Stephan Behrendt

Metastic tumors of the orbit: A retrospective study

PURPOSE: To present the clinical features and facts on prognosis, therapy and diagnostics of orbital metastases treated in the Orbital Center Kiel. METHODS: We reviewed the records of 20 patients with orbital metastases (ca. 2% of all orbital patients seen in a 10-year period). RESULTS: The mean age at first manifestation of orbital symptoms was 64 years. On average, 64 months was the period of time between the onset of the primary disease and orbital manifestation. The sites of the primary tumors were breast (8), choroid (2), prostate (2), gastrointestinal tract (3), lung (2), urinary bladder (1), Schmincke tumor of the throat (1) and unknown origin (1). Eleven patients were female, 9 male. The main primary symptoms consisted of lid swelling (11), red eye (9), diplopia (10), and proptosis (7). Although the majority (16/20) were treated by chemotherapy, radiotherapy or surgery, 19 patients died after a mean survival time of 14.7 months. CONCLUSION: Orbital metastases remain an unfavorable prognostic factor, but the diagnosis and treatment are still important in order to prevent loss of vision and improve the patient’s quality of life. As previous studies have shown, the overall survival rate is still as limited as nearly half a century ago.

Bilateral Cataract after Phakic Posterior Chamber Top Hat-style Silicone Intraocular Lens

BACKGROUND New strategies have been developed for surgical treatment of high myopia. Recently, implantation of minus power posterior chamber intraocular lenses (IOL) into phakic eyes has been introduced. METHODS We report a 37 year-old female patient who developed bilateral anterior subcapsular cataract 7 years after minus-power, top hat-style silicone posterior chamber IOL implantation in Russia. The corrected visual acuity was right eye 20/200 and left eye 20/63. Because of the high myopia and the posterior chamber IOL in her phakic eyes, biometry for IOL calculation gave contradictory results. Both posterior chamber IOLs were found to be adherent to the crystalline lenses. After posterior chamber IOL explantation and phacoemulsification, intraoperative retinoscopy was performed. With this aphakic refraction, the IOL power was calculated and implanted. The explanted posterior chamber IOLs were examined by scanning electron microscopy. RESULTS After bilateral operation the corrected visual acuity increased to right eye 20/32 and left eye 20/40, respectively. On scanning electron microscopy, a membranous structure of unknown origin was noted on the entire surface of the explanted posterior chamber IOLS. CONCLUSION There is a potential risk of cataract formation after implantation of this top hat-style silicone posterior chamber IOL. If cataract extraction in this specific situation is needed, a different approach for calculating the aphakic IOL power is necessary, such as intraoperative retinoscopy.

Complications of silicone disc intraocular lenses

Abstract Through a 4.5 mm comeoscleral incision, we implanted one of two types of foldable, silicone disc, posterior chamber intraocular lenses (IOLs) in the bag in 35 eyes of 32 patients after phacoemulsification and capsulorhexis. Five lenses were explanted in the early postoperative period because of complications. We followed 24 eyes for an average of 38 months. At the end of follow‐up, 5 of the lenses had decentered by 1 mm; 8 (33%) had developed clinically significant posterior capsule opacification (PCO). We believe the IOLs’ disc shape may not allow firm fixation, resulting in opacification. On average, there were no significant differences in long‐term results between the two silicone disc lens types.

Effect of folding on the multifocal silicone intraocular lens: scanning electron microscopic study.

PURPOSE To evaluate whether the surface of the refractive zonal multifocal silicone intraocular lens (IOL) is altered by different folding and implantation instruments and is more sensitive to manipulation during folding than the surface of a monofocal IOL. SETTING Department of Ophthalmology, University Hospital, Kiel, Germany. METHODS Evaluated were the refractive multifocal silicone IOL (SA-40N, Array) and an otherwise identical monofocal IOL (SI-40NB) from the same manufacturer (Allergan Inc.). Different folding devices (folding blocks, folding and implantation forceps, and an injector system) were used. The IOLs were kept folded for 60 seconds; 24 hours later, scanning electron microscopy (SEM) was performed. In addition, the cartridges of the injector system were examined by SEM. RESULTS Overall, regardless of the folding and implantation instruments used, both the multifocal and monofocal IOLs had discrete surface alterations. The cartridges of the injector system had a rough surface at the tip, while the proximal portion appeared smooth. CONCLUSION There were no signs of lesions particularly affecting the surface of multifocal IOLs.

