[Risk of dislocation and cataract formation in 240 IOGEL lenses. 4 years experiences]. / Luxationsgefahr und Nachstarbildung bei 240 IOGEL-Linsen. 4jährige Erfahrungen.

Following planned extracapsular cataract extractions we implanted 240 IOGEL lenses into the capsular bag and noticed 5 dislocations into the vitreous cavity, 2 after an Nd-YAG capsulotomy, 4 postoperatively and 1 after surgical repositioning. Postoperatively, one lens was subluxated into the anterior chamber. Thirty-three patients required a 4- to 5-mm Nd-YAG capsulotomy because of a fibrotic or regenerative secondary cataract. Two lenses dislocated 2 and 6 weeks after the YAG capsulotomy into the vitreous cavity; the capsulotomy was performed 5 and 6 months, respectively, after the implantation. In 4 patients the IOGEL lens dislocated 3 times within the first 3 days and once within the first 3 months after implantation. Primary stable placement in the bag could be achieved, however. One patient required repositioning of the lens because of decentration 3 months after implantation. The lens dislocated on the following day. Late dislocation of the flexible and soft IOGEL lens can be due to the fact that the lenses do not adhere to the capsular sheets. Furthermore, postoperative capsular shrinkage enlarging a posterior capsular opening leads to lens dislocation. Eight patients underwent a secondary anterior chamber lens implantation. In three patients the IOGEL lens was explanted, in two of them without and in one of them with serious complications. The other five patients still have their IOGEL lens deep in the vitreous without complications. We suggest that if a YAG capsulotomy is necessary, it should not be performed before the 6th postoperative month. It should also not exceed 4 mm in diameter and no IOGEL lens should be implanted if a capsular rupture occurs intraoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipoprotein (a): a risk factor for retinal vascular occlusion.

The protein moiety of lipoprotein (a) consists of apoB-100 and apolipoprotein (a). Lipoprotein (a) is an independent risk factor for premature atherosclerosis. Apolipoprotein (a) and plasminogen are structurally homologous. Through interference with the fibrinolytic system, lipoprotein (a) may act as a thrombogenic factor. In the present study, we determined lipoprotein (a) concentrations in 84 patients (60 men and 24 women) with retinal vascular occlusion (RVO) and in 2 groups of healthy volunteers (n = 40 and 46). In all, 29% of the patients had Lp (a) levels of above 300 mg/l. In the two reference groups, only 10% and 9% of the subjects exceeded this level. According to the chi-square test, the association between Lp (a) levels and RVO was significant. Lp (a) concentrations did not differ between patients with arterial occlusion and those with venous occlusion. No difference in the total cholesterol, triglyceride, or LDL-cholesterol values was observed between patients and controls. We therefore conclude that Lp (a) represents an independent risk factor for RVO.

Surgical management of ocular hypotony.

Over the last 5 years, at the Eye Department in Bremen, 13 eyes with persistent hypotony have been treated by a refixation of the detached ciliary body, the so-called 'direct cyclopexy'. Ten eyes became hypotonous because of a traumatic cyclodialysis and 3 eyes as a result of an antiglaucomatous cyclodialysis surgery. The duration of the hypotony was from 10 days to 3 months, and the various cyclodialyses extended from 30 to 120 degrees. The postoperative follow-up was from 6 months to 5 years. The intraocular pressure was stabilised in all 10 eyes with traumatic cyclodialysis. In the 3 eyes with postoperative cyclodialysis all needed further antiglaucomatous procedures because of high intraocular pressure. In all 13 eyes the typical signs of hypotony disappeared postoperatively and visual improvement was achieved. The surgical procedure is discussed.

Direct cyclopexy after persistent hypotony as a complication after cyclodialysis and goniotomy.

The surgical technique of direct cyclopexy, which has been performed on 3 patients suffering on persistent hypotony after cyclodialysis and goniotomy, is reported. The extension of the cyclodialysis reached from 60 to 90 degrees, the persistence of hypotony from 12 to 36 months, and the postoperative follow-up from 10 to 24 months.

Refixation of the ciliary body after traumatic cyclodialysis.

