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To document an association between Terrien's marginal degeneration and posterior polymorphous dystrophy.A 23-year-old Saudi man presented with decreased vision, peripheral corneal thinning with vascularization and scarring, and abnormalities of the posterior stroma and Descemet's membrane.Clinical examination, corneal topography, and specular microscopy were consistent with a diagnosis of Terrien's marginal degeneration and posterior polymorphous dystrophy.We report the first case, to our knowledge, of the simultaneous occurrence of Terrien's marginal degeneration with posterior polymorphous dystrophy.

Age-related macular degeneration (AMD) is a common cause of visual loss among elderly patients. Although some risk factors have been determined, the ultimate cause of the disease is not known. For a long time, therapeutic nihilism has been the rule among ophthalmologists confronted with such patients. Bangerter has not shared this attitude, especially since the time that he incidentally discovered, more than 40 years ago, the beneficial effects of radiotherapy, in discouraging the growth of new vessels at the posterior pole of the eye. A variety of approaches are combined and used by Bangerter in the treatment of the different types of AMD, including retrobulbar injections of either vasodilating medications (in the dry - or atrophic - type) or corticosteroids (in the wet - or exudative - type), general medical measures aimed at improving metabolic and vascular functions such as supplementation with trace elements, antioxidants, and vitamins; ozone therapy; advice to increase physical fitness, improve nutrition, and abstain from smoking; and protection from excessive light exposure. Being convinced of the usefulness of his type of combination treatment, he has always rejected undertaking controlled clinical trials, of only single aspects of the therapy, as unethical and invalid. For this reason, scientific journals have not proven cooperative in several attempts at publishing his results, as collected in retrospective surveys. Recently, however, some of the several approaches combined by Bangerter in treating AMD have been pronounced effective by other investigators. We present here an overview of his treatment approaches, as few people are aware of them, to clear up misconceptions and to set records straight.

To study the outcome of phacoemulsification (PE) compared to standard extracapsular surgery before the introduction of state-of-the-art techniques (capsulorhexis, hydrodissection, nuclear cracking, nuclear chopping, sutureless incisions) and sophisticated equipment.Charts from 375 patients (453 eyes) undergoing PE between 1984 and 1989 were randomly selected and studied retrospectively. A minimum age of 35 years, and a minimum follow-up of three months were required.A large eye hospital in the Kingdom of Saudi Arabia staffed with an international faculty of ophthalmic surgeons.Patients over 35 years of age undergoing PE for immature, mature and traumatic cataract.Postoperative visual acuity, and rate or frequency of intraoperative complications.66.5% achieved visual acuity of 20/40 or better, which compares favourably with the 36.5% of eyes reaching this level of visual acuity after mainly standard extracapsular cataract surgery in another study at our hospital. Posterior capsule ruptures occurred in 7.5% and vitreous loss in 5.5%. Other ocular disease (odds ratio 7.51 confidence interval 4.43-12.7) and intraoperative complications (odds ratio 2.97 confidence interval 1.38-6.42) were statistically significant predictors for final visual acuity of under 20/40 (p =0.001 and 0.005 respectively).The outcome of PE was better than that of standard extracapsular cataract extraction in the same setting. However, since PE appeared to be used selectively, no clear advantage compared to extracapsular cataract extraction is evident in the period before the introduction of modern state-of-the-art PE-techniques.

Large choristomas that straddle the cornea and limbus can be removed and a lamellar graft sutured to the excision site. A central penetrating keratoplasty performed later can restore a clear visual axis.

Phototherapeutic keratectomy (PTK) is an effective treatment for many superficial corneal disorders. The efficacy of PTK for the treatment of climatic droplet keratopathy (CDK) has not been reported.We report the results of excimer laser (Summit Technology, Inc, Waltham, Mass) PTK on 75 eyes (67 patients) with "smooth" climatic droplet keratopathy (55 eyes) and "irregular" climatic droplet keratopathy (20 eyes) in whom more than 6 months of follow up are available.PTK was successful in reducing corneal opacification in both smooth (98%) climatic droplet keratopathy and irregular (80%) climatic droplet keratopathy. Achievement of a clear or mildly hazy cornea following PTK was more likely to occur with smooth (80%) climatic droplet keratopathy than irregular (25%) climatic droplet keratopathy (P = 0.01). Eyes with smooth climatic droplet keratopathy were more likely to obtain more than one line of improved uncorrected (56% vs. 25%) or spectacle-corrected visual acuity (61.8% vs. 21.2%) than those with irregular climatic droplet keratopathy (P = 0.03 and 0.005, respectively). Delayed re-epithelialization (longer than 14 days) was more common in irregular CDK (21%) than in smooth CDK (9%), as was the incidence of secondary microbial keratitis (10.0% vs. 1.8%).PTK is effective in reducing superficial corneal opacification in CDK, although serious complications may occur, especially in advanced irregular CDK.

