[Laser flare in combined cataract and glaucoma surgery]. / Laser-Flare bei kombinierter Katarakt- und Glaukomchirurgie.

BACKGROUND: We used a laser-flare meter to compare inflammation of the anterior chamber in combined cataract and glaucoma surgery with that in pure filtering surgery. MATERIALS AND METHODS: In 34 consecutive patients with primary chronic open-angle glaucoma (PCOG) we combined glaucoma surgery and cataract extraction with phacoemulsification and implantation of a foldable intraocular lens via the same incision. We compared the results with those in 32 PCOG patients receiving a single goniotrephination and in 45 PCOG patients receiving cataract extraction via clear cornea with implantation of a foldable lens. RESULTS: The increase in the flare in the first 2 days was significant in those receiving combined cataract and glaucoma surgery and in those receiving single goniotrephination but not in those receiving a single cataract extraction. After 3 weeks there was no significant difference to the preoperative value in any of the groups. The highest flare values were in patients after combined surgery, significantly higher than after cataract extraction in the first days and higher than in the goniotrephination patients 3 weeks after the operation. CONCLUSION: The highest flare on the first day was in combined cataract and glaucoma surgery. This may explain the more frequent scarring of the filtering bleb in combined surgery. Postoperatively the intraocular pressure and number of drugs used for glaucoma did not differ in patients with combined and single goniotrephination.

Comparison of analgesia and akinesia after retrobulbar injections at different speeds.

PURPOSE: To assess how the speed of injection of local anesthetic solutions affected pain of injection, bulbar akinesia and analgesia with retrobulbar anesthesia (RBA). METHODS: 70 patients undergoing RBA for cataract surgery were enrolled in a prospective masked trial. They were allocated randomly to receive 5 ml anesthetic solution injected either within 20 seconds (group A) or within 60 seconds (group B). Additionally, akinesia of the orbicularis muscle was created according to O'Brien's technique. The pain of injection was registered on an ordinal analogue scale immediately before and after RBA. The following data were collected before and 20 minutes after retrobulbar injection: eye motility (Kestenbaum test), and corneal sensitivity (0: no sensitivity; 1: sensitivity remaining). Data were also collected on age, sex, and bulbar length, and any side effects of the intervention. RESULTS: Injection pain did not differ in the two groups. After RBA horizontal and vertical eye motility was slightly lower in group A than group B. Persistent motility was found in 18 patients in group A and 16 in group B. Median horizontal and vertical motility was 0 mm in both groups. Four patients in group A and five in group B had corneal sensitivity persisting after RBA. CONCLUSIONS: This comparison of different injection velocities brought to light no significant differences regarding bulbar analgesia and akinesia after RBA.

[Ocular injuries and triage after the bombing attack on the United States embassy in Nairobi (Kenya)]. / Okuläre Verletzungen und Triage nach Bombenattentat auf die Botschaft der Vereinigten Staaten von Amerika in Nairobi (Kenia).

BACKGROUND: As a result of the terrorist bombings of the United States Embassies in Daressalam (Tansania) and Nairobi (Kenya) on August 7, 1998, over 200 people were killed. 5000 persons were injured severely. The purpose of this article is to provide a review of our experiences in the evaluation and treatment of patients with multiple simultaneous ocular injuries sustained in the Nairobi attack. PATIENTS AND METHODS: We treated eight survivors of the assault, four of them with extremely severe eye injuries. A three-tiered system of triage developed. The first level occurred on scene, in which minor injuries were treated locally and more severe injuries were transported by aeromedical evacuation to Landstuhl Regional Medical Center (LMRC), in Germany among other locations. Surgical exploration of all patients arriving at LRMC was performed and surgical repair was undertaken when appropriate and technically possible. Patients requiring vitreoretinal surgery were transferred either to Saarland University Eye Hospital, Homburg, Germany, or Walter Reed Army Medical Center, Washington, DC. RESULTS: Only one eye required enucleation, due to an almost complete extrusion of the retina. It was possible to stabilize even severely injured eyes with multiple intraocular foreign bodies. CONCLUSIONS: Modern microsurgical techniques such as temporary keratoprothesis, perforating keratoplasty, and pars plana vitrectomy can now save eyes and often allow restoration of usuable visual acuity where this once have been deemed impossible.

