[The cornea as an indicator for systemic diseases]. / Die Hornhaut als Indikator für Systemerkrankungen.

Numerous systemic diseases can be manifested at the cornea. Sometimes the corneal involvement is the first sign of the systemic process. It may be manifested in many different forms, such as an ulcer in the corneal periphery or a crystalline keratopathy. Therapy is interdisciplinary and primarily directed against the underlying disease.

Conjunctival amyloidosis -- clinical and histopathologic features.

PURPOSE: Conjunctival amyloidosis is a rare disorder. It is often clinically not suspected or diagnosed. This study intended to demonstrate the clinical and histopathologic features of this infrequent disease, including an immunohistochemical search for amyloidotic proteins. METHODS: Retrospective case series of the clinical and histopathologic characteristics of six patients with conjunctival amyloidosis. Immunohistochemical analysis with respect to possible amyloidotic components of the conjunctival deposits was performed. RESULTS: The diagnosis of amyloidosis was not suspected in all six cases presenting with an amelanotic conjunctival lesion. In three patients a conjunctival tumor of unknown origin, in one case each a papillomatous alteration of the conjunctiva, a conjunctival granulomatous inflammation, and a lymphoma were assumed respectively. The diagnosis of amyloidosis was made by histopathology. Immunohistochemical examination found lambda and kappa light chains as well as prealbumin within the amyloid deposits in one of the six specimens. CONCLUSIONS: The diagnosis of amyloidosis has to be kept in mind in cases with an unclear conjunctival mass or inflammatory process. Only a tissue biopsy is able to prove the diagnosis. A possible underlying systemic disease has to be ruled out.

[Ophthalmologists in the proximity of Adolf Hitler]. / Augenärzte im Umfeld Adolf Hitlers.

Adolf Hitler met or at least knew about 5 ophthalmologists. The chair of ophthalmology in Berlin, Walther Löhlein, personally examined Hitler's eyes at least two times. The chair of ophthalmology in Breslau, Walter Dieter, developed "air raid protection spectacles" with the aid of high representatives of the NS-system and probably Adolf Hitler himself. Heinrich Wilhelm Kranz became rector of the universities of Giessen and Frankfurt/Main. He was known as a very strict advocate of the NS-race hygiene. Werner Zabel made plans for Hitler's diet and tried to interfere with Hitler's medical treatment. Finally, Hellmuth Unger was an influential representative of the medical press and a famous writer. Three of his novels with medical topics were made into a film which Hitler probably saw. Hitler had, so to say, a small "ophthalmological proximity" which, however, did not play a significant role for himself or the NS-state.

[The melanocyte and the eye: a review with special emphasis on the cornea]. / Der Melanozyt und das Auge: eine Übersicht unter besonderer Berücksichtigung der Kornea.

BACKGROUND: Various publications especially from the field of dermatology have indicated in the recent years that the melanocyte is a "multitalent" with--besides UV-protection--(neuro-)humoral and immunological functions. Moreover, the melanocyte could play a role as a scavenger of free radicals or in pressure perception, so that it could even perhaps be part of the "intraocular pressure sensor". It is generally assumed that the cornea is devoid of melanocytes under physiological conditions. However, to the best of our knowledge a systematic investigation with a larger quantity of specimens has not been performed thus far. METHODS: 103 corneal specimens (whole eyes, corneal explants with different corneal diseases, corneoscleral donor buttons) and 13 pterygia (corneal part) were studied immunohistochemically using the monoclonal antibody Melan A which is specific for melanocytes. RESULTS: In healthy cornea melanocytes are found in the limbal area. In the corneal periphery, up to 1 mm distant from the limbus, the melanocytes disappear so that the mid-peripheral and the central epithelium of the cornea are devoid of melanocytes. Under pathological conditions (dystrophies, scars, ulcers) there is only exceptionally an invasion of melanocytes into the mid-peripheral corneal epithelium. The central epithelium almost always remains free of melanocytes even in various corneal diseases. In more than 50% of the pterygia melanocytes can be found in the epithelium. CONCLUSIONS: Under certain, pathological conditions melanocytes can settle in more central regions of the corneal epithelium. Thus, the very few "corneal melanomas" described in the literature could have theoretically developed within the cornea itself (and not within the limbus). Obviously, the cornea possesses mechanisms to inhibit centripetal migration of melanocytes perhaps via a (still hypothetic) "corneal melanocyte suppression factor" ("CoMeSuF"). To identify this factor will be the task for the coming years. If this factor is really existent it could possibly serve as a therapy for melanocytic proliferations (melanomas).

