[Current recommendations of dacryocystorhinostomy]. / Aktuelle Empfehlungen zur Dakryozystorhinostomie.

UNLABELLED: CURRENT RECOMMENDATIONS OF DACRYOCYSTORHINOSTOMYOBJECTIVE: With the implementation and the development of endoscopic systems, especially in functional endoscopic sinus surgery (FESS) in the last two decades, the gold standard considered external dacryocystorhinistomy (DCR) by Toti in patients with an obstruction of the lacrimal sac or the nasolacrimal duct has been replaced more and more by endonasal techniques. The endonasal approach, first performed in 1893 by Caldwell and publiciced by West 1911, has been modified since than, reached increasing acceptance and is nowadays often performed be ENT surgeons and ophthalmologists. MATERIAL AND METHODS: This review article presents the possible reasons of an obstruction of the lacrimal sac or the nasolacrimal duct with consecutive epiphora or recurrent dacryocystitis, describes diagnostic procedures and indications of therapy, and tries to demonstrate the surgical change towards endoscopic endonasal techniques. We compare both operation techniques and discuss their advantages with the focus on the endonasal approach. The relevance of additional adjuvants described in literatur (laser, use of mitomycin or fluoruracil or silicon intubation) are presented and discussed, too. RESULTS: At the end we discuss the published results of both techniques (endonasal vs. external DCR) and compare their success rates. In spite of the tendency towards endonasal endoscopic techniques the results of this approach seem to be a little worse in comparison to the results after external DCR.

Radiation effects on the optic nerve observed after brachytherapy of choroidal melanomas with 106Ru/106Rh plaques.

From 1966 to 1990 a total of 93 juxtapapillary choroidal melanomas were treated using 106Ru/106Rh plaques with a notch for the optic nerve. The choroidal melanoma was controlled after brachytherapy in 79 cases (85%). Fourteen eyes (15%) had to be enucleated because of tumor regrowth. Eye and optic nerve phantoms were fabricated, loaded with small-volume thermoluminescent dosimeters, treated with active plaques, and the radiation dose determined at the optic disc and along the optic nerve. The median dose within the anterior optic nerve was 51.2 Gy (range 10.3-60.5 Gy). The probability of developing complete radiation optic neuropathy (RON) was 23% and 53% at 5 and 10 years, respectively. The probability of developing partial RON was 66% at 5 years and 82% at 10 years. The probability of retaining visual acuity better than 0.5 was 38% at 5 years and 26% at 10 years. No dose-response relationship could be established from the ophthalmological, morphological and functional findings. Eyes following plaque irradiation with 50 Gy or more in the center of the optic nerve experienced significant radiation optic neuropathy, other eyes did not.

[Effect of change in refraction by increasing intraocular pressure with the suction cup method on pattern reversal VECP]. / Einfluss der Refraktionsänderung bei Erhöhung des Augeninnendruckes mit der Saugnapfmethode auf das Pattern-reversal-VECP.

When IOP is increased by the suction cup method, refraction changes will occur, depending on the shape of the cup and the height of the IOP increase. Similar refraction changes were simulated in six healthy volunteers by employing spherical and cylindrical glasses during pattern-reversal visual evoked cortical potential (VECP) with various check sizes and amount of contrast. While the pattern-reversal VECP latencies were not influenced, the amplitudes were reduced considerably. By using contact lenses and a suitably shaped suction cup, refraction changes could be compensated for. In 22 healthy volunteers pattern-reversal VECPs were derived with and without the application of contact lenses with artificially raised IOP. A comparison showed that the amplitudes differed significantly. Without contact lenses a negative pressure of more than 40 mmHg resulted in a drop in the amplitudes with a plateau formed between 80 and 120 mmHg. With compensation by contact lenses the amplitudes are found to be unaltered or even slightly increased until a negative pressure of 120 mmHg is reached in the suction cup, after which they drop. Plotting the pattern-reversal VECP amplitudes (obtained with refraction changes being compensated for by contact lenses) against ciliary perfusion pressure, one finds the characteristic curve described by Ulrich et al., suggesting an autoregulative capacity between 15 and 20 mmHg in healthy persons. The latencies, which remain uninfluenced by refraction changes, are also not altered within an IOP increase of 15-20 mmHg.

Refraction changes during elevation of intraocular pressure by suction cup, their reflection in the pattern visual evoked cortical potential and their compensation.

Visual evoked cortical potential studies using pattern stimuli with the intraocular pressure raised artificially by the suction cup method have been reported. Possible changes in the refraction of the eye due to the method employed and their influence on the pattern visual evoked cortical potential have not been considered. Changes in the refraction of the eye during artificial intraocular pressure elevation and the influence of such changes on pattern visual evoked cortical potentials were studied. The refraction changes were found to depend on the shape of the suction cup. They could be compensated for by employing properly shaped suction cups and contact lenses. The behavior of amplitude and latency of the pattern visual evoked cortical potential at artificially elevated intraocular pressure with compensation for refraction changes has been studied and found to depend in a characteristic manner on ocular perfusion pressure.

Pr VECPs related to ciliary perfusion pressure in primary open angle glaucoma. A study using contact lenses to compensate for refraction changes during artificially raised IOP.

Pr VECP studies in glaucoma patients with the IOP raised artificially by the suction cup method have recently been performed by several authors, who arrived at different results. The reason for those differences may be the changes employed. The refraction changes depend on the shape of the suction cup and the height of the artificial IOP raise. By using contact lenses and a suitably shaped suction cup refraction changes could be compensated for. Studies of the pr VECP with suction cup IOP elevation and simultaneous compensation for refraction changes by applying contact lenses were made on 17 patients with primary open angle glaucoma and 21 healthy volunteers. In healthy subjects pr VECP amplitudes were found unaltered or even slightly increased until 120 mmHg of negative pressure were reached in the cup. Beyond that range they dropped. Latencies remained unaltered over that range of negative pressures. Plotting the pr VECP amplitudes and latencies against ciliary perfusion pressure we obtained unaltered potentials over a range of ca. 20 mmHg, which we interpreted as autoregulative capacity. In the 17 glaucoma patients various degrees of impaired autoregulation were found corresponding to the progression of glaucoma damage.