[Are diurnal and nocturnal intraocular pressure measurements over 48 h justified?]. / Sinnhaftigkeit von Tages-/Nacht-Augeninnendruckmessungen über 48 h.

PURPOSE: Diurnal intraocular pressure (IOP) measurements are recommended in cases of visual field deterioration in glaucoma patients. In this study the rationale of 24 h versus 48 h IOP measurements was investigated. PATIENTS AND METHODS: Mean IOP and maximum IOP values were obtained in 80 patients over a period of 48 h. The IOP measurements (Goldmann tonometry) of day 1 and 2 (taken every 4 h) were compared. To reduce interindividual and intraindividual differences of measurements the statistical calculation took a tolerance level of ± 2 mmHg and ± 1 mmHg into account. RESULTS: Maximum IOP measurements were found to differ between 37.5 % and 65.0% respectively for right eyes and 28.8 % and 47.5% respectively for left eyes depending on the measurement tolerance (±2 mmHg or ±1 mmHg) between day 1 and day 2. Mean IOP values were found to differ by 25 % and 51.3 % respectively for right eyes and 26.3 % and 46.3% respectively for left eyes (± 2 or ± 1 mmHg in) between day 1 and day 2. A time-related clustering of extreme deviations could not be found but the maximum values from all patients were found to be roughly equally distributed over daytime and nighttime hours. CONCLUSIONS: Both maximum IOP and mean IOP measurements were found to differ by at least ± 2 or ± 1 mmHg between day 1 and 2 at a significant percentage and the maximum values did not peak at a predictable time point during the 48 h. Therefore, 48 h IOP measurements appear to be more reliable than 24 h measurements.

[Unilateral loss of visual function with edema of the optic nerve in a 35-year-old male patient]. / Einseitige Visusminderung mit Papillenödem bei einem 35-jährigen Patienten.

Ocular manifestations of acute lymphoblastic leukemia (ALL) are manifold. A funduscopic image which shows optic disc edema, serous retina detachment, intraretinal hemorrhages and infiltrations indicates an extramedullary recurrence of ALL. Reduction of visual acuity in patients in remission can often be one of the first signs of ALL relapse and can also occur without systemic changes. Regular ophthalmologic and oncologic controls are of great importance. The early recognition of ALL relapse is important to initiate early treatment. However, the prognosis for visual acuity is usually low.

[Spontaneous resolution of vitreomacular traction syndrome]. / Spontan reversibles vitreomakuläres Traktionssyndrom.

Incomplete posterior vitreous detachment may lead to anterior posterior and tangential traction to the macula. At the location of the attachment, a cystoid retinal degeneration develops. The causative therapy in such cases is a pars plana vitrectomy (ppV) to release the vitreomacular traction. Only a few cases of spontaneous resolution of traction macular edema are described in the literature. Long-standing macular edema may damage the photoreceptors; therefore, ppV should be planned because only about 10% of cases of vitreomacular traction syndrome resolve spontaneously.

Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma.

PURPOSE: To investigate the long-term efficacy of selective laser trabeculoplasty (SLT) in primary open-angle glaucoma, the authors performed a non-randomized, prospective, non-comparative clinical case series. METHODS: Fifty-two eyes of 52 patients (19 male, 33 female) with primary open angle glaucoma were treated with SLT. Patients were treated with the Coherent Selecta 7000 (Coherent, Palo Alto, CA, USA) frequency-doubled q-switched Nd:YAG laser (532 nm). A total of approximately 50 non-overlapping spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ per pulse. After surgery, patients were maintained with the drug regimen identical to that before treatment. RESULTS: After 1 year the average reduction in intraocular pressure (IOP) from the baseline was 24.3% (6.0 mmHg), after 2 years 27.8% (6.12 mmHg), after 3 years 24.5% (5.53 mmHg), and after 4 years 29.3% (6.33 mmHg). A Kaplan-Meier survival analysis revealed a 1-year success rate of 60%, a 2-year success rate of 53%, a 3-year success rate of 44%, and a 4-year success rate of 44%. CONCLUSIONS: Despite a declining success rate, SLT is an effective method to lower IOP over an extended period of time.

[Long-term results after epilenticular intraocular lens implantation following traumatic cataract]. / Langzeitergebnisse nach epilentikulärer Intraokularlinsenimplantation bei traumatischer Katarakt.

