[The relationship between the temperature increase caused by phacoemulsification and the damage to the corneal endothelium]

PURPOSE

Endothelial cell damage can be found after a phacoemulsification. The reason for this cell damage is not yet known. The temperature rise inside the anterior chamber during the emulsification of the lens is considered as a potential damage mechanism. The aim of this study was to investigate the relationship between the temperature increase and the cell damage.

MATERIALS AND METHODS

This study was performed with 86 enucleated porcine eyes, which were divided into six groups A-F. Group A served as control group. Phacoemulsification was simulated in the groups B-E with different surgically relevant system settings. The temperature change was measured simultaneously with temperature sensors inside the anterior chamber. Inside the eyes of group F, the instruments were positioned and irrigation and aspiration were activated, but no ultrasound was applied. For all 86 corneas, the endothelial cell damage was quantified with a standardised evaluation protocol using scanning electron microscopy (SEM). A potential correlation was checked between the observed cell damage and the measured temperature rise.

RESULTS

The highest temperature increase in group E with an obstructed aspiration line and an output power setting of 50 % was 17.77 °C. The temperature increase in group D with an output power setting of 100 % and unblocked fluid flow was significantly lower (p = 0.006). The highest temperature increase in group D was 8.89 °C. In contrast, the cells in group D were rated with a significantly lower score value than the cells in group E (p < 0.001). No significant correlation between the temperature rise and the cell damage could be obtained in due consideration of all measured data. However, an increase of the output power setting was connected with a non-linear increase of the cell loss.

CONCLUSION

The temperature rise was not the main reason for the endothelial cell damage in the performed experiments. Therefore, there seems to be no causal relationship between the temperature increase inside the anterior chamber during a common phacoemulsification and the endothelial cell damage. Due to the strong dependence between the output power setting and the cell damage, the lowest output power setting should be used during surgery which ensures the emulsification of the nucleus.

Zur Problematik des Glaukoms in Afrika - ein Erfahrungsbericht aus Kamerun

BACKGROUND

Glaucoma is one of the most common causes of blindness in the world. This aspect is well known for the developed countries, however in Africa blindness mainly occurs due to cataract, trachoma and onchocercosis. Glaucoma is not mentioned enough. Patients present with severe findings after a long-lasting history of disease.

PATIENTS AND METHODS

In our project experienced surgeons and young medical doctors have been practising regularly in Cameroon since 2001. By means of support from the "Komitee zur Verhütung von Blindheit" and medical industries we keep in contact with a local ophthalmologist. During the consultation of hundreds of patients we have often seen highly advanced glaucoma cases.

RESULTS

The medical therapy of glaucoma and also the surgical procedures are limited -- modern antiglaucomatosa are not available. We achieved sufficient regulation of intraocular pressure after trabeculectomy with or without cataract surgery in many cases. The success rate was decreased by severe scar reactions especially in young black people. In advanced glaucoma cases and oculus ultimus we also used the old techniques of iridencleisis. There was a good postoperative regulation of eye pressure, but sometimes we saw a giant filtering bleb after this iris-mutilating procedure.

CONCLUSIONS

Glaucoma is a very complex problem, also in Cameroon. Although the diagnostic possibilities are limited, the therapeutic spectrum is differentiated. The introduction of a robust laser for cyclophotocoagulation would be a useful alternative.

[HIV seroprevalence in ophthalmologic patients of Cameroon]

BACKGROUND

It is difficult to estimate the exact HIV infection rates in countries such as Cameroon because of diagnostic and statistical problems. The majority of people seek help from traditional healers outside the health system.

PATIENTS AND METHODS

A screening for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) was performed on 2452 patients of the western province of Cameroon. All data were evaluated regarding HIV seroprevalence and ophthalmological findings in HIV-seropositive patients. The test covered all patients who came for cataract surgery (group 1), all outpatients with suspicious ophthalmological findings (group 2), and all remarkable patients of the collaborating department of general medicine (group 3) between 20 September 2000 and 20 September 2001.

RESULTS

Of the 2452 screened patients, 467 (19.0%) were HIV seropositive. A positive test result was obtained in 29 (5.5%) of the 525 patients in group 1, 154 (35.6%) of the 433 patients in group 2, and 284 (19.0%) of the 1494 patients in group 3. The main ocular manifestations of the 154 HIV-seropositive patients in group 2 were uveitis (17.6%), squamous cell carcinoma of the conjunctiva (14.9%), zoster ophthalmicus (14.9%), and corneal ulcers (11.0%).

