Further ophthalmological information on Byzantine chroniclers and historians.

The historical importance of information on ophthalmological topics by Byzantine chroniclers and historians prompted us to enlarge our researches on this subject. Thus we present 17 various subjects in continuation of our previous article published in Documenta Ophthalmologica, 'History of Ophthalmology' (Vol. 5, 121-132, 1992).

Some Byzantine chroniclers and historians on ophthalmological topics.

Byzantine historians and chroniclers recorded events not only of national importance, but also of daily life. The authors present various aspects in relation to ophthalmology. A selection of subjects including eye disorders and injuries, as well as visual problems discussed in myths, narratives and religious dogmas are presented.

The terms glaucoma and cataract in the ancient Greek and Byzantine writers.

The authors deal with the meaning of the terms glaucosis and hypochyma, in the texts of ancient Greek and Byzantine medical writers. The analysis of these texts shows us that the meanings of these terms do not correspond to the modern ones. In the texts the term glaucosis corresponds to the modern cataract, and the term hypochyma to the pathological formation of a kind of membrane which appears in the space of the pupil, due to coagulation of a fluid.

Eye references in the Homeric Epics.

After a short introduction to the Homeric Epics, the name of Homer and the time and place where the poems were written, the authors refer to the terms of the eyes and to the verses where they are found. Among these terms, the most important is the term omicron phi theta alpha lambda mu omicron sigma, the first term for the eye in ophthalmology, which has remained throughout the years unchanged. Finally, they refer to the injuries of the eyes, the participation of the two sons of Asclepios in the Trojan campaign and to the verses including the classical paragraph '... a doctor is more capable than the other men ...' Both Epics relating to the cardinal human values: prudence, temperance, fortitude and justice, contain the lofty ideal of human excellence, called by the Greeks alpha rho epsilon tau eta.

Ophthalmology according to Aetius Amidenus.

The authors analyze the diseases described in the chapter 'Concerning the maladies of the eye' by the outstanding Byzantine author Aetius Amidenus. Where possible, the authors try to compare the medical ideas of Aetius with the up-to-date nosologic entities. To give a more comprehensive analysis, the authors try to complete the classification of diseases on an anatomic basis, following in most of the points that of Aetius. The ophthalmological diseases are classified as follows: a) eye-lids; b) cornea; c) sclera and conjunctiva; d) anterior chamber, iris and lens; e) lacrymal ducts; f) disturbances of the vision; and g) various others. The authors emphasize that the seventh chapter (Z' logos) constitutes a significant ophthalmologic manual, containing almost all the pertinent knowledge of that time.

The treatment of eye diseases in the Asclepieia.

The authors give a short report of ophthalmic treatment in Asclepieia by the priests, who had learned these cures through tradition from other priests. This can be testified by the writings on the stone tablets, which were found in the excavations of the Asclepieion at Epidaurus (1883). They give information concerning illnesses and their treatment. From this historical source we selected certain cases with eye-diseases and their treatment. Included is a part from Aristophanes' comedy "Ploutos", giving interesting ophthalmic treatments. These treatments by the priests, representing God Asclepius, mainly took the form of medicines and operations performed in a psychologically mysterious atmosphere.

[The ophthalmologist B. Adamandiadis and the history of the "Adamandiadis-Behçet syndrome"]. / Der Augenarzt B. Adamandiadis und die Geschichte des "Adamandiadis-Behçet-Syndroms".

This article presents the scientific and social work of Benedikt Adamandiadis and the history of the "Adamandiadis-Behçet syndrome". The authors also attempt to describe the inestimable contribution to modern Greek ophthalmology. It is not the authors' intention to underscore Adamandiadis' importance as the discoverer of the syndrome - for him, the fulfillment of his duties as a scientist and a human being was always more important than personal fame -, but merely to correct an historical injustice.

"Eye injuries" by the Byzantine writer Aetios Amidinos.

The authors give a short report of the "Injuries of the Eye" by the Byzantine writer Aetios Amidinos. He wrote 16 medical books, among them "The 7th Logos", including Eye Diseases. In all his writings, there is a substantial resort to ancient medical literature, mainly to the books of Galen. He describes the Eye Injuries in 5 chapters with remarkable critical ability and suitable treatment. Thus he is acknowledged as one of the most cultured and productive writers of that period.

[Spontaneous rejection of an intraocular foreign body]. / Spontane Abstossung eines intraokularen Fremdkörpers.

