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Background: Endoscopes play a more and more important role in visualizing and treating pathologies of the lacrimal drainage system. The present study analyzes the results obtained during endoscopy of the lacrimal ducts using a gradient-index (GRIN-) endoscope., Patients and Methods: 44 patients, 18 to 87 years old (mean 59 years +/- 18.9), with chronic epiphora or symptoms of affection within the lacrimal ducts were examined using a rigid gradient-index (GRIN-) endoscope. Examination was performed ambulatory using drops for local anesthesia., Results: All 44 patients showed pathologic conditions in the lacrimal drainage system. 2 patients had chronic changes. 25 patients had a relative stenosis (16 presaccal, 9 postcanalicular ones). 17 patients had a total stenosis (12 presaccal, 5 postcanalicular ones). 33 patients showed a single-sided pathology while 11 patients showed a bilateral one. The GRIN-endoscope could be used in all patients and gave excellent image quality of the pathologies., Conclusions: Endoscopy with a GRIN-endoscope can complement the ambulatory diagnostics and therapy of the lacrimal drainage system. In the patient group studied (n = 44), presaccal pathologies (n = 28) were twice more frequent than postcanalicular ones (n = 14). Further developments could enlarge the indications of the GRIN-endoscope.

Background: Using small endoscopes it is now possible to evaluate the status of lacrimal ducts in vivo. GRIN-Lenses produce better pictures from the lacrimal ways than fiber-bundles. GRIN-endoscopes are rigid. The present study is concerned with the feasibility and indications of such GRIN-endoscopic examination., Patients and Methods: Two different GRIN-endoscopes with a distal diameter of 0.89 mm were used. One with a phi 0.5 mm optic and an additional working channel and another one with a phi 0.35 mm optic and two additional working channels. One channel each was used for injection of air or 0.9% NaCl. Either a laser fiber or another instrument (max phi 0.16 mm) could be introduced into the second channel. 44 patients in age between 18 and 87 with symptoms of epiphora or signs of chronic lacrimal way affections were examined., Results: The presaccal lacrimal ducts could be clearly visualized in all patients. In case of presaccal stenosis, the examination of the lacrimal sac was not always possible. The endoscope used, based of GRIN-lenses, gave an excellent image quality. Endoscopy under local anesthesia was well tolerated by all the patients with affection of the lacrimal drainage system. Because this ambulant examination does not stress the patient too much, it could be repeated a number of times. Endoscopy under general narcosis could enlarge the application spectrum. This method can complement the ambulant diagnostics and therapy of the lacrimal drainage system.

Background: To explore the relationship between ocular (fundus) hemoglobin and that sampled and measured conventionally. To look for differences in hemoglobin density determined by both methods when the body hemoglobin is acutely (blood donation) or pathologically e.g. anemia altered., Patients and Methods: Conventional (capillary and antecubital) and ocular fundus (papillary and choroidal) determinations of hemoglobin density in 14 females and 23 males, aged 25 to 30 years were compared. Application of the ocular method before and after blood donation in 21 females and 12 males, aged 20 to 68 years was performed. All these subjects were ophthalmologically and systemically healthy. Five male and 5 female anemia patients, aged 27 to 90 years, were also measured as above., Results: Good correlation between fundus hemoglobin density and capillary (r = 0.81) and venous (r = 0.61) hemoglobin was observed in healthy persons. Differences in hemoglobin density according to gender were obvious at all fundus sites measured. Following blood donation, papillary hemoglobin density in males moreover increased, while that in females decreased (F = 7.53), suggesting a gender-specific difference in the ocular blood regulation, an effect also noted in the anemia patients., Conclusions: Comparison of conventional and ocular determination of hemoglobin reveals good correlation in healthy people. However, in acute or chronic blood loss the papillary hemoglobin level differs from that measured peripherally. A gender-related regulatory capacity of the ocular tissues under low-level conditions can be shown: Male persons maintain ocular hemoglobin at a normal level even when peripheral hemoglobin falls to low values, whereas female persons show a decrease in ocular hemoglobin parallel to the venous levels. Hence, under such extreme conditions,--and only in males--the ocular method yields values other than those from the conventional method, because ocular regulatory mechanisms, otherwise undetected, are exquisitely revealed.

