[Increased prevalence of congenital dacryostenosis following cesarean section]. / Erhöhte Prävalenz konnataler Tränenwegsstenosen nach Sectio caesarea.

BACKGROUND: Congenital nasolacrimal duct obstruction (dacryostenosis) with a persisting membrane at Hasner's valve is the most common cause of persistent tear and ocular discharge in infants. PURPOSE: To evaluate whether there is an association between congenital dacryostenosis and delivery via cesarean section. MATERIAL AND METHODS: In a prospective study we examined 107 children (mean age 9.2 ± 7.1 months) with congenital dacryostenosis. We evaluated data about the mode of delivery (vaginal delivery versus cesarean section) and gestational age at the time of birth. Within the first 8 months of life children were treated by probing using local anesthesia, whereas older children were treated using general anesthesia. After the age of 11 months treatment included nasolacrimal duct intubation with a bicanalicular stent. Statistical analyses were performed using binomial tests, Fisher's exact test and the t-test. RESULTS: In this study 51 children delivered by cesarean section were compared with 56 children delivered by spontaneous vaginal delivery. A total of 44 age-matched pairs from both groups were evaluated in order to eliminate confounding factors due to gestational age at delivery. Based on the published rate of cesarean sections from the same region of the State of Hesse between 2002-2004 we observed a statistically significant association between congenital dacryostenosis and delivery by cesarean section among the 88 age-matched patients (P = 0.009). Moreover, subgroup analysis revealed a significant association between congenital dacryostenosis and delivery by primary cesarean section (P = 0.00004). The prevalence of surgical treatment was not statistically different between both groups based on the mode of delivery (P = 0.8). CONCLUSION: Our results suggest that delivery via cesarean section is associated with a significantly higher prevalence of congenital dacryostenosis.

[A 16-year-old female patient with massive bilateral blepharedema]. / Sechzehnjährige Patientin mit massivem beidseitigem Lidödem.

CASE REPORT: A 16-year-old female patient initially presented with bilateral swelling and redness of the eyelids already existing for the duration of two days. The symptoms had started after the patient dyed her eyelashes and eyebrows with henna. THERAPY: Systemic antihistamine and glucocorticoid therapy led to no visible improvement. An intravenous antibiotic treatment was started which resolved the symptoms entirely. CONCLUSION: The diagnosis of an allergic contact dermatitis with a secondary bacterial infection was made.

[Endonasal dacryocystorhinostomies with transillumination and intubation in patients with combined pathologies of the nose and after revision]. / Endonasale mikroskopische Dakryozystorhinostomie mit Endoillumination und Intubation bei Patienten mit kombinierten Tränenwegspathologien oder Revisionen.

BACKGROUND: The results of endonasal dacryocystorhinostomies (DCR) with transillumination and intubation are presented. MATERIALS AND METHODS: In the period from 1999 to 2009 follow-up examinations of 50 endonasal DCRs were carried out. All patients over 18 were included. The files were systematically evaluated. The follow-up examinations were performed after a minimum of 6 months with anamnesis of epiphora. RESULTS: 50 endonasal DCRs were performed on 40 patients. Initial surgery was performed on 27 lacrimal ducts, 16 patients had already had operations. Corrective surgery was required in 8 cases (7 endonasal DCRs, 1 external DCRs). 78 % women and 22 % men were included. The median age at the time of operation was 48 years; the median duration of preoperative symptoms was 24 months. In 42 % of the cases a chronic dacryocystitis was found. Pre-existing conditions were sarcoidosis in three cases and one case of Wegener's granulomatosis. As well as lacrimal duct obstruction, additional pathologies were treated in the same session [septoplasty (n = 12), sinus operations (n = 10), and cauterisation of the nasal concha (n = 7), removal of a dacryocele (n = 1), conchectomy (n = 1)]. 20 operations were performed on the right side, 26 on the left side and two bilateral. The median duration of the operation was 51 minutes. No operative complications were encountered. The length of stay in hospital was on average four days. The median of follow-up was 23 months. The success rate was 78 %. DISCUSSION: The success rate of endonasal DCRs is about 70 to 95 %. Thus, the achieved rate in this study is acceptable, especially as 16 of 40 patients underwent revision surgery. Probably this is attributed to the technique of transillumination. The safe intraoperative localisation of the lacrimal sac with a light probe seems to have a positive effect on the removal of obstructions.

