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Wir berichten uber Erfahrungen bei der Therapie des malignen Melanoms der Konjunktiva bei primar erworbener Melanose mit Hilfe einer adjuvanten lokalen Mitomycin-C-Behandlung. Zwischen 1998 und 2001 wurden13 Patienten mit lokaler Chemotherapie bei malignem Melanom (MM) der Konjunktiva behandelt. Bei allen war das MM aus einer primar erworbenen Melanose (PEM) hervorgegangen. Bei 7 Patienten lag ein Tumorstadium pT2 vor, bei 3 Stadium pT3. Bei 3 Patienten war das Lid in den malignen Prozess einbezogen (Stadium pT4). Die lokale Chemotherapie wurde nach inzisionaler Biopsie in 2 Zyklen zu je 14 Tagen mit 14-tagiger Pause durchgefuhrt. Bei 4 Patienten wurde ein 3. Zyklus angeschlossen. Eine Regression des Tumors wurde bei allen Patienten beobachtet. Schwere okulare oder systemische Nebenwirkungen wurden nicht bemerkt. Im Beobachtungszeitraum blieben 9 Patienten rezidivfrei, bei 3 kam es zu einem Rezidiv. Bei diesen 3 Patienten war das Lid primar in den Tumorprozess eingeschlossen. Die lokale Chemotherapie mit Mitomycin C stellt eine Bereicherung des therapeutischen Spektrums dar. Wir halten die Kombination aus inzisionaler Biopsie mit chirurgischer Tumorvolumenreduktion und lokaler Mitomycin-C-Therapie fur eine gute Option, wenn das Tumorstadium pT3 nicht uberschritten wird.

BACKGROUND: To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. PATIENTS AND METHODS: 12 patients (9 female; 3 male; mean age 77.5 +/- 3 years) were referred from one ophthalmologic surgeon because of opacification of IOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. RESULTS: IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 microm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). CONCLUSIONS: Postoperative opacification of hydrogel foldable lenses (Hydroview(R)) are apperantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.

Background To determine success rate of trabeculotomy in patients with juvenile and late-juvenile glaucoma in a retrospective study. Patients and methods 46 eyes of 41 juvenile glaucoma-patients (24 female, 17 male) were submitted to trabeculotomy during the period of 1980-1997. Patients age at the time of surgery was 30.2 +/- 10.5 years (11-49 years, median 21 years). Follow-up time was 35 +/- 46 months (1-155 months). Results Median preoperative visual acuity was 1.0 (range 0.002 to 1.25), postoperative visual acuity at the end of the follow up period was 0.8 (median) with a range from 0.002 to 1.2. In all patients preoperative intraocular pressure was elevated and a glaucomatous configuration of the optic disc was noticed. Preoperative intraocular pressure (IOP) ranged from 30.5 +/- 13.2 mm Hg, after surgery IOP was 16.2 +/- 5 mm Hg. Mean decrease of the IOP postoperatively was 54.4%. In 37% of the eyes IOP was lower than 23 mm Hg without additional medication, in 47% of the eyes IOP was lower than 23 mm Hg with additional medication. In 8 eyes additional antiglaucoma-surgery was necessary. After a follow-up time of 60 months 81% of the patients (n = 37 eyes) had an IOP below 23 mm Hg, after 120 months in 80% of the patients (n = 29 eyes) IOP was below 23 mm Hg. Conclusion The success rate of trabeculotomy (defined as the ability to lower intraocular pressure lower than 23 mm Hg with or without antiglaucoma medication) in our patients is 84%. After second operation, success rate is 89%. Trabeculotomy for patients with juvenile open angle glaucoma is a safe procedure and avoids problems and complications of filtering procedures.