Background: Earlier studies in monkeys have shown that latanoprost 0.005% lowers the IOP by improving the uveoscleral Outflow. We wanted to know if this is also the case in the human eye., Patients and Methods: We used our new aqueous humor outflow test with 2-nitrophenyl-acetate in 9 healthy human volunteers, mean age 32 +/- 8.3 years. They were measured before and 12 h after receiving one drop of latanoprost 0.005% in one eye, randomly chosen. The ocular Photometer was used to quantify the disappearance of the dye out of the anterior chamber., Results: The half-life time of the dye is shortened after latanoprost 0.005%. It is significantly correlated to the pressure lowering effect of latanoprost 0.005% (r2 = 0.5968)., Conclusion: The dye-dilution technique proves that latanoprost 0.005% influences the outflow of the human eye. The better the outflow, the greater the pressure drop in the eye. The experiment nicely shows that photometric quantification of 2-nitrophenyl-acetate is a simple, reliable test for the knowledge of the aqueous humor outflow.

History: Dental regulation with the Headgear System is a method applied worldwide, and only few cases of device induced injuries have been documented. However, such injuries can be very severe, as can be seen from our case. Therefore, the risk/benefit relation should be considered., Patient: In December 1995, a 10-year-old female patient with a scleral perforation near the limbus was sent to Zürich university eye clinic as emergency case. The evening before, the patient had tried to remove her dental brace (Headgear) by pulling it over her head without disengaging the rubber bands serving for fixation before. During this attempt, the brace escaped at eye level, shot into her face and caused a skeletal perforation in her left eye as well as contusion bulbi in her right eye. In the further course, a fulminant endophthalmitis (streptococcus spp and anaerobic mixed oral flora) developed in the patient's left eye, which could not be controlled inspite of two interventions with vitrectomy and finally made an enucleation necessary., Conclusion: Disregarding the worldwide application of this device in the treatment of defective positions of teeth, the present case demonstrates that it is necessary to thoroughly instruct the patients regarding the handling of the Headgear and to inform them of possible dangers.

Background: Upper-lid gold weight insertions in patients with long-standing facial palsy allow closure of the eye through an increased gravitational pull on the relaxed eyelid and complete opening without restriction of the peripheral visual field., Materials and Methods: Between 1990 and 1995, 45 patients underwent eyelid rehabilitation for facial nerve paralysis at the New York Eye & Ear Infirmary. Their charts and outcomes were reviewed retrospectively. Twelve patients were followed prospectively at the University Hospital Zurich since December 1995., Results: One gold weight extruded twice in one patient. Delayed infections 1-3 months after surgery occurred in 6.6% and could be treated without removal of the gold weight. Tarsorrhaphies were necessary in 11%. Overall one third of all patients had their gold weight removed during this 5-year observation period. They all had return of their facial movements and did not require further lid loading. All prospectively evaluated patients had a marked improvement of their dry eye symptoms and a better quality of life., Conclusion: The analysis of 57 patients indicates, that gold weight insertions are a simple, reliable, reversible and successful technique for early rehabilitation of the paralyzed eyelid, often combined with lower lid shortening procedures. We favor early implantation in patients with severe facial nerve injury, concomitant Vth nerve palsy, inadequate patient compliance, in patients with one eye only or with disturbing dry eye symptoms.

This paper present a tonometer incorporated in a contact lens, which allows simultaneous measurement of intraocular pressure and performance ophthalmoscopy. The tonometer can record the pulse curve continuously, which can give us an indication of any circulatory problem. The device is therefore expected to yield additional information useful for the diagnosis of early glaucoma. Te device has three force sensors built in, which allow continuous measurement of the force exerted on the eye surface by the contact lens. The force of the contact lens on the eye can be altered and makes the adjustment of different eye pressures possible. These induced changes of the eye pressure and their influence on the fundus can be checked. We have taken some measurements on enucleated human eyes to compare our device with a Statham tansducer in the vitreous. We found a good correlation. We are currently taking measurements in volunteers. The clinical relevance of these observations and measurements will be examined in a future study.

