Biomedical subjects
Publications and source records attributed to H Busse.
The treatment of retinal detachments due to macular holes without further central peripheral holes with intraocular tamponades (SF6, silicone oil) is preferred to episcleral techniques. After treatment of 24 cases of retinal detachments due to macular holes a therapeutic program is proposed.
Recently, enucleation of choroidal melanomas tends to be replaced by less radical treatments such as photocoagulation. Use of Ruthenium 106 plaques has proved to be efficient in Germany. Because the Beta rays of Ruthenium 106 have only limited tissue penetration they are used only for tumors of less than 6-7 mm thickness and less than 18 mm2 surface. This report describes 62 cases of choroidal melanomas treated with Ruthenium 106. With a follow-up period of 12 to 48 months, 32 cases had total regression, including 2 cases with metastases. 15 patients required a second procedue and 15 had additional photocoagulation. In 23 of 51 patients the visual acuity remained unchanged. In 26 patients the visual acuity decreased and 2 patients had an improvement. 13 patients with melanomas inside or close to the macular area decreased their visual acuity.
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CT examinations before and after radiotherapy were performed in 48 patients with choroidal melanomas who were submitted for a bulb-preserving irradiation with ruthenium-106. The authors wanted to investigate to which extent further, especially pretherapeutic informations are obtained by computed tomography, if performed in addition to well-known ophthalmologic examinations (ophthalmoscopy, fluorescence angiography, sonography). Furthermore the side reactions of therapy induced by the intervention or by the tumor should be visualized. The measurements of the tumor prominence were of special importance for the therapy planning, because they allowed to verify the response of radiotherapy by computed tomography. Our own patients had an average tumor regression of 1 to 2 mm within the first three months after the irradiation with ruthenium-106; after six months the prominence of the melanomas had decreased by 3 to 4 mm on an average. Interesting side effects, also for the ophthalmologist, were acute radiogenic retino-uveitises and parabulbar oedemas found in several patients who showed a marked regression within one or two weeks. Some late effects were scleral scars at the point of fixation of the ruthenium calotte.
Between 1970 and 1977 407 eyes were operated on for glaucoma of different origins, the procedure used being goniotrepanation with scleral flap. Ninety of these eyes were followed up for more than 5 years (7.2 years on average) with regard to long term effects of the operation. Open-angle glaucoma accounted for 73% of the cases. IOP was normal without drug treatment in 68 eyes (76%), and with drugs in a further 19 (21%). In other words, IOP was regulated for 5 years or more postoperatively in 97%. The investigation also covered the condition of the lens, (extension of cataract?), visual acuity and the morphology of the bleb.
The conjunctival approach combined with the lateral canthotomy incision is very appropriate for exploration and reconstruction of orbital fractures and provides exposure medially and laterally. 18 pure blow-out fractures, 16 zygomaticomaxillary fractures and 6 other middle-face traumas were treated in that way. No serious complications ever occurred in our series, except one suture granuloma. Based on own experience and satisfactory functional and cosmetic results this technique should be preferred instead of the infraorbital and the subciliary incision.
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After a survey of the literature on the therapy of choroidal melanomas the authors report on the technique and results of 106Ru/106Rh irradiation in 42 eyes with choroidal melanoma and 2 metastatic uveal tumours treated between 1980 and 1983. The technique is limited to tumours with a prominence of 5 to 6 mm and maximum extension of 18 mm. After an observation time of 12 to 36 months total tumour regression was found in 24 cases of melanoma and 2 metastatic tumours. Nine cases needed a second irradiation, 4 cases an additional photocoagulation. Because of multiple metastases 1 patient with an advanced tumour (11 mm of prominence, only eye) died 1 year after treatment.
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The results of 106Ru/Rh-irradiation in 42 eyes with choroidal melanomas from 1980 to 1983 are reviewed. Indication for this treatment is a tumor size of 1 to 6 mm prominence and maximum extension of 18 mm (12 diameter papillae). In 24 cases a total regression ("grey mouse") was found after an observation time of 12 to 36 months. In nine cases a second irradiation was performed, in four cases an additional photocoagulation. One patient with an advanced tumor (11 mm prominent, single eye) died one year after treatment.
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A new concept of a foreign-body microextractor is introduced. The holding part consists of flexible, silicone-covered, looplike branches that adapt to the form of the foreign body and surround it completely, so a safe extraction through the scleral incision is guaranteed.
We examined the healing process of transplanted rat corneas in relation to the swelling of the grafts. Rat corneas were stored parallel in Macrodex 6% (Knoll) and MK medium (McCarey and Kaufman) at 4 degrees C for 48 h and successively applied in penetrating keratoplasty. The healing process was investigated by observation with a slit lamp and histological methods. Graft swelling before transplantation did not influence the healing process. We concluded that decreased graft swelling is not paralleled by improved wound healing in rat corneas. This phenomenon confirms our previous observations of bovine corneas, that decreased water uptake in vitro is not paralleled by increased vitality of the corneas.
In cases of total loss of the lacrimal canalicular system, e.g. due to untreated traumatic laceration, resection of an infiltratively growing malignant tumour of the medial canthus or severe canaliculitis a substitutional surgical procedure using the newly developed hydrophilic lacrimal tube is indicated, as experience with homoplastic material has shown that successful long-term results with homoplastic material (arteries, veins and prepared conjunctival tube) cannot be expected. The advantages of the new material compared to the acrylic tubes of L. T. Jones are the hydrophilic nature and its softness as a result of which no problems with fixation of the tube and pressure necrosis of the medial canthus exist. The implantation is done after performing a conjunctivo-dacryocystotomy or conjunctivo-ductostomy. In cases of conjunctivo-dacryocystotomy the tube may be removed after 1 to 1 1/2 years.