[Unilateral macular hemorrhage of unknown origin].
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Adult↗
Biomedical subjects
C Framme
Publications and source records attributed to C Framme.
Comparison of reduced and standard light application in photodynamic therapy of the eye in two rabbit models.
BACKGROUND: Current PDT treatment for age-related macular degeneration uses a standard radiant exposure of 50 J/cm(2) at an irradiance of 600 mW/cm(2). However; there is a general problem with the unusually high irradiance; in fact, the rate of photochemical production of singlet oxygen may be limited by insufficiently oxygenized neovascular tissue. It was the aim of this study to evaluate the efficacy of verteporfin (Visudyne) photoactivation to induce thrombosis of choriocapillaries and in experimentally induced corneal neovascularizations in rabbits by varying irradiance and retinal radiant exposure. MATERIALS AND METHODS: The light-dose threshold to induce micro-thrombosis in the choriocapillaries (seven eyes) and in corneal neovascularizations (eight eyes) of Chinchilla-Bastard rabbits using different retinal irradiances (100 and 600 mW/cm(2)) at different radiant exposures (20, 10, 5, 2.5, 1.25, 0.62, and 0.3 J/cm(2)) was evaluated. Induction of neovascularizations was performed 7 days prior to PDT treatment using intracorneal silk sutures. A dose of 2 mg/kg verteporfin was intravenously infused 10 min before standard PDT. The criterion for vascular thrombosis was vessel closure as determined by fluorescein angiography 1 h and 1 day post exposure. RESULTS: Experiments on the choroid revealed vessel closure 1 h after irradiation at ED(50) = 10.8 J/cm(2) (both 600 and 100 mW/cm(2)) and after 24 h at ED(50) = 2.4 J/cm(2) (600 mW/cm(2)) versus 1.8 J/cm(2) (100 mW/cm(2)). Vessel closure was enhanced at irradiation with 100 mW/cm(2). Regarding corneal neovascularizations, vessel thrombosis was observable by dark appearance of irradiated clotted neovascular tissue and angiographically by a lack of leakage at ED(50) thresholds of 0.62 J/cm(2) (1 h) and 0.41 J/cm(2) (1 day) for 100 mW/cm(2) and of 0.99 J/cm(2) (1 h), and 0.67 J/cm(2) (1 day) for 600 mW/cm(2). Thus in both experiments thresholds for vessel closure were reduced by a factor of 1.5 for the lower intensity. Histology revealed more selective vessel occlusion without RPE and photoreceptor damage for 100 mW/cm(2) rather than 600 mW/cm(2) intensity at threshold irradiation. CONCLUSION: Low-intensity PDT with verteporfin for neovascular tissue seems to be more effective than regular high-intensity PDT. Future preclinical trials should address the issue of proper dosimetry for effective PDT in age-related macular degeneration.
Animals↗
[Selective retina therapy: methods, technique, and online dosimetry].
Selective retina therapy (SRT) is currently under evaluation, as a new and very subtle laser method, for the treatment of retinal disorders associated with a degradation of the retinal pigmentary epithelium (RPE). SRT makes it possible to selectively effect the RPE, sparing the adjacent neural retina with the photoreceptors and also the choroid below the RPE. In the best case, the therapy leads to regeneration of the RPE and a long-term metabolic increase at the chorio-retinal junction. In contrast to conventional laser photocoagulation, which is associated with complete thermal necrosis of and around the treated site, absolutely no scotoma occurs in SRT. This paper reviews the methods and mechanisms behind the selective effects of the RPE. In vitro and preclinical results are used to describe the bandwidth of selective effects with respect to different irradiation settings. An optoacoustic technique is introduced to visualize effects that cannot be seen by ophthalmoscopy and to facilitate dosimetry control without recourse to angiography completes the report.
Humans↗
[Selective RPE laser treatment with a scanned cw laser beam in rabbits].
