[Acute persistent bilateral loss of vision]. / Akuter persistierender bilateraler Visusverlust.

Bilateral severe vision loss is a dramatic illness that requires extended diagnostics and immediate therapy. We report on a 37-year-old man who was admitted with lower back pain, headache, and fever. Within 3 days he developed meningism, pleocytosis in the cerebral spinal fluid, and bilateral vision loss, with the vision loss occurring within a few hours. Magnetic resonance imaging showed swelling of the optic nerves. No signs of infectious or immunologic disease could be detected. Despite antibiotic and antiviral treatment followed by immunosuppression with high-dose methylprednisolone, the patient's symptomatology did not decline. The disease course resulted in bilateral atrophy of the papillae caused by bilateral fulminant optic neuritis.

[Eyelid swelling caused by a meningioma in an 8-year-old girl. Case report and review of the diagnosis and the treatment for meningiomas in childhood and adolescence]. / Lidschwellung durch ein Meningeom bei einem 8-jährigen Mädchen: Fallbericht und Ubersicht über Meningeome im Kindes- und Jugendalter.

BACKGROUND: Tumours of the eyelid and orbit with different biological behaviour and localisation may cause eyelid swelling. Orbital meningiomas are rare, particularly in childhood and adolescence. CASE REPORT: We report the case of an 8-year-old girl with frontobasal meningioma, who was admitted to the hospital because of a one-sided upper eyelid swelling. With the example of this case, the diagnosis, treatment and aftercare of meningiomas in childhood and adolescence will be discussed. CONCLUSIONS: The treatment strategy of meningiomas in childhood requires a close interdisciplinary cooperation of ophthalmology, paediatric oncology, neurosurgery and radiotherapy. Moreover, controlled investigations should yield information about the efficiency of modern irradiation techniques or adjuvant chemotherapy in the treatment of inoperable or malignant meningiomas.

[Iridocorneal endothelial syndrome (ICE-S): classification, clinical picture, diagnosis]. / Iridocorneo-endotheliales Syndrom (ICE-S): Klassifikation, Klinik und Diagnostik.

The iridocorneal endothelial (ICE) syndrome includes progressive essential iris atrophy, the Cogan-Reese syndrome, Chandler's syndrome and mixed forms. The term ICE-S was proposed by Scheie and Yanoff in 1975 and by Yanoff in 1979. The capacity of migration of the abnormal corneal endothelial cell layer across the anterior chamber angle, and on to the anterior surface of the iris, possible on to the back surface of the iris and across the zonula fibers is responsible for corneal edema, secondary glaucoma, nevi, noduli and atrophy of the iris, and pupillary distortion. The contraction of the migrated membrane-like ICE tissue produces holes in the iris. The diseases are usually unilateral in young patients. The etiology is still not clear. Theories include membrane formation, low grade of inflammation and viral infection with Herpes simplex or Epstein-Barr virus. Glaucoma and edema of the cornea are the main therapeutic problems.

[Erdheim-Chester disease as differential diagnosis in bilateral exophthalmos]. / Die Erdheim-Chester-Krankheit als Differenzialdiagnose bei beiderseitigem Exophthalmus.

This report describes the case of a patient who had symmetrical exophthalmos, periorbital xanthelasmas and reduced vision. Next to Wegener's granulomatosis the differential diagnosis of Erdheim-Chester disease is discussed. It concerns a rare systemic histiocytosis of unknown etiology. Above all, the skeleton system with symmetrical long bone osteosclerosis is affected. Manifestations in the area of the orbit have seldom been reported with bilateral retrobulbar infiltrations, exophthalmos, diplopia, compression of the optic nerve and periorbital xanthelasmas.

[Traumatology of the eyelids--what is to be done for the initial care?]. / Traumatologie des Lides -- was ist zu tun bei der Erstversorgung?

We describe the injuries of the eyelids depending on the reason, type and severity of the trauma. We are giving a diagnostical guide. By references to the anatomical specialties of the eyelids we deliver therapeutical recommendations for the different types of injuries.

[Results of the Hughes operation]. / Ergebnisse der Operation nach Hughes.