Facemasks and intensified hand hygiene in a German household trial during the 2009/2010 influenza A(H1N1) pandemic: adherence and tolerability in children and adults.

Non-pharmaceutical interventions (NPI) such as facemasks and intensified hand hygiene may be effective in preventing influenza infections in households. It may be equally important that household members, especially children, can learn to use, maintain and tolerate these measures. We monitored adherence and tolerability of these NPI within a cluster-randomized trial in households with influenza index patients. We recruited 147 participants in 41 households, 39 (95%) out of 41 index patients were children (aged <14 years). In households assigned to wear facemasks, their use peaked on day 4 after symptom onset of the index patient at 73% and at 65% for children and adults, respectively. Mean daily frequency of hand disinfection in households assigned to intensified hand hygiene measures peaked at 7·7 (day 6) for children and at 10·1 (day 5) for adults. The majority of participants reported no problems with mask wearing. Data suggest that usage of NPI can be taught and that measures are well tolerated by adults and even sick children alike.

[Electronically recorded occlusion treatment in amblyopes older than 7 years: acuity gain after more than 4 months of treatment?]. / Elektronisch erfasste Okklusionstherapie bei über 7-jährigen Amblyopen: Visusanstieg noch nach mehr als 4 Monaten?

BACKGROUND: According to the ROTAS study most of the improvement in visual acuity (VA) during amblyopia therapy of children aged 3 to 8 years occurs during the first 6 to 8 weeks . Sattler reported a VA gain in 11-year olds even during the second year of treatment . So far there are no standards concerning the intensity and duration of the treatment of patients older than 7 years of age. After a report on electronic monitoring of occlusion treatment in patients aged 7 to 16 years for 4 months , we now analyse whether this age group benefits from a longer-lasting treatment. MATERIALS AND METHODS: In this pilot study the progression of VA was analysed in 11 patients (age range 7.18 to 15.76 years; median 11.42 years) during 12 months of occlusion therapy (types of amblyopia: 5 anisometropic, 1 strabismic, 5 combined). The daily occlusion times were recorded using the occlusion dose monitor (ODM) . At the beginning of treatment the prescription of the occlusion regime (median) was 6 h/d (range 4 to 7 h/d), the (decimal) VA 0.2 (range 0.02 to 0.63) for single and 0.16 (range 0.02 to 0.8) for crowded optotypes. RESULTS: The recorded occlusion time (median) was 4.4 h/d during the 12 months of treatment, the VA gain (median) was 0.4 log units for single (range 0.2 to 0.7 log units) and 0.3 for crowded optotypes (range--0.1 to 0.6). During the period of 4 to 12 months of treatment (received occlusion 4.12 h/d) the VA gain was 0.1 log units for single and for crowded optotypes. The maximum VA gain during the interval of 4 to 12 months of treatment was 0.2 log units, both single and crowded. The interocular difference for crowded VA (median) decreased from 0.9 to 0.6 log units during treatment, however only one patient achieved an interocular difference of < 0.2 log units. CONCLUSION: The patients presented here were able to integrate daily occlusion lasting several hours and the electronic monitoring of occlusion treatment into their daily routine over a period of 12 months. During this period the VA of all included types of amblyopia improved significantly, both from a clinical and statistical point of view. Further long-term studies using ODMs with larger groups of patients may identify factors for success of treatment, reveal the long-term stability of the improvement and contribute to a standardised treatment in this age group.

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in adults]. / Evaluation anatomischer Veränderungen des vorderen Augenabschnitts nach Augenmuskelchirurgie bei Erwachsenen mittels optischer Kohärenztomografie.

