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Uveal effusion can lead to anterior swelling of the choroid up to angle-closure glaucoma. This article reports the case of a 57-year-old male patient who presented with headache, vertigo and bilaterally reduced visual acuity. The examination showed a myopic shift and angle-closure glaucoma caused by uveal effusion. The medical history revealed that 3 days before the appearance of the symptoms, treatment with chlorthalidone was added to the antihypertensive medication. After discontinuation of the chlorthalidone intake the uveal effusion and its concomitant symptoms disappeared without residues.Eine uveale Effusion kann zu einer anterioren Aderhautamotio bis zur Verlegung des Kammerwinkels führen. Wir stellen den Fall eines 57-jährigen männlichen Patienten vor, der sich mit Kopfschmerzen, Schwindel und beidseitiger Sehverschlechterung vorstellte. In der Untersuchung zeigte sich eine uveale Effusion mit Myopisierung und Winkelbockglaukom. Die Symptome begannen im zeitlichen Zusammenhang mit der Erweiterung der antihypertensiven Therapie um Chlortalidon. Nach Absetzen des Medikaments bildete sich der Befund ohne Residuen zurück.

Infections can affect all structures of the eye. This article focuses on corneal and uveal infections, and on endophthalmitis. The typical pathogens, the signs and symptoms and the therapy are presented.HORNHAUTENTZüNDUNG (KERATITIS): Eine Keratitis kann durch viele unterschiedliche Erreger verursacht werden. INFEKTIöSE UVEITIS: Bei der infektiösen Uveitis zeigen sich vermehrt alte Infektionen wie die Syphilis oder die Tuberkulose, aber auch lokale Infektionen mit Protozoen oder Viren. ENDOPHTHALMITIS: Die Endophthalmitis als Komplikation von intraokularen Eingriffen gewinnt durch die Zunahme der Kataraktoperationen und vor allem der intravitrealen Medikamentengabe immer mehr an Bedeutung.

The aim of this study was to determine the anatomic sites of severe visual impairment and blindness in children in an integrated school for the blind in Malawi, and to compare the results with those of previous Malawian blind school studies.Children attending an integrated school for the blind in Malawi were examined in September 2011 using the standard WHO/PBL eye examination record for children with blindness and low vision. Visual acuity [VA] of the better eye was classified using the standardised WHO reporting form.Fifty-five pupils aged 6 to 19 years were examined, 39 (71 %) males, and 16 (29 %) females. Thirty eight (69%) were blind [BL], 8 (15 %) were severely visually impaired [SVI], 8 (15 %) visually impaired [VI], and 1 (1.8 %) was not visually impaired [NVI]. The major anatomic sites of visual loss were optic nerve (16 %) and retina (16 %), followed by lens/cataract (15 %), cornea (11 %) and lesions of the whole globe (11 %), uveal pathologies (6 %) and cortical blindness (2 %). The exact aetiology of VI or BL could not be determined in most children. Albinism accounted for 13 % (7/55) of the visual impairments. 24 % of the cases were considered to be potentially avoidable: refractive amblyopia among pseudophakic patients and corneal scaring.Optic atrophy, retinal diseases (mostly albinism) and cataracts were the major causes of severe visual impairment and blindness in children in an integrated school for the blind in Malawi. Corneal scarring was now the fourth cause of visual impairment, compared to being the commonest cause 35 years ago. Congenital cataract and its postoperative outcome were the commonest remedial causes of visual impairment.

The uveal effusion syndrome is a rare disease characterized by serous choroidal detachment. The pathogenesis of idiopathic uveal effusion syndrome has not yet been conclusively established. One hypothesis is an abnormality of diffusion of extravascular proteins in the choroid leading to decompensation of the pigment epithelium pumping capacity. Fluid then accumulates in the subretinal space leading to retinal detachment which results in loss of visual acuity. It typically affects males and hypermetropia is another risk factor. When looking at the fundus a circular serous detachment of the choroid and choroidal puckering is typical. The fluorescein angiography shows hyperfluorescence in the form of a leopard-spot pattern. Space-occupying lesions have to be excluded with the help of ultrasound or magnetic resonance tomography. The uveal effusion syndrome is a diagnosis by exclusion. Treatment varies because of the different hypotheses for the pathogenesis. An intraocular tamponade in combination with laser coagulation may for example be an effective treatment.

