Giant cell astrocytoma of the retina. Clinicopathologic report of a case not associated with Bourneville's disease.

A 56-year-old man presented with a disc-based intraocular mass at the posterior pole with massive subretinal exudation. Fluorescein angiography, ultrasonography, and CAT scans did not aid final diagnosis. Four months later, the patient presented again, with massive tumor progression, total retinal detachment due to proliferative vitreoretinopathy, and rubeosis iridis. Pathologic evaluation of the enucleated globe revealed a giant cell astrocytoma of the retina.

Tumor regression after photocoagulation of malignant melanomas of the choroid: an ultrasonographic study.

Ultrasonography was performed in 24 eyes harboring malignant melanomas of the choroid to study tumor regression after xenon-arc photocoagulation at periodic intervals after each photocoagulation session. Ophthalmoscopically, 20 (83%) eyes revealed a complete regression of the tumor after 3 months to 3 years of treatment. However, ultrasonography revealed complete tumor regression in only 13 (65%) out of these 20 eyes while the remaining 7 (35%) 9 eyes had a residual tumor prominence of 0.75-1 microsecond. 14 (70%) out of 20 tumors were completely regressed 1 year after photocoagulation treatment. Most of the eyes revealed complete disappearance of the tumor after 3-5 photocoagulation sessions. Though 4 tumors which did not respond to photocoagulation treatment were located in the central temporal retina within the vascular arcade, no statistically significant difference could be seen between tumor regression and location of the tumor. Complete tumor regression was seen in 4 out of 5 eyes after encircling coagulation alone while 16 out of 19 eyes revealed complete tumor regression after addition of direct treatment of the tumor. Photocoagulation appeared to be a useful tool in the treatment of small choroidal melanomas.

Complications of local beta radiation of uveal melanomas.

The results of local beta ray radiation of 295 eyes containing a uveal melanoma (including 74 melanomas of the anterior choroid and ciliary body) are presented with special respect to the complications of treatment. The most frequent complications were radiation retinopathy and optic neuropathy. Complications known to occur from other radiation methods, such as dry eye syndrome, loss of cilia, and scleral necrosis, did not occur in our series. The incidence of radiation cataract, as compared to the treatment with 60Co plaques, was lower in our series. An average of 700 Gy delivered to the scleral base of the tumor was needed for uveal melanomas which could be destroyed. This radiation dose resulted in a 10% incidence of radiation retinopathy.

[Treatment of malignant melanomas of the uvea with 106-ruthenium applicators. Report on the first 100 Essen cases]. / Die Behandlung von malignen Melanomen der Uvea mit 106-Ruthenium-Applikatoren. Bericht über die ersten hundert Essener Fälle.

The results of treatment of the first 100 patients with uveal melanomas treated with 106-Ruthenium applicators in Essen are presented. The mean follow-up period was 2 years; 80 of the patients presented with choroidal melanomas and 20 with melanomas of the ciliary body. Five of the 100 patients had metastatic disease originating from the primary uveal melanoma. Compared to 60-cobalt therapy, therapeutic results are similar in terms of tumor regression, but the incidence of complications was significantly lower. In 16 patients the eye with the tumor had to be removed, because of tumor growth (12), neovascular glaucoma (3), and vitreous hemorrhage (1). Visual acuity did not decrease in 20% of the cases treated. In the light of our results 106-Ruthenium therapy seems to be a reliable method of tumor treatment in tumors with a maximum prominence not exceeding 8 mm.

[Initial results in percutaneous radiotherapy of malignant melanomas of the choroid with the linear accelerator]. / Erste Ergebnisse in der perkutanen Strahlentherapie von malignen Melanomen der Aderhaut mit dem Linearbeschleuniger.

