Hygiene von Phakoemulsifikations- und Vitrektomiegeräten Kontaminierung und Bewertung

BACKGROUND: Contamination of automated surgical equipment is widely disregarded as a potential source of perioperative infection. We investigated the possibility of contamination of the aspiration fluid by the vacuum control manifold (VCM). The normal, unsterile internal VCM was compared with a modified external VCM that was regularly disinfected. MATERIALS AND METHODS: We investigated 37 aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. There were 25 specimens from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 specimens from one system equipped with a modified external VCM (control group). No hygiene procedures were used with the hidden internal VCM, but the modified external VCM was regularly rinsed and filled with 70% isopropanol overnight. Specimens were collected under sterile conditions, centrifuged, cultured for bacterial growth on blood agar and MacConkey agar for 24-48 h at 37 degrees C, and analyzed microbiologically. RESULTS: Aspiration fluids of irrigation/aspiration systems used for intraocular surgery were found to be severely contaminated with bacteria originating from the VCM. In all aspiration fluid specimens from internal VCM systems, 2(+)-4+ bacterial growth was found. Stenotrophomonas maltophilia (17), Comamonas acidovorans (8), and Agrobacterium radiobacter (13) were found most frequently. All specimens from the modified external VCM system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between experimental and control groups (P = 0.0001, chi 2). CONCLUSIONS: We found that the aspiration fluid of common phaco- and vitrectomy systems was strongly contaminated by bacteria originating from the internal VCM. The technical modification of an external VCM allows easy disinfection and prevents contamination of the aspiration fluid.     

Differentialdiagnostische und therapeutische Erwägungen bei Pupillotonie und Adie-Syndrom

Zusammenfassung An Hand von 33 Pupillotoniefällen, bei denen die Augensymptome Teil eines Adie-Syndroms sind, wird die Differentialdiagnose gegenüber der Lues des Zentralnervensystems ausführlich behandelt. Von den diagnostischen Maßnahmen wird der Cocain-Pilocarpin-Versuch hervorgehoben und statistischer Berechnung unterzogen. Nach Vorgeschichte und Klinik werden Fälle von Adie-Syndrom ohne nachweisbare Ursache von denen symptomatischer Art (nach Encephalitis, Trauma, Mangelkrankheiten, bei Hirnarteriosklerose, Encephalopathia hypertonica u. a.) unterschieden. Da bei der Pupillotonie bzw. beim Adie-Syndrom die Zeichen vegetativer Dysregulation vorherrschend sind, wird in übereinstimmung mit anderen Autoren als Sitz der Läsion das Hypothalamusgebiet mit dem subcorticalen vegetativen Zentrum angenommen. Abschließend werden therapeutische Erwägungen dargelegt, die symptomatischer Art sind und sich auf die tonische Akkommodationsstörung konzentrieren, weil sie die Patienten am stärksten behindert.Auszugsweise vorgetragen auf der Tagung über Oto-Neuro-Ophthalmologie vom 11.–13. 10. 62 in Dresden.     

Stäbchen- und Zapfenwirkung von Fischhypophysen-Implantationen bei Retinitis pigmentosa und Maculadegenerationen

Zusammenfassung Durch Fischhypophysen-Implantationen konnte bei Retinitis pigmentosa-Fällen die Dunkeladaptation, bei Maculadegenerationen die Funktion der Netzhautmitte bedeutend verbessert werden. Die auf die Stäbchen und Zapfen ausgeübte Wirkung wird mit einer Sehstoff-Neogenese fördernder Wirkung melanocytenaktiver Stoffe erklärt.Mit 3 Textabbildungen     

Differenz und Entfernung zwischen zentraler und dünnster Stelle der Hornhaut

Background

The aim of the study was to quantify the difference in corneal thickness between the central and thinnest points (?Pachy_Z-Pachy_D), the distance between the center of the cornea and its thinnest point (vector length_PachyD) and to explore the impact of refractive state, age and ocular side.

Patients and methods

This was a multicenter, retrospective, cross-sectional study and medical records of 16,872 eyes were reviewed. The Orbscan® (Bausch and Lomb) procedure was used for pachymetry and keratometry.

Results

The results showed that ?Pachy_Z-Pachy_D and vector length_PachyD were higher in hyperopic eyes (?Pachy_Z-Pachy_D: 11.99?±?12.08 µm, vector length_PachyD: 0.85?±?0.44 mm) compared to myopic eyes (?Pachy_Z-Pachy_D: 9.2?±?7.86 µm, vector length_PachyD: 0.7?±?0.37 mm; p?<?0.001). Refractive state, age and ocular side demonstrated an independent, statistically significant impact on ?Pachy_Z-Pachy_D and vector length_PachyD.