BACKGROUND: There are several methods for the repair of large defects of the upper and lower eyelids, but we prefer the original procedure by Hughes. This operation has been used traditionally for partial and total reconstruction of lid defects after tumour resection in 7-10%. The advantage of this technique is the rebuilding of the eyelid with the lid tissue itself. We present the results of operations by the Hughes method over a 10-year-period. PATIENTS AND METHODS: Between 1986 and 1996 we operated on 60 out of 600 patients with neoplastic tumours of the eyelids and 1 patient with a large traumatic defect of the upper eyelid by the original operation method of Hughes. We report on a retrospective study of 55 patients including 30 males and 25 females with a mean age of 68.6 years. The duration of the histories of the tumours ranged from 2 month to 10 years. The lower eyelids were involved in 46 patients and the upper lids in 9. In 80% (45 patients) we found basal cell carcinomas and in 17% (9 patients) squamous cell carcinomas. RESULTS: Therapy of tumours: 50 out of 54 tumours (92.6%) were resected in sano and 4 not. During the dissection of the lids we carried out a tissue biopsy but no further tumour tissue was found in three patients. The fourth patient needed three further operations before recovery. In six patients we recognised a new tumour, one of them suffered from Lewandowsky-Lutz-Syndrom, developed a new tumour in the orbit and required exenteration orbitae. Early complications: arterial bleeding in one case, in four cases mild dehiscence of the wound between the graft and the remaining lid, in two patients with high risk, infection of the wound, one rejection of the skin graft, one small infiltration of the cornea. Late complications: In six cases we recognised recurrence of the tumour and three patients with entropium and seven patients with heavy trichiasis needed revision. Minor complications such as mild distichiasis, partial incomplete closing of the lids, a smaller lid fissure or notching of the canthus of the lid which did not require revision. The results were quite satisfactory from a functional and aesthetic point of view. CONCLUSIONS: We recommend the operation method of Hughes for reconstruction of large defects of the eyelids of any reason.

[On the relevance of the long-time follow-up of the cyclocryotherapy]. / Zur Relevanz der Langzeitkontrolle der Zyklokryokoagulation.

UNLABELLED: In spite of the availability of cyclocryodestructive laser therapy there still appears to be an indication for cyclocryotherapy in different kinds of glaucoma. PURPOSE: Cyclocryotherapy very often appears to be the operation of choice in cases of progressive functional visual loss if a patient is not sufficiently helped with the maximum tolerated medical therapy. We investigated long-term IOP effects and possible complications in our group of patients undergoing cyclocryotherapy. PATIENTS: Cyclocryotherapy was performed on 109 eyes of 97 patients from 1988 to 1994. Cyclocryotherapy was performed as follows: 67 of 109 eyes were controlled for IOP for an average of 10 months (3-41 months). We applied cryotherapy six times 3-4 mm behind the limbus for an average duration of 50 to 60 s over half of the circumference. RESULTS: We achieved satisfactory IOP control (IOP K 22 mm Hg) in 40 eyes, however, with 30 additional operations. One eye developed phthisis bulbi, and 3 other eyes became blind because of complications in neovascular glaucomas. Neovascular glaucoma cases responded the least. CONCLUSIONS: Cyclocryotherapy produced a statistically significant IOP reduction in eyes with primary open-angle glaucoma or secondary glaucoma. Close long-term follow-up appears advisable in order to check the eyes for possible increase in IOP or complications of surgery.

[Relevance of long-term follow-up of cyclocryocoagulation]. / Zur Relevanz der Langzeitkontrolle der Zyklokryokoagulation.

UNLABELLED: In spite of the availability of cyclocryodestructive laser therapy there still appears to be an indication for cyclocryotherapy in different kinds of glaucoma. PURPOSE: Cyclocryotherapy very often appears to be the operation of choice in cases of progressive functional visual loss if a patient is not sufficiently helped with the maximum tolerated medical therapy. We investigated long-term IOP effects and possible complications in our group of patients undergoing cyclocryotherapy. PATIENTS: Cyclocryotherapy was performed on 109 eyes of 97 patients from 1988 to 1994. Cyclocryotherapy was performed as follows: 67 of 109 eyes were controlled for IOP for an average of 10 months (3-41 months). We applied cryotherapy six times 3-4 mm behind the limbus for an average duration of 50 to 60 s over half of the circumference. RESULTS: We achieved satisfactory IOP control (IOP < or = 22 mm Hg) in 40 eyes, however, with 30 additional operations. One eye developed phthisis bulbi, and 3 other eyes became blind because of complications in neovascular glaucomas. Neovascular glaucoma cases responded the least. CONCLUSIONS: Cyclocryotherapy produced a statistically significant IOP reduction in eyes with primary open-angle glaucoma or secondary glaucoma. Close long-term follow-up appears advisable in order to check the eyes for possible increase in IOP or complications of surgery.

