[Infantile hemangioma of the eyelid]. / Kindliches Hämangiom im Lidbereich.

Hemangiomas are one of the most common vascular tumors in infancy. In most cases no therapy is necessary and spontaneous regression is observed; however, if they arise in the periocular region, immediate action is required as rapid growth frequently leads to obstruction of the visual field with the risk of developing amblyopia and orbital suppression up to permanent disfigurement and stigmatization of those affected. Novel pharmaceutical treatment options led to a significant paradigm shift in the treatment of pediatric hemangiomas.

[The aging eyelid]. / Das alternde Lid.

Surgery of the aging eyelid makes great demands on the oculoplastic surgeon regarding preoperative diagnostics as well as choosing the ideal surgical method. This is not only important regarding reconstructive anatomic function but also for aesthetic aspects. This paper gives a résumé of modern diagnostics and therapy of the involutional syndrome of the eyelid. Treating ptosis of the eyebrow, blepharoplasty, blepharoptosis as well as malposition of the lower lid such as ectropion and entropion not only has an impact on the visual system but also on the individual facial features. Considering and treating this makes the highest demands on the oculoplastic surgeon to consider and treat the above problens in order to achieve ideal results.

[Use of lavage fluid containing diphoterine for irrigation of eyes in first aid emergency treatment]. / Verätzungen des Auges Diphoterinhaltige Augenspüllösung in in der Erste-Hilfe-Therapie.

PURPOSE: Eye irrigation is a widely accepted therapeutic must in first aid treatment. The burning agent is removed, diluted, and if possible neutralized. Usually water, NaCl 0.9%, Ringer's lactate or phosphate buffer are the most accepted rinsing solutions. We present a relatively new substance called Previn (Diphoterine in countries other than Germany). It is a hypertonic, polyvalent, and amphoteric substance. Its binding energy for acids, bases, reducers, and oxidation is stronger than the binding energy of biological compounds for these burning agents. Concerning its compatibility with the eye and its efficacy, we compare Previn to the rinsing solutions in general use. MATERIAL AND METHODS: The first experiment (I) shows the effects of ocular rinsing with 500 ml Previn in ten healthy human subjects compared with phosphate buffer rinsing. Evaluation is done by slit lamp examination and confocal microscopy. An experimental study (II) compares in vitro buffering capacity (a) of Previn to other rinsing solutions and shows (b) in vivo efficacy of rinsing with Previn versus other rinsing solutions by pH measurements on the corneal surface and anterior chamber of rabbits after a 30-s burn with 1 N sodium hydroxide. RESULTS: (I) No harmful effect of irrigation with Previn could be found. Its compatibility with the eye is comparable to phosphate buffer rinsing. (II a) Buffering capacity was found to be stronger for Previn in acids and bases compared to phosphate buffer or Ringer's lactate. (II b) The in vivo study on rabbits proved Previn effect onaqueous pH comparable to phosphate buffer in buffering 1 N NaOH, whereas NaCl showed no buffering effect at all. CONCLUSION: The above studies have shown that Previn (Diphoterine) is comparable to other rinsing solutions concerning its compatibility with the human eye. Its buffering capacity is comparable to phosphate buffer. Previn and phosphate buffer should only be used in first aid treatment and not for continued rinsing therapy.

[Transplantation of autologous oral mucosa in the treatment of a symblepharon in Wegener's disease--a case report]. / Schleimhautplastik mit autologer oraler Mukosa zur Therapie des Symblepharon bei Morbus Wegener--eine Kasuistik.

BACKGROUND: Wegener's disease, an immune vasculitis, is characterized by granulomata and vasculitis of small and large vessels. Ocular manifestations are observed in approximately half of all cases. PATIENT: We report on a 58-year-old male with severe generalized Wegener's disease which was first diagnosed in 1986. The involvement of the central nervous system became clinically manifest by a stroke, of the kidneys by incipient renal insufficiency, and of the larynx by recurrent subglottic stenosis of the trachea. The first ocular involvement, a conjunctivitis, was observed in 1988. Despite systemic immuno-suppressive therapy, local conservative therapy and repeated surgical procedures, his vision decreased bilaterally from 60/60 to hand movement (OD) and light perception only (OS) during the following years because of a massive bilateral symblepharon. Transplantation of autologous oral mucosa to the conjunctiva led to a persistent increase of vision and a good cosmetic result. CONCLUSIONS: We conclude that in patients with Wegener's disease, who have developed a symblepharon despite intensive therapy, the transplantation of oral mucosa can produce a sufficient functional and cosmetic result.

[Resection of the Müller muscle. Indications, technique and results]. / Die Müller-Muskel-Resektion. Indikation, Technik und Ergebnisse.

From 1987 to 1992, 582 operations for blepharoptosis were performed in our department. Twenty-five cases of superior tarsal muscle resection in 22 patients were reviewed retrospectively and serve as the basis of the present study. The blepharoptosis was mild to moderate (up to 4 mm) in 20/25 cases. Preoperatively, the phenylephrine eye drops test was positive in 20/25 cases. The indication for both congenital and acquired blepharoptosis was independent of the activity of the levator muscle. The resection was performed by a conjunctival approach. Three techniques of muscle stump refixation were tested without any significant difference in the results. A satisfactory eyelid elevation of more than 2 mm was achieved in 16/25 operations. A moderate effect (1-2 mm) was measured in 5/25 and an unsatisfactory effect (< 1 mm) in 4/25 cases. In contrast to the Fasanella-Servat procedure, the above-mentioned technique leaves all other structures of the upper eyelid intact, especially the accessory lacrimal glands.

[Orbital exenteration. A preventable course in tumor treatment?!]. / Exenteratio orbitae. Vermeidbarer Verlauf in der Tumorbehandlung?!

We reviewed the conditions leading to the mutilating procedure of orbital exenteration in 24 patients at our institution between 1980 and 1993. In 17 cases, including 16 of 17 patients with malignant tumours of the eyelid, this operation could potentially have been avoided. Three of these 17 patients first saw a doctor at an extremely advanced and otherwise untreatable stage of the tumour. The other 14 patients had at least one previous treatment attempt. Six patients with basal cell carcinoma had been primarily treated with radiation alone; two of them developed a squamous cell carcinoma subsequently. In six cases primary reconstruction was performed despite incomplete resection. In one patient a meibomian gland carcinoma was misdiagnosed as a chalazion and excised without histological examination. In another case of squamous cell carcinoma a cutaneous incisional biopsy 6 months prior to orbital exenteration revealed a papilloma. These results emphasize the necessity of careful histological examination in the treatment of lid tumours.