BACKGROUND: Selective RPE laser therapy with sparing of the neurosensory layer is possible by applying repetitive microsecond laser pulses. Macular diseases such as diabetic maculopathy, soft confluent drusen due to age-related macular degeneration or central serous chorioretinopathy were shown to be treated successfully-without concurrent laser scotoma-by this technique. It was the goal of this study to show, if selectivity could also be achieved using a conventional green cw-laser by scanning the beam across the retina during irradiation. MATERIAL AND METHODS: A cw-laser beam at 532 nm was coupled to a slitlamp via a single mode optical fiber. The spot (18 microm) was scanned across the retina of Dutch-belted rabbits through a contact lens using a two-dimensional acusto-optical deflector. The scan-field was 300 microm x 300 microm in size and consisted of six separate scan lines. The scanning speed was adjusted so as to produce 5 micros exposure at each absorber in the center of the scan line. The entire scan pattern was applied 100 times at each site at a frame rate of 100 Hz. Dose response curve was measured by variation of the laser power. ED(50)-thresholds for RPE damage were calculated by fluorescein angiographic leakage in irradiated areas after exposure to different laser intensities. The extent of selectivity was examined by light microscopy. RESULTS: Clinically the selective laser-induced RPE defect was demonstrated by fluorescein angiographic leakage and concurrent absence of ophthalmoscopic visibility. The angiographic ED(50)-damage threshold was 161 mJ/cm(2) (66 mW). Ophthalmoscopic visibility was not noticed even with the maximum available radiant exposure of 438 mJ/cm(2) (180 mW). Thus the safety range between angiographic and ophthalmoscopic thresholds had a factor of at least 2.7. First histological examinations revealed selective RPE destruction with intact photoreceptors for irradiation at laser power levels 2 times above angiographic threshold. CONCLUSION: Selective RPE targeting is feasible with a conventional green cw-laser when scanning the focused laser beam across the fundus with a speed such that every point in exposed RPE is irradiated for duration of 5 micros.
Animals↗
[Fundus autofluorescence after selective RPE laser treatment].
BACKGROUND: The selective RPE laser treatment is a new technique which selectively damages the RPE and avoids adverse effects to the neural retina. A problem is the ophthalmoscopically non-visibility of the laser lesions. The aim of the study was to investigate whether fundus autofluorescence (AF), which is derived from the lipofuscin contained by the RPE cells, is changed due to the RPE damage, and thus may be used for non-invasive treatment control. METHODS: A total of 26 patients with macular diseases, i.e. diabetic maculopathy (DMP), soft drusen maculopathy (AMD) and central serous retinopathy (CSR), were treated with repetitive short laser pulses (800 ns) from a green Nd:YAG laser (parameters: 532 nm, 100 and 50 pulses at 500 and 125 Hz, retinal spot diameter 200 micrometer, pulse energies 70-175 microJ). AF was excited by 488 nm and detected by a barrier filter at 500 nm (HRA, Heidelberg engineering). Patients were examined by ophthalmoscopy, fluorescein angiography and autofluorescence measurements at various times after treatment (i.e. 1 h, 1 and 6 weeks, 3, 6 and 12 months). RESULTS: None of the laser lesions was ophthalmoscopically visible during treatment although fluorescein angiography showed leakage of the irradiated areas. Identification of the lesions was possible by AF imaging showing an intensity decay in the irradiated area in 22 out of 26 patients, predominantly in patients with CSR and AMD. Lesions could be identified as hypoautofluorescent spots 1 h after treatment. During follow-up the laser spots became hyperautofluorescent. In patients with DMP some AF images were less helpful due to diffuse edema and larger retinal thickness. CONCLUSION: Imaging of non-visible selective RPE laser effects can be achieved by AF measurements predominantly in patients without retinal edema. Thus AF may replace invasive fluorescein angiography in many cases to verify therapeutic laser success.
Adult↗
Autofluorescence imaging after selective RPE laser treatment in macular diseases and clinical outcome: a pilot study.