[Perioperative conjunctival flora]. / Untersuchungen der perioperativen Konjunktivalflora.

BACKGROUND: The conjunctival flora is of great interest for each case of intraocular operation preventing postoperative infections. Despite of negative cultures before the operation we investigated in a prospective randomized study perioperatively the bacterial situation of the conjunctiva in 105 patients. MATERIAL AND METHODS: We took conjunctival swabs for microbiological examination from patient's eye operated on cataract or glaucoma, on the day of admission to the eye clinic and in the morning of the operating day. In addition, specimens were taken by nurses with Transwab MW-172 P before the local anaesthesia, disinfection of the conjunctiva and lids and application of eye drops, after these procedures by a research worker, at the end of the operation by the surgeon and two to three days after the operation by nurses with Transwab MW-172 P again. In 53 patients we collected lacrimal fluid to measure the lysozyme concentration. RESULTS: Out of 686 conjunctival swabs we have found 126 (18.4%) positive cultures. Staphylococcus epidermidis had the highest incidence (109 = 86.5%) followed by Staphylococcus aureus (7 = 5.5%). Only in 28 eyes all conjunctival swabs, taken at different times, were negative. There was an increase of positive cultures from routine swabs on the day of admission from 13 (12.4%), to 33 (31.7%) in the swabs taken on the day of the operation in the morning. On the other side the positive cultures decreased then continuously before and after the preparation of the operation, at the end of the operation and during two to three days postoperatively. There was'nt any statistical correlation between the concentration of the lacrimal lysozyme and the rate of positive cultures. CONCLUSION: The preoperative bacteriological diagnostic of the conjunctiva is important mainly for the prevention of postoperative endophthalmitis despite the transience and fluctuation of the conjunctival flora but also in case of endophthalmitis for rapid specific antibiotical therapy.

[Effect of tonometry and nasolacrimal duct irrigation on bacterial flora of the conjunctiva]. / Einfluss der Tonometrie und TNW-Spülung auf die Keimflora der Konjunktiva.

This study was undertaken to assess the influence of preoperative ophthalmological examinations on the microbial flora of the conjunctiva. For this purpose, 112 patients awaiting ocular surgery were included in the study. Conjunctival swabs for microbiological investigation were taken by nurses on the day of admission. In addition, specimens were taken before an ophthalmological examination, after applanation and impression tonometry, after irrigation of the lacrimal duct and 2 h after the end of all examinations. A last swab was taken preoperatively. Comparison of the microbiological results of the first two specimens only showed an agreement in 53% of the cases. The increase after tonometry and irrigation of the lacrimal duct in the number of swabs that were positive was not permanent. Swabs that were primarily germ-free and those that were mostly contaminated also showed strong bacterial fluctuation. Based on the present results, there is no strong evidence that the microorganisms found at the preoperative examinations correlate with a higher risk of postoperative infection. Disinfection of the conjunctival sac and the application of antibiotic drops are necessary on the day before the operation and immediately before it.

Laparoscopic vascular surgery: four case reports.

