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[Ophthalmologic symptoms of Down's syndrome (author's transl)].

After a short description of the general symptoms of Down's syndrome, the ophthalmologic aspects of the disease are discussed. The study is based on the examination of 1047 mongolian children. The various eye-symptoms were present in different frequencies according to sex and type. The results were compared with those in the literature of the last 100 years and identical as well as highly significant divergent values were found.

Blindness↗

Pure homonymous hemiachromatopsia. Findings with neuro-ophthalmologic examination and imaging procedures.

The study describes neuro-ophthalmologic findings in two patients with brain infarction who developed homonymous hemiachromatopsia with resolution to pure homonymous achromatopsia in an upper quadrant. All other visual parameters were normal; only color perimetry was capable of demonstrating the visual disorder. The results are presented with special emphasis on the macular region. Computed tomography studies and magnetic resonance imaging revealed lesions in the caudal and medial occipitotemporal gyri as well as in adjacent cortical regions. The lesions were secondary to disordered circulation in a proximal occipitotemporal branch of the posterior cerebral artery. The anatomical findings and functional relations of color vision in man are discussed in the light of animal findings.

Adult↗

Ophthalmological follow-up of type 1 (insulin-dependent) diabetic patients after kidney and pancreas transplantation.

We studied the effect of successful kidney and pancreas transplantation on visual function and diabetic retinopathy in 18 patients with long-term Type 1 (insulin-dependent) diabetes mellitus (17 to 38 years) and with advanced proliferative retinopathy. The average age of the patients was 42 years. Prior to transplantation, 5 eyes were in end-stage ophthalmic complication due to neovascular glaucoma. An ophthalmological follow-up was performed between 1-6 years post-surgery. Analysis of the results showed that the diabetic retinopathy had stabilized after transplantation in 12 cases (66%) with a supplementary photocoagulation in the majority of cases. The proliferation continued in 4 patients (22%) leading to blindness in 2 patients and recurrence of vitreous haemorrhages despite the photocoagulation in the other 2 cases. An improvement was observed on fluorescein angiography in a patient with pre-papillar glial proliferation without photocoagulation. Ten patients were reported to have a cataract and were operated on in two cases before transplantation; in one patient, the cataract increased following transplantation. In conclusion, the kidney and pancreas transplantation was not effective in our patients in reversing the clinical and angiographic signs of diabetic retinopathy. Moreover, a worsening of the lesions was observed in some cases; this was probably due to the irreversible microangiopathic lesions due to advanced evolution of diabetes.

Adult↗

Diode lasers in ophthalmology.

Compact laser emitting diodes of gallium-aluminium-arsenide are now available for incorporation into clinical lasers in ophthalmology. These lasers are cheap and have low running costs. They are portable and their wavelength of emission (810 nm) may be advantageous in certain clinical situations. Clinical trials in retinal vascular disease, trabeculoplasty, and cyclophotocoagulation, have been encouraging. Recent advances allow laser delivery through binocular indirect ophthalmoscopes, endolaser and contact transscleral probes in addition to slit lamp mounted versions. Laser delivery in situations which were previously impossible has immense implication for prevention of blindness due to glaucoma and retinal vascular disease throughout the world.

Animals↗

Biofeedback techniques in the treatment of visual and ophthalmologic disorders: a review of the literature.

The literature on the use of biofeedback techniques in the treatment of visual and ophthalmologic disorders is reviewed. Although this consists mainly of case studies, there is mounting evidence that biofeedback may be applicable to the treatment of strabismus, nystagmus, blepharospasm, elevated intraocular pressure, and myopia. because of the success in applying biofeedback techniques in the treatment of other neuromuscular disorders, it is concluded that the use of these techniques in the treatment of blepharospasm and strabismus shows the most promise.

Biofeedback, Psychology↗

Optical and long wave holography: potential applications in ophthalmology.

The first part of this paper describes the process of optical holography, and discusses the possibilities and some of the merits of the application of optical holographic techniques in the field of ophthalmology, such as: 1. Holographic observation of the eye and the light-path through the cornea and the lens, leading to the evaluation of the optical constants of the eye. 2. Holographic interferometric measurements of the configuration changes which accompany accommodation or changes in the intra-ocular pressure. 3. Three-dimensional observations of the fundus. The second part of the paper is devoted to long wave holography, which has attained special attention in electromagnetic (non-optic) and ultrasonic wave propagation. Although these two forms of wave propagation differ in their physical properties, there are many similarities in their signal processing techniques, the collection of wave fronts emerging from the object, and in the visualization of images.

