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  • 1
    Electronic Resource
    Electronic Resource
    Ocular manifestations in a father and son with EEC syndrome (1997)
    Springer
    Graefe's archive for clinical and experimental ophthalmology 235 (1997), S. 512-516 
    Details
    ISSN: 1435-702X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract • Background: The ectrodactyly —ectodermal dysplasia —clefting (EEC) syndrome is a rare disease which follows an autosomal-dominant pattern of inheritance. Due to the ectodermal dysplasia there is atresia of the lacrimal duct system and aplasia of the meibomian glands with a defective tear film. Therefore, vascularized corneal scars often form during early adult life. • Patients: Father aged 41 years, and son aged 23 months.Both patients: stenosis/atresia of lacrimal duct systems (the father had twice undergone dacryocystorhinostomy externally) with epiphora, lip-palate clefting, syndactylies of fingers and toes, lobster deformities of hands.Additional ophthalmological findings in the father: bilaterally extracted juvenile cataracts with implantation of intraocular lenses, bilateral extensive vascularized corneal scars.Additional dermatological findings in the father: malignant melanoma of the calf, now in complete remission following several operations on the melanoma and several cycles of chemotherapy for the metastases. • Discussion and therapeutic conclusions: Father and son show the full clinical picture of the EEC syndrome with clefting, lobster-like deformities of the hands and ectodermal dysplasia with tear duct atresia and aplasia of the meibomian glands with defective tear film. During childhood, the main handicapping features are the clefting and the hand deformities with their respective multiple operative revisions. During early adulthood, however, the ocular problems become the predominantly handicapping aspects of the EEC syndrome; due to the ectodermal dysplasia, vascularized corneal scarring develops. Tearing and secondary inflammation due to lacrimal duct atresia has to be treated by early dacryocystorhinostomy. As secondary infections promote the development of corneal scars, one should not postpone the operation too long. Infections have to be treated promptly by local antibiotics. Because of the aplasia of the meibomian glands, artificial tear substitution should be given on a regular basis to support the defective tear film. Thus, the development of vascularized corneal scars can perhaps be delayed. Once corneal scarring has developed, perforating keratoplasty has a poor prognosis due to the ectodermal dysplasia, the absence of the meibomian glands and the defective tear film. Three factors lead to the formation of vascularized corneal scars: recurrent infections of lid margins and conjunctiva due to obstructed tear ducts; defective tear film with insufficient lipid phase due to the aplasia of the meibomian glands; and primary corneal epithelial defects in the course of the generalized ectodermal dysplasia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00947009
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  • 2
    Electronic Resource
    Electronic Resource
    The Ahmed Glaucoma Valve – a new implant for high intraocular pressure (1999)
    Springer
    Der Ophthalmologe 96 (1999), S. 653-657 
    Details
    ISSN: 1433-0423
    Keywords: Key words Glaucoma • Glaucoma drainage system ; Schlüsselwörter Glaukom • Drainagesystem • Ahmed Glaucoma Valve
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Hintergrund: Nach Implantation klassischer Drainagesysteme (z. B. Molten-Implantat) bei therapierefraktärem Glaukom ist das Hypotoniesyndrom in der ersten postoperativen Phase eine gefürchtete Komplikation. Durch die Integration eines Druckminderers in das System (Ahmed Valve) soll dies verhindert werden. Patienten und Methode: Bei 10 Patienten mit therapierefraktärem Glaukom wurde eine Ahmed Glaucoma Valve implantiert. Das mittlere Alter der Patienten beträgt 59 Jahre (22–81), die postoperative Nachbeobachtungszeit 8 Monate (4–20). Ergebnisse: Der Median des früh-postoperativen Drucks betrug 5,5 mm Hg (Range 4–8,5). Bei 2 Patienten trat vorübergehend eine Aderhautamotio auf, eine aufgehobene Vorderkammer wurde nicht beobachtet. Sechs Patienten hatten in den folgenden Wochen einen Druckanstieg über 22 mm Hg, der bei 3 durch Bulbusmassage dauerhaft gesenkt werden konnte. Bei 2 Patienten wurde eine Spülung des Drainagesystems durchgeführt. Bei 9 der 10 Patienten ist die Tension dauerhaft normalisiert, bei einem mit zusätzlicher lokaler antiglaukomatöser Medikation. Schlußfolgerung: Die Ahmed Valve bietet bei therapierefraktärem Glaukom eine sichere Methode zur Augendrucksenkung.
