[Risk of bacterial contamination after povidone-iodine disinfection for cataract surgery]. / Bakterielles Kontaminationsrisiko nach Povidon-Iod-Desinfektion in der Kataraktchirurgie.

BACKGROUND: Povidone-iodine alone or in combination with antibiotics is commonly used for presurgical disinfection in cataract surgery. In spite of the use of the combination Povidone-iodine and ofloxacin, the rate of ocular contamination as assessed from surgical knives was reported to be as high as 26 %. The aim of this study was to investigate the efficacy of diluted Povidone-iodine alone for surgical disinfection. PATIENTS AND METHODS: 126 consecutive patients undergoing elective cataract surgery with a conjunctival wound and a scleral tunnel received prior to surgery a disinfection with diluted Povidone-iodine eye drops (Braunol 1:10 diluted = 0.8 % Povidone-iodine, 3 times every 5 min). To assess residual bacteria on the ocular surface after disinfection, the surgical knives for the side ports and the scleral tunnel were cultured in thioglycolate broth. RESULTS: In 8 out of 126 (6 %) patients the culture from the surgical knives revealed a positive result (89 % coagulase negative Staphylococci). Four of these 8 cases occurred during a single list. All control cultures remained negative. CONCLUSION: Diluted Povidone-iodine eye drops alone are highly effective for bacterial disinfection when applied properly. The rate of contamination using 0.8 % Povidone-iodine in our series was considerably lower as compared to that of other studies.

Corneal calcification following intensified treatment with sodium hyaluronate artificial tears.

AIM: To report a potential adverse effect of intensified treatment with sodium hyaluronate artificial tears. METHODS: Five cases of deep calcium deposition in the cornea associated with ocular surface disease and frequent use of hyaluronic acid artificial tears are described. All patients used one formulation of phosphate buffered hyaluronate eye drops when rapid calcification developed. All eyes required corneal graft surgery for visual rehabilitation. Specimens at keratoplasty were available for light microscopy and investigation by dispersive x ray analysis. The phosphate concentration in the medication used for topical treatment was measured and compared to alternative hyaluronate preparations. RESULTS: Light microscopy showed dense mineralisation of the entire stroma. The crystalline deposits consisted of hydroxyapatite, Ca5(PO4)3OH. A 50-fold higher concentration of phosphate was measured in the sodium hyaluronate eye drops used for treatment (50.9 mmol/l) when compared with normal serum. The other hyaluronate formulations showed phosphate concentrations from <0.1 mmol/l to 10.9 mmol/l. CONCLUSIONS: The hyaluronate artificial tear formulation "Hylo-Comod" favours the formation of insoluble crystalline calcium phosphate deposits in presence of epithelial keratopathy. This is because of its high phosphate concentration and typically frequent instillation. Manufacturers and prescribers should be aware that topical preparations may contain considerable amounts of phosphate which may lead to sight threatening corneal complications.

[Lacrimal duct endoscopy with the rigid GRIN endoscopy]. / Tränenwegendoskopie mit einem starren GRIN-Endoskop.

BACKGROUND: Endoscopes play a more and more important role in visualizing and treating pathologies of the lacrimal drainage system. The present study analyzes the results obtained during endoscopy of the lacrimal ducts using a gradient-index (GRIN-) endoscope. PATIENTS AND METHODS: 44 patients, 18 to 87 years old (mean 59 years +/- 18.9), with chronic epiphora or symptoms of affection within the lacrimal ducts were examined using a rigid gradient-index (GRIN-) endoscope. Examination was performed ambulatory using drops for local anesthesia. RESULTS: All 44 patients showed pathologic conditions in the lacrimal drainage system. 2 patients had chronic changes. 25 patients had a relative stenosis (16 presaccal, 9 postcanalicular ones). 17 patients had a total stenosis (12 presaccal, 5 postcanalicular ones). 33 patients showed a single-sided pathology while 11 patients showed a bilateral one. The GRIN-endoscope could be used in all patients and gave excellent image quality of the pathologies. CONCLUSIONS: Endoscopy with a GRIN-endoscope can complement the ambulatory diagnostics and therapy of the lacrimal drainage system. In the patient group studied (n = 44), presaccal pathologies (n = 28) were twice more frequent than postcanalicular ones (n = 14). Further developments could enlarge the indications of the GRIN-endoscope.

[Rigid GRIN-endoscope for endoscopy of the tear ducts]. / Starres GRIN-Endoskop zur Tränenwegsendoskopie.

