Ophthalmic complaints as a climacteric symptom.

The menopausal syndrome is characterized by a variety of emotional and physical symptoms of varying intensity. A total of 1287 women who attended the Outpatient Department for Climacteric Symptoms and Osteoporosis Prophylaxis (1st Department of Gynaecology and Obstetrics, University of Vienna Medical School) constituted the study population. These women, who were seeking relief from various complaints or for prophylactic assessment and treatment, visited the clinic over the period 1988-1989. We placed special emphasis on ophthalmic complaints as evidence of the incipient climacteric period. Of the 430 patients with eye complaints, 98 underwent ophthalmological investigation. Within our patient group, we analyzed the incidence and severity of menopausal eye complaints as well as therapeutic responses to hormone replacement therapy on an epidemiological scale. Potential endocrinological factors are discussed.

[Advances in the field of surgical therapy of strabismus (author's transl)]. / Fortschritte auf dem Gebiet der operativen Schielbehandlung.

During the past 10 years the surgical treatment of strabismus has received different new impulses. Two fundamental novelties in this field have been reported and three not unimportant contributions towards the facilitation of, or improvement in therapy: Cüppers described a method to improve and/or eliminate the dynamic squinting angle in cases of ocular nystagmus by the so-called "Fadenoperation" and Aichmair demonstrated the possibility of re-establishing the function of a traumatically paralyzed abducens muscle by means of muscular neurotisation. Aichmair and Abel discovered in a comparative study that there is no necessity to bandage patients after a squint operation; this is of especial importance in small children as there need no longer be any fear of the postoperative binocular bandage. Aichmair and Fries demonstrated a simple method for the precise measurement of the volume of implantates to eliminate enophthalmus after blow-out fractures; this helps the surgeon to avoid over- or undercorrection. They stressed, furthermore, the importance of the right shape of the implantate. de Decker published a new method of tucking of the superior oblique and of recession of the inferior oblique that facilitates the operation and at the same time enables more accurate dosation.

[Cyclic esotropia (alternate day squint) (author's transl)]. / Zyklisches Einwärtsschielen (Alternate Day Squint)

One case of the extremely rare conditioning of cyclic esotropia is reported following a short review of the literature and clinical features of this form of strabism. According to our experience the only effective treatment is operative correction on the day of the squint. It is not advisable to wait until the alternate day squint cycle breaks down and a permanent convergent squint develops.

[Randomized field study of the etiology of strabismus concomitans]. / Randomisierte Feldstudie über die Atiologie des Strabismus concomitans.

After an introduction to the problems of binocular vision and an overview of the literature, the authors report on the reasons for undertaking this study and on its practical implications. Up to now, no other randomized study has been undertaken to our knowledge on children of this age group in such a large city as Vienna. All children in primary 3 classes in 20 out of the 256 elementary schools were examined ophthalmologically and orthoptically. It was found that hereditary factors are of statistically significant importance. Especially important for the ophthalmologist is also the statistically significant relation between the diagnosis poor range of fusion, poor fixation, incorrect Worth test for distance and/or proximity, and poor or lacking stereoscopic vision with the occurrence of strabism. The authors were astonished to find a remarkably high percentage of exophoria (58%), in contrast to esophoria (16%). It is interesting for prophylaxis and therapy that children originating from families where spectacles are worn, acted more cooperatively and tended to take the orders of the physician more seriously than those coming from families without eye problems. The promotion of genetic research related to squint and more counselling for couples wishing to have children or confronted with risk factor problems would be desirable, as well as the inclusion of more obligatory ophthalmological examinations in the mother-child medical "passport".

[An unusual case of Marcus Gunn phenomenon]. / Sonderform eines Marcus-Gunn-Phänomens.

The author gives a short review on the course of the disease and the typical symptoms of regular Marcus Gunn phenomenon i.e. the retraction of an usually ptotic lid when the patient opens his mouth or moves his jaw to the healthy side of his face. He then reports on a boy now aged 3 and a half that had suffered from Marcus Gunn phenomenon since his birth, although the disease almost disappeared in the first years of his life. Only a short time before the parents noticed again the phenomenon, occurring now in a modified version; the retraction of the lid appears mainly then when the child pulls himself up from a lying position or raises the arm of this side where the ptosis is located.