BACKGROUND: In the light of studies in children which showed no significant changes concerning anterior chamber depth, central corneal thickness and chamber angle width after eye muscle surgery, the aim of this study was to evaluate such changes in adults by means of optical coherence tomography. PATIENTS AND METHODS: Using the Visante™ OCT (Carl Zeiss, Meditec, Jena) we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0° (CW0) and 180° (CW180) in 17 patients who had undergone eye muscle surgery on a minimum of one horizontal muscle preoperatively, one week and four months postoperatively. Exclusion criteria were an age under fifteen years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 43 years (min: 15; max: 67 years). RESULTS: In all eyes (one and two muscles), no significant differences of mean values taken preoperatively, one week and four months postoperatively were seen: CCT: 538 ± 51 mm; 535 ± 39 mm; 535 ± 46 mm (p = 0.77); ACD: 2.98 ± 0.44 µm; 3.01 ± 0.45 µm; 3.01 ± 0.40 µm (p = 0.42); KW 0: 38.0 ± 5.2° 38.4 ± 6.0° 37.8 ± 5.2° (p = 0.98); KW 180: 33.7 ± 5.6° 35.6 ± 5.7° 34.5 ± 6.8° (p = 0.32). The differences between the corresponding data of both subgroups (one vs. two muscles) concerning central corneal thickness (p-value: 0.74; 0.89; 0.42), anterior chamber depth (p-value: 0.31; 0.23; 0.36) as well as chamber angle width at 0° (p-value: 0.73; 0.27; 0.81) and at 180° (p-value: 0.87; 0.67; 0.89) were not significant. CONCLUSION: Using optical coherence tomography of the anterior eye segment in adults after muscle surgery, either in one or in two muscles - in accord with the results in children - no significant changes concerning central corneal thickness, anterior chamber depth and chamber angle width were seen.

Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas.

BACKGROUND AND PURPOSE: Cranial nerve palsies are regularly observed in patients with arteriovenous fistulas of the cavernous sinus. The purpose of our study was to determine the long-term clinical outcome-with a special focus on extra-ocular muscular dysfunctions-in patients who had undergone endovascular treatment of a cavernous sinus fistula with detachable coils. MATERIALS AND METHODS: Sixteen patients were recalled for an ophthalmoneurologic control examination (mean interval of 4.4 years). The mRS and the EQ-5D questionnaire were used for the description of general outcome. Age, duration of symptoms, character of the fistula (direct, dural), and coil volume were tested to assess their relevance for persistent symptoms. RESULTS: All patients displayed complete regression of chemosis, exophthalmus, and pulsating tinnitus with no evidence of recurrences. Oculomotor disturbances persisted in 9 of 13 patients and caused permanent diplopia in 7 patients. In 15 patients a mRS score of 1 or 2 was achieved; however, 7 patients reported some limitations in life quality (EQ-5D). A significant correlation was found between coil volume and persistent diplopia (P = .032) and persistent cranial nerve VI paresis (P = .037). CONCLUSIONS: Coil embolization of the cavernous sinus led to durable closure of AVF and reliable regression of acute symptoms. However, long-term follow-up showed a 44% rate of persistent cranial nerve deficits with disturbances of oculomotor and visual functions. This may be explained by the underlying fistula size itself and/or the space-occupying effect of the coils. As neuro-ophthalmologic outcome is crucial for control of therapeutic success, patients should be routinely examined by ophthalmologists.

Coagulation disorders and the risk of retinal vein occlusion.

