[Cataract surgery 220 years ago].

The author reports on the first 14 cataract extractions performed by Karl Kaspar von Siebold, a Würzburg surgeon, in 1766/67. He used Daviel's method. At that time there was no anesthesia, no sterility or even antisepsis, and no optical correction of aphakia for his patients.

[Pallor of the optic papilla--an early sign of glaucoma. A clinical controlled study of optic disk pallor and papillar cupping in glaucoma simplex, ocular hypertension and normal eyes with the optic nerve head analyzer].

Double examinations of 99 eyes (34 healthy, 12 with ocular hypertension, 53 with primary open-angle glaucoma) were performed with the Optic Nerve Head Analyzer to evaluate whether an increase in disk pallor or in the cup-disk ratio (CDR) is the earlier sign of glaucoma. In eyes with primary open-angle glaucoma the CDR and the mean optic disk pallor value are significantly higher than in healthy eyes. There is no significant difference in the CDR of patients with ocular hypertension as compared to normals.

Long-term studies of visual field changes by means of computerized perimetry (Octopus 201) in eyes with glaucomatous field defects after normalization of the intra-ocular pressure.

Unlabelled: 126 eyes with open-angle glaucoma and defects of the visual field were studied over five years (+/-1.3) by repeated perimetries with Octopus Perimeter, Program 31, after the IOP had been normalized from 26.49 mm Hg to 19 mm Hg.

[Optic papilla parameters in healthy subjects--quantified with the optic nerve head analyzer].

The cup-disk ratio (CDR), the size of the neuroretinal rim area as well as the other disk parameters investigated with the Optic Nerve Head Analyzer (ONHA) were measured in double examinations of 32 healthy eyes in 32 patients. Thus, "normal" values were determined for the various disk parameters. A new method is presented for calculating one average pallor value for the disk.

Successful goniotomy in hemophilia A.

An infant of 8 months with congenital glaucoma and hemophilia A lost one eye due to haemorrhages after trabeculotomy in an eye hospital. Only thereafter, the hemophilia A was discovered. We did a goniotomy of the fellow eye in November 1971 after normalization of the factor VIII activity.

[Site and depth of glaucomatous visual field defects in relation to the size of the neuroretinal edge zone of the optic disk in glaucoma without hypertension, simple glaucoma, pigmentary glaucoma. A clinical study with the Octopus perimeter 201 and the optic nerve head analyzer].

The size of the neuroretinal rim area of the disk was measured with the Optic Nerve Head Analyzer in 57 eyes of 57 patients with low-tension glaucoma (LTG), glaucoma simplex (POAG), and pigmentary glaucoma. The visual fields were examined with Program 33 or 31 (30 degrees eccentricity, 6 degrees grid) of the Octopus 201 Perimeter. The mean sensitivity loss per test point in the central field, in the field quadrants, and in the ranges from 0 degrees-10 degrees, 10 degrees-20 degrees, and 20 degrees-30 degrees were calculated with the Delta program.

[Acupuncture for pain in the cranial region and for blepharospasm without organic cause].

In patients with functional ophthalmological disturbances classical acupuncture therapy was compared to a technique of inserting the needles close to superficial nerves. Seventy-five patients with migraine, 47 patients with functional blepharospasm, 18 with trigeminal neuralgia, and 9 with posttraumatic pain syndromes were treated. Treatment comprised seven sessions at four-day intervals.

[Effect of neodymium YAG laser treatment of glaucoma on endothelial cell density of the cornea].

In a prospective clinical study corneal endothelium cell density was measured by means of contact specular microscopy prior to and 2, 4 and 12 weeks after Nd-YAG laser treatment. Two different laser techniques were applied: 19 eyes with narrow-angle glaucoma were treated by laser iridotomy, 21 eyes with open-angle glaucoma underwent laser treatment of the trabecular meshwork. The Nd-YAG laser was driven in Q-switched mode (nanosecond range) for iridotomy and in free-running mode (millisecond range) to treat the trabecular meshwork.