Given the problems associated with iris-sutured and scleral-fixated intraocular lenses (IOLs), pars plana fixation might be a safer and more effective approach. Significant improvements in lens design and materials, and changes in surgical approach and technique may now make pars plana fixation an attractive alternative. As contrasted with Girard's technique (1981), the implant loops would not be incorporated (buried) into the scleral wall, nor would the IOL be inserted through the pars plana. Advantages of a pars plana fixation include the low risk of intraoperative and postoperative hemorrhage, and the chance of avoiding contact between the IOL, iris, and pars plicata, depending on the lens design. Only the nonpigmented inner layer of the pars plana would be in direct contact with the haptic of the IOL. Thus, pigment dispersion should not occur unless there is contact with the iris.

Die Ergebnisse der ersten 160 radiaren Keratotomien eines Operateurs werden besprochen. Nahezu alle Operationen wurden an Angestellten einer grosen Klinik oder ihren Angehorigen vorgenommen. Insgesamt wurde an 141 Augen von 76 Patienten jeweils ein einziger ambulanter Eingriff in Lokalanasthesie durchgefuhrt. In 104 Fallen wurden 4 Einschnitte und in 37 Fallen 8 Einschnitte gelegt. Fur die ersten 40 Operationen wurde das Mikrometermesser auf 500 μ gestellt (Gruppe I). Weitere 46 Operationen wurden mit einer Einstellung von 550 μ vorgenommen (Gruppe II). Bei 55 Augen wurde pachymetriert und eine Einstellung von 110% der dunnsten ermittelten Hornhautdicke gewahlt (Gruppe III). Einen Visus von 0,5 oder besser erzielten 77,5% in Gruppe I, 87,0% in Gruppe II und 87,3% in Gruppe III. 50% in Gruppe I, 69,6% in Gruppe II und 61,8% in Gruppe III erreichten einen Visus von 1,0 oder besser. Korrigiert wurden durchschnittlich 2,5 dptr. in Gruppe I, 3,09 dptr. in Gruppe II und 3,64 dptr. in Gruppe III. Die Perforationshaufigkeit betrug 0% in Gruppe I, 2,17% in Gruppe II und 3,6% in Gruppe III. Trotz dieser bestenfalls durchschnittlichen Resultate waren die meisten Patienten mit dem Erfolg des Eingriffes sehr zufrieden.

In part A a brief overview of systemic side effects of ophthalmic drugs such as antibiotics, betablockers, adrenergics, mydriatics and carboanhydrase inhibitors is given. Part B deals with ocular side effects of common drugs such as antibiotics, tuberculostatics, antirheumatics, corticosteroids and phenothiazines.

Several ptosis problems bring plastic surgeons and strabologists together to share experiences and ideas. I n general, there are the analyses of active and passive forces, the surgery on positions and motions, combined disorders of motility and ptosis, and various 'kinetic' ptoses, which can be defined as motility patterns which do not suit the physiological task of the upper lid. In particular, therapeutic strategies of lid suspensions by means of fresh autogenous fascia lata strips are dealt with: in third nerve palsy, third nerve aberrant regeneration, fibrosis syndrome, advanced myopathy, Marcus-Gunn-lid phenomenon. A curious case of ptosis in downgaze only shows another kinetic feature. The advantage of the sling system is its lasting elasticity which perpetuates a dynamic steady state against the variable active forces of the orbicularis muscle. This facilitates the correction of the position of palsied lidsand still permits the closing of the eye. The slingdampens'kinetic' variations of the width o...

Following a brief review of various interpretations of the disease and its treatment, the author's observations in 13 cases (18 eyes) treated during a period of ten years are reported. The data (Tables 2 and 3) are discussed with reference to the different forms of clinical manifestation of the disease (Table 4). Therapeutic aspects are outlined on the basis of the personal experience of the authors. If conservative measures (mydriasis, hyperosmotics, carboanhydrase inhibitors) fail to control ciliary block glaucoma, surgical procedures directed at the anterior hyaloid membrane are indicated. This structure is approached either via the pars plana or via the transpupillary route after lens extraction. In some cases lens extraction alone was sufficient.