Background In this study, we have focussed on the clearing of the host cornea after successful penetrating keratoplasty (PK) for pseudophakic bullous keratopathy and the clinical factors that may influence this phenomenon. Patients and methods We recruited the study group out of all keratoplasties performed in our department between 1984 and 1996 using the following criteria: (1) pseudophakic bullous keratopathy that involved the whole host cornea preoperatively, (2) no additional ocular diseases, (3) all operations performed before January 1st 1996, (4) sufficient photodocumentation, (5) complete clinical records, (6) clear graft at the end of the follow-up period. Using these criteria, 48 patients (28 females and 20 males; mean age at the time of surgery 72.7 +/- 8.8 years) were included in the study group. Donor age ranged from 34 to 86 years (mean age 65.8 +/- 12.0 years). The opacity of the host cornea was graded from 0 to 3 (0 = clear cornea; 3 = total opacity) within a circular zone of 1 mm diameter adjacent to the graft in four quadrants (I-IV). Finally, an index for the mean opacity index was calculated [TG = (I + II + III + IV)/4] and correlated with clinical parameters. Results The index for the mean opacity was 2.8 preoperatively. After a mean follow-up of 9.6 +/- 12.3 months, the index decreased significantly to 1.8 (p = 0.01). Mean visual acuity before PK was 20/400, at the end of the follow-up it was 20/50. The index of opacification was significantly correlated with patients age (p = 0.03; r = 0.2) and inversely with the follow-up period (p = 0.001; r = -0.6) and with the visual acuity at the end of the follow-up period (p = 0.05; r = -0.2). Using the 193-nm excimer laser for donor and host trephination led to a higher clearing of the host circular zone (mean opacification index 1.7) than mechanical trephination (mean 2.1) (p = 0.01). Conclusion Our results indicate that expansion of donor endothelial cells onto host's Descemet's membrane is possible and successful with respect to clearing of the host cornea in pseudophakic bullous keratopathy. Nonmechanical excimer laser trephination of donor and host from the epithelial side seems to promote this phenomenon due to a better apposition of the cut surfaces.

Patient We report on a 30-year old female with bilateral visual loss within four days. She assured that she had been able to do computer-work until four days before presentation. Ophthalmoscopy and echography established the diagnosis of a bilateral papilledema. Visual acuity was 20/500 in both eyes. Perimetry revealed a small central residual visual field. Further examinations lead to the diagnosis of a primary pseudotumor cerebri. Clinical course and therapy Conservative treatment of the elevated intracranial pressure and ventriculo-peritoneal shunting improved visual acuity and visual field and lead to a decrease of the papilledema. Follow up time was 30 months. Conclusion In a small number of patients pseudotumor cerebri presents with an acute visual loss. Immediate diagnosis and therapy can lead to an improvement of vision.

Background Persisting angle-closure glaucomas with circular anterior synechia and lost anterior chamber are at the moment an unsolved therapeutical problem. Antiglaucomatous anterior cyclodiathermy is a last therapeutical option to serve the eye. Patients and methods We retrospectively examined the results and the complications of 29 eyes, which were consecutively treated with anterior cyclodiathermy between 1992 and 1998. Results We found a significant decrease of the intraocular pressure (IOP) during mean follow-up of 10 month, reduction of antiglaucoma medication, no change of visual acuity and no severe complications (no phthisis bulbi, no severe intraocular hemorrhage, no sympathetic ophthalmia). Conclusion Anterior cyclodiathermy is a successful treatment for selected patients with severe forms of glaucoma, if other operation techniques and antiglaucoma medication fail to decrease the IOP.

BACKGROUND: Congenital hereditary endothelial dystrophy (CHED) is a rare bilateral corneal disease. The stromal opacity is supposed to result from terminal misdifferentiation of the endothelial cells. In this study we present the morphological and functional results after penetrating keratoplasty in children with CHED who were operated in our department between 1981 and 1997. PATIENTS AND METHODS: In a retrospective clinical cross-sectional study we looked up case histories of 13 eyes from 8 children (7 female, 1 male) with a mean age of 6.0 +/- 3.1 years (ranged from 3 to 14 years). In all children penetrating keratoplasty was performed by one surgeon (GOHN), in 3 eyes using nonmechanical excimer laser trephination. The graft-diameter was in 7 eyes 7.0/7.1 mm, in 2 eyes 7.0/7.2 mm, in 2 eyes 6.5/6.6 mm (resp. 6.8 mm), in 2 eyes 6.0/6.1 mm (resp. 6.2 mm). Fixation of grafts was achieved in 2 eyes by single running suture, in 8 eyes by double running suture and in 3 eyes by multiple interrupted sutures. RESULTS: During a mean follow-up of 4.0 +/- 2.4 years visual acuity increased in all patients (from light perception to 6/20 preoperatively to 2/200 to 14/20 postoperatively). In one patient corneal endothelial-epithelial-decompensation occured (both eyes unterwent previous antiglaucomatous surgery elsewhere), and in 1 patient loosening of one suture happened after 10 month. No immunological graft reaction occurred during follow-up. After excimer laser trephination (3 eyes from 2 patients) visual acuity and corneal astigmatism after surgery was favorable in comparison to all other patients. CONCLUSION: In children with CHED penetrating keratoplasty results not only in a clear cornea but also in a satisfactory functional outcome. Postoperatively periodical morphological controls and assessment of refraction as well as means to prevent amblyopia are indispensable before age 7.