Over the past years, there has been a dramatic increase in the number of identifiable causes of thrombophilia. However, to date, there are no large, prospective studies to assess an optimal, cost-effective approach with regard to screening and case finding for thrombophilic risk factors in patients presenting with retinal vessel occlusion. Two hundred twenty-eight patients with retinal vein occlusion (RVO) and 130 age-matched healthy controls were prospectively screened for thrombophilic risk factors. Both cohorts were divided into three subgroups, depending on the patients' age at the time of the RVO or a previous thromboembolic event. Patient age < or =45 years was associated with a high prevalence of coagulation disorders (p<0.0001). Among patients < or =45 years and >45 to < or =60 years, a family history of thromboembolism was strongly associated with the presence of thrombophilic disorders. The absence of cardiovascular risk factors was found to be a strong predictor for the presence of coagulation disorders in all patient groups (< or =45 years, p=0.003; >45 to < or =60 years, p=0.0008; >60 years, p=0.001). Multivariate analysis revealed the presence of resistance to activated protein C (p=0.014), antiphospholipid antibodies (p=0.022), and deficiency of the anticoagulant proteins (p=0.05) as independent risk factors for the development of RVO among patients < or =45 years. Our results indicate that thrombophilic disorders are associated with the development of retinal vein occlusion in patients < or =45 years by the time of the RVO or a previous thromboembolic event, in patients with a family history of thromboembolism, or in patients without cardiovascular risk factors.

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in children]. / Veränderungen des vorderen Augenabschnittes nach Augenmuskelchirurgie--Evaluation bei Kindern mittels optischer Kohärenztomografie.

BACKGROUND: The aim of this study was to quantify and to evaluate changes concerning anterior chamber depth, central corneal thickness and chamber angle width because of altered forces on the eye bulb after eye muscle surgery in children by means of optical coherence tomography. PATIENTS AND METHODS: Over the course of four months, we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0 degrees (CW0) and 180 degrees (CW180) in 28 eyes of 28 children, who underwent eye muscle surgery on one horizontal muscle. Measurements were taken preoperatively, one week and four months postoperatively using Visante (TM) OCT (Carl Zeiss, Meditec, Jena). Exclusion criteria were an age under five years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 6.5 years (range: 7.1, max: 8.9; min: 5.3). RESULTS: Mean values taken preoperatively, one week and four months postoperatively were: CCT: 534 +/- 32 microm; 533 +/- 30 microm; 536 +/- 31 microm (p = 0.12); ACD: 2.98 +/- 0.3 mm; 2.97 +/- 0.3 mm; 2.96 +/- 0.4 mm (p = 0.73); CW 0: 38.1 +/- 3.6; 38.9 +/- 4.7; 38.3 +/- 4.7; CW 180: 34.7 +/- 4.2; 35.3 +/- 4.3; 36.2 +/- 5.2; (p = 0.41). The differences between the mean values in all measurement rows were not significant. CONCLUSION: In children who underwent eye muscle surgery on one horizontal muscle this procedure had no significant impact on central corneal thickness, anterior chamber depth and chamber angle width of the operated eyes within a postoperative period of four months.

[Modular semiquantitative quality assessment of ophthalmic health information on the internet--reproducibility and correlation between different assessment categories]. / Modulare semiquantitative Qualitätsbewertung augenheilkundlicher Gesundheitsinformationen im Internet--Reproduzierbarkeit und Korrelation zwischen verschiedenen Bewertungskategorien.

BACKGROUND: Quality evaluation of web-based health information in ophthalmology requires valid standards and reproducible assessment procedures. The objective was to evaluate the interrater-reliability of quality assessment of ophthalmic websites and a possible correlation between the results of the evaluation categories reliability/trustworthiness, quality of medical content and accessibility/usability. MATERIALS AND METHOD: After selection with the search engine "Google" 20 ophthalmic websites had been analysed by two independent evaluators using criteria checklists (modified Afgis transparency criteria, modified BITV test, medical content related to AMD) related to the aforementioned 3 categories. RESULTS: The interrater-reliability was almost perfectly estimated with Kappa-values of 0.91 for reliability/trustworthiness plus 0.89 for accessibility/usability and 0.79 for content. On average 62.5 % (+/- 17.43 %), 27.36 % (+/- 16.5 %) and 59.54 % (+/- 15.73 %) of the quality requirements were fulfilled for reliability/trustworthiness, content and accessibility/usability, respectively. No significant correlation was found between reliability and content (r = -0.039, p = 0.8709), reliability and accessibility/usability (r = -0.284; p = 0.228) plus content and accessibility/usability (r = 0.199; p = 0.4047). CONCLUSION: Sufficiently operationalised criteria are prerequisites for reproducible results of quality assessment of ophthalmic websites between different observers. The assessment within a single category, such as reliability/trustworthiness, does not allow one to draw conclusions on other categories such as content or accessibility/usability or the overall quality of a website. Therefore, simplified tools for quality assessment of health information by laymen and patients may have a limited validity.

