Complications in orbital lesions.

Excellent imagination of anatomy and diagnostic procedures are the basis for the diagnosis and therapy of orbital lesions. They can divided into (1) periorbital, and (2) intraorbital diseases: (1.1) fractures of the orbital floor; (1.2) alterations of the orbital roof; (1.3) endonasal ethmoidal removal; (1.4) operations for orbital decompression; (2.1) arterial lesion with increase of tension after retrobulbar injection, vulneration of the ethmoidal arteries and resection of orbital fat; (2.2) retrobulbar tumors. Examples are demonstrated. The most frequent complications are disturbances of motility, but operative revisions of these should not be done before 6 months have passed. Additional therapeutic recommendations are made.

Normal pattern electroretinograms in amblyopia.

Checkerboard reversal stimuli were used to evoke transient pattern electroretinograms (P-ERGs) from the eyes of 14 patients with amblyopia and 14 normal subjects. In the control group, and in normal eyes of patients, pattern electroretinograms were obtained with monocular central fixation. Amblyopic eyes were examined by monocular and binocular fixation, and the fixation point was shifted horizontally and/or vertically until the P-ERG reached its maximal amplitude. After adjusting visual fixation, there were no significant differences in amplitude between the normal and the amblyopic eyes. In addition, the differences between both eyes were compared with the right-left eye variability of the 14 normal subjects. In the amblyopic eyes, no P-ERG abnormality was observed. These results do not support previous reports of reduced P-ERG amplitudes and are in agreement with recent findings obtained under steady-state conditions.

[Experiences with a modified, intraocular pressure-reducing excision of the ciliary body]. / Erfahrungen mit einer modifizierten, augeninnendrucksenkenden Ziliarkörperexzision.

The treatment of hemorrhagic secondary angle-closure glaucoma following central venous occlusion is generally very difficult. Sautter's ciliary body excision is preceded by two semicircular cyclocryocoagulations performed within 7 days of each other. If IOP remains above 30 mm Hg and the subjective complaints are unchanged, oculopression lasting 10 minutes is performed after local retrobulbar anesthesia. The lowering of pressure thus achieved is sufficient to render a Flieringa ring and paracentesis unnecessary. Several illustrations are included showing the surgical procedure. In 9 cases of hemorrhagic glaucoma following central venous occlusion, there was a further deterioration in vision 8 to 23 months postoperatively. Preoperatively, IOP was between 36 and 63 mm Hg; at late postoperative follow-ups it was between 5 and 30 mm Hg. Complications worth mentioning included three slight losses of vitreous, bleeding into the anterior chamber in four cases, and one loss of the anterior chamber with caput medusae of the iris and secondary opacification of the lens. In 2 cases of aphakic secondary angle-closure glaucoma there was no deterioration in vision and a lowering of pressure to under 30 mm Hg, in spite of 3 preceding intraocular operations. The authors regard the slightly modified ciliary body excision as a possible way of preserving the bulb.

[Inflammatory and regressive changes of the posterior surface of the cornea]. / Entzündliche und regressive Alterationen der Hornhautrückfläche.

A 52-year-old woman contracted a serious influenza; three weeks later a dropshaped patch, whitish-yellow in color and deeply vascularized, was seen on the posterior upper surface of the cornea of one eye. It was accompanied by an anterior uveitis. The Tyndall phenomenon was positive. The sensibility of the upper quadrants of the cornea was reduced, temporally to 1.84 g/mm2, nasally to 3.20 g/mm2. Central vision was approx. 0.03. The condition was treated locally with steroid eye drops and generally with Diclofenac 2 X 50 mg. The infiltration became clearer as a result and vision increased to 0.8. Further examinations over a period of 2-1/2 years revealed crystal-like deposits and fiberglass-like structures. The erythrocyte sedimentation rate remained elevated. Since the etiology of these changes is still unknown, the authors suggest the purely descriptive term 'deep parenchymatous keratitis'. It would seem likely that this is a herpetic condition, especially in view of the decreased sensibility of the upper quadrants of the cornea.

[Ocular motility disturbances following frontal sinus operations (author's transl)]. / Bewegungsstörung des Augapfels nach Stirnhöhlenoperationen.