CONCLUSIONS

This study shows that the seroprevalence of the screened population of Cameroon lies between 5.5% (results of group 1) and 19.0% (results of group 3).

Radiotherapie von Augen- und Orbitatumoren

Malignant diseases of the orbit are multifaceted and require in the majority of the cases an interdisciplinary treatment. Advances in radiotherapy, surgery and chemotherapy make a high cure rate possible, especially in children's tumors. In adults these tumors reach a tumor control rate of nearly 90 %, even with preservation of the eye in most of the cases. There are only two curative therapy options for tumors in this region: radiotherapy and surgery. The therapy for tumors of the eye and the orbit require the total spectrum of the radiotherapeutic techniques depending on the tumor entity, its spread and localization. In a prevailing number of malignant tumors (tumors of the eyelids, tear glands, orbit, metastases) the application of the radiotherapy as an external, fractionated radiotherapy is standard practice, if necessary in combination with operation and/or chemotherapy. Particularly in the therapy for ocular tumors brachytherapy with radionuclides (e. g., ruthenium) is possible and in a few centers world-wide proton therapy is available. As an alternative procedure in special modalities, stereotactic radiotherapy may be considered. Altogether the new radiotherapy techniques permit a dose increase in the tumor region and/or a reduction of the doses to healthy tissues and lead so to a better local tumor control rate and a decrease in acute and chronic side effects.

Improvement of the recurrence-free interval using biological adjuvant therapy in uveal melanoma

This study was an attempt to compensate for an alleged aetiological deficiency in melanoma by the prophylactic oral administration of the essential biological components missing. Nine random patients suffering from high-risk uveal melanoma (T3) were, in this preliminary study, treated secondarily with biological dietary adjuvants after primary standard therapy, enucleation or brachytherapy. Secondary treatment consisted of certain natural amino-acids, trace-element salts, folic acid and a diet containing neurogenic lipid components. It entailed no side-effects, no toxicity and was inexpensive. None of these nine patients has suffered recurrent disease. The mean follow-up time was over 80 months (median 69, range 58-140 months). Local tumour control was 100%. This clinical result is significantly better (p = 0.018) as compared to similar T3 uveal melanoma patients in standard care who did not receive adjuvant dietary remedies after primary treatment. The control patients consisted of similar adjusted T3 cases selected from the Swedish official registries, and T2 patients from Germany. Based on the previous positive clinical results obtained with cutaneous malignant melanoma in bioimmunotherapy this additional positive result supports the notion that biological components administered orally may compensate for the etiological deficiency leading to malignant melanoma.

[Intraocular involvement as initial symptoms of non-Hodgkin lymphoma]

BACKGROUND

The diagnosis of a intraocular lymphoma is often delayed because of a symptomatic pseudouveitis.

CASE REPORT

We report on a 68-year-old female patient, who was referred because of a tumor of the optic disk in her right eye and bilateral uveitis with secondary glaucoma. The painful blind right eye was enucleated. The assumed diagnosis of a pseudouveitis as an initial manifestation of a B-cell lymphoma was confirmed histologically. She developed systemic extension and recurrence in the second eye despite polychemotherapy. The patient died from complications of her systemic tumor disease 15 months after initial symptoms.

CONCLUSIONS

An initially unilateral and later bilateral uveitis in elderly patients which does not respond to steroid therapy could also be suspicious for an intraocular lymphoma. If the conjunctiva is not involved, the confirmation of the diagnosis requires a diagnostic viteous biopsy.

Long-term follow-up of Ru-106/Rh-106 brachytherapy for posterior uveal melanoma

BACKGROUND

Currently available information about survival, local tumor control rates, secondary enucleation rates, and visual acuity following Ru-106/Rh-106 applicator therapy for choroidal and ciliochoroidal melanomas is limited in terms of duration of follow-up among surviving patients.

METHODS

The authors performed a retrospective descriptive study of the rates of survival, local treatment failure, secondary enucleation, and visual acuity decrease in 140 patients (141 eyes) with choroidal or ciliochoroidal melanoma treated by Ru-106/Rh-106 applicator radiotherapy between 1964 and 1976. Median follow-up duration among surviving patients in this series was 17.3 years (mean 18.6 years). The Kaplan-Meier method was used to estimate cumulative survival rates and event rate curves. Multivariate Cox proportional hazards modeling was used to identify prognostic clinical variables associated with the various evaluated outcomes.