We present the case of a 41-year-old female patient with acute onset of nyctalopia, xanthopsia and impairment of visual field. The ophthalmologic examination revealed peripheral choroidal elevation with accompanying retinal detachment. Due to the the presence of a nanophthalmic eye without any evidence of inflammation or malignant growth, the diagnosis uveal effusion syndrome could be made.

The records of the University Eye Clinic are almost completely preserved at the historical archive of the University of Tübingen since 1865 and shell now be reduced.150 records from the historical archive of the University of Tübingen were selected. We were interested in those patients treated for the first time at the University Eye Clinic between 1895 and 1899. Only diseases of the optic nerve, the uveal tract and the retina were considered. The records were distributed into groups following historical classification and statistics of the same period. These statistics were also used to compare our selection with all patients treated. For information about frequency, diagnostics and therapy a questionnaire was developed.Glaucoma: The data of the subgroup "Glaucoma simplex" showed high correspondence with the historical data regarding the frequency (24.3 vs. 25.5%). The data of the subgroup "Glaucoma secundaria" differed (34.5 vs. 25.5%). Testing the visual acuity was the first step of examination here and in all groups (100%). Measurement of intraocular pressure with digital palpation followed (86.3%). First of all Eserin eye drops were applicated (76.5%). Iritis: The frequency of acute iritis was 16.8 vs. 25.0%, and of chronic iritis 59.6 vs. 52.2%. As typical symptoms ciliar injections, fixed anisocore pupil and exudation were often seen (80.0%). Chronic iritis showed as typical symptom posterior synechia (80.9%). Atropin eye drops were firstly applied in acute iritis (100%), chronical iritis was treated by iridectomy (57.1%). Myopia: In all subgroups our data differed from the historical data. Staphyloma posticum was the characteristic diagnosis (65.8%). Myopia was treated by decision of the lens. Retinal detachment: The frequency 37.2 vs. 28.0%. In nearly all cases retinal detachment was described after ophthalmoscopic examination (92.8%). The first therapeutical step was to keep the patients staying in bed (53.8%).As expected, diagnostic and therapeutical options were strongly limited in Tübingen 100 years ago. Nevertheless, therapeutic successes were achieved in certain cases.

From 1983 to 1994 enucleated as well as bulbi obtained post mortem from 20 guinea pigs were ophthalmopathologically examined routinely. Eleven cases (one bilateral) with anamneses as hydrophthalmus, exophthalmus or retrobulbar abscess showed histologically osseous choristomas in the stroma of the ciliary body. In one case the osseous choristoma was already macroscopically recognizable. These heterotopic bone formations were causative for a secondary open angle glaucoma. Furthermore, it explains the obscured clinical symptoms of glaucoma together with the resulting exposition keratopathy. The aetiopathogenesis is discussed comparatively.

The causes of hypo- and hyperchromic heterochromia were analysed in 94 patients. The hypochromic forms were the commonest, especially the Fuchs-Herrenschwandt heterochromia, and heterochromia simplex. Also after degenerative diseases and accidents appears almost exclusively hypochromic heterochromia. Causes of hyperchromic heterochromia (siderosis, melanosis, wart-iris) were in the minority. Finally a heterogenous group of pseudoheterochromiae were more closely examined. This group seemed to be mainly hypochromic but in 2 rare cases the pseudoheterochromia was cuased by a brown dystrophy of the repeatedly inflamed cornea, probably associated with repeated fluorescien-staining of large corneal erosions.

In many uveal lesions a choroidal excavation can be demonstrated by B-scan-sonography. By clinical and experimental methods it can be shown that this phenomenon is elicited by differences of reflectivity between the highly reflective choroid and low reflecting uveal lesions. Therefore, the choroidal excavation is not specific for one tumor, but will always be demonstrable, when a low reflective lesion (melanoma, hemorrhage) is present in the choroid. High reflective lesions (metastases, hemangioma) do not exhibit such an excavation.

For six months the anterior chambers of rabbits were examined at regular intervals with the slit-lamp photograph. The reactions of iris, aqueous, and cornea were observed after implanting one PMMA-disc (0.25 mm thickness and 1.5 mm diameter) through a lancet incision. At the place where the disc touched the iris one could see during the half year period hyperaemia iridis, ciliary injection, atrophia iridis, and foreign-substance-granuloma of the iris with partial adhesion of the iris wrinkles. The cause for these reactions is a toxin in the PMMA. Mechanical irritation and plastic alteration could be excluded by the experimental method.

