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Purpose: To determine if a test formulation of latanoprost 0.005% (Bausch & Lomb) eyedrops reduced intraocular pressure (IOP) as well as Xalatan® (latanoprost 0.005%) in patients with ocular hypertension (OH) or primary open-angle glaucoma (POAG)., Methods: This multicenter, randomized, investigator-masked, parallel-group study allocated 266 patients with OH or POAG in a 1:1 ratio to latanoprost or Xalatan administered once daily for 6 weeks. The primary endpoint was the mean change in 8:00 AM IOP of the study eye from baseline to week 6. Secondary endpoints included mean change in 8:00 AM IOP from baseline to week 2, and in 12:00 noon and 4:00 PM IOP from baseline to week 2 and week 6. The safety and tolerability of both drugs were also assessed., Results: Both study groups had comparable demographics and baseline characteristics. The mean (SD) change in 8:00 AM IOP from baseline to week 6 was -7.29 (2.61) and -7.54 (2.80) mmHg with latanoprost and Xalatan, respectively. Latanoprost was found noninferior to Xalatan in the primary analysis (mean [SEM] treatment difference, 0.252 [0.504] mmHg; 95% confidence interval [CI] -0.408, 0.913; p = 0.0001; noninferiority margin, 1.5 mmHg) and met the predefined definition of equivalence to Xalatan (95% CI within [-1.5, 1.5 mmHg] margin). The IOP-lowering effects of latanoprost and Xalatan were comparable at all assessed time points. Both study treatments demonstrated a comparable safety and tolerability profile., Conclusions: Bausch & Lomb latanoprost 0.005% is clinically equivalent to Xalatan for treating OH and POAG as demonstrated through this unique comparative trial.

Case Report: Granulomatous infectious processes have a wide differential diagnosis. This report describes the case of a 73-year-old woman who had gone through an 8-year ordeal involving several paranasal sinus operations, development of chronic facial pain, orbital exenteration of the left eye, and now threatening loss of the remaining right eye on account of progression of the chronic inflammation. Despite repeated histologic examination of ENT material by various pathologic institutes, neither the histology nor laboratory parameters were able to point us in the right direction. In the end, it was the clinical course which led to the diagnosis of Wegener's granulomatosis., Conclusion: In chronic necrotizing granulomatous inflammatory processes in the region of the paranasal sinuses with involvement of the surrounding anatomic structures (orbit, skull base), Wegener's granulomatosis should be included in the differential diagnosis at an early stage, even if the typical signs of vasculitis and the typical antibodies are absent. The clinical course calls for an interdisciplinary treatment approach in conjunction with internists experienced in immunosuppressant therapy.

Objectives/hypothesis: Magnetic resonance imaging (MRI) has become the investigation of choice to follow up patients after vestibular schwannoma resection., Study Design: Retrospective., Methods: Postoperative MRI findings of 70 patients after vestibular schwannoma resection through a transtemporal (n = 48) and a translabyrinthine (n = 22) approach were reviewed. Time-dependent changes in intensity, size, and shape of enhancement in the internal auditory canal before and after contrast administration, postoperative temporal lobe gliosis, and changes of fat grafts were evaluated., Results: After vestibular schwannoma resection, all patients showed signal enhancements in the internal auditory canal ranging from a faint to high signal intensity in the first postoperative MRI, 3 to 6 months after surgery. In the next MRI at 12 to 24 months after surgery, 30 patients (43%) showed a decreased signal, 35 patients (50%) a stable enhancement, and 5 patients (7%) an increased enhancement in the internal auditory canal depicted as an intense nodular or mass-like pattern. In patients with decreased or stable enhancement, a residual tumor could be excluded in the following MRI scans, whereas in all patients with increased enhancements after 12 to 24 months, signal enhancement further increased and residual tumors were detected. Different degrees of temporal lobe gliosis were found in 15 of 48 cases (31%) after transtemporal tumor removal. Enhancement of fat grafts used in 22 cases decreased to different degrees in 14 cases (64%)., Conclusions: Differentiation of residual tumor from scar tissue in the internal auditory canal after vestibular schwannoma resection requires close, long-term follow-up. Nodular and progressive enhancements in the internal auditory canal indicate residual tumor. Linear enhancement in the internal auditory canal has been found to be a common finding after vestibular schwannoma resection not associated with residual tumor.

