Abstract: Indications, results and complications in 90 consecutive cases of intravitreal silicon injection are reported. Intravitreal silicon injection was performed according to the principles described by J. Scott. The patients, mostly cases which were inoperable with standard techniques, underwent surgery in the period between the beginning of 1978 and the end of 1979. The follow-up period was between five months and two years. An anatomic success was achieved in about 70% of the cases. The intraoperative complications were mostly hemorrhages and new retinal tears. Most of the late complications, such as cataract and glaucoma, could be surgically treated. The advantages and disadvantages of this procedure are discussed.

Abstract: Persisting hypotony in 8 eyes due to traumatic cyclodialysis extending from 75 degree - 240 degree was cured by a modified technique of "direct cyclopexy". Our approach consists of the following elements: 1.4 mm lamella limbal based scleral window in the area of the cyclodialysis. 2. Incision of the basal scleral lamella directly behind and parallel to the scleral spur. 3. Bipolar cautery of the ciliary muscle. 4. Under direct visual control, suture of the insertion of the ciliary muscle to the scleral spur with 10/0 nylon. In all cases intraocular pressure was normalized, no anterior synechiae and no secondary glaucoma ensued. Postoperative tonographic C-values were below the upper normal limit. The degree of functional improvement depends on the duration of hypotony and other contusional changes. Early "direct cyclopexy" is recommended.

Abstract: Long-term regulation of IOP after trephining procedures was studied in 65 eyes with regard to the anatomical localization of the trephine hole. The observation period ranged between six and 39 months. The anatomical localization had no statistically significant influence on long-term pressure regulation after surgery, nor on the immediate postoperative situation. It was clinically impossible to localize the trephine within the trabecular area including Schlemm's canal with a high degree of accuracy. The use of larger-diameter trephines did not increase the probability of striking Schlemm's canal. With larger-diameter trephines the immediate effect on IOP was more pronounced, but the long-term IOP response was poorer. The absence of a filtering bleb or the development of a large filtering bleb was significantly more often associated with poor regulation of IOP in the long term. Where the trephine was positioned closer to the sclera, the incidence of choroidal detachment was higher. The diameter of the trephine had no effect on the occurrence of postoperatively flat chambers or choroidal detachments. Nor did the anatomical localization influence the incidence of postoperatively flat chambers.

Abstract: The "Fadenoperation" creates an artificial paresis, the effect of which increases in the field of action of the muscle operated upon. The postoperative effect on eye position and motility was studied in order to find the typical curve of influence upon the angle in different directions of gaze. In esotropia a fixation of the medial rectus muscle 13 mm behind its insertion will create an average angle reduction of 4 degrees in the primary position of gaze and 12 degrees (9 degrees long-term) in lateral gaze with the operated eye adducted. - Fadenoperations cause a reduction of (overacting) convergence (non-accomodative), adduction, and changing angle. The paper deals with the majority of patients who show overacting convergence and changing angles but lack an increasing angle in version movements. This means that in lateral gaze overcorrection may occur: From the curve of angle reduction the surgeon can derive a slight exponential decrease of each of the three partial functions. Fadenoperation, therefore, will suit well in patients showing overactions of all three components, but will bring "side effects" in cases which lack one or two of these dysfunctions. Bilateral Fadenoperations produce a minor incomitance pattern.

Abstract: In three patients with endocrine orbitopathy and motility disturbances the affected extraocular muscles were recessed under topical anesthesia, taking the degree of active motility, which was checked intraoperatively, into account. The advantages of the use of topical anesthesia in patients suffering from endocrine orbitopathy are discussed.

Abstract: A report on 70 cases of retraction syndrome (Stilling-Turk-Duane). The patients presented with typical symptoms: severe limitation of abduction, slight limitation of adduction and convergence, which is always accompanied by retraction of the globe, narrowing of the palpebral fissure, vertical deviation and elevated intraocular pressure, and a remarkable motility of the globe in the orbital axis. All symptoms are explicable by fibrosis or coinnervation of the lateral rectus muscle. Usually, single binocular vision is present with or without a forced attitude of the head. This forced attitude is such that the affected eye utilizes the reduced abduction fully and does not avoid the abduction (as in typical abducens-paresis), but retraction. In cases of single binocular vision, surgery is indicated only when the forced attitude of the head is intolerable. We restrict surgery to recession of horizontal rectus muscles according to the forced attitude.

Abstract: A living mature eye fluke of the genus Philophthalmus was removed from under the conjunctiva of a man from the north of Sri Lanka. This is the third report on infection of a human by Philophthalmus sp., the second with subconjunctival infection by cercaria is discussed.

