[Ultrasound diagnostics in ophthalmology (standardized echography): part 2: diseases of the orbit - ultrasound biomicroscopy diagnostics]. / Ultraschalldiagnostik in der Ophthalmologie (standardisierte Echographie) : Teil 2: Erkrankungen der Orbita - Ultraschallbiomikroskopie-Diagnostik.

Ultrasound diagnostics have been one of the most important noninvasive supplementary diagnostic procedures in ophthalmology for many decades and are indispensable for many intraocular and orbital diseases. When the echography examination and analysis of the echograms obtained are correctly carried out, ultrasound diagnostics are characterized by a high measure of specificity and sensitivity.

[Ultrasound diagnostics in ophthalmology (standardized echography): part 1: principles and diseases of the eyeball]. / Ultraschalldiagnostik in der Ophthalmologie (standardisierte Echographie) : Teil 1: Grundlagen und Erkrankungen des Bulbus.

Ultrasound diagnostics has been one of the most important additional diagnostic non-invasive techniques in ophthalmology for many decades and is essential for many intraocular and orbital diseases. When echographic investigations and analysis of the echograms obtained are correctly carried out, ultrasound diagnostics demonstrates a high degree of specificity and sensitivity.

[Enlargement of an extraocular eye muscle: a symptom of cysticercosis]. / Raumforderung in einem äusseren Augenmuskel: Manifestation einer Zystizerkose.

BACKGROUND: Cysticercosis is one of the two infections caused by Taenia solium. It is endemic in areas with poor hygienic standards. In western countries the patients history of previous living or travelling in endemic areas is important. Neurocysticercosis is a manifestation with single or multiple ocular, orbital or cerebral lesions. PATIENT: Two patients presented with severe headache and pain in the ocular region. Both patients were diagnosed to have a cystic lesion in an extraocular muscle. RESULTS: Both patients had a manifestation of cysticercosis. Additionally patient no. 1 had a myositis of this muscle, patient no. 2 had a posterior scleritis. CONCLUSION: Without evidence of an eosinophilia and stool ova and cysts and without a positive ELISA-test for cysticercosis the pathognomonic appearance of the thickened muscle, the cyst and the scolex inside should lead to the diagnosis cysticercosis.

[Vitreoretinal operations with local anesthesia]. / Vitreoretinale Operationen in Lokalanästhesie.

The objective of this prospective study was to evaluate the intra- and postoperative pain in vitreoretinal surgery under retrobulbar anesthesia (RBA) in 53 patients, considering objective stress parameters such as blood pressure, heart rate and plasma concentration of cortisol (PCC). The level of pain was graded on a standard 4-point nominal scale. Mean pain score after RBA was 1.04, decreased perioperative to 0.77, and increased again with a maximum at 8 h postoperative to 1.15. The quality of RBA significantly correlated with the patient's pain during and at the end of surgery (P < 0.001). At the end of surgery (P < 0.001). At the end of surgery pain also correlated with the duration of surgery (P < 0.01). In 14 patients PCC was measured preoperatively. PCC decreased significantly after oral premedication with Lorazepam (18.4 to 12.6 micrograms/dl, P < 0.001). In the further course of surgery no significant differences in PCC could be detected in 26 patients. Pain during the operation correlated significantly with intraoperative (P = 0.01) and postoperative (P = 0.03) PCC. The objective stress parameters blood pressure and heart rate did not differ significantly during surgery. Of our patients, 77.4% decided that they would choose RBA again in case of ocular surgery.

[New knowledge of echographic imaging of the optic nerve. Experimental and clinical studies]. / Neue Erkenntnisse über die echographische Darstellbarkeit des N. opticus. Experimentelle und klinische Untersuchungen.

The optic nerve can be displayed in vivo by A- and B-scan techniques. To achieve correlations between the anatomical structure of the optic nerve and the echograms and to answer the question if by the usual examination techniques the diameter of the nerve can be measured, experimental studies on bovine optic nerves were carried out: examination of the bovine optic nerve in vitro with the A-scan technique; measurement of the sound velocity in bovine optic nerves. Additionally, we compared the two most common A-scan techniques for the display of the optic nerve in vivo in 47 normal persons and in 35 patients with changes of the optic nerve. The experimental studies showed that the orbital fat and outer sheaths of the optic nerve cause refraction of the sound beam. The sound velocity of ultrasound in bovine optic nerves was measured to 1567 +/- 25 m/s. The two most common examination techniques in vivo showed no differences in normal persons, but significant differences in patients with increased subarachnoidal fluid.

[Clinical studies of reduced accommodation in patients with HIV-1 infection]. / Klinische Untersuchungen zur Reduktion der Akkommodationsbreite bei Patienten mit HIV-1-Infektion.