Congenital glaucoma is one of the main causes of blindness in children and is more common in Saudi Arabia than in Western countries, perhaps owing to the prevalence of consanguinity with families. Trabeculotomy has given poorer in Saudi Arabia than elsewhere. This study compared the results of trabeculotomy (67% success rate) with trabeculectomy (54% success rate), and reports fewer complications following trabeculotomy.

10 Zwergschweine wurden langfristig mit Lipofundin S parenteral ernahrt. Dabei war es moglich, Uberlebenszeiten bis zu 62 Tagen zu erreichen. Fur die gute Vertraglichkeit dieser Emulsion sprechen im wesentlichen folgende Punkte: Die gute Verwertung bestatigen folgende Ergebnisse

The author reports an unusual case of a marked hypotony-syndrome without a recognizable cause, occurring after a previously operated chronic angle block glaucoma. On the assumption of a minimal cyclitis local corticosteroid therapy was commenced and lead to recovery of visual function. There were, however, problems in stabilizing intraocular tension both upwards and downwards. The steroids could not be withdrawn, even after 6 months, without the hypotony reappearing. On the other hand, the use of 2 drops of Decadron (dexamethasone) daily lead to tensions above 40 mmHg. The clinical situation is interpreted as a steroid-dependent hyposecretion-normosecretion in the presence of an occluded chamber angle.

Two cases are presented, one with a pure cranial compression injury, the other mainly with chest trauma. Both patients noted immediate unilateral blindness. Vision did not improve in either within four months. Fluorescein angiography was performed and showed arteriolar as well as venous damage, with occlusion of arterioles and venules. As the impact in morbus Purtscher is usually very brief, reflux cannot explain the fundus changes. More likely a pressure wave is the cause of vessel damage with subsequent infiltration of blood, or plasma, into the wall of the vessel and obliteration of the lumen; it is also a cause of rupture of capillaries and hemorrhage. In traumatic asphyxia, on the contrary, a sustained force leads to reflux of blood and massive congestion with subsequent vessel damage and diapedesis. The prognosis in morbus Purtscher is often poor.

After introductory remarks concerning the Posner-Schlossman-syndrome (syndrome of glaucomatocyclitic crises) a case is reviewed. The concurrence with Addison's disease in this patient gives rise to speculations as to possible connections between the two conditions, but the conclusion is that the simultaneous occurrence of the two diseases at present must be regarded as coincidental.

A cases of Pyoderma vegetans attacking only the outer skin of the eyelid and leaving free the conjunctiva is reported. The diagnosis of this rare condition, belonging to the pemphigus diseases, depends on clinical course and especially on histological investigation. The aetiology of Pyoderma vegetans still remains unknown, an immun-pathological mechanism is discussed.

A family is described in which unilateral retinal detachment and oradialysis occurred in four of the six members (the father and three of his five children); there was no record of previous trauma. None of the subjects is myopic nor is any of them suffering from degenerative changes of the fundus. In all four cases the detachment was observed when they were aged between 18 and 26. An autosomal-dominant mode of inheritance is suspected but cannot be regarded as proved until the third generation has been examined.

A new classification of the glaucomas concerned with the mechanisms of the intraocular pressure rise is presented. We differentiate hyperproduction and outflowblock glaucomas. The latter are divided into pre-, intra- and postrabecular forms. It is stressed that a gonioscopically open angle can be hydrodynamically closed and vice versa. This classification is based on the anatomical location of the outflow blockage and not on the gonioscopic impression.

The various causes of elevated intraocular pressure following glaucoma surgery are described. One has to differentiate between failures after peripheral iridectomy (Table 1) and those following filtering interventions. The clinical picture of a postoperative narrow-angle glaucoma must be analyzed carefully; it may be due to pupillary block, plateau-iris syndrome or even to a ciliary block (malignant glaucoma). The failure of filtering procedures may be due to mechanisms blocking the trephination opening, cicatrization of the conjunctiva or a ciliary block. The diagnosis criteria of the different conditions and the respective therapeutic measures are outlined.

A circumscribed central bullous detachment of Descemet's membrane occuring on day 8 after an uncomplicated cataract extraction is reported. The lesion responded to conservative management and resolved without sequelae.

