Michael J. M. Groh

Postoperative Kunstlinsen-Eintrübungen bei 12 Hydrogel-Intraokularlinsen (Hydroview®)

Background: To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. Patients and Methods: 12 patients (9 female; 3 male; mean age 77.5 ± 3 years) were referred from one ophthalmologic surgeon because of opacification of lOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. Results: IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 μm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). Conclusions: Postoperative opacification of hydrogel foldable lenses (Hydroview®) are appearantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.

Rhegmatogenous retinal detachment after block excision of epithelial implantation cysts and tumors of the anterior uvea

OBJECTIVE To report on frequency, time of occurrence, treatment, and final outcome of rhegmatogenous retinal detachment after block excision, combined with corneoscleral tectonic grafts, of intraocular epithelial implantation cysts and tumors of the anterior uvea involving the anterior chamber angle. DESIGN Noncomparative case series. PARTICIPANTS The study included 144 patients who had consecutively undergone scleral full-thickness block excision of tumors of the anterior uvea (n = 87) or intraocular epithelial implantation cysts (n = 57). Diameter of the block excision ranged between 5.5 and 20 mm. In 39 patients, the tumor extended posterior to the ora serrata. INTERVENTIONS Retinal detachment surgery. MAIN OUTCOME MEASURES Retinal detachment rate, visual acuity, risk factors. RESULTS Retinal detachment occurred in 10 (6.9%) of 144 patients (2 of 57, or 3.5% of patients with cysts; 8 of 87 or 9.2% of patients with tumors) 3 to 12 months after block excision. Six patients underwent primary pars plana vitrectomy with temporary endotamponade by silicone oil, which was removed 3 to 9 months later. In four patients, a scleral buckling procedure only was performed. After a mean follow-up of 31 months after silicone oil removal or the buckling procedure (median, 30 months; range, 13-42 months), the retina has remained attached in all patients operated on. Visual acuity increased from 2/20 (median; range, light perception-6/20) to 8/20 (median; range, 2/20-12/20). In the eyes with retinal detachment compared to the eyes without retinal detachment, the block excision was significantly larger (13.75+/-4.86 mm vs. 9.41+/-3.02; P = 0.01) and was located significantly more posteriorly (limbus distance of posterior excision margin: 6.75+/-2.87 vs. 4.35+/-3.24 mm; P = 0.01). CONCLUSIONS Scleral buckling procedures and primary pars plana vitrectomy with temporary ocular endotamponade can give acceptable results in eyes with rhegmatogenous retinal detachment occurring after block excision of epithelial implantation cysts or tumors of the anterior uvea. Despite intraoperative vitreous prolapse or tumor extension posterior to the ciliary body, rhegmatogenous retinal detachment occurs in fewer than 10% of patients undergoing block excision of cysts or tumors of the anterior uvea. Size and posterior location of the block excision are the main risk factors for rhegmatogenous retinal detachment, which becomes unlikely later than 12 months after surgery.

