[Clinical and experimental results in the treatment of massive periretinal proliferation (MPP), a retinal detachment with a most unfavorable prognosis]

Today eyes with massive periretinal proliferation which are often seen after uncured retinal detachments or after perforating injuries can be cured at least in 25 to 35% of the cases, even with modern surgical techniques. This is due to proliferation of cells, which enter through different pathways--retinal tears, perforating wounds of sclera and chorioidea, damaged retina or retinal vessels--into the vitreous and form membranes, which prevent the retina to attach. In the vitreous gel these cells of different origin can transform into fibroblast-like or myofibroblast-like cells. They also behave in the same way like fibroblasts or myofibroblasts and cause a kind of excessive wound healing and scar formation in the vitreous cavity. With the use of modern vitreous techniques we could cure nearly 43% of 14 patients with MPP after uncured retinal detachments or after perforating injuries. Because mechanical removal of intravitreal and periretinal membranes alone turned out to be unsuccessful in nearly 60%, methods of medical therapy to suppress this cell-activity seemed to be rather needed. By animal experiment we tried to produce retinal detachments by transplantation of homologue fibroblasts into the vitreous cavity of rabbit eyes, and observed traction detachments in 55% of the eyes. Histologic examination showed a rapid change of loose, round fibroblasts into elongated cells with long nuclei, which formed strands and caused vasoproliferation, especially where the strand reached the rabbit retina. By means of autoradiography the peak of cell activity turned out to be in the 3rd week after cell-transplantation and further examinations of the optic disc showed, that the vascular endothelium cell might be one source of the proliferation. There was no difference between the number of eyes which developed retinal detachment in the aphakic eyes and in the lentectomized and vitrectomized eyes, but we observed the clinical appearance of MPP earlier and more pronounced in the lentectomized and vitrectomized eyes. In the last experiment we tried to inhibit intraocular proliferation with intravitreal dexamethasone alcohol. This leaded to a significant reduce of the number of experimental detachments and vasoproliferations.

[Is there drug alternative in the treatment of massive periretinal proliferation? (author's transl)]

Only a small percentage of eyes with massive periretinal proliferation (MPP) can be successfully treated by vitrectomy. This is due to the reproliferation of cells which combine to form membranes, thus causing redetachment of the retina. These filaments and membranes are formed from "fibroblast-like" cells originating from the glia cells and pigmented epithelial cells. The author attempted to produce retinal detachment by traction in 20 rabbit eyes by means of intravitreally injected homologous fibroblasts (250,000 in 0.1 ml); this was successful in 11 cases (55%). In another series with 16 rabbit eyes, 1 ml dexamethasone alcohol was administered intravitreally in addition to the fibroblast transplantation in order to inhibit fibroblast activity. This resulted in retinal detachment by traction in one case only (6%). Hence the number of detachments by traction was significantly lower with eyes with additional intravitreal administration of dexamethasone.

[Differential diagnosis of ischemic optic neuropathy (author' transl)]

The levels of the immunoglobulins IgA, IgM, and IgG, as well as the complement components C3 and C4 were measured in the sera of patients with vascular pseudopapillitis. The ischemic papilledema was caused by either temporal or idiopathic arteritis. In the temporal arteritis group, the levels of IgG, IgM and C4 were significantly higher than in the idiopathic group. However, these facts are of little value for the differential diagnosis of vascular pseudopapillitis, because there is a considerable overlapping of values in the two groups.

[Prophylactic treatment of retinal detachment]

The indications for and results of prophylactic treatment of retinal detachment during a period of five years are reported and compared with the results in the literature. Half of the cases (3 out of 6 eyes) which developed a retinal detachment had been horse-shoe tears combined with a vitreous hemorrhage. For this reason a small buckle operation is recommended in these cases, to prevent further traction. Lattice degeneration should rather be observed than treated, except in special cases: This includes eyes where the fellow eye had a detachment from a lattice degeneration, cases in which one eye is blind from an uncured detachment or has no useful visual acuity, and eyes whose fellow eye has giant tears. In aphakic eyes treatment of lattice degeneration is recommended, because the incidence of detachment from these areas is high, especially in young aphakic cases. In one aphakic eye which had been photocoagulated several times the formation of a preretinal membrane was observed.

[Corneal sensitivity after retinal reattachment operation]

The corneal touch threshold (CTT) was determined in 35 eyes before and after retinal reattachment operations. In some cases the CTT of the unaffected eye was taken for comparison. The new aesthesiometer developed by Draeger in 1977 was used and measured CTT in the center of the cornea and in the 12, 3, 6, and 9 o'clock position 1 mm from the limbus. Thirty eyes (86%) showed a rise in CTT after retinal reattachment operations, irrespective of the method of anaesthesia used, and the decrease in corneal sensitivity was observed for up to a period of 5 years postoperatively. Loss of corneal sensitivity was more marked in operations with diathermy and scleral pocketing than in cases with cryopexy and plombage operations. Extremely high CTT values were observed in eyes that underwent encircling procedures, cryopexy, vitrectomy, and gas injection. There was a significantly higher decrease in corneal sensitivity after encircling procedures than after plombage operations.