    Notes: Summary In incurable glaucoma the implantation of traditional drainage systems (such as the Molteno implant) usually leads to extreme hypotension in the eye in the first postoperative period. The Ahmed Glaucoma Valve presents an alternative method to avoid this problem. Patients and method: Ten patients with incurable glaucoma received an Ahmed Glaucoma Valve. The average age was 59 years (22–81) and the follow-up period was an average of 8 months (4–20). Results: In the early postoperative period the average IOP was 5.5 mm Hg (range 4–8.5). We saw chorioidal detachments in two patients but no shallow anterior chamber. In six patients the pressure rose over 22 mm Hg, but we induced filtration by massaging the eye or rinsing the system in three and two patients, respectively. In nine of the ten patients, tension was definitively regulated, in one with an additional topical medication against glaucoma. Conclusions: Unlike the classic glaucoma drainage systems, the Ahmed Glaucoma Valve reduces intraocular pressure in the first postoperative period without the problems of excessive hypotension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050469
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  • 3
    Electronic Resource
    Electronic Resource
    Peribulbäranästhesie transkutan oder transkonjunktival? (1997)
    Springer
    Der Ophthalmologe 94 (1997), S. 324-326 
    Details
    ISSN: 1433-0423
    Keywords: Key words Peribulbar anesthesia ; Transcutaneous anesthesia ; Transconjunctival anesthesia ; Pain ; Schlüsselwörter Peribulbäranästhesie ; Transkutan ; Transkonjunktival ; Schmerz
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Fragestellung: Die transkonjunktivale Peribulbäranästhesie soll im Gegensatz zur transkutanen Technik durch den Einblick in den Fornix eine bessere Identifizierung der Bulbusgrenzen ermöglichen und weniger schmerzhaft sein. Das Ziel unserer Untersuchungen war ein Vergleich zwischen beiden Injektionsarten. Patienten und Methode: Bei jeweils 23 Patienten wurde ohne zusätzlichen Fazialisblock die Peribulbäranästhesie transkutan bzw. transkonjunktival gesetzt. Vor der Peribulbäranästhesie erhielten alle Patienten Oxybuprocain –α-Augentropfen zur Anästhesie der Bindehaut. Vor sowie 20 min nach der Injektion wurden folgende Meßgrößen erhoben: Schmerz-Score (visuelle Analogskala), Häufigkeit einer auftretenden Bindehautchemosis und Nachinjektionen. Zusätzlich wurde die Einsehbarkeit des Fornix während der transkonjunktivalen Peribulbäranästhesie beurteilt. Ergebnisse: Die Schmerzen bei der transkonjunktivalen Injektion (5,66±2,4) waren signifikant höher (p = 0,05) als nach der transkutanen (4,20±2,4). Bei 2/3 der Patienten mit transkonjunktivaler Injektion war der obere Fornix nicht oder nur schlecht einsehbar. Schlußfolgerung: Die transkonjunktivale Peribulbäranästhesie scheint bezüglich der Anästhesie keine Vorteile im Vergleich zur transkutanen Injektion zu besitzen.