In 10 eyes a direct refixation of the ciliary muscle to the scleral sporn with many 10 X 0 nylon sutures very close to each other has been performed after a traumatic cyclodialysis. In all 10 eyes the intraocular pressure could be normalized between 12 and 18 mm Hg, the visual acuity recovered in all cases and the signs of ocular hypotony disappeared at the anterior and posterior segment. The follow-up ranged from 6 months to 4 1/2 years. The extent of cyclodialysis ranged from 30 to 120 degrees. In 5 eyes the direct cyclopexy was performed within 10 days after the traumatic cyclodialysis and in 5 eyes after 2-3 months, which was not important for the visual recovery. Intraoperatively no complications were seen and postoperatively in only 4 eyes a temporary increase of intraocular pressure was noted.

Ciliary surgery for glaucoma.

Ciliary Body excision for the treatment of intractable glaucoma has been performed in 64 eyes (75 operations) between 1975 and 1985. The indications, intra-and postoperative complications and the results are presented. In the majority of the patients the indication for surgery was a secondary closed angle glaucoma with aphakia. All the eyes had been previously operated on at least three times, some having had as many as seven other antiglaucomatous procedures before the partial excision of the pars plicata of the ciliary body. The preoperative intraocular pressures pressures ranged from minimally 35 mm Hg to over 50 mm Hg. Intraoperative complications such as vitreous loss and vitreous haemorrhages from ciliary body vessels were reduced to a minimum by the use of a Fleiringa-ring, a paracentesis and an extensive cauterisation of the ciliary body tissue. The postoperative complication of scleral wound dehiscence was reduced by a double scleral wound closure. Postoperatively the intraocular pressure was reduced to a satisfactory level in nearly 80% of cases.

Combined perforating keratoplasty and intracapsular cataract extraction.

251 eyes underwent the combined procedure of perforating keratoplasty and intracapsular cataract extraction from 1968 to 1983. The preoperative preliminaries as well as the intraoperative details are described. The histological diagnoses were Fuchs' endothelial-epithelial dystrophy, keratoconus, leukoma adherens and different kinds of keratitis. 89% of the grafts were clear, 11% irreversibly cloudy. Visual acuity was improved in 88%. Postoperative high intraocular pressure was no special problem and not affected by the combined procedure. Vitreal complications were seen in only 14%. The diameter for transplant and patient's cornea can be reduced to 7.3 mm for both.

Antiglaucomatous ciliary body excision.

Between 1974 and 1984, we performed 106 ciliary body excisions in a total of 90 eyes. Of the 85 eyes for which at least six months of follow-up data were available, 72 had secondary partial angle-closure glaucoma with aphakia, ten had secondary partial angle-closure glaucoma without aphakia, and three had secondary open-angle glaucoma. Forty-eight eyes had undergone three or more (in some cases as many as nine) previous antiglaucomatous procedures before ciliary body excision and 27 had undergone one or two previous procedures. Preoperative intraocular pressures ranged from 35 to 60 mm Hg. After six months, intraocular pressure was 19 mm Hg or less in 60 eyes with no other treatment, although ten eyes required a second excision. Another five eyes had intraocular pressures of 19 mm Hg or less with medical therapy (one reoperation) and seven had intraocular pressures of 22 mm Hg or less without medical therapy (one reoperation). Ciliary body excision failed in 13 eyes. Four of these had persistent hypotony (intraocular pressures of less than 4 mm Hg) and nine had intraocular pressures above 40 mm Hg. Reasons for failure included rubeosis iridis (seven eyes), an overlarge excision (three eyes), and expulsive hemorrhage, siderosis bulbi, and Lowe's syndrome (one eye each). Postoperative visual acuity was unchanged in 45 eyes, somewhat improved in 15, and worse in 21.

Hereditary ocular dysproteinhydria of the aqueous humour with crystalline deposits.

We describe a family with coloured crystalline deposits on the corneal endothelium and on the lens surface. A protein with a molecular weight of about 110,000 and an isoelectric point of 7-8 could be demonstrated in the aqueous humour, which was not found in the controls or in the serum of the family members. The pedigree is suggestive of autosomal dominant inheritance. To our knowledge this is the first report of this entity.