Orbital impalement injury. An unusual case.

A 24-year-old man suffered an orbital impalement injury from a car aerial antenna that penetrated the medial third of the right lower lid. Immediately after the accident a convergent eye position, diplopia, and complete paresis of the upper lid as well as reduced abduction could be observed; the uninjured globe could not be moved beyond the midline. According to orbital tomograms and a traction test an incarceration of the medial rectus muscle was suspected. Electromyography 24 days after the accident revealed a peripheral paresis of the abducens nerve but an intact medial rectus muscle. Surgical exploration of the muscle was postponed, and the condition of the eye gradually improved; 8 days after the electromyography the clinical examination as well as the electromyogram showed near to normal results.

[Abundant familial occurrence of strabismus amblyopia (author's transl)]. / Gehäuftes familiäres Auftreten von Strabismus und Amblyopie.

Report on a family of 14 in which the mother and her first four children, born out of wedlock and having different fathers, had healthy eyes and no ocular troubles. Her husband, the father of the eight younger children, presented with concomitant strabismus and amblyopia in the left eye. All his children squinted also, and all but one had amblyopia and poor fixation in the affected eye.

[The influence of phospholine iodide on the squinting angle (author's transl)]. / Der Einfluss von Phospholinjodid auf den Schielwinkel.

The author discusses the results of phospholine iodide therapy on 112 children with convergent strabismus and comes to the conclusion that the possible complications of this therapy are not outweighed by its only very modest success.

[Tumorous form of acute myeloid leukemia (author's transl)]. / Tumoröse Form einer akuten myeloischen Leukämie

The author describes a rare tumorous form of acute myeloid leukemia in a boy aged 4 and a half years. It appeared as unobtrusive swelling of the left upper lid and led to the diagnosis of leukemia. After the beginning of cytostatic therapy the swelling disappeared. In the preterminal state an excessive protrusio of the left globe occured which made the closure of the lid impossible. The right eye was never involved.

Therapy of blow-out fractures.

The number of patients with fractures of the bony orbit has recently increased because of increasing accidents, expecially car accidents. Due to the good cooperation of maxillofacial surgeons and ophthalmoligists the latter are asked for consultation in the first days after the accident. Therefore the possibility exists to diagnose rather often a blow-out fracture even without X-ray examination. The methods of primary and secondary management are enumerated.

[Treatment of covergence insufficiency by "convergence-card" (author's transl)]. / Die Behandlung der Konvergenzschwäche mit Hilfe der Konvergenzkarte.

A report is given on a simple possibility to influence favorably convergence insufficiencies by means of physiological diplopia; a so-called "convergence-card" is described as well as its usefulness for eye-training; the case reports of 4 typical patients are described.

[Objective vision test in very young children (author's transl)]. / Objektive Sehschärfebestimmung bei Kleinstkindern

By means of the Catford Visual Acuity Apparatus it is possible to determine objectively the visual acuity even in very young children easily and in a very short time; in children aged less than one year in most cases only a binocular later on a monocular acuity could be ascertained. There are almost no difficulties caused by the language. The visual results of 100 patients are given, 63 of which were under 3 years old; 10 children were aged between 5 and 24 months. A control group of 30 patients was also tested with Pflüger optotypes, and the results were compared; half of them were as good as, half of them -- mostly slightly -- better than the results gained by the Pflüger-test. We can therefore recommend the use of the Catford Apparatus in very young children and in such cases where the visual acuit can be determined only under very difficult conditions. The results are exact and can be assumed to be the same as with Pflüger's optotypes. Moreover, the Catford's apparatus may be also used for the testing of aggravants.

[Unilateral congenital anophthalmos with Trabecular agenesia and hydrophthalmos of the other eye (author's transl)]. / Einseitiger angeborener Anophthalmus mit Balken-agenesie und Hydrophthalmus am anderen Auge.