[Corneal sensitivity after photocoagulation for diabetic retinopathy]

Corneal sensitivity was determined with the Draeger aesthesiometer in 39 patients with proliferative diabetic retinopathy who underwent treatment with a xenon photocoagulator or argon laser. In 29 patients measurements were performed before and after photocoagulation; in 10 patients the unaffected eye was used for comparison. Statistical evaluation showed a significant difference between the mean values for corneal touch threshold before and after argon laser coagulation. After xenon photocoagulation, corneal sensitivity was reduced in all patients (n = 7). It was shown that corneal sensitivity was significant lower after xenon photo coagulation than with argon laser coagulation.

[Ocular manifestations of temporal arteritis (author's transl)]

A report is presented of 15 patients with ocular manifestations of temporal arteritis. Ophthalmoscopy revealed anterior ischaemic neuropathy of the optic nerve in 12 patients, occlusion of central retinal artery in 2 cases and secondary atrophy of the optic nerve in 1 patient. No involvement of eye muscles of other ocular complications were seen. 10 patients showed occult temporal arteritis, whilst classical features were present in 5 patients. The diagnosis was proven histologically, and high-dosage cortisone therapy was instituted. 13 out of the 15 patients could be saved from blindness of both eyes. Temporal arteritis is an ophthalmological emergency which requires immediate diagnosis and therapy.

[Vitrectomy with intraocular gas bubble in complicated cases of retinal detachment (author's transl)]

Vitreous surgery techniques combined with intravitreal gas bubble were employed in six cases of unsuccessfully treated retinal detachment. Surgical techniques, indications and complications are reviewed.

[Follow-up study of macular function after retinal detachment surgery (author's transl)]

Forty patients successfully operated on for retinal detachment involving the macula were followed up for periods ranging from six months to nine years. The follow-up examination included testing for visual acuity, color perception and metamorphopsias, as well as biomicroscopy and fluorescein angiography. Postoperative visual acuity was correlated with the preoperative duration of retinal detachment. As expected, visual outcome was reduced in cases with lesions demonstrated by biomicroscopy and/or fluorescein angiography. In some patients visual acuity and color perception were impaired and metamorphopsias were present, even though the macula appeared normal in funduscopy and fluorescein angiography. This may be due to a possible misalignement of the photoreceptors as demonstrated in the owl monkey by Machemer.

[Spontaneous regression of exudative retinal detachment after cryotherapy and scleral buckling (author's transl)]

A report on four cases of exudative retinal detachment following scleral buckling with cryotherapy. In two cases subretinal fluid began to reaccumulate 24 hours after operation and in two cases after 48 hours. Cryotherapy is assumed to be the main factor causing this exudative response. In all four cases the fluid resorbed within 11 days to five weeks without further surgical intervention.

[Is some therapeutic influence upon macular function after postoperative re-attachment of the retina possible? (author's transl)]

Two groups of cases, comprising 20 and 22 patients respectively, successfully operated on for retinal detachment with involvement of the macular area are compared with each other, the second group having been treated postoperatively with i.m. injections of retina phosphatides. Examinations of the visual acuity and metamorphoptic phenomena were performed one week, and then 2, 4, 8 and 12 weeks after surgery. The cases thus treated achieved better visual acuity during the first week than the untreated ones; however, 3 months after surgery, visual acuity of both groups was almost equal. Form and extension of metamorphoptic phenomena were not essentially different.

[Occult temporal arteritis--a case report (author's transl)]

A 57-year-old female patient with ischaemic papilloedema developed vascular pseudopapillitis of the opposite eye three months later. Temporal arteritis was diagnosed by means of a biopsy of the temporal arteries. Such cases of occult temporal arteritis are characterized by the absence of typical general symptoms and pathological laboratory findings, or, alternatively, these symptoms appear only much later than the ischaemic alteration to the fundus. Hence, one should consider occult temporal arteritis when confronted with any ischaemic process of the optic nerve, and also in the case of occlusion of the central retinal artery, expecially in cases with a simultaneous rise in the blood-sedimentation rate, since high doses of steroids, when given in time, may prevent total loss of sight.

[Differential diagnosis of ocular myopathies]

While the ocular myopathies were hitherto classified in various syndromes solely on the basis of symptom complexes, biochemical and electron-microscopic studies are leading to new findings in the pathogenesis of these conditions, which are probably enzymopathies. At the same time, with the aid of electron microscopy, a classification of the myopathies is attempted on the basis of the morphological changes seen in the affected cells. However, the occurrence of giant mitochondria is no longer characteristic for myopathies. An acumulation of lipid vacuoles in the cells is currently designated "sudanophilic myopathy", and is frequently found in cases suffering from a carnitine deficiency. However, it is still difficult to demonstrate the enzyme defect responsible for the disease. -- Two cases of "sudanophilic myopathy" are reported. At first, a carnitine deficiency was assumed, but this could not be proved in subsequent follow-ups; the condition was therefore probably due to another type of enzyme deficiency in these two cases.

