[Telemedical-supported screening of retinal vessels ("talking eyes")]. / Telemedizinisch unterstütztes Screening der retinalen Gefässe ("Talking Eyes").

BACKGROUND: Cerebral and retinal vessels behave similarly under the influence of vascular risk factors. Several groups have shown that retinal microvascular abnormalities represent an independent risk factor with regard to strokes and heart attacks. AIM OF THE STUDY: The aim of this study was to perform a prospective screening examination with regard to retinal microvascular abnormalities as well as an extended vessel diagnosis in a subgroup of patients with lower arteriovenous risk values. METHODS: In the course of a prospective cross-sectional study ("Talking Eyes") between 1.9.2001 and 1.8.2002 a telemedical-supported screening of the retina (study I) was carried out in 7,163 subjects. The patients were selected without any inclusion or exclusion criteria. The mean age was 48.2 +/- 8 years (18 - 83 years) with a sex distribution of 39.2 % females to 60.8 % males. Digital fundus photos of the right and left eyes were taken for all patients. The pictures were taken without pupil dilation using a CANON-NM camera. The pictures and case histories were stored in a central server using web-based software (MedStage, Siemens). In a central reading centre, the arteriovenous ratio of both eyes was determined telemedically using the Parr-Hubbard formula and the retinas subjected to a standardised examination by an ophthalmologist. The retinal risk factor was calculated on the basis of the arteriovenous ration, the presence of microvascular abnormalities and the case history. The reproducibility of measurement of the arteriovenous ratio (Kronbach alpha coefficient) was evaluated by double measurements on 1,332 images. In a subgroup of study I with arteriovenous ratio values < 0.76 (N = 107), an extended vessel diagnosis with measurement of 24-h blood pressure and vessel-relevant blood values (homocysteine, cholesterol, LDL, HDL, CRP, TG, HbA1c) was carried out (study II). RESULTS: Study I: The Kronbach alpha coefficient as a measure of reproducibility amounted to 0.77. The mean arteriovenous ratio of the retinal vessels was 0.83 +/- 0.09 and showed a pronounced age dependence (R = 0.9, p < 0.0001). On multivariate testing the arteriovenous ratio correlated significantly (R = 0.33, p < 0.001) with the factors age, systolic blood pressure, diastolic blood pressure and body mass index. Diastolic blood pressure followed by age had the largest influence. The prevalence of microvascular abnormalities in the right (RE) and left (LE) eyes, respectively were: cotton wool foci RE 0.0015 %, LE 0.003 %, retinal haemorrhage RE 0.1 %, LE 0.1 %, focal stenoses RE 3.4 %, LE 3.4 %, tortuositas vasorum RE 4.1 %, LE 4.0 %, arteriovenous crossing signs RE 11.2 %, LE 11.2 %. On multivariate testing the occurrence of microvascular abnormalities correlated significantly (R = 0.38, p < 0.001) with the factors high blood pressure known from case history, body mass index, and gender. Arterial hypertension had the strongest influence followed by diastolic blood pressure. The calculated retinal risk factor correlated with the prevalence of angina pectoris. Study II: 2/3 of the subjects with arteriovenous risk factor values < 0.76 exhibited pathologically high 24-h blood pressure values. For these patients there were significant correlations between the arteriovenous ratio and the low-density lipoprotein concentration as well as the Framingham risk score. CONCLUSION: In the course of a prospective, telemedical-supported screening examination of the retinal vessels of more than 7,000 subjects the arteriovenous ratio exhibited a strong dependence on age and blood pressure. Among the subjects with lowered arteriovenous ratio values, 2/3 exhibited arterial hypertension in the 24-h blood pressure determination.

[Management of conjunctival malignant melanoma associated with primary acquired melanosis (PAM) using 0.02% mitomycin C eyedrops]. / Therapie maligner Melanome der Konjunktiva bei primär erworbener Melanose (PEM) mit Mitomycin-C-0,02%-Augentropfen.