Background: The yellowing is a precursor of the cataract. In the diabetic patient this phenomenon is established earlier than in normal control groups. In the literature the yellowing is explained by elevated glucose levels. Does the duration of diabetes play a key role for this phenomenon?, Materials and Methods: The yellowing of the lens can be very well detected by the ocular photometer. Using this device, 52 well regulated diabetics without retinopathy and 19 diabetics with mild background retinopathy were examined. We determined the contrast-transfer ratio of the lens, which has been correlated with the age, the duration of diabetes, the weight of the patient, the bodymass index and the hemoglobin a1c of the patient., Results: Without retinopathy none of the introduced correlations were significant. If the diabetes is well regulated, even a long duration of diabetes does not cause any yellowing of the lens. With mild retinopathy the yellowing of the lens could not be detected because of the sites of measurement, which were changing. A high correlation between the duration of diabetes and the intensity of the macula and the excavation has been found. The macula gets darker and the excavation gets brighter., Conclusions: The yellowing of the lens does not depend on any of the presented parameters. In diabetics with mild background retinopathy the macula gets darker. This can be interpreted as an hyperemia of the choroid. Most probably this phenomenon is caused by the decline of sympathetic nerve fibers.

Background: This paper presents a tonometer built into a contactlens, which allows to measure the eye-pressure and to perform ophthalmoscopy at the same time. Artificially induced changes of the eye-pressure and their influence on the visible fundus can now be checked simultaneously. The contactlens-tonometer (CGT) also is able to record continuously the pulse-curve, which can indicate any circulatory problem. So, the device is expected to give us additional diagnostic criteria of early glaucoma. Each ophthalmologyst in the field will be able to perform with this device a oculodynamometry in an easy way. By this it is possible to estimate the pressure-tolerance of the optic disk from glaucoma-patients., Measurements: There have been taken some measurements on enucleated human eyes, comparing our device with a Statham-transducer in the vitreous. We found a good correlation. In a second step, we made measurements (65) on healthy volunteers, comparing the device with Perkins-Tonometry., Results and Conclusions: We found a correlation (R = 0.58). The error of the measurements was about +/- 3 mm Hg. Considering both, the deviation of the Perkins-Tonometer with which our results were compared, and the fact of a good correlation (R = 0.999) in the study with the enucleated human eyes, we found that the contact-lens-tonometer measures the intraocular pressure exactly. In future studies, we want to analyze the dynamic component of the measurements.

The author reviews some physiologic aspects of the general, the cerebral and the ocular circulation. The latter two basically behave in the same manner in that over a wide range of systemic blood pressure they maintain a constant perfusion pressure. Furthermore there are very few substances which really influence their vessel diameter and, most important, there exist almost no pressure-fluctuations. The author discusses the differences and similarities of the three vascular systems and draws some conclusions with regard to the treatment of AION and glaucoma.

As a model for our study we selected 11 pseudophacic patients with secondary cataracts who experienced good postoperative visual acuity after extracapsular cataract extraction. Besides best visual acuity and contrast sensitivity Pattern-ERG (PERG) and Contrast-Transfer-Ratio (CTR) were measured before and after YAG-Kapsulotomy was performed. Visual acuity and contrast sensitivity increased in all patients after treatment, whereas CTR increased in eight patients. PERG was measured in five patients, in two cases its amplitudes were higher, the other measurements revealed unchanged or lower amplitudes. Our model shows that in addition to the usual psychophysic tests, with CTR and PERG there are objective methods available to measure discrete opacities of the visual system.

The cerebral perfusion is continuously and highly sensitively dependent on arterial pCO2. Does the ocular perfusion behave in a similar manner? To answer this question, the authors measured the following parameters before and after the inhalation of 10% CO2: a) the increase of capillary pCO2, using a transcutaneous sensor, and b) the redness (pallor) of the retinal tissue, an expression of its hemoglobin content, was measured at two retinal locations with the Ocular Photometer (OPM). Initial results from young test-volunteers and patients with documented carotis stenoses show that the choroid is able to maintain constant its blood-volume even under changing loads.