Value of conjunctival biopsy in the diagnosis of sarcoidosis

SummaryPurpose: Retrospective study concerning the value of conjunctival biopsy in the diagnosis of sarcoidosis. Patients and methods: Between 1990 and 1996 we performed conjunctival biopsy in 11 patients (mean age 42.7 ± 16.4 years) with suspect of sarcoidosis. Results: In 8 of the 11 patients the diagnosis of sarcoidosis was established during the clinical course. In four of these eight patients conjunctival biopsy was positive. Five of the eight were under systemic steroids at the time of biopsy. Of the four patients with clinically established sarcoidosis and negative biopsy, three were under systemic steroids at the time of biopsy. In two patients diagnosis of sarcoidosis was established primarily by conjunctival biopsy. Conclusion: Conjunctival biopsy is a simple tool in the diagnostic of sarcoidosis. If possible, biopsy should be undertaken before systemic steroid treatment. We consider conjunctival biopsy to be useful as the first diagnostic tool before other invasive methods.ZusammenfassungHintergrund: Retrospektive Studie zur Wertigkeit der Bindehautbiopsie bei der Diagnosestellung der Sarkoidose (Morbus Boeck). Patienten und Methode: Wir haben bei 11 Patienten (mittleres Alter: 42,7 ± 16,4 Jahre), bei denen wir im Zeitraum 1990–1996 eine Bindehautbiopsie bei Verdacht auf Sarkoidose durchgeführt haben, retrospektiv die Wertigkeit der Biopsie für die Diagnosestellung untersucht. Ergebnisse: Von den 11 Patienten mit Verdacht auf Sarkoidose hatten 8 Patienten eine klinisch gesicherte Sarkoidose im Rahmen der Krankengeschichte. Von diesen 8 Patienten war die Bindehautbiopsie bei 4 Patienten positiv. Von den 8 Patienten mit klinisch gesicherter Sarkoidose standen 5 Patienten unter Steroiden zum Zeitpunkt der Biopsie. Bei den Patienten mit klinisch gesicherter Sarkoidose und negativer Biopsie standen 3 von 4 Patienten unter Sterioden zum Zeitpunkt der Biopsie. Bei zwei Patienten konnte die Diagnose einer Sarkoidose primär durch die Bindehautbiopsie gestellt werden. Schlußfolgerung: Die Bindehautbiopsie ist ein einfaches diagnostisches Mittel zur Diagnosefindung bei Verdacht auf Sarkoidose. Nach Möglichkeit sollte die Bindehautbiopsie vor der Verabreichung systemischer oder lokaler Steroide erfolgen. Die Durchführung einer Bindehautbiopsie vor anderen invasiven Maßnahmen zur Diagnosefindung bei Verdacht auf Sarkoidose halten wir für sinnvoll.

Entwicklung der Endothelzellzahl der Wirtshornhaut Situation nach Blockexzision und exzentrischer Korneoskleralplastik

ZusammenfassungHintergrund. Die Blockexzision von Tumoren der vorderen Uvea und zystischer Epithelinvasion stellt eine bulbuserhaltende kurative Maßnahme dar. Das Ziel dieser Studie war, die Entwicklung des Wirtshornhautendothels bei dieser peripheren Korneoskleralplastik zu quantifizieren. Patienten und Methoden. In einer retrospektiven Querschnittstudie (149 Blockexzisionen) wurde die Endothelzellzahl im Zentrum der Wirtshornhaut untersucht. In die Studie gingen 53 Endothelfotografien von 30 Patienten ein. Der Durchmesser der Blockexzision betrug 8,5±1,9 mm. Ergebnisse. Die Hornhautendothelzellzahl nahm signifikant mit der Beobachtungsdauer nach Blockexzision ab. Statistisch ergab sich kein Zusammenhang zwischen Endothelzellzahl und Indikation zur Operation bzw. dem Blockdurchmesser. Der mittlere Visus vor Blockexzision betrug 0,8±0,3. Der letzte Visus im Beobachtungszeitraum wurde mit 0,3±0,3 angegeben. Schlussfolgerung. Der Endothelzellverlust nach Blockexzision könnte neben dem Operationstrauma durch eine chronische immunologische Reaktion gegen das Spenderendothel und eine nachfolgende Migration der Wirtsendothelzellen auf das korneosklerale Transplantat verursacht sein.AbstractPurpose. Block excision of anterior uveal tumors and cystic epithelial ingrowth to the anterior chamber is a curative treatment for morphological rehabilitation of the globe. This study quantified the course of the host corneal endothelium after this peripheral corneoscleral graft. Patients and methods. This retrospective cross-sectional study examined 53 specular microscopic photographs of the central host cornea in 30 patients. The diameter of the block excision was 8.5±1.9 mm (6.0±11.0 mm). Follow-up after surgery averaged 37.9±47.6 months (1–216). Results. The corneal endothelial cell count decreased with the duration of follow-up after block excision. The cell count was not related to indication for surgery or to diameter of block excision. Mean visual acuity was 16/20 before block excision and 6/20 at the end of follow-up. Conclusion. There is a significant loss of endothelial cells of the host after block excision, requiring a second central penetrating keratoplasty in some patients. Loss of endothelial cells may be due to the surgical trauma, chronic immunological reaction against the donor endothelium, or migration of the host endothelial cells onto the corneoscleral graft.

