Thomas-Michael Wohlrab

Argon laser therapy of benign tumors of the eyelid

PURPOSE To report the therapy of benign eyelid tumors with an argon laser as an alternative to surgery. METHODS Forty-one patients with 47 benign tumors of the eyelid were included in this study. In all patients, the eyelid tumor was eliminated by argon laser. In 24 cases the lower eyelid and in 23 cases the upper eyelid was involved, including the lid margin in 17 cases. Laser spot size ranged from 150 to 500 microm. Argon laser power density varied between 4.1 and 61.1 W/mm2. Spots were counted between 40 and 1204. Twenty-seven of 41 patients treated were followed up; the mean follow-up period was 5.8 months (range, 3 to 24 months). Postoperatively, histologic confirmation was obtained in 42 cases of the 47 treated tumors. RESULTS All patients were satisfied regarding the laser therapy and the cosmetic result. Remarkably, the wounds were dry after argon laser therapy. No infections of the wounds occurred; wounds were epithelialized after 2 to 3 weeks by a normal-appearing epithelium. The area of argon laser treatment was less pigmented than the surrounding skin and showed no obvious remarkable notches. As a complication, one patient developed a viral conjunctivitis. No relapses occurred during follow-up. CONCLUSIONS Argon laser therapy of benign eyelid tumors may result in very satisfactory wound healing. Taking the short follow-up and the limited number of cases into account, it seems to be a useful alternative to traditional surgery, especially for tumors positioned close to the lacrimal papillae.

Zyanoacrylatverletzungen des Auges

ZusammenfassungHintergrund. Zyanoacrylate sind in Nagellacken, Sekundenklebern und in Gewebeklebern wie Histoacryl® enthalten. Die Einbringung in den Bindehautsack oder auf die Hornhautoberfläche kann zu einem u. U. massiven Visusverlust führen. Patienten. In einem Zeitraum von 10 Jahren wurden 5 Patienten mit einer Verletzung durch Zyanoacrylat beobachtet. Viermal handelte es sich um Sekundenkleber, einmal um den Gewebekleber Histoacryl®. Die Therapie bestand in einer eher zurückhaltenden Spülung. Lediglich bei der ersten, am schwersten betroffenen Patientin wurden Teile des Klebstoffs mechanisch entfernt, bei allen weiteren Patienten wurde die spontane Ablösung abgewartet. Die bei 80% der Patienten auftretende Erosio corneae zeigte eine gute Heilungstendenz. Bei allen Patienten normalisierte sich die Funktion, Folgeschäden blieben aus. Schlussfolgerungen. Akzidentell akquirierte Zyanoacrylate entfalten auf der Augenoberfläche weder stärkere thermische noch chemisch-toxische Wirkungen. Entsprechende Verletzungen haben deshalb eine sehr gute Prognose. Therapeutisch erscheint eine konservative Vorgehensweise (Abwarten der spontanen Klebstoffabstoßung) sinnvoll.AbstractBackground. Cyanoacrylates are contained in nail glues, instant glues, and tissue adhesives such as Histoacryl®. Cyanoacrylates may inadvertently contaminate the conjunctival sac and cause massive loss of visual function and serious discomfort to the patient. Patients. Over a 10-year period five patients with a cyanoacrylate lesion of the ocular surface have been observed. Four were injured by instant glue and one by Histoacryl®. Therapy included moderate rinsing. In the most severely affected patient parts of the glue were removed mechanically; spontaneous rejection of the glue was awaited in the other four. After the glue had been rejected, four patients showed corneal erosion which healed without problems. Visual function returned to normal in all patients, and there was no persistent tissue damage. Conclusions. Cyanoacrylates exert no substantial thermal, chemical, or toxic effects on the ocular surface when inadvertently entering the conjunctival sac. Cyanoacrylate trauma therefore has a very favorable prognosis. The conservative approach of awaiting spontaneous glue rejection is appropriate.

Age-Corrected Normal Values for Perimetry

Purpose: Age-corrected values are indispensable in assessing discrete changes in light difference sensitivity (LDS) when evaluating perimetric results. In order to detect incipient visual field defects, the present study aimed particularly to determine function of normal values depending on age and eccentricity. Methods: A test group (n = 83) of ophthalmologically and clinically unremarkable subjects 18–74 years of age was examined with the ‘Centerfield’ perimeter. A brief introductory program was first used to familiarize each test person with the situation. Then values in the central visual field (30Results: Age-related normal values were calculated both as group averages and as lines of regression by statistical analysis of the resulting data. In contrast to other perimetric studies, decreases in LDS at different test points for persons aged 20 years to persons over 60 were not linear. Conclusions: Age-related normal values should be reviewed for other perimeters.

Sudden increase in intraocular pressure as an initial manifestation of myelodysplastic syndrome.