According to the literature, a fully developed cataract should be removed generally when the macula is intact. However, patients with a slowly progressing retinal disease find themselves in a particularly difficult situation. In this clinical, retrospective study, 24 retinitis-pigmentosa (RP) patients after cataract surgery were asked whether they recommend cataract surgery early or late in the course of the development of the retinal disease. A correlation was found between the answers to this question and the time elapsed between each patient's own operation and his interview. Three preference groups resulted through statistical evaluation: 1) those who recommend an early operation (n = 8), 2) those who recommend a late operation (n = 8), and 3) those who were undecided (n = 8). All patients had been operated at the same time following the RP onset and cataract diagnosis. Those patients who preferred a late operation had been questioned in this regard considerably later after their own operation than those who preferred an early operation. In other words, the preference for an early or late operation depended on how much prior to the questioning the patient's own operation had been conducted. The RP patient, quite disease conscious, has an exact conception of the ideal time of cataract operation in RP patients in general, but this does not always coincide with the opinion of his physician. It is considerably more necessary to consider the individual situation of the RP-patient than that of normal cataract patients.

Hopeless glaucoma cases fluctuate between excessive pressures and phthisis. Due to the underlying disease (neovascularization in the chamber angle, chronic inflammation, dysgenesis, aphakia) the customary surgical pressure-lowering operations often fail and medication is also useless. As a "last-ditch" measure, there remains only destruction of the ciliary body. In the Zurich eye department, noninvasive cyclophotocoagulation has been performed since 1987. The present paper reports on the first cases with long-term follow-up.

In this paper the authors report on 11 patients with giant tear detachment, whose fellow eyes were prophylactically treated with cryopexy or laser coagulation. The patients were followed up for between 4 and 12 years. The prophylactic lesions were located radially or circumferentially (circumscribed or extending through 180 degrees). In 4 out of 11 patients new tears developed during the follow-up period. The tears occurred between 1 month and 7 1/2 years after prophylactic treatment. In one of these cases a giant tear (90 degrees) developed in spite of prophylaxis: this was a case in which the coagulations extended circumferentially for 180 degrees; the new tear originated posteriorly to the scars. In contrast to this only multiple small horseshoe tears were observed in the other 3 patients: in these cases the prophylactic lesions were arranged radially or were circumferential and circumscribed. Some of these horseshoe tears were still attached and were treated with cryopexy or laser coagulation; others were already detached, reattachment was achieved by cryopexy and radial buckling of the tears.

Contrast sensitivity (CS) and differential light sensitivity (LUE) tend to deteriorate with increasing severity of the neuropathy. However, the correlation between the two psychophysical functions is low for the total number of optic neuropathies as well as for groups with different visual acuities. This fact is mainly explained by the range of scatter in LUE values. Moreover, visual acuity is much better correlated with CS than with LUE. CS and LUE represent different visual functions that may be processed by separate neural structures.

On the basis of a number of examples the authors describe specific glaucomas which have often reached their final stages by the time the patients are referred to the clinic. They include sub-acute and chronic angle-closure glaucoma, pseudoexfoliation syndrome, and pigmentary glaucoma. An unpleasant feature of these glaucomas is that, somehow or other, treatment comes too late: complete cupping of the optic disk when the ophthalmologist is first consulted, increased intraocular pressure in exfoliation syndrome detected too late, or a tardy decision to perform an iridotomy or a fistulizing operation. The following are some important points: gonioscopy should be performed not only at the initial examination but also at subsequent ones; subacute and chronic pupillary or angle-closure glaucomas are progressive diseases for which the sensible therapy is not miotics but laser iridotomy; because papillary changes usually precede visual field changes (automated perimetry notwithstanding), particular attention must be paid to the former. This can only be accomplished with exact documentation. Therefore, glaucoma follow-up means pressure measurement and gonioscopy and examination of the optic disk and visual field. In conclusion, aids for decision-making and a follow-up schedule are presented.

There are several methods of accurately measuring the contours of the papilla and rim. Of these methods, photogrammetry and its refinements are known to provide reproducible results. Unfortunately, there is a discrepancy between the accuracy of these methods and the biological "background noise". This noise does not allow the precision of these methods to be improved beyond a certain level. This also applies for determination of the color of the papilla. An alternative to this problem is to use the "provocation" test. In this article, we try to show the importance of the dynamic test of the papilla (dynamic provoked circulatory response): measuring the change in pallor of the rim during an artificial increase in the intraocular pressure.

