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Multifocal retinochoroiditis was diagnosed in 16 patients (13 female, 3 male). The patients also had cells in the vitreous, and in some cases pronounced retinal vasculitis, cystoid macular edema and papilledema. The patients' ages ranged from 62 to 77 years. There was anterior segment involvement in 13 cases. One patient had subretinal neovascularization in both eyes. Fluorescein angiograms revealed leaks from the retinal vessels, papilledema, and macular edema. So far, the authors have not succeeded in classifying the changes described as belonging to a known disease entity. The findings most closely resembled a disease described by Dreyer and Gass in 1984 as "multifocal choroiditis and panuveitis". Similar changes were seen by Tiedemann in 1987, in patients with Epstein-Barr viral antibodies.

Multifocal retinochoroiditis was diagnosed in 16 patients (13 female, 3 male). The patients also had cells in the vitreous, and in some cases pronounced retinal vasculitis, cystoid macular edema and papilledema. The patients' ages ranged from 62 to 77 years. There was anterior segment involvement in 13 cases. One patient had subretinal neovascularization in both eyes. Fluorescein angiograms revealed leaks from the retinal vessels, papilledema, and macular edema. So far, the authors have not succeeded in classifying the changes described as belonging to a known disease entity. The findings most closely resembled a disease described by Dreyer and Gass in 1984 as "multifocal choroiditis and panuveitis". Similar changes were seen by Tiedemann in 1987, in patients with Epstein-Barr viral antibodies.

Eyes suffering from cataract and glaucoma often present particular situations which require particular surgical approaches. The technique to be chosen mainly depends on the depth of the anterior chamber, on the state of the pupil, and on whether or not a fistulizing operation has already been performed. According to the given situation, different surgical options need to be considered. Five such different situations are presented and relevant surgical procedures are described. Although lens implantation in glaucoma usually proves to be more difficult than in normal cataractous eyes, careful selection of an appropriate surgical technique usually provides a good surgical result.

A total of 301 posterior chamber lenses implanted consecutively by one surgeon were examined on postoperative days 3-7 with special regard to both centering and the position of the haptics. It was possible to evaluate 296 eyes. In these, 83.1% of the lenses were ideally centered, while 16.9% were found to be slightly eccentric. There was one serious lens dislocation. The position of the haptics was evaluated in 245 eyes. The attempt to fix both haptics in the sulcus was achieved in 74.7% of the cases. Of the implants fixed in the sulcus, 96.2% were ideally centered. In the remaining cases 11 lenses were fixed entirely in the capsule but in 51 one loop was in the sulcus and the other in the capsule. While the lens is usually centered well when both loops are in the capsule (81.8%), it is significantly less well centered if one loop is fixed in the sulcus and the other in the capsule (41.2%). The data are discussed.

The present paper describes the results of angiographic examinations of 48 eyes (29 patients) with intermediate uveitis. More than 50% of the cases displayed pathologic changes of the retinal blood vessels, such as increased fluorescein staining of the vessel walls and leakages of the retinal veins or venules, respectively. Some 20% of the eyes manifested cystoid macular edema and/or edema of the optic disk which had gone undetected by ophthalmoscopy. These findings suggest that vascular changes may play a role in the pathogenesis of intermediate uveitis. The question as to whether this disease might be caused rather by retinal vasculitis than by uveitis is discussed.

Frequently relapsing acute bilateral uveitis, retinitis and papillitis were observed in a young male smoker. Long-term therapy with azathioprine (150 mg/day), fluocortolone (15 mg every other day) and phenprocumarol proved to be the only means of suppressing the ocular symptoms and achieving a relatively steady condition. Simultaneously relapsing thrombophlebitis of the lower extremities indicated that thrombangiitis obliterans might be the basic disease. The ophthalmic literature on this condition is critically reviewed.

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.