Objective: The etiopathogenesis in audiovestibular symptoms can be elusive, despite extensive differential diagnosis. This article addresses the value of magnetic resonance imaging (MRI) in analysis of the complete audiovestibular pathway., Study Design: Retrospective evaluation., Setting: Tertiary referral center., Patients: Consecutive sample of 354 patients (mean age 49 years, range 8 to 86 years) with audiovestibular disorders., Intervention: Contrast-enhanced MRI of the head with thin-slice investigation of the inner ear, internal auditory meatus, and cerebellopontine angle., Main Outcome Measure: All MRIs were evaluated by experienced independent investigators. Statistical analysis was performed using the Statistical Package of Social Sciences data analysis 9.0., Results: MRI abnormalities were seen in 122 of 354 patients (34.5%). The MRIs revealed the following: 4 pathologic conditions (1.1%) of the cochlea/labyrinth, 23 abnormalities (6.5%) at the internal auditory meatus/cerebellopontine angle, 12 pathologic lesions (3.4%) that involved the central audiovestibular tract at the brainstem, 78 microangiopathic changes of the brain (22%), 3 focal hyperintensities of the brain that turned out to be the first evidence of multiple sclerosis in 2 patients and sarcoidosis in 1 patient, and 1 temporal metastasis. Other pathologic conditions, such as parotid gland or petrous bone apex tumors, were unrelated to the audiovestibular symptoms., Conclusions: This study indicates that contrast-enhanced MRI can be used to assess a significant number of different pathologic conditions in patients with audiovestibular disorders.

Papillary tumors of the middle and inner ear have been interpreted histogenetically in many ways. In 1989 Heffner proposed the endolymphatic sac epithelium as a possible origin. These rare tumors are clinically aggressive and can cause extensive temporal bone destruction. Because of this behavior, endolymphatic sac tumors (ELST) were classified as low-grade adenocarcinomas, although metastasis has not yet been documented. Two papillary neoplasms of the temporal bone are presented, which we believe are examples of adenomatous tumors arising from the epithelium of the endolymphatic sac. One was associated with a pituitary adenoma. A third case of a papillary middle ear neoplasm is described that shows histologic features similar to the other two, but it was located in the tympanum and had no connection to the endolymphatic sac. This report focuses on clinical, radiologic, and histologic findings of papillary tumors of the temporal bone with additional emphasis on modern concepts of histogenesis and aspects of differential diagnosis.

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible.

Surgery after pre-operative embolization has become the main treatment modality in angiofibroma therapy. As surgical planning is based on precise preoperative tumour evaluation, knowledge of the characteristic growth patterns is of great interest. Analysis of tumour extension and blood supply, as well as methods of controlling intra-operative bleeding, help in determining the appropriate surgical approach. Though benign, angiofibroma demonstrates a locally aggressive nature. This fibrovascular tumour is characterised by typical radiological findings and by predictable growth patterns. The tumour extension and blood supply can be accurately determined by CT, MR imaging and angiography. With classic radiological findings, no pre-operative biopsy is necessary in most angiofibromas. Advances in radiological imaging have contributed to improved surgical planning and tumour resection. The surgeon is able to select the least traumatic approach with secure haemostatic control, which is also critical for avoiding the disturbance of facial skeletal growth in this group of young patients. Embolization, pre-operative autologous donation and the cell saver system for immediate retransfusion of the collected blood after filtration, are important tools for dealing with blood loss in angiofibroma surgery as they minimize homologous blood transfusion.

