No evidence for increased growth hormone responses to growth hormone-releasing hormone in patients with diabetic retinopathy.

Several studies report increased growth hormone (GH) responses to provocative stimuli in patients with diabetic retinopathy. We studied GH responses to 1 microgram/kg body wt human pancreatic GH-releasing hormone 1-44 (hpGHRH 1-44) in 33 patients with type I diabetes mellitus, 31 patients with type II diabetes mellitus, and 2 control groups (N = 11 and 8). Based on the results of fundoscopy and fluorescein angiography, the diabetic patients were subdivided into patients without diabetic retinopathy, patients with nonproliferative diabetic retinopathy, and patients with proliferative diabetic retinopathy. Growth hormone responses to hpGHRH 1-44 in diabetic patients with proliferative or nonproliferative retinopathy or without retinopathy were not significantly different regardless of the type of diabetes. Remarkably, GH responses to hpGHRH 1-44 in type I diabetic patients without retinopathy were significantly higher than the matched controls. Our data suggest that diabetic retinopathy in type I and in type II diabetes is not associated with increased GH responsiveness to hpGHRH 1-44, whereas in type I diabetes mellitus without diabetic retinopathy, a GH hyperresponsiveness to hpGHRH seems to occur.

[Indications and results of cryotherapy of eyelid tumors]. / Indikation und Ergebnisse der Kryotherapie von Lidtumoren.

Since 1980, 112 patients presenting with tumours of the eyelid were treated by cryotherapy at the First University Department of Ophthalmology in Vienna. In 103 cases, histological examination revealed basal cell epithelioma, in 7 cases spindle cell epithelioma and in 2 cases a naevus. There were 69 female and 43 male patients and the average age was 68 years. Tumour recurrence existed in 29 of these patients who had previously undergone surgical treatment or radiotherapy. The low temperatures required for cryotherapy are produced by the use of liquid nitrogen. Contact freezing was performed in cases of tumours of up to 8 mm diameter; larger tumours or those with an irregular surface were treated by spray freezing. Within a follow-up period of 5 years, 9% of the patients with basal cell epithelioma and spindle cell epithelioma experienced recidivation.

[Reconstruction of the medial canthal area and lower eyelid]. / Rekonstruktion des medialen Lidwinkels und des Unterlides.

This paper presents the case report of a patient with an extensive tumour of the lower eyelid and the medial canthal area treated by a combination of two surgical procedures. We combined the method described by Hughes and modified by Smith--a tarsoconjunctival graft from the upper eyelid--for reconstruction of the canthal area with a Tenzel lateral rotation skin flap. The combination of these methods enables the transplanted part of the tarsal tissue to be kept relatively small, which reduces the risk of postoperative complications of the upper eyelid. Moreover, with the rotation flap it is possible to control the tension of the lower eyelid exactly. The postoperative result is satisfactory.

[Light and electron microscopic findings in eyelid tumors after cryotherapy]. / Licht- und elektronenmikroskopische Befunde von Lidtumoren nach Kryotherapie.

Over the past five years 112 patients underwent cryotherapy of lid tumours. Two methods of freezing, contact freezing and spray freezing, were used. Biopsy specimens for histological studies were taken before and after cryotherapy. The results of light and electron microscopy are reported. Electron microscopic examination shows that cryonecrosis exhibits the well known general characteristics of necrosis. Cryotherapy results in extensive tumour necroses and this fact explains the success rate of 90.9% in basalioma 5 years after therapy.

[Recurrence of vasoproliferative activity after photocoagulation. A fluorescence-angiographic study]. / Erneutes Auftreten von vasoproliferativer Aktivität nach Photokoagulation. Eine fluoreszenzangiographische Studie.

Although photocoagulation is no cure for diabetic retinopathy, it slows down or, in favourable cases, prevents further progression. In order to achieve the desired therapeutic effect, photocoagulation has to include the ischaemic mid-periphery of the retina. Following a latency period of varying duration during which no further progression is evident either on ophthalmoscopic examination or fluorescein angiography, recurrence of neovascularization is observed in some cases. The therapeutic management entails additional panretinal photocoagulation, in particular at the periphery. The authors report on 75 patients who, following panretinal photocoagulation, were treated by additional argon-laser coagulation.