A report is given on cryotherapy of a subconjunctival iris prolapse in a 46-year-old man 23 days after cataract extraction. The procedure is simple, without complications, and was in accordance with descriptions in the literatur also in this case successful.

After implanting a disc (0,25 mm thickness and 1,5 mm diameter) of soft contact lens materials ("Soflens", "Hydroflex", "Hydron") in the anterior chamber of rabbits through a lancet incision, the reactions of iris, aqueous and cornea were observed for six months at regular intervals with slit lamp photograph. At the place where the disc touched the iris one could see during half a year periodic hyperaemia iridis and foreign-substance-granuloma of the iris. The cause of these reactions is a toxin in the HEMA. The reactions are more intense than with PMMA.

In 61 patients echographically examined in A and AB mode at Münster University Eye Hospital a membrane-like echo was found between the retina and the choroid. The acoustic characteristics were studied. The usefulness for the differential diagnosis of retinal detachment was demonstrated with several situations of the retina. The thickness of the retina and choroid can be measured in routine examinations.

A dominantly inherited cleavage of the pigment layer of the iris has been observed throughout three generations. In the two elder generations, luxation and rapidly progressing opacification of the lenses occurred; after cataract extraction, a cleavage of the pigment layer of the ciliary body could also be seen through the iridectomy. The lenses had reduced sagital and spherical diameters (4X7 mm). Furthermore, a peculiar form of glaucoma and a peripheral retinal detachment has been observed in the eldest generation.

Fluorescence angiography of the iris was performed on 135 patients with diabetes mellitus. The changes in the iris were classified as iridopathia diabetica simplex and iridopathia diabetica proliferans, corresponding to similar changes in diabetic retinopathy. Thus punctata leakage of dye, especially around the pupillary margin, was classified as iridopathia diabetica simplex, whereas additional, angiographically verified new vessel formation was described as iridopathia diabetica proliferans. 123 of 135 patients (91.1%) showed diabetic changes of the iris. Of these 85 (62.9%) had iridopathia diabetica simplex changes and 38 (28.2%) had iridopathia diabetica proliferans changes. The incidence of diabetic iris changes appeared unrelated to age but appeared to increase with duration of diabetes. A correlation between the onset of diabetic vascular changes of the iris and of the retina could not be confirmed: the diabetic changes in the iris vessels can precede those of the retina whereas, on the other hand, almost all patients with a diabetic retinopathia also show an iridopathy. Iris angiography is of clinical value because first signs of diabetic vascular damage can be seen in the iris earlier than in the retina, the iris appearing normal on slit-lamp microscopy.

With a modified method of infrared pupillography--especially developed for the use in clinical neurological routine diagnosis--the time course of the direct phasic pupillary light reflex in man was investigated under physiological and pathological conditions. The described method allows a high resolution of the time course of the light reflex and is superior to kinematographic as well as video-methods described so far. Normally the physiological time parameters are bilaterally symmetrical, also in cases of so-called physiological anisocoria. On the other hand in pathological anisocorias of various etiology pronounced side-differences and abnormal time parameters can be found. Also in cases of isocoria with clinically no abnormal findings of pupillomotor response pathological side-differences can be determined by infrared pupillography. Disturbances of the afferent arc, of the efferent arc and of combination of those as well as pupillary abnormalities to be located in the midbrain area, can be exactly analyzed and documented. Furthermore the method allows an objective documentation of the course in cases of dysfunction of the autonomic nervous system, like in intoxications, or to monitor drug-induced therapeutical measurements. The investigations and findings indicate that infrared pupillography, an objective method for analyzing the dynamics of the pupillary light reflex, is suitable for clinical neurological routing diagnosis.

A case is presented of unilateral chorioidal detachment following bilateral retinal ablation for diabetic retinopathy by argon laser photocoagulation.

The clinical and irisangiographical findings of 2 patients with essential progressive iris atrophy of the juvenile are reported. Histopathological examination was possible in one case. The differential diagnosis including to iridoschisis, Chandler's syndrome, Cogan-Reese (iris-naevus) syndrome is discussed. The aetiology of this rare disease remains obscure. Most authors believe that the iris stroma changes and pigment epithelial atrophy result from a vascular deficiency. Iris angiographical findings confirm this belief. The prognosis is poor, due to the therapy resistant secondary glaucoma. Surgery of the ciliary body appears to be the only possible procedure.

