First results of myopia correction with intracorneal ring segments (ICRS)

PROBLEM: The Implantation of intracorneal ring segments (ICRS) offers the possibility of reversible, refractive surgery for correction of lower myopia up to -5.0 D. We report our first results 1 year after implantation of ICR segments. PATIENTS AND METHODS: From April 1997 to August 1998 we implanted ICRS in 48 eyes of 31 patients (12 male, 19 female) to correct myopia. The preoperative refraction (spherical equivalent) was between -1.0 and -5.0 D (astigmatism < 1.0 D). The average age was 34.0 years (range 19-48 years). ICRS implantation was performed in peribulbar anaesthesia. All operations were done by the same surgeon. RESULTS: The average follow-up was 10 months (ranges 1-12 months). After 6 months the deviation from the target refraction of all eyes was < 1.5 D; 26 of 27 eyes (96.3%) showed a deviation of < or = 1.0 D. Six months after surgery, 18 of 27 eyes (66.6%) showed an uncorrected visual acuity of 20/20 or better, 23 of 26 eyes (88.4%) showed 20/25 or better, and 25 of 26 eyes (96.2) 20/40 and better. Only 1 of 16 eyes showed an uncorrected visual acuity of 20/50. In all eyes, the best-corrected visual acuity was 20/20 or better. In 2 eyes an ICRS exchange and implantation of a thicker ring was necessary because the target refraction could not be achieved with the first implanted ring. In 2 eyes an ICRS reposition was done to optimize the location of the ring within the cornea. In 4 eyes we explanted the ring due to double vision (1 x) and distorted vision (3 x) caused by induced astigmatism. After explantation the preoperative refraction (+/- 0.15 D) was reached within 1 to 1.5 months. There was no regression after 6 months (n = 27) or after 1 year (n = 7). CONCLUSION: Our 1-year results of ICRS implantation show that myopia correction with the advantage of reversibility and lower complication rate is possible by this refractive surgical method. Ring exchange and explantation are possible. Earlier postoperative complaints like photophobia, unstable visual acuity or discomfort usually disappear rapidly. The decision of 95.0% of the patients to have ICRS implantation also into the second eye shows the high degree of satisfaction.     

Beitrag zur Mastoiditis im Kindesalter

Zusammenfassung Die h?ufigste Komplikation der Otitis media ist die Mastoiditis. Trotz der Antibiotika entwickelt eine nicht zu vernachl?ssigende Anzahl von Kindern eine subakute, chronische Form der Mastoiditis, die mit den gleichen intra- und extrakranialen Komplikationen einhergehen kann. Es wird über 59 Kinder mit Mastoiditis berichtet, die klinischen Symptome, Keimspektrum, Antibiotikasensibilit?t und die aufgetretenen Komplikationen werden dargelegt. Bei allen Kindern wurde eine Mastoidektomie durchgeführt. Die diagnostischen und therapeutischen Probleme der chronischen Mastoiditis werden unter Einbeziehung der Risikofaktoren diskutiert.      

Heilungsverlauf und Komplikationen nach Augenmuskeloperationen

BACKGROUND: Varying reports on the incidence of operative and postoperative complications following eye muscle surgery have been published. The purpose of this study was to quantify complications after various types of eye muscle surgery as well as minor pathological changes of the anterior and posterior segment. PATIENTS AND METHODS: This prospective study included all patients who underwent eye muscle surgery at the Department of Strabismology and Neuroophthalmology, Giessen, from January to May 1998. Five hundred eyes of 377 patients aged 2-82 years were included. The spectrum of procedures comprised: recessions, resections, tucks, R&R procedures, transpositions, bimedial retroequatorial myopexies, and revisions of rectus and oblique muscles. All patients were examined 1 day preoperatively and 1 day, 1 week, and 3 months postoperatively. Any complications and even minor pathological changes of the anterior and posterior segment were documented. Some changes were assessed by means of a score (0-3). RESULTS: One day postoperatively, 30% of eyes had inflammatory pseudoptosis, most of them mild. Conjunctival swelling and injection were frequently mild and moderate, after 1 week mostly mild. Conjunctival irritation was more pronounced following resection than tucking. Punctate epithelial keratopathy was noted in 1.6% of cases (first postoperative day), dellen in 4.3% (first postoperative week). Three months postoperatively, 14.3% of eyes had biomicroscopically visible conjunctival folds and 91.3% had minimal conjunctival scars. None of the patients had a scleral perforation or other serious complication. CONCLUSIONS: Eye muscle surgery rarely entails complications. Revisions due to organic pathological changes are extremely rare. Possible development of dellen requires check-up 4-7 days postoperatively. Tucking of rectus muscles causes less conjunctival irritation than resection.     

