Ulrike Grenzebach

Optic nerve decompression in the comatose and conscious patients after trauma

Objective To investigate the efficacy of early optic nerve decompression in comatose and conscious patients with indirect traumatic optic neuropathy.

Ultrasonic visualization of the effect of blinking on the lacrimal pump mechanism

BackgroundThe role of the lacrimal sac (LS) and the medial canthal tendon in the lacrimal pump mechanism is controversial. This study used ultrasonic visualization to analyze this phenomenon.MethodsMovements of the LS and the medial canthal tendon during blinking were visualized with sonography. In addition, the maximal profile area of the LS was measured before and after blinking using 15-MHz sonography in 14 individuals with a normal lacrimal drainage system and in six patients with lacrimal duct obstruction.ResultsThe upper part of the LS could be located as an echolucent structure between the lacrimal bone and the medial canthal tendon. The medial canthal tendon appeared to compress the LS during lid closure and release the LS during lid opening. The measured profile area of the visible normal LS at the compression time decreased by 50%. The dilated LS of patients with obstruction could also be compressed by the orbital muscle on blinking, but the maximum area decrease was only 15.5%.ConclusionThe findings imply that the lacrimal part of the orbicularis muscle contracts during blinking, with the medial canthal tendon compressing the LS in a cranial direction. Completion of lid closure then compresses both canaliculi and LS, forcing the intrasacral fluid through the drainage system. The expansion of the LS during the opening phase of the blink causes suction, and after opening of the punctal areas the canaliculi and LS vacuum breaks to reload with tear fluid. These findings demonstrate the importance of the orbicularis muscle and the medial canthal tendon for the lacrimal pump mechanism during blinking.

Preseptal transconjunctival approach for orbital floor fracture repair: ophthalmologic results in 209 patients

Conclusions. The transconjunctival approach to orbital floor fractures permits excellent exposure of the inferior orbit and provides a good surgical outcome, especially with regard to ocular motility. Objective. Surgical access to orbital floor fractures can be accomplished via the transconjunctival approach. The majority of studies on this subject deal with surgical aspects and complications. The purpose of this study was to report the ophthalmologic outcome after transconjunctival orbital floor fracture repositioning in a significant number of patients. Material and methods. In a retrospective study, the data of 209 patients with orbital floor factures treated via the transconjunctival approach with (n=181) and without (n=28) lateral canthotomy were analyzed. Results. The commonest cause of injury was forms of violence (32%). An isolated fracture of the orbital floor had occurred in 62 cases, while concomitant facial fractures were present in the remaining 147. A total of 24 patients (11%) had an exophthalmos and 13 (9%) an enophthalmos. Most patients (69%) complained of infraorbital dysesthesia. When elevating the eyeball, the majority of patients showed a marked or severe disturbance of ocular motility (53% in abduction; 51% in adduction) and diplopia (37% in abduction; 36% in adduction). Thirteen patients required repeat surgery. After a follow-up period of 2 years, infraorbital dysesthesia was observed in only three patients, one of whom presented with a considerable persistent enophthalmos of 4 mm, and only four patients had persistent reduced motility and diplopia.

Examination of preschool children for ametropia: First experiences using a new hand-held autorefractor

introduction Over the last decades, various methods have been investigated for preschool screening for amblyogenic ametropia. The SureSight is a new hand-held wavefront-analyzing autorefractor designed for screening. methods A total of 338 children (31/2–41/2years-old) were examined in their kindergartens without cycloplegia using the new instrument. Of these, 56 had a cycloplegic retinoscopy as a reference measurement. Hyperopia ≥3 dpt, myopia ≥1 dpt, astigmatism ≥1 dpt and anisometropia ≥1 dpt were considered amblyogenic ametropia. results Testability was 99.4%. Accuracy was high for cylinder power and axis but poor for the spherical equivalent. Sensitivity was 41% for the detection of amblyogenic hyperopia, 95% for astigmatism and 75% for anisometropia, with specificity values of 92, 79 and 73%. conclusion The high testability and accuracy for cylinder power and axis are the strong points. The poor accuracy for the spherical equivalent is probably caused by the lack of cycloplegia. At present, non-cycloplegic autorefractor screening cannot be recommended due to the low specificity. Our findings support the advice that objective refraction in childhood must be performed with cycloplegia.

Does general anesthesia have a clinical impact on intraocular pressure in children

Reliable measurement of intraocular pressure (IOP) is crucial in pediatric patients with suspected glaucoma. General anesthesia (GA) is usually needed in infants to allow a thorough examination. However, anesthesia itself may influence IOP, depending on the type used and the depth of sedation. The purpose of this study was to evaluate the normal distribution of IOP during GA in healthy children and to analyze differences in IOP relative to the anesthetics used and the measurement time point.

Leukemic hypopyon in acute myeloid leukemia.

Purpose. Leukemic hypopyon uveitis in acute myeloid leukemia (AML) is a very rare condition. We report this case of an unusual finding in a 2½-year-old boy in second remission after chemotherapy for relapsed AML. Methods. A young patient with an AML FAB M5 in second remission developed pain, photophobia, and conjunctival injections in the right eye. Recent bone marrow aspiration showed no blast increase and recent peripheral blood sampling presented no evidence of relapse. Results. The patient showed a viscous hypopyon and a myotic pupil in the right eye that was refractory to corticosteroids. Anterior chamber aspiration revealed atypical blasts similar to the leukemic cells that were found in the bone marrow aspirate at the time of systemic relapse. Conclusions. Timely anterior chamber aspiration and subsequent cytology is useful in differentiating leukemic hypopyon from true intraocular inflammation in AML patients. This is the first report about a leukemic hypopyon uveitis in AML without systemic findings of malignant cells in a child.