BACKGROUND: The purpose of this study was to analyze the late postoperative outcome and complication rate after lensectomy with primary epilenticular intraocular lens (IOL) implantation for traumatic cataract. MATERIAL AND METHODS: We retrospectively reviewed the data of 11 patients who were operated on for traumatic cataract after penetrating or blunt ocular trauma between 1997 and 2002. One patient developed cataract due to a large rupture of the posterior capsule after blunt trauma. Ten patients sustained a penetrating ocular injury with (7 eyes) or without (3 eyes) intraocular foreign body (IOFB). In all patients the IOL was implanted at the beginning of the operation into the ciliary sulcus in front of the opaque lens followed by pars-plana lensectomy and vitrectomy. RESULTS: The mean follow-up was 27.4 months. Eight eyes (72.7 %) achieved a final visual acuity of 0.5 or better. Major causes of limited visual acuity were central corneal scars causing irregular astigmatism. In all patients the IOL was safely and easily implanted into the ciliary sulcus. During the subsequent pars-plana lensectomy and vitrectomy as well as during the follow-up period all IOLs remained anatomically stable and well centered. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Epilenticular IOL implantation followed by pars-plana lensectomy is an easy and safe method to treat traumatic cataract in the setting of penetrating ocular trauma repair. It is associated with a favorable visual outcome and a low rate of postoperative complications.

[Phacogenic uveitis with luxation of of Soemmering's ring formation in the vitreous body 63 years after cataract surgery]. / Phakogene Uveitis bei Luxation des Soemmering'schen Nachstarwulstes in den Glaskörper 63 Jahre nach Kataraktoperation.

BACKGROUND: After extracapsular cataract extraction, the remaining epithelial cells near to the equator may lead to the formation of a Soemmerings ring. Only 4 cases of dislocation of the ring in the vitreous are reported in the literature. A spontaneous dislocation associated with a phacolytic uveitis has not been described before. HISTORY AND SIGNS: In 1999 a 68-year-old man attended our clinic with a vision loss from 0.3 to hand movements in his left eye. For some years his right eye had been blind after unsuccessful retinal detachment surgery. In his left eye conjunctival inflammation, anterior chamber flare and complete occlusion of the pupil were found. Intraocular pressure was normal under hypotensive medication. Ophthalmoscopy was not possible and ultrasound revealed a ring-like dense structure in the vitreous cavity. THERAPY AND OUTCOME: Pars plana vitrectomy showed a Soemmerings ring, which was successfully removed by pars plana fragmentation. Forty-eight months postoperatively the patient had a visual acuity of 0.2 in a healthy and normotensive eye. CONCLUSIONS: Even years after cataract extraction a spontaneous dislocation of Soemmerings ring is possible.

[Primary implantation of posterior chamber lenses after traumatic cataract peneration]. / Primäre Hinterkammerlinsenimplantation nach penetrierender Hornhautverletzung mit traumatischer Katarakt.

PURPOSE: To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS: We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS: The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.

[Ophthalmomyiasis externa acquired in Germany: case report and review of the literature]. / Autochthon in Deutschland erworbene Ophthalmomyiasis externa: Kasuistik und Literaturübersicht.

UNLABELLED: Infestation with larvae (maggots) is known as myiasis. Ophthalmomyiasis externa refers specifically to infestation that involves the lids and conjunctiva in man. Ophthalmomyiasis which originates from Germany is unusual, because the vector of the Oestrus ovis larvae is most prevalent in the warm climate of Mediterranean countries. The sheep nasal botfly (Oestrus ovis sp.) is responsible for most cases of external ophthalmomyiasis. This case report gives a detailed description of the larvae, their life cycle and an overview of infestations in Germany as well as the therapy of ophthalmomyiasis. CASE REPORT: At the end of August 1999, a 28-year-old man attended the outpatient department of Giessen University Eye Clinic with a foreign body sensation in his left eye. He reported that something hit his left eye while he was climbing on his motorbike in the early evening hours. Shortly afterwards he had a foreign body sensation in his left eye. On history taking he reported no other ophthalmologic problems in the past. Slitlamp biomicroscopy revealed white, vivid, approximately 1.5-mm-long, light-sensitive maggots on the conjunctiva and under the upper lid. These were removed mechanically and the conjunctiva rinsed with saline. Local therapy was not applied. CONCLUSION: Infestation with larvae of O. ovis has to be considered not only in tourists from Mediterranean countries, but also in Germany in the late summer.

Sensitivity of the MTI photoscreener for amblyogenic factors in infancy and early childhood.

