Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure.

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of combined surgery. PATIENTS AND METHODS: Combined surgery (CS) consisting of pars plana vitrectomy (PPV), phacoemulsification, and implantation of a posterior chamber intraocular lens (PC IOL) in the capsular bag was performed on 26 patients. Another 26 had phacoemulsification with PC IOL insertion one to 84 months (mean 17.3) after PPV (sequential surgery, SS). Mean follow-up was 21.9 months after CS and 19.5 months after the cataract surgery in the SS group. The data were analyzed in a prospective, nonrandomized fashion. RESULTS: Visual acuity and refraction, astigmatism, accuracy of biometry, intraocular pressure, intraoperative, postoperative and long-term complications, and medical treatment were comparable in the two groups. Among the four uveitis patients in each group, transient fibrin formation was more frequent with CS (100%) than with SS (25%). The advantages of CS are that only one operation is needed, intraoperative working conditions are good, macular recovery is not masked by postvitrectomy cataract formation, and ideal lens centration is achievable. Potential disadvantages of CS include a longer operative time and increased technical demand, shrinkage of the anterior capsular opening, which may interfere with fundus view, and increased inflammation may be seen in patients with preexisting uveitis. CONCLUSION: Combined surgery in selected patients is a safe and effective approach, and outcomes are comparable to sequential surgery.

[Orbital fat atrophy in glaucoma patients treated with topical bimatoprost--can bimatoprost cause enophthalmos?]. / Orbitale Fettgewebsatrophie bei lokaler Bimatoprost-Therapie - Kann Bimatoprost einen Enophthalmus verursachen?

PURPOSE: The aim of this communication is to report enophthalmos as a possible new adverse effect of topical bimatoprost treatment. PATIENTS AND METHODS: A retrospective case series of five glaucoma patients under long-term topical bimatoprost treatment was evaluated. Documentation with photo and Hertel exophthalmometry was reviewed. RESULTS: In all five patients a deep lid sulcus, reduced infraocular fat pads and enophthalmos-suspicious Hertel values were found (mean 11.9 mm; SD 2.4). Other aetiologies for enophthalmos were excluded anamnestically and by clinical examination. CONCLUSION: Bimatoprost may lead to an alteration of the eyelid with deepening of the lid sulcus and may also be responsible for an iatrogenic orbital fat atrophy. A possible mechanism of action might be the induction of apoptosis of orbital fibroblasts with a remodelling of the extracellular matrix. Prospective studies are necessary to confirm this cross-sectional observation.

[Prognosis of penetrating keratoplasty in secondary endothelial atrophy of diverse etiology]. / Prognose nach perforierender Keratoplastik bei sekundären Endothelatrophien unterschiedlicher Genese.

Endothelial atrophy following cataract extraction is an increasingly important indication for perforating keratoplasty (PK). Other significant indications for PK are the treatment of endothelial atrophy following vitreous/retinal surgery for perforating injuries or primary retinal pathology. We evaluated the first year post-operative course of fourteen patients that underwent PK: 7 patients with silicon-oil induced keratopathy (group I), and 7 patients with endothelial atrophy following anterior segment surgical procedures (group II). On follow-up, group II exhibited a significant improvement of visual acuity. In group I, despite the clarity of the graft, there was no improvement of vision because of the development of retrocorneal membranes, or pre-existing or progressive retinal changes.

Qualified rescue by ski patrols -- safety for the skier.

This study aims to determine whether the training of ski-patrol teams is still adequate in view of a marked change in injury patterns. All accidents which occurred during two winter seasons (n = 579, 583 patients) in the Oberwallis ski area in Switzerland are analysed retrospectively. As the analysis of the accidents' data are similar to other studies and first aid training is standardised throughout Switzerland, the results of this study can be viewed as representative for other areas of Switzerland. The generally high level of training is reflected by the accuracy of "on-scene" diagnoses: 77.5 % were "correct", 12 % "mainly correct". In the remainder, the most frequent problems were underestimation or failure of recognition of multiple injuries (n = 25), head injury (n = 10), injuries to the trunk (n = 9) and to the spine (n = 7). Special emphasis on these topics during the training of ski patrols should result in the further improvement in on-scene first aid and rescue.

Cytomegalovirus retinitis and optic neuritis in a child with severe combined immunodeficiency syndrome.

BACKGROUND: Although cytomegalovirus (CMV) infection of the retina and brain is common in patients with acquired immunodeficiency syndrome (AIDS), it is exceedingly rare in patients with immunodeficiencies due to other causes. This is the first report on ocular and cerebral histopathology of disseminated CMV in a child with severe combined immunodeficiency syndrome (SCID). METHODS: The authors examined by routine histopathologic methods the eyes of a 2-year-old white boy with SCID and bilateral CMV retinitis who died after failure of a third attempt at allogeneic bone marrow transplantation (BMT). RESULTS: Cytomegalovirus inclusions were found in the necrotic retinal remnants, in the hyperplastic and scarred retinal pigment epithelium, and bilaterally in the optic nerves. There were infiltrates of macrophages in response to the infection or the infused silicon, but no lymphoid infiltrates. Cytomegalovirus inclusions also were found in brain tissue. CONCLUSION: The histologic features resembled those of CMV retinitis and optic neuritis in AIDS.