Die aus der serologischen Forschung schon lange Zeit bekannten Phanomene der aktiven und passiven Anaphylaxie mit Fremdeiweis konnten auch fur bakterielles Eiweis tierexperimentell bestatigt werden. Es lies sich zeigen, das die mikrobielle Allergie — im Gegensatz zur Serumallergie — nur in Verbindung mit Zellen uud nicht allein durch Serum passiv ubertragen werden kann. Auf die Frage der Allergie vom Fruh- bzw. Spattyp wird kurz eingegangen.

Bloodserum of 203 patients suffering from endogenous uveitis was examined by means of electrophoresis and immunelectrophoresis. In general, the albumins are reduced, the globulins rather increased. No specific or abnormal globulins were found. Acute uveitis, however, seems to stimulate the production of γ1A(β2A)-globulins, chronic uveitis apparently increases the γ1A(β2A)-globulin-contents of the serum. The clinical importance of electrophoresis and immunelectrophoresis in uveitis is limited.

Der bei primar chronischer Polyarthritis im Serum auftretende sog. Rheumatoidfaktor konnte bei Kaninchen experimentell induziert werden, und zwar in einer ersten Gruppe mit virulenten bzw. abgetoteten Bakterien und in einer zweiten Gruppe mit homologem Uveagewebe, zum Teil in Kombination mit Freundschem Adjuvans. In Abhangigkeit von der Injektionsart (subcutan, intravenos, intraocular und intraperitoneal) und der Haufigkeit der Antigen-Belastung lies sich im Serum ein Faktor nachweisen, der wie der Rheumatoidfaktor im Latex-Test gammaglobulinbeladene Latexpartikelchen agglutinierte. Homologe Uvea mit Adjuvantien ist anscheinend ein besonders starker Reiz zur Bildung dieses Serumfaktors.

Es wird uber histologische Untersuchungen von Hornhautgewebe bei akutem Keratoconus berichtet. Im Keratoconusbereich wird eine Verdichtung der Intercellularsubstanz des Hornhautstromas, Polstellung der Parenchymzellen, eine umschriebene Zellvermehrung uber dem Deszemetris und Ubergang in ein Narbenstadium beobachtet. Die Hornhautnerven sind morphologisch intakt, das Hornhautepithel zeigt uncharakteristische regressive Veranderungen, wie sie auch bei anderen Hornhauterkrankungen vorkommen. Die histologischen Befunde lassen keine Ruckschlusse auf die Ursache des akuten Keratoconus zu.

18 Meerschweinchen wurden mit homologer Uvea und komplettem Freundschen Adjuvans systemisch allergisiert. 5 Kontrollen erhielten nur das Adjuvans ohne Uvea. Serologische (Antiuvea-Antikorper) und histopathologische (Auge, innere Organe) Veranderungen traten nur bei den mit Uvea und Adjuvans behandelten Tieren auf. Nur 9 von 18 Versuchstieren, jedoch alle Kontrollen uberlebten die Versuchsdauer von 6 Monaten. Die Natur des an die Uvea gebundenen pathogenen Faktors blieb unklar. Eine eindeutige Uveitis wurde nur einmal beobachtet, zwei weitere Tiere zeigten jedoch eine deutliche Chorioiditis.

Peritoneal- und Vorderkammerzellen von Kaninchen, die gegen hitzegetotete Tuberkelbacillen allergisiert worden waren, wurden auf die Uvea (Vorderkammer) gesunder Tiere passiv ubertragen. Anschliesende Injektion von Tuberkulin oder Tuberkelbacillen oder beiden nacheinander in die Vorderkammer fuhrte zu eindeutig nachweisbaren uveitischen Reaktionen. Wurden die gleichen Versuche mit antikorperhaltigem Serum vorgenommen, so kam es nicht zur Reaktion. Die demonstrierte spezifische Uberempfindlichkeit schien auf das Auge beschrankt zu bleiben; intravenose oder intracutane Antigeninjektionen fuhrten nicht zu klinisch fasbaren Symptomen.