[Diabetic choroidopathy--a retrospective fluorescein angiography study. Preliminary report]. / Diabetische Chorioidopathie--eine retrospektive fluoreszenzangiographische Studie. Vorläufige Mitteilung.

Both histologic studies and findings with Indocyanin green angiography furnish clear indications of the existence of diabetic choroidopathy. Out of 19,387 fluorescein angiograms made over the last 15 years at the First Ophthalmological Clinic of Vienna University, 902 were selected in which the choroidal vascular system is at least partially visible due to melanin hypopigmentation. The pathologic changes in the choroid observed in these angiograms can be allocated in two basic types of pathologic fluorescence: on the one hand hyperfluorescent lesions such as drusen in Bruch's membrane in suprisingly young diabetics, extremely hyperfluorescent lobules of the choriocapillaris, choroidal aneurysms, and neovascularizations; on the other hand, hypofluorescent lesions or structures were observed, such as delayed filling of the choriocapillaris and, in the late phase of angiography, varicose and tortuous choroidal vessels, drained and appearing dark in contrast to the diffuse background fluorescence.

[Fundus changes in hyperlipidemia]. / Fundusveränderungen bei Hyperlipidämie.

Of a total of 26 patients with hyperlipidemia, 4 developed flat yellow patches of varying size and shape in the macular area. In a different study a total of 9 subjects with similar flat yellow patches were examined; 6 had increased levels of serum cholesterol and triglycerides. The likelihood that such patients have hyperlipidemia is well over 50%.

[Cataract surgery following goniotrephination]. / Kataraktoperation nach Goniotrepanation.

A report on our experience with cataract surgery on 20 patients who had undergone goniotrephination (after Fronimopoulos) one to three years (average 2.3 years) previously. In ten cases microsurgical preparation of the conjunctival and scleral flap revealed that the cleft was completely open; in four cases it was partially closed and in six cases totally occluded. In 16 cases, postoperative intraocular pressure was well regulated without additional medication. In two cases mitotic therapy was required for only six to eight weeks postoperatively to achieve normotonic values. In two further cases this regimen had to be followed indefinitely to achieve lasting pressure regulation.

[Long-term study following panretinal argon laser coagulation in proliferative diabetic retinopathy]. / Langzeitbeobachtung nach panretinaler Argonlaserkoagulation bei proliferativer diabetischer Retinopathie.

Fifty-eight Type I diabetics were followed up for a minimum of 5 years after panretinal argon laser coagulation in both eyes for proliferative diabetic retinopathy. During the course of this study, 18 patients were excluded because thorough follow-up examinations according to our systematic approach had become impossible. The results of this study indicate that successful photocoagulation depends essentially on the initial findings, on the type and extent of treatment as well as on regular and thorough follow-up examinations.

[Changes in the visual field and dark adaptation following panretinal photocoagulation in diabetic retinopathy]. / Veränderungen des Gesichtsfeldes und der Dunkeladaptation nach panretinaler Photokoagulation bei diabetischer Retinopathie.

Within the past 5 years panretinal photocoagulation was performed in both eyes of 36 patients (Type I diabetics) with proliferative retinopathy. The age of these patients was between 21 and 38 years. The average follow-up period was 3.6 years. The effects on visual acuity, visual field, and dark adaptation were examined: in 65.3% of the cases (47 eyes) visual acuity remained unchanged; in 34.7% (25 eyes) central visual acuity was reduced. Depending on the coagulation technique and the number of coagulates applied, the visual field narrowed in a more or less pronounced way. Moreover, in all patients the dark adaptation threshold was elevated after panretinal photocoagulation.

[Diabetic pre-retinopathy]. / Diabetische Präretinopathie.

In 169 out of 409 diabetic patients without any ophthalmoscopically or biomicroscopically visible retinal changes, typical symptoms of diabetic pre-retinopathy were revealed by fluorescein angiography: capillary dilatation (89.3%), capillary occlusion (78.7%), leakage from small blood vessels (54.4%) and arteriovenous shunts (40.8%). No correlation was found between the duration of the diabetes mellitus and the onset of diabetic pre-retinopathy. Juvenile diabetics developed significantly more capillary occlusions, while in diabetics of advanced age capillary occlusions and leakage from small vessels were encountered with almost equal frequency.

