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Background: The management of traumatic optic neuropathy remains controversial. This retrospective study presents the results of 19 cases of indirect optic neuropathy where surgical decompression represented the primary mode of treatment., Methods: Nineteen patients (20 optic nerves) with traumatic optic neuropathy underwent primary surgical decompression. The surgery was performed using the transethmoidal technique., Results: The extent of bony optic canal injury documented during surgery indicated that this had been underestimated in this series by CT findings. Vision improved in eight patients, five of whom had had no light perception preoperatively., Conclusion: Primary surgical decompression of the optic nerve within 48 h of injury produces beneficial results. Testing of visual acuity 6 weeks after surgery does not serve as a reliable predictor of final outcome.

Purpose: Age-corrected values are indispensable in assessing discrete changes in light difference sensitivity (LDS) when evaluating perimetric results. In order to detect incipient visual field defects, the present study aimed particularly to determine function of normal values depending on age and eccentricity., Methods: A test group (n = 83) of ophthalmologically and clinically unremarkable subjects 18-74 years of age was examined with the 'Centerfield' perimeter. A brief introductory program was first used to familiarize each test person with the situation. Then values in the central visual field (30 degrees) were determined with a threshold-splitting program. In addition, the peripheral visual field was examined after a short break., Results: Age-related normal values were calculated both as group averages and as lines of regression by statistical analysis of the resulting data. In contrast to other perimetric studies, decreases in LDS at different test points for persons aged 20 years to persons over 60 were not linear., Conclusions: Age-related normal values should be reviewed for other perimeters., (Copyright 2002 S. Karger AG, Basel)

Background: Cyanoacrylates are contained in nail glues, instant glues, and tissue adhesives such as Histoacryl. Cyanoacrylates may inadvertently contaminate the conjunctival sac and cause massive loss of visual function and serious discomfort to the patient., Patients: Over a 10-year period five patients with a cyanoacrylate lesion of the ocular surface have been observed. Four were injured by instant glue and one by Histoacryl. Therapy included moderate rinsing. In the most severely affected patient parts of the glue were removed mechanically; spontaneous rejection of the glue was awaited in the other four. After the glue had been rejected, four patients showed corneal erosion which healed without problems. Visual function returned to normal in all patients, and there was no persistent tissue damage., Conclusions: Cyanoacrylates exert no substantial thermal, chemical, or toxic effects on the ocular surface when inadvertently entering the conjunctival sac. Cyanoacrylate trauma therefore has a very favorable prognosis. The conservative approach of awaiting spontaneous glue rejection is appropriate.

Background: Eye lesions caused by superglue (instant glue) are relatively rare, and hence therapeutical experiences are limited., Patient: A female intended to treat a mild conjunctivitis by herself with anti-inflammatory eye drops. Inadvertently she took a tube of instant glue which then filled most of the conjunctival sac. After intensive rinsing the hardened glue was mechanically removed as far as possible. Remaining glue was spontaneously rejected within a few hours. After four days the resulting subtotal corneal erosion had healed, and visual function had returned almost to normal., Conclusions: Inspite of the dramatic, acute aspect the clinical course after superglue lesions is usually benign. Therapeutically, vigorous manipulations seem to be more harmful than useful. Spontaneous rejection of the glue should be awaited instead.