Conclusions

As a result of the significant impact of refractive state, age and ocular side on ?Pachy_Z-Pachy_D and vector length_PachyD, these variables should be considered in a normative data collection.     

Augeninnendruck während und nach dem Spielen von Hoch- und Niedrigwiderstandblasinstrumenten

Background

A Valsalva maneuver was performed while playing wind instruments during which the intraocular pressure (IOP) increased.

Methods

IOP was assessed by a rebound tonometer while playing 32 high and low resistance wind instruments in a sitting position. The measurements were obtained during normal and laboured playing sequences as well as after cessation.

Results

The highest increase in IOP of 9.2 mmHg (p<0.001) could be observed during laboured playing of high resistance wind instruments. Additionally a negative correlation was detected between the level of the IOP increase and the relative decrease towards the initial value after performance.

Conclusion

IOP changes found in particular during laboured playing with high resistance wind instruments could be a risk factor for glaucomatous optic nerve damage.     

Retinale Nervenfaser schichtdicke und peripapillärer Blutfluss bei Glaukompatienten und Gesunden

BACKGROUND: In progressive glaucoma there is increasing loss of retinal nerve fibers and therefore decreasing nerve fiber layer thickness. As measurements of capillary blood flow have been reported to depend on nerve fiber layer thickness, this could result in incorrectly high blood flow measurements in patients with advanced glaucoma. METHODS: In 33 healthy controls and 59 glaucoma patients we measured retinal nerve fiber layer thickness by laser polarimetry and relative capillary blood flow by scanning laser doppler flowmetry three times on the nasal and temporal peripapillary retina. For statistical analysis a regression analysis was used. RESULTS: The correlation coefficients for volume, velocity, and flow with nerve fiber layer thickness at the same location were 0.02/-0.03/-0.02 in the temporal retina and -0.22/-0.07/-0.19 in the nasal retina (all correlations nonsignificant). CONCLUSION: No correlation was found between nerve fiber layer thickness and capillary blood flow. Measurement of capillary blood flow in glaucoma patients thus does not appear to be affected by decreasing nerve fiber layer thickness.     

Untersuchungen über Adsorption und Haftfestigkeit der Mydriatica und Miotica im Modellversuch

Ohne ZusammenfassungMit 4 Textabbildungen.     

Risikofaktorenanalyse und Therapievergleich zwischen Heparin und Hämodilution bei Zentralarterienverschluss des Auges

No standards are available for the treatment of central retinal artery occlusion (CRAO). The aim of this study was to compare data about visual acuity development under heparin treatment with those from hemodilution. Data on 139 patients suffering from CRAO between 1991 and 2000 were examined retrospectively. Risk factors were listed. Therapies were compared in 38 of these patients, 23 of whom received full heparinization and 15 of whom received hemodilution. Many risk factors were shown. Neither therapy showed serious complications. Visual acuity improved significantly, by three or more lines, in five of 23 patients (21.7%) under full heparinization and six of 15 patients (40%) receiving hemodilution. Differences were not significant. For ethical reasons, the normal cause of disease in these patients cannot be studied and is still unknown. Because of many vascular risk factors, we recommend adapted therapies. Treatments should be examined in controlled studies.     

Ischämie und Hypoxie

In hypoxic or ischemic states, the receptors of the ganglion cells are overstimulated by release of neurotransmitters. Glutamate and GABA (gamma-aminobutyric acid) are the decisive neurotransmitters in the retina. It is presumed that the extent of cell death depends on the degree of depolarization, which in turn is determined by the amount of excitatory (glutamate) or inhibitory (GABA) receptors of the corresponding ganglion cell.The assumption is that the receptor profile of the individual ganglion cells determines the sensitivity of these cells to hypoxia or ischemia, i.e., the time up to cell death, and thus represents the underlying cause of the different rates of cell death in primary chronic open-angle glaucoma.Research on this receptor profile could be of pivotal importance for the approach to neuroprotective treatment of primary chronic open-angle glaucoma.     