[Ultrasound localization of haptics of sclera attached posterior chamber lenses. Comparison of 2 high resolution ultrasound instruments]. / Sonographische Lokalisation der Haptik skleralfixierter Hinterkammerlinsen. Zwei hochauflösende Ultraschallgeräte im Vergleich.

BACKGROUND: The ciliary sulcus as the intended location of transsclerally fixated posterior chamber lenses (PCL) is withdrawn from the surgeon's view. Using high-resolution ultrasound, we acquire pictures that postoperatively allows us to determine the position of the haptics. METHODS: After transscleral fixation of PCLs in nine patients, we localized the haptics (central part and distal part of the haptic) by high-resolution ultrasound using the Ultrasound Biomicroscope 840 (Humphrey, 50 MHz) and the 13-System-ABD (M & C, 20 MHz). RESULTS: In most cases the central part of the haptic was located in the ciliary sulcus (UBM 840: 11/18; 13-System-ABD: 13/18). The peripheral part of the haptic could not be located in the ciliary sulcus in most cases (UMB 840: 5/18, 13-System-ABD: 6/18). In 6/36 cases the results of evaluation of the positioning of the haptic were different in both ultrasound examination systems. CONCLUSIONS: Both kinds of instruments lead to a sufficiently exact location of the haptics in all cases. Due to the higher resolution of the UBM 840 the structures of the ciliary body can be better demonstrated. The disadvantage, however, is that the instrument is more difficult to handle than the 13-System-ABD.

[Comparison of classical keratometry and computer-assisted corneal topography in high grade postoperative astigmatism after perforating keratoplasty]. / Vergleich von klassischer Keratometrie und computergestützter Hornhauttopographie bei hohem postoperativem Astigmatismus nach perforierender Keratoplastik.

UNLABELLED: The standard keratometry measures the central corneal refractive power by only four sample points. there is a risk for poor or incorrect measurements in high irregular postoperative astigmatism following penetrating keratoplasty. Therefore we compared the standard keratometry with the computer assisted corneal topography. METHOD: In the study 43 consecutive measurements after penetrating keratoplasty, with an astigmatism > 4 dpt measured with standard keratometry (Zeiss Ophthalmometer), were analyzed. A computer assisted corneal topography (Eye Sys) was performed simultaneously. 22 measurements were received before, 21 measurements after T-incisions. The astigmatism value and axis measured by keratometry and corneal topography were compared and the correlation coefficient were calculated. As a simple index for the asymmetry of the resulting corneal cylinder measured by corneal topography, the frequency and the axis difference of both steep hemimeridians within the 3 mm zone were determined. RESULTS: The astigmatism values measured by standard keratometry (8.1 +/- 2.7 dpt) were significantly higher than the values measured by the computer assisted corneal topography (6.1 +/- 2.2 dpt). The difference of the cylinder axis measured by standard keratometry and corneal topography was 19 +/- 23 degrees; 10 +/- 15 degrees before and 29 degrees +/- 26 degrees after T-incision. The comparison of the astigmatism values showed a correlation coefficient of 0.82 in the total group, of 0.84 before and of 0.83 after T-incisions. In 26% of all measurements the axis difference of both steep hemimeridians (3-mm zone) was more than 30 degrees. After T-incisions this difference increased. CONCLUSIONS: Based on the results of this study, it seems reliable to identificate patients with high postoperative astigmatism following penetrating keratoplasty by standard keratometry.

[Is cranial corneoscleral 6 mm "no-stitch" tunnel incision contraindicated in against-the-rule astigmatism?]. / Ist eine kraniale korneosklerale 6 mm "No-stitch"-Tunnelinzision bei einem Astigmatismus gegen die Regel kontraindiziert?

