Julius R. Lukas

Two fibromuscular transverse ligaments related to the levator palpebrae superioris: Whitnall's ligament and an intermuscular transverse ligament.

This study was performed to reinvestigate the detailed anatomy of the connective tissues related to the levator palpebrae superioris (LPS).

Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma

PURPOSE To present the clinical and histologic findings of a patient in whom intumescent cataract developed after successful topical mitomycin-C (MMC) chemotherapy for conjunctival melanoma originating from primary acquired conjunctival melanosis (PAM) with atypia. DESIGN Observational case report; follow-up at 30 months. METHODS In a patient with PAM and subsequent conjunctival melanoma that was successfully treated with topical MMC chemotherapy an intumescent cataract developed after two cycles of 0.04% MMC, each for 1 month. RESULTS After MMC chemotherapy pigmentation of the acquired melanosis vanished almost completely. Histopathology of the check-up specimen revealed local tumor control. Six weeks after the completion of the second cycle, an intumescent cataract developed. Cataract surgery was performed uneventfully. The patient was followed up for 30 months. CONCLUSIONS In selected cases, topical MMC chemotherapy is effective for treating conjunctival melanoma. Although severe complications are rare and usually transient, development of cataract may be observed. A prospective study should be initiated.

Rapid Communication The Mydriatic Effect of Tropicamide and its Diagnostic Use in Alzheimer's Disease

The mydriatic effect of topically administered tropicamide was investigated as a possible diagnostic indicator for Alzheimers disease. Although an initial series seemed to show a correlation between hypersensitivity to tropicamide and intellectual impairment, subsequent testing showed a greater inter- and intra-individual variation than that between the normal group and the group of patients with intellectual impairment. This procedure seems, therefore, to lack sufficient specificity to be useful for such a diagnostic purpose.

Observations on the number, distribution and morphological peculiarities of muscle spindles in the tensor tympani and stapedius muscle of man

Although the middle ear muscles have been described for the first time more than four hundred years ago their role in modulation and transmission of sound is not yet fully understood. Surprisingly very little is known about proprioceptors in these muscles, especially in man, although this seems to be the key to the understanding of their various functions. Therefore, the question for proprioceptive sensory organs in these muscles is still relevant. The tensor tympani and stapedius muscles of four women who had donated their bodies to our institute were taken. Complete serial sections of these muscles were made which were either impregnated with silver, stained with ferric oxide for acidic polysaccharides or incubated with antibodies against S-100 protein. Thereby four to eight (mean five) muscle spindles distributed along the whole muscle could be detected in the tensor tympani muscles. These spindles contain one to three intrafusal muscle fibres and their length ranges from 140 to 4270 microm (mean 1492.8 microm). Furthermore, in three stapedius muscles one to two (mean 1.7) muscle spindles were found. They were from 350 to 500 microm (mean 482 microm) long and contained only one intrafusal muscle fiber. Regarding the diameter of intrafusal muscle fibers in both, the tensor tympani as well as the stapedius muscle, no difference to extrafusal muscle fibers of these muscles could be detected. The structure of these spindles differs considerably from those found in skeletal muscles. The morphological findings presented strongly suggest that muscle spindles occur regularly in both middle ear muscles. The results presented herein are consistent with clinical findings obtained from electromyographic studies and may help to elucidate all functions the middle ear muscles might serve in man.

Sensory innervation of the guinea pig extraocular muscles: A 1,1′-dioctadecyl-3,3,3′3′-tetramethylindocarbocyanine perchlorate tracing and calcitonin gene-related peptide immunohistochemical study

The sensory apparatus of the extraocular muscles attains special interest because of the great variation among different species with respect to the proprioceptors. The sensory innervation of the guinea pig extraocular muscles, lacking both muscle spindles and tendon organs, was investigated with a fluorescence double‐labelling method. Primary sensory perikarya were assessed by postmortem application of 1,1′‐dioctadecyl‐3,3,3′3′‐tetramethylindocarbocyanine perchlorate (Di‐I) to the extraocular muscle nerves. Traced neurons were found in the ipsilateral ophthalmic part of the trigeminal ganglion. This is in line with findings in other species. Calcitonin gene‐related peptide (CGRP) was detected immunohistochemically within the trigeminal ganglion. No somatotopic organization was observed for CGRP‐like immunoreactive perikarya. Small (maximal diameter below 30 μm), medium (maximal diameter between 30 and 50 μm), and large (maximal diameter larger than 50 μm) trigeminal ganglion cells were found among the primary afferent perikarya from extraocular muscles. Among CGRP‐like immunoreactive cells, only small and medium cells were observed. Double‐labelling experiments indicated the CGRP content of primary afferents of the guinea pig extraocular muscles. The relationship to former morphological categories of ganglion cells is discussed. Primary afferent neurons with CGRP‐like immunoreactivity might have efferent functions and might also be involved in inflammatory processes of extraocular muscles. J. Comp. Neuol. 380:16–22, 1997.

Ten-year follow-up of epikeratophakia for the correction of high myopia

OBJECTIVE To determine the long-term functional results of epikeratophakia for myopic patients. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Twenty-two patients (32 eyes; average age, 43+/-6 years) who underwent epikeratophakia surgery for high myopia. Mean preoperative myopia was -18.74+/-9.16 diopters (D; range, -7 D to -49 D). Follow-up was 12+/-2 years. MAIN OUTCOME MEASURES Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), change in mean keratometry, visual acuity under glare conditions, BCVA versus potential acuity meter reading, and patient satisfaction with the visual outcome. RESULTS Mean preoperative UCVA increased from 20/800+/-20/400 (range, counting fingers-20/400) to 20/80+/-20/200 (range, 20/250-20/32) in 24 eyes. Mean preoperative BCVA of 20/32+/-20/64 increased only in five eyes, whereas six eyes had no change and 18 eyes had a more than one line loss of Snellen BCVA. Mean preoperative keratometry reading decreased from 43.67+/-0.90 D (range, 41.0-46.25 D) to 37.40+/-2.92 D (range, 29.43-47.68 D). In the presence of glare, mean BCVA decreased to 20/100+/-20/100 (range, counting fingers-20/32). Potential acuity meter (PAM) readings were significantly (P<0.05) higher than BCVA. Mean PAM reading was 20/25+/-20/100 (range, 20/100-20/16). Seven patients (11 eyes) were extremely satisfied with the operative result more than 10 years after the operation, whereas four patients (four eyes) were not satisfied at all. CONCLUSIONS Epikeratophakia for the correction of myopia improved UCVA significantly, but BCVA decreased. The removal of the lenticules in patients who were not satisfied with their visual acuity was uncomplicated, and acceptable vision could be achieved with either contact lenses or intraocular lens implantation.

The mydriatic effect of tropicamide and its diagnostic use in Alzheimer's disease

The mydriatic effect of topically administered tropicamide was investigated as a possible diagnostic indicator for Alzheimers disease. Although an initial series seemed to show a correlation between hypersensitivity to tropicamide and intellectual impairment, subsequent testing showed a greater inter- and intra-individual variation than that between the normal group and the group of patients with intellectual impairment. This procedure seems, therefore, to lack sufficient specificity to be useful for such a diagnostic purpose.