Biomorphometry of corneal epithelium with slit lamp-adapted optical coherence tomography

Introduction. The purpose of this study was to evaluate the biomorphometry of the corneal epithelium with slitlamp-adapted optical coherence tomography (OCT). Patients and methods. In a clinical study, slitlamp-adapted OCT of the cornea was performed in 15 patients before and immediately after therapeutic corneal abrasion. Central corneal epithelium thickness measurements were compared to the pre- and postoperative central corneal thickness. Results. Preoperatively, the corneal epithelium could be visualised from the highest OCT light reflections at the interfaces air-tear film and epithelium-Bowman's membrane. The preoperative mean geometrical central epithelial thickness determined with OCT ranged from 65±12 μm to 72±14 μm (45–92 μm). The mean difference of the pre-and postoperative central corneal thickness was 48±19 μm (9–79 μm). This resulted in a deviation from the direct epithelial thickness measurements of 26–33%. The reproducibility of the geometrical epithelial thickness was ±9 μm. Conclusions. Slitlamp-adapted OCT enabled a noncontact evaluation of the corneal epithelium. The difference between direct and indirect corneal epithelium thickness measurements could be related to the partial optical inclusion of the precorneal tear film and the Bowman's membrane. With some restrictions the biomorphometry of the corneal epithelium with slitlamp-adapted OCT seems to be a valuable technique to monitor therapeutical and refractive procedures of the cornea.     

Rezidivierende Erosio corneae nach mechanischen Traumata Ergebnisse der transepithelialen phototherapeutischen Keratektomie

Background. Recurrent corneal erosion is a common clinical disorder characterised by repeated spontaneous breakdown of the corneal epithelium. The pathomechanism is due to abnormalities of the adhesion complex between the corneal epithelium and the stroma. In addition to local medical treatment, bandage lenses, debridement and anterior stromal puncture, patients can also be treated by excimer laser phototherapeutic keratectomy. Methods. We present a series of 45 eyes where a transepithelial therapeutic excimer photoablation (t-PTK) was carried out after recurrent erosions caused by mechanical trauma. We used the flying spot excimer laser Technolas 217-C (Bausch&; Lomb Surgical) and the scanning spot laser MEL70 (Aesculap Meditec). Treatment was performed in the relapse-free period. The zone of ablation measured 6–9 mm and the ablation depth10–30 μm. The mean follow-up period was 7 months (range 3–22). Results. After the first t-PTK treatment, 41 eyes remained without a relapse, but 8 patients had persistent symptoms, 4of which had a new epithelial breakdown and in 2 patients a second t-PTK had to be carried out. Conclusions. T-PTK appears to be a safe and effective procedure for treatment of recurrent corneal erosion. However, relative contraindications, such as a previous chemical burn, must be taken into account.     

Lidverletzungen Epidemiologische Aspekte

Purpose. To present epidemiological data on eyelid trauma which appear rarely in the literature. Patients and methods. Medical records of 180 patients given surgical treatment for eyelid injuries at the ophthalmology department of LMU Munich between 1997 and 1999 were evaluated. Clinical findings of eyelids and eyeballs, surgical procedures and complications during wound healing were considered. Results. Out of 180 patients, 140 suffered blunt trauma of which 66 were due to manual work, 38 to sudden falls, 23 to violence, 7 to motor vehicle accidents and 6 to sports. From 26 cutting injuries caused by glass, 12 were caused by broken spectacles, 8 were caused by sudden falls, 4 by violence and only 2 by car accidents. Clinically 85 patients showed injuries of the upper eyelid, 55 of the lower and 40 of both lids. The lid margin was affected in 43 patients and the lacrimal drainage system in 28. Wound contamination occurred in 34 patients, 19 had foreign bodies and 13 loss of tissue. Accompanying injuries of the face was noticed in 16 patients and of the eyeball in 79 patients of which 31 were superficial, 36 were eyeball contusions of varying severity, 12 were perforations or ruptures and 4 patients additionally had orbital bone fractures. The average time from injury to surgery was 3.3 h. A total of 100 patients needed simple skin suturing, 26 sutures to the skin and subcutaneous tissue including the orbicularis and levator muscle, 43 needed readaption of the lid margin and 24 repair of the canalicular system. Post-operatively only one patient developed a necrosis and one an infection. Conclusions. In eyelid trauma, the lid margin is affected in 24% and the lacrimal drainage system in 16% of all injuries. Our data also showed a high association (44%) of eyelid injuries with trauma to the eyeball. This emphasises the necessity for eyelid injuries to be treated primarily by an ophthalmic surgeon, although difficult primary reconstruction and early complications in particular, are relatively rare.     