PROBLEM Reduced accommodation in HIV-patients has been described. Yet, in literature, statistics on this item cannot be found. PATIENTS AND METHOD In 58 HIV-infected subjects of different infection stages, accommodation was measured using Clement-Clark's accommodometer. Average age was 34.9 years (sigma = 8.3 years) Stages of HIV-infection were defined according to CDC (Centers for Disease Control)-classification. RESULTS The decrease in accommodation did not show any correlation to the stage of HIV-infection neither to its frequency nor to its amount. An antiretroviral therapy may reduce accommodation loss. However, the effect is not statistically significant. Incommodating accommodation loss occurred only in a few cases. CONCLUSION Reduced accommodation is an early ophthalmological symptom of HIV-1-infection. Possible causes of this phenomenon may be either direct neuronal infection by HIV 1, pathologic changes of the lens or the ciliary body.

Evaluation of eyes harbouring perfluorocarbon liquid with standardized ophthalmic echography.

For the detection of perfluorocarbon liquid (PFCL) left in the globe after vitreoretinal surgery, the method of standardized ophthalmic echography proved to be very helpful and effective. Larger amounts as well as only a few remnant drops of PFCL are represented in standardized A-scans and in contact B-scans by typical acoustic signals caused mainly by the slow velocity of ultrasound in PFCL. A safe differentiation from other intraocular conditions can be made with standardized echography.

Ocular growth in infant aphakia. Bilateral versus unilateral congenital cataracts.

In a prospective study the changes in the ocular axial lengths and in the overall refractions were examined in cases of unilateral and bilateral congenital cataract requiring surgery during the first year of life. Measurements were taken on 18 children with unilateral and on 20 children with bilateral congenital cataract at the time of surgery and up to eight years postoperatively. Surgery was performed via a pars plana/plicata approach, and all infants were fitted with contact lenses. In cases of unilateral cataract, the ocular axial length tended to be superior to the age-matched values already prior to surgery. After four to eight years, one third of the eyes were clearly above normal. In cases of bilateral cataract, the axial lengths were reduced at the age of surgery in the majority of cases, and particularly in eyes that required surgery during the first six months of life. The curvatures of the contact lenses tended to remain unchanged in bilateral cataract, and decreased by about 0.7 mm in unilateral cases. This also reflects the high degree of microphthalmia in bilateral cases. After four to eight years, the degree of microphthalmia had usually increased. The overall refraction decreased significantly in unilateral and bilateral cataract during the first four years of life. The mean values were higher in bilateral than in unilateral cataract at all ages. The mean decrease was 15 diopters in unilateral cataract (SD +/- 5.5 dpt), and 10 diopters in bilateral cataract (SD +/- 6 dpt). When correlating the age-matched differences in the ocular axial lengths at the time of surgery with the overall refractions after four to eight years, a good correlation was found in the unilateral cases (eight eyes), and a poor correlation in the bilateral cases (24 eyes). The data indicate that intraocular implants should not be used in bilateral cataract requiring surgery during the first year of life as long as there is no possibility to change their refraction while in place. In unilateral cases, a relatively accurate prediction appears possible in a small number of eight eyes. However, an additional important correction with glasses would be needed before reaching the final refraction resulting in a high degree of aniseiconia, and eliminating the chances for binocular vision that are small anyway. Furthermore, data from other authors would indicate that the change in refraction may be much more important than expected when using intraocular implants in unilateral congenital cataract requiring surgery during the first year of life.(ABSTRACT TRUNCATED AT 400 WORDS)

Quantitative color Doppler imaging in untreated and irradiated choroidal melanoma.

Histological data indicate the importance of tumor vascularization as a determinant of the biological behavior and the response to radiotherapy in choroidal melanoma. Duplex ultrasound and color Doppler imaging, the combination of B-mode ultrasound and pulse-waved Doppler analysis, were used to measure quantitatively neovascular blood flow in 31 patients with choroidal melanoma. Follow-up studies (20 patients) were performed to investigate the change of tumor blood flow in choroidal melanomas after radiotherapy. Blood flow was detected in 30 out of 31 melanomas (size 3.1-17.8 mm) within the tumor and at the tumor base with a mean peak systolic frequency of 1.0 kHz (range 0.3-2.7 kHz), a mean end diastolic frequency of 0.3 kHz (range 0.1-1.0 kHz), and a mean frequency of 0.7 kHz (range 0.2-1.3 kHz). Two and six months after 106Ru/106Rh beta-ray application, 19 patients showed a significant decrease in peak systolic frequency. This occurred with and in advance of the decrease in the tumor size. In one patient, a rising maximum systolic frequency after radiotherapy marked a recurrent tumor growth. Results indicate that the quantitative measurement of tumor blood flow by duplex ultrasound and color Doppler imaging may be a new diagnostic modality for monitoring the effectiveness of radiotherapy in choroidal melanoma.