[Selective thrombophilia screening of young patients with retinal vein occlusion]. / Selektives Thrombophiliescreening junger Patienten mit venösen retinalen Gefässverschlüssen.

BACKGROUND: The potential impact of coagulation abnormalities on retinal vascular occlusive diseases, individually and in combination with cardiovascular risk factors, remains unclear. PATIENTS AND METHODS: In a prospective case-control study a cohort of 74 young patients with central, hemicentral or branch retinal vein occlusion (RVO) (

["Fragebogen zum Kindlichen Sehvermögen (FKS)". Assessment of quality of life with the German version of the Children's Visual Function Questionnaire]. / Fragebogen zum Kindlichen Sehvermögen (FKS). Die deutsche Version des "Children's Visual Function Questionnaire"--ein Instrument zur Erfassung der Lebensqualität sehbeeinträchtigter Kinder.

BACKGROUND: The assessment of quality of life plays an increasing role in ophthalmology. Standardized questionnaires such as the National Eye Institute Visual Function Questionnaire (NEI-VFQ) are useful instruments to evaluate the impact of ophthalmological diseases on the quality of life in adults. In children and infants, different instruments are needed, partly because of the changing developmental stages with age. Felius and colleagues developed a questionnaire to assess the quality of life in young children with visual impairment, the Children's Visual Function Questionnaire (CVFQ). It was validated in the United States. Our aim was to translate and adapt the questionnaire to make it applicable for the German-speaking countries. METHODS: Two independent groups in the ophthalmology departments of the University of Frankfurt and the University of Freiburg translated the questionnaire into German. In cooperation with the authors of the CVFQ, a consensus adaptation was created, which was then reexamined by the two German groups to establish the adaptation presented here. RESULTS: The German adaptation, like the original instrument, exists in two versions, one for infants and children <3 years of age and one for children > or =3 years. Besides vision and general health, the questionnaire assesses the following quality-of-life domains: competence, personality, family impact, and treatment. The first data for patients with an ophthalmological diagnosis (amblyopia and occlusion treatment, and aphakia with contact lens treatment) were collected and compared with data of children without visual impairment. CONCLUSION: The translated CVFQ provides an instrument for those in German-speaking countries to assess the quality of life in visually impaired children. The data sample shows its applicability for assessing the influence of diseases of the visual system and their treatment on the patients' and families' lives.

[Thrombophilic disorders associated with non-arteritic anterior ischaemic optic neuropathy in patients < 60 years of age]. / Thrombophile Gerinnungsstörungen bei unter 60-jährigen Patienten mit nichtarteriitischer anteriorer ischämischer Optikusneuropathie.

BACKGROUND: The potential impact of coagulation abnormalities on non-arteritic ischaemic optic neuropathy (NAION), individually and in combination with cardiovascular risk factors, remains unclear. PATIENTS AND METHODS: In a prospective case-control study a cohort of 26 NAION patients < 60 years at the time of the NAION or a previous thromboembolic event and 50 subjects matched for age and sex were prospectively screened for thrombophilic risk factors. RESULTS: Overall, thrombophilic defects were found to be present in 12 of 26 patients (46.2 %) and in 9 of 50 (18 %) controls (p = 0.01). The most frequent coagulation disorders were high levels of factor VIII (p = 0.04) and lipoprotein (a) (p = 0.03). Moreover, we identified two patients with homozygous resistance to activated protein C, which is the first description of this coagulation disorder associated with NAION. Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (p = 0.038). CONCLUSIONS: Our results indicate that thrombophilic disorders are associated with the development of non-arteriitic ischaemic optic neuropathy in patients < 60 years of age at the time of a first thromboembolic event. Selective screening of young patients and patients without cardiovascular risk factors may be helpful in identifying NAION patients with thrombophilic defects.