BACKGROUND: The therapy of malignant diseases of the conjunctiva with local chemotherapy is an extension of the therapeutic options in this field. We report on our experience in the therapy of malignant melanomas of the conjunctiva associated with primary acquired melanosis (PAM). METHODS AND PATIENTS: Between March 1998 and April 2001, 13 patients with malignant melanoma of the conjunctiva associated with PAM (6 female; 7 male; mean age 57+/-13 years) were treated with local chemotherapy. The tumor was classified as stage pT2 (pN0, pM0) in seven patients, stage pT3 (pN0, pM0) in three patients and in the remaining three patients the lid was involved in the malignant process (pT4, pN0, pM0). Local chemotherapy (mitomycin C 0.02% eyedrops 5 times a day) was applied after incisional biopsies in 2 cycles for 14 days with a 14-day break. In 4 patients a third cycle was included. RESULTS: Regression of the tumor was observed after completion of the therapy in all cases. Severe ocular or systemic secondary effects were not seen in our patients. Nine patients were without recurrence within the follow-up time. In three patients, a recurrence of the disease was observed. In these cases, the eyelid was involved in the process. CONCLUSION: Local chemotherapy with mitomycin C is a useful option in the treatment of malignant melanomas of the conjunctiva associated with PAM if the tumor stage is pT3 or less. From our point of view the combination with incisional biopsy is of great benefit. Prognosis of conjunctival malignant melanomas involving the lid margin (pT4) is poor.

[Corneal neural paralysis after block excision including the 3 and 9 o'clock meridian]. / Korneale Neuroparalyse nach Blockexzision im Bereich des 3- und 9-Uhr-Meridians.

PURPOSE: Corneal innervation is mainly supported by the long posterior ciliary nerves. Anatomically, the long ciliary nerves run with the long ciliary arteries at 3 and 9 o'clock. The aim of this retrospective study was to find out if block excision of anterior uveal tumors or epithelial ingrowth located at the 3 or 9 o'clock position of the limbal circumference causes corneal neuroparalysis. PATIENTS AND METHODS: Between 1980 and May 1999, a total of 151 block excisions were performed in our department (92 block excisions because of anterior uveal tumors and 59 because of cystic epithelial ingrowth to the anterior chamber). In 27 patients, anterior uveal tumors or cystic epithelial ingrowth were located at the 3 or 9 o'clock position of the limbal circumference (14 patients with cystic epithelial ingrowth and 13 patients with anterior uveal tumors). Mean age of all patients was 54.4 +/- 15.7 years at the time of surgery. Mean diameter of the block excision was 10.7 +/- 4.5 mm for tumor-patients and 9.0 +/- 1.2 mm for patients with anterior chamber cysts. Mean follow-up time was 93.6 +/- 43 months. RESULTS: Only 1 of 27 patients exhibited a moderate neuroparalytic corneal ulcer during the follow-up time. In the remaining 26 patients, no signs of clinically relevant corneal neuroparalysis such as epithelial disorders or neuroparalytic ulcers were found. CONCLUSION: Block excision of tumors or cystic epithelial ingrowth located at the 3 or 9 o'clock position of the limbal circumference did not lead to severe neuroparalytic disorders of the host cornea. This may be an important factor in postoperative management of patients undergoing block excision and corneoscleral grafting.

[Postoperative opacification of 12 hydrogel foldable lenses (Hydroview(R))]. / Postoperative Kunstlinsen-Eintrübungen bei 12 Hydrogel-Intraokularlinsen (Hydroview(R)).

BACKGROUND: To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. PATIENTS AND METHODS: 12 patients (9 female; 3 male; mean age 77.5 +/- 3 years) were referred from one ophthalmologic surgeon because of opacification of IOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. RESULTS: IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 microm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). CONCLUSIONS: Postoperative opacification of hydrogel foldable lenses (Hydroview(R)) are apperantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.

Screening models for glaucoma.