Objective: To evaluate the intraoperative and late complications of osteoplastic sinus surgery with fat obliteration with long-term magnetic resonance imaging (MRI) follow-up., Methods: The operative records of all patients who underwent osteoplastic frontal sinus surgery with fat obliteration between January 1, 1986 and December 31, 1997 were reviewed and the postoperative clinical course and magnetic resonance imaging (MRI) scans were analyzed if available. MRI analyses revealed that changes in the distribution of fatty and fibrous tissue, the development of necrosis or oil cysts, recurrences, inflammatory complications, and mucoceles were time-dependent occurrences., Results: Eighty-two operative records were evaluated and 59 patients were followed 1 to 12 years after surgery. Eighty-six MRI scans in 51 patients were available for analysis. The most frequent intraoperative complications were exposure of orbital fat (19.5%), unintentional fracture of the anterior wall (19.5%), incorrect placement of the anterior wall (17%), and dural injury (9.8%). Persistent changes of the frontal contour (embossment, depression) occurred in 10.2% and the esthetic result was unfavorable in 5.1% of the cases. Mucoceles could be detected in 5 of 51 cases (9.8%). The amount of adipose tissue detectable in the last scan was less than 20% in the majority of cases (53%), and more than 60% in only 18% of the cases. The amount of adipose tissue decreased significantly with time (the median half-life was 15.4 mo)., Conclusions: Osteoplastic frontal sinus surgery with fat obliteration is very useful and successful in patients in whom the frontal sinus is not accessible via an endonasal approach or the natural drainage cannot be reestablished. MRI is currently the most valuable diagnostic tool to evaluate the frontal sinus after obliteration with adipose tissue. The method has some limitations with regard to detection of small recurrent mucoceles and differentiating vital adipose tissue from fat necroses in the form of oil cysts. In these difficult cases, long-term MRI follow-up is necessary.

Surgery is the most common treatment for angiofibromas, but the approach is still a major point of discussion. Five cases of angiofibroma with typical localisation were treated surgically by an endonasal approach at the Fulda Academic Teaching Hospital from 1994 to 1997. This article presents an analysis of the clinical findings, computer tomography and magnetic resonance imaging, preoperative embolization, operative technique and complications. Endoscopic and radiologic follow-up ranging from 5 to 39 months excluded any residual tumour or recurrence. The endonasal microendoscopic approach with adequate preoperative embolization should be considered as an useful technique for removing tumours with considerable size without using an external incision.

Hemangiomas of the skull base are rare neoplasms and are easily misdiagnosed as acoustic neuromas when occurring in the internal auditory canal. Among these tumors, ossifying hemangiomas are characterized histologically be newly formed bone tissue within their substance. We describe a 26-year old female patient who presented with left-sided sensorineural hearing loss and tinnitus. T2-weighted magnetic resonance imaging demonstrated a bright space-occupying lesion of the internal auditory canal with extension to the geniculate ganglion. Bony erosions of the internal auditory canal were proved by high-resolution computed tomography. A hemangioma was suspected preoperatively and was resected via a middle cranial fossa approach. Histologically, new bone formations were found in a cavernous hemangioma. In general, radiologic findings can suggest a hemangioma of the internal auditory canal and help to differentiate it from acoustic neuroma. Based on the histological findings of intratumoral bone formation, the hemangioma in our patient was classified as an ossifying hemangioma. However, reactive bone formation at the borders of a tumor in the internal auditory canal can also be mistaken as new intratumoral bone formation.

Despite increasing advances in endonasal frontal sinus surgery, obliteration of the frontal sinus is necessary in some cases for definitive clearing frontal sinus pathology. Reviewing the literature and considering pathophysiological aspects, successful obliteration of the frontal sinus depends on the complete removal of the mucosa and a sufficient closure of the nasofrontal duct, but not on the material used for obliteration, if special considerations are taken into account and foreign materials are avoided. Complete removal of the mucosa has to include removal of the inner bony cortex of the frontal bone. Occlusion of the nasofrontal duct is achieved with a sufficiently fixed fibrous layer.