SELTENE URSACHE EINES PERAKUTEN VISUSVERLUSTES : PSEUDOTUMOR CEREBRI : FALLBERICHT UBER VERLAUF MIT REZIDIV NACH DEKOMPRESSION DES N.OPTIKUS

ZusammenfassungBeim primären Pseudotumor cerebri liegt eine ätiopathogenetisch ungeklärte Hirndrucksteigerung vor, die sich klinisch in unterschiedlichen Verlaufsformen äußert. Die Therapie ist kontrovers. Es wird der Fall eines Verlaufs mit foudroyanter und schwerster Visusminderung sowie Rezidiv nach operativer einseitiger Optikusdekompression vorgestellt. Bei einer 30jährigen Patientin kam es innerhalb von 48 h zu Kopf- und Nackenschmerzen und perakuter Visusminderung auf 1/50 am RA und Wahrnehmung von Handbewegungen und Lichtschein am LA. Fundoskopisch bestand eine STP von 9 Dptr. beidseits. Der initialen Besserung aller Symptome nach operativer Dekompression des N. opticus folgte nach 3 Monaten ein Rezidiv. Eine 24-h-Hirndruckmessung zeigte erhöhte Werte. Nach Anlage eines ventrikuloperitonealen Shuntes kam es zur deutlichen, bis sechs Monate danach anhaltenden Befundbesserung. Der primäre PTC kann mit foudroyantem Visusminderung einhergehen. Bei unzureichender Wirksamkeit konservativer Therapien stehen unterschiedliche operative Verfahren (Optikusdekompression, Liquorshuntverfahren) zur Vefügung.SummaryIn primary pseudotumor cerebri (PTC) intracranial pressure is elevated by so far unknown mechanisms. There is a wide range of clinical courses. Therapy is controversial. We present a case of PTC with acute visual loss. After optic nerve sheath decompression a relapse occured. A 30-year old female patient experienced visual loss within 48 h accompanied by headache and slight neck stiffness. Visual acuity was 1/50 in the right eye; in the left eye just hand movements and light were perceived. Fundoscopy revealed a 9 dptr. prominent optic disc bilaterally. After optic nerve sheath decompression (ONSD) she improved, but underwent a relapse after 3 months. Twenty-four-hour measurement of intracranial pressure revealed elevated values. As a consequence ventriculo-peritoneal shunting was performed, leading to prominent improvement. Primary PTC can cause acute visual loss. If conservative treatment fails, different surgical procedures should be considered.

Cystic epithelial growth after penetrating keratoplasty: successful curative treatment by block excision

Editor,—Most of the reported cases of epithelial growth in the anterior chamber are related to cataract surgery and injuries.1-3 Epithelial invasion of the anterior chamber after perforating keratoplasty (PK) is a rare complication. Only a few authors report on epithelial cysts after PK,45 while the majority of the presented patients in the literature suffer from diffuse epithelial downgrowth.167 We present three patients with cystic epithelial growth in the anterior chamber 1–10 years after primary PK and histopathological findings after complete removal of the cyst. ### CASE REPORTS All three patients were referred to our department with cystic epithelial growth into the anterior chamber. Primary PK was carried out elsewhere. Block excision and corneoscleral grafting were performed by one of us (GOHN) in all three patients. Technical aspects of block excision have been described in detail earlier.28-10 #### Patient 1 Patient 1 is a 31 year old man. He underwent PK on his right eye because of a keratoconus. Thirteen months later cystic epithelial growth in …