Frequently relapsing acute bilateral uveitis, retinitis and papillitis were observed in a young male smoker. Long-term therapy with azathioprine (150 mg/day), fluocortolone (15 mg every other day) and phenprocumarol proved to be the only means of suppressing the ocular symptoms and achieving a relatively steady condition. Simultaneously relapsing thrombophlebitis of the lower extremities indicated that thrombangiitis obliterans might be the basic disease. The ophthalmic literature on this condition is critically reviewed.

Report on the clinical and fluorescein-angiographic appearance of leiomyoma of the ciliary body in a 23-year-old woman, the surgical technique and histopathological findings. The tumor was wholly excised and histologically verified, preserving the bulb and a useful degree of vision. The histological differential diagnosis is discussed.

Die Geschichte der Staroperation geht weit zuruck. Die praantike Hindumedizin (500 v. Chr. oder fruher) lehrte die Reklination; sie wurde wahrscheinlich von den Alexandrinischen Schulen (300–200 v. Chr.) uberliefert, von Celsus (25 v. bis 50 n. Chr.) sowie von Galen (131–201 n.Chr.) erwahnt und spater von arabischen Arzten (900–1000 n.Chr.) praktiziert. Obwohl diese bereits die Diszission und Aspiration der Linse gekannt haben sollen, bleibt die Reklination bis in die Mitte des 17. Jahrhunderts die vorherrschende Methode.

If not complicated by vitreous- or retinal traction the rhegmatogenous retinal detachment has an extraordinarily good chance to be healed surgically. The principle to safely seal the retinal hole by a circumscribed and controlled plombage from the outside of the eye - successfully developed as a surgical method by Custodis - appears now to be accepted everywhere. Nowadays the mayor modifications of this principle are widely used in retinal detachment surgery. The author outlines different clinical pictures patients may present with before surgery. He points to the surgical ways adequate to the given situation. The pros and cons of each approach are discussed. Generally spoken, the author prefers episcleral implants placed whether radially or circumferentially as the case may require. However, other techniques such as intrascleral implants are considered to have also their indications.

Die Diskussion uber das beste Verfahren der Kataraktoperation ist nicht abgeschlossen, vielmehr werden intra- und extrakapsulare Extraktion, kornealer und korneoskleraler Schnitt, fortlaufende Naht und Einzelnaht mit meist wechselnden Argumenten gegeneinander abgewogen. Die Phakoemulsifikation hat die Diskussion erneut angefacht.

Regarding immunopathogenesis of the Vogt-Koyanagi-Harada syndrome (VKHS), peripheral blood lymphocytes of a female patient with this disease were tested for sensitization against several antigens such as myelinic basic protein (BP) and uveoretinal, brain and spleen tissue homogenates. For comparison, cells of seven patients with chorioretinitis only and cells of six patients with encephalitis of unknown etiology were also tested. Cells of healthy donors served as controls. The electromobility test and the leucocyte migration test were used as in vitro test systems for cell-mediated immunological reactivity. The results show a strong sensitivity against BP and uveoretinal and brain tissue homogenates in VKHS. In the patients suffering from chorioretinitis, a strong reactivity against uveoretinal homogenate only was found, while in patients with encephalitis, responses to brain antigens only were observed. Reactions towards spleen tissue homogenate were negative in all experiments. The extent to which this tissue-specific immunological reactivity, which is different from the monoreactivity in chorioretinitis or encephalitis, might be a characteristic phenomenon of the VKHS is discussed.

After treatment of secondary angle closure glaucomas by ciliary body exposure with lamellar scleral resection five eyes had to be enucleated. In view of the histological findings taken from these eyes mode of action and therapeutic value of this operation are considered. The effectiveness of scleral resection seems to be doubtful and there is evidence that permanent regulation of intraocular tension depends mainly on direct diathermy of the ciliary body.

A case of Reiter's disease in a 15-month-old child is presented. The manifestation of this syndrome in childhood is an extraordinary event, so far few cases only have been observed. The symptoms of the syndrome are urethritis, arthritis and iritis. A specific infection could not be demonstrated. The typical clinical features are discussed and compared with earlier reports. Speculations on the etiology are made.