Ultrastructural and Immunohistochemical Findings after Linear Excimer Laser Keratectomy

BACKGROUND One human pathology specimen has been studied previously following the use of the excimer laser for the correction of astigmatism. We report histopathologic findings following linear corneal excisions with the excimer laser. METHODS A 193 nm excimer laser was used to create symmetrical, transverse excisions in a human eye to correct astigmatism. Three months later, a full-thickness corneal transplant was performed due to unsatisfactory refractive results. The excised corneal button was examined with light microscopy, transmission electron microscopy and immunohistochemistry. RESULTS An area 10 to 20-micron wide was observed between the epithelial cells within the keratectomy and the sharply dissected stromal lamellae. This area stained positive for laminin and pro-collagen type III. Some epithelial cells showed processes reaching into this area. Descemets membrane, immediately underneath the area of the keratectomy, contained atypically striated collagen fibers. CONCLUSIONS These findings demonstrate wound healing changes similar to those reported following diamond knife keratotomy and photorefractive keratectomy for myopia. The changes in the posterior cornea are similar to those previously reported when an excimer laser beam approached Descemets membrane.

Schwere intra- und postoperative suprachorioidale Blutungen

ZusammenfassungHintergrund: Ziel unserer Untersuchung war es, Risikofaktoren, therapeutisches Vorgehen sowie funktionelle und anatomische Ergebnisse nach schweren suprachorioidalen Blutungen zu analysieren. Patienten und Methode: Seit 1989 kam es achtmal intraoperativ und dreimal postoperativ zur Blutung. Sie traten bei folgenden operativen Eingriffen auf: Perforierende Keratoplastik (5 ×), extrakapsuläre Kataraktextraktion (3 ×), Pars-plana-Vitrektomie (2 ×), intrakapsuläre Kataraktextraktion (1 ×). Ergebnisse: Neun Eingriffe wurden in Intubationsnarkose, zwei in Retrobulbäranästhesie durchgeführt. Bei sechs Augen kam es zur expulsiven Blutung mit Verlust intraokularer Gewebeanteile. Spezielle okuläre Risikofaktoren wie z. B. Voroperationen und ¶-erkrankungen, Verletzungen oder Myopie, sowie allgemeine Risikofaktoren (kardiovaskuläre Erkrankungen, Diabetes, etc.) wurden erfaßt. Am Ende der Nachbeobachtungszeit war der Visus gegenüber dem präoperativen Befund bei 7 Patienten schlechter, bei 3 Patienten besser und bei 1 Patienten unverändert. 4 Augen waren amaurotisch, wovon 2 enukleiert wurden. Schlußfolgerung: Auch mit modernen operativen Methoden bleibt die Prognose massiver suprachorioidaler Blutungen ernst. Betroffen sind nahezu ausschließlich Patienten, die eine Vielzahl okulärer und allgemeiner Risikofaktoren auf sich vereinigen.SummaryBackground: The aim of this study was to analyze risk factors, therapeutic strategies, and functional and anatomic results of eyes with severe suprachoroidal hemorrhage. Patients: Eight of 11 bleeding episodes occurred intraoperatively and 3/11 postoperatively. Bleeding was associated with the following surgical procedures: perforating keratoplasty (5 ×), extracapsular cataract extraction (3 ×), pars plana vitrectomy (2 ×), intracapsular cataract extraction (1 ×). Results: Nine operations were performed with general anesthesia, two after retrobulbar injection. Ocular risk factors (e. g., prior operations, ocular diseases) and general risk factors (e. g., cardiovascular diseases, diabetes) were analyzed. At the end of the follow-up time visual acuity had improved in three eyes, and it was unchanged in one eye and worse in seven eyes. Four eyes were amaurotic; two of them had to be enucleated. Conclusions: In spite of using state-of-the-art surgical techniques the prognosis of suprachoroidal bleeding remains serious. Patients who have a combination of several ocular and general risk factors almost exclusively are the ones who afflicted by this complication.