BACKGROUND: Screening for amblyogenic factors in infancy by pediatricians is unsatisfactory, as they hardly ever detect ametropia or microstrabismus. As photoscreening seems to be a helpful method to detect even small squint angles and refractive errors, we tested the MTI photoscreener for its sensitivity with respect to amblyogenic factors. PATIENTS AND METHODS: One hundred and twelve children aged 6-48 months were first examined with the MTI photoscreener. Then each child underwent complete medical examination by an ophthalmologist and an orthoptist. The examination included the Hirschberg test (corneal reflex evaluation), the Brückner test (fundus red reflex), and, where possible, the Lang stereotest, the cover test and visual acuity assessment, as well as a motility test, biomicroscopy, ophthalmoscopy in mydriasis and refractometry in cycloplegia. Exclusion criteria were any organic pathological results, manifest strabismus, ametropia > or = 2 D and astigmatism > or = 1 D. An orthoptist, a pediatrician and two ophthalmologists independently evaluated the Polaroid pictures according to the criteria given in the handbook of the MTI photoscreener. RESULTS: For 10 children the evaluation with the MTI photoscreener was not possible despite the fact that photographs were retaken several times. Thirteen photographs showing obvious pathologic findings despite their poor quality were included. Eighty-three of the remaining 102 children failed the eye examination according to the above-mentioned criteria. The mean sensitivity of the MTI photoscreener was determined to be 82.8%. The ability to correctly identify the absence of any amblyogenic factors (specificity) was 61.8%. CONCLUSIONS: Sensitivity was high when compared to the usually low detection rate during pediatric examinations. Due to the low specificity, effectiveness was poor. Therefore an ophthalmological examination should be included in the preventive screening during infancy and early childhood.

[Endophthalmitis after intra-oral block of the infraorbital nerve]. / Endophthalmitis nach enoraler Blockade des Nervus infraorbitalis.

BACKGROUND: Most penetrating needle puncture injuries occur in retro- or peribulbar anesthesia. Hereby only a small percentage of patients develop endophthalmitis. Ocular penetration after enoral infraorbital nerve block has not yet been reported in literature. HISTORY AND FINDINGS: In June 1995 a 74-year-old man presented with a fulminant fibrinous and purulent endophthalmitis. Because he suffers from trigeminal neuralgia his anesthesiologist performed an infraorbital nerve block from enoral two days ago. During this procedure the patient felt a sharp ocular pain. THERAPY AND OUTCOME: We suspected an ocular penetration and performed a vitrectomy with intravitreal antibiotic instillation on the admission-day. A needle penetration site near the inferior rectus muscle was detected and after exocryocoagulation a 5 mm wide radial buckle was sutured over penetration site. Three months postoperatively vision recovered from hand moving to 20/50 and all infiltrations had been disappeared. Only preexisting cataract prevented a better vision. 10 months later after successful cataract extraction with intraocular lens implantation patient left hospital with a vision of 20/30. CONCLUSION: Careful anamnesis would have prevented this accidental globe penetration. Right upper palate is absent presumably due to congenital cleft malformation or surgery. This allowed needle penetration through smooth tissue into the right globe. Fortunately, endophthalmitis develops only in a small percentage after needle puncture. We recommend immediate pars-plana-vitrectomy and intravitreal antibiotics in case of endophthalmitis after ocular penetration.

Vitrectomy in diabetic patients with a blind fellow eye.

Results of pars plana vitrectomy for complications of proliferative diabetic retinopathy were analysed in 32 consecutive patients with a blind fellow eye due to diabetic eye disease. The mean follow-up period was 22.3 months. Only 16% of all eyes examined had received full scatter photocoagulation prior to referral for vitrectomy. Out of 9 eyes with vitreous haemorrhage, 8 improved to a visual acuity of > or = 0.2 postoperatively. Amid 23 eyes which were vitrectomized for advanced traction retinal detachment, only 4 eyes improved to a postoperative visual acuity of > or = 0.02. In this group 12 eyes deteriorated after vitrectomy, 3 eyes progressing to no light perception. The postoperative visual outcome after vitrectomy for traction retinal detachment in this group of diabetics with a blind fellow eye (mean postoperative visual acuity 0.03 +/- 0.05) was significantly worse (p < 0.000) compared to a group of 196 patients with a seeing fellow eye who were vitrectomized for traction retinal detachment at our clinic (mean postoperative visual acuity 0.09 +/- 0.11). Therefore we conclude that traction retinal detachment in this subgroup of patients is a particularly severe presentation of diabetic retinopathy with a guarded functional prognosis after vitrectomy. Our results demonstrate the importance of timely full scatter photocoagulation and early vitrectomy in eyes with progressive fibrovascular proliferation not responding to panretinal photocoagulation. We conclude that especially diabetic patients with a blind fellow eye must be followed closely and assigned to vitrectomy at an earlier stage of their disease in order to improve functional prognosis.