The use of vitreous surgery instruments in anterior segment surgery is described. The bimanual ocutome technique has been used, in some cases in combination with the special infusion/cutting needle. Three different approaches (limbus, pars plana, limbus and pars plana) are illustrated. The choice of surgical procedure is discussed; it depends mainly on the anterior segment pathology. Personal views and experience (64 eyes) are compared with those of other authors.

Nach den allgemein ungunstigen Erfahrungen mit Vorderkammerlinsen in den funfziger und sechziger Jahren haben wir an unserer Klinik lange gezogert, dem Trend zur Einpflanzung von irisgestutzten Linsen zu folgen. Die unter mikrochirurgischen Bedingungen durchgefuhrte Katarakt-Extraktion mit ihrer geringen Komplikationsrate schien unter Verwendung des Kryogerates und einer zuverlassigen Wundnaht fast nicht mehr verbesserungsfahig zu sein. Die Korrektur der Aphakie mit Brillenglas oder Haftschale hatte zwar die bekannten Nachteile, verglichen mit den zunachst befurchteten Komplikationen durch intraokulare Linsen schien damit aber ein Minimum an Risiko und ein Optimum an Effekt erreicht zu sein. Die weitere Entwicklung auf diesem Gebiet, insbesondere die weltweit zunehmenden Erfahrungen mit Irislinsen last jedoch diese Problematik in einem anderen Licht erscheinen. Die optischen Vorteile intraokularer Linsen sind so unbestritten, und die nach ca. 15 Jahren Beobachtungszeit berichteten Ergebnisse doch soweit ermutigend, das wir uns im Oktover 1976 entschlossen haben, bei gewissen Indikationen intraokulare Linsen einzupflanzen. Wir verfugen daher erst uber eine kleine Anzahl entsprechender Patienten, namlich 23. Die langste postoperative Beobachtungszeit betragt 11 Monate, die kurzeste liegt bei 1 1/2 Monaten. Als Indikation fur eine intraokulare Linsenimplantation wurden bisher vorwiegend die einseitige Katarakt bei uber 60 Jahre alten Patienten sowie die beidseitige fortgeschrittene Linsentrubung bei ausgedehnter Makuladegeneration angesehen. Gerade bei alten Patienten mit Makuladegeneration wird das fur sie so wichtige periphere Gesichtsfeld durch die Starbrille erheblich eingeschrankt; das Tragen von Haftschalen ist wegen des nicht adaquaten zentralen Visus fur diese Patienten unmoglich.

The results of a penetrating keratoplasty depends not only on certain morphological-biochemical and immunological factors, but also on an adequate surgical technique. The indications for perforating corneal grafting have constantly extended during the past 20 years and are classified according to the chances of success and to the emergency of grafting; some unusual indications are mentioned. Complications are rarely observed, but may occur during or after the surgery. Postoperative care is discussed.

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.

Bericht uber zwei Falle von einseitiger Stauungspapille durch orbitale Myositis unbekannter Genese.

A total of 301 posterior chamber lenses implanted consecutively by one surgeon were examined on postoperative days 3-7 with special regard to both centering and the position of the haptics. It was possible to evaluate 296 eyes. In these, 83.1% of the lenses were ideally centered, while 16.9% were found to be slightly eccentric. There was one serious lens dislocation. The position of the haptics was evaluated in 245 eyes. The attempt to fix both haptics in the sulcus was achieved in 74.7% of the cases. Of the implants fixed in the sulcus, 96.2% were ideally centered. In the remaining cases 11 lenses were fixed entirely in the capsule but in 51 one loop was in the sulcus and the other in the capsule. While the lens is usually centered well when both loops are in the capsule (81.8%), it is significantly less well centered if one loop is fixed in the sulcus and the other in the capsule (41.2%). The data are discussed.

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.