Occult malformations of the skull base are rare anomalies. They are often not detected until they give rise to complications such as meningitis or cerebrospinal fluid rhinorrhea. We used high-resolution computed tomography, fluorescein endoscopy, cisternography, magnetic resonance imaging, and duraplasty to diagnose occult malformations of the skull base in 4 patients. The four patients had had between 4 and 6 attacks of meningitis. Cerebrospinal fluid rhinorrhea was confirmed in 3 cases. The following occult malformations were found: (1) an encephalocele of the glabella/cribriform plate and a meningocele at the petrous bone apex, (2) a meningoencephalocele at the petrous bone apex, (3) dural lesions in the regions foramen rotundum/sphenoid sinus and frontal sinus/cribriform plate, and (4) a dural lesion of the sphenoid sinus. In patients presenting with recurrent meningitis, meningitis with isolation of upper airway pathogens, or cerebrospinal fluid rhinorrhea, modern diagnostic methods should be used to search for dural lesions. Diagnosis of an occult malformation makes it possible to perform the necessary surgical repair and thus prevent the further occurrence of potentially fatal episodes of meningitis.

The authors review their experience in detecting occult traumatic dural lesions. In a retrospective study covering the period from January 1, 1984 to December 31, 1996, 23 patients were evaluated for occult traumatic dural lesions. Clinical presentation, diagnostic work-up, and management of the dural lesions were analyzed.The clinical presentations of the previously undetected dural lesions of the anterior skull base were meningitis in eight cases, cerebrospinal fluid (CSF) rhinorrhea in eight cases, both meningitis and CSF rhinorrhea in five cases, and a pulsating swelling in the region of the right upper eyelid in one case. In another case a fracture of the posterior frontal wall was detected incidentally on the preoperative CT scan performed prior to surgery for chronic sinusitis. One patient had a CSF fistula of the lateral skull base in addition to the frontobasal fistula. The interval between trauma and diagnosis varied from 1 to 48 years. Dural lesions were localized by high-resolution CT, fluorescein nasal endoscopy, CT cisternography, and MRI. Intraoperative exposure of the dural lesions and duraplasty were possible in all cases. During the first attempt successful repair of the dural lesions was accomplished in 22 (95.7%) of the 23 patiants. Two interventions were necessary to close a CSF leak of the cribriform plate.Modern clinical and radiologic diagnostic methods should be employed to search for an occult dural lesion in patients with recurrent meningitis, meningitis caused by upper airway pathogens, or CSF rhinorrhea. The patient will remain at risk of potentially fatal meningitis until the lesion is appropriately repaired by duraplasty.

It has been shown that inhibition of phosphodiesterase (PDE) or an increase in intracellular cyclic adenosine monophosphate (cAMP) can lower the intraocular pressure in mammalian eyes. The PDE inhibitor rolipram binds with high affinity to a cAMP-dependent PDE. In the following study, receptors for rolipram in the mammalian eye are determined by autoradiography. About 1050 histological sections of rabbit (albino and pigmented), rat, monkey (baboon and marmoset) and human eyes were examined concerning rolipram-binding sites in different structures. The highest specific binding of rolipram to the ciliary body epithelium was seen in human, rabbit and baboon eyes. Marmoset eyes showed the highest specific binding in the ciliary body muscle, rat eyes in the retina. Specific binding was consistently high in the ciliary body epithelium and therefore at the site of aqueous humor formation. Because of these results and the known mode of action of rolipram, one can assume a close connection between rolipram-binding sites and the regulation of intraocular pressure.

A papillary neoplasm that was presumed to originate from the endolymphatic sac was described by Heffner in 1989. This tumor was considered to be a "low-grade adenocarcinoma" because of its behavior: slow growth, local destruction and failure to metastasize. The clinical manifestations are hearing loss, vertigo, facial nerve paralysis and/or cerebellar disorders. Endolymphatic sac tumors have previously been mistaken for such neoplasms as paraganglioma, choroid plexus papilloma and carcinoma, adenomatous tumor of the middle ear and secondary metastases. The diagnosis of this neoplasm is facilitated by CT and MRI. The treatment of choice is total removal of tumor as soon as possible and requires clinical awareness of this rare but important pathologic entity.