In a one-year-old female patient, unilateral anophthalmos was ascertained by clinical, echographic and X-ray examination. In addition, the cranial computer tomogram showed trabecular agenesia. The globe of the other eye was existent and was enlarged by hydrophthalmos. Pediatrically this case represents a syndrome with multiple anomalies of etiologically unknown origin; apart from the ocular malformation there are a severe cerebral developmental disturbance, an apallic syndrome, hypsarrhythmia, peculiar disproportional bodily structure with skeletal anomalies as well as an abnormal susceptibility to infections of the respiratory system and a marked, isolated IgA-deficiency. Neither chromosomal anomaly nor familiarity was discovered.

[Fibrin gluing of the extraocular eye muscles. Experimental use in the rabbit]. / Fibrinklebung an äusseren Augenmuskeln. Experimentelle Anwendung am Kaninchen.

An experimental animal study was conducted to determine whether fibrin glue could be used in strabismus surgery (recession, resection, and muscular neurotization). Fibrin glue was used in place of some or all of the commonly used 7-0 Vicryl sutures. In order to evaluate the adhesion of the fibrin glue the rabbits' eyes were enucleated 10-67 days after surgery, fixed in 8% formalin solution and then histologically examined. In the recession and resection specimens a solid joint between muscles and sclera was found, without any significant scar formation or atrophy of the muscles. The muscular neurotization specimens also exhibited a firm connection between the two muscles, with no abnormal loss of muscle fibers by cicatrization or atrophy. In none of the cases did the conjunctiva show any tendency to conglutination. In view of the simplicity of the fibrin gluing technique and the uniform bonding effect, application in human patients is recommended.

[Eye manifestations as climacteric symptom]. / Augenbeschwerden als klimakterisches Symptom.

The menopausal syndrome consists of a variety of psychic and physical signs of different intensity. At our outpatient department for problems in menopause and prevention of osteoporosis (1. Dept. of Gynaecol. and Obstetrics, Vienna) 1287 women who were consulting this department for the first time because of prevailing complaints or prophylactic reasons, were registered during the years 1988 and 1989. In the course of this work we paid particular attention to the symptom "eye complaint" as a sign of the beginning of the menopausal period. 98 out of 430 patients with eye complaints were examined ophthalmologically. Referring to our patient population we tried to analyse epidemiologically the frequency and the degree of severity of menopausal eye complaints as well as the therapeutical response to a hormone substitution therapy. To what extent an endocrinological explanation can be found and which facts lead us assume such a statement, we have tried to demonstrate in the discussion.

[Complications following orbital floor fractures]. / Komplikationen nach Orbitabodenfrakturen.

Complications after orbital floor fractures were studied in 76 cases (follow-up time 4 years). The following procedures were performed by the maxillofacial surgeon: repositioning of the orbital floor, tamponade of the maxillary sinus, covering of the defect with Lyodura, autologous bone grafting, and balloon catheterization. A satisfactory result was achieved after the primary operation in 75% of the cases. In cooperation with the ophthalmologist a variety of complications in 19 patients were studied and analyzed. The results of this study show the necessity of diagnostic and surgical cooperation between the specialists concerned.

[Muscular neurotisation in traumatic abducens paresis (A new method of operative treatment) (author's transl)]. / Muskuläre Neurotisation bei traumatischer abduzensparese. Ein neuer Weg der operativen Behandlung

Traumatic abducens pareses occur quite often. The methods of operation known until now often achieved no good functional result. Therefore the authors experimentally tried to reinnervate by means of "musculr neurotisation" in 10 rabbits an extraocular muscle previously denervated. After 6 months the histological examination revealed the presence of newly germinated medullated nerve fibers and motor end plates. This was the proof that eye muscles may be reinnervated. Consequently in 5 patients with traumatic abducens paresis an implantation of the inferior oblique muscle was done. The functional improvement secured by this method of operation which for the first time has been applied on the human eye was good, in some cases even extremely good, depending on the time elapsed between lesion and operation.