Fortschritte der Ophthalmologie : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft最新文献

In cases of PC-IOL implantation and ruptured capsule there will be a higher risk of the lens loosening into the vitreous, although many successful cases have been reported. Three years ago we investigated 42 eyes with PC-IOL that had experienced previous posterior capsular or zonular rents and partial vitreous loss. Three to 5.5 years after PC-IOL implantation we have now performed a second investigation on 38 of these patients to examine fixation of the lenses, visual acuity, intraocular pressure and the fundus of the eye. The 38 lenses all remained stable. The rate of patients achieving 20/40 or better visual acuity decreased from 68% at the first investigation to 55% (21/38). Excluding all patients with vision-limiting preoperative conditions such as age-related macular degeneration, we found a relation-ship of 83% to 75% (21/28). In addition to the three retinal detachments and two cases of endophthalmitis found during the first investigation, we also found another retinal detachment at the follow-up examination. Only two of these six eyes with severe complications had useful vision. We conclude from our investigation that PC-IOL implanted following a posterior capsule-zonular break during ECCE can remain stable, but still lead to serious complications.

Immunoregulation in the eye requires both an effective defense against exogenous pathogens and protection of the delicate anatomy of the eye against "innocent bystander destruction", which accompanies inflammatory reactions. We studied the role of uveal cells for local immunoregulation in the eye and investigated the effect of cultured Lewis rat ciliary body cells on antigen-specific 3[H]-thymidin incorporation in a T-helper-lymphocyte cell line (ThS) specific for the retinal-soluble antigen (SAg). Ciliary body cells inhibit the proliferation of ThS. This inhibition is not species-specific and is mediated by at least two mechanisms: a soluble inhibitor and a contact-requiring factor that is trypsin-sensitive, suggesting a protein molecule. After removal of these inhibitory components, ciliary body cells also exhibit the capacity to effectively present SAg to ThS. This dual effect of ciliary body cells on T-helper lymphocytes supports the concept of active local immunoregulation in the eye.

In a prospective study begun in March 1986, specular-microscopic endothelial cell photographs were taken in non-selected patients with primary, chronic, open-angle glaucoma who had not had intraocular surgery. Age-matched cataract eyes with normal intraocular pressure served as the control group. Standard specular microscopic examinations (Bio Optics LSM 2000 and Clinical Specular Microscope Camera) to evaluate the endothelial cell count, as well as the morphology and quality of the endothelium, revealed the following results. In 3204 normal eyes with normal intraocular pressure (10-20 mmHg), the cell count was observed to be age-dependent and to have an average value of 2293 +/- 394 cells/mm2; the cells generally had a regular arrangement. In 302 eyes with primary, chronic, open-angle glaucoma with intraocular pressures between 19 and 32 mmHg, there was a significant (p less than 0.001) reduction, in cell count to 1582 +/- 248 cells/mm2. The cell picture was composed of clearly enlarged, but regularly arranged cells. A statistical evaluation (matched age groups, etc.) was carried out using the Mann-Wilcoxon rank test.

The incidence of retinal detachment following cataract extraction was studied in a myopic population of 803 eyes, which were selected by a measurement of the axial length out of 3,184 cases consecutively operated on. The incidence of retinal detachment following intracapsular cataract extraction was 1.5%, which was very similar to that after extracapsular cataract extraction: 1.8%, in the lowest range of date published in the literature. The incidence of retinal detachment of the pseudophakic myopic eye (operated on with the extracapsular technique, combined with implantation of a posterior chamber lens, the PMMA optic disc, diameter 5.8 mm with a 10 degrees angulated haptic and modified prolene-C loops) was 1.1%, in which the cases of intraoperative posterior capsule rupture with vitreous loss were included. There was no correlation between the incidence of retinal detachment and axial length. All cases of retinal detachment appeared in eyes with an axial length of 24.2 to 27.0 mm. In 9 of 11 (75%), retinal detachments occurred during the first 18 months after cataract extraction. In our opinion extracapsular cataract extraction with implantation of a posterior chamber lens is the best method of providing postoperative retinal detachment of the cataractous myopic eye. The question of the incidence of retinal detachment following cataract removal by the extracapsular technique and secondary capsulotomy by the Nd-YAG laser is still interesting.

