[Clinical aspects and therapy of secondary glaucomas].
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Biomedical subjects
Publications and source records attributed to H Busse.
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Clinical echographic examinations were performed in 15 cases of traumatic cataract. As a result certain criteria were established which give some information on the condition of the posterior capsule of the lens. Echographic examination prior to reoperation enables the procedure to be optimized with regard to IOL implantation, anterior vitrectomy, or prevention of retinal detachment.
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The cause of visual impairment must always be clarified as soon as possible. During the last 6 years visual loss in 60 selected patients was caused by infectious processes, mucoceles, benign tumours, endocrine ophthalmopathies, head traumas etc. The comparison of preoperative and postoperative visual function in 48 cases treated by decompression of the orbit and in 12 cases treated by decompression of the optic nerve demonstrated visual improvement in 68 per/cent. Surgically we preferred the transethmoidal route and in some cases the lateral osteoplastic approach. In respect of the success of the surgical therapy, a correlation with the interval between the time of manifestation of visual loss and the time of surgery was found. Furthermore, the results depended on the basic diseases.
Two-dimensional-electrophoretic analysis has been applied to non-neoplastic mammary epithelium from eight healthy women, tumor tissue from eight "diploid" mammary adenocarcinomas, and tumor tissue from eight "aneuploid" mammary adenocarcinomas. Compared with non-neoplastic mammary epithelium, a slight numerical net non-neoplastic mammary epithelium, a slight numerical net increase of the protein spots was detected in "diploid" tumors and a marked increase in "aneuploid" tumors. Two prominent spots were present in all 16 malignant tissues examined and absent in all eight non-neoplastic tissues (silver staining method). The results suggest that a difference in the composition of cellular proteins exists both between non-neoplastic mammary cells and malignant tumor cells, and between "diploid" and "aneuploid" tumors.
Twelve of 25 patients were treated at the University Eye Clinic in Münster because of retinal detachment due to a macular hole. Partial fluid gas exchange (SF6), vitrectomy and SF6, or vitrectomy and silicone instillation, were used, and the patients were examined both pre- and postoperatively by ultrasonography with particular attention to the situation at the posterior pole. These echographical examinations enabled us to evaluate the following three criteria: staphyloma posticum, stiffness of the retina, and vitreous adhesions. All of these conditions mean that the prognosis will be worse if SF6 gas instillation is used alone. In these cases, a vitrectomy should also be performed or a Klöti-Klemme procedure is useful when stiffness of the retina or staphyloma posticum is present. Preoperative ultrasonography is useful when setting up an adequate therapy plan.
The favored treatment of intraocular melanomas in Germany is 106-ruthenium eye plaque therapy. The Departments of Radiation Therapy and Ophthalmology (University of Münster) initiated a clinical study in 1981 to reveal the effect of high-dose beta irradiation (15.000 cGy to the apex of the tumor) regarding tumor regression, treatment related side effects, visual acuity, and survival. Sixty-seven patients have been treated since 1981. In 12 patients a second course of irradiation has been performed because of insufficient tumor regression or no change after the first plaque treatment. Sixty-five percent (44/67 pts.) were over 60 years of age. Twenty-four patients had a small tumor (up to 3 mm in height), 20 patients had a medium sized tumor (3.1-5 mm in height), and 22 patients had a large tumor (more than 5.1 mm in height). Fifty-one patients had a follow-up of at least 12 months. A total tumor regression was achieved in 34/51 patients (67%), partial tumor regression occurred in 13/51 patients (25%), and in 4/51 patients (8%) there was no change after the first course. After the second course of 106-ruthenium-irradiation 5 of the 12 patients showed total tumor regression, 3 had partial regression, and in 4 patients only an increase of the tumor echogenity could be assessed by ultrasonography, but no change in height. Visual acuity, which depends mostly on the localization of the tumor, was preserved at pretreatment levels in 72% of the patients. Two patients died with documented metastatic disease, one patient died of myocardial infarction. There was only one enucleation because of neovascular glaucoma.
From 1972 to 1983 iridocyclectomy was performed in 18 patients because of an invasive growing tumor of the iris and ciliary body. Surgical techniques were those of Mackensen (1972), the trap-door technique, and a trepanation of the sclerocornea with regrafting. In 16 out of 18 cases total removal of the tumor was accomplished; in two cases there was a recurrence. In the other cases it was possible to preserve useful visual acuity.
Within the first 3 to 4 days after occurrence of a premacular subhyaloid hemorrhage the posterior vitreous boundary layer may be lacerated by argon laser coagulation in such a way, that the blood floats into the vitreous body, where it is absorbed within a few weeks. Older premacular hemorrhages under an intact vitreous boundary layer, typically green-white in color have to be treated by more invasive vitreo-surgical procedures.
Nevoxanthoendotheliomas (and juvenile xanthogranulomas) are very rare benign skin diseases which occur in infants. An ocular manifestation, mainly in the iris, has been found in approximately. 10% of the cases, The clinical picture is characterized by a recurrent unilateral hemorrhage of the anterior chamber, which is the reason for seeing an ophthalmologist. The clinical diagnosis of juvenile xanthogranuloma is based on the characteristic iris changes - heterochromia, circumscribed vascularized tumor, or diffuse thickening of the iris. Sometimes elevated intraocular pressure is also found. In combination with a mild local steroid, radiotherapy with 300 to 400 cGy should be started immediately in order to prevent a sometimes uncontrollable secondary glaucoma. The good results achieved in 5 of the authors' own cases underline the value of low-dose radiotherapy in this disease: the affected eye was healed in all 5 cases.
The authors report on their experience with UV-absorbent posterior chamber IOLs (ORC) implanted between April 1, 1984 and April 1, 1985 (n = 125). Short-term complications and in particular post-operative sterile uveitis, corresponded to those in a group (n = 135) who had had regular PMMA lenses implanted. While no significant lowering of glare perception could be proved after implantation of the UV-block-lenses, color perception seemed to be more correct with these lenses. Because of the short observation time no significant statements can be made regarding the frequency of cystoid macular edema.
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The prognostic value of preoperative examination with the retinometer (Rodenstock) in cases of macular pucker with many different causes was studied on the basis of 17 cases. The authors found that the visual acuity after membrane peeling correlated with the preoperative test with the laser interference instrument in most cases. Therefore, this examination can be helpful in deciding whether or not surgery is necessary.
Description of a newly developed 0 degree stereo coworker microscope manufactured by the Zeiss company; it gives the coworker a stereoptic view of the surgical field, with coaxial illumination.
The authors report on long-term observations of patients who underwent surgery for congenital glaucoma between 1961 and 1976. It was possible to perform follow-up examinations in 46 out of 100 patients. In 66 out of 73 eyes (90%), intraocular pressure was regulated to below 22 mm Hg appl. after periods ranging from 5 to 22 years, in 16 eyes with additional local treatment with beta-blockers. Over 60% of the cases had central vision better than 0.4, and only 2 of the patients had to be educated in special schools. All of the others were at least capable of attending elementary school and 50 percent of them were even able to go on to higher schools.