AIM: Selective retinal pigment epithelium (RPE) laser treatment is a new technique which selectively damages the RPE while sparing the neural retina. One difficulty is the inability to visualise the laser lesions. The aim of the study was to investigate whether fundus autofluorescence (AF) is changed because of the RPE damage, and thus might be used for treatment control. Additionally, the clinical course of patients with various macular diseases was evaluated. METHODS: 26 patients with macular diseases (diabetic maculopathy (DMP), soft drusen maculopathy (AMD), and central serous retinopathy (CSR)) were treated and followed up for at least 6 months. Treatment was performed with a train of repetitive short laser pulses (800 ns) of a frequency doubled Nd:YAG laser (parameters: 532 nm, 50 and 500 pulses at 100 and 500 Hz, retinal spot diameter 200 micro m, pulse energies 75-175 micro J). AF was excited by 488 nm and detected by a barrier filter at 500 nm (HRA, Heidelberg Engineering, Germany). Patients were examined by ophthalmoscopy, fluorescein angiography, and autofluorescence measurements at various times after treatment (10 minutes, 1 hour, 1 and 6 weeks, 3, 6, and 12 months). RESULTS: Fluorescein angiography showed leakage from the irradiated areas for about 1 week after treatment. None of the laser lesions was ophthalmoscopically visible during treatment. Identification of the lesions was possible by AF imaging showing an intensity decay in the irradiated area in 22 out of 26 patients, predominantly in patients with CSR and AMD. Lesions could be identified 10 minutes after treatment as hypoautofluorescent spots, which were more pronounced 1 hour later. During follow up the laser spots became hyperautofluorescent. In patients with DMP some AF images were less helpful because of diffuse oedema and larger retinal thickness. In these cases ICG angiography was able to confirm therapeutic success very well. Most of the patients have had benefit from the treatment, with best results obtained for CSR patients. CONCLUSION: Imaging of non-visible selective RPE laser effects can be achieved by AF measurements predominantly in patients without retinal oedema. Therefore, AF may replace invasive fluorescein angiography in many cases to verify therapeutic laser success. Selective laser treatment has the potential to improve the prognosis of macular diseases without the risk of laser scotomas.
Adult↗
[Central retinal artery occlusion. Importance of selective intra-arterial fibrinolysis].
BACKGROUND: Conventional treatment of a central retinal artery occlusion usually has a poor prognosis but intra-arterial fibrinolysis (IF) of the ophthalmic artery is an invasive treatment option. The importance of IF was evaluated in 62 patients with central retinal artery occlusion and in addition the risk spectrum for this disease was considered. MATERIAL AND METHODS: Data from charts of 62 patients were retrospectively analysed. Visual recovery after IF (n = 17) was compared to conventional treatment (e.g. decrease of IOP, improvement of rheological conditions, n = 45). Patients were excluded from IF if the occlusion was present for more than 8 h, if there was a history of bleeding and previous operations, or if they were older than 85 years. IF was performed using either urokinase (n = 7) or tPA (n = 10). RESULTS: Out of 62 patients, 22 (35%) with central retinal artery occlusion underwent catheterisation. Stenosis of the carotid artery excluded IF in 5 out of these 22 cases, therefore only 17 patients were treated by IF. Of the patients, 40 (65%) were excluded from IF for various reasons: 47% (19/40) arrived later than 8 h after occlusion, 17% (7/40) did not consent to IF, 15% (6/40) had medical contraindications and 13% (5/40) were over 85 years of age. Two patients required no IF because of a cilioretinal anastomosis with moderate visual acuity and another patient showed spontaneous visual recovery during ophthalmic examination. Of the 17 patients treated with IF, 4 achieved an improvement of visual acuity by more than 2 lines, no change of visual acuity was observed in 12/17 patients and 1/17 lost more than 2 lines after treatment. Of the 45 conservatively treated patients, 16 achieved improvement by more than 2 lines and no change occurred in 29/45 patients. Three patients treated with IF suffered from a stroke during treatment. The main risk factor for central retinal artery occlusion was high blood pressure in 32% of all cases and nicotine abuse in 16%. CONCLUSIONS: Many patients presented too late for IF. However, there was no statistical difference between patients with IF and conventional treatment with regards to the improvement of visual acuity. Additionally there is an increased risk of a stroke from IF, therefore a prospective study is necessary to evaluate the importance of IF. Stabilisation of high blood pressure may be the best prophylaxis for preventing a central retinal artery occlusion.