Quantitative duplex and color Doppler ultrasound in the follow-up of beta-irradiated (106Ru/106Rh) choroidal melanomas. A prospective study.

The tumor response to radiotherapy depends highly on the local oxygen concentration, which is governed by the tumor's microcirculatory network. The aim of this prospective study was to quantitate the neovascular blood flow in human choroidal melanomas prior to 106Ru/106Rh irradiation and during a 1-year follow-up period. Pulsatile blood flow was elicited by means of duplex and color Doppler ultrasound in 54 of a total of 55 untreated melanomas with a mean peak systolic frequency of 1.0 kHz (range 0.3-2.7 kHz). The neovascular blood flow decreased significantly 4 and 6 months after beta-irradiation. No intrinsic tumor vascularity was detected 8 and 12 months after treatment. In 3 patients, a rising peak systolic frequency occurred following radiotherapy in advance of recurrent tumor growth. Results indicate that the noninvasive quantitation of neovascular blood flow in irradiated choroidal melanomas by pulsed Doppler ultrasound offers a new diagnostic modality for assessing tumor recurrence.

Orbital tumours--the importance of standardized echography.

In a survey the diagnostic usefulness of standardized echography in orbital disease is demonstrated. Considering differential diagnoses it is stressed that ultrasonically determined location and size of the orbital lesion will not do alone. The main object is to achieve a specific diagnosis by way of tissue differentiation. The method is based on standardized A-scan supplemented by contact B-scan and Doppler sonography. Middle and posterior orbit is examined by transocular techniques. A paraocular approach is used for more anterior lesions. From personal experience from more than 300 orbital tumours examples are forwarded illustrating quantitative echography (internal structure, reflectivity, sound attenuation), topographic echography (borders, shape, location), and kinetic echography (consistency, mobility, vascularity). The combination of all nine criteria gives important guidelines concerning the specific lesions met in the orbit and paraorbital regions. The correlation between acoustic and histopathological features is stressed.

Duplex and color Doppler ultrasound in the differential diagnosis of choroidal tumors.

There is paucity of data on the value of neovascular blood flow measurements in the differential diagnosis of human choroidal tumors, mainly due to difficulties in quantitating tumor vascularity in vivo. Color Doppler imaging and Duplex ultrasound, the combination of B-mode ultrasound and pulse Doppler analysis, were used to quantify tumor blood flow in 103 untreated tumors of the choroid. Pulsatile blood flow was detected at the tumor base of 62 choroidal melanomas (tumor height (TH) 3.1-11.7 mm) with a mean peak systolic frequency (MPSF) of 0.98 kHz (range 0.3-2.7 kHz). Compared to melanomas pulsatile neovascular flow in choroidal metastases (TH 2.1-6.5 mm, n = 12) was significantly higher (MPSF 1.87 kHz, range 0.8-3.5 kHz). No Doppler signals were elicited from age-related macular degeneration (n = 9), choroidal nevus (TH 1.5-2.1 mm, n = 18) and choroidal osteoma (n = 2). The results indicate that the quantitative measurement of tumor blood flow by duplex and color Doppler ultrasound may serve as a new diagnostic tool in the evaluation of intraocular tumors.

Retrobulbar cysts in Aicardi's syndrome.

Case report of a four-year-old girl with Aicardi's syndrome diagnosed from the triad: absence of the corpus callosum, focal seizures, and chorioretinal lacunae. In addition, MR scans and orbital ultrasonography detected retrobulbar cysts behind the right microphthalmic eye not described so far. Analyzing the histological data from two previous reports, it becomes likely that the cysts have formed from abnormal migration of neuroretinal tissue through the border of the optic disc coloboma that was also present. This pathomechanism is also known in isolated colobomatous microphthalmos in which cysts may occur.

[Duplex sonography in ophthalmology: current approaches to research and perspectives]. / Duplex-sonographie in der Ophthalmologie: aktuelle Forschungsansätze und Perspektiven.

Duplex ultrasound imaging combines the investigation of morphological structures and hemodynamic data analysis. In ophthalmology the technique permits a non-invasive evaluation of retinal and orbital vascular disorders for diagnostic purposes as well as the quantitative measurement of vascularity in intraocular and orbital tumors. We present current approaches to quantitate velocity patterns in the ophthalmic and retinal artery by Duplex ultrasound imaging. Results and clinical applications of Duplex ultrasonography studies designed to characterize the vascular network in intraocular and orbital tumors are reviewed.