[Accessibility of information on eye diseases on the internet for the visually impaired user]. / Zugänglichkeit von Informationsangeboten über Augenerkrankungen im Internet für sehbehinderte Nutzer.

BACKGROUND: The number of visually impaired people who use the internet for obtaining health information around the eye, is rising continuously. For this reason the accessibility for visually impaired persons to such websites is an important factor. Our investigation deals with the question: How good is the accessibility for the visually impaired to gather information on eye diseases on the Internet and how could this be improved? MATERIALS AND METHOD: After identification using the the search engine "Google", 20 websites of German university eye hospitals have been checked for their accessibility using the modified BITV test which is based upon 52 test criteria. RESULTS: On average 70.75 % (+/- 6.19 % min. 56.6 %, max; 86.79 %) of the required accessibility criteria have been fulfilled. This corresponds to an average accessibility value of 70.58 % (+/- 6.69 % min. 56.31 %, max. 89.32 %). According to the BITV test, this means that the average of the analysed websites is not accessible. The improper use of mark-up languages, unclear document or web page titles or missing alternative texts for pictures, graphics and navigation elements and misleading navigational architecture are frequent findings. This builds up the greatest accessibility barriers, although these barriers could be eliminated even with a relatively low expense. CONCLUSION: Good accessibility allows not only a barrier-free access to information for visually impaired users but is also a most important feature related to search engine optimisation.

[Importance of imaging diagnostics and interventional therapy for diseases of the lacrimal drainage canals]. / Die Bedeutung bildgebender Diagnostik und interventioneller Therapie bei Erkrankungen der ableitenden Tränenwege.

Epiphora (continuous watering of the eyes) is frequently caused by obstruction of the lacrimal draining system. Radiographic imaging of the tear ducts after contrast injection with the DSA (digital subtraction angiography) dacryocystography technique is still the gold standard in patients with severe epiphora which does not respond to conservative therapy. Recent techniques, such as 3D rotational dacryocystography, MRI and CT are able to show the anatomic surroundings in addition to the ductal structures and are especially useful for planning endoscopic operations. Dacryocystographically assisted interventions, such as balloon dilatation or stenting of tear duct stenoses are technically feasible. Balloon dacryocystoplasty is especially successful in patients with incomplete or short distance obstructions of the nasolacrimal duct. Stenting may improve procedural success and patency rates. Minimally invasive interventional therapy is useful as an initial treatment in selected cases, however, long-term success rates may be limited and operative dacryocystorhinostomy still plays an important role. Comparative studies for evaluation of different therapeutic options are necessary.

[Presaccal stenosis as a cause of epiphora]. / Die präsakkale Stenose als Ursache der Epiphora.

BACKGROUND: Dacryocystographic evaluation of the location of stenoses of the lacrimal pathways was carried out in patients with epiphora to define the frequency and morphology of canalicular stenosis. PATIENTS AND METHODS: Digital subtraction angiography (DSA) dacryocystograms of 55 consecutive patients with severe epiphora and stenoses of the lacrimal draining system were reviewed in a consensus between three evaluators to determine radiomorphologic criteria for the diagnosis of canalicular stenosis. In 9 cases 3D rotational dacryocystography was additionally used. RESULTS: A total of 80 stenotic lesions were detected including 19 (24%) canalicular, 26 (32%) saccal and 35 (44%) ductal stenoses. In 9 of the patients 3D rotational dacryocystography was used to differentiate between canalicular (n=4) and saccal (n=5) stenosis. Increased resistance during continuous injection of contrast material and lack of distension of the distal ductal system were the main criteria for diagnosis of canalicular stenosis. CONCLUSION: Presaccal stenoses accounted for nearly 25% of the stenoses found in this study. This type of stenosis occurs frequently and should not be overlooked on dacryocystography. 3D rotational dacryocystography may be helpful in unclear cases.

[Examination methods in the diagnosis of uni- and bilateral cataracts in childhood]. / Untersuchungsmethodik zur Diagnostik der ein- und beidseitigen kindlichen Katarakt.

