[Examination of the cornea using optical coherence tomography]. / Untersuchungen der Hornhaut mittels optischer Kohärenztomographie.

INTRODUCTION: This study evaluated the clinical use of optical coherence tomography (OCT) for two-dimensional representation of the cornea. PATIENTS AND METHODS: Noncontact slitlamp-adapted OCT was used in selected cases to evaluate pathologically altered corneas and to measure the central corneal thickness and curvature. RESULTS: OCT provided correlation between differences in reflection and morphological changes. Scar tissue resulted in hyper-reflective light scattering, whereas cystic lesions were hyporeflective. Precise biomorphometry also allowed representation of intrastromal and retrocorneal changes. Central corneal thickness measured by OCT yielded reproducible values and corneal curvature could be calculated from the optical signals of the corneal surface. CONCLUSIONS: OCT provides high-resolution representation of the cornea and exact evaluation of its morphology, thickness, and curvature. Due to the noncontact, simple, and rapid examination using the slitlamp the corneal OCT method is a promising additional diagnostic modality.

[Thermal damage to the corneal endothelium in diode laser thermokeratoplasty]. / Thermische Schädigung des Hornhautendothels bei der Dioden-Laserthermokeratoplastik.

Laser thermokeratoplasty (LTK) can be applied for correction of hyperopia and astigmatism by means of concentrically placed coagulations. Because of the temperature rise during coagulation, damage of the endothelial cells directly below the irradiated areas is possible. In this study, we examined the extent of the thermally denatured zones for different laser parameters and the threshold of thermal endothelial damage as a function of of temperature and duration of elevated temperatures. The threshold for thermal damage of endothelial cells was determined in isotonic NaCl solution for temperature exposures of 10 s and 1 min in a water bath. To determine the damage zones, corneas were irradiated under standardized conditions with a continuously emitting infrared (cw-IR) laser diode at various wave-lengths and different power values and were stained after preparation with trypan blue and alizarine red. The extensions of the damage zones were compared with calculated isotherms. Fifty percent cell damage was found at temperatures of 65 degrees C for heating times of 10 s and at 59 degrees C for 1 min. With thicker corneas, less laser power and higher absorption coefficients, the damage zone was reduced. The damage range determined corresponded to the calculated isotherms of 60 degrees C and 70 degrees C. Regarding clinical LTK, a loss of endothelial cells can be predicted and minimized or totally avoided by choosing the appropriate irradiation parameters.

[Atypical constellation of findings in Schimmelpenning-Feuerstein-Mims syndrome--case report and overview]. / Atypische Befundkonstellation bei Schimmelpenning-Feuerstein-Mims-Syndrom--Kasuistik und Ubersicht.

BACKGROUND: The Schimmelpenning-Feuerstein-Mims-syndrome is a phacomatosis of unknown pathogenesis and is presumed to be based on alterations in early embryogenesis. The syndrome is expressed by congenital nevi characterized by hyperplasia of the sebaceous glands and papillary acanthosis. Other manifestations include ophthalmic, neurologic, cardiovascular, skeletal and urogenital involvement. Eye-findings are variable and may affect all parts of the organ. All patients have a nevus sebaceus of the skin and many of them are described to suffer from seizures and/or mental retardation and/or abnormalities of the central nervous system/skull. The atypical constellation of findings in our case makes it of interest to report and give a short review. PATIENT: A 17-year-old boy with Schimmelpenning-Feuer-stein-Mims-syndrome has been followed up by us since birth. RESULTS: Beside an unilateral combined nevus sebaceus and verrucosus of the face, neck and skull and an aplasia of a rib there were marked ocular symptoms. The affected right eye showed a dermoid, a wide lid-opening, microcornea, stenosis of the lacrimal ducts, a high myopic fundus, the optic disc with an inverse conus and a posterior scleral staphyloma. There were no seizures or mental retardation combined with normal radiologic findings of the central nervous system and the skull. CONCLUSION: The presented findings in our patient with Schimmelpenning-Feuerstein-Mims-syndrome emphasized the high variability of the expression of this disease, which may lead to difficulties in establishing correct diagnosis to prevent unnecessary examinations and inadequate therapies.