In a series of 3,222 cataract operations where enzymatic zonulolysis with Alphachymotrypsin was employed, the authors describe two complications which are thought to be due to the effects of the enzyme. They are the persistent iridoplegia in 18 cases (0.05) and the filamentary keratitis in 34 patients (1.05%). The clinical picture of an acute enzymatic intraocular pressure increase and the appearance of a persistent iridoplegia are discussed. Furthermore, these complications are brought together in tables and associated with other which are also thought to be caused by Chymotrypsin.

The authors describe a family with autosomal-dominant inheritance of hereditary Bruch's membrane drusen. After the death of the proband who was kept under clinical observation with fluorescein-angiographic examination over a period of seven years, the authors obtained the bulbus for histopathologic study. Light microscopic changes in the boundary-line structures of the retina and choroid and the occurrence of an intraretinal membrane in the maculopapillary bunch area are described. This membrane is thought to represent a "predisciform stage" in the development of this hereditary dystrophy.

4 patients out of 2 pedigrees present an association of dominant drusen, central chorioretinal dystrophy and retinal crystals. It seems to be transmitted in an autosomal dominant mode. Drusen have also been found in 4 patients (3rd generation) at the age of 40 years. Central chorioretinal dystrophy and retinal crystals have not been found prior to the age of 60 years. Visual acuity and central scotoma depend on the central chorioretinal dystrophy. Electro-oculograms and electroretinograms exhibited relatively little changes. 2 patients showed phenotype II and IV of Fredriksen.

The nevus of Ota (naevus fusco-coeruleus-ophthalmo-maxillaris) is demonstrated by two clinical cases. The authors describe the disease, the morphology and the problem of malignancy.

The possibilities for treatment of the anterior segment of the eye with the new glaucoma research laser, model 152, constructed by Britt-Corp. are reported on, along with the possibilities of vasodesolation, pupilplastics, iridontomies and iridectomies. Especially mentioned is the technic and possibility of laser-trabeculopuncture. This laser archieves remarkable success also in open-angle glaucoma and closed-angle glaucoma provided the technic is suitable. It is shown that all operations can be carried out by an ambulant patients and practicly without any complications. There are no problems during the aftertreatment for the doctor or for the patient.

Eighty days after i.c. cryoextraction of the lens without any complications, intra- or postoperative, choroidal detachment was observed in a 68-year-old woman (hypertension, diabetes m..amaurosis of the right eye after central artery embolism). -Conventional decongestive drugs (Reparil, Tantum, Tanderil) had no effect. Within 6 days of treatment with microwaves, 2.5% Hydrocortisone and atropine eye-drops and Prednisolone (10 mg/die) internally there was complete regression of the detachment.

In the last four years we have treated with the mobile argon-laser beam 25 cases of aphakic pupillary block glaucoma (p. b. g.). According to the time of manifestation of the p. b. g. the patients were divided into an "early" and a "late" group. In the "early" group (17 eyes) the glaucoma manifested itself 1--4 days after cataract extraction. In the "late" group (8 eyes) p. b. g. appeared from 4 weeks to 3 years after cataract extraction. In 14 of the 17 cases of the first group we achieved a prompt reformation of the anterior chamber and a considerable decrease of intraocular pressure immediately after laser application. In 3 cases of the first group, where the pupil was under relative or absolute mydriasis before argon-laser treatment, the mobile laser beam failed to produce satisfactory results. In all of the 8 patients of the "late" group a reformation of the anterior chamber was achieved, but in only 4 of them did i. o. pressure normalize owing to extensive anterior synechiae. Laser application left either very slight or no traces at all on the iris. In order to ascertain the actual effect of the laser beam upon the iris, we applied laser under identical conditions in eyes which had no glaucoma but were to undergo enucleation because of choroidal melanoma. The histological examination revealed a slight degree of hyperaemia of the iris as an oedema of the connective tissue, while the iris sphincter did not appear to be affected by laser treatment.