1868 beschrieb von Graefe erstmalig die CPEO. Sie wird daher auch Augenmuskeldystrophie von Graefe genannt. Schon 1890 vermutete Fuchs als Erster aufgrund von Muskelbiopsien, das eine Myopathie und nicht eine Kernschadigung der Augenmuskelnerven vorliegt. Zwischenzeitlich wurde jedoch immer wieder eine Erkrankung der entsprechenden Hirnnervenkerngebiete diskutiert. Heute bestehen keine Zweifel mehr, das die CPEO vorwiegend eine Myopathie darstellt. Es scheint jedoch hinsichtlich der Atiologie der Erkrankung von besonderem Interesse zu sein, das abnorme Mitochondrien vom gleichen Typ sowohl in den Augenmuskeln als auch im Kleinhirn bei einem Fall von CPEO mit cerebellarer Ataxie 1973 von Adachi gefunden wurden.

Following a brief review of various interpretations of the disease and its treatment, the author's observations in 13 cases (18 eyes) treated during a period of ten years are reported. The data (Tables 2 and 3) are discussed with reference to the different forms of clinical manifestation of the disease (Table 4). Therapeutic aspects are outlined on the basis of the personal experience of the authors. If conservative measures (mydriasis, hyperosmotics, carboanhydrase inhibitors) fail to control ciliary block glaucoma, surgical procedures directed at the anterior hyaloid membrane are indicated. This structure is approached either via the pars plana or via the transpupillary route after lens extraction. In some cases lens extraction alone was sufficient.

There are only few reports in the literature about the coincidence of a glaucoma with a chalcosis. After briefly presenting such a case the authors discuss the differential diagnosis; a strictly monocular chronic simple glaucoma, a contusion glaucoma or a glaucoma secondary to chalcosis. Since glaucoma and chalcosis coincide so infrequently there is no basis for assuming a true secondary glaucoma due to chalcosis existing, as is the case with siderosis.

A report on 38 eyes with glaucoma simplex that were treated by laser-trabecular-puncture 2 years ago is given. By this method one attempts to perforate the trabecular meshwork by means of a laser beam. Gonioscopy revealed that the pores had become occluded by scar tissue and goniosynechiae. In only 3 eyes (7.9%) was the intraocular tension lowered. The hypothesis is made, that in these cases contracture of scar tissue in the iris tissue led to a pull on the trabecular network and hence to an improvement of liquor drainage.

Die Amotioprophylaxe bei intraokularen Splitterverletzungen umfast mehr als nur die Anwendung eines Koagulationsverfahrens oder die Schaffung eines Sklerabuckels nach der Extraktion des Fremdkorpers. Sie beginnt bereits mit der sorgfaltigen Lokalisation des Splitters und endet Monate oder Jahre spater mit regelmasig durchgefuhrten Funduskontrollen. Zahlreiche Faktoren konnen nach Verletzung des hinteren Bulbussegmentes zu einer Amotio fuhren, wie aus dem folgenden Schema hervorgeht (Tabelle 1). Die entscheidende Rolle durften dabei wohl die bindegewebigen Veranderungen im Glaskorper und im Bereiche der vitreoretinalen Grenzschicht spielen, weniger die etwa entstandenen Netzhautdefekte.

Ptosischirurgie ist nicht leicht. Die Perfektion sehr erfahrener Operateure sollte nicht daruber hinwegtauschen. Ptosischirurgie gehort auch nicht zu den haufigsten Eingriffen. Die Erfahrung des einzelnen Operateurs ist daher beschrankt. Aus der geschilderten Situation lassen sich unterschiedliche Konsequenzen ziehen: 1. Uberweisung an Ptosisspezialisten. Dies ist operationstechnisch sicher die beste Losung; jedoch fur den Patienten oft unbequem und daher nicht immer praktikabel. 2. Ausweichen auf risikolose, technisch einfache Verfahren wie Fasanella-Servat. Dies genugt bei einem Teil der Ptosispatien-ten, ist jedoch in der erzielbaren Wirkung begrenzt, opfert wertvolles Tarsusgewebe und ist nicht wiederholbar. 3. Durchfuhrung einer Levatorresektion. Diese 3. Alternative wird erleichtert durch die Wahl einer einfachen Grundtechnik wie z.B. die Levatorresektion nach Fox, von der Bindehautseite aus.