Background: Aim of the present study was to investigate woundhealing after allogen heterotopic cartilage transplantation in a rabbit model., Material and Methods: Cartilage discs were transplanted by central lamellar keratoplasty (diameter 5.0 mm) in eleven New Zealand White Rabbits. Cartilage was harvested of the ears of rabbits at the day of transplantation. The cartilage discs 0.5-0.6 mm thick were prepared with 5.2 mm diameter and transplanted within 12 hours. Fixation was performed by eight 10-0 nylon sutures. Postoperatively, dexamethasone ointment containing gentamicin was applied three times a day for three weeks. Clinical course was documented by photographs. For histological examinations the transplanted eyes were enucleated after one day or three days, and after 3, 6 or 12 months., Results: Allogen cartilage healed firmly in the cornea within two months. During the course of observation the cartilage grafts thinned and were replaced by normal appearing collagen fibrills. In one case neovascularisation of the cornea occurred and reached the cartilage graft, but did not invate. Histologically, in all cases no leukocytes could be seen in the cartilage or its neighbourhood. The cartilage grafts did not proliferate and remained avascular. The intraocular structures showed no inflammatory reaction., Conclusions: Allogen cartilage grafts to a clear corneal pounch do not induce an inflammatory reaction. Therefore, autologous cartilage prepared of ears seems to be useful biological material in ophthalmologic surgical procedures, for example to fill up corneal defects. To investigate if cartilage grafts will be helpful to stop neovascularisation in keratoplasty further studies with vascularisized corneas are necessary.

Purpose: To report the therapy of benign eyelid tumors with an argon laser as an alternative to surgery., Methods: Forty-one patients with 47 benign tumors of the eyelid were included in this study. In all patients, the eyelid tumor was eliminated by argon laser. In 24 cases the lower eyelid and in 23 cases the upper eyelid was involved, including the lid margin in 17 cases. Laser spot size ranged from 150 to 500 microm. Argon laser power density varied between 4.1 and 61.1 W/mm2. Spots were counted between 40 and 1204. Twenty-seven of 41 patients treated were followed up; the mean follow-up period was 5.8 months (range, 3 to 24 months). Postoperatively, histologic confirmation was obtained in 42 cases of the 47 treated tumors., Results: All patients were satisfied regarding the laser therapy and the cosmetic result. Remarkably, the wounds were dry after argon laser therapy. No infections of the wounds occurred; wounds were epithelialized after 2 to 3 weeks by a normal-appearing epithelium. The area of argon laser treatment was less pigmented than the surrounding skin and showed no obvious remarkable notches. As a complication, one patient developed a viral conjunctivitis. No relapses occurred during follow-up., Conclusions: Argon laser therapy of benign eyelid tumors may result in very satisfactory wound healing. Taking the short follow-up and the limited number of cases into account, it seems to be a useful alternative to traditional surgery, especially for tumors positioned close to the lacrimal papillae.

Background: We compared the standard suprathreshold strategy to the so-called threshold splitting strategy with 5 and 2 dB steps. The aim of the study was to establish whether the threshold splitting strategy had advantages over the suprathreshold strategy that has been used to date., Method: We examined the 30 degrees visual field in 49 volunteers using suprathreshold perimetry and on the same day threshold splitting perimetry on the Tübinger Automatic Perimeter CC. A total of 191 test points were examined in suprathreshold strategy. Using the threshold splitting strategy, 67 test points were examined, with a test-point design similar to other perimeters with the threshold splitting strategy. The criteria for inclusion in the study were central light sensitivity differences greater than 25 dB, fixation better than 80% and an illumination class density < 2., Results/discussion: The average duration of the examination using the suprathreshold strategy was 2-3 min quicker than the threshold splitting strategy in normal visual fields or small scotomas, but it took up to 15 min longer if large scotomas were presents. Interpretation of the scotoma configuration showed subjective differences: the smaller the scotoma, the greater the differences because of the fact that threshold splitting perimetry utilizes test points that are farther apart than those used in suprathreshold perimetry.

A 23-year-old female presented with a yellow-brownish, asymptomatic tumour of the bulbar conjunctiva in her left eye. The lesion had been detected 5 years previously and had grown since then. Prior to presentation there were 2 episodes of intratumoral hemorrhage. Funduscopy revealed tortuous vessels on the left. Complete tumour excision was performed. Histology showed numerous channels lined by a flat endothelium, and inflammatory cells in the fibrous septae. A diagnosis of a conjunctival lymphangioma was established. The tortuosity of the retinal vessels was probably associated by chance or caused by an undetected orbital lymphangioma.

