[Influence of light through the eyes on metabolism and hormones]. / L'influence de la lumière à travers l'oeil sur les métabolismes et sur les hormones.

The eye plays a double role: on the one side it is the optic camera, on the other side independent of the optic path ways it is the light receptor which stimulates the retino-hypothalamique pathway of the endocrine-visceral system. To determine this influence, we compared the metabolisme (water balance, blood sugar and blood cell count) as well as the hormones (ACTH, Cortisol) of fifty patients with bilateral almost total cataract, before (practically blind) and after cataract surgery (regain of light). There was a significant difference between the metabolic and hormonal values before and after cataract extraction, reaching physiologically normal levels due to the stimulating influence of light after the operation.

[Distribution of radioactively labeled digitalis in the eye]. / Verteilung von radioaktiv markiertem Digitalis am Auge.

Twenty-four hours after instillation of radioactively labeled digoxin into the conjunctival sac the radioactivity is concentrated in the various ocular tissues. A fourfold enrichment was observed in highly vascularized tissues such as the iris, ciliary body, and retina, as opposed to tissues with minimal vascularization such as the sclera. No concentration of digoxin was observed in the untreated control eye. Only in the sclerae was there a slight enrichment, corresponding to that found in the blood. Values in the untreated control tissues (skeletal muscle and skin) were minimal. These experiments show that the retina, ciliary body, and iris have a selective affinity for locally administered digoxin.

[Effect of light on the eye on metabolism and hormones]. / Der Einfluss des Lichtes über das Auge auf den Stoffwechsel und die Hormone.

Numerous metabolic parameters in serum and urine were examined in 110 cataract patients before and after cataract surgery. The marked reduction in light passing through the eye due to opacities (vision less than 1/10) leads to characteristic metabolic and hormonal disturbances. ACTH and cortisol production decreases, metabolism slows down and due to an adrenal insufficiency for which the pituitary is responsible there are characteristic changes in the cortisol-dependent metabolic processes. In addition, an "energetic action" of the light affecting the hypothalamus via the retino-hypothalamic pathways (the "energetic portion" of the visual pathway) was proved in patients who were blinded by cataract and had metabolic disturbances as a result. Postoperatively, after elimination of the lens opacities, the metabolism and hormones of the same patients returned to normal. As a result of restoration of exogenous light stimulation to the diencephalon-hypophysis system via the retinohypothalamic pathway ("energetic pathway" of the optic system) the metabolism and hormones returned to normal during the patients' stay in the hospital. These comparative investigations in the same patients before and after cataract extraction provide for the first time irrefutable scientific evidence of the influence of light via the eye on the human organism.

[Heterochromia complicata Fuchs]. / Heterochromia complicata Fuchs.

We are indebted to I. Loewenfeld and her ophthalmologist colleague H. S. Thompson for having called for an explanation of the clinical picture of Fuchs's heterochromic cyclitis in their "Critical Review." In the present author's view, the reason why so many different opinions are held concerning the clinical picture and the etiology is that only a few authors (Franceschetti, François, Georgiades, Hollwich, Huber, Kimura, Hogan and Thygeson, Perkins, Sugar and others) have been able to follow up collectives of their own, of up to 50 patients and more, for many years. None of the investigators deny the presence of typical precipitates, observed both under direct light and retroillumination; typical because they are only found in Fuchs's heterochromia and its variation Posner-Schlossman syndrome. The course is inflammation-free, since, in contrast to all other forms of diseases of the anterior uvea, neither external signs of inflammation nor posterior synechiae occur. Etiologically, according to the behavior of the pupil (François 1949, 1954), there is sympathicoparalysis, while according to Amsler and Huber as well as Verrey, Franceschetti and Herrmann there is a corresponding pathologically increased fluorescein permeability of the vessels in the anterior segment and an extreme tendency to bleeding, as shown by the filiform bleeding when the anterior chamber is opened. The sympathicoparalysis also explains the inflammation-free vascular fragility, with escape of cell elements, primarily protein (albumins) and lymphocytes (Verrey, Matteucci, Franceschetti and Hermann, and François) into the aqueous and vitreous. Therefore, the syndrome should no longer be termed "heterochromic cyclitis" but rather "heterochromia complicata" as proposed by E. Fuchs. In view of the somatic features, amounting to a status dysraphicus, the condition is probably connected with a congenital developmental anomaly of the sympathetic nerve (François); these features have been described by Franceschetti, Hollwich, Passow, Perkins, Sugar, Huber and many others. There may also be immunologic factors (Loewenfeld and Thompson); however, research into these is still only at an early stage.