Hornhautinfiltrate und Hornhautgeschwüre

ZusammenfassungHintergrund Wir bemerkten in den letzten Jahren vor allem bei jungen Kontaktlinsenträgern eine Zunahme von Hornhautinfiltraten und -geschwüren. Das veranlasste uns, das Patientengut mit Keratitis speziell auf Erkrankungsursachen zu untersuchen.Patienten und Methode Von Januar 1999 bis August 2000 wurden die Befunde von 210 konsekutiven Patienten (239 Augen) retrospektiv erfasst. Speziell ausgewertet wurden: Anteil der kontaktlinsentragenden Patienten, Patientenalter, Lokalisation und Zahl der Infiltrate, Art des Erregers sowie entstandene Dauerschäden durch Narbenbildung.Ergebnisse Bei 134 (56%) von 239 Augen mit Keratitis wurden Kontaktlinsen als Sehhilfe benutzt, davon bei 127 (53%) weiche. Das Alter betrug bei diesen Patienten durchschnittlich 28,2 Jahre (±13,0 Jahre), die anderen Patienten waren deutlich älter(46,0 Jahre ±22,5 Jahre). Insgesamt lagen bei 71% (170 Augen) zentrale solitäre Infiltrate vor, bei 19% (45 Augen) multiple Randinfiltrate und bei 10% (24 Augen) Hornhautulzera. Ein Erregernachweis gelang bei 33% (78 Augen), wobei der am häufigsten nachgewiesene Keim bei nicht kontaktlinseninduzierten Keratitiden Staphylococcus aureus (22 Augen) war. Bei den Augen mit weichen Kontaktlinsen wurden vorwiegend gramnegative Erreger wie Serratia spp. (7 Augen), Pseudomonas spp. (6 Augen), Stenotrophomonas maltophilia (6 Augen) und Klebsiella oxytoca (5 Augen) isoliert. 20% (26 von 127 Augen) der durch weiche Kontaktlinsen bedingten Keratitiden behielten eine Hornhautnarbe.Schlussfolgerung Unsere Analyse zeigt, dass in unserem Patientengut der Großteil der Keratitiden durch das Tragen von weichen Kontaktlinsen verursacht wurde. Ein Fünftel dieser im Vergleich zum gesamten untersuchten Patientengut jüngeren Patienten behielt eine Hornhautnarbe. Das Risiko, eine Keratitis zu entwickeln, ist somit bei weichen Kontaklinsen erhöht. Dies sollte im Hinblick auf Patientenaufklärung und Handhabung von weichen Kontaktlinsen berücksichtigt werden.     

Papillenschwellung und Makulaödem

Ohne Zusammenfassung

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Papillary swelling and macular edemaA 13-year-old boy with reduced right-sided vision and visual field deficits

     

Empfehlungen zur Akutbehandlung von Ver?tzungen und Verbrennungen der Augen und Lider

With these recommendations the authors want to improve the acute therapy of eye burns based on the literature and clinical experience. Due to the lack of studies with high evidential value we base these recommendations on the results of experimental work and reports of successfully treated eye burns. A development of this document by systematic research is necessary. Despite the limited knowledge, the collated facts are the current state of the art of treatment according to the knowledge and research of the authors. The most important clinical recommendation is to rinse a chemically or thermally burnt eye as soon and as extensively as possible. Any delay worsens the prognosis. Substances on the market for first aid have different levels of clinical evidence. Thus saline and amphoteric diphoterine have been evaluated in a prospective clinical study showing an advantage for the amphoter. Water, borate buffer, phosphate buffers and derivatives have never been proven to work in clinical applications. Nevertheless, they are recommended. Within experimental work in vitro we could show the value of polyvalent decontamination. Side-effects of phosphate buffers have been demonstrated in retrospective clinical and prospective experimental studies so that even in cases of beneficial effects on pH we cannot recommend these substances which propagate corneal calcification. Special types of burns, such as hydrofluoric acid need special treatment but as clinical studies are lacking only experimental data can offer suitable recommendations.     

Augenirritation und Augenver?tzung

Chemical burns of the eye are becoming rare due to improvements in occupational protection. Effective decontamination is the foundation for good clinical results of this ophthalmological emergency. The toxicological aspect focuses on classifying the specific toxicity of a chemical substance by evaluating the degree of eye irritation and eye burns. Chemical substances are classified into defined risk levels by specific tests. The traditional ophthalmological approach is based on the clinical presentation of eye burns as a result of contact with a specific toxic substance. In an integral approach it is shown that substance-specific characteristics, such as concentration and specific reactivity as well as individual features, such as mode and duration of exposition have an influence on the clinical appearance of the tissue damage. The decontamination is dependent on the mode of action and the effectiveness of the decontamination solution. Amphoteric substances have the best effectiveness for decontamination of the eye due to their specific characteristics.     

Muskelsensibilität und Fixation

Zusammenfassung Mit einer modifizierten Methode nachMarx (1913) werden die Abweichbewegungen des fixierenden Auges im Dunkeln bei der Primärstellung, bei 30° Abduktion und 30° Adduktion mit Hilfe von Nachbildern gemessen. Nach retrobulbärer Anaesthesie sind diese Abweichbewegungen signifikant größer. Die Ergebnisse sprechen für den Einfluß der Muskelsensibilität auf die Abweichbewegungen des Auges bei der Dunkelfixation.Mit 2 Textabbildungen     

Das Elektroretinogramm und das Elektrocorticogramm des Kaninchens bei Hypoglykämie und Anoxie

Ohne ZusammenfassungMit 6 Textabbildungen