PURPOSE: We report four cases of laparoscopic vascular procedures (two iliofemoral bypasses, one aortobifemoral bypass, and one aortoiliac endarterectomy) performed with a technique that does not require insufflation of the peritoneal cavity with gas. METHODS: Initially in the porcine model and later in patients, we developed a laparoscopic technique with a mechanical arm used to mechanically elevate the abdominal wall, creating a working cavity. Conventional vascular instruments were used in combination with laparoscopic devices. Five to seven ports were needed for the procedures (four to six ports of 0.5 to 1.5 cm and one incision of 4.0 cm). Exposure was maintained by use of roticulating fan retractors and laparotomy sponges. End-to-side technique was used for all graft anastamoses (cross-clamp time of 40 to 70 minutes). Distal anastamoses were performed through an open femoral incision. Operative time was 5 hours (iliac procedure) and 7 hours (aortic procedure). RESULTS: All patients were ambulating and tolerating a regular diet within 24 hours (iliac procedures) or 48 hours (aortic procedures) after operation. They were discharged home on the second (iliac procedures) or third (aortic procedures) postoperative day. Within 1 week they had resumed normal daily activities. No complications occurred, and no blood bank products were transfused. When compared with the standard surgical approach, gasless laparoscopic technique gave a faster postoperative recovery with less pain and decreased the risk of wound herniation, dehiscence, and infection. From a laparoscopic standpoint, the use of disposable instruments was minimized and the theoretical risk of CO2 embolism eliminated. CONCLUSION: These four cases demonstrate that laparoscopic vascular bypass procedures are feasible and that the accepted advantages of laparoscopy can be extended to patients undergoing vascular surgery.

[Retinal rosettes and their relation to the vitreoretinal barrier in the chronobiologic model]. / Netzhautrosetten und ihre Beziehungen zur vitreoretinalen Grenzschicht im chronobiologischen Modell.

Chronobiological experiments were carried out on animals to investigate the peristatic development of retinal rosettes in the course of a day. Every 3 h one single dose of four different concentrations of cyclophosphamide (CP) was applied subcutaneously under defined conditions in young mice of the Agnes Bluhm strain, Halle. A series of 1,396 eyes was studied to determine which retinal malformations were present in the fine tissue. The authors found daily variations in all rosettes in the inner retinal layers, which are of interest here. However, there was no hint of any circadian pattern. The incidence in rosettes in the inner retinal layers increased in correspondence with a decrease in CP concentration. Disturbances of the vitreoretinal limiting membrane were not only detected in rosettes placed in the ganglion and nerve fibre layers and in epiretinal positions, but also in very large rosettes penetrating all retinal layers. In 7 eyes a special form of rosettes was found: a rosette scattered in the vitreous body like a floater. The authors emphasize the importance the localization of rosettes has for clinical practice.

[Malignant non-Hodgkin lymphomas of the orbital region. Histological classification and immunohistochemical studies]. / Maligne Nicht-Hodgkin-Lymphome des Augenbereiches. Histologische Klassifizierung und immunhistochemische Untersuchungen.

We analysed 15 cases of malignant non-Hodgkin's lymphomas of the orbital region in a retrospective study of the biopsy material from 1965 to 1981. There were 9 cases of lymphoplasmacytic immunocytomas , 1 case of pleomorphic immunocytoma, 2 cases of centroblastic-centrocytic lymphoma and 1 case of plasmacytoma, lymphoblastoma and pleomorphic immunoblastoma . In the majority of cases the orbital region was the primary site of the lymphoma. In a minor part the lymphomas were the expression of a generalized lymphomatous disease. The 15 patients were 12 men and 3 women from 38 to 82 years of age. The peak of incidence was in the septuagenarians . In some of the cases the neoplastic nature of the lymphoproliferative disorder was proved immunohistochemically by the presence of monoclonal cytoplasmic immunoglobulin. The clinical course of the disease was very different and could not be predicted bioptically. Discussing the results we compared our own findings with those in the literature.

[Lymphomata and pseudolymphomata in the region of eyelid and orbital cavity (author's transl)]. / Lymphome und Pseudolymphome im Lid- und Augenhöhlenbereich.

The results of a retrospective study on patients with lymphomata and pseudolymphomata are presented. The interpretation of histological findings may be difficult. This is demonstrated by two cases. In both of them the histological structures in the biopsies were regarded as benign. The course of the disease however, demonstrated malignancy. The term "pseudotumour" of the orbita ought to be used carefully. The treatment and the prognosis of malignant lymphomata demand a classification, reflecting the biological behaviour of the lymphomata. Such classification was elaborated by an International group and is known as the Kiel classification. It should be applied in lymphomata of the orbital region, too. The use of an uniform classification of the malignant lymphomata is essential for all disciplines, involved in the diagnosis and treatment of the neoplasms.