Bilaterale simultane LASIK Pro und Kontra

Until recently simultaneous bilateral laser in situ keratomileusis (LASIK) was regarded as contraindicated in Germany. However, the procedure was sporadically performed, because it offers patient comfort and is more cost effective than sequential LASIK. Even though the complication rate is below the calculated rate of 0.01%, bilateral complications may have catastrophic effects on the patient. In addition, there is the theoretical disadvantage that the results from the first eye cannot be used for the second eye. However, this effect has yet to be clinically proven.     

126. Indikationen und Komplikationen in der Behandlung infizierter Femur-Pseudarthrosen

Zusammenfassung Zur Stabilisierung der infizierten Femur-Pseudarthrose ist unabhängig von der ossären Abstützung bei gegebener Indikation die ausreichend dimensionierte Platten-Osteosynthese anderen Verfahren vorzuziehen. Andernfalls ist der Fixateurexterne indiziert. Seine Montage erfordert am Oberschenkel spezielle Kenntnisse, die sich an den individuellen Knochen— und Weichteilbefunden orientieren. Wir unterscheiden den Oberschenkelfixateur Typ I bis IV, welche beispielhaft demonstriert werden. Die Komplikationen werden zunächst vom Blutverlust und der Infektaktivität, später durch chronische Weichteilfisteln, Abscesse, osteomyelitische Resthöhlen und Spontanfrakturen bestimmt. Eine Studie analysiert die Behandlung und Spätergebnisse von 96 infizierten Femur-Pseudarthrosen.     

Besonderheiten von Patienten mit diabetischem Fußsyndrom und ihren Therapeuten

Zum Thema Der Autor dieser Arbeit versucht, das Problem des diabetischen Fu?-Syndroms über medizinische Gesichtspunkte hinaus unter philosophischen und psychologischen Aspekten zu sehen und zu behandeln. Das Theorem der okkludierenden diabetischen Mikroangiopathie – so wird vorgetragen – gelte im Bereich der naturwissenschaftlichen Medizin unver?ndert, obwohl es seit wenigstens 10 Jahren als falsch erkannt sei. Verschleppte Erkennung diabetischer Fu?l?sionen, versp?tete Krankenhauseinweisungen und unn?tige hohe Amputationen seien Ausdruck dieses Irrtums. Ob die in dieser Arbeit angestellten überlegungen neue Wege weisen und dem Ziel dienen, unsere Patienten m?glichst effektiv zu führen und zu beraten und mit evaluierten Methoden konservativ und operativ optimal zu behandeln, bleibt dem kritischen professionellen Leser dieser Zeitschrift zur Entscheidung vorbehalten.     

Massiver Pulmonalkapillarenverschluss durch Mikrothromben Unerwartete Ursache eines tödlichen Rechtsherzversagens während Lebertransplantation

We report the case of a 46-year old man who developed an unexpected fatal cardiac failure during liver transplantation. Attempts at resuscitation were unsuccessful. At necropsy the lungs showed numerous microthrombi occluding small lung vessels and pulmonary capillaries. Thrombi were not found in other organs. The source of this extensive thrombus formation is not known. The thrombi could have been developed within the liver, the venous blood stream between liver and lungs or the pulmonary capillaries. In our experience, this complication is very rare, and a risk profile is not known.     

Lasertherapie in der Dermatologie und Ästhetischen Medizin Nebenwirkungen, Komplikationen und Behandlungsfehler

Many different laser systems are used in dermatology. To wisely choose the correct laser for a given problem, one must be aware of both the spectrum of disorders for which each laser is suited and the potential side effects. We compare the side effect and complication profiles of the common laser systems pointing out their possibilities and limitations. Typical treatment errors will be pointed out. Dermatological training, extensive experience in laser therapy and compliance with quality guidelines are prerequisites for safe and successful treatment.