[Transplantation of autologous submandibular glands in very severe keratoconjunctivitis sicca. 2 year outcome]. / Transplantation der autologen Glandula submandibularis bei schwerster Keratoconjunctivitis sicca. 2-Jahres-Ergebnisse.

INTRODUCTION: The conservative treatment of the most severe cases of keratoconjunctivitis sicca (KCS) can be sometimes frustrating. Especially with an underlying autoimmunologic disorder, even the application of artificial tears as often as every 5 min may not prevent further damage to the ocular surface. A microvascular transplantation of the autologous submandibular gland (SG) can be performed by a maxillo-facial surgeon as an alternative approach for those cases. We report 2 years of ophthalmological experience with the results of this procedure. MATERIAL AND METHODS: To date 27 operations have been performed in 23 patients. The SG was moved from its natural site into the temporal fossa. The secretory duct was implanted into the conjunctival fornix and the gland's vessels connected to the temporal artery and vein. A complete ophthalmological examination has been performed in 25 eyes of 21 patients up to 1 year and in 11 eyes of 9 patients 2 years after surgery. RESULTS: Three months and 1 year postoperatively 19 of 25, and 2 years postoperatively 8 of 11 transplants remained vital. The baseline secretion increased in patients with a vital transplant from an average of 1.6 +/- 1.3 mm before the operation to 16.2 +/- 11.3 mm after 3 months and 20.6 +/- 10.6 mm after 1 year. Ten of 19 vital grafts were reduced 1 year after transplantation in a minor second procedure to control an increasing epiphora. Subsequently baseline secretion was reduced to 13.6 +/- 8.2 mm 2 years after transplantation. Patients with a vital graft reported in 84% of cases (16 of 19) at 3 months, and 79% at 1 year (15 of 19) and 2 years (7 of 8), a strong relief of dry eye symptoms. In 58% (3 months), 79% (1 year) and 63% (2 years) of the eyes with a vital transplant all artificial tear substitution could be stopped. Break-up time increased significantly, resulting in reduced bengal rose staining. CONCLUSION: The transfer of the autologous SG into the temporal fossa can be used to provide patients with very severe KCS with a continuous, endogenous source of ocular lubrication. Despite surgical denervation the graft maintains a sufficient baseline secretion over a period of years. Subjective symptoms and the application of pharmaceutical lubricating substances are reduced to a large extent. If epiphora occurs, it can be controlled by surgically reducing the transplant. The influence of SG saliva on the ocular surface is the object of ongoing studies.

[Consequent use of the Aachen therapy concept after severe chemical burns of both eyes]. / Konsequente Anwendung des Aachener Therapiekonzeptes nach schwerer Verätzung beider Augen.

BACKGROUND: Severe chemical burn and its complications still are a serious threat to the afflicted eye, particularly in case of insufficient treatment. Rehabilitation of visual acuity can be achieved only in the minority of cases. PATIENT: We present a 49-year-old female patient, who suffered a severe chemical burn in both eyes by alcaline detergent. Visual acuity was OD 20/50, OS light perception. After directly started acute treatment as well as peritomy, peridectomy, tenon plasty and application of a PMMA contact lens a stabilization was achieved. Complete rehabilitation of visual acuity was gained by EDTA abrasion, excimer treatment, penetrating keratoplasty and cataract surgery. Last examination showed a visual acuity of 25/20 in both eyes. CONCLUSIONS: Even in severe chemical burn an optimal result can be achieved by using an adequate treatment conception. Immediate beginning of therapy is important as well as persistent and persevering application of the treatment. Repeated, if necessary daily, excisions of necrotic tissue associated with tenon plasty and application of a PMMA contact lens have special importance.

Transplantation of the autologous submandibular gland for most severe cases of keratoconjunctivitis sicca.