Abstract: The authors investigated the wound closure of conjunctival wounds with fibrin adhesive as compared to a suture technique in rabbits. Similarly, the fixation of a transplant of lyophilized dura mater on the sclera by fibrin adhesive was also compared with a suture technique. Both clinically and histologically, there were only negligible differences in wound healing in the two series. In particular, no toxic reaction caused by the adhesive substance was observed. To avoid failures in wound closure with the investigated tissue adhesive there must be no tension at the edges of the wound.

Abstract: The authors report on two siblings with severe malformations of the eyes. The 16-year-old girl has bilateral microphthalmus with aplasia of the right optic nerve and a Dandy-Walker cyst of the cerebellum. The right eye has no optic disk or retinal vessels. Her 13-year-old brother has unilateral aplasia of the optic nerve with cryptophthalmus and contralateral microphthalmus. In a computer tomography examination no optic nerve could be demonstrated on the left. The presence of an oculocerebral dysplasia in a brother and sister with healthy parents suggest an autosomal-recessive mode of inheritance of the aplasia of the optic nerve with microphthalmus and/or cryptophthalmus.

Abstract: Segmentale ischamische Infarkte von Uvea und Retina wurden nach Injektion von kristallinem Cortison in keloidale Narben der gleichseitigen Stirnhaut beobachtet. Sieben gleichartige Falle aus der neueren Literatur - ebenfalls uberwiegend durch kristalline Kortikosteroide - und mehrere aus dem Anfang des Jahrhunderts - durch Paraffin - werden angefuhrt. Als morphologische Grundlage fur diese seltene, aber typische Komplikation ist die Funktion der A. ophthalmica als Brukkenarterie zwischen extra- und intrakraniellem Kreislauf anzusehen. Jede Druckerhohung in Asten der A. carotis externa - etwa bei Injektionen peribulbar oder im Gesicht - bewirkt eine Stromungsumkehr und kann bei Injektion embolisierend wirkenden Materials zu ischamischen Infarkten in Auge und Orbita fuhren. Segmental ischemic infarctions in the uvea and retina were seen following injections of crystalline cortisone into keloids in the ipsilateral forehead skin. Seven similar cases described in the recent literature - also mainly due to crystalline corticosteroids - and several cases due to paraffin treatment, dating from the early years of this century, are discussed. The morphological basis of this rare, though typical, complication is the function of the ophthalmic artery as a bridging artery between the extracranial and intracranial circulation. An increase in pressure in branches of the external carotid artery - caused, for example, by peribulbar or facial injections - results in a reversal of flow and can lead to ischemic infarctions in the eye and orbit if embolizing substances are injected.

Abstract: Now that a clinically suitable viscous substance (Healon) has become available for use in ophthalmic surgery, it is worthwhile to examine in greater depth the problems of tactility and methods of resolving them with viscous substances. These are not simple substitutes for aqueous humor which, once introduced, may be left in the eye. It is more appropriate to compare them with mechanical instruments employed for a specific purpose and subsequently removed. Thanks to their stabilizing effect, viscous substances increase safety in many types of manipulation. However, their use calls for a thorough knowledge of their side-effects. This has to be learned, as is the case with any new instrument.

Abstract: Intermittent divergent strabismus represents an entity in terms of motoric characteristics rather than in its sensorial basis. Separate investigations were carried out in two clinics on 156 patients. The results were evaluated together, the authors discussing each case. Only in 27 cases was the condition cured. The main group comprised 78 patients with subnormal binocular vision based on facultative microexotropia and instable/normal correspondence. Basic microexotropia with obligate ARC was found in 51 cases, i.e., more often than expected. Testing the stereo threshold proved to an inadequate criterion for cure.

Abstract: Within the past five years we have performed excision of one quadrant of the ciliary body (pars plicata) (e.c.b.) in 22 eyes with secondary narrow-angle glaucoma. Prior to e.c.b. numerous surgical procedures for glaucoma had been attempted. Sixteen of the eyes were aphakic, six phakic. In nine eyes secondary angle closure was due to rubeosis iridis. The observation period following e.c.b. averaged 27.4 months. The preoperative tensions ranged between 40 and 50 mmHg. In 12 out of 22 eyes e.c.b. alone was sufficient to lower the intraocular pressure permanently; in seven cases local therapy (Timolol, Eppystabil) and/or oral Diamox respectively had to be added. Two eyes became atrophic and blind between one and 1.5 years following e.c.b.