Adult↗
Results of vitrectomy and the no-touch-technique using autologous adjuvants in macular hole treatment.
BACKGROUND: Anatomic and functional results of macular holes using vitrectomy and platelet-concentrate (PC) or autologous whole blood (WB) were investigated without peeling any epiretinal membrane in order to minimize retinal trauma. METHODS: 44 patients with macular holes stage II, III and IV underwent a vitrectomy with removal of posterior cortical vitreous (in stage II and III) and C2F6 gas endotamponade. No peeling of any epiretinal membrane or the ILM was performed. In 14 patients autologous WB was injected and in 30 patients autologous PC. The mean follow-up time was 9.3 months. RESULTS: An anatomic closure was observed in 36.4% of patients in the WB-group and in 93.9% of patients in the PC-group. SLO-microperimetry showed a reduction of absolute scotomas in 80% of the WB- and in 75% of the PC-group. In the WB-group 1 retinal detachment and 1 branch vein occlusion occurred; in the PC-group 3 retinal detachments, 1 central artery occlusion, 1 macular pucker, 1 cystoid macular edema, 1 late reopening and 1 secondary glaucoma were observed. In both groups no endophthalmitis occurred. CONCLUSION: If autologous platelet concentrate is available, high anatomic success rates can be achieved without aggressive membrane removal, which may cause retinal damage. Autologous whole blood cannot be recommended as an alternative adjunct for the treatment of macular holes without membrane removal.
Adult↗
[Invasive aspergillosis of the orbit in immunocompetence].
BACKGROUND: An isolated aspergillosis of the sphenoidal sinus is a difficult diagnosis because the often misleading clinical symptoms of this rare disease can develop late and first be presented to the ophthalmologist. Because of this even life-threatening disease in normally immunodeficient patients, fast diagnostics and treatment is indicated. CASE REPORT: We report about an immunocompetent man to suffer from an invasive aspergillosis involving the sphenoidal sinus after external operation of a mucocele. Aspergillus infiltrated the right orbit by bone erosion and led to an acute loss of vision on his right eye and a pathological visual field (visual acuity 0.1). A systemical antimycotic therapy was performed and the right orbit and the optical channel were operated to remove the mycosis. During operation the optical nerve was found to be completely surrounded by the mycosis. After surgery visual acuity recovered slowly but completely in about two weeks (visual acuity 1.0) and visual field examination revealed normal findings. These findings were stable now for one year. CONCLUSION: The main findings of unilateral acute visual loss and pre-operations of the paranasal sinuses in combination with persistent headache can lead to the suspect of an aspergillosis infection. It is important to establish correct diagnosis--especially in immunocompetent patients--early to prevent a probably irreversible visual loss and in an advanced stage to handle the life-threatening risk of this disease.
Aged↗
Quality of salivary tears following autologous submandibular gland transplantation for severe dry eye.