For social and economic reasons, glaucoma screening is a useful and necessary task, with possible benefits for individuals and the health care system arising from the early diagnosis and early therapy of patients with glaucoma. Early treatment of patients with glaucoma decreases the probability that those patients will become blind and lowers the direct and indirect costs for patients with glaucoma. Most of the reported studies dealing with glaucoma screening used only one parameter (eg, intraocular pressure) to detect and to discriminate glaucoma patients from healthy subjects. Glaucoma screening devices might be combined to obtain the best specificity and sensitivity. Because the diagnosis of glaucoma is very closely associated with a morphologic change in the optic nerve head, one screening parameter should be the morphology of the papilla. To increase specificity and sensitivity, a combination of morphologic and functional testing might be useful. In this review, we report the context of glaucoma screening in terms of health economics, the testing quality of devices for functional and morphologic screening, and the results of a pilot study.

[Mid- and long-term results after trabeculectomy in patients with juvenile and late-juvenile open-angle glaucoma]. / Mittel- und langfristige Ergebnisse nach Trabekulotomie bei Patienten mit juvenilen und spätjuvenilen Offenwinkelglaukomen.

BACKGROUND: To determine success rate of trabeculotomy in patients with juvenile and late-juvenile glaucoma in a retrospective study. PATIENTS AND METHODS: 46 eyes of 41 juvenile glaucoma-patients (24 female, 17 male) were submitted to trabeculotomy during the period of 1980-1997. Patients age at the time of surgery was 30.2 +/- 10.5 years (11-49 years, median 21 years). Follow-up time was 35 +/- 46 months (1-155 months). RESULTS: Median preoperative visual acuity was 1.0 (range 0.002 to 1.25), postoperative visual acuity at the end of the follow up period was 0.8 (median) with a range from 0.002 to 1.2. In all patients preoperative intraocular pressure was elevated and a glaucomatous configuration of the optic disc was noticed. Preoperative intraocular pressure (IOP) ranged from 30.5 +/- 13.2 mm Hg, after surgery IOP was 16.2 +/- 5 mm Hg. Mean decrease of the IOP postoperatively was 54.4%. In 37% of the eyes IOP was lower than 23 mm Hg without additional medication, in 47% of the eyes IOP was lower than 23 mm Hg with additional medication. In 8 eyes additional antiglaucoma-surgery was necessary. After a follow-up time of 60 months 81% of the patients (n = 37 eyes) had an IOP below 23 mm Hg, after 120 months in 80% of the patients (n = 29 eyes) IOP was below 23 mm Hg. CONCLUSION: The success rate of trabeculotomy (defined as the ability to lower intraocular pressure lower than 23 mm Hg with or without antiglaucoma medication) in our patients is 84%. After second operation, success rate is 89%. Trabeculotomy for patients with juvenile open angle glaucoma is a safe procedure and avoids problems and complications of filtering procedures.

[Development of endothelial cell number in the host corneal endothelium. Status after block excision and eccentric corneal scleroplasty]. / Entwicklung der Endothelzellzahl der Wirtshornhaut. Situation nach Blockexzision und exzentrischer Korneoskleralplastik.

PURPOSE: Block excision of anterior uveal tumors and cystic epithelial ingrowth to the anterior chamber is a curative treatment for morphological rehabilitation of the globe. This study quantified the course of the host corneal endothelium after this peripheral corneoscleral graft. PATIENTS AND METHODS: This retrospective cross-sectional study examined 53 specular microscopic photographs of the central host cornea in 30 patients. The diameter of the block excision was 8.5 +/- 1.9 mm (6.0-11.0 mm). Follow-up after surgery averaged 37.9 +/- 47.6 months (1-216). RESULTS: The corneal endothelial cell count decreased with the duration of follow-up after block excision. The cell count was not related to indication for surgery or to diameter of block excision. Mean visual acuity was 16/20 before block excision and 6/20 at the end of follow-up. CONCLUSION: There is a significant loss of endothelial cells of the host after block excision, requiring a second central penetrating keratoplasty in some patients. Loss of endothelial cells may be due to the surgical trauma, chronic immunological reaction against the donor endothelium, or migration of the host endothelial cells onto the corneoscleral graft.

[Clearing of the host cornea after penetrating keratoplasty for pseudophakic bullous keratopathy]. / Aufklaren der Wirtshornhaut nach perforierender Keratoplastik wegen pseudophaker Hornhautendothel-Epithel-Dekompensation.