Purpose: To demonstrate a rare complication in contactology., Case Report: A 26-year-old female had "lost" her hard contact lens in the right eye 2 years previously. Afterwards, new contact lenses were not tolerated. The patient had a slight intermittent epiphora but no further complaints. She consulted her ophthalmologist for new spectacles. At presentation, there was a firm tumour without signs of inflammation in the right upper lid area. When the lid was everted a hard contact lens was found within the tarsal plate which could be easily removed in the operating room. Microbiologic investigation disclosed no bacteria. Histology showed a circumscribed papillary reaction and a chronic non-specific inflammation with few eosinophils and no giant cells. Two weeks later the lens-related cavity was only slightly filled up by granulation tissue., Conclusions: After "loss" of a contact lens superior dislocation and finally tarsal implantation should be kept in mind. The process of contact lens migration reveals some interesting features: 1. Generally, it causes only minor symptoms though it may last for years. 2. Bacterial contamination rarely occurs. 3. Histologically, the inflammation is often mild or even absent. Eosinophils and giant cells are of minor or no importance indicating that allergy and giant-cell reaction play no significant role. 4. The lens related cavity probably heals slowly, possibly because of a (partial) epithelialization.

A 3.5-year-old girl suffered from a penetrating injury of the left eye. One and a half years later epithelial ingrowth was detected. Although block-excision was performed in the usual manner without technical problems the retina was excised accidentally. Histology revealed that the retina had been massively displaced in anterior direction prior to surgery because of fibrovascular proliferations.

After 13.5 years in vivo a 2-0 Terylene frontalis loop was excised because of an insufficiency. Histology showed a persisting giant cell reaction while lymphocytes were almost totally absent. The fibrils of the suture seemed to be intact. However, they were separated by ingrowing connective tissue which, on theoretical grounds, should improve the function of the frontal muscle on the upper eyelid. Therefore, insufficiency of the loop was probably caused by the (subclinical) foreign body reaction or the long-lasting mechanical stress leading to tissue damage.

Patient: A 62-year-old former miner with silicosis of the lungs but otherwise in good general condition presented with a solid nodule in the nasal left lid area for a duration of three months. Because of a central ulceration the reference diagnosis was basalioma. The tumour infiltrated the nasal part of the upper and lower eyelid and the tear ducts so that these were unrinseable. Similar lesions have been present since two years in other skin regions., Methods: Two cutaneous biopsies confirmed the diagnosis of a Mycosis fungoides without detectable expression of the CD30-antigen. Medical investigation finally revealed hepatosplenomegaly and cervical, inguinal and abdominal lymph node involvement. A lymph node biopsy three months after presentation again showed a T-cell-lymphoma which was CD30-positive now., Therapy: Systemic polychemotherapy was started. The lid lesions completely resolved, and the tear ducts were rinseable again.

Background: Evaluation of perimetric results requires a comparison with age-corrected values for the assessment of discrete light sensitivity changes. This is especially true in recording incipient glaucomatous visual field defects. The aim of the present study was to establish age-corrected normal values with the Tübingen Automatic Perimeter., Method: A test group (n = 85) of ophthalmologically and clinically unremarkable subjects 18-70 years of age was examined. The criteria for exclusion from the study were glaucoma or hereditary eye disease in an immediate family relative, diabetes mellitus, unstable or manifest hypertonia, multiple sclerosis, convulsive disorders, a previous stroke, or the use of psychoactive drugs. A brief introductory program was used to familiarize the test person, together with a threshold program for values in the central visual field. In addition, the peripheral visual field was examined. The threshold-splitting program of the Tübingen Automatic Perimeter 2000cc was used for examinations. RESULTS/DISCUSSION. Age-related normal values were calculated both as regression lines and group averages by statistical analysis of the resulted data. Surprisingly, the decrease found in people 20-70 years of age was in the center with 0.5 dB clearly smaller than at the periphery with 4-6.5 dB. Details of the evaluation are described.