    Notes: Background: Transconjunctival peribulbar anesthesia is reported to permit better identification of the bulbar limits because of a better view into the fornix; it is also said to be less painful compared to transcutaneous peribulbar anesthesia. The aim of our study was to compare the two injection techniques. Patients and methods: This study comprised 46 patients undergoing eye operations under local anesthesia. They were allocated randomly in a prospective and simple masked study. Twenty-three patients received transconjunctival injections and 23 patients transcutaneous peribulbar injections. Before injection, all patients received Oxybuprocain eyedrops for anesthesia of the conjunctiva. In all cases no separate injections for lid akinesia were performed. Before and 20 min after the injection, the following parameters were assessed: pain score (visual analog scale), frequency of conjunctival chemosis and the necessity for supplemental anesthesia. For identification of the bulbar limits we checked if it was possible to see the caudal and the cranial fornix. Results: The transconjunctival injection was significantly (P = 0.05) more painful (5.6±2.4) than the transcutaneous injection (4.2±2.4). Among the patients with transconjunctival injection, in 66.6% the cranial fornix could not or was only poorly seen. Conclusions: Transconjunctival peribulbar anesthesia appears not to be more advantageous than transcutaneous peribulbar anesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050122
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  • 4
    Electronic Resource
    Electronic Resource
    Neurophysiological examinations in patients with pituitary surgery (1998)
    Springer
    Der Ophthalmologe 95 (1998), S. 28-32 
    Details
    ISSN: 1433-0423
    Keywords: Key words P-VEP • Pituitary • Adenoma • Electrophysiology ; Schlüsselwörter Muster-VEP • Hypophyse • Adenom • Elektrophysiologie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Fragestellung: Hypophysenadenome sind Tumoren der Sellaregion, die zu einer Kompression des Chiasma opticum führen können. Augenärztliche Untersuchungen stellen somit einen wichtigen Bestandteil der perioperativen Betreuung dieser Patienten dar. Patienten und Methode: Neben den klassisch ophthalmologischen Untersuchungsmethoden des bestkorrigierten Fernvisus und der Gesichtsfelduntersuchung verwandten wir die elektrophysiologische Methode der Muster-visuell evozierten Potentiale (M-VEP), um den perioperativen Verlauf nach durchgeführter transphenoidaler Resektion kontrollieren zu können. Ergebnisse: Die N75–P100-Amplitude des M-VEP erwies sich als sensitivster Marker zum Nachweis einer postoperativen Erholung. Es kommt nach durchgeführter Operation zu einem signifikanten Anstieg dieser Amplitude, wobei die P100-Latenzzeit sowie der Fernvisus und der Gesichtsfeldbefund keine signifikante Änderung zeigen. Schlußfolgerung: Das Muster-VEP stellt eine wichtige Ergänzung zur Verlaufskontrolle bei Erkrankungen mit der Gefahr der Optikuskompression dar.
    Notes: Background: Pituitary tumors are adenomas of a region of the sella turcica which can produce compression of the anterior visual pathway. Patients and methods: Besides clinical signs of visual improvement such as enhanced visual acuity and visual field, the use of electroophthalmological methods can help monitor patients after neurosurgery. Results: The N75 P100 amplitude of the p-VEP has proven to be the most sensitive marker for measuring-improvements after surgery. This amplitude significantly increased, whereas latency time, visual acuity and visual field showed no statistically significant changes after surgery. Conclusions: The p-VEP is an important tool in treating patients with compression of the visual pathway.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050231
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  • 5
    Electronic Resource
    Electronic Resource
    Developments in eye and general diseases in the Landesschule für Blinde und Sehbehinderte des Saarlandes in the last 20 years (1998)
    Springer
    Der Ophthalmologe 95 (1998), S. 51-54 
    Details
    ISSN: 1433-0423