BACKGROUND: In this study, we have focussed on the clearing of the host cornea after successful penetrating keratoplasty (PK) for pseudophakic bullous keratopathy and the clinical factors that may influence this phenomenon. PATIENTS AND METHODS: We recruited the study group out of all keratoplasties performed in our department between 1984 and 1996 using the following criteria: (1) pseudophakic bullous keratopathy that involved the whole host cornea preoperatively, (2) no additional ocular diseases, (3) all operations performed before January 1st 1996, (4) sufficient photodocumentation, (5) complete clinical records, (6) clear graft at the end of the follow-up period. Using these criteria, 48 patients (28 females and 20 males; mean age at the time of surgery 72.7 +/- 8.8 years) were included in the study group. Donor age ranged from 34 to 86 years (mean age 65.8 +/- 12.0 years). The opacity of the host cornea was graded from 0 to 3 (0 = clear cornea; 3 = total opacity) within a circular zone of 1 mm diameter adjacent to the graft in four quadrants (I-IV). Finally, an index for the mean opacity index was calculated [TG = (I + II + III + IV)/4] and correlated with clinical parameters. RESULTS: The index for the mean opacity was 2.8 preoperatively. After a mean follow-up of 9.6 +/- 12.3 months, the index decreased significantly to 1.8 (p = 0.01). Mean visual acuity before PK was 20/400, at the end of the follow-up it was 20/50. The index of opacification was significantly correlated with patients age (p = 0.03; r = 0.2) and inversely with the follow-up period (p = 0.001; r = -0.6) and with the visual acuity at the end of the follow-up period (p = 0.05; r = -0.2). Using the 193-nm excimer laser for donor and host trephination led to a higher clearing of the host circular zone (mean opacification index 1.7) than mechanical trephination (mean 2.1) (p = 0.01). CONCLUSION: Our results indicate that expansion of donor endothelial cells onto host's Descemet's membrane is possible and successful with respect to clearing of the host cornea in pseudophakic bullous keratopathy. Nonmechanical excimer laser trephination of donor and host from the epithelial side seems to promote this phenomenon due to a better apposition of the cut surfaces.

[Results after cyclodiathermy: report on 29 eyes]. / Die antiglaukomatöse "direkte" Pars-plicata-Diathermie; Bericht über 29 Augen.

BACKGROUND: Persisting angle-closure glaucomas with circular anterior synechia and lost anterior chamber are at the moment an unsolved therapeutical problem. Antiglaucomatous anterior cyclodiathermy is a last therapeutical option to serve the eye. PATIENTS AND METHODS: We retrospectively examined the results and the complications of 29 eyes, which were consecutively treated with anterior cyclodiathermy between 1992 and 1998. RESULTS: We found a significant decrease of the intraocular pressure (IOP) during mean follow-up of 10 month, reduction of antiglaucoma medication, no change of visual acuity and no severe complications (no phthisis bulbi, no severe intraocular hemorrhage, no sympathetic ophthalmia). CONCLUSION: Anterior cyclodiathermy is a successful treatment for selected patients with severe forms of glaucoma, if other operation techniques and antiglaucoma medication fail to decrease the IOP.

[Papilledema and acute loss of vision in a patient with pseudotumor cerebri]. / Stauungspapille und akuter Visusverlust bei einer Patientin mit Pseudotumor cerebri.

PATIENT: We report on a 30-year old female with bilateral visual loss within four days. She assured that she had been able to do computer-work until four days before presentation. Ophthalmoscopy and echography established the diagnosis of a bilateral papilledema. Visual acuity was 20/500 in both eyes. Perimetry revealed a small central residual visual field. Further examinations lead to the diagnosis of a primary pseudotumor cerebri. CLINICAL COURSE AND THERAPY: Conservative treatment of the elevated intracranial pressure and ventriculo-peritoneal shunting improved visual acuity and visual field and lead to a decrease of the papilledema. Follow up time was 30 months. CONCLUSION: In a small number of patients pseudotumor cerebri presents with an acute visual loss. Immediate diagnosis and therapy can lead to an improvement of vision.

[Congenital divided compound nevi of the eyelids]. / Kongenitale geteilte Compound Naevi der Augenlider.