Background: Epithelial ingrowth to the anterior chamber is a rare event after ocular injury or intraocular surgery. We report on four patients with primary cystic epithelial ingrowth (with primary curative cystic formation when treated with block excision) who underwent Nd:YAG-laser puncture of the cysts elsewhere. This treatment led to a change from a cystic to a diffuse form with a poor prognosis for the eye. Patients: Three women and one man were seen in our outpatient department. Cystic epithelial ingrowth happened after intraocular surgery (1 x goniotomy, 2 x cataract surgery) or perforating injury (1 x). All four patients were treated elsewhere with puncture of the cysts (by Nd:YAG-laser). At first presentation in our department a change of cystic to diffuse epithelial ingrowth was noticed. Curative treatment by block excision was no longere possible. Diffuse epithelialisation of the anterior chamber resulted in secondary glaucoma with a poor prognosis. Conclusions: In our experience puncture of intraocular epithelial cysts may lead to a transformation to diffuse epithelial ingrowth with possible loss of the eye. Surgical opening of the cyst or subtotal excision is therefore contraindicated from our point of view. In case of cystic epithelial ingrowth of less than 5 hours of the limbal circumference, blbck excision in toto is indicated.

Retrospective study concerning the value of conjunctival biopsy in the diagnosis of sarcoidosis.Between 1990 and 1996 we performed conjunctival biopsy in 11 patients (mean age 42.7 +/- 16.4 years) with suspect of sarcoidosis.In 8 of the 11 patients the diagnosis of sarcoidosis was established during the clinical course. In four of these eight patients conjunctival biopsy was positive. Five of the eight were under systemic steroids at the time of biopsy. Of the four patients with clinically established sarcoidosis and negative biopsy, three were under systemic steroids at the time of biopsy. In two patients diagnosis of sarcoidosis was established primarily by conjunctival biopsy.Conjunctival biopsy is a simple tool in the diagnostic of sarcoidosis. If possible, biopsy should be undertaken before systemic steroid treatment. We consider conjunctival biopsy to be useful as the first diagnostic tool before other invasive methods.

BACKGROUND: Congenital divided nevi of the eyelids are a rare melanocytic lesion. Only 30 patients are reported in literature. We report on a 6-year-old boy and a 41-year-old male with this lesion and give a short overview of the literature. CASE REPORTS: Patient 1: A 6-year-old boy presented with a pigmented divided nevus of the left eye involving the upper and lower lid naselly. The lesion had increased in size in the last one year. Otherwise the results of ophthalmological examination were unremarkable. The divided nevus was completely excised. Histopathological studies revealed a melanocytic compound nevus. Patient 2: A 41-year old male presented in our department with a divided pigmented nevus on his left eye involving the upper and lower lid laterally. The lesion had gradually increased since birth. Otherwise the results of ophthalmological examination were unremarkable. A subtotoal excision and debulking procedure was performed. The defect in the lower eyelid was covered using a transposition flap from the upper eyelid. Histopathological examination revealed a melanocytic compound nevus. CONCLUSION: Divided nevi of the eyelids may be disfiguring and include the possibility of deprivation amblyopia when reaching a certain size in childhood. Malignant changes of this lesion were not observed so far. Total excision or subtotal excision and a debulking procedure may be helpful.