Selected features of cell morphology of the retinal pigment epithelia (RPE) were compared in newborn (42 eyes) and adult albinotic rats (34 eyes) at the age of 9 months. The RPE of newborn rats was found to consist of nearly homeomorphous, hexagonal, mononucleate, and relatively small cells (monomorphism). Minimal regional differences were found to exist. In adult albinotic rats the density of the RPE cell population was found to be considerably reduced, but the cells and nuclei were generally enlarged. A high percentage of RPE cells was found to contain two nuclei, and as a rule there were always some cells with three, four or even more nuclei. The picture of the cell mosaic was characterized by marked pleomorphism with regionally determined graduation. Pleomorphous changes were more pronounced in the central than in the more peripheral areas. The genesis and dynamics of cellular pleomorphism are also discussed.

Increasing loss of vision caused by peculiar macroscopic and functional retinal changes was the first ophthalmologic manifestation of Wilson's disease in a 22-year-old patient. Neither retinal changes nor great visual impairment has been described thus far in the literature concerning this disease. Likely correlations are discussed with Menkes syndrome, an X-linked inborn error of copper metabolism with onset in early childhood.

Herpes simplex virus (HSV) can induce severe inflammation in the retina. Von Szily described a model in which anterior chamber injection of HSV results in anterior uveitis with relative protection of the retina, but contralateral retinitis. The role of the immune system in the von Szily mouse model was investigated in our experiments. Earlier experiments demonstrated resistance to contralateral retinitis in some mouse strains. Our results suggest that natural killer (NK) cells do not play an important role in this phenomenon. In the next step the role of NK cells and T cells in the retinitis was investigated. After depletion of NK cells with anti-NK antibody, sensitive BALB/c and resistant CB17 mice did not have a higher incidence of retinitis. CB-17 mice developed more encephalitis after depletion, demonstrating an important role of NK cells against generalization of HSV. The role of T cells was investigated using T-cell-deficient nude mice. These mice had bilateral retinitis in about 95% of cases, demonstrating the role of T cells in protection of the retina in this model. Anti-HSV-1 serum transfer provided protection for the contralateral retina.

During vitreoretinal surgery, 23 epiretinal membranes from eyes treated with silicone oil were removed. They were examined by immunohistochemical methods and compared with 15 membranes from eyes affected by proliferative vitreoretinopathy (PVR) and not treated with silicone oil and with 4 membranes from eyes with intermediate uveitis. PVR membranes from eyes treated with silicone oil showed a high level of macrophages and a strong expression of HLA-DR. Additionally, lymphocytes were found in PVR membranes, a finding that has not been described before. Similar changes were seen in proliferations removed from eyes affected by uveitis, but these membranes were found to have smaller amounts of extracellular substance. In contrast to this, most cells in the PVR membranes from eyes not treated with silicone oil react with vimentin, GFAP and cytokeratin. In none of these membranes were we able to find T-lymphocytes. It is not possible to say whether or not the different findings are attributable ot the silicone oil.

75 eyes of 75 patients with different types of glaucoma (21 eyes with normal-tension glaucoma, 49 eyes with primary open-angle glaucoma and 5 eyes with pigmentary glaucoma) were examined by automated light-sense, flicker and resolution perimetry. All fields were classified as being "normal" (N) or having "diffuse loss" (D), "localized loss" (L) and "diffuse plus localized loss" (DL) in masked fashion. The frequency distributions for the various field loss categories against the highest intraocular pressure ever reported in the patients' records were plotted. The frequency distributions for the purely localized defects show a peak at 20 mmHg and are markedly skewed to low pressure values, while the diffuse plus localized damage and the purely diffuse loss, however, show a peak at about 30 mmHg. The data support the hypothesis that diffuse field loss may be an indicator of pressure-induced damage.

By employing the so-called inversion recovery technique, one has a nuclear magnetic resonance method at hand that allow discrete imaging of lesion in the intraorbital portion of the optic nerve in patients with optic neuritis. In our series, signal rich areas were visible in affected optic nerves in 15 of 18 patients. The areas of increased signal intensity involved the middle or the proximal third of the nerve and were still demonstrable following recovery of visual function. On the other hand, inversion recovery studies of the affected optic nerves following long inflammation free periods after an attack were within normal limits. Inflammatory edema or alterations in glial tissue may be considered as the causes of the increased signals.