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PubMed1997

[Use of botulinum toxin in ophthalmology].

BACKGROUND: Botulinum Toxin A produces muscle palsies by blocking the neuromuscular transmissions. The numerous applications of Botulinum-chemodenervation in ophthalmology are demonstrated. RESULTS: In blepharospasm und facial hemispasm Botulinum Toxin A injections represent an excellent alternative to medical and surgical therapy. They have to be repeated after several weeks or month. Other indications are spastic entropium and lagophthalmos. In paralytic strabismus Botulinum Toxin injections (intramuscular under EMG control) serve to prevent contracture of the homolateral antagonist and thus to facilitate recovery of the agonist with restauration of binocular single vision or in non recovering cases to simplify the surgical treatment by making no more necessary the usual recession of the homolateral antagonist. In concomitant strabismus Botulinum-chemodenervation is applicable above alle in small angle deviations under 25 degrees, in sensory strabismus, in residual squint angles after surgery and in contraindications against surgery of any cause. Botulinum Toxin can also be used to stimulate a weakening procedure with control of resulting binocular function or disturbing diplopia. CONCLUSIONS: Botulinum Toxin A injections are of considerable therapeutic value in blepharospasm, spastic entropion, lagophthalmus, as well in paralytic strabismus and certain cases of concomitant strabismus.

Blepharospasm↗
PubMed1995

[Value of electrophysiology in ophthalmologic monitoring of patients with endocrine orbitopathy].

BACKGROUND: Patients with Graves' ophthalmopathy may suffer from optic nerve involvement. Different ophthalmological examinations reveal the stage of this disease. PATIENTS AND METHODS: In a retrospective study 27 patients with Graves' ophthalmopathy were examined. Best corrected visual acuity, intraocular pressure, visual field, motility and thickness of ocular muscle were determined. Registration of visual evoked cortical potentials (P-VEP) and pattern electroretinograms (P-ERG) were performed regularly. RESULTS: In our study group severe damage of the optic nerve could be avoided by short examination intervals and early treatment. CONCLUSIONS: Regular controls of P-VEP reveal optic nerve involvement at an early stage, at which visual acuity might not be altered. Therefore, this electrophysiological examination should be used in controlling patients suffering from Graves' ophthalmopathy.

Adult↗
PubMed1994

[Postoperative endophthalmitis at the Geneva Ophthalmologic Clinic].

The postoperative endophthalmitis is a rare and serious complication of the intraocular surgery, which may result in the loss of the visual function. Retrospectively, the authors reviewed the 14 postoperative endophthalmitis cases at the department of ophthalmology of Geneva between 1983 and 1992. For cataract extractions, the following incidence was observed: 0.115% (8 of 6954 cases). In 36% (5 of 14 cases), the culture was positive. The best treatment was a early vitrectomy associated with antibiotherapy. In 57% (8 of 14 cases), the visual outcome was equal to or better than 0.2.

Adult↗
PubMed1995

Lightning and electrical injuries: neuro-ophthalmologic aspects.

Lightning and electrical injuries have widespread manifestations involving almost all organ systems of the body, including the central nervous system (CNS) and the eye. This article considers the neuro-ophthalmologic effects of lightning and electrical injury.

Animals↗
PubMed1994

[GRIN-endoscopy for laser treatment in ophthalmology].

Endoscopes for use in ophthalmology can be manufactured with diameters smaller than 0.89 mm. Because gradient-index (GRIN) lenses yield a higher resolution than ordered fiber bundles having the same diameter, GRIN lenses with a diameter of either 0.35 mm or 0.50 mm were utilized to manufacture thin high resolution endoscopes. Whatever the working distance, the resolution obtained with a GRIN lens having a diameter of 0.50 mm was higher than that obtained with a GRIN lens of 0.35 mm. Thanks to the miniaturization, an additional working channel could also be integrated within the endoscope. This allowed new combinations of various surgical instruments. This channel can be used as a guide for an optical fiber for laser therapy or as an irrigation/aspiration channel. The use of such an instrument where the observation path is parallel to the surgical instrument was compared to the application of the endoscope as a separate monitoring system. The advantages and inconveniences of both systems are discussed. Preference is given to a system where the diameter of the observation channel is maximum and the optical fiber for laser delivery is integrated but adjustable along its length within the endoscope.

Endoscopes↗
PubMed1993

[Ophthalmologic follow-up of diabetic retinopathy].

The mean frequency of ophthalmological check-ups should vary between one year in diabetic patients without fundus changes and six months in patients with background retinopathy. Shorter screening intervals are needed in proliferative stages, during gravidity and adolescence and in cases with loss of vision. Fluorescein angiography is indicated if the treatment modality is based on its results (focal laser treatment in significant macular edema or panretinal photocoagulation in early proliferative or severe pre-proliferative stages). Theory and practice differ markedly. A questionnaire sent 1988 to 146 ophthalmologists and internists revealed that in Switzerland probably no more than one-half of all diabetic patients are regularly seen by an ophthalmologist. An actual questionnaire given to all 58 diabetic patients seen within 3 months in our eye clinic shows that about one quarter of the patients were not aware of the risk of diabetic eye disease.

