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Two men with recent history of lightining strike were referred to our hospital. Both patients complained of metamorphosia in one eye and reduced visual acuity. Funduscopy revealed target-like alterations at the fovea. Fluorescein angiography showed window defects of the central retinal pigment epithelium in both patients. One patient developed an anterior subcapsular cataract. If the eye is part of the current-circuit, the melanin granules of the iris, pigment epithelium, and choroid might act as a resistor. The resulting accumulation of heat may lead to damage of the surrounding tissues.

Familial adenomatous polyposis (FAP) is an autosomal-dominant precancerous condition characterized by the appearance of hundreds to thousands of colorectal polyps. The responsible gene (APC) has been mapped and identified. The cancer prevention policy for persons at risk (children and sibs of FAP patients) implies an early diagnosis of the disease. A presymptomatic diagnosis allows to limit the regular rectosigmoidoscopic examination to those persons having inherited the disease gene. Presymptomatic diagnosis can be achieved by molecular genetic methods (direct and indirect genotype analysis) and by funduscopic examination of retinal pigment anomalies that are characteristic for FAP. The aim of this study was to examine the power of the molecular genetic and ophthalmologic methods for presymptomatic diagnosis in FAP. For this purpose 60 FAP families with 171 persons at risk were examined. By direct mutation analysis a presymptomatic diagnosis was achieved in 32% of the persons at risk; indirect genotype analysis was possible in 88% of the families in which more than one FAP patient was available. The ophthalmologic examination allowed a presymptomatic conclusion in 79% of the persons at risk. In no case there was a discrepancy in the results between the methods applied. The ophthalmologic presymptomatic test is useful especially in families where the index patients has a new mutation in the APC gene that has not been identified.

In 153 eyes with idiopathic posterior subretinal neovascularization (IPSN) and myopia of no greater than −6 dpt, the relative risk of this disorder was determined with regard to refraction. It was shown that the probability of developing this condition is directly proportional to the degree of myopia. By using data obtained from the literature for calculating the relative risk regarding refraction, it was demonstrated that the same is true for subretinal neovascularization in degenerative myopia greater than −7.5 dpt (Fuchs' spot). The relative risk for developing one of both disorders increases exponentially with increasing myopia.

In 14 patients with ophthalmoplegia plus Tc-99m hexamethylpropylene amineoxime (HMPAO) brain SPECT imaging was performed. Three patients showed bilateral parieto-occipital hypoperfusions, and two patients had left parietal defects (one with an additional right temporal lesion). Two patients presented with occipital hypoperfusions and one with a distinct hypoperfusion in the medial part of both frontal lobes. Hypoperfusion of the visual cortex might result from permanently decreased input from the degenerated retina. The hypoperfusion in the visual cortex and in other regions alternatively might reflect direct central nervous system (CNS) involvement due to neuronal degeneration or to impaired vascular function caused by morphologically changed mitochondria in smooth muscle and endothelial cells. The data suggest CNS involvement in ophthalmoplegia plus with abnormalities of cerebral blood flow similar to those found in other mitochondrial encephalomyopathies.

Limited data is available as to what extent Norwegian hospital doctors ask their patients about their smoking habits, and to what extent doctors offer their patients help in smoking cessation.A random sample of 1,025 hospital doctors was mailed a questionnaire. After 14 days a reminder letter was sent to non-responders; 76% of the doctors responded.Altogether 98% of the doctors stated that they asked their patients with smoking-related disease about their smoking habits. In cases of non-smoking related disease, 73% of the doctors stated that they asked about the smoking habits of their patients (83% of female and 69% of male doctors). If doctors knew that a patient wanted to quit smoking, 25% of them stated that they often recommended nicotine replacement therapy. Less than 7% of the doctors regularly offered smoking cessation courses, handed out self-assistant material, or gave the patients other smoking cessation advice.The study indicates that doctors often ask their patients about their smoking habits, but there is clear potential for improvement as to the smoking cessation advice.

To evaluate whether oxidative tissue damage and inflammatory reactions occur in epiretinal membranes of eyes suffering from proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and macular pucker (MP).Epiretinal membranes were removed during surgery and frozen at -80 degrees C (PDR, n = 26; PVR, n = 24; MP, n = 15), and oxidative tissue damage and inflammatory activity (MPO) of the membrane tissue were determined. The values are expressed as means of thiobarbituric acid-reactive substances (TBARS, nmol/mg) and MPO (units/mg).Both TBARS and MPO activity were significantly elevated (P0.05) in membranes of eyes suffering from PVR and PDR compared to MP. The myeloperoxidase activity in PDR membranes was significantly increased (P0.05) compared to PVR.Inflammatory cells and oxidative metabolites lead to oxidative reactions in PDR and PVR. The proliferation of membrane tissue may be enhanced through products of the lipoxygenase pathway, which is active in inflammatory cells and leads to oxidative tissue damage. Chemoattraction of leukocytes by oxidative metabolites renders the process self-progagating. Since patients suffering from MP have an intact vitreous body with an intact antioxidative system, this reaction occurs to a lesser degree, resulting in less membrane-growth activity. The cell-growth-enhancing properties of inflammatory cells should be further investigated in PDR and PVR with regard to new therapeutic interventions.

To free both of the surgeon's hands for bimanual work in the vitreous cavity, Koch and coworkers developed the multiport illumination system, which, however, requires enlarged sclerotomies.To evaluate the safety of the multiport illumination system we analyzed the first postoperative year of those 104 vitrectomies, that were performed using this system between January and December 1991. It was used only for patients suffering from advanced vitreoretinal changes that most likely require bimanual surgery.No specific intraoperative or postoperative complications were encountered that might possibly have been caused by the multiport illumination system. Postoperative fibrinous reactions were noted in the vitreous cavity of 7 patients, and in the anterior chamber of 15 patients. Rebleeding was observed in a total of 17 patients.When these complications were compared to data from other retrospective studies of vitrectomy and its complications, the multiport illumination, system was found to be as safe as conventional devices.