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

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 Unpublished, handwritten notes on 92 cataract operations were found only a short time ago in the library of the University of Basle.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).

When oxygen plasma was used for plasma etching it was possible to hydrophilize the surface of silicone intraocular lenses (IOLs) without changing the chemical composition or the properties of deeper layers of the polymer. The modification was characterized by surface analysis. (Electron spectroscopy = XPS, contact angle estimations) and by scanning electron microscope. A cytotoxic influence of the modified surface could be excluded by cell culture experiments in which we evaluated cell spreading, cell morphology, DNA synthesis and protein synthesis. In vivo experiments on rabbits showed that the postoperative foreign body reaction was not significantly influenced by the hydrophilization of the IOL surface. Over the entire follow-up period (12 weeks), there was a reduced tendency to induce posterior synechiae in the group with hydrophilized lenses (P = 0.009). The number of dislocations and the incidence of posterior opacification did not differ significantly; on the other hand there were indications of improved adhesion to the posterior lens capsule of the hydrophilized IOL.

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.

An automatic visual acuity test examining visual acuity at 5 m distance is presented. An LCD screen with 400 x 640 pixel is used for graphic display. The Landolt rings are selected randomly. The test presented here complies well with the criteria of DIN 58220. Accuracy estimates for representation of the Landolt rings in raster graphics are discussed. With the method suggested, the testing of visual acuity, one of the most important tests in ophthalmological practice, is simplified and its reliability and results are improved. The method allows tests at short time intervals to trace the time dependency of visual acuity. Furthermore, the test may be delegated to support personnel.

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.

We examined 44 HIV-positive patients in different disease stages with electroretinogram (ERG), pattern-electroretinogram (PERG), and visually evoked cortical potentials (VECP). Sixty-eight of the 88 eyes examined had a normal fundus and full central vision. Twelve eyes showed cotton-wool ecudates and 8 eyes CMV retinitis. Fifty-four eyes with normal fundus were examined by ERG. Of these 28 (52%) showed marked reduction of the amplitude. In the PERG, 20 eyes out of 50 examined (40%) showed an amplitude reduction. In the VECP, 12 out of 65 eyes (19%) had a reduced amplitude. In the ERG, 7 of 11 eyes (64%) with cotton-wool exudates showed marked pathological findings, as opposed to 4 of 10 cases (40%) in the PERG and 3 of 12 (12%) in the VECP. Seventy-five percent of the eyes with CMV retinitis (6 of 8 cases) showed pathological findings in the ERG and VECP and 100% (all 7 cases examined) in the PERG. These electrophysiological findings suggest that there are diffuse disorders in the retina of HIV-positive patients. It is possible that these findings are based on direct infection of the retina with HIV, or that they represent a vascular disorder, subclinical infection or are related to side effects of the drugs used for the HIV infection.

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.

Uni- or bilateral dilatation of pupils that are not reactive to light and lack miosis in response to 1% pilocarpine may be caused by contact with plants containing alkaloids such as scopolamine and atropine. Other causes of a non-light-reactive dilated pupil, such as Adie's tonic pupil, third nerve palsy and lesion of the mesencephalic pretectal region, must be excluded before testing the iris sphincter reaction to 1% pilocarpine. Among the naturally growing flowers in Germany, deadly nightshade (Atropa belladonna), jimson weed (thornapple, Datura stramonium) and black henbane (Hyoscyamus niger) contain enough alkaloids to cause mydriasis by direct contact. However, in most cases an accidental mydriasis by plants in Germany is caused by Datura arborea taxa, e.g. Datura suaveolens, D. candida, D. aurea and D. sanguinea. They contain up to 0.6% dry weight scopolamine. These plants can grow very large and are often planted in tubs. They have to be cut back each year before the winter. This is typically how the eye is contaminated by parts of the plants, which can cause dilatation of the pupil mimicing a neuroophthalmological disorder.