Electromagnetic Phenomena↗

Automutilation of the cornea. I. Ophthalmological aspects.

Automutilation of the cornea occurs more frequently than is generally supposed. The patient, particularly at his first visit, certainly will not reveal the cause of the cornea lesion. In two University Eye Clinics 19 patients were seen in whom the diagnosis of automutilation of the cornea could be made. It is important for the ophthalmologist to bear the possibility of automutilation in mind. In 6 of our patients corneal grafts were performed. All these grafts failed because of further automutilation. Corneal transplantation is certainly not indicated; these operations were performed because the patient's true condition had not been spotted in time. Better forms of treatment are tarsorrhaphy or the application of closely occluding bandages. In this way fair results were obtained in 2 cases. It is wrong to force the patient to a confrontation (i.e. to tell him that automutilation is suspected). Confrontation can lead to more severe mental disorders. In all cases psychiatric treatment is absolutely essential. The ophthalmological prognosis for this condition is poor and psychiatric help is quite often refused.

Adult↗

[Homogeneity of G-DRGs in ophthalmology].

BACKGROUND: Since the year 2004 hospitals in Germany are obliged to participate in a payment system based on diagnosis-related groups (DRG), which bases hospital reimbursement on the diagnosis and treatment of patients. The aim of this study was to analyze the data of the first German national hospital cost data calculation for their homogeneity. METHODS: The cases at the LMU hospital in Munich were calculated analogous to the national hospital cost data calculation for a period of 7 months. These exemplary data were then analyzed in detail for homogeneity. RESULTS: For many DRGs, the numbers of cases in the analysis were within a range similar to those in the official nationwide calculation. The costs and lengths of stay were similar to those of the official national calculation. CONCLUSIONS: Many ophthalmologic DRGs are quite inhomogeneous necessitating regrouping to avoid false incentives. For cases with high complexity the current system may lead to cost deficits especially for hospitals providing maximum care.

Analysis of Variance↗

[Classification of visco-elastic substances for ophthalmologic surgery].

UNLABELLED: Individual properties of a viscoelastic substance for ophthalmologic applications are intimately tied to its chemical and rheologic characteristics. Independent comparative data for vicoelastic substances are not readily available or interpretable. MATERIAL AND METHODS: Twenty-six different commercially available viscoelastic substances were investigated using the Advanced Rheometric Expansion System and the Rheometric Scientific 800 device to analyze elastic and viscous modulus, complex viscosity (dynamic frequency dependance) and viscosity at the zero shear rate by extrapolation using the Ellis fit. RESULTS: Viscosity (cps) at zero shear rate (s-1, mean of six different samples): Sodium hyaluronate products: Amivisc Plus: 128; AMO Vitrax: 41; Biolon: 243; Dispasan: 130; Dispasan Plus: 782; Healon: 243; Healon GV: 2451; Healon 5: 5525; Microvisc (Morcher Oil): 1162; Microvisc Plus: 3663; Morcher Oil: 1253; Provisc: 207; Rayvisc: 78; Viscoat: 58; Viscorneal (Allervisc): 733; Viscorneal Plus (Allervisc Plus): 1176; Visko: 206; Visko Plus: 1683. Hydroxypropylmethylcellulose (HPMC) products: Acrivisc: 7; Adatocel: 8; Coatel: 6; HPMC Ophthal H: 94; HPMC Ophthal L: 7; Ocucoat: 6; PeHa-Visko: 5; Visco Shield: 60. CONCLUSION: Sodium hyaluronate as well as HPMC viscoelastic substances demonstrated remarkable differences in rheological properties from each other. In some cases, the results of this independent investigation differed from the values provided by the companies. A new division of commercially available viscoelastic substances into subgroups is presented, which provides a scientific base for various practical viscosurgical aspects. These real rheologic properties of each substance allow the ophthalmic surgeon to choose the viscoelastic substance that is most suitable for the surgical situation.

Adjuvants, Immunologic↗

[Gene transfer in ophthalmology].