Adult↗
PubMed1992

[Patients with late-life vision damage in occupational rehabilitation. Preliminary ophthalmologic treatment, concomitant manifestations and an illustration provided by the growing number of patients with juvenile diabetes].

The rehabilitation centre in Veitshöchheim (near Würzburg) offers different kinds of training programs for the adult visually handicapped. This is usually preceded by a long time of unemployment. Diabetes mellitus was the third most common disease at the centre and 25% of the patients with diabetes mellitus were already legally blind. In a retrospective study we looked at the medical and ophthalmological treatment and the education the 76 patients with diabetes mellitus had received before coming to the rehabilitation center. All charts from February, 87, to September, 90, were included in the study. According to the classification of visual acuities by the WHO we formed four groups (less than or equal to 1/50; 1/35-0.1; 0.125-0.3; greater than 0.3) and compared them with each other. In the groups with the lowest visual acuity the medical management of the diabetes mellitus had been much poorer than in the better groups. Related to the bad visual acuity was the higher incidence of proliferative diabetic retinopathy and the significantly lower percentage of panretinal lasercoagulations. 47% of the patients with diabetes mellitus had been trained in jobs that would not have been recommended to a potential visually disabled by an ophthalmologist or the office for labour exchange. Only in 10% of the cases could a job be maintained by the help of technical devices (including low vision aids). To ensure best medical treatment and counselling concerning the choice of an appropriate job a close team work between practising ophthalmologist, general practitioner, and the office for labour exchange is needed. Thereby the cost and psychological impact of a retraining program could hopefully be lowered.

Adult↗
PubMed1991

[Type IV allergy to components of ophthalmologic drugs].

A review is given on allergens in topical ophthalmological drugs, which are of importance as to allergic type IV-skin reactions. The diagnostic proceedings are demonstrated and the special importance of patch testing and chamber scarification test is outlined by a case report.

Conjunctivitis, Allergic↗
PubMed1991

[Octopus perimetry in neuro-ophthalmologic diseases. A contribution to the problem of optimal program choice based on 427 cases].

From the patient population of the University Eye Clinic Basel 427 cases, who had been tested with the Octopus perimeter 201 because of neuro-ophthalmologic problems, were retrospectively examined. Above all it was interesting to find out, which program to use in order to get a maximum degree of information with a minimum of examinations. The quantitative programs 31 to 34 gave most often the clinically relevant information concerning the opticus- and chiasma affections. The only exception was the anterior ischemic opticoneuropathy where the semiquantitative program 07 delivered the better information. With supragenicular affections program 07 delivered by far, and most often, the clinically relevant information. Because of our results we can make the following recommendations: if a pregenicular lesion is suspected, it is sensible to use quantitative programs with a homogenous test point distribution within 30 degrees testing area. If a supragenicular lesion is suspected, the registration of the total extension of the defect is of greater practical value than a quantitative threshold determination. In this case, the survey program 07 is suitable. If visual disturbance is present, without a hint of its location, it is recommended to start with the survey program 07 and thereafter, according to test results, specifically continue with a quantitative program.

Adolescent↗
PubMed1990

[The Gray Scale of the Octopus N1 perimetry analysis program in neuro-ophthalmology].

The gray scale of the Octopus neuro-ophthalmologic program N1 shows the difference between actual values and age-related normality. This permits optimal visualization of slight relative scotomas. The interpolation algorithm is computed for the four individual quadrants of the visual field, enabling either lateral hemianopic or fascicular defects to be sharply delineated. In addition, the N1 program automatically provides a global, nonsectorial gray scale which is useful for demonstrating visual defects which are not delineated by either the horizontal or the vertical meridian.

Algorithms↗
PubMed1989

[Ophthalmologic study in diabetic retinopathy].

A questionnaire sent to 72 ophthalmologists and 74 general practitioners or internists revealed that in Switzerland probably no more than one-half of all diabetic patients are regularly seen by an ophthalmologist. The mean frequency of ophthalmological check-ups varies between about one year in patients with no fundus changes and six months in patients with background retinopathy. All diabetic patients should be screened regularly with a view to early laser treatment in proliferative stages.

Diabetes Mellitus, Type 1↗
PubMed1989

[Differential diagnosis of ophthalmologic syndromes using a computer program].

A Fortran program which can be run on IBM-compatible personal computers has been written for the differential diagnosis of ophthalmologic syndromes. The user enters the symptoms observed and the computer displays a list of syndromes in which these symptoms occur. The program at present covers 219 syndromes and 1094 symptoms, and can be expanded. Its use is expected to make differential diagnosis and the scientific clarification of syndromes easier.

Computer Systems↗
PubMed1987

[Ophthalmologic peculiarities of sarcoidosis].