The differential diagnosis of granulomatous epitheloid cell reaction, which is the typical histologic finding in sarcoidosis, is discussed and the involvement of the different ocular tissues illustrated. The biomicroscopic picture is compared with histopathologic findings. As the incidence of conjunctival manifestation of sarcoidosis is high (over 50% in serial sections at different levels), it represents a possibility of confirming the diagnosis histologically without any bioptic risk.

A 42-year-old male with beginning proliferative diabetic retinopathy developed a serous choroidal detachment as a complication following excessive light coagulation (retinal ablation); under conservative antiphlogistic treatment the choroidal detachment disappeared within one week.

A- and B-scan sonography was performed in 83 patients with choroidal detachment; a serous choroidal detachment is characterized by high, bifurcated echospikes and an echo-free subchoroidal space in A-scan sonography. The B-scan presents a typical arc shape. In hemorrhagic choroidal detachment multiple echoes with low to medium reflectivity can be demonstrated in the subchoroidal space. The echographic differential diagnosis of other intraocular diseases is discussed.

The clinical, fluorescencangiographical and histopathological findings in 3 cases of non-pigmented iris cysts are described. The first case was a posttraumatic cyst after cataractextraction, the second in all probability, also a posttraumatic cyst and the third case was a spontaneous intrastromal nonpigmented iris cyst. Although the clinical and histopathological findings are not always helpful in the differential diagnosis between non-pigmented posttraumatic and non-pigmented spontaneous iris cysts, we believe, that fluorescencangiography may provide valuable additional information. The preoperative differentiation is important, because radical excision including the affected cornea or sclera is necessary in the posttraumatic cases, whereas only a simple iridectomy is required for the spontaneous cysts.

Visual acuity was tested in 34 patients (64 eyes), age 73.6 years, following systemic cortisone administration. A significant improvement in vision was found (82.81% and 67.19%) after three as well as after an average of ten months. It is remarkable that some of the patients (17 eyes), who were treated with vessel-active substances, and in some cases also with the vitamins A and E, also showed improvement in visual acuity comparable with the group treated with cortison only. In the small group (six eyes) with moist macular degeneration a slight improvement was only recorded in one case. The probable effects of cortisone in the course of arteriosclerotic chorioretinopathy are explained with the aid of histological findings of other authors.

Indications, results and complications of 100 consecutive cases of pars plana vitrectomy are reported. In 83% of patients with anterior segment and/or vitreous opacities a clear view to the fundus could be obtained; visual acuity improved significantly in 73%. Complicated retinal detachments, not managable with conventional retinal surgery, could be reattached in 26% of the cases. In carefully selected patients vitrectomy was indicated to stabilize the anatomic situation and to prevent further visual deterioration.

Detachment of the choroidea after retinal detachment surgery is a very common finding. The combination of rhegmatogenous retinal detachment and preoperative choroidal detachment is a very rare condition with poor prognosis which has received only very little attention in the literature. Therefore, we reviewed the last 1000 consecutive case histories of patients who had undergone surgery for retinal detachment in our clinic. We found choroidal detachment postoperatively in 102 cases, but the combination of rhegmatogenous retinal detachment with preoperative choroidal detachment only in four of the 1000 patients. To evaluate the causative factors we recorded some datas, e.g., preoperative IOP, previous ocular trauma, refractive error. The congruent findings in the four cases are discussed.

The clinical picture, the angiogram, the echogram, and especially the positive P 32 test led in a 30-year-old man to the diagnosis of a choroidal melanoma. Histologic examination revealed a tuberculoma.

Topographical criteria in B-Scan ultrasonograms of ocular fundus lesions are discussed that leads to the possibility of differentiating retinal from uveal lesions, especially if the retina is detached.

It was recently stressed by Scheerer that retinal detachment in a highly myopic eye may be caused by hyperaemia of the choroid, presumably occuring during heavy physical labour which is performed by a non-trained person. Clinical studies have shown, however, that choroidal detachment, resulting from either hemorrhagic, or serous accumulation of fluid during operative procedures or during postoperative periods, is not followed by retinal detachment. Also experimental occlusion of large choroidal vessels, associated with hyperaemia in the choroidal vasculature, does not lead to retinal changes inducing the separation of the neuroretina from the pigment epithelium layer. Thus, it is concluded that choroidal hyperaemia, possibly occuring during heavy physical labour, has no relationship to the development of a retinal detachment in a "disposed" eye.