Today, the management of congenital and developmental pediatric uni- and bilateral cataract is still a problem, particularly because untreated lens opacity has a high amblyogenic potential. Such irreversible deprivation amblyopia in pediatric cataracts requires an early diagnosis. Due to the increased inflammatory reaction postoperatively, a minimally traumatic operation, intensive occlusion therapy and optimal correction with glasses or contact lenses are also necessary. Uni- and bilateral cataracts and their preoperative diagnostics have to be considered separately.

[Surgical treatment of congenital cataracts]. / Chirurgische Therapie der kongenitalen Katarakt.

Due to the anatomical dimensions being smaller and the tissue structures being softer and more elastic in the young patient, surgery of paediatric cataracts represents a special challenge for the ophthalmic surgeon. Surgery is performed via a limbal or pars plana approach. The extreme high rate of secondary cataract formation in the paediatric or adolescent eye with closed posterior capsules is countered by means of complicated capsular surgery, special intraocular lens (IOL) implantation techniques, and vitreoretinal surgical procedures. It is customary not to implant IOLs before the children are 1-2 years old as increased axial length growth must be expected during the first 18 months after birth. IOL power is selected so that postoperative refraction is within the hyperopic range and with time, undercorrection will be balanced by bulbus growth. Preoperative and postoperative therapy is highly dependant on the extent of trauma sustained during surgery and should contain anti-inflammatory medication with and without steroids as well as antibiotics. Orthoptic follow-up examinations are also decisive for the long-term result.

[Visual distortions and depersonalization-de-realization syndrome]. / Gestörte visuelle Wahrnehmung beim Depersonalisations-Derealisationssyndrom.

Disturbances of visual perception like micropsia, macropsia, teleopsia, pelopsia, metamorphopsia or loss of stereoscopic depth perception are usually considered in ophthalmology as symptoms of retinopathy, especially maculopathy or disorders of binocularity. Differential diagnostic considerations include disorders like migraine and epilepsy but not the visual disturbance pertaining to the depersonalization-de-realization syndrome, although the above-mentioned symptoms are more prevalent in this psychogenic disorder. This article gives a review of depersonalization-de-realization in order to enable the ophthalmologist to include this syndrome into his diagnostic considerations.

[A new possibility for imaging the lacrimal draining system. Three-dimensional rotation dacryocystography]. / Eine neue Darstellungsmöglichkeit der Tränenwege. Die dreidimensionale Rotationsdakryozystographie.

BACKGROUND: The aim was to investigate the applicability of a 3D rotation angiography system for imaging lesions of the lacrimal draining system. PATIENTS AND METHODS: Five patients with stenosis of the lacrimal system were enrolled in this pilot project to undergo a distension dacryocystography as 3D rotation angiography. The 3D reconstructions are derived from 100 radiographic projection images, which are obtained during a 240 degrees rotation of an angiographic C-arm. Volume-rendering techniques show plastic representations of the contrast-enhanced ductal system with the possibility of additional virtual dacryoendoscopy. The adjacent bony structures and the nasal cavity can also be visualized by special window settings and cuts through the 3D data set. Exact calibration of the X-ray system allows for precise measurements of distances. A sufficient 3D representation needs permanent injection of contrast material for about 5.5 s. Outpatient examination under surface anesthesia is well tolerated. RESULTS: The high-resolution 3D reconstructions show detailed images of lesions of the endoluminal surface and give a plastic impression of the site of obstructions. In contrast to normal DSA dacryocystography, the contrast-enhanced ductal system, the adjacent bone, and even the soft tissues of the nasal cavity are demonstrated simultaneously. A disadvantage is an incomplete representation of the residual lumen of subtotal stenoses and the one and one-half times higher radiation dose compared to normal dacryocystography. CONCLUSION: Dacryocystography with 3D rotation angiography opens a new dimension of minimally invasive imaging of the lacrimal drainage system, which may be helpful for exact planning of dacryocystorhinostomy procedures.