Twenty-seven eyes harboring a choroidal melanoma which could not be treated by other methods were treated with external beam radiation using a linear accelerator. After a mean follow-up period of 15.6 months 3 eyes had to be enucleated. In two eyes fresh tumors developed, which were successfully treated with local beta-radiation. In the remaining 22 eyes the tumor growth was stopped or the tumor regressed. External beam therapy for choroidal melanomas seems to be an effective alternative to enucleation in eyes with tumors not accessible for other methods of treatment and which cannot be enucleated, e.g., single eyes.

[The Annette von Droste-Hülshoff syndrome]. / Das Annette von Droste-Hülshoff-Syndrom.

In the past, physicians interested in the great poetess Annette von Droste-Hülshoff argued as to whether she suffered from chronic tuberculosis or Graves' disease. We can now explain her physical appearance without any difficulty, thanks to our knowledge of the oculopathy of prematurity. Annette von Droste-Hülshoff was a premature infant delivered in the seventh or eighth month, and there is no doubt that she suffered from severe myopia and myopic exophthalmos. Moreover, she had a divergent pseudosquint, as can be seen in some portraits of her; this was very probably caused by a dragged disc or dragged retina (i.e., displacement of the macula). The increasing number of outstanding talents seen among premature infants, who now grow up thanks to the incubator, reminds us that Annette von Droste-Hülshoff's vast knowledge and her poetic genius were an expression of her prematurity, which is documented in biographies and by cryptic autobiographical evidence.

Healon in retinal detachment with proliferative vitreoretinopathy.

In 73 eyes, retinal detachments complicated by proliferative vitreoretinopathy (PVR) were treated by intravitreal injections of Healon, in addition to scleral buckling procedures. The number of completely reattached retinas three months postoperatively was dependent upon the grade of PVR: 50% were reattached when PVR comprised only one quadrant (Grade C-1); 30% when two to four quadrants were involved (Grade C-2, C-3 and D-1). Reattachment was not achieved in two cases of PVR with funnel-like configurations (D-2). Major complications that could be attributed to Healon did not occur. The results indicate that Healon injections, combined with scleral buckling procedures, are an encouraging approach to retinal detachments with PVR Grades C-2 through D-1.

Biometric studies of the eyeball and retinal detachment.

The relationship between axial length and equatorial diameter and eye volume has been studied in 4 groups of eyes: intact emmetropic eyes, emmetropic eyes with retinal detachment, eyes with moderate myopia and retinal detachment, and eyes with high myopia and retinal detachment. It was found that eyes with detached retinas, regardless of whether they are myopic or emmetropic, are of significantly different dimensions from emmetropic control eyes. There is usually a significant increase in equatorial diameter and therefore in equatorial circumference. The results indicate that eyes with detached retinas differ from normal eyes in their abnormally large size.

Bjerrum lecture. Treatment of diabetic retinopathy with photocoagulation. Results of photocoagulation therapy of proliferative retinopathy in childhood-onset and maturity-onset diabetes and an approach to the dosage in photocoagulation.

The results of photocoagulation treatment of proliferative retinopathy in childhood onset and maturity onset diabetes are compared with each other. It is clearly shown that childhood onset diabetes needs more photocoagulation treatment than maturity onset diabetes, and that this difference is statistically significant. From this comparison we approach the problem of the dosage of photocoagulation considering either the surface of the coagulated field or the volume of the coagulated retina. Further papers on the same problem will be published from our hospital.

[Proliferative diabetic retinopathy at the time of diabetes diagnosis]. / Proliferative diabetische Retinopathie zum Zeitpunkt der Diabetesdiagnose.

The diagnosis of proliferative retinopathy led to a search for a hitherto undiagnosed diabetes mellitus in 5 patients. In 3 further patients advanced proliferative retinopathy was found only a few months after diagnosis of diabetes. In all 8 patients it was possible to regulate the diabetes with oral medication. The mean age of the patients was 49.1 years, the youngest being 42, the oldest 54. The question as to whether the courses of proliferative retinopathy and diabetes mellitus may be heterogeneous is discussed.