRK. CONCLUSIONS: Excimer laser ablation of the cornea has an acute effect on lacrimal gland protein secretion. Changes in tear composition may lead to feelings of dryness and to a decrease in tear film stability postoperatively.

[Phototherapeutic use of excimer laser]. / Az excimer lézer fototerápiás felhasználásáról.

The photorefractive excimer laser is not only able to alter the refractive power of the corneas but also suitable to treat superficial corneal pathologies. Authors performed phototherapeutic keratectomies (PTK) in 80 eyes of 77 patients. The age was on average (+/- S.D.) 49.4 +/- 22.03 years. The follow-up time varied between 3-24 months. All treatments were performed with the Aesculap Meditec MEL 60 ArF excimer laser, working in the 193 nm extreme ultraviolet-C range. Authors conclude that the best postoperative results can be achieved with PTK in cases of recurrent corneal erosions and superficial corneal opacities. Favourable outcome could be expected in treatment of infectious corneal ulcers. In cases of bullous keratopathy the subjective complaints decreased and it was successful to postpone the time of perforating keratoplasty. The PTK is not recommended in case of corneal Bowen disease and recurrent pterygia. A hyperopic shifts was observed in 2 eyes. Besides, the traditional surgical methods the phototherapeutic keratectomy is an important progress in treatment of superficial corneal pathologies. Applying the method, the recurrent erosions healed quicker, in most of the cases the transparency of the cornea could be reestablished in the pupillary area and the need for perforating keratoplasty could be postponed or avoided.

[Experience with excimer laser photorefractive keratectomy]. / Excimer lézeres fotorefraktív keratektomiák során szerzett tapasztalataink.

UNLABELLED: The correction of refractive errors based on superficial ablation of the cornea has a couple of years long history. Authors performed photorefractive laser surgery with the Aesculap Meditec MEL 60 ArF excimer laser in 221 eyes of 147 patients. The follow-up time varied between 2-24 months, average 8 months. They have treated the following groups: 1. group: 0-6.0 D; 2. group: -6.5-9.0 D; 3. group: eyes with refractive error above -9.5 D; 4. group: hypermetropic eyes; 5. group: eyes with astigmatism. RESULTS: In the 1. group the average -4.58 +/- 1.25 D refractive error decreased to -0.19 +/- 0.53 D in the follow-up time; 2. group: from -7.46 +/- 1.22 D to -0.45 +/- 0.83 D; 3. group: -13.76 +/- 5.46 D to -1.52 +/- 1.74; 4. group: +428 +/- 1.6 D to +0.91 +/- 2.41 D; 5. group; from -6.74 +/- 2.81 D sph -2.3 +/- 1.54 cyl to -0.51 +/- 1.3 D sph -0.54 +/- 1.06 D cyl. According to their experiences they conclude: the best results have been achieved in the first two groups and in eyes with astigmatism (1., 2., 5. groups). In severe myopia cases postoperative correction is usually needed, which is significantly smaller than the preoperative spherical correction. The method is able to change the refractive power of the cornea and provides an efficient alternative to the spectacles and contact lenses.

[Results of photorefractive keratectomy after treatment of 2053 eyes]. / Az excimer lézeres fotorefraktív keratectomia tapasztalatai 2053 szem kezelése kapcsán.

To evaluate the 12 months refractive results of photorefractive excimer keratectomy (PRK) in high number of eyes with different type of refractive error. Between October 1992 and December 1996. 2053 eyes of 1098 patients were treated with the Aesculap Meditec MEL 60 argon-fluoride excimer laser. Refractive results were concluded at the 12th post-PRK month. The following patient groups were used during the study: Group 1.: Eyes between -1.0 D and -6.0 D (n = 651); Group 2.: -6.0 és -9.0 D (n = 216); Group 3.: Eyes with refractive error above -9.0 D (n = 163); Group 4.: Hypermetrop eyes (n = 160); Group 5.: Eyes with myopic astigmatism (n = 746); Group 6.: Eyes with hypermetropic astigmatism; Group 7.: Pure astigmatism (n = 13). In Group 1. The preoperative average -3.94 +/- 1.3 D refractive error decreased during the 1-year follow-up period to -0.47 +/- 0.54 Dpt; in Group 2. The preoperative -7.65 +/- 1.07 D to -1.16 +/- 1.86 D; in Group 3. The preoperative average -13.58 +/- 3.51 D to -3.11 +/- 2.75 D; in Group 4. The preoperative +4.04 +/- 1.77 D to +1.02 +/- 1.16 D in Group 5. The preoperative -6.06 +/- 2.78 D spherical component decreased to -0.95 +/- 1.33 D-ra, whereas the preoperative cylindrical component from -1.5 +/- 1.08 D to -0.13 +/- 0.58 D; in Group 5. The preoperative +4.57 +/- 1.78 spherical component to +1.13 +/- 1.38 D; whereas the preoperative cylindrical component from +1.57 +/- 0.96 D to +0.38 +/- 0.77 D; in Group 7. The preoperative a -3.98 +/- 1.2 D cylinder decreased to -0.62 +/- 0.75 D cylinder. PRK decreased effectively the preoperative correction need in every treatment group. The results are the better, the smaller the preoperative correction need is.

[Unilateral ptosis in the background of unilateral corneal arcus lipoides -- a case report]. / Unilaterale Ptosis assoziiert mit unilateralem Arcus lipoides -- Kasuistik.

BACKGROUND: Arcus lipoides corneae is a common bilateral degenerative disorder with ageing but only rarely occurs unilaterally. Clinically visible cream-coloured ring-shaped corneal opacities are caused by excessive lipoid deposits in the corneal stroma. Our aim is to discuss theoretical aspects of the possible impact and pathomechanism of unilateral ptosis in unilateral arcus lipoides. CASE REPORT: The authors report the case of a 70-year-old female patient who was treated for chronic pancreatitis and hyperlipoproteinemia. She had congenital ptosis on the left side, and an arcus lipoides corneae in her left eye. The patient underwent extracapsular cataract extraction, and irregular high-grade astigmatism developed. An irregularity of the wound healing was apparent from the keratometric values, which decreased after removal of the corneal sutures. CONCLUSION: The known etiological factors of unilateral arcus lipoides, like contralateral stenosis of the internal carotid artery, traumatic or iatrogenic hypotony, chronic iridocyclitis of the eye were absent in our patient.

Posterior avulsion of the optic nerve due to deceleration trauma.

A patient with complete transection of the optic nerve (posterior avulsion) and explosion of the eyeball, due to an attempted suicide is reported. The symptoms, mechanism of injury and therapeutic possibilities in complete transection and in partial posterior optic nerve avulsions are discussed. Although this case ended up with enucleation, the partial avulsions are not without hope. The importance of team-work is emphasized in polytraumatic patients.