BACKGROUND: Using small endoscopes it is now possible to evaluate the status of lacrimal ducts in vivo. GRIN-Lenses produce better pictures from the lacrimal ways than fiber-bundles. GRIN-endoscopes are rigid. The present study is concerned with the feasibility and indications of such GRIN-endoscopic examination. PATIENTS AND METHODS: Two different GRIN-endoscopes with a distal diameter of 0.89 mm were used. One with a phi 0.5 mm optic and an additional working channel and another one with a phi 0.35 mm optic and two additional working channels. One channel each was used for injection of air or 0.9% NaCl. Either a laser fiber or another instrument (max phi 0.16 mm) could be introduced into the second channel. 44 patients in age between 18 and 87 with symptoms of epiphora or signs of chronic lacrimal way affections were examined. RESULTS: The presaccal lacrimal ducts could be clearly visualized in all patients. In case of presaccal stenosis, the examination of the lacrimal sac was not always possible. The endoscope used, based of GRIN-lenses, gave an excellent image quality. Endoscopy under local anesthesia was well tolerated by all the patients with affection of the lacrimal drainage system. Because this ambulant examination does not stress the patient too much, it could be repeated a number of times. Endoscopy under general narcosis could enlarge the application spectrum. This method can complement the ambulant diagnostics and therapy of the lacrimal drainage system.

[Value of scanning laser ophthalmoscopy and polarimetry compared with perimetry in evaluating glaucomatous changes in the optic papilla and nerve fiber layer]. / Wertigkeit der Scanning-Laser-Ophthalmoskopie und Polarimetrie gegenüber der Perimetrie zur Beurteilung von glaukomatösen Papillen- und Nervenfaserschichtveränderungen.

The aim of the study was to establish quantitative correlations between morphological changes at the optic nerve head (ONH) and the retinal nerve fiber layer (NFL) and functional abnormalities i.e. visual field alterations in glaucoma. A cross-sectional study of open-angle glaucoma patients of various stages was performed. Scanning laser tomographic (TopSS) assessment of the ONH and scanning laser polarimetric (Nerve Fiber Analyzer) measurements of the peripapillary NFL thickness (NFLT) were compared to results of computerized static perimetry (Octopus G-1). One eye from each of 157 glaucoma suspects (n = 58) and patients with established open-angle glaucoma (n = 99) was assessed. The parameter "modulation" (difference between maximum and minimum of NFLT) gave the best correlation (r2 = 0.23) to the visual field index for mean sensitivity. Tomography gave the best correlation between the neuroretinal rim area at the inferior and superior pole of the ONH and the visual field index loss variance (r2 = 0.20). Conventional planimetric data of the ONH and clinical assessment of the NFL yielded slightly better correlations to the visual field data than the scanning laser tomography or polarimetry. Although NFL parameters are more complicated to obtain, they yield better correlations to diffuse visual field loss than parameters of the ONH. The new scanning laser techniques do not improve these correlations between morphology and function; however, they allow objective assessment of ONH and NFL parameters without mydriasis.

Skin capillary aneurysms detected by indocyanine green in type I diabetes with and without retinal microaneurysms.

Functional diabetic microangiopathy of skin vessels is well known (decreased reactivity of arterioles to various stimuli, increased capillary pressure and permeability). In contrast to conventional capillaroscopy, recently introduced infrared fluorescence videomicroscopy with indocyanine green allows one to depict capillary aneurysms, even when filled with plasma alone. Seventeen healthy volunteers (mean age 37.7 years), 14 patients with type I diabetes without (31.3 years) and 17 with retinal microaneurysms (46.8 years) were studied. The mean duration of diabetes in patients without retinal microaneurysms was 14.2 years (4-36 years) and in those with retinal microaneurysms 21.5 years (8-49 years). Nailfold capillary aneurysms were present in 3 of 17 healthy controls, in 7 of 14 patients without and in 10 of 17 patients with retinopathy. Patients with type I diabetes with and without retinopathy exhibited significantly more skin microaneurysms (p < 0.05 and < 0.005, respectively) than the controls. The prevalence in the patients with retinal microaneurysms tended to be even higher. Skin capillary aneurysms, which may be depicted in vivo by sophisticated infrared fluorescence videomicroscopy, even when filled by plasma alone, are an important morphological feature of diabetic microangiopathy.

Variability of different patterns of skin oscillatory flux in healthy controls and patients with peripheral arterial occlusive disease.

