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

After local application of pilocarpine (minimum 1%), timolol (0.5%) or levobunolol (0.5%) to 6 patients, cell differentiation of the conjunctival epithelium was compared to that in 48 healthy persons. The least difference was found after pilocarpine application. The five ultrastructurally defined cell types were found to vary least when compared to the same cell types in normal subjects. The patients treated with timolol and levobunolol showed a reduction in secretory epithelial cells, especially within the conjunctiva bulbi, and a pronounced increase in cells with rough endoplasmatic reticulum. In addition to a loss of desmosomes and zonulae occludentes on the cell surface, a minimum 1-year application of the three antiglaucomatous medications leads to a reduction in the microvilli and microplicae and, particularly in patients treated with beta blockers, to intracellular changes, specifically increased vacuolization and dilation of the rough endoplasmatic reticulum. The latter may be attributable to the action of benzalkonium chloride (present as a preservative in all three eye drops studied) on the superficial epithelial cells. The cytotoxic action of the preservative may be intensified by the simultaneous application of beta blockers due to their destabilizing effect on the tear film.

The results of 32 keratoprosthesis operations performed in the course of 20 years are presented. In about one-third of the cases the results proved to be lasting. On the basis of the author's experience, rejection can be prevented for a longer period provided that the prosthesis is attached with cyanoacrylate on its basis. The importance of the new biopolymeric materials is discussed.

Angiographically visible lesions were produced in the fundus of rabbit eyes with repetitive 5 microseconds pulses and continuous wave exposures with 50-ms to 1-s pulse duration from an modified argon laser (514 nm). The ophthalmoscopic and the fluorescein angiographic findings showed less damage in the neural retina and the choroid after repetitively pulsed irradiation. Light microscopy and transmission electron microscopy showed that the neural retina and the choroid can mostly be spared by using repetitive 5 microseconds pulses, even though the damage to the retinal pigment epithelium is similar to the damage caused by continuous wave irradiation. Possible clinical applications, e.g. for macular edema and central serous retinopathy, are discussed.

We report a case of severe, bilateral panuveitis with disseminated chorioretinis. With systemic steroid therapy the inflammation resolved within 4 weeks, resulting in chorioretinal scarring. Because the agglutination titer against Yersinia enterocolitica type 3 was increased to 6 times over normal, we consider Yersinia to be the most probable cause of the panuveitis. Concomitantly, serology revealed evidence for recent infection with mumps and shigella. Both can cause anterior uveitis. Therefore, we cannot exclude interactions, which may influence the clinical picture. After reviewing the literature we describe for the first time a case of chorioretinits and panuveitis associated with infection by Yersinia.

A new experimental rabbit model was developed to investigate vitreoretinal proliferation (PVR). PVR was initiated by injection of zymosan A from Saccharomyces cerevisiae into the vitreous. The experiments were performed in two groups. In group A zymosan was injected into the normal vitreous; in group B zymosan was injected after the vitreous body had been degraded by the previous injection of hyaluronidase. In group A only moderate phagozytotic activity was found up to the 5 h day. However, in group B excessive invasion of macrophages was observed within 20 h and phagozytotic activity increased markedly. This was confirmed by an increase of enzymatic activity of beta-n-acetyl-glucoseaminidase in the anterior chamber and in the vitreous space. Transmission electron microscopy revealed characteristic morphology in zymosan A, which can apparently only be digested very slowly in the phagocytes. Therefore, macrophages could be traced during their transformation into fibroblastlike cells forming the vitreoretinal membranes.