[Clinical experience with cryotherapy of lid tumors (author's transl)]. / Klinische Erfahrungen mit der Kältebehandlung von Lidtumoren.

Eleven patients with lid tumors underwent cryotherapy. Of these, six suffered recurrence of the tumor following surgery or radiotherapy, respectively. The patients' average age was 66.1 years. The temperatures required for cryotherapy were obtained with fluid nitrogen. Two possible modes of treatment may be distinguished. In contact freezing (used in eight cases) the cryoapplicator is in direct contact with the surface of the tumor. In the second method, spray-freezing (used in three cases), fluid nitrogen is sprayed at a certain pressure directly on to the surface of the tumor. In all cases treatment was performed on outpatient basis. The indications for treatment, the technique applied and the results obtained hitherto are presented.

[A new classification scheme of non-proliferative diabetic retinopathy (author's transl)]. / Ein neues Klassifikationsschema der nichtproliferativen diabetischen Retinopathie.

The correlation of the topography of certain areas of the fundus, which exhibit relentless progression of microangiopathy (within the framework of general fluctuations in the course of the disease), as well as the degree of predominance of capillary perfusion and permeability disturbances in these respective areas justifies a classification of non-proliferative diabetic retinopathy into three distinct types: (1) pre-maculopathy/maculopathy in non-proliferative diabetic retinopathy (DR), (2) nonproliferative DR, and (3) non-proliferative DR lacking a tendency towards vasoproliferation or maculopathy. These results are based on regular biannual angiographic examinations of six different standard fundus areas in a total of 365 patients with non-proliferative DR. This scheme of classification has prognostic as well as therapeutic consequences.

Coagulation factors of contact phase of haemostasis are normal in well-controlled type-I diabetic patients despite presence of diabetic retinopathy.

Alterations of plasma coagulation factors have been reported in diabetic patients with severe microangiopathy and metabolic derangement. No information is available, however, for well-controlled type-I diabetic patients. Thus, we studied coagulation factors of the contact phase and inhibitors in 80 fairly well-controlled diabetics (42 female, 38 male, age 28 +/- 11 SD years). Mean HbA1c in these patients was 6.6 +/- 1.0 SD, duration of diabetes ranged from 6 months to 30 years, and 36% had retinopathy shown by fluorescein angiography. The well-controlled diabetic patients did not differ from controls in terms of the activity of prekallikrein, factor XII, high molecular weight kininogen, kallikrein inhibitor, C-1-esterase inhibitor and antithrombin III. Only alpha-2-macroglobulin, an inhibitor of the contact phase of blood coagulation, was elevated significantly in these patients (p less than 0.05). Diabetics with retinopathy had similar activities of prekallikrein, factor XII, high molecular weight kininogen, kallikrein inhibitor, c-1-esterase inhibitor and antithrombin III when compared with patients without retinopathy and controls respectively. alpha-2-macroglobulin did not differ in patients with and without diabetic retinopathy but were significantly elevated in both groups compared with controls. Correlation analysis showed significant positive correlation between HbA1c and the activity of high molecular weight kininogen, kallikrein inhibitor and alpha-2-macroglobulin. In patients with poor metabolic control (n = 11; 6 female, 5 male; age 25 +/- 5 SD years; HbA1C 10.7 +/- 0.9) prekallikrein (p less than 0.05), kallikrein inhibitor (p less than 0.005) and alpha-2-macroglobulin (p less than 0.005) were significantly elevated compared to the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

[Retinal pseudothrombosis]. / Pseudothrombosis retinae.

As opposed to florid diabetic retinopathy, pseudothrombosis in type I diabetics has a favorable prognosis and responds well to panretinal photocoagulation therapy. In the past decade eight cases of retinal pseudothrombosis were evaluated, treated and kept under observation at the department for diabetic eye complications of the 1st University Eye Clinic, Vienna. Photocoagulation therapy repeated at brief intervals halted progression in all cases and improved visual acuity. In the follow-up period (2-10 years) no further episodes of progression were seen.

[Long-term ophthalmologic follow-up of diabetic children]. / Ophthalmologische Langzeitbeobachtungen kindlicher Diabetiker.