Bilateral simultaneous acute amaurosis as primary manifestation of encephalomyelitis disseminata

SummaryBackground: Bilateral simultaneous acute amaurosis as a primary manifestation of demyelinating disease is extremely rare. Patient: The clinical course of a 24-year-old patient who initially presented with a bilateral complete loss of vision is demonstrated. Morphologically both optic discs appeared slightly blurred and prominent. Otherwise there were no anterior and posterior segment abnormalities. Examination of the cerebrospinal fluid revealed an increased number of cells and protein without oligoclonal bands. On MRI multiple white matter lesions were visible. Laboratory tests showed no specific abnormalities, especially with respect to infectious or vasculitic diseases. Under intensive steroid therapy (initially 1000 mg prednisolone/day), visual acuity recovered almost completely. Nine months after onset of the disease visual acuity was 1.0 in both eyes. Conclusions: Even in patients with a fulminant onset of the disease almost complete visual recovery is possible. Differential diagnosis should rule out vasculitic autoimmune optic neuritis, infections, tumors, processes of the paranasal sinuses, toxic, and hereditary causes.ZusammenfassungHintergrund: Eine beidseitige simultane akute Amaurose im Rahmen einer Neuritis nervi optici als Erstmanifestation einer Encephalomyelitis disseminata ist außerordentlich selten. Kasuistik: Es wird ein Krankheitsverlauf eines 24 jährigen Patienten dargestellt, der sich initial wegen eines binnen 24 Stunden eingetretenen vollständigen beidseitigen Visusverlustes vorstellte. Morphologisch zeigten sich die Papillen diskret randunscharf und prominent bei ansonsten unauffälligem Befund. Neurologisch wurde im Liquor eine erhöhte Zellzahl und eine Eiweißvermehrung ohne oligoklonale Banden festgestellt. Im MRT fanden sich multiple Entmarkungsherde, serologisch ergab sich kein Anhalt für eine Infektion bzw. eine Vaskulitis. Unter hochdosierter Steroidgabe (initial 1000 mg Prednisolon/Tag) kam es zu einer nahezu vollständigen Visuserholung. Neun Monate nach Krankheitsbeginn betrug der Visus beidseits 1,0. Weitere Krankheitsschübe sind bisher nicht aufgetreten. Schlußfolgerung: Auch bei einem fulminanten Krankheitsbeginn ist eine weitgehende Visuserholung möglich. Differentialdiagnostisch gilt es, vaskulitische Neuritiden, Infektionen, Tumoren, Nasennebenhöhlenprozesse und toxische oder hereditäre Ursachen auszuschließen.

Schwere intra- und postoperative suprachorioidale Blutungen@@@Severe intra- and postoperative suprachoroidal hemorrhage: Risikofaktoren, Therapie, Ergebnisse

ZusammenfassungHintergrund: Ziel unserer Untersuchung war es, Risikofaktoren, therapeutisches Vorgehen sowie funktionelle und anatomische Ergebnisse nach schweren suprachorioidalen Blutungen zu analysieren. Patienten und Methode: Seit 1989 kam es achtmal intraoperativ und dreimal postoperativ zur Blutung. Sie traten bei folgenden operativen Eingriffen auf: Perforierende Keratoplastik (5 ×), extrakapsuläre Kataraktextraktion (3 ×), Pars-plana-Vitrektomie (2 ×), intrakapsuläre Kataraktextraktion (1 ×). Ergebnisse: Neun Eingriffe wurden in Intubationsnarkose, zwei in Retrobulbäranästhesie durchgeführt. Bei sechs Augen kam es zur expulsiven Blutung mit Verlust intraokularer Gewebeanteile. Spezielle okuläre Risikofaktoren wie z. B. Voroperationen und ¶-erkrankungen, Verletzungen oder Myopie, sowie allgemeine Risikofaktoren (kardiovaskuläre Erkrankungen, Diabetes, etc.) wurden erfaßt. Am Ende der Nachbeobachtungszeit war der Visus gegenüber dem präoperativen Befund bei 7 Patienten schlechter, bei 3 Patienten besser und bei 1 Patienten unverändert. 4 Augen waren amaurotisch, wovon 2 enukleiert wurden. Schlußfolgerung: Auch mit modernen operativen Methoden bleibt die Prognose massiver suprachorioidaler Blutungen ernst. Betroffen sind nahezu ausschließlich Patienten, die eine Vielzahl okulärer und allgemeiner Risikofaktoren auf sich vereinigen.SummaryBackground: The aim of this study was to analyze risk factors, therapeutic strategies, and functional and anatomic results of eyes with severe suprachoroidal hemorrhage. Patients: Eight of 11 bleeding episodes occurred intraoperatively and 3/11 postoperatively. Bleeding was associated with the following surgical procedures: perforating keratoplasty (5 ×), extracapsular cataract extraction (3 ×), pars plana vitrectomy (2 ×), intracapsular cataract extraction (1 ×). Results: Nine operations were performed with general anesthesia, two after retrobulbar injection. Ocular risk factors (e. g., prior operations, ocular diseases) and general risk factors (e. g., cardiovascular diseases, diabetes) were analyzed. At the end of the follow-up time visual acuity had improved in three eyes, and it was unchanged in one eye and worse in seven eyes. Four eyes were amaurotic; two of them had to be enucleated. Conclusions: In spite of using state-of-the-art surgical techniques the prognosis of suprachoroidal bleeding remains serious. Patients who have a combination of several ocular and general risk factors almost exclusively are the ones who afflicted by this complication.