BACKGROUND: Congenital divided nevi of the eyelids are a rare melanocytic lesion. Only 30 patients are reported in literature. We report on a 6-year-old boy and a 41-year-old male with this lesion and give a short overview of the literature. CASE REPORTS: Patient 1: A 6-year-old boy presented with a pigmented divided nevus of the left eye involving the upper and lower lid naselly. The lesion had increased in size in the last one year. Otherwise the results of ophthalmological examination were unremarkable. The divided nevus was completely excised. Histopathological studies revealed a melanocytic compound nevus. Patient 2: A 41-year old male presented in our department with a divided pigmented nevus on his left eye involving the upper and lower lid laterally. The lesion had gradually increased since birth. Otherwise the results of ophthalmological examination were unremarkable. A subtotoal excision and debulking procedure was performed. The defect in the lower eyelid was covered using a transposition flap from the upper eyelid. Histopathological examination revealed a melanocytic compound nevus. CONCLUSION: Divided nevi of the eyelids may be disfiguring and include the possibility of deprivation amblyopia when reaching a certain size in childhood. Malignant changes of this lesion were not observed so far. Total excision or subtotal excision and a debulking procedure may be helpful.

Rhegmatogenous retinal detachment after block excision of epithelial implantation cysts and tumors of the anterior uvea.

OBJECTIVE: To report on frequency, time of occurrence, treatment, and final outcome of rhegmatogenous retinal detachment after block excision, combined with corneoscleral tectonic grafts, of intraocular epithelial implantation cysts and tumors of the anterior uvea involving the anterior chamber angle. DESIGN: Noncomparative case series. PARTICIPANTS: The study included 144 patients who had consecutively undergone scleral full-thickness block excision of tumors of the anterior uvea (n = 87) or intraocular epithelial implantation cysts (n = 57). Diameter of the block excision ranged between 5.5 and 20 mm. In 39 patients, the tumor extended posterior to the ora serrata. INTERVENTIONS: Retinal detachment surgery. MAIN OUTCOME MEASURES: Retinal detachment rate, visual acuity, risk factors. RESULTS: Retinal detachment occurred in 10 (6.9%) of 144 patients (2 of 57, or 3.5% of patients with cysts; 8 of 87 or 9.2% of patients with tumors) 3 to 12 months after block excision. Six patients underwent primary pars plana vitrectomy with temporary endotamponade by silicone oil, which was removed 3 to 9 months later. In four patients, a scleral buckling procedure only was performed. After a mean follow-up of 31 months after silicone oil removal or the buckling procedure (median, 30 months; range, 13-42 months), the retina has remained attached in all patients operated on. Visual acuity increased from 2/20 (median; range, light perception-6/20) to 8/20 (median; range, 2/20-12/20). In the eyes with retinal detachment compared to the eyes without retinal detachment, the block excision was significantly larger (13.75+/-4.86 mm vs. 9.41+/-3.02; P = 0.01) and was located significantly more posteriorly (limbus distance of posterior excision margin: 6.75+/-2.87 vs. 4.35+/-3.24 mm; P = 0.01). CONCLUSIONS: Scleral buckling procedures and primary pars plana vitrectomy with temporary ocular endotamponade can give acceptable results in eyes with rhegmatogenous retinal detachment occurring after block excision of epithelial implantation cysts or tumors of the anterior uvea. Despite intraoperative vitreous prolapse or tumor extension posterior to the ciliary body, rhegmatogenous retinal detachment occurs in fewer than 10% of patients undergoing block excision of cysts or tumors of the anterior uvea. Size and posterior location of the block excision are the main risk factors for rhegmatogenous retinal detachment, which becomes unlikely later than 12 months after surgery.

[Expulsive hemorrhage in perforating keratoplasty--incidence and risk factors]. / Expulsive Blutung bei der perforierenden Keratoplastik--Inzidenz und Risikofaktoren.