RESULTS

The 15-year survival rate based on all causes of death was 48.0% (standard error=4.4%), and that based on confirmed and suspected metastatic uveal melanoma was 66.7% (standard error=4.5%). The cumulative 15-year rates of local treatment failure and secondary enucleation were 36.8% (standard error=4.4%) and 34.4% (standard error=4.5%) respectively. The cumulative 10-year rates of visual acuity loss to less than 20/200 and no light perception were 62.8% (standard error=4.4%) and 40.6% (standard error=5.2%) respectively. Prognostic factors associated with death from confirmed and suspected metastatic melanoma were greater tumor diameter and anterior tumor location. Greater tumor diameter was associated with local treatment failure. Baseline visual acuity equal to or worse than 20/200 was associated with profound visual acuity loss.

CONCLUSIONS

Although a high proportion of treated eyes eventually lost a great deal of vision, and although many treated eyes ultimately underwent secondary enucleation, a substantial number of patients treated by plaque radiotherapy in this series survived for well over 10 years and retained the tumor-containing eye with a visual decrease of varying severity.

[Intraocular invasion of melanoma of the conjunctiva]

BACKGROUND

The treatment of a localised conjunctival melanoma usually requires local excision combined with cryotherapy, brachytherapy and/or local chemotherapy.

CASE REPORT

A 71 year old woman suffering from a conjunctival melanoma located at the limbus of her left eye was treated by local excision and cryotherapy. After this therapeutic procedure two recurrences occurred which had been again treated by excision and cryotherapy and finally brachytherapy. Nevertheless, a third recurrent tumor developed and was treated again with deep lamellar sclerectomy and keratectomy. During this procedure the anterior chamber was opened inadvertently in a tiny spot. Some months later an intraocular invasion of the melanoma was diagnosed clinically and the eye had to be enucleated 5 years after the first treatment. Histological examination revealed extended melanoma growth into iris, ciliary body, anterior choroid, and tumor cell seedings in the antertior chamber.

CONCLUSIONS

Removing a conjunctival melanoma especially such a tumor growing at the limbus, the surgeon has to pay attention not to open the anterior chamber during sclerectomy and keratectomy. The possibility that prior local surgical excision aided the intraocular extension is discussed.

[Mitomycin C in treatment of conjunctival melanoma and primary acquired melanosis]

BACKGROUND

Since 1995 we have used Mitomycin C additionally in the treatment of conjunctival melanoma and primary acquired melanosis.

METHODS

We report on the therapy results of 14 patients suffering from pigmented conjunctival lesions (malignant melanoma 9 and primary acquired melanosis 5). After local excision, cryotherapy or irradiation all patients received one eye drop Mitomycin C (0.02%) four times daily for four to six weeks.

RESULTS

We observed regression of the pigmentations in 11 cases after median follow up of 13.1 months. In one patient there was no change. Two cases showed progression with tumefaction. There were no adverse reactions except conjunctival hyperemia during therapy.

CONCLUSIONS

Topical administration of Mitomycin C may be useful in the treatment of pigmented conjunctival lesions. Longer follow-up periods are necessary.

Diagnosis and clinical management in malignant Müllerian tumors of the fallopian tube. A report of four cases and review of recent literature

Four out of 42 cases of primary tubal malignancy diagnosed in our histopathological laboratory were malignant mixed Müllerian tumors (MMMT). All four patients were postmenopausal with a mean age of 66.5 years at diagnosis. A correct preoperative diagnosis was made only in one case. Tumor staging (FIGO) revealed stage IIa, IIIc and IV. One patient died of postoperative pulmonary embolism, a second patient of an unknown cause five month after surgery and a third patient died of disease after 11 months with secondary deposits in pelvic peritoneum, omentum and paraaortic lymph nodes. The fourth patient is still alive. One patient received chemotherapy alone, one by radiation and chemotherapy and two patients by radiation alone. Tumor spread at the time of diagnosis and the residual tumor volume were the most important prognostic factors. All tumors were histologically the homologous type of MMMT (carcinosarcomas). No heterologous elements were found. Metastatic tumors showed only sarcomatous elements.