[A Roman orbital implant?]. / Römisches Orbitaimplantat?

During an excavation in Regensburg/Germany the skeleton of an approximately 20-year-old Roman man was found who was buried in the 3rd/4th century after Christ. A "stone" was found which fitted into the left orbit precisely. After a thorough investigation of the "stone" and with the ophthalmohistorical literature in mind an orbital "implant" as well as a petrified medical paste ("Kollyrium") could be ruled out almost with certainty. Possibly the "stone" served another medical purpose or was used for protection of the eye.

[Ocular manifestations in xeroderma pigmentosum]. / Augenmanifestationen bei Xeroderma pigmentosum.

BACKGROUND: The aim of this study was to evaluate ocular changes in patients with xeroderma pigmentosum (XP) and Cockayne syndrome (CS). Both diseases belong to the progeroid syndromes caused by single gene mutations with premature aging. Both syndromes are very rare autosomal recessive diseases caused by a gene defect leading to deficient DNA repair. PATIENTS: 12 patients (4 female, 8 male) with XP between 3 and 67 years old and a 39-year-old female patient with CS were examined. The examination included visual acuity testing, slit lamp biomicroscopy, funduscopy and performance of a Schirmer test. RESULTS: Changes of the lids in the XP group included blepharitis in 7 patients, distichiasis in 2, and madarosis in 3 patients. 8 patients had multiple lentigines solares of the lids. One patient showed scars of the lower lids after excision of a squamous cell carcinoma and a basal cell carcinoma. Conjunctival lesions comprised a tumour of unknown origin of the conjunctiva in 1 patient, teleangiectasia of the conjunctiva in 5 patients, pterygia in 4, and pinguecula in 1 patient. Two patients had an intraepithelial melanosis of the conjunctiva, and one showed conjunctival nevi. Two patients had corneal scars and corneal vascularisation, another a significant conjunctivalisation of the cornea. A Schirmer test was feasible only in 3 patients. Tear production was markedly reduced in all these patients. Break-up time was shortened significantly in 6 patients examined. The patient with the CS showed atrophy of the pupillary rim and a subcapsular cataract. Funduscopically there were pigment epithelial changes. CONCLUSIONS: Patients with XP often exhibit ocular changes. Beside the light-dependent degenerative and inflammatory manifestations at the lids, the conjunctiva and the cornea patients with XP also develop malignancies early in life. The majority of patients suffer from dry eye symptoms.

[Glaucoma drainage implants]. / Glaukom-Drainagechirurgie.

INTRODUCTION: The number of available glaucoma drainage implants has increased in recent years and now offers additional therapeutic opportunities in refractory glaucoma patients. METHODS: In drainage surgery two different functional principles are practised. The most commonly used implants (Ahmed, Krupin, Schocket, Molteno, Baerveldt) drain ocular fluid via a silicone tube into an episcleral reservoir. Multiple studies have compared the operative results of tubes, which differ in insertion, valve, material and surface characterstics. In analogy a miniature stainless steel implant (Ex-PRESS) is implanted at the limbus into the anterior chamber and drains subconjunctivally. These implants shunt ocular fluid under a scleral flap or directly under the conjunctiva. Intrascleral systems (Seton, SLOX, Silicone tubes) drain ocular fluid from the anterior chamber into the suprachoroidal space to regulate intraocular pressure (IOP). RESULTS: In the literature the postoperative success rates in tube shunts range between 22 % and 100 % depending on glaucoma form and implant. Most of the studies were retrospective. Miniature stainless steel devices (Ex-PRESS) placed directly under the conjunctiva may cause erosion of the conjunctiva and hypotony. Implantation under a scleral flap decreases these complications. Compared with trabeculectomy the implantation of this shunt under a scleral flap reduces the early postoperative rate of hypotony and choroidal effusion. Microimplants of Schlemm's canal ab externo or interno should reduce the intraocular pressure by connecting the anterior chamber and Schlemm's canal. Suprachoroidal shunts are an option in patients with scarred conjunctiva. Though, complications of fibrous encapsulation and dislocation are described. DISCUSSION: The development of drainage implants allows the reduction or avoidance of complications which are typical of traditional glaucoma filtering surgery. However, in the absence of long-term follow-ups, the procedures with their new side effects have to be further evaluated.