[Malignant transformation of a choroidal nevus 6 years after brachytherapy of a non-contiguous choroidal melanoma - a case report and review of literature]. / Maligne Transformation eines Aderhautnävus 6 Jahre nach Bestrahlung eines davon entfernten Aderhautmelanoms: Ein Fallbericht sowie Literaturübersicht.

BACKGROUND: Brachytherapy is a well established procedure for treatment of malignant choroidal processes. Approximately 5 % of the cases, will show local recurrences within 6 years. We report a patient who has developed a malignant transformation of an uveal nevus following brachytherapy of a non-contiguous uveal melanoma. In addition, we reviewed the literature concerning similar cases. HISTORY AND SIGNS: In 1991 a Ruthenium application was performed on a 65-year old patient suffering of an equatorial malignant choroidal melanoma. At that time, a nevus at the posterior pole was present. From 1997 to 1998 the nevus continuously increased in size. Visual acuity decreased and a retinal detachment developed. Combining the clinical and the sonographic findings, the diagnosis of a malignant melanoma arising of a nevus was established. Enucleation was performed in 1998. THERAPY AND OUTCOME: Histologic examination revealed the diagnosis of an epithelioid-cell-type malignant uveal melanoma arising in a nevus. Till now, the patient is free of metastatic disease. CONCLUSION: Non-contiguous development of uveal melanomas in the same eye are extremely rare. We could identify in the literature 5 cases of non-contiguous melanomas following brachytherapy of an uveal melanoma. In none of these cases, the secondary melanoma has arisen in a nevus. Follow-up examination of patients with uveal melanoma treated with brachytherapy should include not only examination of the treated area, but also the whole fundus of the eye in order to recognize secondary tumours as early as possible.

[Effects of carotid artery thrombendarterectomy on pulsatile ocular blood flow]. / Die Auswirkung einer Arteria-carotis-Thrombendarteriektomie auf den pulsatilen okulären Blutfluss.

UNLABELLED: Successful operations of clinically significant carotid artery stenosis by carotid endarterectomy (CEA) are leading to a better perfusion in the region of this artery. It still creates problems to make a statement about cerebral and ocular perfusion during the operation. METHODS: In 10 patients who underwent a CEA the pulse amplitude (PA) of the intraocular pressure (IOP) was measured intraoperatively by a pneumotomography (OBF-Systems, U.K.) and the so called pulsatile ocular blood flow (pOBF) was determined. The middle arterial blood pressure (MAP) was taken invasively during the operation. RESULTS: During the clamping phases no PA could be recorded. PA (p = 0.04) and pOBF (p = 0.028) increased on the side which had been operated on. No correlations of PA and pOBF to MAP were found. CONCLUSION: This method can prove an increased pulsatile ocular blood flow after successful CEA.

[Merkel cell tumor of the eyelids: review of the literature and report of 2 patients]. / Merkelzelltumor der Augenlider: Literaturübersicht und ein Bericht über zwei Patienten.

BACKGROUND: The Markel cell carcinoma is a rare malignant skin tumor. The tumor was first described in 1972 by Toker and he named it trabecular carcinoma. We had the opportunity to treat two patients with a Merkel cell carcinoma of the upper and lower eyelid and reviewed the literature using the "Medline" database concerning Merkel cell carcinomas of the ocular adnexa. HISTORY AND SIGNS: A 76-year-old female patient was referred to our hospital because of an inflammatory tumor of the left upper eyelid present for two months. A 91-year-old male patient noticed for four weeks a painless itching lesion at the left lower eyelid. The remaining ophthalmologic examination in these patients was unremarkable. THERAPY AND OUTCOME: Both tumors were excised. Histological and immunohistochemical examination verified a Merkel cell carcinoma in both cases. The 76-year-old female patient exhibited no recurrent tumor after a follow-up of 18 months. The 91-year-old male patient had a recurrent tumor inferior to the temporal lower eyelid 7 months after tumor excision, however, lymph node metastasis is not present as of yet. The patient underwent radiation therapy with cobalt of the left orbit with a total dose of 60 Gy. CONCLUSION: Merkel cell carcinomas can occur everywhere on the skin; the eyelids are affected in 10% of all cases. Best histochemical markers are cytokeratin 20 and neurospecific enolase. A review of the literature revealed 31 patients with Merkel cell carcinomas involving the eyelids. Female patients were more often affected than male patients. The upper eyelid was more frequently involved than the lower eyelid. Recurrent disease is frequent.