BACKGROUND: This study aimed to characterise the composition of the pre-ocular fluid after transplantation of the autologous submandibular gland (SMG) for patients with severe dry eye. METHODS: Stimulated and unstimulated pre-ocular fluid from 15 patients (17 eyes) with a viable SMG graft ("SMG-salivary tears"), as well as normal tears and SMG saliva (20 normal subjects/ 20 eyes), was sampled. As global tear parameters, fern pattern analysis and SDS gel electrophoresis were performed. As specific quality parameters, total protein content, secretory immunoglobulin A (SIgA), lysozyme, amylase, sodium, potassium and osmolality were measured using routine laboratory methods. The flow rate of SMG-salivary tears was determined in 5 patients by means of sequential scintillography. RESULTS: The fern pattern of SMG-salivary tears was coarse and thus more similar to normal SMG saliva than tears. SDS gel electrophoresis of the SMG-salivary tears showed albumin and two unidentified proteins in addition to the normal tear pattern. Osmolality and total protein content of SMG-salivary tears were higher than in normal SMG saliva, but still lower than in normal tears. High activities of normal tear antibacterial proteins (SIgA, lysozyme and amylase) were detected in the salivary tears. Stimulation of the secretion did not alter the composition of SMG-salivary tears. The flow rate of SMG-salivary tears was closer to that of normal tears than normal SMG saliva. CONCLUSION: Salivary tears resulting from SMG-transplantation represent condensed SMG saliva. Thus their quality is intermediate between normal tears and normal SMG saliva. High levels of secretory proteins demonstrate that the gland maintains an active function. Surgical denervation and residual tear components from the ocular surface are the most likely factors to cause the complex differences between normal SMG saliva and SMG-salivary tears. The effects of this secretion on the ocular surface are currently being evaluated in a clinical and laboratory study.
Adolescent↗
[Complications after external retinal surgery in pseudophakic retinal detachment--are scleral buckling operations still current?].
BACKGROUND: After conventional buckling procedures for pseudophakic retinal detachment the primary reattachment rate is 60 to 90% according to literature. Primary vitrectomy may be advantageous in these cases. The purpose of this study was to investigate the spectrum and role of potential side effects like anisometropia and diplopia, to find arguments for or against primary vitrectomy. Also risk factors for pseudophakic retinal detachment were analyzed in our study group, because they may be different from former studies, which were mostly undertake at the time of ec cataract extraction. PATIENTS AND METHODS: The data from 115 patients (120 eyes) with pseudophakic retinal detachment, who undergone buckling procedure between 1991 and 1996 were retrospectively reviewed. We analyzed the retinal reattachment rate, choroidal detachment, postoperative visual acuity, refraction, occurrence of diplopia, anisometropia and metamorphopsia. RESULTS: The primary retinal reattachment rate was 83.3%. There was a retinal redetachment rate of 16.7%. The primary PVR-rate was 4.2%. After the first reoperation an reattachment rate of 91.6% could be achieved, after the second one an overall rate of 95%. A choroidal detachment occurred in 29.2%. Postoperatively (26.5 months +/- 17.2) we found a cellophane maculopathy in 26.5% with consecutive metamorphopsia in 12.1%. 13 patients (15.9%) complained about diplopia, which had to be corrected by operation in 2 cases and prismatic glasses in 4 cases. Anisometropia could be deserved in 16.4%. The buckling procedures caused refractive changes of -1.80 dpt +/- 1.78 after an encircling band and +0.38 dpt +/- 1.01 after a plombage (average -1.05 +/- 1.86). 20% of patients treated with an encircling band developed anisometropia and only 8.3% of patients with a plombage. Postoperatively the visual acuity raised significantly from 0.3 to 0.6 (median). Best visual recovery could be observed in patients, who underwent only one operation. CONCLUSIONS: The primary retinal reattachment rate in pseudophakic retinal redetachment after conventional buckling procedures in our patients are comparable to those in the literature. In spite of phacoemulsification the risk-factors for pseudophakic retinal detachment has not changed. A considerable number of patients complained about postoperative complications like anisometropia and diplopia, which could be avoided by primary vitrectomy. To compare anatomic and functional results of both procedures a randomized prospective study should be undertaken.
Adult↗
[Clinical results of intravitreal administration of tissue-type plasminogen activator (tPA) and gas for removal of subretinal hemorrhage in senile macular degeneration].