[Differential diagnosis of retinoblastoma]. / Schwierige Differentialdiagnose eines Retinoblastoms.

An 8-year-old boy presented with a white pupillary reflex. This clinical picture suggested a diagnosis of retinoblastoma or Coats' disease. Ultrasonography did not reveal the characteristic signs often seen in retinoblastoma. However, diagnostic vitrectomy and subsequent enucleation confirmed the diagnosis 'retinoblastoma'.

Epithelial tumors of the lacrimal gland: clinico-pathologic correlation and management.

Between 1960 and 1987 29 patients underwent surgery at the Munich University Eye Hospital for benign and malignant tumors of the lacrimal gland. Fifteen tumors were classified as pleomorphic adenomas (three of them with malignant transformation), nine as adenoid cystic carcinomas, two as adenocarcinomas, two as oxyphilic adenomas, and one as oxyphilic adenocarcinoma. The clinico-pathologic correlation of these tumors is described. All age groups were involved in both benign and malignant epithelial gland tumors. A fast growing lesion with bone destruction of the lacrimal fossa in association with pain was found to be highly suspicious of a malignant epithelial tumor. Prior to surgery, inflammatory lesions and lymphomas should be ruled out by clinical history, examination, diagnostic imaging techniques, and, occasionally, by a short course of oral corticosteroids. A diagnostic biopsy prior to tumor excision and a transfrontal surgical approach via craniotomy has a negative impact on the prognosis. Thus it is mandatory to remove epithelial lacrimal gland tumors completely at the time of the initial surgical procedure. Craniotomies facilitate recurrences of lacrimal gland tumors by infiltration into the central nervous system. Lateral orbitotomies using the Krönlein technique are the best surgical approach for successful removal of these unusual tumors.

[Acute vitreous hemorrhage--possibilities for differential diagnostic, echographic assessment]. / Akute Glaskörpereinblutung--Möglichkeiten der differentialdiagnostischen, echographischen Abklärung.

In acute vitreal hemorrhage, echography is the method of choice for evaluation of the vitreous body. Echography ist capable of providing information on the localization, the density, and the mobility, and in certain diseases, also on the cause of the hemorrhage. The echographic findings (standardized echography) recorded in 216 patients with acute vitreal hemorrhage examined within 14 months (Jan. 1988 to Feb. 1989) were evaluated. In 91 patients (42%) diabetic retinopathy was known: in such cases echography can disclose proliferative changes and traction-detachment of the retina. In 58 patients (27%) echography revealed a posterior vitreous detachment, while in 17 patients (8%) an additional retinal detachment was found. In 39 patients (18%) a degenerative, disciform lesion of the macula was revealed as the cause of the hemorrhage, in 5 patients (2%) a malignant melanoma of the choroid, and in 2 patients a (large) retinal tear. In 5 patients, apart from the vitreous opacities no changes in the posterior segment could be found.

[Digital subtraction phlebography of the orbit. Technic and diagnostic value]. / Die digitale Subtraktionsphlebographie der Orbita. Technik und diagnostischer Stellenwert.

Orbital venography in the diagnostic assessment of vascular and extravascular expanding lesions of the orbit has been almost abandoned during the last decade due to the rapid development of computed tomography, ultrasound echography, and magnetic resonance imaging. Digital subtraction angiography (DSA) is a new angiographic modality that has recently replaced conventional techniques. DSA saves time and contrast media while facilitating vascular imaging and processing; this decreases the invasiveness of angiographic procedures. We describe the technique used for orbital phlebography via puncture of a frontal vein and injection of a contrast medium during manual compression of the infraorbital veins. We present the history and diagnostic findings of a 21-year-old man suffering from an orbital varix and discuss the diagnostic value of digital subtraction phlebography. In summary, the application of digital subtraction techniques is recommended as an additional diagnostic modality, particularly when impaired venous perfusion of the orbit is suspected.

[Teratoma orbitae in the neonatal period]. / Teratoma orbitae im Neurgeborenenalter.

The orbital teratoma is a rare congenital neoplasm. It develops from ectopic pluripotential germinal cells. In none of the cases so far described in the literature were there any signs of malignancy. The clinical appearance of the tumor is very typical; it can be diagnosed by means of ultrasound and CT scan, as shown in the present paper. Fewer than 20% of all published cases of congenital orbital teratoma were treated by methods aimed at preserving the ocular bulb. The reason why so many cases were treated by exenteration of the entire orbit was the fear of malignancy which seemed to derive from the rapid growth of the tumor. However, not a single confirmed case of malignant orbital teratoma has been described in the literature. Hence an attempt should be made to perform a local excision of the tumor without sacrificing the ocular bulb. There is then a chance that some vision will be preserved and that development of the bony structures of the orbit will be improved.