BACKGROUND: Research into the molecular and genetic basis of disease is continually expanding. How does the increasing knowledge about the genetic basis of eye diseases contribute to the development of new therapeutic strategies? MATERIALS AND METHODS: Gene therapy, here defined as the introduction of genetic material into human cells, offers great opportunities. Gene transfer strategies can be used for gene replacement in recessive disease, gene inactivation in dominant disease, expression of "rescue factors" and apoptosis modulators in degenerative disease, "suicide genes" for example in proliferative diseases and expression of immunmodulatory factors in immunological disorders. Viral vector systems have been developed to introduce the gene of interest into the target cell. RESULTS: Most of the published strategies include the use of vectors for gene transfer. Adenovirus (AV), adenoassociated virus (AAV), encapsulated adenovirus mini-chromosomes (EAMs), herpes simplex virus (HSV) and lentiviruses are the most frequently used viral vector systems to date. Their advantages and disadvantages, the in vivo models used for gene transfer in retinal degeneration, and the results obtained to date by different research groups in the field will be reviewed. CONCLUSIONS: Gene transfer into ocular tissues has been demonstrated with growing functional success and may develop into a new therapeutic tool for clinical ophthalmology.

Eye Diseases↗

[Ophthalmological rehabilitation - experience at the University Eye Hospital Heidelberg].

BACKGROUND: The rehabilitation of low vision patients is of increasing importance since the number of these patients has grown rapidly. We wanted to evaluate the actual spectrum of patients concerning age and diagnoses and the appropriate low vision aids (LVA) in 1 year. METHODS: The records of the patients seen in our low-vision unit in 1996 were retrospectively evaluated. We correlated visual function, ophthalmological diagnoses and age to the magnification needed for rehabilitation and the use or prescribed LVAs. RESULTS: There was a nearly homogeneous distribution concerning age with a range from 0 to 99 years. Most patients presented with age-related macular degeneration (25.6 %) while 10 % each had retinitis pigmentosa and optic atrophy. Simple low vision aids such as high plus reading additions (29 %) and magnifiers (18.5 %) were prescribed in the majority of patients. However, closed-circuit TV (CCTV) systems were necessary in 25 %. CONCLUSIONS: Rehabilitation of low vision patients is often possible with simple LVAs. This is especially true for patients suffering from age-related macular degeneration. Since there is a tremendous-amount of different diseases, adequate diagnostic and individual counseling is of major importance.

Adolescent↗

Isolated ophthalmological manifestations due to malfunction of a lumboperitoneal shunt: shortening of the spinal catheter in three pediatric patients.

A long-term follow-up study was conducted in 28 pediatric patients treated with lumboperitoneal shunting. Shunt malfunction was observed in 3 patients (10.6%) who presented with isolated ophthalmological abnormalities 3, 5, and 11 years after surgery. The mechanism of this phenomenon is considered to be very slowly developing malfunction secondary to shortening of the spinal catheter associated with child's growth. The importance of periodic funduscopic examination in patients treated with lumboperitoneal shunting in infancy is stressed.

Adolescent↗

[Ophthalmological diagnosis in systemic vasculitis].

Ocular manifestations of systemic vasculitides are extraordinarily pleomorph and have been described for many decades. In the introduction the special interaction of the immune system and the eye is outlined. Thereafter diagnostic procedures of patients suffering from systemic vasculitides are shown from an ophthalmological view point. Many examples, which show multiple possibilities of ocular manifestations on systemic vasculitides, are given. With regard to the anatomy of the eye, a review is given on the involvement of the 1) outer eye and a tear film, 2) lacrimal duct diseases, 3) diseases of the lid, 4) diseases of conjunctiva, 5) diseases of sclera, 6) diseases of the cornea, 7) diseases of the lens, 8) intraocular inflammation, 9) retinal affections, 10) optic nerve inflammation, and 11) orbiota involvement. Frequencies of these structures involved in the various systemic vasculitides are outlined. Principally every systemic vasculitis can induce every eye manifestation; however, larger patient groups show characteristic features of eye manifestations in systemic vasculitides. Special reference is given to Wegener's granulomatosis, giant-cell arteritis and Behcet vasculitis.

Diagnosis, Differential↗

Optic neuropathy in systemic lupus erythematosus and antiphospholipid syndrome (APS): clinical features, pathogenesis, review of the literature and proposed ophthalmological criteria for APS diagnosis.

