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[Fluorescence angiography as a basis for successful prophylactic and therapeutic light coagulation for diabetic retinopathy (author's transl)].

The fluorescence angiogramme served as a basis for the plan of treatment and as a criterion of treatment success in 192 patients with diabetic retinopathy who underwent xenon-light coagulation between January 1971 and October 1972. In 64 patients this success could be statistically evaluated comparing the untreated partner eye according to the exact Fisher-test. The rate of success of light coagulation showed itself to be statistically highly significant (p less than 0.01%) with regard to retinal morphology and haemodynamics, but with regard to visual acuity only statistically barely significant (p less than 5%). For the influencing of the capillary occlusion process with light coagulation no statistical significance (p = 25.19%) was found, and for the influencing of the capillary permeation disturbances with light coagulation a slight statistical significancing of the capillary permeation disturbances with light coagulation a slight statistical significnace (p less than 5%) was calculated. For avoiding or hindering present or threatened new vessel formation with light coagulation we calculated a statistical significance of p less than 1%.

Capillaries

Light coagulation of the eye.

A brief description is given of the history and early application of light coagulation in ophthalmology. The technique was originally developed by Meyer-Schwickerath in 1949 following clinical observation of macular damage sustained from watching an eclipse. A variety of different light sources were attempted in the prototype instruments before Carl Zeiss (Oberkochen) developed the first commercial model using a high-pressure Xenon lamp in combination with an ophthalmoscopic view of the funds. The ophthalmological clinical procedure originally advocated by Meyer-Schwickerath for light coagulation is briefly outlined and its potential application as a prophylactic treatment in certain specified pathologies is indicated.

Eye Diseases

[Diabetic retinopathy: 10 years after light-coagulation (author's transl)].

A retrospective study of 19 patients, who suffered from diabetic retinopathy, were submitted to a xenon-light-coagulation 10 years ago and have been regularly checked, shows better results in the treated eyes than in the untreated fellow-eyes in regard to visual acuity and background morphology. In cases of poorly controlled metabolism, heavy smoking and simultaneous suffering from hypertension and nephropathy the prognosis of the treated eyes is unfavourably affected.

Diabetic Retinopathy

Diabetic retinopathy and light-coagulation.

In diabetic retinopathy, a low resistance of flow between choroid and retina is found which goes with an increased intake of tissue fluid into the retinal vessels and the appearance of retinal oedema. Light coagulation destroys the choriocapillaris which does not regenerate. As less fluid becomes available to be sucked up by the retinal vessels, the oedema will now disappear and consequently, the retinopathy subsides.

Diabetic Retinopathy

[Diabetic retinopathy. Analysis of progressive attacks, prophylaxis and therapy with light coagulation].

If one follows the course of diabetic retinopathy on the basis of retinal fluorescence angiography one can distinguish two main courses: Cases displaying an evolution mainly characterized by an increase of capillary hyperpermeability, and others in which the capillary occlusive processes outweigh hyperpermeability. Fluorescence angiography in addition provides paramount clues in regard to initiation of photocoagulation as well as its mode and extent of application and will furthermore render an adequate documentation of successful treatment.

Blood Vessels

[Light coagulation in central and paracentral choroiditis (author's transl)].

Since 1966 photocoagulation has been performed in 52 cases and 54 eyes of choroiditis located on the posterior pole. The course of the cases treated is compared with a control group treated with drugs. Photocoagulation shortens the duration of the acute inflammatory process, decreases the frequency of recurrences by about 40% and improves the visual prognosis. The follow-up 1 year to 9 years later (average 7 years) showed in the control group a visual function of 0.5, in the treated group of 0.8.

Acute Disease

[Vascular anastomoses at the posterior pole of the eye (author's transl)].

Anastomoses between vessels of the fundus may occur as congenital malformations or secondary to vascular diseases affecting the eye. Congenital anastomoses can be of the racemose hemangioma type, with severe malformation of the retinal vessels, ocular complications, and neurologic manifestations, or as simple A-V shunts with visual impairment but limited tendency to show other ocular or neurologic involvement. These anastomoses must be distinguished from other vascular malformations like telangiectasis (Leber, Coats) or the angiomatous lesions of von Hippel's disease. Secondary anastomoses may be confined to the retinal vessels or involve chorioretinal connections. Retinal anastomoses occur in vascular disorders like retinal vein occlusions, diabetes, periphlebitis and hemoglobinopathies. They are often amenable to treatment by light coagulation. Chorioretinal anastomoses occur whenever Bruch's membrane is destroyed by traumatic, inflammatory, degenerative or physical (light coagulation) influences. Light coagulation may be the appropriate treatment, although complications are not rare.

Adolescent