BACKGROUND: Expulsive hemorrhage is a severe complication of intraocular surgery. In a retrospective study we looked up surgical records of all penetrating keratoplasties (PK) performed in our department between 1989 and 1998. In all patients suffering from expulsive or preexpulsive choroidal hemorrhage we intended to find out possible risk factors and to report on the final outcome of these eyes. PATIENTS AND METHODS: Between January 1989 and November 1998 a total of 2421 PKs were performed. Nine preexpulsive and three expulsive hemorrhages occurred. The group of patients with preexpulsive hemorrhage consists of four females and five males (mean age 57 +/- 6.5 years). Three patients (one female, 2 males; mean age 67 +/- 8.5 years) suffered from expulsive hemorrhage. RESULTS: Incidence of expulsive hemorrhage was 0.1% (preexpulsive hemorrhage 0.4%). All twelve operations were performed under general anesthesia. Risk factors for preexpulsive hemorrhage were: previous ocular surgery (three patients), ocular trauma (2 patients) and internal diseases (five patients): arterial hypertension, coronary heart disease, diabetes. Preoperative visual acuity was light perception to 4/20, visual acuity at the last postoperative examination after a mean follow-up of 41.0 +/- 22.6 months ranged from light perception to 12/20. Risk-factors for expulsive hemorrhage were: previous ocular surgery (two patients), primary open angle glaucoma (two patients), coronary heart disease (one patient) und asthma bronchiale (one patient). One of the patients awoke from general anesthesia during the "open-sky" situation. Preoperative visual acuity was light perception to 2/400, visual acuity at the last postoperative examination (mean follow-up 14.0 +/- 1.0 months) was light perception in all eyes. CONCLUSION: The incidence of an expulsive hemorrhage was 0.1% in 2412 Pks. Risk factors are ocular and internal predispositions which can hardly be controlled, although arterial blood pressure was not significantly elevated during opening of the globe.

[Changes in retinal blood flow by topical administration of 0.1% dipivefrin]. / Retinale Blutflussveränderungen durch topische Gabe von Dipivefrin 0.1%.

PURPOSE: Most of the antiglaucomatous drugs affect ocular blood flow. Blood flow of the anterior uvea under the effect of glaucoma medication has been described in the literature, but measurement of microcirculation at the posterior pole correlated to glaucoma medication is rarely found. We present a placebo-controlled study in which we focused on the short and long-term effects of topical dipivefrine 0.1% on the microcirculation of the retina and optic nerve head. PATIENTS AND METHODS: In a randomized, placebo-controlled double-masked study we examined 40 healthy persons (21 male and 19 female) with a mean age of 35 +/- 4.6 years. Two groups of volunteers (n = 20) were treated either with placebo or dipivefrine 0.1% for 5 days twice a day. Measurement of microcirculation was done at baseline, 30 min after the first application and on days 3 and 5. Microcirculation was evaluated by scanning-laser Doppler flowmetry (SLDF, Heidelberg Engineering; Heidelberg, Germany) [retinal and optic nerve head capillary blood flow (ONH)]. Systemic parameters were checked at all times of blood flow measurement (blood pressure, pulse); intraocular pressure (IOP) was also measured at baseline, 30 min after and on days 3 and 5. RESULTS: Systemic parameters: None of serum medications affected blood pressure or pulse. Dipivefrine 0.1% lowered the IOP significantly (P = 0.01). Microcirculation: dipivefrine 0.1% leads to a significant reduction of retinal capillary blood flow (P = 0.01). ONH blood flow was not significantly affected by dipivefrine 0.1%. CONCLUSION: Retinal capillary perfusion is affected by dipivefrine 0.1% medication. In neuroprotection, it is of interest that glaucoma medication did not alter the microcirculation in a way that leads to an increase of hypoxemia. Therefore, we consider dipivefrine 0.1% not to be useful for long-term glaucoma treatment.

[Value of conjunctival biopsy in diagnosis of sarcoidosis]. / Wertigkeit der Bindehautbiopsie bei der Diagnosestellung der Sarkoidose.