Optic neuropathy is a well-known ocular manifestation occurring in patients with systemic lupus erythematosus (SLE), and it remains one of the major causes of blindness in these patients. We report data from six SLE patients with optic neuropathy, one of whom was considered to have antiphospholipid syndrome (APS). This patient had monolateral optic neuropathy, whereas the other five SLE patients had bilateral optic nerve disease. We believe that the monolateral occurrence of optic neuropathy in our patient can be considered as a 'focal' neurological disease due to a thrombotic event involving the ciliary vasculature. Conversely, bilateral optic nerve damage in SLE could be considered to be a 'general' neurological disease due to different immunological mechanisms, such as vasculitis. Additionally, the literature on SLE patients affected by optic neuropathy is reviewed to evaluate the major clinical features, particularly neurological features. In reviewing the literature, it appears that bilateral optic neuropathy in SLE occurs more frequently than monolateral optic neuropathy, and the main neurological manifestation seen in these patients is transverse myelitis, particularly in SLE patients with bilateral optic nerve disease. Finally, we propose a clinico-ophthalmological spectrum of APS and outline the ocular clinical manifestations that can be considered as diagnostic for the syndrome.

Adult↗

Direct medical costs of age-related macular degeneration in Italian hospital ophthalmology departments. A multicenter, prospective 1-year study.

This study calculated the resource utilization and direct medical costs related to age-related macular degeneration (AMD). We conducted a multicenter observational study in 1999 in seven hospital ophthalmology departments in northern and central Italy. A total of 476 patients aged over 50 years with the diagnoses were classified into three prognostic groups: (a) drusen (23.7%), (b) geographic atrophy (16.4%), and (c) retinal changes associated with choroidal neovascularization (CNV) (59.9%). In addition to the costs reimbursed by the Italian National Health Service, we estimated also patients' out of pocket expenses. The mean cost per patient per year was 383.2 euro; patients with CNV were by far the most costly (540.1 euro, vs. 158.1 euro for drusen and 147.9 euro for geographic atrophy). Hospital costs and diagnostics were the main cost determinants. Services directly paid for by patients (private consultations and OTCs) amounted to 46.5 euro for patients with CNV, 50.3 euro for drusen, and 68.8 euro for geographic atrophy. The major finding of the study was that the presence of CNV involved higher expenditure than drusen or geographic atrophy. This suggests that the costs of AMD rise significantly with the severity of the illness.

Aged↗

Clinical immunology in ophthalmology. The 1975 Bedell lecture.

Immunology has played a recognizable role in ophthalmology for many years. The old immunology concerned itself with antibodies, skin tests, complement, agglutinins, precipitants, and lysins. The old immunology was responsible for the remarkable development of vaccines, vaccinations, antisera, and the prophylactic use of toxins. The new immunology cannot display such achievements as yet. However, continued study in this area could lead to significant improvements in diagnosis, prognosis, and the development of effective immunoregulants in inflammatory and neoplastic disease.

Animals↗

A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome in Africa.

A prospective study of ophthalmologic findings in 20 African patients with the acquired immunodeficiency syndrome (Group 1) and nine patients with acquired immune deficiency syndrome related complex (Group 2) disclosed that 11 patients in Group 1 and two patients in Group 2 had ocular involvement. Cotton-wool spots, Roth spots, and hemorrhages were frequent features in Group 1. In this series, unlike most others, perivasculitis occurred in five patients whereas cytomegalovirus retinitis and ocular involvement of Kaposi's sarcoma were not observed. These African patients also differed from those previously described in the high proportion of women (11 of 29) and the lack of the usual risk factors (homosexuality, intravenous drug abuse, and hemophilia).

Acquired Immunodeficiency Syndrome↗

Neuro-ophthalmologic dilemma: chronic optic neuritis?

A patient with an 8-month history of chronic progressive visual loss was referred to the Neuro-ophthalmology Consult Office of Washington University with a diagnosis of chronic optic neuritis. Previous diagnostic studies, including CAT scan, had been negative. Because chronic progressive visual loss is considered a hallmark of mass lesion, more vigorous investigation, including repeat CAT scans, was undertaken, leading to the diagnosis and removal of a 2 cm meningioma.

Adult↗