Abstract: One hundred and forth-three patients suffering from infantile strabismus, who had undergone surgery on the horizontal eye muscles between the ages of 0 and 6 years were re-examined with the aim of establishing a correlation between the date of operation and functional healing (binocular single vision in space). In 89 patients (62%) a cosmetically satisfactory result (alignment) was achieved. The number of operations and functional healing (binocular single vision in space). In 89 patients (62%) a cosmetically satisfactory result (alignment) was achieved. The number of operations needed decreased with increasing age. Of the 89 patients with alignment, 61 (69%) were found to have binocular single vision in space, while 13 (15%) patients presented with stereopsis. Impairment of functional results was found to correlate with higher age at the first operation or on the date when alignment was reached for the first time, respectively. In cases with amblyopia or vertical divergences which had received insufficient postoperative treatment, attainment of binocular single vision or, respectively, the stability thereof was impaired. Therefore, with respect to functional healing, early surgical correction of strabismus is only recommended if adequate postoperative conservative and/or surgical after-treatment is assured. The postulate that successful functional healing can only be achieved by operations up to the second year (early surgery) is not supported by our data.

Abstract: Our of 688 eyes with perforating injuries in 16 cases (2.33%) which were operated on in the years 1973 to 1979, a serious intraocular infection occurred. In 8.94% of the cases in which there were foreign bodies, and in 0.88% of the remaining cases, without intraocular foreign bodies, infection also occurred, although antibiotics were administered prophylactically. With intensive combined antibiotic therapy, and by performing vitrectomy as early as possible it is sometimes possible to save the bulb, and in some cases useful residual function can be achieved. The success of early results of vitrectomy in endophthalmitis recorded in the literature to date could not be obtained as late results in our cases.

Abstract: The authors report on the results of cyclocryotherapy of the ciliary body applied in 79 eyes with secondary glaucoma of various etiology. In 40% of the cases regulation of intraocular pressure and freedom from pain were achieved during an eleven-month follow-up. The results were remarkably favorable in cases of neovascular glaucoma (regulation of IOP in 50%) and secondary glaucoma following iridocyclitis and intraocular hemorrhages, which usually have a very poor prognosis.

Abstract: The technique of operations on rectus muscles is usually easy but indication is sometimes difficult and uncertain. These operations should bear repeating and therefore an appropriate technique should be used. The wide variety of results is considered in the hight of the author's own case material. Not only the extent of squint deviation, refraction but also sensory status, age, etc. play a role in selecting the aim, tuning and extent of the operation. Besides simple standard operations, special techniques such as "faden operation", "anse", etc., are discussed.

Abstract: From an original group of 36 Patients (15 with relatively advanced chronic open-angle glaucoma and 21 with ocular hypertension) 21 (seven glucoma and 14 ocular hypertension) were well controlled with Timolol alone or in combination with other pressure-lowering drugs after a three years' observation period. Dropouts occurred mainly in the first half of the treatment period. In most of these cases a glaucoma operation was necessary; more rarely, Timolol was discontinued due to intolerance. The overall success rate of 40% with Timolol alone (14 out of 36 patients) is lower than the 60% to 70% found in other long-term studies. If one considers only the results in the ocular hypertension group, the figure of 68% is more in line with the aforementioned results. In the light of similar studies it appears essential to take into account not only the total number of patients treated but also the degree of severity of the glaucoma. In severe glaucoma Timolol alone is seldom effective enough.

Abstract: In the introduction, the principles and limitations of modern glaucoma surgery are described. There then follow some personal observations on the history of goniotrepanation, from which it is evident that the scleral flap is not the invention of any single surgeon, but rather the result of experiments by several. The importance of the scleral flap was proved by the almost simultaneous appearance of trabeculectomy and goniotrepanation and, some time later, of Schleie's covered fistulizing operation. The technical details of goniotrepanation and the features peculiar to this procedure are then described. It follows from this description that goniotrepanation is a microsurgical procedure demanding skill and experience on the part of the surgeon. Comparative studies of goniotrepanation in the literature are then discussed in detail. These are concerned with postoperative findings, pressure regulation, morphological changes at the site of the operation and the effect on visual function. The advantages of goniotrepanation and the function of the parathalamus, which represents a new drainage path for the aqueous, are then described. The procedure creates a normal balance between the quantity of aqueous produced and its drainage to the exterior, resulting in a normalization of intraocular pressure. This drain does not lead directly to the subconjunctival space, but indirectly, via normal pathways, through the parathalamus formed by the flap. The creation of the parathalamus can be useful in glaucoma surgery; it offers advantages as regards both indication and surgical technique.

Abstract: The ultrasonographic findings in 39 cases of malignant melanoma of the choroid has been correlated with histopathological results. Tumors with hemorrhages and/or necrosis showed a lower reflectivity than those with a higher amount of connection tissue. B-scan ultrasonography was found to be reliable for the measurement of the extent of the tumor in all three dimensions.