Variability of patterns of laser Doppler flux motion was analysed at 5 different sites at the foot of 12 healthy controls and 24 patients with different degrees of ischemia due to peripheral arterial occlusive disease. Patterns were evaluated by means of the frequency histogram method. Three main flux motion components were detected at mean frequencies of 3.5 +/- 1.1 min-1 (low frequency waves, LF), 17.2 +/- 2.7 min-1 (high frequency waves, HF) and at 62.6 +/- 8.5 min-1 (pulsatile waves, PF). The characteristic pattern in normals consisted of LF and PF waves. In severe ischemia oscillatory flux was predominantly characterized by the combination of LF and HF waves and loss of pulsatile flux, or by the absence of any flux motion. Claudicants covered the entire spectrum of the flux motion patterns. In controls spatial variations were mainly due to the occasional presence of HF waves at one of the 5 sites. With increasing ischemia spatial variability of HF waves decreased due to more homogeneous presence. Loss of pulsatile flux was inhomogeneous in claudicants but almost complete in severe ischemia. Whereas LF waves were almost always observed at all sites of controls and claudicants there was considerable spatial variability in severe ischemia due to inhomogeneous loss of LF waves. Prevalence of the distinct flux motion patterns was well reproducible in controls and patients. Patterns showed a marked day to day variability when sites of measurement were compared.

[Microangiopathy in chronic venous insufficiency]. / Mikroangiopathie bei chronischer venöser Insuffizienz.

Skin in the medial malleolar region was examined in 15 patients with moderately severe venous insufficiency (9 women, 6 men; mean age 57 [35-76] years), using intravital fluorescence microscopy, transcutaneous pO2 measurement and laser Doppler flowmetry. The findings were compared with those in a healthy control group (8 women, 7 men; mean age 53 [35-73] years). The arteriolar vasoconstriction response was tested by comparing laser Doppler flowmetry readings in the recumbent and sitting positions. Transcutaneous pO2 was likewise measured in both positions. Capillary morphology and microangiodynamics were investigated before and after injection of Na-fluorescein. The microangiopathy of moderately severe venous insufficiency was characterised fluorescence microscopically by greatly dilated, elongated and winding (glomerulus-like) capillaries, and by an increase in the pericapillary leakage diameter (halo). However, the vasoconstrictive response to change in posture remained largely intact, and there was little alteration in the spontaneous rhythmic flow waves. In contrast, flow in the recumbent position was significantly increased (P less than 0.001), since laser Doppler flowmetry also measures the flow in deeper (1-6 mm), non-nutrient skin vessels. In spite of a normal capillary count, the mean transcutaneous pO2 was reduced, in keeping with the microangiopathy observed in the superficial nutrient capillaries. These pronounced morphological and dynamic changes explain the development of trophic lesions.

[Dermatomyositis--diagnostic value of capillary microscopy]. / Dermatomyositis--Diagnostische Wertigkeit der Kapillarmikroskopie.

The results of conventional capillary microscopy and fluorescence videomicroscopy are described in 7 patients with well established dermatomyositis (mean age 34.3 +/- 19 years, mean duration of the illness 25.7 +/- 26.9 months). All patients showed marked microangiopathy characterized by avascular fields, increased capillary tortuosity and enlargement, and enhanced transcapillary diffusion. The capillary microscopy pattern was not specific for dermatomyositis. Nevertheless, capillary microscopy plays an important role in the differential diagnosis of this condition. It remains unclear how sensitive this method is in the early detection of dermatomyositis.

The frequency histogram--a new method for the evaluation of laser Doppler flux motion.

A digital filter system (DFS) was implemented to describe the frequency components of laser Doppler signals. The DFS calculates a frequency histogram on the basis of the prevalence of a certain frequency band during the sample period. This approach seems to be more suitable for the detection of low-power small-amplitude flux motion components recorded by laser Doppler as compared to the commonly used fast Fourier algorithm. Fourier analysis provides an amplitude-relevant frequency spectrum which may overlook relevant frequency components with small amplitude due to low power or short duration. DFS allows better detection of such signals as demonstrated by the initial clinical results of this study evaluating flux motion on the feet of 4 healthy controls and 10 patients with peripheral arterial occlusive disease. Three frequency components are easily distinguished corresponding to low (3.6 +/- 1.5 cycles/minute) and high (18.6 +/- 4.5 cycles/min) frequency flux motion and the pulsatile waves due to cardiac action.