Since February 1979, 22 juvenile angiofibromas have been treated among 312 tumors of the skull base managed in the ENT Department, Fulda. According to a general staff consensus the treatment of choice was complete surgical removal. This was achieved in 20 cases with one operation and in one case with two operations. In addition to removal of tumor, functional and aesthetic aspects had to be considered as aims of operative treatment, including among others preservation of the facial skeleton, infraorbital nerve, nasolacrimal drainage system and vision. In rare cases complete excision of the tumor is not possible. The value of cytostatic therapy is demonstrated in one patient with uncommonly advanced disease. Considering the extensive regression of tumor achieved in this case after chemotherapy with Adriamycin and decarbazine, one has to raise the question if the chemotherapeutic approach was more than just palliative. From our experience chemotherapy should be considered a possible alternative to radiation in the management of unresectable juvenile angiofibromas.

The obliteration of the frontal sinus via an osteoplastic approach is performed with the aim of achieving a permanent 'switching off' by final and conclusive clearing out. For this, freshly harvested abdominal fat has shown itself to be the best clinically. It is possible to demonstrate the vitality of fat transplanted into the frontal sinus without an operation, i.e. by a macroscopical and histological examination using magnetic resonance imaging (MRI). The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T.S.II, Philips Medicine Systems, Eindhoven, Netherlands) with a quadrature (square) head spool. We produced T1-weighted spin echo images (TR: 450-550 ms; TE: 20-25 ms), T2-weighted fast spin echo images or in double-echo technique in transverse orientation (Turbo SE or TR: 2000-2500 ms; TE: 50-90 ms) and short tau inversion recovery (STIR) sequences for fat suppression (TJ: 140 ms; TR: 1400 ms; TE: 30 ms). The fat implanted into the frontal sinus of 11 patients aged 22-65 years, having undergone an osteoplastic frontal sinus operation with obliteration, was examined post-operatively by MRI. Objectives were the time-dependent distribution of portions of vital fatty or connective tissue, the eventual development of necroses or cysts as well as recurrences, inflammatory complications or re-epithelization of the frontal sinus four to 24 months post-operatively. In only six out of 11 cases was vital fatty tissue found. Fatty necrosis occurred five times, whereas in four cases a transformation into granulation tissue and in one case into connective tissue could be seen. All 11 patients were complaint-free. Long-term observations are needed to see if differences in the recurrence rate of frontal sinus disease are dependent on whether the implanted fat remains vital or necrosed and transformed.

The morphologic correlate of the so-called subepithelial haze after photorefraktive keratectomy (PRK) has not yet been decided. Excimer laser keratectomy 100 microns in depth was performed in an eye that was scheduled for enucleation. Three months after surgery a dense scar was diagnosed with the slit lamp. After enucleation the cornea was investigated by light microscopy. The thickness of the scar was less than 1 micron in most sections with a maximum of 5 microns. This surprising finding explains the predominantly scattering power of the subepithelial haze, which results in a relatively good visual acuity of 20/30 to 20/25 in most clinical cases.

Focal cerebral ischemic symptoms, Horner's syndrome and mostly ipsilateral headache are the characteristic clinical triad of extracranial carotid artery dissection. Lower cranial nerve palsies seem to be uncommon and rare. By means of two cases with identical clinical symptoms and of a literature review we make clear, that ipsilateral lower cranial nerve palsies, especially a hypoglossal nerve palsy, are not uncommon. Without focal cerebral ischemic symptoms they can be the only sign of extracranial carotid artery dissection. Computed tomography of the skull base with regard to the high cervical internal carotid artery is as an usually quickly available examination an alternative to magnetic resonance imaging.

Pneumosinus dilatans (PSD), first described by Meyes in 1898, is an abnormal dilatation of one or more of the paranasal sinuses without bony erosion. The term sinus pneumocele indicates the presence of bony erosion. Review of the literature from 1968 to 1992 revealed 24 cases of idiopathic PSD and 17 cases of pneumocele of various paranasal sinuses. PSD occurred most commonly in the frontal sinus. Males were more often affected than females. The average age for males ranged from 16.5 for the maxillary sinus to 35.5 years for the sphenoid sinus. Pneumoceles occurred most commonly in the maxillary sinus. The average age for males ranged from 29 years for the frontal sinus and 47 years for the ethmoid sinus. Two patients (1 pneumocele and 1 PSD) had a temporary loss of vision. We report the case of a 37-year-old mountain climber who experienced temporary loss of vision in his left eye above 3000 m. Vision returned below 2000 m. High resolution computed tomography scan revealed pneumosinus dilatans of the sphenoid sinus with dehiscence of the optic canal on the left side. Endonasal microendoscopic resection of the anterior wall of the left sphenoid sinus was performed. The patient has remained symptom-free after 2 years of follow-up. Pneumosinus dilatans should always be considered in the differential diagnosis of sudden visual loss associated with atmospheric pressure changes.