BACKGROUND: There is a risk to increase a preexisting astigmatism against the rule by performing the incision at the 12 o'clock position. PATIENTS AND METHODS: In the prospective study 15 patients with a preoperative astigmatism over 0.25 D axis 90 degrees +/- 15 degrees the first cataract extraction was performed by a cranial, the operation of the other eye by a temporal 6-mm no-stitch tunnel incision. RESULTS: The mean corneal astigmatism against the rule preoperatively was 1.02 +/- 0.5 D with cranial incision and 1.27 +/- 0.8 D with temporal incision. Postoperatively the corneal astigmatism was 2.18 +/- 0.9 D with cranial incision and 0.71 +/- 0.7 D with temporal incision. In comparison to the pre-existing astigmatism, there was an increase of the astigmatism with cranial incision more than double, with temporal incision the astigmatism was significant lowered. Postoperatively the astigmatism with temporal wound location was significant lower than with cranial incision. CONCLUSION: Under the aspect of a 1.5 D higher average astigmatism postoperatively, we conclude that a cranial 6-mm no-stitch tunnel incision in preoperative astigmatism against the rule is contraindicated.

Bacterial anterior chamber contamination with foldable silicone lens implantation using a forceps and an injector.

PURPOSE: To compare the rate of anterior chamber (AC) contamination during implantation of a foldable three-piece silicone lens using a forceps and an injector. SETTING: Department of Ophthalmology, University of Saarland, Homburg (Saar), Germany. METHODS: In a prospective, randomized study, we cultured AC aspirates of patients who had phacoemulsification with silicone lens implantation through a 3.5 mm temporal clear corneal incision. In Group A, the lens was implanted with a forceps and in Group B, with an injector. Immediately after lens implantation, the AC aspirate (0.05 to 0.10 ml) was collected and sent to the microbiology department. All cultures were incubated for 3 days. As a topical antibiotic, gentamicin was given preoperatively and intraoperatively. RESULTS: One hundred patients (50 in each group) were examined. In each group the bacterial contamination of the AC was 2%. CONCLUSION: Bacterial contamination of the AC was not significantly different after silicone lens implantation with a forceps and with an injector.

[Clinical aspects of ataxia teleangiectatica (Louis-Bar syndrome)]. / Zur Klinik der Ataxia teleangiectatica (Louis-Bar-Syndrom).

BACKGROUND: Ataxia telangiectasia is an autosomal recessive inherited multisystem disease of childhood characterized by progressive cerebellar ataxia, oculo-cutaneous telangiectasia, immunological defects with increased susceptibility to infection and malignant neoplasms. PATIENT: A 20-year-old patient with ataxia telangiectasia (Louis-Bar syndrome), demonstrating the typical features of this hereditary disease, is described. The ophthalmological findings showed telangiectasia of the horizontal conjunctival vessels in the exposed bulbar conjunctivae and oculomotor signs with pathological pursuit and command movements, dissociated nystagmus, failure of gaze holding and convergence. RESULTS: The ataxia is the first symptom and becomes apparent when the child starts to walk. The pathognomonic telangiectasia at the light-exposed areas of the bulbar conjunctiva point the way to the diagnosis. There is no specific treatment for this disease. CONCLUSIONS: The ophthalmologist is able to confirm the clinical diagnosis by demonstrating the telangiectasia. Due to the increased disposition to malignant neoplasms regular check-ups should be performed.

[Eye injuries caused by opening or explosion of beverage bottles]. / Augenverletzungen durch Offnung oder Explosion von Getränkeflaschen.

Exploding beverage bottles can cause serious ocular injuries. The mechanisms of injury and the consequences were studied retrospectively in 21 patients admitted to the hospital between 1982 and 1992. Most of the patients (76%) were injured by propulsion of the bottle cap. Bottle explosions following dropping on the floor were the most frequent cause of perforating ocular injuries by glass fragments from a beverage bottle. Among our patients, 12 (57%) had severe globe contusions and 9 (43%) had lamellar or penetrating globe injuries. In 83% of the contusions, 100% of the lamellar injuries and 62% of the penetrating eye injuries almost complete visual rehabilitation (vision 0.5-1.0) was achieved. Vision was saved in all the injured eyes. About 2% of all eye injuries admitted to hospital are caused by bottle explosions. The consumer can reduce the danger of bottle explosions by storing bottles in a cool place and taking care not to shake then before use. Manufacturing industry is called upon to develop and to use stopper systems connected to the bottles to prevent propulsion of bottle caps.