The present paper deals with the frequency of different ophthalmic sarcoid changes and their morphological and photographic characteristics. In addition, the diagnostic value of conjunctival biopsy is evaluated. The findings were based on repeated ophthalmological examinations of an unselected group of 281 patients with histologically confirmed sarcoidosis. Conjunctival (37/218) and lacrimal gland (33/254) changes were encountered more often than sarcoid uveitis (22/281), and a conjunctival granuloma was the most frequent single sarcoid ophthalmic finding. Sarcoid changes in the eyes and the adnexae were often characterized by a scarcity of symptoms and a typical outward appearance. In some cases of sarcoid uveitis fluorescein angiography revealed in the iris and the retina nodules which showed features suggesting the proliferative nature of the disease. The iris infrared transillumination technique illustrated the affinity of sarcoid nodules in the pupillary area. Conjunctival biopsy showed epithelioid cell granulomas compatible with sarcoidosis in nearly half of the patients in whom it was suspected in a slit-lamp examination of the conjunctivae. In the diagnosis of sarcoidosis, conjunctival biopsy is a procedure to be recommended before more demanding methods are tried.

Biopsy↗
PubMed1987

[Long-term ophthalmologic follow-up of diabetic children].

Sixty-four infant diabetics were kept under observation for an average of 6.1 years to obtain ophthalmologic and endocrinologic data (biomicroscopic fundus examination, fundus photography, fluorescein angiography; blood sugar level, HbA1c determination, ketoacidosis, microalbuminuria, HLA-DR typing). In 28 patients (44%, Group B) retinal vascular changes corresponding to the picture of diabetic preretinopathy were detected by fluorescein angiography. In 36 children (56%, Group A), the retinal vascular system was normal. In 16 patients vascular anomalies increased during the observation period, while in 12 patients no further changes were seen. On comparing the endocrinologic findings in the two groups, the only statistically significant difference was in the ketoacidosis values. A tendency to hypoglycemic attacks, as well as elevated HbA1c and microalbuminuria levels, was likewise more frequent in Group B. Aside from the typical distribution, HLA-DR typing revealed a considerable percentage of children with 1/4 localization in Group B only. It was not seen in any patient in Group A. These results give rise to the hope that HLA-DR typing will enable prognostic conclusions to be drawn concerning the time of onset and progression of diabetic retinal alterations in the future.

Adolescent↗
PubMed1986

[Use of botulinum toxin in ophthalmology].

Botulin toxin A was introduced as a treatment in ophthalmology by Dr. Scott of San Francisco. One important application is in cases of blepharospasm, where the toxin is injected into the lateral parts of the lower and upper lid and, if necessary, over the eyebrows in a single dose of 1-2 nanograms, preferably using a needle under electromyographic control. The effect on the blepharospasm is visible after a few days and lasts for several months. The procedure can be repeated several times. The second application is in cases of strabismus. In paralytic strabismus, contracture of the antagonist of the paralyzed muscle can be weakened by local injection of botulin toxin with a coaxial electrode under electromyographic control. Good results were observed in cases of eye muscle disorders in endocrine ophthalmopathy. In concomitant strabismus (exotropia or esotropia) administration of botulin toxin is also possible although a certain paresis of the injected muscle has to be taken into account. The doses for strabismus vary between 1/2 and 2 nanograms of the toxin. The administration of botulin toxin either in blepharospasm or strabismus has no systemic side effects and is a safe procedure if performed under careful electromyographic control. First personal experiences in the treatment both of blepharospasmus as well paralytic strabismus and concomitant strabismus are reported.

Blepharospasm↗
PubMed1986

[The incidence of visually impaired drivers seen in ophthalmologic consultation].

On the basis of a critical review by Dr. rer. nat. Bresser the calculation contained in the paper "Ophthalmological Experiences with Automobile Drivers with Inadequate Visual Acuity" is corrected. From the information on visits to the ophthalmologist contained in the study data, the average frequency of repeated visits can be worked out to 1.56. As a consequence, the average duration of unsuitable vision is 22.1 months. This results in a prevalence P = 360750. However, this figure can only apply to drivers who visit an ophthalmologist. According to a recent study based on a random sample of the population, the true number of drivers with unsuitable vision seems to be more than 4 times the figure quoted.

Automobile Driving↗
PubMed1986

[Ophthalmologic implants--a risk at high altitudes?].

In the course of an experimental study typical ophthalmological implant materials were transported to altitudes of up to 48,000 feet. Spherical prostheses manifested practically no changes in volume, while scleral sponge material for detachment surgery released death bubbles during decompression. It is pointed out that less severe effects are likely to occur in this respect under clinical conditions, and likewise that the measured values are only of consequence for the patient in cases of rapid decompression.

Altitude↗
PubMed1984

Ophthalmological signs and prognosis in patients with a subarachnoid haemorrhage.

In cases of subarachnoid haemorrhage from various causes, ophthalmological signs can be a feature. In the clinical examination they can be of assistance in determining the site of the aneurysm or other responsible lesion, and they can also be of prognostic value. In a series of 48 cases the significance of these ocular signs is evaluated and discussed.

Adult↗