Sixty-four infant diabetics were kept under observation for an average of 6.1 years to obtain ophthalmologic and endocrinologic data (biomicroscopic fundus examination, fundus photography, fluorescein angiography; blood sugar level, HbA1c determination, ketoacidosis, microalbuminuria, HLA-DR typing). In 28 patients (44%, Group B) retinal vascular changes corresponding to the picture of diabetic preretinopathy were detected by fluorescein angiography. In 36 children (56%, Group A), the retinal vascular system was normal. In 16 patients vascular anomalies increased during the observation period, while in 12 patients no further changes were seen. On comparing the endocrinologic findings in the two groups, the only statistically significant difference was in the ketoacidosis values. A tendency to hypoglycemic attacks, as well as elevated HbA1c and microalbuminuria levels, was likewise more frequent in Group B. Aside from the typical distribution, HLA-DR typing revealed a considerable percentage of children with 1/4 localization in Group B only. It was not seen in any patient in Group A. These results give rise to the hope that HLA-DR typing will enable prognostic conclusions to be drawn concerning the time of onset and progression of diabetic retinal alterations in the future.

Reversible changes of visual acuity and pattern-electroretinograms after blue-green argon laser photocoagulation of diabetic patients.

Visual acuity, color vision, pattern-visual-evoked-potentials (P-VEPs) and pattern-electroretinograms (P-ERGs) were measured in 13 diabetic subjects before, and 24 hours and 5 weeks after blue-green argon laser treatment. As control, the same examinations were performed in 7 normal subjects and 7 diabetic patients before and after slit lamp examination with the Goldman three mirror contact lens. Visual acuity and P-ERG amplitudes were significantly reduced one day after the laser treatment, while 5 weeks after the laser coagulation, visual acuity and P-ERG amplitudes recovered to pretreatment values. The control group showed no significant changes after slit lamp examination. Since fluorescein angiography revealed no macular changes after laser treatment, the possibility of a reversible functional light damage after blue-green argon laser coagulation (ALC) is discussed.

[Ocular findings in hemodialysis and following kidney transplantation in childhood and adolescence]. / Augenbefunde bei Hämodialyse und nach Nierentransplantation im Kindes- und Jugendalter.

Between August 1980 and January 1987, 23 patients undergoing treatment for chronic renal failure underwent eye examinations. Hemodialysis and subsequent kidney transplants were performed in 18 patients; in two patients a kidney transplant was performed alone, and in three others hemodialysis without transplant. The interval between dialysis and transplantation averaged 23.1 months, the mean follow-up after transplantation 20 months. Patients who underwent hemodialysis alone were followed up for periods of two, three and 85 months. The patients' ages when hemodialysis treatment was first instituted ranged from six to 17 years (average 11.8 years). The mean age at the time kidney transplants were performed was 13.6 years (ranging from one to 17 years). Seventeen patients had conjunctival and corneal infiltrations in the area of the palpebral fissure. In two cases infiltrations were confined to the conjunctiva. Four patients had no pathologic changes, in either the cornea or the conjunctiva. Slitlamp examination revealed subcapsular losses of lens transparency in eight patients; these losses were manifested by delicate punctiform and patchy configurations. In nine cases fundus ophthalmoscopy revealed constricted retinal arteries. Within the period of observation all but one of the patients had unchanged vision. The one exception (cystinosis) had reduced visual acuity due to an accumulation of crystalline inclusions in the cornea.

[Indications for cataract surgery in diabetics]. / Indikationen zur Kataraktoperation beim Diabetiker.

Twenty-five patients suffering from incipient cataract and diabetic retinopathy were submitted to cataract extraction. The intention was not only to improve visual acuity but also to permit better follow-up by fluorescein angiography and useful treatment by xenon light or laser coagulation. Postoperative complications were no more common than in nondiabetic patients, and a comparison with nine cases who refused surgery showed that the diabetic retinopathy was managed better in the aphakic eyes in respect of visual acuity and diabetic fundus changes.

[Laser therapy in central serous retinopathy (author's transl)]. / Lasertherapie bei Chorioretinitis centralis serosa.

Within the last five years 42 patients presenting with central serous retinopathy underwent argon laser photocoagulation. Both the plan of treatment and the evaluation of therapeutic success were based on the fluorescein angiogram.