[Resorption of post-traumatic cilio-choroid (supra-choroid, sub-scleral) hematoma. A histopathologic study]. / Resorption posttraumatischer ziliochorioidaler (suprachorioidaler, subskleraler) Hämatome. Eine histopathologische Untersuchung.

The healing process of ciliochoroidal (suprachoroidal, subscleral) hematomas was studied histopathologically in 75 eyes enucleated between 1 and 42 days following a traumatic incident. The ciliochoroidal hematomas occur from ruptured vortex veins or ciliary blood vessels located in the suprachoroidal (subscleral) space. Detached ciliary blood vessels and nerves form a network within the hematoma. In early stages there is little fibrin formation and no signs of coagulation are visible. Then hyperemia of uveal blood vessels develops, followed by a perivascular accumulation of polymorphonuclear leukocytes and lymphocytes with edema. About 11 days after the traumatic event a thin mesenchymal cell layer covers the outside of the hematoma, which at this stage shows some hemolysis. After 2 weeks proteinaceous exudate with lipid vacuoles is present and fibroblastic activity is increased on the uveal side of the hematoma and along the septating blood vessels and nerves. After 3 weeks the outer uvea is impregnated by phagocytic cells containing hemosiderin (hemosiderophages). Twenty-eight days after trauma the fibrous lining of the hematoma has increased. In principle a seroma with septum formation has evolved from the suprachoroidal hematoma. This is regarded as a complicated healing process, which hinders surgical drainage of long-standing post-traumatic hemorrhagic ciliochoroidal detachment and therapy of post-traumatic ocular hypotony.

[Does combined pancreas-kidney transplantation modify diabetic retinopathy in type-1 diabetic patients?]. / Beeinflusst die kombinierte Pankreas-Nieren-Transplantation die diabetische Retinopathie bei Typ-1-Diabetikern?

The study group consisted of 30 patients with a functioning pancreas graft of at least 12 months. Fifty-seven eyes were examined; 26 eyes from 15 patients with a non-functioning pancreas graft made up the control group. Three patients were in both groups because their graft was rejected after a 12-month period. The mean age in the study group was 37 years, the mean observation time 38 months. The mean duration of diabetes before transplantation was 24 years and all patients were on kidney dialysis. Retinal coagulation for diabetic retinopathy had previously been performed in 80.7% of the patients. The mean age (38 years), observation time (36 months), duration of diabetes before transplantation (24 years), and incidence of retinal coagulation (84.6%) were comparable in the control group. All patients had regular ophthalmological examinations every 6 to 12 months. This included best-corrected visual acuity, applanation tonometry, slit-lamp examination and dilated binocular funduscopy. Seven 30 degrees fundus pictures of the posterior pole were taken: The images were graded by comparing them with the ETDRS (Early Treatment Diabetic Retinopathy Study) Group standard photographs. The original Airlie House grading scale was changed because we did not take stereoscopic pictures. Evaluation and grading were done independently by two examiners. The retinopathy score was graded from 0 (no retinopathy) to 11 (no evaluation possible due to opaque media). Visual acuity remained stable in both the study and control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetic retinopathy and pancreas transplantation: a 3-year follow-up.

The effect of simultaneous pancreas and kidney transplantation on diabetic retinopathy was studied in a prospective study with 30 patients (57 eyes) and 15 control subjects (26 eyes), patients who lost the pancreas, but preserved kidney function. There was no significant difference between the groups after a mean observation time of more than 35 months (a range of 12 to 96 months). Both populations had a stable retinopathy during follow-up. This seems to be a consequence of the far advanced retinopathy (mean duration of type 1 diabetes was 22 years) and the high percentage of coagulated eyes (81% and 85%, respectively), but is not related to the organ transplantation. A closer look at the few patients who did not receive laser coagulation (14 patient and 6 control eyes), produced a different result. Four control eyes experienced a significant deterioration of the retinopathy which had been stable before rejection. It is the most important and so far never mentioned aspect of this study, that periods of destabilisation are a definite threat for the retinopathy. Nevertheless, it seems questionable whether we will ever be able to make a definite statement on the pancreas-eye relation, as long as the transplantation must be restricted to carefully selected late-stage diabetic subjects.

[Pancreas transplantation in Type I diabetic patients]. / Pankreastransplantation bei Typ-I-Diabetikern.

Successful pancreas transplantation can result in the longterm normalization of glucose metabolism. Since most pancreas recipients already have severe diabetic complications, and the observation period after transplantation is rather short, an assessment of the effect of complete glucose normalization on these diabetic changes is problematic. It has, however, been shown that the development of diabetic nephropathy can be prevented, peripheral microcirculation improved, and autonomic and peripheral neuropathy and retinopathy stabilized. These positive effects are, possibly, in part due to the elimination of uremia, since most patients receive both a pancreas and a kidney. The aim must be to perform pancreas transplantation in an early stage of diabetes, even though remarkable improvements have also been reported in terminal stages of the disease, and the quality of life of these patients has been significantly improved.

Metabolic control and effect on secondary complications of diabetes mellitus by pancreatic transplantation.

After successful pancreatic transplantation blood glucose can be normalized without exogenous insulin, although oral and intravenous glucose tolerance remains impaired in 10-45% of the patients. There is no significant deterioration of glucose control with time in most patients. Since most recipients of pancreatic grafts have far advanced secondary diabetic lesions and the observation time after grafting is rather short, the effects of pancreatic transplantation on these complications are difficult to interpret. However, the development of diabetic nephropathy can be prevented, skin microcirculation improves significantly, while autonomic and peripheral neuropathy and diabetic retinopathy remain stable or improve slightly in most patients. But these ameliorations may be in part due to elimination of uraemia, since in almost all patients combined pancreas/kidney transplantations were performed. It is concluded that pancreas grafting probably has to be performed much earlier in the course of diabetes, although the improvement in the quality of life is striking even in the end-stage diabetics studied so far.