[A new surgical technique in congenital cataracts for prevention of regenerated cataract. Controlled central excision of capsular leaves with endodiathermy coagulation of the capsular sac periphery]. / Neue operative Technik der Cataracta congenita zur Verhütung regeneratorischen Nachstars. Kontrollierte zentrale Exzision der Kapselblätter mit Endodiathermiekoagulation der Kapselsackperipherie.

Inherent in all operative methods of congenital cataract surgery with the aim of preserving the posterior leaf of the capsule is the risk of recurrence. Even after phakectomy of the pars plicata, secondary cataract can occur in the peripheral remains of the capsule, and this method also entails the risk of retinal detachment and loss of the capsule diaphragm, which would otherwise allow subsequent IOL implantation. We developed a new surgical technique to preserve the peripheral capsular sac and to avoid secondary cataract within the optical axis. Unipolar diathermy coagulation was applied to the anterior peripheral leaf of the capsule, provided that both leaves of the capsule were touching when slight pressure was applied to the probe. In preliminary studies of autopsy eyes, fusion of the capsular leaves was clearly apparent, even if the lens epithelium was not morphologically destroyed by diathermy coagulation. These were 42 eyes with congenital cataract (12 children with bilateral cataract, 9 eyes with mild anterior PHPV syndrome). Their ages were between 4 weeks and 8.5 years and the period from April 1988 to December 1992; follow-up was 1 to 4.5 years: 36 eyes, 6 eyes with PHPV. The following operation was undertaken in the children. After central anterior capsulectomy and aspiration of the lens, the anterior and posterior leaves of the capsular sac were fused circularly at the periphery by unipolar endodiathermy coagulation. The posterior chamber was deepened by viscoelastic substance allowing diathermy application at the anterior capsule with risk.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correction of astigmatism by controlled bipolar scleral diathermy. Initial clinical experience]. / Korrektur des Astigmatismus durch kontrollierte bipolare Skleradiathermie. Erste klinische Erfahrungen.

Twelve eyes (9 patients with an average age of 35.3 years) were treated for astigmatism using temperature-directed bipolar scleral diathermy applied either directly to the limbus or 1 mm from it. The patients were then followed up for a period of 3 to 15 months. Using an electrode distance of 1 mm, diathermy was applied for 2.5-4.5 s until a scleral temperature of 60-65 degrees C was reached. A decrease in astigmatism from 9.5 dpt (s = 5.55) preoperatively to 1.7 dpt (s = 0.98) postoperatively was achieved as the final result. A further increase in astigmatism was noted up to the 3rd postoperative months of up to 5.4 dpt (s = 1.26). The refractive status achieved after this period proved to be stable. Retrogression of the initial effect varied according to the initial condition. Partial recurrence of astigmatism up to 5.16 dpt (s = 1.26) was observed within 6 months in cases of congenital astigmatism. In contrast, following IOL implantation. A further reduction of astigmatism up to 2.5 dpt 3 months postoperatively was noted after an initial reduction from 6.3 dpt (s = 0.25) preoperatively to 3.5 dpt (s = 1.08) postoperatively. Following perforating keratoplasty, one eye that had not been fitted with a contact lens showed a reduction in astigmatism of from 18 preoperatively to 1.2 dpt post-operatively after treatment. Nevertheless, an increase in astigmatism of up to 10.7 dpt was observed after 3 months. In cases with permanent contact lenses after keratoplasty, the situation was different.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute and chronic inflammatory reactions following implantation of artificial lenses]. / Akute und chronische Entzündungsreaktionen nach Implantation künstlicher Linsen.

Inflammatory reactions following IOL-implantation are being caused by different factors. A recent finding refers to the fact that bacteria of usually low pathogenity (i.e. Probionibacterium acnes, Staph. epidermidis, Staph. aureus haemolyticus) can enter the eye during implantation into the capsular bag and can cause an initially localized endophthalmitis. Previously this clinical appearance had frequently been mistaken as a "Toxic Lens Syndrome". Clinically, a persisting or increasing fibrin reaction with or without hypopyon, a typical whitish appearance of the capsule and a more or less marked vitreous infiltration up to a generalized endophthalmitis may be observed. For diagnostic purposes an isolation of germs from the fibrin network in the pupillary area or from the excised fragments of the capsular bag can be successful. Therapy of choice are locally applied antibiotics (i.e. the combination of Cephalosporin with Tobramycin) or eventually an operative intervention. If this is performed in the early course, the IOL can be saved in the majority of cases, although the visual acuity is usually reduced. Postoperative inflammatory reactions can also be caused by individual disposition (pseudoexfoliation, glaucoma, uveitis). No importance is being attributed furthermore to diagnoses like "Toxic Lens Syndrome" or "Pseudo-phako-anaphylactic Endophthalmitis'. Postoperative inflammatory reactions can be divided into five different clinical courses. In cases of bacterial contamination the prognosis is worsened by mono-steroid therapy.