[Demonstration of the tonographic effect in YAG laser trabeculoplasty in chronic glaucoma].

In a pilot study comprising 16 eyes of 16 patients with chronic open-angle glaucoma the tonographic outflow facility was examined before and after Nd-YAG laser treatment of the trabecular meshwork. For evaluation of the facility effect of laser trabeculoplasty, the tonographic record between the third and seventh minute according to the tonography test of Leydhecker was used. An improvement in outflow facility was established which correlated with the postoperative fall in IOP.

[Glaucoma without ocular hypertension. A clinical study].

One hundred eighty-four glaucomatous eyes (125 patients) with visual field defects of Stage I and II in the central visual field were examined with the Octopus perimeter 201, Program 31 or 33, and were divided into 3 groups according to maximum intraocular pressures: (1) low-tension glaucoma (21 mm Hg), (2) glaucoma simplex (22-29 mm Hg), (3) glaucoma simplex (30-39 mm Hg). In these three groups of glaucomatous eyes the cupping of the optic disk, vision and blood pressure were examined and a further check for cardiovascular risk factors was carried out by the internist. All three groups proved to have an equally high incidence of cardiac insufficiency, abnormal EKG changes and diabetes.

[Fibrin adhesion and postoperative anti-fibrinolytic care of conjunctival wounds].

The closure of conjunctival wounds by means of the fibrin adhesive technique has been reported by several authors; however, the clinical results were only partially satisfactory. Premature clot lysis resulted in disturbances of wound healing. These observations were corroborated by our the present authors' findings.

Perimetry update.

The possible applications of computer-assisted static perimetry are examined after five years of personal controlled studies of different types of computerized perimeters. The common advantage of all computer-assisted perimeters is the elimination of the influence of the perimetrist on the results. However, some perimeters are fully computer-assisted and some are only partially so.

[The physician's obligation to educate patients - legal aspects - patients' expectations].

There is some uncertainty among doctors and lawyers about the form and content of presurgical medical enlightenment of the patient. Presurgical enlightenment is of increasing significance with respect to malpractice suits. Current jurisdiction has developed principles of enlightenment that are often difficult for the doctor to handle.

[Topography of early glaucomatous visual field defects in computerized perimetry].

A total of 301 visual fields of 215 glaucoma patients exhibiting early glaucomatous field loss up to Stage II according to Aulhorn were investigated to determine the frequency distribution of absolute and relative defects at the 73 test points of Program 31 of the Octopus computer perimeter. The following results were obtained: (1) The frequency of absolute and relative defects was higher in the upper half of the visual field; (2) The frequency of both absolute and relative defects increased from 6 to 30 degrees eccentricity in the upper visual field, predominantly in the upper nasal quadrant, whereas in the temporal lower quadrant there were less absolute defects but equally frequent relative defects; (3) Defects in the nasal quadrant and above the horizontal meridian are most frequent (between 18 and 30 degrees absolute, between 12 and 30 degrees relative), while temporally of the blind spot and below the horizontal meridian they are quite rare; (4) In the upper half of the field, defects are closer to the fixation point and blind spot; the area between blind spot and macula largely free of defects. --In 71 eyes of 69 patients a similar frequency distribution was found with the Competer computer perimeter (test field 15-20 degrees eccentricity) giving good correlation with the Octopus results.

The ocular responses of oral administration of penbutolol in the glaucomatous patient.

A single oral dose of 20 mg or 40 mg Penbutolol was given to two groups of ten untreated glaucoma patients. The drug significantly decreased intraocular pressure and was dose-related. The IOP response was paralleled with a decrease in pulse rate without significant effect on blood pressure.

Patient information before cataract surgery.

Patients have to be informed before cataract surgery about possible complications, about chances and risks. This should be done in a written manner with additional verbal explanations. We documented all details of 4,300 cataract operations on computer-readable forms and obtained statistics on type and frequency of complications as well as visual acuity 1 week after the operation.