Severe intra- and postoperative suprachoroidal hemorrhage

ZusammenfassungHintergrund: Ziel unserer Untersuchung war es, Risikofaktoren, therapeutisches Vorgehen sowie funktionelle und anatomische Ergebnisse nach schweren suprachorioidalen Blutungen zu analysieren. Patienten und Methode: Seit 1989 kam es achtmal intraoperativ und dreimal postoperativ zur Blutung. Sie traten bei folgenden operativen Eingriffen auf: Perforierende Keratoplastik (5 ×), extrakapsuläre Kataraktextraktion (3 ×), Pars-plana-Vitrektomie (2 ×), intrakapsuläre Kataraktextraktion (1 ×). Ergebnisse: Neun Eingriffe wurden in Intubationsnarkose, zwei in Retrobulbäranästhesie durchgeführt. Bei sechs Augen kam es zur expulsiven Blutung mit Verlust intraokularer Gewebeanteile. Spezielle okuläre Risikofaktoren wie z. B. Voroperationen und ¶-erkrankungen, Verletzungen oder Myopie, sowie allgemeine Risikofaktoren (kardiovaskuläre Erkrankungen, Diabetes, etc.) wurden erfaßt. Am Ende der Nachbeobachtungszeit war der Visus gegenüber dem präoperativen Befund bei 7 Patienten schlechter, bei 3 Patienten besser und bei 1 Patienten unverändert. 4 Augen waren amaurotisch, wovon 2 enukleiert wurden. Schlußfolgerung: Auch mit modernen operativen Methoden bleibt die Prognose massiver suprachorioidaler Blutungen ernst. Betroffen sind nahezu ausschließlich Patienten, die eine Vielzahl okulärer und allgemeiner Risikofaktoren auf sich vereinigen.SummaryBackground: The aim of this study was to analyze risk factors, therapeutic strategies, and functional and anatomic results of eyes with severe suprachoroidal hemorrhage. Patients: Eight of 11 bleeding episodes occurred intraoperatively and 3/11 postoperatively. Bleeding was associated with the following surgical procedures: perforating keratoplasty (5 ×), extracapsular cataract extraction (3 ×), pars plana vitrectomy (2 ×), intracapsular cataract extraction (1 ×). Results: Nine operations were performed with general anesthesia, two after retrobulbar injection. Ocular risk factors (e. g., prior operations, ocular diseases) and general risk factors (e. g., cardiovascular diseases, diabetes) were analyzed. At the end of the follow-up time visual acuity had improved in three eyes, and it was unchanged in one eye and worse in seven eyes. Four eyes were amaurotic; two of them had to be enucleated. Conclusions: In spite of using state-of-the-art surgical techniques the prognosis of suprachoroidal bleeding remains serious. Patients who have a combination of several ocular and general risk factors almost exclusively are the ones who afflicted by this complication.

Orbit-Net: a discussion panel for orbitology on the Internet

We would like to inform the readers of the Journal Orbit about a new international and interdisciplinary medium for exchange of information concerning orbitology. This platform on the Internet is called ORBIT-NET and was first presented November 8th, 1996 in Kiel, Germany at the 3rd workshop of the Deutsche Gesellschaft fur Schadelbasischirurgie e.V. and on April 10th, 1997 in London, England at the 3rd European Skullbase Congress. It is designed for experts interested in research, the clinical symptoms, diagnosis and therapy of orbital diseases. ORBIT-NET is based on the exhange of electronic mail (E-mail) via Internet. In order to participate, access to the Internet, a computer with modem and E-mail-software are required. Discussion takes place in English and is free of charge. Each participant can question the others, present interesting cases, ask for comments, differential diagnoses and therapeutic suggestions and point out latest aspects of research. The interdisciplinary aspect of orbitology makes ...