PURPOSE/METHODS We studied a rare initial manifestation of myelodysplastic syndrome in an 82-year-old woman who had acute secondary glaucoma in the right eye and mature cataracts in both eyes. RESULTS/CONCLUSION Therapy with glaucoma control medications and cataract extraction in the right eye resulted in expulsive hemorrhage and subsequent enucleation of the right eye. After cataract extraction, examination of the left eye disclosed a central serous retinal detachment and hemorrhage. Histopathologic analysis of the right eye demonstrated myelocytic and lymphocytic infiltration.

Book Reviews · Livres nouveaux · Buchbesprechungen

Conjunctival inflammation is one of the most frequent conditions presenting to the ophthalmologist. While in the past decades, bacterial infections of the conjunctiva have become much easier to diagnose and treat, the non-infectious disorders still pose confounding problems. Inflammatory Diseases of the Conjunctiva provides an in-depth review of the pathological mechanisms causing these diseases. The strength of this book lies in its presentation of immunological knowledge which is indispensable for the understanding of conjunctival inflammation. As immunology is a very dynamic field of research, the authors put great emphasis on giving up-to-date information on basic research findings and putting them in perspective regarding their clinical relevance. In this the book is of great value for the clinician. It is also very well structured, dealing with individual disease entities in separate chapters and providing sections on laboratory investigations, differential diagnosis and treatment options in each of them. Some topics are given special consideration in ‘focus’ sections, among them dry eye syndrome, laboratory investigations of conjunctival inflammation and apoptosis in the conjunctiva. Dr. Holger Baatz, Frankfurt G.A. Fishman, D.G. Birch, G.H. Holder, et al.

Comparing “suprathreshhold” and “threshhold splitting perimetry” using the Tübinger Automatic Perimeter CC

Background: We compared the standard suprathreshhold strategy to the so-called threshhold splitting strategy with 5 and 2 dB steps. The aim of the study was to establish whether the threshhold splitting strategy had advantages over the suprathreshhold strategy that has been used to date. Method: We examined the 30 ° visual field in 49 volunteers using suprathreshhold perimetry and on the same day threshhold splitting perimetry on the Tübinger Automatic Perimeter CC. A total of 191 test points were examined in suprathreshhold strategy. Using the threshhold splitting strategy, 67 test points were examined, with a test-point design similar to other perimeters with the threshhold splitting strategy. The criteria for inclusion in the study were central light sensitivity differences greater than 25 dB, fixation better than 80 % and an illumination class density < 2. Results/Discussion: The average duration of the examination using the suprathreshhold strategy was 2–3 min quicker than the threshhold splitting strategy in normal visual fields or small scotomas, but it took up to 15 min longer if large scotomas were present. Interpretation of the scotoma configuration showed subjective differences: the smaller the scotoma, the greater the differences because of the fact that threshhold splitting perimetry utilizes test points that are farther apart than those used in suprathreshhold perimetry.Einleitung: Am Tübinger Automatikperimeter CC wurde eine vergleichende Studie zwischen der bekannten, schwellenorientiert überschwelligen Strategie und einer Schwellenwertstrategie mit 2 facher Eingabelung in 4- und 2-dB-Schritten durchgeführt. Ziel der Untersuchung war es, festzustellen, ob die Schwellenwertstrategie Vorteile gegenüber der bisher eingesetzten schwellenorientiert überschwelligen Strategie bietet. Methode: 49 freiwillige Patienten wurden am gleichen Tag mit der schwellenorientiert überschwelligen Perimetrie und der Schwellenwertperimetrie am Tübinger Automatikperimeter im 30 °-Gesichtsfeld untersucht. Die Untersuchung erfolgte mit 191 Punkten bei der schwellenorientiert überschwelligen Strategie. 67 Punkte wurden bei der Schwellenwertstrategie eingesetzt, ähnlich der Prüfpunktanordnung anderer Perimeter mit Schwellenwertstrategie. Einschlußkriterien waren: zentrale Lichtunterschiedsempfindlichkeit > 25 dB, Fixation > 80 %, geprüfte Leuchtdichteklasse < − 2. Ergebnisse/Diskussion: Bei unauffälligen Gesichtsfeldbefunden oder kleinen Skotomen war die schwellenorientiert überschwellige Strategie um 2–3 min schneller als die Schwellenwertstrategie, bei großen Skotomen um bis zu 15 min langsamer. Auch in der subjektiven Prüfung der Ausfallskonfiguration fanden sich Unterschiede. Bei großflächigen Skotomen war die Erkennbarkeit der Ausfallskonfiguration für beide Strategien gegeben. Mit Abnahme der Skotomgröße führte das grobe, bei der Schwellenwertperimetrie verwendete Raster dazu, daß im Vergleich zur schwellenorientiert überschwelligen Perimetrie mit größerer Rasterdichte die Erkennbarkeit der Ausfallskonfiguration nachließ.

Akzidentelle Retinektomie bei Blockexzision wegen zystischer Epithelimplantation

A 3.5-year-old girl suffered from a penetrating injury of the left eye. One and a half years later epithelial ingrowth was detected. Although block-excision was performed in the usual manner without technical problems the retina was excised accidentally. Histology revealed that the retina had been massively displaced in anterior direction prior to surgery because of fibrovascular proliferations.