[Bipolar temperature controlled diathermy of the sclera for controlled refractive change of the cornea]. / Bipolare temperaturgesteuerte Diathermie der Sklera zur kontrollierten refraktiven Veränderung der Hornhaut.

A bipolar scleral diathermy unit measuring tissue temperature beneath the electrodes was used in 27 autopsy eyes to induce corneal curvature changes in order to modify corneal refraction. The optimal coagulation temperature was found to be between 65 degrees and 70 degrees C. The refractive effect was influenced by the distance of the electrodes (1 mm, 2 mm, 3 mm), their location ("limbal distance") and their position in reference to the limbus ("radial", "parallel"). The highest corneal curvature changes were observed with diathermy applied directly at the limbus or 1 mm distance from the limbus. The corneal meridian corresponding to the treated sclera regularly became significantly steeper and the untreated 90 degrees meridian flatter. Limbus parallel diathermy administered directly at the limbus showed a 0.91 mm increase in the corneal curvature with a 2 mm distance or a 0.34 mm increase with a 3 mm distance of both electrodes. Placing the electrodes radially or parallel of the limbus revealed greatest changes in corneal refraction using diathermy directly at the limbus or 1 mm distant from the limbus. The refractive effect decreased as the distance from the limbus increased. Corneal astigmatism could be decreased and increased in a quasi-controlled manner. Over-lapping diathermy offered the potential of gradually changing the corneal power. Histological sections showed that scleral collagen had only a superficial coagulation effect. Scleral diathermy offers great advantages in comparison to corneal incisions for the therapy of corneal astigmatism. Further investigations are in progress.

[Efficacy of the "Fadenoperation" (author's transl)]. / Zum Wirkungsprofil der Fadenoperation.

The "Fadenoperation" creates an artificial paresis, the effect of which increases in the field of action of the muscle operated upon. The postoperative effect on eye position and motility was studied in order to find the typical curve of influence upon the angle in different directions of gaze. In esotropia a fixation of the medial rectus muscle 13 mm behind its insertion will create an average angle reduction of 4 degrees in the primary position of gaze and 12 degrees (9 degrees long-term) in lateral gaze with the operated eye adducted. - Fadenoperations cause a reduction of (overacting) convergence (non-accomodative), adduction, and changing angle. The paper deals with the majority of patients who show overacting convergence and changing angles but lack an increasing angle in version movements. This means that in lateral gaze overcorrection may occur: From the curve of angle reduction the surgeon can derive a slight exponential decrease of each of the three partial functions. Fadenoperation, therefore, will suit well in patients showing overactions of all three components, but will bring "side effects" in cases which lack one or two of these dysfunctions. Bilateral Fadenoperations produce a minor incomitance pattern.

[Keratometry of infants under general anaesthetic (author's transl)]. / Keratometrie bei Kleinkindern in Narkose.

In infants, silicone contact lenses mostly have to be fitted under a general anaesthetic. For that purpose keratometry is essential. A simple procedure using a vertically moveable ophthalmometer is described. Errors on k-reading must be avoided.

[Results of aphakia correction with permanent silicone lenses]. / Ergebnisse der Aphakie-Korrektur mit Silikon-Permanentlinsen.

Silicone contact lenses were fitted postoperatively to 114 aphakic eyes (55 children, 59 adults) and followed up for a maximum of 2 years. Provided they were fitted carefully the lenses were well tolerated for surprisingly long periods of time. Complications observed were superficial ulcer in 2 cases and circumscribed corneal infiltration in 3 cases and circumscribed corneal infiltration in 3 cases and circumscribed corneal infiltration in 3 cases. Corneal vascularization was not found. Postoperative vision was good, corneal astigmatism being reduced by 0.87 D on average. The main problems were deposition of organic material and in some cases poor hydrophilic properties of the lenses. Constant lens mobility is essential for long-term tolerance and avoidance of complications. At present it is recommended that the use of permanent-wear silicone lenses be restricted to special indications.

[Experiences with continuous wear of silicone lenses (author's transl)]. / Erste Erfahrungen mit Silikon-Permanentlinsen.

Experiences with continuous wear of silicone lenses in 66 aphakic eyes are reported. By a careful fitting a long-term wearing has been obtained, the lenses were well tolerated in all cases. There was no vascularisation of the cornea. Three cases of temporary infiltration of the cornea have occured.