OBJECTIVE: This study aimed to examine the long-term qualitative and quantitative function of the secretion of transplanted autologous submandibular glands in patients with most severe keratoconjunctivitis sicca. DESIGN: The study design was clinical. PARTICIPANTS: The authors performed 26 operation in 22 patients. A complete ophthalmologic examination was performed in 16 eyes of 13 patients 1 week and 3 months and in 8 eyes of 8 patients 1 year after surgery. INTERVENTION: The submandibular gland was moved from its natural site into the temporal fossa. The glands supplying vessels were connected to the temporal artery and vein, and its secretory duct was implanted into the conjunctival fornix. MAIN OUTCOME MEASURES: Scintigraphy with Tc 99m Pertechnetate was used to document the graft vitality. Subjective symptoms and application frequency of artificial tears were recorded. Baseline as well as stimulated secretion and breakup time were measured and rose bengal staining and ocular ferning test were performed. In selected cases, the secretory product could be sampled for the detection of electrolytes, amylase, and secretory immunoglobulin A (SIgA). RESULTS: Scintigraphy showed vital gland tissue in 14 of 16 grafts at 3 months and 6 of 8 grafts at 1 year after surgery. Two of the 16 transplants were lost completely during the first 3 postoperative months, 1 because of an underlying autoimmunopolyendokrinopathy and the other because of an insufficient vascular anastomoses. In eyes with a vital transplant, baseline secretion and breakup time were increased significantly at 3 months and 1 year after surgery. Patients with a vital transplant reported a strong relief of symptoms and were able to stop taking artificial tear substitution at 1 year. Electrolytes showed a fluctuating concentration. A year after transplantation, the SIgA and amylase concentrations were more than ten times increased compared to normal tear values. CONCLUSION: Microvascular transferral of an autologous, paralytic submandibular gland results in a significant relief of subjective symptoms, a reduction of artificial tear applications, and an increase of baseline secretion over the first postoperative year. The composition and volume of the secretory product fluctuate, but high values of SIgA and amylase show an actively secreting graft. Although the authors' long-term experience still is limited, they believe that the procedure is a promising alternative approach for desperate dry eye conditions.

[Comparative studies with various corneal topography measurement devices]. / Vergleichende Untersuchungen verschiedener kornealer Topographiemessgeräte.

PURPOSE: It is difficult to measure the topography of the cornea with high resolution and visualize it on a map displaying refraction. This is demonstrated by the ongoing improvement and further development of different methods and by the fact that users of these techniques are not always satisfied. MATERIALS AND METHODS: Five different ring projectors were compared. Spherical and aspherical ball standards were used to measure the standard deviation of the refraction of the system. A patient group of eight people with healthy eyes was used to compare the measurement accuracy and operational errors. Some patients were also measured after cataract surgery. The lateral and axial range of the devices was determined. RESULTS: The measurement accuracy for ball standards for the five devices was below 1/8 D. For the in vivo case in the control group it was below 1/4 D for four devices. Furthermore, the reproducibility of the results, the accuracy of angle determination and the influence of mechanical and optical design will be discussed. The study demonstrates applications and limits of this measurement method.

[Clinical heterogeneity of non-Hodgkin's lymphoma of the eye with extraocular manifestations]. / Klinische Heterogenität beim Non-Hodgkin-Lymphom des Auges mit extraokulärer Manifestation.

Primary, ocular Non-Hodgkin lymphoma is a multicentric disease. The prognosis is mostly determined by involvement of the central nervous system and/or visceral organs. Since ocular symptoms often precede accompanying manifestations and since the eye is easily accessible to diagnostic measures, the ophthalmological diagnosis is essential for early detection and treatment of this complex disease, which has a poor prognosis. To illustrate the extraordinary heterogeneity of the clinical symptoms, four case reports have been selected which demonstrate various ocular symptoms and extraocular localizations. The ophthalmological variability ranges from typical uveitis to retinitis and vasculitis with varying symptoms during the progression of the disease. Completely different extraocular features were induced by long-standing, local infiltrates within basal ganglia, a diffuse infiltration of the brain leading to an acute increase in intracranial pressure, a peripheral tumour within the spinal channel or massive infiltrates of liver, lung and kidneys. Lack of pathognomonic features, high clinical variability and the limited value of imaging techniques and histopathological measures often lead to serious delays in diagnosis.