[Review of 402 goniotrephinations]

In a review of 402 goniotrephinations the preoperative diagnosis was open-angle glucoma in 61%, chronic congestive glaucoma in 21%, acute glaucoma in 11%, secondary glaucoma in 5%, and juvenile glaucoma in 2%. In 77% of the eyes followed for periods of up to seven years IOP returned to normal. Supplementary local therapy or digital eyeball massage raised the percentage of eyes with normal pressure values to 92,8%. Visual acuity was maintained or improved in 76%. There was no case of visual field defect during the early postoperative period, and no correlation was found between the regulation of IOP and the condition of the filtering bleb. In 10,4% complications occurred during the early postoperative period and in 1% late complications were seen. In 45% of the secondary glaucoma cases and in three out of seven cases of buphthalmus IOP was normalized.

[Massage of the bulb and intraocular pressure after goniotrepanation (author's transl)]

Intraocular pressure should be controlled via applanation tonometry, beginning with the fourth day after goniotrepanation, for a period of about three weeks, for early detection of postoperative pressure increases which can occur occasionally, so that they may be treated by digital massage of the bulb. This can be effective even in later post-operative pressure increases and support the effect of additional pressure-lowering treatment.

[The value of an outpatient clinic for patients with retinal detachment]

The article reports on an outpatient department for retinal detachment patients established since 1972 in the First Eye Clinic in Vienna. Of the 225 patients treated up to 1978, 19 had a relapse, 9 patients were subjected to prophylactic retinopexy in the tear area which had not coagulated sufficiently, whereas in 15 cases latent tears were found in healed eyes and in 17 cases in the second eye. In two patients, beginning detachment in the second eye was detected at an early stage, whereas in two cases detachment occurred despite continual control. The article underlines the usefulness of this outpatient section for clinical and research work.

[Echoculometry of the scleral buckle after retinal detachment surgery with and without subretinal drainage (author's transl)]

In a series of 32 eyes, the elevation of the scleral buckle was measured by means of A-scan echo-oculometry at the end of retinal detachment surgery, 6 and 10 h later, and 2, 3, 4, 8, 14, and 21 days after cryopexy and plombage with a 5 mm diameter silicon sponge. Subretinal drainage was applied in 50% of the cases. In more than 50% maximal indentation was found 2 days postoperatively; in less than 50%, 3 days postoperatively. Statistically significant, this maximum appeared earlier in cases with subretinal drainage than in cases without drainage. The highest elevation of the buckle persisted from one to two weeks and decreased during the third week.

[Does indirect binocular ophthalmoscopy influence the results of retinal deteachement surgery (author's transl)]

The statistical comparison of two collectivs of patients showed, that with routine use of indrect binocular ophthalmoscopy and renunciation of drainage of the subretinal fluid (49% of the cases) the curing rate of the cases which were operated with a combination of cryopexie and plombage raised from 75% to 96%. Even the results of visual acuity improved.

[Ocular myopathy with giant mitochondriae (author's transl)]

A case of progressive external ophthalmoplegia and a slight coincident affection of the scapulohumeral muscle group is recorded. Thorough examination including EMG and biopsy from ocular and skeletal muscle tissue confirmed the clinical diagnosis of myopathy. By means of electron microscopy the affection could be identified as a type of myopathy characterized by giant mitochondriae. Causative factors were not detectable. The function of the thyroid and the carnitine level in the muscle tissue and blood serum were normal.

[Macular function after successful surgery of retinal detachment (author's transl)]

Following successful surgery 20 cases of retinal detachment with previous separation of the macular area were submitted to examination of visual acuity, colour perception and metamorphopsia. Improvement of visual acuity usually developed during the 12-week-period of supervision; this improvement was related to the preoperative duration of the detachment. The disturbance of colour sense was confined to the perception of yellow and blue, beeing independent of the duration of the retinal detachment; as a rule a tendency to improvement was found during the time of observation. Labile postoperative metamorphopsias were more pronounced in the spoke-test than in the Amsler-test. No evident connexions between the duration of retinal detachment and the intensity of metamorpoptic distortions could be found. In cases with retinal tears in the posterior segment cured with a high plombade effect stable visual distortions occurred in the Amsler-test only. Such distortions seem to be due to mechanical factors and cannot be considered real metamorphopsias.

[The efficacy of Piracetam on the mental functional capacity of chronic alcoholics (author's transl)]

Piracetam, 1-pyrrolidone acetamid, was tested in 40 chronic alcoholics with a more or less marked psycho-organic syndrome by means of psychological tests. It was a double-blind-cross-over study. Statistical analysis of the results showed that Piracetam improves the energo-functional capacity of the cortex i.e. the basal functions of the cortical cells such as activating capacity, vital dynamic, flexibility, intellectual reactivity and stress tolerance. Apart from the overall improvement we also observed an improvement of specific cerebral performances which is however unimportant in comparison with the greneralized effect.