As oculoplastic surgery is preferred for direct closure of lid defects, spontaneous wound healing after excision of lid tumors is not common. Thus, spontaneous reformation of lid defects as an alternative treatment to surgical procedures was investigated. In 12 patients with a clinical diagnosis of basal-cell carcinoma, lid tumors were removed surgically by full-thickness excision in 1 group (n = 6) or cutaneous excision only in the other group (n = 6). The mean follow-up period was 5 months in the first group and 9 months in the second group. Cosmetic and functional results were satisfactory in all patients. The scar tissue simulated the former tarsus. The wounds were completely covered by a normal-appearing epithelium. Spontaneous wound healing may lead to considerable stiffness of the lower lid and to an acceptable reformation of the lid margin. There was no elevation of the lid margin and, remarkably, no secondary surgery due to an entropion or an ectropion was necessary.

Levocabastine is a potent and highly selective H1-receptor antagonist specifically developed for the topical treatment of allergic conjunctivitis. This study assessed the effects of levocabastine eye drops on accommodative capacity in 20 healthy volunteers and on parameters influencing glaucoma in 12 glaucoma patients. A single dose of levocabastine (0.5 mg/ml) did not influence accommodative capacity, pupil diameter, or intraocular pressure (IOP) in volunteers. Similarly, levocabastine (0.5 mg/ml, one drop in each eye twice daily) for two weeks was well tolerated by patients with glaucoma. Measurement of IOP, iridocorneal angle, depth of the anterior chamber, visual acuity and near-point in these patients provided no evidence of exacerbation of glaucoma or interactions with concurrent antiglaucoma medication. Application site reactions (local irritation and ocular pain) were the only adverse effects, with an incidence comparable to placebo-treated controls. In conclusion, ocular levocabastine appears to be well tolerated, with no apparent effects on accommodative capacity or glaucoma.

Background: In patients with corneal opacity caused by diseases like okular pemphigoid, Stevens-Johnson-Syndrome or burns, visual rehabilitation can only be achieved with keratoplasty or keratoprosthesis. The first has generally a poor prognosis in these circumstances, and the latter bears several problems in the postoperative course as well. A biological, corneal replacement could possibly combine the advantages offered by keratoplasty (no interaction between host tissue and plastic) and keratoprosthesis (more permanent transparency). Theoretical considerations and practical experience suggest that the best candidate would be hyaline cartilage., Material and Methods: Bovine sterni were used to obtain circular cartilage slices which were approximately 60 microns thick, having a diameter of approximately 6 mm. These slices were implanted in one eye each of 4 rabbits instead of the natural cornea. The eyes were enucleated after 8 to 29 days., Results: The cartilage remained so transparent that the iris and to a certain extent the fundus blood vessels could be visualized. Connective tissue served to bind the host cornea to the cartilage, but did not infiltrate the cartilage. Perforation was observed in 3 animals. The extent of epithelialization of the cartilage slices ranged form ca. 30% to 95%. None of the animals exhibited an intraocular inflammation. The cartilage did not proliferate and remained avascular. Secondary intraocular changes, with the exception of anterior synechiae, could not be detected., Conclusions: A tissue for biological corneal replacement has to fulfill many requirements which to a certain extent can be achieved with the use of hyaline cartilage. Despite numerous, unsolved problems, a biological corneal replacement as an alternative to keratoplasty and keratoprosthesis in cases of corneal blindness does not seem out of imagination.

Purpose/methods: We studied a rare initial manifestation of myelodysplastic syndrome in an 82-year-old woman who had acute secondary glaucoma in the right eye and mature cataracts in both eyes., Results/conclusion: Therapy with glaucoma control medications and cataract extraction in the right eye resulted in expulsive hemorrhage and subsequent enucleation of the right eye. After cataract extraction, examination of the left eye disclosed a central serous retinal detachment and hemorrhage. Histopathologic analysis of the right eye demonstrated myelocytic and lymphocytic infiltration.