Automatische kinetische Perimetrie mit unterschiedlichen Prüfgeschwindigkeiten

Introduction. Because kinetic perimetry is performed manually, it is difficult to standardize. This study evaluated the effect of different velocities of various stimuli on the results of automated kinetic perimetry. Materials and methods. Twelve ophthalmologically healthy subjects were tested with stimuli III₄, I₄, I₂, I₁ using the Twinfield perimeter at velocities of 1–7°/s. Results. Results of stimuli III₄ and I₄ were not dependent on velocity. Concerning stimuli I₂ and especially I₁ the isopters were narrower for increasing velocity, and variance in results was greater above 4°/s. Conclusion. The recommended velocity of 2°/s is often exceeded in daily clinical practice, which explains part of the variation in findings between studies. Automated kinetic perimetry could ensure a constant, slower velocity and thus improve standarization.     

Fundamentals of wavefront-guided refractive corneal surgery

The clinical introduction of aberration-sensing and wavefront-guided refractive surgery opens new ways in diagnostic and therapy of high order optical aberrations of the human eye. The main application is the optimization of current treatment methods such as LASIK or PRK. The aim of wavefront-guided treatments is to omit the detoriation of the optical performance under mesopic conditions of the eye by the refractive treatment and, if possible, to increase contrast sensitivity by correcting the higher order aberrations. First clinical trails on wavefront-guided corneal laser surgery demonstrate the possibility of improving the optical quality of the eye by LASIK or PRK and to correct irregular astigmatism.     

Behçet's disease: diagnostic and prognostic aspects of neurological involvement

This study was conducted to describe clinical and prognostic aspects of neurological involvement in Behçet's disease (BD). Patients referred for neurological evaluation fulfilled the criteria of the International Study Group for Behçet's Disease. We analyzed disability and survival by the Kaplan-Meier method, using Kurtzke's Extended Disability Status Scale (modified for BD) and the prognostic effect of demographic and clinical factors by Cox regression analysis. We studied 164 patients; of the 107 diagnostic neuroimaging studies: 72.1% showed parenchymal involvement, 11.7% venous sinus thrombosis (VST) and the others were normal. CSF studies were performed in 47 patients; all with inflammatory CSF findings (n=18) had parenchymal involvement. An isolated increase in pressure was compatible with either VST or normal imaging. The final diagnoses were VST (12.2%), neuro-Behçet's syndrome (NBS) (75.6%), isolated optic neuritis (0.6%), psycho-Behçet's syndrome (0.6%), and indefinite (11%). VST and NBS were never diagnosed together. Ten years from onset of BD 45.1% (all NBS) reached a disability level of EDSS 6 or higher, and 95.7±2.1% of the patients were still alive. Having accompanying cerebellar symptoms at onset or a progressive course is unfavorable. Onset with headache or a diagnosis of VST is favorable. Two major neurological diagnoses in BD are NBS and VST. These are distinct in clinical, radiological, and prognostic aspects, hence suggesting a difference in pathogenesis.     