BACKGROUND Because of the retinal alterations visual acuity of patients with retinitis pigmentosa is more affected by loss of contrast than in normal persons. Therefore cataract in retinitis pigmentosa (mostly posterior subcapsular cataract) leads earlier to decreasing visual acuity than is expected from the lens opacity. In a retrospective study we have looked up all patients with retinitis pigmentosa and cataract which were operated between 1989 and 1997 at our department. PATIENT AND METHODS Between 1989 and 1997 50 eyes of 36 patients (21 female, 15 male; mean age 51 +/- 11.4 years) with the diagnosis of retinitis pigmentosa and cataract underwent extracapsular cataract extraction and IOL-implantation. In a retrospective study we studied all case histories of these patients. Mean follow up time was 1.2 +/- 1.2 years. RESULTS Preoperative visual acuity was 0.1 +/- 0.1, best postoperative visual acuity was 0.3 +/- 0.2. Visual field was not affected by cataract-surgery. Postoperative complications were not found. 2/3 of all patients were satisfied with the postoperative visual acuity, 1/3 of all patients did not give comments. CONCLUSION In patients with retinitis pigmentosa cataract surgery leads to significant increase of visual acuity. Cataract extraction should not be with held from patients with retinal dystrophy.

BACKGROUND Ophthalmological diseases caused by parasites are a very rare entity in middle europe. Ophthalmomyiasis caused by parasites living in our country are only reported as case history in literature. PATIENT We report on a 28-year old patient, seen in our department in august 1997 suffering from ophthalmomyiasis externa. CASE HISTORY The male patient was riding on a motorbike when a fly gets into his right eye. 12 hours later he had a feeling of pain in the eye. When having a closer look to his right eye, he found some fly larva (2.0! 0.8 mm) in the conjunctival sack. The patient could extract the fly larva from the conjunctival sack by himself. On examination at our department we found a unspecific irritation of the conjunctiva. The fly larva was identified as larva of oestrus ovis ("Schafsbremse"). CONCLUSION Although ophthalmomyiasis is a very rare entity in middle europe single appearance is possible even in our country. No specific therapy was necessary in this case.

Background Alagille syndrome is a arteriohepatic dysplasia which is in most cases correlated with ocular disorders. The most common ocular defect is a posterior embryontoxon. Patient We report on a 27-year-old patient suffering from Alagille syndrome, seen in our department for 23 years. Within these 23 years the ophthalmological status concerning visual acuity and intraocular pressure of the patients was stable. Iris-stroma-atrophy showed a small increase on both eyes. Conclusion In comparision to patients with Axenfeld anomaly a development of glaucoma is not observed in these patients. Maybe the anomalies of the anterior chamber angle are less severe or different from those in Axenfeld anomaly. The disease is also correlated with hepato- or/and splenomegalie by biliary hypoplasia, cardiac disorders etc. Cooperation of paediatricians, internal specialists and ophthalmologists are necessary for the treatment of these patients.

Epithelial ingrowth to the anterior chamber is a rare event after ocular injury or intraocular surgery. We report on four patients with primary cystic epithelial ingrowth (with primary curative cystic formation when treated with block excision) who underwent Nd:YAG-laser puncture of the cysts elsewhere. This treatment led to a change from a cystic to a diffuse form with a poor prognosis for the eye.Three women and one man were seen in our outpatient department. Cystic epithelial ingrowth happened after intraocular surgery (1 x goniotomy, 2 x cataract surgery) or perforating injury (1 x). All four patients were treated elsewhere with puncture of the cysts (by Nd:YAG-laser). At first presentation in our department a change of cystic to diffuse epithelial ingrowth was noticed. Curative treatment by block excision was no longer possible. Diffuse epithelialisation of the anterior chamber resulted in secondary glaucoma with a poor prognosis.In our experience puncture of intraocular epithelial cysts may lead to a transformation to diffuse epithelial ingrowth with possible loss of the eye. Surgical opening of the cyst or subtotal excision is therefore contraindicated from our point of view. In case of cystic epithelial ingrowth of less than 5 hours of the limbal circumference, block excision in toto is indicated.