PURPOSE: Retrospective study concerning the value of conjunctival biopsy in the diagnosis of sarcoidosis. PATIENTS AND METHODS: Between 1990 and 1996 we performed conjunctival biopsy in 11 patients (mean age 42.7 +/- 16.4 years) with suspect of sarcoidosis. RESULTS: In 8 of the 11 patients the diagnosis of sarcoidosis was established during the clinical course. In four of these eight patients conjunctival biopsy was positive. Five of the eight were under systemic steroids at the time of biopsy. Of the four patients with clinically established sarcoidosis and negative biopsy, three were under systemic steroids at the time of biopsy. In two patients diagnosis of sarcoidosis was established primarily by conjunctival biopsy. CONCLUSION: Conjunctival biopsy is a simple tool in the diagnostic of sarcoidosis. If possible, biopsy should be undertaken before systemic steroid treatment. We consider conjunctival biopsy to be useful as the first diagnostic tool before other invasive methods.

[Outcomes after penetrating keratoplasty in congenital hereditary corneal endothelial dystrophy (CHED). Report on 13 eyes]. / Ergebnisse nach perforierender Keratoplastik bei kongenitaler hereditärer Hornhaut-Endotheldystrophie (CHED). Bericht über 13 Augen.

BACKGROUND: Congenital hereditary endothelial dystrophy (CHED) is a rare bilateral corneal disease. The stromal opacity is supposed to result from terminal misdifferentiation of the endothelial cells. In this study we present the morphological and functional results after penetrating keratoplasty in children with CHED who were operated in our department between 1981 and 1997. PATIENTS AND METHODS: In a retrospective clinical cross-sectional study we looked up case histories of 13 eyes from 8 children (7 female, 1 male) with a mean age of 6.0 +/- 3.1 years (ranged from 3 to 14 years). In all children penetrating keratoplasty was performed by one surgeon (GOHN), in 3 eyes using nonmechanical excimer laser trephination. The graft-diameter was in 7 eyes 7.0/7.1 mm, in 2 eyes 7.0/7.2 mm, in 2 eyes 6.5/6.6 mm (resp. 6.8 mm), in 2 eyes 6.0/6.1 mm (resp. 6.2 mm). Fixation of grafts was achieved in 2 eyes by single running suture, in 8 eyes by double running suture and in 3 eyes by multiple interrupted sutures. RESULTS: During a mean follow-up of 4.0 +/- 2.4 years visual acuity increased in all patients (from light perception to 6/20 preoperatively to 2/200 to 14/20 postoperatively). In one patient corneal endothelial-epithelial-decompensation occured (both eyes unterwent previous antiglaucomatous surgery elsewhere), and in 1 patient loosening of one suture happened after 10 month. No immunological graft reaction occurred during follow-up. After excimer laser trephination (3 eyes from 2 patients) visual acuity and corneal astigmatism after surgery was favorable in comparison to all other patients. CONCLUSION: In children with CHED penetrating keratoplasty results not only in a clear cornea but also in a satisfactory functional outcome. Postoperatively periodical morphological controls and assessment of refraction as well as means to prevent amblyopia are indispensable before age 7.

[Cataract surgery in patients with retinitis pigmentosa]. / Kataraktchirurgie bei Patienten mit Retinopathia pigmentosa.

BACKGROUND: Because of the retinal alterations visual acuity of patients with retinitis pigmentosa is more affected by loss of contrast than in normal persons. Therefore cataract in retinitis pigmentosa (mostly posterior subcapsular cataract) leads earlier to decreasing visual acuity than is expected from the lens opacity. In a retrospective study we have looked up all patients with retinitis pigmentosa and cataract which were operated between 1989 and 1997 at our department. PATIENT AND METHODS: Between 1989 and 1997 50 eyes of 36 patients (21 female, 15 male; mean age 51 +/- 11.4 years) with the diagnosis of retinitis pigmentosa and cataract underwent extracapsular cataract extraction and IOL-implantation. In a retrospective study we studied all case histories of these patients. Mean follow up time was 1.2 +/- 1.2 years. RESULTS: Preoperative visual acuity was 0.1 +/- 0.1, best postoperative visual acuity was 0.3 +/- 0.2. Visual field was not affected by cataract-surgery. Postoperative complications were not found. 2/3 of all patients were satisfied with the postoperative visual acuity, 1/3 of all patients did not give comments. CONCLUSION: In patients with retinitis pigmentosa cataract surgery leads to significant increase of visual acuity. Cataract extraction should not be with held from patients with retinal dystrophy.