Advances in ophthalmology = Fortschritte der Augenheilkunde = Progres en ophtalmologie最新文献

Central retinal vasculitits of the type reported herein occurs monocularly in young males. The presenting symptom is always a massive vitreous hemorrhage with gross visual loss, which tends to persist indefinitely. Vitrectomy through the pars plana is followed by complete visual recovery; the condition becomes quiescent, although recurrent hemorrhages may occur. Other complications seen after surgery are glaucoma and retinal detachment. 6 cases were seen in a period of 11/2 years.

Short comparison between psychophysic and electrodiagnostic tests in 20 eyes with macular edema from diabetic retinopathy. De Lange's curve, the critical flicker frequency in central fixation and the macular ERG are compared with the classical EOG and global ERG data. The methodology is briefly described. It allows a new approach of the macula and the macular ERG responses confirms the clinical tests.

The corneal epithelium serves as a barrier between tear film and stroma and maintains a smooth corneal surface. The optical features of the cornea, namely refraction and transparence, depend largely upon the characteristics of the superficial corneal layers. Any lesion of this superficial cell coat facilitates the penetration of particles of even small diameter (virus, bacteria) towards the stroma. In fact, viral corneal diseases usually start in the epithelium, the virus being replicated in transformed epithelial cells. Corneal wounds are rapidly covered by migrating epithelial cells, invading the lesion from the border of the epithelial defect. Cohesion between epithelium and underlying stroma remains very weak unless regenerating epithelial cells have synthesized a basement membrane, allowing thus a firm attachment between epithelial hemidesmosomes and basement membrane. Recurrent erosions occur readily in the absence of epithelial basement membranes. Presumably, corneal epithelium is involved in the biosynthesis of fibrillar collagen of the superficial stromal layers. Corneal wound healing is delayed by a pathological epithelium. Corneal hydratation is controlled by the endothelium. It maintains a bulk flow of water towards the aqueous humor side against a pressure gradient and regulates the movement of metabolites. In the case of endothelial malfunction, the corneal stroma thickens due to a swelling of mucopolysaccharides. The endothelium synthesizes a very thick basement membrane (Descemet's membrane). In penetrating corneal wounds, Descemet's membrane is synthesized by the endothelium.

Uveitis is divided into five clinical groups based on its severity and natural history. By using this classification appropriate and graded forms of therapy can be applied to individual patients with uveitis. In Group 1 patients (anterior uveitis syndrome) topical cortisone drops or ointment will control the disease. Group 2 (posterior uveitis) patients require local steroids (topical, subconjunctival or retrobulbar) and systemic steroids. Appropriate specific therapies are indicated if a causal organism can be identified. Patients in Groups 3 (cyclitis), Group 4 (uveitis in children) and Group 5 (severe intractable uveitis) are exposed to a high risk of cystic macula degeneration and must be treated with local and systemic cortisone and cytotoxic drugs if the steroid fails to control the inflammation or if cortisone has to be used excessively high dosage. The recommended regime of treatment is summarised in the diagram in figure 7.

Fluorescence angiography of the iris was performed on 75 patients with diabetes mellitus. The changes in the iris were classified as iridopathia diabetica simplex (ID-s) and iridopathia diabetica proliferans (ID-p), corresponding to similar changes in diabetic retinopathy. Thus punctate leakage of dye, especially around the pupillary margin, was classified as ID-s, whereas additional, angiographically verified new vessel formation was described as ID-p. 69 of the 75 patients (92%) showed diabetic changes of the iris. Of these, 50 (67%) had ID-s changes and 19 (25%) had ID-p changes. The incidence of diabetic iris changes appeared unrelated to age but appeared to increase with duration of the diabetes. A correlation between the onset of diabetic vascular changes of the iris and that of the retina could not be confirmed: the diabetic changes in the iris vessels can precede those of the retina whereas, on the other hand, almost all patients with a diabetic retinopathia also show an iridopathy. The clinical value of iris angiography lies therein that the first findings of diabetic vascular damage can be seen in the iris earlier than in the retina, the iris appearing normal on slit-lamp microscopy.

The slit lamp microscope is widely used in assessing patients pre-operatively and post-operatively with conical cornea which is a less sophisticated form of operating microscope. It is operative in terms of being used constantly in the surgeon's consulting rooms for the assessment of the patients pre- and post-operatively and therefore occupies a large proportion of the time involved in the treatment of these people. The management of these patients involves not only their local corneal disease but often more important the management of their emotional and medical problems particularly when there are associated atopic problems of eczema and asthma. Unfortunately there is no microscope or easy method in the control of these problems.