[Contribution of the pediatrician in the early diagnosis of eye diseases. 2]. / Der Beitrag des Pädiaters in der Frühdiagnostik von Augenerkrankungen. Teil 2.

Cataract, glaucoma, retinoblastoma and stenoses of the lacrimal passages are diseases that a carefully examining pediatrician will be able to detect at his work in the child-welfare centre or during his outpatient consulting hours. The timely treatment of the cataract (operation and subsequent optical correction) and of the infantile glaucoma (mostly fistulizing operation) is crucial to the future development of the virus. Retinoblastomas that often only at an advanced stage are identified and then will be remarkable by a greyish white pupillary reflex ("amaurotic cat's eye") in many cases make enucleation indispensably necessary. The frequently occurring stenoses of the lacrimal passages are to be pretreated with local antibiotic therapy and eliminated by subsequent probing.

[Contribution of the pediatrician in the early diagnosis of eye diseases]. / Der Beitrag des Pädiaters in der Frühdiagnostik von Augenerkrankungen.

In the 1st part, the conditions for the coordinated use of both eyes are described. Strabism continues to be the major reason for disorders of binocular vision. Particularly, causes, simple diagnostic procedures and therapy of infantile squint (soncomitant strabismus) and of paretic squint are reported in detail. Further, ocular nystagmus as ocular symptom of diverse motor and sensorial disturbances is classified and described. Finally, the most important forms of congenital, myogenic, senile, traumatic and neurological ptosis are presented and the time of therapeutic approach is fixed.

[Clinical interpretation of retinal circulatory measurements. I. Technical measurement possibilities and clinical interpretation aid]. / Klinische Interpretation retinaler Durchblutungsmessungen. I. Messtechnische Möglichkeiten und klinische Interpretationshilfe.

The present possibilities to measure blood flow and other magnitudes of retinal microcirculation in vivo are discussed. On this basis, a simple model designed for retinal microcirculation is presented as a tool for the clinical interpretation of measuring results. Based on the experience of over 200 measurements of retinal microcirculation magnitudes, subsequent reports give a clinical interpretation of measuring results, utilizing the measuring models presented. Thus, it is intended to demonstrate the actual clinical significance of such measurements.

[ Fibrinolysis in diabetes mellitus]. / Untersuchungen zur Fibrinolyse bei Diabetes mellitus.

In 198 diabetic patients of type I and type II and in 111 healthy persons of a control group the activity of fibrinolysis was investigated before and after a venous occlusion test of ten minutes. Spontaneous fibrinolysis was significantly diminished in diabetics of both types in comparison to the control group. A relationship to the degree of seriousness of retinopathy could not be identified in type I. The activity of fibrinolysis decreased in all test persons in old age. In diabetics patients of type II as well as in that age group being more than 56 years old there were smaller activities of fibrinolysis at higher stages of retinopathy. A negative linear correlation of this spontaneous activity of fibrinolysis could be found for the duration of the disease as well as for age. Different forms of diabetic therapy and the sex allowed no influence of the activity of fibrinolysis to be recognized. An increase of the activity of fibrinolysis after congestion could be established in diabetics as well as in the control group. After venous congestion the fibrinolytic activity showed no differences any longer in diabetics and in the control group, with age, duration of the disease and form of therapy being taken into consideration. Before and after venous congestion a negative linear correlation could be revealed between the activity of fibrinolysis and the height of blood sugar level. Therefore, the real blood sugar concentration should be taken into account in evaluating the fibrinolytic activity.

[Clinical interpretation of retinal circulatory measurements. IV. Photocoagulation in diabetic retinopathy and venous occlusive diseases]. / Klinische Interpretation retinaler Durchblutungsmessungen. IV. Fotokoagulation bei diabetischer Retinopathie und venösen Verschlusserkrankungen.