    Keywords: Key words Visual impairment • Blindness • School for the visually handicapped and the blind • Multiple handicaps • Early promotion ; Schlüsselwörter Sehbehinderung • Blindheit • Mehrfachbehinderung • Sehbehindertenschule • Frühförderung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Fragestellung: Ziel dieser Studie war die Erfassung der Entwicklungen an einer Landesschule für Blinde und Sehbehinderte im Verlauf der letzten 20 Jahre bezüglich der Diagnosen und des Anteils Mehrfachbehinderter. Patienten und Methode: Untersucht wurden alle 175 Kinder der Sonderschule und der Frühförderung der Landesschule des Saarlands. Die Ergebnissse wurden mit einer Querschnittuntersuchung aus dem Jahr 1975 verglichen. Ergebnisse: Die wesentlichen ophthalmologischen Diagnosen waren: Optikusatrophie (17,5 %), okulärer Albinismus (11,9 %), Narbenstadium IV und V einer Retinopathia praematurorum (11,1 %) sowie tapetoretinale Dystrophien mit verwandten Syndromen (8,7 %) und Myopia permagna (7,9 %). Blind waren 10,3 %, sehbehindert 47,1 %, mehrfachbehindert (sehbehindert/blind) 42,5 % (1975 respektive 36,4 %, 49,2 %, 14,4 %). Schlußfolgerungen: 1. Die Erkrankungen, die früher in einer Sehbehinderten- und Blindenschule dominierten, sind selten geworden (Katarakt, Aphakie, Buphthalmus, Makuladystropie – hier alle je 〈 5 %). 2. Der Anteil vollblinder Schüler ist deutlich kleiner geworden. 3. Es besteht eine zunehmende Tendenz der integrativen Betreuung sehbehinderter Schüler ohne zusätzliche Behinderungen in Regelschulen. 4. Der Anteil der mehrfachbehinderten Kinder (Schulbereich: 42 %, Frühförderung: 74 %) steigt.
    Notes: Background: The aim of the study was the evaluation of how ophthalmological diagnoses and the proportion of multiply handicapped children has changed within the last 20 years at a state school for visually handicapped and blind children. Patients and methods: A profile investigation was conducted on all 105 children at the Landesschule für Blinde und Sehbehinderte des Saarlandes and compared to the results of an examination from 1975. Results: The predominant ophthalmological diagnoses were: optic atrophy (17.5 %), ocular albinism (11.9 %), scar-stage IV and V of retinopathy of prematurity (11.1 %), as well as tapetoretinal dystrophies with related syndromes (8.7 %) and myopia magna (7.9 %). Blind: 10.3 % (1975: 36.4 %); visually handicapped: 47.1 % (1975: 49.2 %); multiply handicapped: 42.5 % (1975: 14.4 %). Conclusions: (1) The diseases that dominated in earlier years in schools for the visually handicapped have become rare (cataract, aphakia, buphthalmia, macular dystrophy – all less than 5 %); (2) the proportion of completely blind pupils has become much smaller; (3) there is an increasing tendency to educate visually handicapped pupils in regular schools with integrative aids; (4) there is also an increasing proportion of multiply handicapped children (school and kindergarten: 42 %, early patronage 74 %).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050235
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  • 6
    Electronic Resource
    Electronic Resource
    Determination of haptics of transsclerally fixated posterior chamber lenses by high-resolution ultrasound: a comparison of two different instruments (1999)
    Springer
    Der Ophthalmologe 96 (1999), S. 187-192 
    Details
    ISSN: 1433-0423
    Keywords: Key words Transscleral suture fixation • Cataract surgery • Ultrasound biomicroscopy ; Schlüsselwörter Skleralfixierte Hinterkammerlinsen • Ultraschallbiomikroskopie • Kataraktchirurgie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Hintergrund: Bei transskleraler Fixation von Hinterkammerlinsen (HKL) entzieht sich die Lage der Haptik der direkten Beobachtung des Operateurs. Die hochauflösende sonographische Darstellung des vorderen Augenabschnitts ermöglicht postoperativ die Überprüfung der angestrebten Haptiklage im Sulcus ciliaris. Patienten und Methode: Wir untersuchten die Position der Linsenhaptik (zentraler und peripherer Anteil) bei 9 Patienten nach transskleraler Fixation einer HKL mit zwei unterschiedlich hochauflösenden Ultraschallgeräten, dem Ultrasound Biomicroscope 840 (Humphrey, 50 MHz) und dem I3-System-ABD (M & C, 20 MHz). Ergebnisse: Der zentrale Haptikanteil lag in der Mehrzahl im Sulcus cilliaris (UBM 840: 11/18; I3-System-ABD: 13/18), der periphere Haptikanteil in der Mehrzahl nicht im Sulcus ciliaris (UBM 840: 5/18; I3-System-ABD: 6/18). In 6/36 dargestellten Bügeln differierte die Beurteilung der Bügellage bei der Darstellung mit beiden Ultraschallgeräten. Schlußfolgerung: Beide Geräte sind in der Lage, die anatomischen Verhältnisse im Bereich des Sulcus ciliaris hinreichend genau darzustellen. Im Vergleich beider Geräte bietet das UBM 840 das bessere Auflösungsvermögen, das I3-System-ABD jedoch das komfortablere „handling“.
