[Optic neuropathy in type-1 diabetes and acetylsalicylic acid-refractory thrombocyte activation]. / Opticusneuropathie bei Typ-I-Diabetes und Acetylsalicylsäure-refraktärer Thrombozytenaktivierung.

A 26-year-old female with severe complications from type I diabetes mellitus of 17 years' duration (proliferative retinopathy, nephropathy with renal failure and nephrotic syndrome) developed rapid deterioration of vision in the right eye to 6/60 over a period of several weeks. There were no other neurological signs. Ophthalmological examination showed no worsening of the diabetic retinopathy, but the presence of bilateral optic atrophy, confirmed by visual evoked potentials. CT scan did not reveal any retrobulbar process, and MR scans of both the optic nerves and the visual pathways were unremarkable. The clinical features and the investigations pointed towards ischaemic optic atrophy. Detailed platelet studies showed intravascular platelet activation and an ADP-inducible increase in aggregation, although thromboxane formation was almost absent because of cyclooxygenase inhibition by acetylsalicylic acid. These findings suggest that the ischaemia was due to microcirculatory disturbances secondary to diabetic microangiopathy and platelet hyperreactivity.

[Surgical correction of astigmatism after perforating keratoplasty]. / Chirurgische Astigmatismuskorrektur nach perforierender Keratoplastik.

Microsurgical control of astigmatism after perforating keratoplasty has widely remained an unsolved problem in spite of many sophisticated suggestions and inventions. The frequent irregularity in the recipient cornea and poor predictability with respect to wound healing are the major obstacles. If spectacles or contact lenses cannot provide useful vision, postoperative surgical correction is needed. Ablative or thermal laser techniques have not been sufficiently tried for such cases to be justified, and one may hesitate anyway to apply destructive methods in transplants. We therefore still use T-incisions and wedge resections, which are said to be rather imprecise. Only 3 out of more than 700 keratoplasties performed in our clinic from 1987 through July 1991 required such procedures. Two more cases were referred by surgeons outside the hospital. All five surgical corrections resulted in a good longterm effect with considerable improvement of vision. Thus, as long as alternative methods for surgical correction of postkeratoplasty astigmatism have not proved to be superior, we should continue to practice these "old" methods, which, indeed, are not bad if properly applied.

[Perfluorodecalin as a hydrokinetic substance in complicated retinal detachment]. / Perfluorodecalin als raumtaktische Substanz bei komplizierten Netzhautablösungen.

Perfluorodecalin is a clear colourless fluid with high specific gravity. It is immiscible with gas, blood, water, or any other fluid used in vitrectomy. The low viscosity permits easy injection and removal with microsurgical equipment. The high weight displaces subretinal fluid anteriorly through retinal breaks back into the vitreous space. Posterior retinotomies can be avoided. A large bubble of perfluorodecalin in the vitreous cavity stabilizes the retina mechanically during dissection and peeling of epiretinal membranes. Before the procedure is ended the fluid must be completely removed from the eye and replaced by BSS, air, gas, or silicon oil. We present the surgical technique and preliminary results.

[Keratoplasty in infancy and early childhood with special reference to the auto-rotation technique]. / Keratoplastiken im Säuglings- und Vorschulalter unter besonderer Berücksichtigung der Autorotationstechnik.

Between January 1987 and August 1990, a total of 20 keratoplasties were performed in infants and children in the University Eye Hospital, Düsseldorf, accounting for 4% of all keratoplasties during this period. The indications included malformations of the anterior segment and central corneal opacities, mostly of herpetic or microbial etiology. The ages of the patients varied from 2 weeks to 6 years, and the cases were followed up for an average of 2 years. Five (25%) were treated with the autorotation technique. Visual acuity after surgery was satisfactory, although an irregular astigmatism was found in three cases and one child eventually had to have a contact lens fitted. In view of our encouraging results we recommend that ipsilateral rotational autokeratoplasties should be considered more often for suitable forms of central corneal opacyty, particularly for infants and children.

[Gas gangrene of the eyelids and orbits]. / Gasbrand des Lides und der Orbita.

Infections with Clostridia are very rare in the orbital region. On the basis of a case report of such an infection in the orbit the authors discuss the clinical behavior, diagnosis, and therapy of this infection with anaerobic bacteria. Computerized tomography was been very helpful in the diagnostic procedure.

[Toxic retinopathy in cyclosporin A therapy]. / Toxische Retinopathie unter Cyclosporin A-Therapie.

A bone marrow transplantation was performed in a 17-year-old male patient suffering from acute undifferentiated leukemia. The patient received Cyclosporin A--a powerful immunosuppressive agent--to prevent a severe, chronic graft-versus-host disease. While undergoing this therapy the patient suffered a loss of visual acuity in both eyes 17 months after bone marrow transplantation. The substrates of the visual acuity loss were multiple retinal changes. Cotton-wool spots, intraretinal and preretinal hemorrhages were found in both eyes, and a macula edema in the left eye. The possible role of the immuno-suppressive agent Cyclosporin A in the pathogenesis of these changes is discussed.

[Successful treatment of choroid hemangioma with secondary changes caused by Sturge-Weber syndrome]. / Die erfolgreiche Behandlung eines Aderhauthämangioms mit Sekundärveränderungen bei Sturge-Weber-Syndrom.

A 12 year old patient was treated for Sturge-Weber syndrome with choroidal haemangioma and total exsudative retinal detachment. The diagnosis was supported by echography and thin-layer computed tomography. Because of the exsudative retinal detachment photocoagulation could not be performed. Treatment by percutaneous radiotherapy with Caesium 137 was performed. The retina was reattached by application of 30 Gray. A flat pigmented scar developed in the area of the haemangioma at the posterior pole of the eye. No side effects appeared. The follow-up time is 26 months.

[Radiotherapy of the hemangioma of the choroid]. / Zur Strahlentherapie des Aderhauthämangioms.

For the first time, a report is given on the percutaneous radiotherapy of hemangiomas of the choroid which could not be treated by photocoagulation. Diagnosis and control examinations of these tumors were performed by ophthalmoscopy, fluorescence angiography, and ultrasonography. Ten eyes (nine patients, three out of them with Sturge-Weber's disease) were treated between 1967 and 1982. A first group (five eyes, five patients) treated until 1974 received a target volume dose of 1,65 to 6,5 Gy combined with subsequent photocoagulation. All these eyes could be preserved. In addition, the second group (five eyes, four patients) treated since 1975 with unique radiotherapy showed better results with respect to visual acuity. The average follow-up period was four years (seven months up to nine years). Late effects were not observed. Even in case of advanced disease with retinal ablation and secondary glaucoma, an inactivation of the hemangioma of the choroid and a simultaneous regression of the secondary alterations could be achieved. According to our experiences, enucleations can be prevented by an irradiation with a target volume dose of 20 to 30 Gy.

[Computer tomography contrast media studies for the demonstration and therapy control of angiomatous tumors of the eye using the example of ocular manifestations of Sturge-Weber disease]. / Computertomographische Kontrastmittelstudien zum Nachweis und zur Therapiekontrolle angiomatöser Tumoren des Auges am Beispiel der okulären Manifestation des Morbus Sturge-Weber.

Thin-layer computed tomography of the orbit together with contrast representation by computed tomography in form of circulation studies is the only non-invasive method to represent intraocular hemangiomatous tumors hidden under an exsudative detachment of the retina. This method allows to establish exact tumor parameters which are necessary for an efficient therapy. In this case, radiotherapy with Cs137 is applied.