We found a central retinal vein occlusion in three of nine patients with spontaneous arteriovenous fistulas of the cavernous sinus region. The femoral angiogram displayed a "low-flow" fistula from the internal carotid artery and/or dural branches of the external carotid artery into the cavernous sinus in all three patients. Angiographically, occlusion of the superior ophthalmic vein was present in all three patients. The arteriovenous flow of the shunt was directed into the sphenoparietal sinus and into other cerebral veins, but not into the orbit. This is the first angiographic demonstration of occlusion of the superior ophthalmic vein in patients with central retinal vein occlusion. The decrease in blood flow in the superior ophthalmic vein and the central retinal vein occlusion developed several months after the onset of the cavernous fistula. The occurrence of thrombosis is regarded as the consequence of venous stasis in the superior ophthalmic vein. It is assumed that the thrombosis grew retrogradely along the superior ophthalmic vein towards the central retinal vein. The intraocular pressure was not elevated in two of the three patients and therefore not regarded as the cause of the central retinal vein occlusion. Lid erythema and conjunctival hyperemia were pronounced in the acute stage of the fistula formation.

At the time of Goethe, Jung-Stilling (1740-1817) was highly regarded for his cataract operations. He had a general practice in Elberfeld from 1772 to 1778 and began to carry out his eye operations there. Unpublished, handwritten notes on 92 cataract operations were found only a short time ago in the library of the University of Basle. These notes show us that Jung-Stilling wrote proper case histories that correspond somewhat to the style we use today. Apparently these notes, Report on my cataract cures and healing methods of other eye diseases, formed the basis for the statistical result he published in Marburg in 1791 that represent his main medical work: Methods of taking out cataracts and of healing...

We analyzed retrospectively 239 consecutive patients who had undergone reoperation for repeat retinal detachment; 441 repeat operations were performed. The average follow-up was 2.1 years, and on average we noted 1.8 retinal redetachments per patient. At the last follow-up examination in 173 eyes (72.4%), the retina was reattached; 10.5% of the eyes had a partially detached retina and in 15.9% the retina was again completely detached. Enucleation was necessary in 3 eyes (1.2%). Visual improvement occurred in 45% of the eyes with reattachment of the retina. When the first retinal detachment occurred, 74 eyes were aphakic. Compared to the other 165 eyes there was no difference in anatomic or visual outcome. Aphakic eyes needed fewer additional reoperations (39%) compared to the phakic group (50%, p less than 0.01). One important reason for the surgery being unsuccessful was poor placement of the scleral buckle. In both groups equatorial placement of the scleral buckle led to anatomical success in more than 50%. The eyes in the aphakic group required more vitrectomies (47%) compared to the phakic eyes (34%, p less than 0.01).

We examined 590 endothelial photomicrographs of 327 patients with computerized morphometry; these patients had undergone penetrating keratoplasty in the period from 1981 to 1987. We found a weak negative correlation of r = -0.39 between postoperative endothelial cell density and the postoperative period. The endothelial cell density in the interval 12-24 months postoperatively averaged 1624 cells/mm. This is approximately 380 cells/mm more than described in other studies of that kind. We found significantly higher cell densities for cultured corneas and for corneas of young donors (age up to 39 years) up to 1 year postoperatively. Comparison of the diagnosis groups showed no relevant differences in postoperative cell density.

In animal studies, bromocriptine (Pravidel) has demonstrated immunosuppression because of inhibition of prolactin. After publication of positive results in the treatment of uveitis in a few case reports and in an uncontrolled study we conducted a double-blind placebo-controlled study in 13 patients with chronic recurrent anterior uveitis who had experienced three or more recurrences during the previous year. Therapy was started gradually during the symptom-free interval and continued for 1 year with 2.5 mg twice daily. Two recurrences or relevant side effects led to discontinuation of the therapy. In the bromocriptine group, 2 of 7 patients had no recurrences during the study period. Two patients had to stop because of two recurrences but, in contrast to earlier recurrences, they responded to local corticosteriod treatment within a few days. The remaining 3 patients (1 with one recurrence, 2 without) had to stop because of the side effects (arterial hypotension, arthritic complaints). In 5 of 6 patients in the placebo group treatment was stopped because of recurrences and in 1 patients because she believed she was experiencing a side effect from bromocriptine (breast atrophy). In summary, bromocriptine seems to have a prophylactic effect on anterior uveitis. Side effects were frequent but mild compared to other immunosuppressives. In case of arterial hypotension, additional therapy could make this drug more tolerable.