Neurological complications of primary Sjögren's syndrome

Objective: To better delineate the spectrum of neurological complications of primary Sjögren's syndrome (PSS). Methods: A detailed neurological investigation was prospectively performed in a group of 25 consecutive patients with PSS followed in an internal medicine department between June 1996 and December 1997 (Internal Medicine group). In addition, eleven patients with neurological complications of PSS were identified in the Neurological Department of the same institution during the same period (Neurological group). Results: In the Internal Medicine group, neurological complications were discovered in 10/25 (40 %) patients. Peripheral nervous system involvement was present in 4/25 patients from the Internal Medicine group and in 10/11 patients from the Neurological group and consisted mainly of axonal sensorimotor/sensory polyneuropathy. A motor neuron syndrome was identified in two patients. CNS involvement occurred in 7/25 patients from the Internal Medicine group and in 4/11 patients from the Neurological group. Three patients had spinal cord involvement. Cognitive dysfunction was the most frequent finding (5/25 in the Internal Medicine group, 3/11 in the Neurological group) characterized either by subcortical or corticosubcortical dysfunction. Cognitive impairment was not attributed to mood disturbance and was not associated with specific laboratory or radiological abnormalities. Conclusion: Neurological complications of PSS are frequent since they were present in 40 % (10/25) of patients in a consecutive series of patients from a department of Internal Medicine. Although PNS involvement predominates, complications of PSS affecting the brain or spinal cord are not rare, with subcortical dysfunction as the main finding.     

Anpressdruck eines zirkulären Fertigverbandes im Vergleich zu phlebologischen Kompressionsverbänden

BACKGROUND AND OBJECTIVE: The aim of this study was to measure the pressure exerted by a tubular bandaging material developed for the treatment of leg ulcers in vivo in healthy volunteers and to compare the measured values with the pressure exerted by short- or long-stretch medical compression bandages. PATIENTS/METHODS: This was an open, randomized, prospective study on 15 volunteers with healthy veins. Both static pressure and dynamic pressure fluctuations during exercise (10 toe stands) were measured. All volunteers wore tubular bandage on one leg and on the other leg in random order short- or long-stretch medical compression bandages. RESULTS: The tubular bandaging material produced a more steady pressure over the 8 hours of usage than both the short- and long-stretch bandages. The test subjects found the tubular bandage more comfortable. CONCLUSIONS: The pressure exerted by the different bandaging materials varied with the experience of the bandager and the material used. The tubular bandage maintains a therapeutically beneficial pressure profile throughout the day and provide the conditions necessary for the reliable prevention of edema, thus promising to be effective in the treatment of venous ulcers.     

The vacuum sealing technique. A new procedure to cover soft tissue defects after resection of leiomyosarcoma

The vacuum sealing technique is a new, simple to use procedure for traumatic and chronic soft tissue defects, burns and soft tissue infections. We used this technique for the first time for temporary closure after the resection of deep infiltrating leiomyosarcoma. Radical excision of the tumor with partial resection of the forearm flexor muscles and safety margin of 3 cm led to a large skin defect (12×16 cm). For temporary closure of this defect we used the vacuum sealing technique for 7 days. Because of histologically proven incomplete resection of the tumor, we did a second excision and used the vaccum sealing technique a second time for 7 days. After this time period the granulation of the wound ground was excellent, and we closed the defect by split skin transplantation from the thigh. Bacterial infection or other complications were not seen during use of vacuum sealing technique. The vacuum sealing technique induced optimal local conditions for skin grafting: it facilated granulation tissue production and maintained a clean wound bed without the necessity of changing wound dressing before skin grafting. This technique is painless and does not impair mobility.     

Kutane Manifestation der Zystizerkose

Cysticercosis, an infection with the larva of Taenia solium, is caused by the accidental ingestion of the parasite's eggs. In many countries of the Third World, cysticercosis, and especially neurocysticercosis, is a widespread problem. A patient from Northern Malawi presented not only with cysticercosis but also with BT leprosy and pityriasis versicolor. Dermatologists should be familiar with the clinical picture of cysticercosis in order to make an early diagnosis in patients from at-risk areas.