Chronic application of beta-blockers often induces tachyphylaxia of unknown origin. After long-term topical pretreatment of pindolol and timolol in rabbit eyes (up to 12 weeks, twice a day) beta 2-adrenergic receptors were localized and quantified with autoradiographic methods. Frozen sections of albino rabbit eyes were labelled with [125I] cyanopindolol. Quantification revealed a significant increase in the density of beta 2-receptors after premedication with pindolol in the ciliary body and the corneal epithelium. This increase was detectable after 2 weeks of premedication and reached its maximum after 4 weeks. After premedication with timolol a significant increase of beta 2-receptors in the epithelium of the ciliary body and the corneal epithelium was visible. Following pindolol over an equivalent time-course, to that of timolol administrations, an increasing number of beta 2-receptor sites was also observed. No significant changes were visible for either kind of premedication investigated (pindolol/timolol) in the corneal endothelium, the lens or the choroid. Chronic application of topically instilled beta-blocking agents leads to a significant increase in receptor density in ocular structures that are involved in aqueous humor production. This up-regulation of beta 2-adrenergic receptors might explain the intraocular events at receptor level in relation to the phenomenon of tachyphylaxis.

Background: Since 1968, when the first commercial squash center has opened in Hamburg, squash has become very popular in Germany. Squash is played between two players in a closed court using racquets and a hollow rubber ball which could reach a maximum speed up to 225 km/h. According observations of English and American ophthalmologists there is an increased risk to get an eye injury in this game. Because of the isolation by the former existing wall, Berlin-West was an ideal place to study the ocular hazards of playing squash., Methods: In 1991 about 40,000 squash players existed in Berlin-West playing on 118 courts of 13 commercial squash centers. During January to October 1991 case records of all hospitals with an emergency eye ambulance and of the eye residents were investigated, furthermore all patient records of 1989 and 1990 of the eye clinic of the university hospital Rudolf Virchow, department Charlottenburg, were examined retrospectively., Results: All over 234 sports-related eye injuries were registrated, 78 (33.3%) patients sustained the injury during a squash game, 43 (18.4%) during soccer and 34 (14.5%) during playing tennis. 71 squash players were treated in an hospital ambulance, of these 15 required admission. A total of 206 injuries were sustained by the players. The majority of injuries were superficial, but in 12 cases occured an hyphaema and in 13 an angle recession. In all admitted patients visual recovery was good, during the clinical follow up there were no perimetric, ophthalmoscopic or tonometric impairments. The initial loss of visual acuity of the injured eye compared to the other side was on the average 4.5 lines, at dismissal from the hospital it was on the average 2 lines., Conclusion: Because of the increased risk to get an eye injury during a game of squash, players should be encouraged to wear proper eye protection i.e. closed eye guards according to standards of North-American testing organisations.

Apart from midfacial traumas, laterobasal fractures are the most common skull base injuries the ENT surgeon has to deal with. These fractures often appear in combination with more or less extensive further skull or brain injuries. In these cases interdisciplinary co-operation with the neurosurgeon is necessary. Today, development of high resolution computed tomography makes it possible to define priorities in treatment of these patients exactly.

The photoablation products from human cadaver corneas treated with an excimer laser (192 nm) or an erbium: YAG laser (2.94 microns) were qualitatively analyzed using a combined gas chromatography mass spectrometry (GC/MS) system. GC/MS is the most sensitive analyzing system in use today for molecules with a relative molecular mass of 40 to 400. More than 20 different types of molecules were detected; most of them were identified as alkanes. Comparison of the two types of laser showed larger fragments and fewer different types of molecules after excimer laser treatment than after erbium: YAG photoablation. We postulate that the smaller molecules after erbium: YAG treatment indicate a greater heat during photoablation than with excimer laser treatment.