The right eye of a 17-year-old patient had been injured by a metallic, nonmagnetic foreign body which had perforated the eye at the limbus at 6 o'clock and become lodged in the posterior part of the ciliary body near the ora serrata. The operation to remove the foreign body was unsuccessful. After three months without any inflammatory reaction the patient noticed it in the conjunctiva. The splinter had been spontaneously rejected via the same route by which it had entered the eye; it was removed from the point of entry under local anesthesia. The special circumstances which, in the authors' opinion, led to spontaneous rejection of this foreign body are discussed.

[Familial amyloidosis of the Andrade disease type in a Greek family]. / Familiäre Amyloidose vom Typ Morbus Andrade in einer griechischen Familie.

Andrade's disease, which is a type of familial amyloidosis, is not common in Greece and seems to be restricted to the region of Heraklion, Crete. The authors describe a case of Andrade's disease which began with ocular symptoms when the patient was 29. After two years the full clinical picture of the disease developed. The ocular symptoms are often the first manifestations of this fatal disease. The paper includes the family tree of the patient, proving the hereditary origin of the disease.

[The role of the parathalamus in covered sclerectomy]. / Die Rolle des Parathalamus bei der "gedeckten Sklerektomie".

Twenty-six eyes in which IOP had been regulated at a mean 14 mmHg by goniotrepanation were operated on for cataract after an interval of at least 4 years. On exposing the scleral flap the authors discovered gray-black funiculi on the two unsutured vertical sides, representing new fluid-permeable membranous tissue. Beneath them was a fairly small fluid-filled space, the " parathalmus " - a kind of secondary anterior chamber.

[Goniotrepanation using scleral flap in modern surgery of glaucoma]. / Die Goniotrepanation mit Skleradeckel in der heutigen Chirurgie des Glaukoms.

In the introduction, the principles and limitations of modern glaucoma surgery are described. There then follow some personal observations on the history of goniotrepanation, from which it is evident that the scleral flap is not the invention of any single surgeon, but rather the result of experiments by several. The importance of the scleral flap was proved by the almost simultaneous appearance of trabeculectomy and goniotrepanation and, some time later, of Schleie's covered fistulizing operation. The technical details of goniotrepanation and the features peculiar to this procedure are then described. It follows from this description that goniotrepanation is a microsurgical procedure demanding skill and experience on the part of the surgeon. Comparative studies of goniotrepanation in the literature are then discussed in detail. These are concerned with postoperative findings, pressure regulation, morphological changes at the site of the operation and the effect on visual function. The advantages of goniotrepanation and the function of the parathalamus, which represents a new drainage path for the aqueous, are then described. The procedure creates a normal balance between the quantity of aqueous produced and its drainage to the exterior, resulting in a normalization of intraocular pressure. This drain does not lead directly to the subconjunctival space, but indirectly, via normal pathways, through the parathalamus formed by the flap. The creation of the parathalamus can be useful in glaucoma surgery; it offers advantages as regards both indication and surgical technique.

[The significance of the scleral flap for the surgery of glaucoma (author's transl)]. / Die Bedeutung des Skleralappens für die Chirurgie des Glaukoms.

The importance of the scleral flap used in the covered fistulising operations is reported. The authors describe in detail significant observations contributing to the successful outcome of these operations. They make the hypothesis, supported by their microsurgical observations, for the formation of a slit-like space under the scleral flap, named "Parathalamus", which is an extension of the anterior chamber. This space communicates with the anterior chamber through the trephination hole. The aquous humor flows to the subconjunctival space through a fine membraneous tissue, formed on the surface of the lips of the "parathalamus".

[Local prophylactic measures to prevent postoperative infection after cataract operations (author's transl)]. / Lokale Prophylaxe gegen postoperative Infektionen nach Kataraktoperationen.

The Allen procedure to prevent postoperative endophthalmitis has been applied in cataract operations since 1973. Postoperative endophthalmitis has been observed through the years 1965--1973 in 0.49% of registered cases, while the infection rate has now been lowered to 0.067%.

[Goniotrepanation with scleral flap: recommendations for the microsurgical operation method (author's transl)]. / Goniotrepanation mit Skleradeckel. Richtlinien der mikrochirurgischen Operationsmethode.

After more than five years' experience with goniotrepanation the improved details of the micro-surgical technique operation of are explained.