[Dolasetron, droperidol and a combination of both in prevention of postoperative nausea and vomiting after extracapsular cataract extraction under general anesthesia]. / Dolasetron, Droperidol und die Kombination beider Substanzen zur Prophylaxe von Ubelkeit und Erbrechen nach extrakapsulären Kataraktextraktionen in Allgemeinanästhesie.

BACKGROUND: Both, droperidol and the new 5-HT3-antagonist (e.g. dolasetron) are effective drugs in the prevention of postoperative nausea and vomiting (PONV). It was the aim of this prospective double blind placebo controlled study to determine the efficacy of low-dose droperidol, dolasetron, and a combination of both drugs in the prevention of PONV after extracapsular cataract extraction. METHODS: 148 inpatients undergoing cataract surgery were stratified according to gender and then randomised to receive one of four antiemetic regimens: placebo, droperiodol (10 micrograms x kg-1), dolasetron (12.5 mg), or the combination of both drugs (10 micrograms x kg-1 + 12.5 mg). The drugs were administered intravenously 5-10 minutes before the end of anaesthesia. General anaesthesia and the perioperative management of the patients were standardised: benzodiazepine premedication, induction with etomidate, alfentanil and mivacurium. Maintenance using desflurane in N2O/O2, and a continuous infusion of mivacurium was used. Postoperative analgesia (diclofenac or paracetamol) and antiemetic rescue medication (dimenhydrinate and metoclopramide) was standardised. Nausea, episodes of vomiting, retching and the need for additional antiemetics were recorded for 24-hours. The severity of PONV was categorised using a standardised scoring algorithm. The main aim of the study was the number of patients who stayed completely free from PONV. RESULTS: There were no differences between the two groups with regard to biometric data, type of surgery, and distribution of risk factors for developing PONV. In all three treatment groups significantly less patients suffered from PONV (placebo: 66%; droperidol: 89%, dolasetron: 92%, combination: 89%; p = 0.011). Furthermore, the severity of PONV was reduced (p = 0.012). CONCLUSION: Low-dose droperidol and dolasetron are equally effective to reduce the incidence of PONV after cataract surgery under general anaesthesia. The combination of both drugs revealed no additional effect.

[Central serous chorioretinopathy. Clinical, fluorescein angiography and demographic aspects]. / Chorioretinopathia centralis serosa. Klinische, fluoreszeinangiographische und demographische Aspekte.

UNLABELLED: The purpose of this retrospective study was to analyze the demographic characteristics of central serous chorioretinopathy (CSC). METHODS: Findings of 100 consecutive subjects with CSC were evaluated. Clinical and fluorescein angiographic findings, demographic characteristics, and visual acuity were analyzed. RESULTS: The age of the patients ranged from 28 to 68 years with a mean of 43 years. No significant sex differences were found concerning age and other parameters. The highest age peak was in the group of women. The male to female ratio was 5:1. Patients with chronic CSC were significantly older (P = 0.015) than patients with the other angiographic findings. Median visual acuity was 0.5. In 40% bilateral characteristics of CSC were found. Clinical and fluorescein angiographic findings showed no significant correlation with visual acuity. CONCLUSION: The range of age distribution in CSC is wide. In older patients distinguishing CSC from age-related macular degeneration can be difficult.

Influence of special-effect contact lenses (Crazy Lenses) on visual function.

PURPOSE: Special-effect contact lenses (opaque, tinted soft contact lenses that incorporate decorative images such as "cateyes," stars, or hearts to alter eye color and structure) have become increasingly popular. The purpose of this study was to investigate whether such lenses impair visual function. METHODS: A clear soft contact lens and a special-effect soft contact lens (Crazy lens,) were fit in changing sequence in nine healthy subjects. The parameters studied included: visual acuity, contrast sensitivity (with and without glare), visual field, and mesopic vision (with and without glare). RESULTS: The following parameters displayed a statistically significant difference (P < 0.05). Visual acuity was decreased to 0.9 +/- 0.23 in the Crazy lens group as compared with 1.2 +/- 0.13 in the clear lens group. Goldmann visual field displayed a significant constriction of the isopters: III/4, I/4, and I/3. Mesopic vision without glare was reduced from 1:2.5 to 1:7.4. Contrast sensitivity was significantly reduced in a photopic condition with and without glare and in a scotopic condition without glare. Furthermore, the special-effect lenses were associated with a decrease in lens wearing comfort. CONCLUSIONS: Special-effect contact lenses were associated with a reduction of many visual functions, including visual acuity and contrast sensitivity. For some wearers this may interfere with activities where excellent vision is crucial, such as driving a car.