[Kaposi's sarcoma and AIDS]. / Kaposi-Sarkom und AIDS.

Kaposi's sarcoma occurs as a complication in numerous cases of AIDS, the much-discussed acquired immune deficiency syndrome. Considering the latter's near-epidemic incidence, the clinical and histological features of Kaposi's sarcoma are recalled to mind. Hitherto only sporadically recorded in non-African countries, the disease is now more frequently observed also in the USA and Central Europe. In textbooks of ophthalmology Kaposi's sarcoma has so far been grossly neglected. Therefore, on the basis of historical facts taken exclusively from original papers, Kaposi's sarcoma is reconsidered with special reference to ophthalmological aspects.

[Von Hippel-Lindau syndrome]. / Zum v. Hippel-Lindau-Syndrom.

The von Hippel-Lindau syndrome is an autosomal dominant condition that comprises, apart from angiomas of the retina, the cerebellum, the spinal cord, and the cerebrum, also cystic and blastomatous dysplasias resulting from maldevelopment, namely cystic kidney and pancreas, hypernephroma, and pheochromocytoma. Early observers of the syndrome were the English neurologist John Hughlings Jackson (1872) and the German ophthalmologist Hugo Magnus (1874). The typical association of angiomas of the retina with the cerebellum was first described in 1905 by the Prague ophthalmologist Wilhelm Czermak, long before Lindau (1926). The fact that hypernephromas and pheochromocytomas may form parts of it characterizes the syndrome as a polyneoplastic hereditary disease and the sufferers as members of families at risk. Since the ophthalmologist is often the first to recognize this disease by direct inspection of the fundi, he is responsible for ensuring proper medical care for the affected person and his or her entire family.

[Prevention of cystoid macular edema using indomethacin eye drops]. / Zur Prophylaxe des zystoiden Makulaödems mit Indometacin-Augentropfen.

The effect of 1% Indomethacine solution on the development of post-operative macular edema was examined. Starting from the day of the operation, the patients received 1 drop of either the solution or the placebo 4 times daily for 3 months. Using fluorescein angiography it was demonstrated that post-operative macular edema developed with a significantly lower incidence in patients treated with the prostaglandine inhibitor Indomethacin than in the control group. There was no noticeable difference between the 2 groups with regard to side-effects.

[Vitelliform macular degeneration (Best's disease) (author's transl)]. / Zur Vitelliformen Makuladegeneration (Bestsche infantile Makuladegeneration).

The report concerns an 11-year-old boy with a fresh chorioretinal lesion in the macula of the right eye and an "egg-yolk-like" cyst in the left eye. The contents of the cyst sedimented 4 weeks later in the manner of a pseudo-hypopyon. The typical findings in the macula of the one eye permitted the diagnosis: vitelline macular degeneration, with the full picture of the intact cyst (disc) on the left and the scarred area following the degenerative change of the cyst on the right. In vitelline macular degeneration, we are dealing with the same condition (Brayley and Spivey, Remky, W. Jaeger) as Best's juvenile macular degeneration.

The effect of natural and artificial light via the eye on the hormonal and metabolic balance of animal and man.

Color change of the plaice and frog, and development of the testes in duck are induced by light stimuli via the eye. Eliminating experiences on the frog (Hollwich) and on the duck (Benoit) showed that these stimuli-beside vision-use a separate way, the so-called 'energetic portion' of the visual pathway (Hollwich). In compared studies on blind and on temporarily blind patients involved by cataract in both eyes, we found significant low levels of ACTH and cortisol. The levels normalized after cataract extraction. -Furthermore, we studied the influence of strong artificial illumination (3,500 and 3,200 lx) on healthy persons with considerable and, on the other hand, with minimal difference of their spectral composition to daylight. We found stress-like levels of ACTH and cortisol in the first group. These findings explain the agitated mental and physical behavior of children staying the whole day in school under artificial illumination with strong spectral deviation from daylight. Therefore, to avoid mental and physical alterations, the spectrum of artificial illumination should be largely similar to that of natural light.

[The Custodis procedure--technic and results (author's transl)]. / Das Custodis-Verfahren: Technik und Ergebnisse.