Abstract: A 50-year-old woman presented with a tumorlike growth of the tarsal conjunctiva of the left upper lid. The historical examination revealed an amyloid tumor. It was possible to remove most of the tumor surgically. The resection was followed by almost complete regression of the remnants.

Abstract: During the past five years a presumptive diagnosis of ocular chlamydial disease has been made in 90 patients consulting the outpatient department of Freiburg University Eye Clinic. The diagnosis was confirmed by different methods (giemsa stains, chlamydia cultures and serology, electron microscopy and histology) in 27 cases. The clinical spectrum included inclusion blennorrhea in newborns as well as inclusion conjunctivitis, TRIC keratoconjunctivitis and sporadic trachoma in adults. Presumably the incidence of the disease is much higher than indicated by our figures. We suspect a very high number of undiagnosed cases. These patients usually do not receive proper therapy (tetracyclin or erythromycin for at least three weeks) and their disease may run a protracted course with the risk of permanent eye damage.

Abstract: From 1964 to 1980, 255 patients suffering from choroidal melanoma underwent a primary eye-preserving procedure. Of these, 205 were irradiated with 106Ru/106Rh beta-ray applicators (dose: 80-100 Gy at the summit of the tumor within 14 days). In 132 cases (64.4%) this treatment was successfully within a follow-up period of 5.4 years: 60 patients (45.5%) developed a flat scar, 34 (25.8%) retained a visual acuity of 1.5 to 0.5. Thirty-six eyes had to be enucleated after radiotherapy. Thirty-seven patients died, 21 of them from metastases. The survival rate, 85.1% after five years and 71.9% after ten years, is significantly higher than that of patients whose eyes were enucleated as a primary procedure. Fifty patients suffering from melanoma of the anterior uveal tract were treated with the following surgical procedures: iridocyclectomy in 42 cases, iridectomy in three cases and choroidectomy also in three cases. Twenty patients retained a visual acuity of 1.5 to 0.8 during the average follow-up period of 7.5 years. In 11 patients the eye had to be enucleated later. Four patients died from metastases. The survival rate of this group with local tumor excision was 96% during the follow-up period.

Abstract: Report on a patient suffering from keratosis follicularis spinulosa decalvans (Siemens I syndrome). This ia a very rare clinical picture, at least in its complete form. The patient's father and brother are suffering from an abortive Siemens I syndrome. The condition is a form of hereditary parakeratosis, a spinulose keratosis with typical localization in the eyes and on the skin. Causal therapy is not possible; attempts at conservative and surgical treatment are described. Prognostically, the condition will probably come to a standstill at puberty. The description of this case is intended to illustrate the necessity of close cooperation between dermatologist and ophthalmologist.

Abstract: Bei 20 Patienten mit fruhkindlichem Begleitschielen und einer Horizontalabweichung zwischen 10 und 30 Grad (13 konvergent, 7 divergent) wurde mit Schweiftestglasern nach Arealen mit binokularem Simultansehen auf dem Boden einer harmonisch anomalen Korrespondenz gesucht. - Ein derartiger Bereich konnte bei 18 Patienten in einer Zone zwischen den Gesichtsfeldzentren beider Augen ermittelt werden. Die Befunde lassen vermuten, dass die harmonisch anomale Korrespondenz nur dort ein anomales Binokularsehen erlaubt, wo abbildungsgleiche Netzhautstellen keine wesentliche Funktionsunterschiede aufweisen. In allen anderen Bereichen dient sie im Interesse einer optimalen Detailerkennbarkeit der Hemmung des jeweils peripherer gelegenen Netzhautortes. Twenty patients with concomitant strabismus, ARC and a horizontal deviation of between 10 and 30 degrees (13 convergent, seven divergent) were examined with striated glasses to determine areas of anomalous simultaneous binocular vision. Such an area was found in a zone between the visual field centers of the two eyes in 18 cases. On the basis of these findings the authors suspect that harmonious ARC permits anomalous binocular vision only in field areas where retinal points with identical images have no significant difference in function. In the other areas of the binocular visual field, ARC provides for optimal perception of detail by suppression of the more peripherally situated retinal points.

Abstract: In a 16-year-old boy with congenital bilateral paralysis of the sixth cranial nerve and unilateral paralysis of the seventh nerve (on the right) heterochromia of the right eye was observed, characterized by a lighter color of the iris, precipitates on Descemet's membrane and absence of synechiae. The development of Fuch's heterochromic cyclitis in combination with Moebius' syndrome is discussed in connection with possible pathogenic factors, in particular immunopathologic processes which may contribute to an understanding of the origin and progression of the disease.