[IOL and aniseikonia calculation combined with documentation of surgical data and IOL inventory]. / IOL- und Aniseikonieberechnung verbunden mit Dokumentationen der Operationsdaten und IOL-Lagerhaltung.

The exact recording of operation data is a precondition for keeping the standards high in cataract surgery, but surgeons are reluctant to answer a questionnaire after a strenuous operation. We have designed a program easy to use in the Macintosh Hypercard System that covers all aspects of cataract surgery such as: (1) the operating record; (2) a data sheet for recording the various details of the operation; (3) recording of the data on hard disc; (4) managing the IOL stock list; (5) proposal of IOL models that are in stock with regard to IOL power (SRK2) and aniseiconia. This program enables the surgeon to record the operation data with effortless ease and it is well accepted. There is no dictation. The operating record and data sheet are printed immediately. The program is controlled by a "mouse". Selection of the suitable IOL model is facilitated by the link between the calculation of IOL power and the IOL stock list. In special cases the IOL power can be changed to obtain less aniseiconia.

[Stability of posterior chamber lenses 3-5.5 years after implantation in capsular rupture]. / Stabilität von Hinterkammerlinsen 3-5,5 Jahre nach Implantation bei Kapselruptur.

In cases of PC-IOL implantation and ruptured capsule there will be a higher risk of the lens loosening into the vitreous, although many successful cases have been reported. Three years ago we investigated 42 eyes with PC-IOL that had experienced previous posterior capsular or zonular rents and partial vitreous loss. Three to 5.5 years after PC-IOL implantation we have now performed a second investigation on 38 of these patients to examine fixation of the lenses, visual acuity, intraocular pressure and the fundus of the eye. The 38 lenses all remained stable. The rate of patients achieving 20/40 or better visual acuity decreased from 68% at the first investigation to 55% (21/38). Excluding all patients with vision-limiting preoperative conditions such as age-related macular degeneration, we found a relation-ship of 83% to 75% (21/28). In addition to the three retinal detachments and two cases of endophthalmitis found during the first investigation, we also found another retinal detachment at the follow-up examination. Only two of these six eyes with severe complications had useful vision. We conclude from our investigation that PC-IOL implanted following a posterior capsule-zonular break during ECCE can remain stable, but still lead to serious complications.

[Difficulty in the implantation of intraocular lenses by "hidden" parallax]. / Behinderung bei der Implantation von Intraokularlinsen durch "verdeckte" stereoskopische Parallaxen.

Although this is not the intent of the surgeon, many posterior chamber lenses are nevertheless placed asymmetrically--one loop in the sulcus and the other in the capsular bag. Difficulties can arise during implantation of even the first loop, which is mostly done in the 6 o'clock position. In this situation, a deficit or loss in steroscopic vision is observed. According to the law of Garten, depth perception is increasingly disturbed as the angle between the connection line of the two observer eyes and two smooth, stretched contours being steroscopical objects diminishes to zero. The reason is not a loss of parallaxis, but the fact that there are no structures that can be matched for stereopsis in a horizontal direction. Thus, stereoscopic vision can be improved dramatically by: (1) twisting the axis of the IOL loops into the five to four o'clock direction; (2) enlarging the magnification of the operating microscope until the grain of the structures is visible. It will then be possible to implant the IOL into the capsular bag (or the ciliary sulcus), which is what was intended.

[Computer-assisted determination of parameters of depth perception: studies with the 3-rod device]. / Rechnergestützte Bestimmung von Parametern des Tiefensehens: Untersuchungen mit dem Dreistäbchenapparat.