BACKGROUND: Subretinal hemorrhage in age related macular degeneration (AMD) usually causes acute visual loss and is associated with poor visual prognosis. In order to prevent retinal damage and to perform laser treatment of the underlying choroidal neovascularization (CNV) the subretinal hemorrhage has to be removed from the macular region. This could be achieved by intravitreal injection of tissue plasminogen activator (tPA) and gas. PATIENTS AND METHODS: In 8 consecutive patients, suffering from a massive macular hemorrhage (duration of visual problems: mean 9 days), tissue plasminogen activator (tPA) (40 micrograms in 400 microliters BSS) and SF6-gas (0.75 ml) was transsclerally injected into the vitreous cavity to achieve liquification and displacement of the hemorrhage. RESULTS: In all patients liquification and displacement of the hemorrhage out of the macular region was achieved during follow up. During the first week after operation a significant increase of visual acuity was noticed in all patients, however ophthalmoscopically there was just little reduction of the hemorrhage in the foveolar area. After successful removal of the blood the choroidal neovascularization was treated successfully by laser coagulation in one patient. No laser treatment was performed in the other patients because of the subfoveal location of the neovascularisation or because of disciform scar. Visual acuity increased 4 lines after surgery. In one case the procedure was complicated by a persistent vitreous hemorrhage and vitrectomy had to be performed in another patient due to an endophthalmitis. CONCLUSION: Intravitreal injection of tPA assisted gas displacement of subretinal hemorrhage due to AMD leads to a significant increase of visual acuity during the first week after operation. Although a nearly complete removal of the hemorrhage out of the macular area could be achieved, it was difficult to differentiate this from the spontaneous course. Laser photocoagulation could be performed in only few cases.
Aged↗
[Bilateral vision loss after coronary artery bypass operation. Ischemic retinopathy after coronary artery bypass operation: "post-pump retinopathy"].
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Cardiopulmonary Bypass↗
Quality of salivary tears following autologous submandibular gland transplantation for severe dry eye.
BACKGROUND: This study aimed to characterise the composition of the pre-ocular fluid after transplantation of the autologous submandibular gland (SMG) for patients with severe dry eye. METHODS: Stimulated and unstimulated pre-ocular fluid from 15 patients (17 eyes) with a viable SMG graft ("SMG-salivary tears"), as well as normal tears and SMG saliva (20 normal subjects/20 eyes), was sampled. As global tear parameters, fern pattern analysis and SDS gel electrophoresis were performed. As specific quality parameters, total protein content, secretory immunoglobulin A (SIgA), lysozyme, amylase, sodium, potassium and osmolality were measured using routine laboratory methods. The flow rate of SMG-salivary tears was determined in 5 patients by means of sequential scintillography. RESULTS: The fern pattern of SMG-salivary tears was coarse and thus more similar to normal SMG saliva than tears. SDS gel electrophoresis of the SMG-salivary tears showed albumin and two unidentified proteins in addition to the normal tear pattern. Osmolality and total protein content of SMG-salivary tears were higher than in normal SMG saliva, but still lower than in normal tears. High activities of normal tear antibacterial proteins (SIgA, lysozyme and amylase) were detected in the salivary tears. Stimulation of the secretion did not alter the composition of SMG-salivary tears. The flow rate of SMG-salivary tears was closer to that of normal tears than normal SMG saliva. CONCLUSION: Salivary tears resulting from SMG-transplantation represent condensed SMG saliva. Thus their quality is intermediate between normal tears and normal SMG saliva. High levels of secretory proteins demonstrate that the gland maintains an active function. Surgical denervation and residual tear components from the ocular surface are the most likely factors to cause the complex differences between normal SMG saliva and SMG-salivary tears. The effects of this secretion on the ocular surface are currently being evaluated in a clinical and laboratory study.
Adolescent↗
[Eye involvement in circumscript scleroderma--manifestation of borreliosis?].