Editor,—Most of the reported cases of epithelial growth in the anterior chamber are related to cataract surgery and injuries.1-3 Epithelial invasion of the anterior chamber after perforating keratoplasty (PK) is a rare complication. Only a few authors report on epithelial cysts after PK,45 while the majority of the presented patients in the literature suffer from diffuse epithelial downgrowth.167 We present three patients with cystic epithelial growth in the anterior chamber 1–10 years after primary PK and histopathological findings after complete removal of the cyst. ### CASE REPORTS All three patients were referred to our department with cystic epithelial growth into the anterior chamber. Primary PK was carried out elsewhere. Block excision and corneoscleral grafting were performed by one of us (GOHN) in all three patients. Technical aspects of block excision have been described in detail earlier.28-10 #### Patient 1 Patient 1 is a 31 year old man. He underwent PK on his right eye because of a keratoconus. Thirteen months later cystic epithelial growth in …

Objective To report on frequency, time of occurrence, treatment, and final outcome of rhegmatogenous retinal detachment after block excision, combined with corneoscleral tectonic grafts, of intraocular epithelial implantation cysts and tumors of the anterior uvea involving the anterior chamber angle. Design Noncomparative case series. Participants The study included 144 patients who had consecutively undergone scleral full-thickness block excision of tumors of the anterior uvea (n = 87) or intraocular epithelial implantation cysts (n = 57). Diameter of the block excision ranged between 5.5 and 20 mm. In 39 patients, the tumor extended posterior to the ora serrata. Interventions Retinal detachment surgery. Main outcome measures Retinal detachment rate, visual acuity, risk factors. Results Retinal detachment occurred in 10 (6.9%) of 144 patients (2 of 57, or 3.5% of patients with cysts; 8 of 87 or 9.2% of patients with tumors) 3 to 12 months after block excision. Six patients underwent primary pars plana vitrectomy with temporary endotamponade by silicone oil, which was removed 3 to 9 months later. In four patients, a scleral buckling procedure only was performed. After a mean follow-up of 31 months after silicone oil removal or the buckling procedure (median, 30 months; range, 13–42 months), the retina has remained attached in all patients operated on. Visual acuity increased from 2/20 (median; range, light perception-6/20) to 8/20 (median; range, 2/20–12/20). In the eyes with retinal detachment compared to the eyes without retinal detachment, the block excision was significantly larger (13.75 ± 4.86 mm vs. 9.41 ± 3.02; P = 0.01) and was located significantly more posteriorly (limbus distance of posterior excision margin: 6.75 ± 2.87 vs. 4.35 ± 3.24 mm; P = 0.01). Conclusions Scleral buckling procedures and primary pars plana vitrectomy with temporary ocular endotamponade can give acceptable results in eyes with rhegmatogenous retinal detachment occurring after block excision of epithelial implantation cysts or tumors of the anterior uvea. Despite intraoperative vitreous prolapse or tumor extension posterior to the ciliary body, rhegmatogenous retinal detachment occurs in fewer than 10% of patients undergoing block excision of cysts or tumors of the anterior uvea. Size and posterior location of the block excision are the main risk factors for rhegmatogenous retinal detachment, which becomes unlikely later than 12 months after surgery.

Hintergrund. Ziel dieser retrospektiven Studie war die Frage, ob Blockexzisionen bei 3 und 9 Uhr zu einer Neuroparalyse der Hornhaut fuhren konnen.

Background Dilated episcleral vessels may be observed in patients with orbital tumors, carotid-cavernous-sinus fistula and other orbital obstructive lesions. As an idiopathic phenomenon dilated episcleral vessels may be associated with secondary open-angle glaucoma. Patient We report on a 59-year-old patient with a history of secondary open-angle glaucoma and dilated episcleral vessels for 5 years (Radius-Maumenee syndrome). Results In these patients, the pressure of the episcleral vessels is elevated and therefore the outflow from Schlemm's Canal is reduced. This leads to elevated intraocular pressure and secondary glaucoma. Conclusion Treatment options in this condition include medication to lower the intraocular pressure or microsurgical sinusotomy to reduce the pressure-gradient from Schlemm's Canal to the episcleral vessels.