Psychophysical determination of the thresholds of stereoscopic vision takes about 20 min. During this procedure, you may have the feeling that the thresholds are shifting. To verify this phenomenon, the thresholds must be determined in a period shorter than 20 min, e.g., 4-6 min. This is one of the reasons we constructed a computerized machine to detect the stereoscopic thresholds. The heart of this device is a micrometric screw driven by a stepping motor that moves the central rod of the three-rod apparatus. This motor is controlled by a microcomputer with a basic program. A special program has been designed that functions in a manner similar to that of the Octopus perimeter and detects the thresholds with in a few steps. It is thus possible to reduce the detection time for one threshold dramatically. The first results with this device are not only very precise, but also demonstrate the minute values between stereoscopic thresholds. For an observation distance of 380 mm, we were able to calculate the disparation angles down to 3 s of arc. If a number of measurements are taken, the threshold fluctuations and physiological zero position can be calculated.

[Digital subtraction dacryocystography]. / Digitale Subtraktions-Dakryozystographie.

A comparison of 17 radiological examinations of the lacrimal pathways performed on twelve patients using digital subtraction and conventional film technique showed that digital subtraction dacryocystography yields images of superior quality. Digital subtraction makes enhanced imaging of the opacified tear duct as well as elimination of super-imposing skeletal structures possible, which with conventional techniques frequently impair diagnostic accuracy. In measurements of the radiation dose sustained by the crystalline lens, the radiation level with digital subtraction was found to be considerably lower than with the conventional method.

[Digital subtraction dacryocystography and sialography]. / Dakryozystographie und Sialographie in digitaler Subtraktion.

Fourteen examinations of the tear ducts and 21 sialograms were performed using digital subtraction and conventional techniques. In nine of the former and 15 of the latter, digital subtraction produced better results, in the remainder conventional technique was equally good. The advantages of digital subtraction are due to the removal of superimposed structures of the skull. Dose measurements at the level of the lens of the eye showed a greatly reduced radiation dose when using digital subtraction, as compared with conventional dacryocystography. Digital subtraction techniques with pulsed radiation and the ability to perform pixel shift is an optimal method for performing radiological examinations of the tear ducts and salivary glands.

[Epidermal nevus syndrome (Schimmelpenning-Feuerstein-Mims syndrome) and early childhood cataract development]. / Epidermales Naevus-Syndrom (Schimmelpenning-Feuerstein-Mims-Syndrom) und frühkindliche Kataraktentstehung.

UNLABELLED: The patient, now 14 years old, has been kept under observation since birth (and was the subject of a paper published in 1973 by Leyh and Loewel). She has cataract in both eyes, caused by intensive treatment with corticosteroids. HISTOLOGY: initially adenoma sebaceum, subsequently syringocystadenoma papilliferum. Plastic surgery was performed. With regard to visual development, the patient suffered first from deviations without fixation and now has a visual acuity of 0.25 with cataract lenses, with strabismus and nystagmus latens. Epilepsy and mental retardation have also been diagnosed.

[Nystagmus giratoire and optic nerve hypoplasia in combination with absence of the septum pellucidum (author's transl)]. / Nystagmus giratoire und Mikropapille bei Fehlen des Septum pellucidum.

Septo-optical dysplasia and Optic nerve hypoplasia often are combined with pendular nystagmus in the horizontal, vertikal or rotatory direction. Our patient, 26 year old, showing discret neurological symptoms, added the nystagmus giratoire, perhaps similar to see-saw-nystagmus: Vision was about 0.2. Nystagmus and the whole state did not change within 6 years. The nystagmus was influenced by drugs. There was found also an aplasia of the fovea zentralis. Pneumencephalography revealed in the midline a dilatated single ventricle; the septum pellucidum was absent. Te X-rays of the atlantooccipital axis showed a foramen arcuale atlantis.

[The circulatory disturbance of the optic nerve with special reference to the side distribution and other dispositional factors (author's transl)]. / Durchblutungsstörungen des Sehnervs; über die Seitenverteilung und andere dispositionelle Faktoren.

We examined 38 patients with disturbed blood supply to the optic nerve. The observations suggest: 1. men are more frequently affected than women. 2. the first attack of apoplexia nervi optici occurs most often in the left eye. 3. diabetes mellitus and most probably arterial hypertension are risk factors.