160 patients were operated on due to injuries, inflammations or tumors of the frontal sinus. There occurred in 23.8% temporary and 8.1% permanent double vision. By synoptometric investigations the origin of these disturbances of the ocular motility was analysed and separated into several groups. Different reasons for the cause of the motility-disturbances are given, their prophylaxes and therapy are discussed. The consequence of these investigations is that the method of operation should be modified to an osteoplastic way.

[Fractures of the orbital floor (author's transl)]. / Frakturen des Orbitabodens Diagnose, Behandlung und synoptometrische Kontrollen.

Within 5 years (1973--1977) 171 facial fractures were treated surgically at the University ENT-Clinic Marburg. 115 cases (67,3%) showed a fracture of the orbital floor, either an isolated fracture of the orbital floor (24 cases) or combined with fractures of the orbital rim in combination with midfacial lesions of the central type (42 cases) or of the lateral type (49 cases). After analysing the mechanism of those fractures the main symptoms and the most important diagnostic investigations (x-ray tomograms, synoptometric investigations, forced-duction-test) are shown. By two examples the results of the prae- and postoperative synoptometric investigations are explained. Those investigations enable a more exact diagnosis in all types of orbital fractures and demonstrate exactly the postoperative functional results.

[Examinations of aminoacids in aqueous humour after intravitreous injection of ascorbic acid (author's transl)]. / Aminosäureuntersuchungen im Kammerwasser nach intravitrealer Injektion von Ascorbinsäure.

The ascorbic acid concentration of the vitreous of rabbits was experimentally increased to about 20 times the normal value. 24 h after the intravitreal injection of ascorbic acid 13 out of 16 free amino acids were decreased, only Glutamicacid, Glycine and Alanine were increased. 48 h after the injection 13 amino acids were lowered. On the fourth day 8 amino acids were decreased in relation to normal values. After 4 weeks the concentrations of 5 amino acids were raised further compared to the normal values, but 10 amino acids were concentrated lower than the normal values. Also Glu-acid, Gly and Ala had fallen down to the range of the normal values. The total amino acids include the free amino acids and the amino acids, which we find after 6 h hydrolysis. On the first day 11 amino acids showed elevations, 7 amino acids were decreased. After 4 weeks Taurin, Lysine and Histidin were higher than the normal values, 15 amino acids were lower. In single cases the differences were statistically significant. We suppose, that the changes of amino acids are caused by the ascorbic acid or their derivates. There is an anterior drainage after intravitreal injection. We come to the conclusion, that there is a reversible disturbance of the diffusion and active transport of amino acids by ascorbic acid.

[Tuberous sclerosis with megalocornea and coloboma of the iris (author's transl)]. / Tuberöse Sklerose mit Megalokornea und Iriskolobom

A mentally and physically retarded 4 1/2 year-old boy with epileptic seizures showed a megalocornea on both sides, a coloboma of the iris in the right eye and a white area at the temporal side of the disc in the left eye. At first a coloboma of the disc was suspected. By further controls at the age of 8 years a typical two diopters elevated nodular opaque white mass was seen in place of the white area in the left eye, in addition two flat tumours were also seen. In the right eye with coloboma of the iris there was also a flat area. Radiographically the right kidney showed two ureters with flat calyces. At the age of 8 years symmetrical face naevi occurred only under atropine medication, and showed at the age of 10 years the typical picture of Pringle's tumours.

[Postoperativ binocular function after full prismatic correction in patients with concomitant convergent strabismus and exuberance of convergence (author's transl)]. / Postoperatives Binokularsehen nach Prismenausgleich bei Einwärtsschielern mit Konvergenzüberschuss

We investigated the cases of 50 non amblyopic children with concomitant convergent strabismus and exuberance of convergence, in which a prolonged prismatic correction was performed. 31 children had a 5 degree higher angle of squint in near vision before the application of prism. In 13 out of 31 the angle of squint, which was measured at the gaze for distance, increased more than 6 degrees. The ratio of normal retinal correspondence (NRC) to abnormal retinal correspondence (ARC) is 14:17. 19 patients developed only after prismatic correction of the angle of squint an exuberance of convergence. This phenomenon we call secundary exuberance of convergence. In this group the angle of squint for distance vision increased in only three children more than 6 degrees, while 6 children had a decrease by up to 11 degrees. The ratio NRC: ARC is 7:12. Postoperativ follow-up of binocular function over 4-5 years showed, that the prognosis in case of primary exuberance of convergence is worse than in secondary.