Within the post 11 years 2,722 retinal detachments needed surgery. The mostly used procedure of Custodis consists in an implant, which covering the area of the hole is impressed into the sclera by mattress sutures. In 70% of our cases--due to Custodis--we succeeded in avoiding drainage of the subretinal fluid. Since 1966 the additional diathermy and/or lightcoagulation was mostly replaced by cryopexy. Summarizing the number of retinal detachments operated in the University clinic of Münster during 1955--1957 (Pau), 1958--1961 (Böke) as well as ours (1966--1977), 4,030 retinal surgeries (minus 10% encircling procedures) underwent within 18 years a Custodis procedure. The success rate of 85% indicates that Custodis' technic enables to optimal results.

[Clinical aspects and therapy of the posner-schlossmann-syndrom (author's transl)]. / Zur Klinik und Therapie des Posner-Schlossmann-Syndroms.

UNLABELLED: Difficulties in the early diagnosis of the Posner-Schlossmann syndrome can be avoided by looking for the following typical clinical signs: Very fine, unpigmented precipitates, which are often only signly present, and which are scattered over the entire cornea: bright white in incident light, translucent in reflected light, and in transmitted light dark in spots. Posterior synechiae are not present. Obvious differences in color or heterochromia are present in only 30-40% of the cases. In the remaining cases, there ist only a slight color difference or unilateral, diffusely trophic hypochromia of the iris, often only after several attacks. The chamber angle is and remains open during the attacks. There are similarities between glaucomatocyclitic crisis and heterochromic cyclitis: Unilaterality, the same specific precipitates, no synechiae, and practically the same percentage of color differences of the iris. Hypochromic dystrophy of the iris dependent on the magnitude and duration of the cyclitic process. In both cases, there is the same rate of physical changes, pointing to a congenital damage of the sympathetic nervous system (status dysraphicus Passow). Hence, the Posner-Schlossmann syndrome can be regarded as a special case of heterochromic cyclitis. THERAPY: Neither miotics nor mydriatics, nor operation during the crisis. Acetazolamide (Diamox) combined with local cortisone will stop the crisis.

[Clinical results of the goniothrephining with scleral flap (author's transl)]. / Klinische Ergebnisse der Goniotrepanation mit Skleradeckel.

During 1971-1976 407 goniotrephinings e.g. "Elliot with scleral flap", were performed at the Univ. Eye Hospital Münster. In a follow-up study of 306 operated cases we found 81% primary glaucoma (62.7% simple glaucoma, 18.3% chronic congestive glaucoma) and 19% secondary glaucoma. In 77% of the operated cases the anterior chamber was restored within the first postoperative day. Gonioscopically in 85% the trephining hole was placed within the trabecular meshwork. Nevertheless, this position of the hole had no decisive influence on the later filtration. Postoperatively 2/3 of cases developed a characteristic flat filtering bleb. In 90.4% of the eyes the postoperative IOP was within normal limits. Postoperative follow-up of the visual acuity remained within the limits of age deterioration. Concerning the secondary glaucoma, the pigmentary glaucoma, the traumatic glaucoma and the glaucoma after uveitis, had good results. The results in cases of buphthalmos and hemorrhagic glaucoma were worse. The advantages of goniotrephining are the rapid restoring of the anterior chamber, the protection of the trephining hole by the scleral flap as well as the well "protected" flat and infections-resisting bleb.

[The effect of natural and artificial light via the eye on the hormonal and metabolic balance of man (author's transl)]. / Die Wirkung des natürlichen und künstlichen Lichtes über das Auge auf den Hormon- und Stoffwechselhaushalt des Menschen.

Examinations of hormone levels in blind persons compared with almost blind and people with normal vision and hormone evaluation with increased artificial light exposure show a definite stimulating effect of light on the human hormonal balance. The effect of light is mediated by an intact perception of light by the eye over an "energetic part" of the visual pathway (Hollwich 1948) - hypothalamus - hypophysis - peripheral endocrine gland. Increasing the intensity of artificial light with "neon-tubes" (fluorescent tubes) leads to "light stress" proved by increased hormone production - especially the stress hormone Cortisol. The belief that artificial light is the same as natural light and that it can fully replace it, is inappropriate in the medical view and needs correction.

[A modification of Toti's operation (author's transl)]. / Uber eine Modifikation der "Totischen Operation".

An external dacryocystorhinostomy with simplified suture is described. This method was suggested in 1937 by Kaleff and further developed by us. The modified operation consists of the following: The nasal mucous membrane is prepared free, and from this a complete pedicle is made with the base underneath. The tear sac is split in the long axis into a broad upper and a narrower lower part. The narrow lower part is sewed to the nasal mucous membrane with 3 atraumatic catgut sutures. The broader upper lobe of the sac is fixed to the covering subcutis with 3 catgut sutures.