BACKGROUND: The circumscript cutaneous sclerosis is an inflammato-edematous erythema of the skin, usually leading to a plaque-like sclerosis and cutaneous atrophy. The etiology of this disease remains unknown, but some authors presume a systemic infection with Borrelia burgdorferi as the underlying pathological condition. PATIENT: We present a case of a 66-year-old male patient who suffered from episcleritis of his left eye. Funduscopy showed an unilateral papillary edema. Visual acuity was 1.0. The patient had multiple erythemata of the skin of the body-trunk and the arms. On histological examination the lesions were compatible with circumscript sclerosis. Neurological examination was normal. Brain imaging (MRI), CSF examination and serology showed no pathological findings, although the patient presented with raised antibodies against Borrelia burgdorferi (IgG positive, IGM negative). Intravenous antibiotic treatment and topical steroids for three weeks resulted in a complete recovery of the scleritis, but had no effect on the papillary edema. CONCLUSION: Inflammatory pathological findings of the eye can be associated with circumscript sclerosis, a disease, that is normally limited to the skin. The pathological mechanism remains unclear. The presumption of an underlying borreliosis could not be confirmed in this case.
Aged↗
[Epidemiology of open globe injuries].
BACKGROUND: Severe open globe injuries are frequent emergencies in an ophthalmologic clinic and required immediate operation. The extent of these injuries is various depending on the mechanism of the injury and involvement of ocular tissue. In many cases a full visual rehabilitation can be achieved but in a lot of cases blindness results. To prevent such severe eye injuries it is important to judge the leading injury mechanisms. For this we collected our data about open globe injuries. PATIENTS AND METHODS: Retrospectively we collected the data from 103 consecutive patients in the year 1996 and 1997, presenting with an open globe eye injury followed by operation. The data contained personal patients data, information about mechanism of injury, visual acuity, operation and rehabilitation. Statistical analysis was performed using binomimal-test and t-test for paired and unpaired samples (p < 0.05). RESULTS: 85.4% were male. Most of the injuries happened at home (38%) and at the working place (31%). Assaultive injuries happened in 6.8%. 35% of all patients were craftmen (mechanics, electricians, or the locksmith were preferred). Pensioners were affected in 14.6% of all cases followed by small children (7.8%) and school children (7.8%). In 50% of all cases metal and glass were responsible for the trauma, explosions were noticed in 8.7%. An intraocular foreign body was found in 37.9%. In 62% of all cases no second operation was necessary. An enucleation during the follow-up was performed in 2 cases. CONCLUSION: At least a third of all severe eye injuries would have been preventable. Concerning the non-preventable injuries accidents at home and in children were predominating. The rate of the open globe injuries was 2.32 in 100.000 people, which is about the same like in US-American studies. Most of the injuries happened at home because of carelessness and would have been avoidable. The rate of injuries at the working place is significantly higher than in the USA but there were significantly more gun-shot-injuries or offensive accidents abroad. The rate of accidents at home and in traffic were the same. We think that public campaigns and prevention strategies can help to reduce the potential risk of severe eye injuries.
Accidents, Home↗
Delayed intraocular lens dislocation after neodymium:YAG capsulotomy.
A poly(methyl methacrylate)(PMMA) intraocular lens (IOL) dislocated into the vitreous cavity in 2 patients after a neodymium:YAG (Nd:YAG) laser posterior capsulotomy. In Case 1, the capsulotomy was performed 19 months after extracapsular cataract extraction (ECCE) and sulcus fixation of an IOL. Six months later the IOL dislocated posteriorly. In Case 2, ECCE with intracapsular IOL implantation was followed 4 years later by an Nd:YAG capsulotomy; 6 months later the IOL dislocated into the vitreous cavity within the intact capsular bag. Different mechanisms were responsible for the dislocation: in case 1, radial tearing of the large capsular defect with IOL loosening and dislocation into the vitreous cavity; in Case 2, zonulysis and IOL dislocation within the intact capsular bag. A neodymium:YAG capsulotomy may cause delayed IOL dislocation into the vitreous cavity.
Aged↗