Based on the pathomechanism of diabetic retinopathy, the effect of photocoagulation on retinal microcirculation as assessed by measurements of retinal microcirculation magnitudes is discussed. The clinico-experimental results support the opinion that an essential effect of photocoagulation is due to an improvement in the flow conditions of the noncoagulated central retinal area with regard to metabolic exchange and stasis situation by the coagulation-induced occlusion of peripheral capillary areas. Further clinico-experimental measurements of retinal microcirculation magnitudes for the assessment of the behavior of microcirculation after photocoagulation in venous occlusive diseases of the retina are presented. It is shown that retinal microcirculation immediately after photocoagulation reacts by transitory instationary flow conditions; in this period it is quite possible that an additional blood flow reduction over several days will occur. In particular, the effect of photocoagulation in venous occlusive diseases with narrow arterial vessels is discussed. It is emphasized that with regard to the therapeutic effect of photocoagulation as well as to the discussion of pathomechanisms, apart from blood flow, the differentiated behavior of single retinal vascular areas, such as arteries, arterioles, capillaries, venules and veins, requires more attention. Particularly with this in mind, substantial improvements in differential diagnosis and treatment of retinal circulatory disturbances may be expected from measurements of retinal circulation magnitudes.

[Clinical interpretation of retinal circulatory measurements. II. Blood flow]. / Klinische Interpretation retinaler Durchblutungsmessungen. II. Blutfluss.

Beginning as early as the mid-4th decade of life, an age-dependent reduction in retinal blood flow has to be considered an essential risk factor for disorders of retinal microcirculation. Blood flow measurements are a valuable, but not the sole criterion of microcirculatory disorders. While in retinal occlusive diseases blood flow is a valuable indicator of the severity of microcirculatory disorders, the latter can also occur in the presence of normal and elevated blood flow values. Shifts of the metabolic activity of the retina and changes in the metabolic activity of the retina and changes in the metabolic conditions have to be taken into account when a clinical interpretation is given.

[Clinical interpretation of retinal circulatory measurements. III. Blood flow velocity and vessel diameter in normal persons and in patients with venous occlusive diseases]. / Klinische Interpretation retinaler Durchblutungsmessungen. III. Blutgeschwindigkeit und Gefässdurchmesser bei Normalpersonen und bei Patienten mit venösen Verschlusskrankheiten.

Based on results from measurements of arterial blood velocity, arterial and venous diameters of major segmental retinal vessels in normal persons and in patients with venous occlusive diseases and in continuation of the two preceding parts of this series of articles, further possibilities for the differential diagnosis of measurements of retinal microcirculation magnitudes are discussed. Whereas the measurement of blood velocity is an important criterion for the assessment of the stasis conditions and the arterial involvement in an occlusive disease, the diameters of the vessels offer essential suggestions to local regulative processes. In this connection, a dependence on pH of the contraction state of the smooth vascular musculature detected in porcine coronary arteries is presented. By its transmission to the arterial retinal vessels, it is possible to unequivocally clarify the local regulative and pathological behavior of arterial retinal vessels in terms of flow physiology.

Measurement of flow-physiologic parameters of retinal blood circulation in type 1 and 2 diabetics before and after photocoagulation.

In seven diabetics of type 1 and seven of type 2, the flow physiologic magnitudes were measured in a retinal quadrant before and after photocoagulation. The segmental blood flow, the arterial flow velocity, and the diameters of artery and vein are smaller after photocoagulation than before. Investigations into the time course of the flow-physiologic parameters following photocoagulation show that the flow-physiologic values are stationary about 2 weeks after photocoagulation.

[Kidney changes in patients with proliferative diabetic retinopathy]. / Nierenveränderungen bei Patienten mit proliferativer diabetischer Retinopathie.

On 42 patients (25 males, 17 females) at the age of 46.1 +/- 13.4 years with a proliferative diabetic retinopathy clinical and laboratory examinations were performed for the proof of a renal lesion. This disease was found in 59.5% of the cases. In the foreground of the pathological findings were a proteinuria, a restriction of the creatinine clearance and of the concentration power of the kidneys as well as the hypertension. The diabetic nephropathy had its peak of frequency between the 50th and 60th year of age and showed significant relations to the duration of diabetes as well as to be early age of manifestation. Close ophthalmological and nephrological examinations, particularly of the juvenile diabetics, should render possible an early recognition and treatment of the diabetic microangiopathy.

