[Triple Descemet membrane endothelial keratoplasty. Indications, variations and results]. / Triple-Descemet-Membran-Endothel-Keratoplastik. Indikationen, Variationen und Ergebnisse.

When Descemet membrane endothelial keratoplasty (DMEK) is indicated in patients with phakic eyes, a combination with phacoemulsification and intraocular lens implantation in one sitting should be considered as a triple DMEK. The best possible preoperative deswelling of the cornea should be strived for in order to allow sufficient viewing conditions for the individual stages of cataract surgery. Furthermore, technical details, e.g. regulation of pupillary width also must be considered. The power of the intraocular lens has to be adjusted in order to compensate for the shift of refraction towards hyperopic values induced by DMEK surgery. A rapid and clear improvement in visual acuity can normally be achieved after a triple DMEK. There seem to be no disadvantages compared with a two-stage procedure for DMEK and cataract surgery.

[Refractive changes in triple Descemet membrane endothelial keratoplasty]. / Refraktive Veränderungen bei Triple-Descemet-Membran-Endothel-Keratoplastik.

BACKGROUND: A hyperopic shift, i.e. a shift of refraction in the direction of plus values, in Descemet membrane endothelial keratoplasty (DMEK) is a well-known phenomenon. Because of the need to select an appropriate intraocular lens power this becomes particularly relevant in triple DMEK, which is a combination of DMEK and cataract surgery. OBJECTIVES: In this study the refractive changes induced by triple DMEK were evaluated. The underlying mechanisms were classified based on corneal topographical data. MATERIAL AND METHODS: The study involved a retrospective evaluation of 29 eyes from 26 patients who underwent triple DMEK. The preoperative and postoperative refractions were compared with the initially desired target refraction. Calculations concerning refractive power were performed using corneal topographical data and the Gullstrand formula. RESULTS: On average a hyperopic shift was observed. The operation led to steepening of the posterior corneal surface and flattening of the anterior corneal surface. Both resulted in a reduction of corneal refractive power but changes of the posterior corneal surface were identified as the most important factor. Those patients in whom both eyes had been operated on, showed very similar postoperative topography for both eyes, irrespective of the preoperative values. CONCLUSION: The observed hyperopic shift was a mean value. A prediction of refraction in the individual cases by means of the available parameters was not possible. In general, the selection of an intraocular lens with a stronger myopic target refraction than that for standard cataract surgery is recommended.

[Uveitis intermedia in Whipple's disease]. / Uveitis intermedia bei Morbus Whipple.

We report a case of a 45-year-old man who complained of progressive vision loss in his right eye. Visual acuity was 20/300 in the right eye and 20/25 in the left eye. Bilateral uveitis intermedia R>L was diagnosed and treated with systemic and local steroids. An internal checkup was also done, and duodenal biopsy identified Whipple's disease. Despite specific antibiotic therapy, the patient's follow-up examination showed increased inflammatory activity R>L and bilateral cataracta complicata. Cataract surgery and pars plana vitrectomy with removal of epiretinal membranes were done. Histologic analysis of the vitreous and epiretinal membranes showed periodic acid-Schiff-positive macrophages, pathognomonic for Whipple's disease. Whipple's disease is a rare but severe disease with multiple manifestations and should be considered a differential diagnosis in uveitis.

[A retrosellar arachnoid cyst as a rare cause of homonymous hemianopsia]. / Eine retroselläre Arachnoidalzyste als seltene Ursache einer homonymen Hemianopsie.

BACKGROUND: Arachnoidal cysts are cystic lesions filled with a cerebrospinal-fluid-like content within the leptomeninges. Usually arachnoidal cysts represent a congenital malformation. Clinical signs (increased intracranial pressure and/or neurological defects) may become apparent in children or young adults. PATIENT: A sixteen year old boy was referred to our outpatient clinic because of blurred vision in both eyes since five days. The patient complained of cephalgia and of an increased sleep requirement in the last two weeks. Morphological findings were within the normal range. The visual acuity was 0.7 in the right eye and 0.2 in the left eye. The visual fields showed an incomplete homonymous hemianopia to the right. The CT and MRI revealed a retrosellar arachnoidal cyst. Two weeks after fenestration of the cyst the visual acuity had risen to 1.3 in both eyes and the visual field defects had disappeared nearly completely. CONCLUSION: A retrosellar arachnoidal cyst can impair the visual pathway. Early fenestration prevents permanent damage.

[Retroperitoneal liposarcoma--contribution to differential diagnostic problems of primary retroperitoneal tumors]. / Die retroperitoneales Liposarkom--Beitrag zu differentialdiagnostischen Problemen der primären Retroperitonealtumoren.

The primary retroperitoneal tumours-a rare, but histologically very extensive group of above all malignant tumours-only late appear with their symptoms. Though with the help of the modern radiological investigation methods the proof of a tumour is frequently successful, so in special cases a coordination to organs may make great difficulties also when the total diagnostic spectre is used. These problems shall be shown by the demonstration of a case report.