Background: The first 26 patients who underwent photorefractive keratectomy with an excimer laser in our clinic with a 1-year follow up voluntarily answered a questionnaire., Methods: It was intended to get information about their social status, motivation, expectations, and satisfaction with myopic excimer laser photorefractive keratectomy., Results: All patients wore corrective lenses before surgery; 74% wore no optical correction after the photorefractive keratectomy. "To improve general vision" was the highest ranked motivation while "looking better" was only of minor importance. Seventy-two percent reported that their subjective vision became better; 28% felt that it didn't change, but none reported deterioration of subjective vision. Seventy-five percent of the patients reported improvement of their lifestyle after surgery, whereas 21% reported no change and one patient stated that his lifestyle got worse. On a scale ranging from 1 to 5, early postoperative course was painful with a mean score of 2.25; the treatment itself was considered as professional (1.42 +/- 0.8) and well done (1.54 +/- 0.8). Eighty-four percent of the patients reported that they were satisfied with the overall results., Conclusions: All patients would decide again to have photorefractive keratectomy for myopic correction.

The photoablative products from human cadaver corneas treated with lasers were investigated using gas chromatography and mass spectroscopy. The photoablations were done separately with an excimer laser (193 nm) and with an erbium: yttrium aluminum garnet (Er:YAG) laser (2.94 microns). More than 20 different types of molecules with a molecular weight of 40-400 mass units could be identified, most of which were found to be alkanes. The comparison of the two types of laser ablations showed larger fragments and fewer types of molecules present after excimer laser treatment than after Er:YAG photoablation.

Cerebral arterial infarction is a very rare condition during the neonatal period. In recent times, cerebral infarctions with an atypical bland course are reported in healthy, unsuspected newborns. For the first time, we saw focal seizures and a transient syndrome of inappropriate ADH secretion in a full-term, male newborn with an infarction of the middle cerebral artery as the first sign of this disorder. On the basis of these rare clinical manifestations, the literature about neonatal cerebral infarction is reviewed. The diagnostic possibilities and prognostic expectations are discussed. It is the aim of this case report to call attention to this rare disease in order to avoid a delay in diagnosis and therapy, even if the initial manifestations are atypical.

Results of excimer laser keratomileusis in 26 myopic sighted eyes are presented. The follow-up was at least 9 months. The base-line refraction was -4.48 +/- 1.81 D (range: -1.4 to -9.25 D). After 3 months 85% were within +/- 1 D from the intended refraction. The such defined success rate after 6 months was 87.5%, after 9 months 88%, and after 12 months 92%. One month after surgery we found an overcorrection of +1.45 +/- 1.22 D decreasing to +0.27 +/- 0.94 D at three months, becoming an undercorrection of -0.24 +/- 0.76 D after six, and -0.32 +/- 0.69 D after nine months, and of -0.36 +/- 0.6 D after one year. Stability within the measurement error (+/- 0.25 D) appeared in 79% of the treated eyes six months after treatment. Three patients have been excluded from the study group because they did not follow the protocol. Subepithelial haze occurred in all patients, becoming most intense after 3 months, gradually clearing over the next months. With appropriate steroid medication, the refractive effect may be modulated. Complications as steroid glaucoma, recurrent erosion, loss of acuity, or extensive corneal scarring seem to be very rare.

The anatomic localization of the glucose transport protein in the eyes of rats, rabbits, baboons, marmosets, and humans with [3H]cytochalasin B using in vitro autoradiography showed high densities of glucose carrier densities. These densities were seen in the ciliary body, especially ciliary processes, iris, retina, and in some species, the trabecular meshwork and lens. In the lens, specific [3H]cytochalasin B-binding sites were mainly concentrated in the lens nucleus. Lower concentrations were found in the cortex. During aging, glucose transporter concentration increases up to the age of 8 yr in the marmoset lens nucleus, but decreases in the cortex and retina. Moderate amounts of carrier are located in the corneal endothelium and epithelium. The enrichment of glucose carrier protein in the trabecular meshwork suggests a high metabolic activity and a possible relationship in the regulation of intraocular pressure.