[Androgen regulation in patients with diabetic retinopathy]. / Zur Androgenregulation bei Patienten mit diabetischer Retinopathie.

In 21 male diabetics (juvenile onset diabetes) with diabetic retinopathy and 13 patients without this condition, the HCG and the LH-RH stimulation tests were performed and the results compared to those of 20 persons with normal metabolism and full vision. The findings can be interpreted as hypothalamic hypophysogonadal dysregulation in case of lowered basal testosterone, significantly inverse correlation to the relative responsiveness of Leydig's cells, lacking correlation between LH and testosterone as well as normal LH-RH test. Differences between patients with and without retinopathy were not detectable.

[How effective is photocoagulation? (author's transl)]. / Was vermag die Fotokoagulation und was bewirkt sie?

Six hypotheses relating to the mode of action of photocoagulation, based on comprehensive data gathered from the literature, are put forward and discussed. Particular emphasis is given to the question of achieving a lasting break through of the barrier represented by Bruch's membrane and the pigment epithelium and thus to the altered diffusion conditions between the choriocapillaries and the retina. In addition a peculiar marginal fluorescence in fluorescein serial angiograms of old light coagulation foci is described and compared with data from the literature. The authors put forward a new hypothesis concerning the mode of action of light coagulation; they believe that particularly in the marginal areas affected by photocoagulation, completely new conditions are created for the metabolic exchange between choroid and retina, including the formation of anastomoses and shunts.

[Microcirculation disturbances at the onset of diabetic retinopathy. New therapeutic procedures? (author's transl)]. / Mikrozirkulationsstörungen bei beginnender diabetischer Retinopathie. Neue Wege in der Therapie?

The generalized capillary dilatation demonstrable at the early stage of diabetic retinopathy can now, on the basis of recent results in biochemistry, be assessed as an attempt at autoregulation in relative hypoxia of tissue. In patients with diabetic retinopathy, an elevated HbA1c concentration in the blood can be observed. The DPG level, however, is reduced. Both facts cause reduced oxygen transmission from blood to tissue. Rheologic changes such as augmented aggregation of erythrocytes, decreased deformability of erythrocytes and increased viscosity of blood and plasma finally lead to disturbances of microcirculation in the terminal vascular system. From these latest findings concerning the development of microcirculation disorders in diabetic retinopathy possible consequences for new therapeutic procedures can be derived.

[Device for measurements of blood flow in the great retinal vessels of man (author's transl)]. / Messungen zur Ermittlung des Blutvolumendurchflusses in grossen retinalen Gefässen des Menschen.

A combined measuring unit for the Retinophot is described which can be used to determine the blood flow through the great retinal vessels. This method is possible by combination of the two-point photometry with length measurements by means of rocking-plate micrometry. The first measuring results are presented.

[Comparison of principles for length measurements at the fundus of the human eye (author's transl)]. / Gegenüberstellung von Prinzipien für Längenmessungen am menschlichen Augenhintergrund.

Comparison of principles is presented for length measurements at the fundus of the eye and discussed with respect to minimum measuring errors. Measurements by photography or by optical dislocation of the measuring object to itself are the methods with the least uncertainty under the conditions taken into consideration.

[Length measurements by rocking-plate micrometry at the fundus of the human eye (author's transl)]. / Längenmessungen mittels Planplattenmikrometrie am menschlichen Augenhintergrund.

An additional unit which can be used for length measurements at the fundus of the human eye is described for the ophthalmoscope. The principle of measurement is based on optical displacement of the measuring object to itself. The optical displacement of picture points is made possible by the use of a tilting flat glass plate in the intermediate image plane of the eyepiece. The relation between the optical displacement of picture points and the measuring movement is sufficiently linear for the described device.