During the last four years 232 macrodacryocystographies have been performed. The results are compared with the clinical evaluation of these patients. There are two groups of findings, simple stenosis on one side and anatomical abnormalities on the other side. The stenosis is mostly located before the lacrimal sac and most often involves the common canaliculus.--In the second part of the paper examples of alterations of the lacrimal apparatus show the value of the method in evaluating pathological anatomy.

In general the combined cataract/glaucoma operation is a good procedure for treating cataract and glaucoma simultaneously. The operation was performed in 157 eyes between 1976 and 1980. The mean IOP remained constant after surgery for a follow-up period of over three years on average. The review covered 136 eyes, of which 103 needed no therapy initially after the operation; now only 78 have good IOP without drug therapy. It seems that some time after the operation glaucoma therapy is needed again. The question arises whether it is better to perform a combined operation or to perform trabeculectomy first and cataract extraction later, or even if it is better to perform cataract extraction alone and continue with drug therapy for the glaucoma.

The size of macular scotomata is determined numerically by a series of parallel F2 programs of the Octopus Perimeter. As long as useful foveolar fixation is maintained, the results are reproducible within the limits due to fluctuation of the retinal sensitivity. The scotomata can be mapped on a fundus photograph either by direct calculation or after perimetric determination of a reference distance, e.g., foveola-disc or between angioscotomata. This method furnishes useful information which can facilitate evaluation of different types of lasers in macular photocoagulation.

Halothane lowers the peripheral vascular resistance and blocks autoregulation in the cerebral vessels. Proceeding from the assumption that the papillary vessels behave in like manner, the authors examined increases in papillary pallor under artificial IOP elevation in anesthetized patients with and without Halothane, using the photopapillometer. This provocation test was conducted in 14 patients, first on one eye under normal (N2O/O2) anesthesia, then on the fellow eye after steady state had been attained with subsequently administered Halothane. By quantifying ocular circulatory conditions, the demonstration of the lowering of peripheral vascular resistance in the papillary vessels under Halothane was convincing; the blockage of autoregulation was less obvious. To explain these results the authors suggest that the two effects are gradual and mutually influential.

The authors report on comparative studies of two beta-blockers with regard to various parameters (intraocular pressure, perfusion pressure, and brightness of the papilla). A differential evaluation of these medications shows that measurement of the intraocular pressure alone is not sufficient to elucidate all of their characteristics fully.

Hydroxy-propyl-methyl-cellulose (HPMC) was injected into the anterior chambers or vitreous bodies of rabbit eyes in order to test local and systemic tolerance. In doing so the typical intraoperative complication of capsule rupture, which, in anterior segment surgery in man, allows HPMC to enter the vitreous body, was simulated. Neither clinically, nor in laboratory workup, nor histopathologically could any difference be shown between the local and systemic reactions of HPMC and those of DRSS. The data obtained in the study admit the conclusion that HPMC can be used in surgery of the anterior segment without any risk of adverse reactions.

Of 132 patients who had undergone Nd-YAG laser iridotomy, 70 were randomly selected for follow-up examinations. Nd-YAG laser iridotomies were subsequently performed on 124 eyes (of these 70 patients), 12 for acute angle-closure glaucoma, 19 fellow eyes of those which had angle-closure glaucoma, 70 for chronic angle-closure glaucoma, and 23 eyes with increasingly narrow chamber angle under miotic therapy. The follow-up period ranged from 1 to 25 months (median = 9 months). Eighty-seven percent of the iridotomies remained visibly open. Of 12 acute glaucomas, 10 were successfully treated, whereas only 2 required a basal iridectomy. In the large group of 106 eyes with a "narrow angle condition," a significant pressure reduction from 20.9 +/- 5.8 to 16.7 +/- 3.4 mm Hg and a significant enlargement of the chamber angle resulted. Since fistulizing procedures involve a risk of malignant glaucoma, Nd-YAG laser iridotomy, which this investigation showed to be risk-free, is the initial procedure of choice in narrow-angle conditions, especially subacute and chronic angle-closure glaucoma, in order to alleviate the angle-closure component in such angle-closure situations, to diagnose its contribution to peak IOP, and to facilitate argon laser trabeculoplasty when needed.