    Notes: Background: The ciliary sulcus as the intended location of transsclerally fixated posterior chamber lenses (PCL) is withdrawn from the surgeon's view. Using high-resolution ultrasound, we acquire pictures that postoperatively allow us to determine the position of the haptics. Methods: After transscleral fixation of PCLs in nine patients, we localized the haptics (central part and distal part of the haptic) by high-resolution ultrasound using the Ultrasound Biomicroscope 840 (Humphrey, 50 MHz) and the I3-System-ABD (M & C, 20 MHz). Results: In most cases the central part of the haptic was located in the ciliary sulcus (UBM 840: 11/18; I3-System-ABD: 13/18). The peripheral part of the haptic could not be located in the ciliary sulcus in most cases (UBM 840: 5/18; I3-System-ABD: 6/18). In 6/36 cases the results of evaluation of the positioning of the haptic were different in both ultrasound examination systems. Conclusions: Both kinds of instruments lead to a sufficiently exact location of the haptics in all cases. Due to the higher resolution of the UBM 840 the structures of the ciliary body can be better demonstrated. The disadvantage, however, is that the instrument is more difficult to handle than the I3-System-ABD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050393
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  • 7
    Electronic Resource
    Electronic Resource
    Improvement of the Osteo-odonto-keratoprosthesis according to Strampelli: influence of diameter of PMMA cylinder on visual field (1999)
    Springer
    Graefe's archive for clinical and experimental ophthalmology 237 (1999), S. 308-312 
    Details
    ISSN: 1435-702X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  · Background: In surgical management of severe corneal scarring, the osteo-odonto-keratoprosthesis (OOKP) according to Strampelli is recognised as the best choice. Nevertheless, the patients are handicapped by a restricted visual field. Enlarging the optical cylinder diameter should allow better rehabilitation of the patients. · Patients and methods: A mathematical model to calculate the theoretical maximum visual field according to the length and the diameter of the cylinder of a keratoprosthesis was developed. The theoretical values were compared with our findings in three OOKP patients operated on in our hospital. · Results: The theoretical extent of the visual field with a cylinder of 8 mm length is 55 deg if the diameter is 3 mm and 62 deg if the diameter is 3.5 mm. The visual fields of our OOKP patients in both types of keratoprosthesis are, however, below the theoretically calculated values. Implantation of a prosthesis with a diameter of 3 mm produced horizontal visual fields of 30 and 36 deg in two patients. In one patient with a prosthesis diameter of 3.5 mm the field was 53 deg. · Conclusions: The diameter of the visual field increases with the diameter and decreases with increasing length of the optical cylinder. In OOKP the implantation of a PMMA cylinder with a diameter of 3.5 mm is possible. The enlargement of the diameter of the optical cylinder leads to significant enlargement of the visual field. The size of the cylinder is limited by the diameter of the available root of the tooth.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004170050238
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