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Die Chorioretinitis centralis serosa wird in atiologischen Uberlegungen immer wieder mit einem unspezifischen Distresskonzept in Zusammenhang gebracht. Die depressive Storung stellt hingegen einen klar benennbaren, spezifischen Stressor dar, der nicht zuletzt in der Kardiologie wie Diabetologie als bedeutender, eigenstandiger Risikofaktor bekannt ist. In vorliegendem Fallbericht wird aus psychosomatischer Sicht die klinische Korrelation zwischen einer Chorioretinitis centralis serosa und einer depressiven Storung aufgezeigt, wobei ein lediglich ad hoc naheliegendes sequenziell-reaktives Storungsverstandnis demjenigen einer simultanen Verschrankung gegenubergestellt wird, welches nach unserem Ermessen zu bevorzugen ware.

Background The subjective and objective results during the training phase of phacoemulsification using a 6 mm sclero-corneal tunnel incision at 12 h were evaluated. Patients and methods In a prospective study we evaluated the first 221 cases of phacoemulsification by a cataract surgeon during his training phase. Objective parameters which were analyzed included intraoperative complications, preoperative, early postoperative (p. o.) (1 - 13 days) and late p. o. (to the third month) assessment of refraction, visual acuity and corneal astigmatism. Calculation of the induced astigmatism was performed using the subtraction method and the vector analysis according to Jaffe. For evaluation of subjective results we used a questionnaire in the late p. o. phase. The questionnaire contained questions concerning satisfaction with the explanation of the surgical procedure, the medical personnel, the procedure itself and the result of the operation. Results During surgery, 6 posterior capsular ruptures (2.7 %) and 3 zonular dialyses (1.4 %) occurred. In 6 cases (2.7 %) an anterior vitrectomy was necessary, in two cases (0.9 %) an anterior-chamber lenses had to be implanted. Preoperatively, the average visual acuity was 0.5 +/- 0.14 (n = 221), the early p. o. visual acuity was 0.49 +/- 0.23 (n = 220) and the late p. o. visual acuity was 0.73 +/- 0.31 (n = 121). The average spheric equivalent was early p. o. 0.04 D +/- 1.18 D (n = 208) and late p. o. 0.11 D +/- 1.08 D (n = 118). The difference to the planned refraction was early p. o. 0.68 D +/- 1.13 D, and late p. o. 1.39 D +/- 1.18 D. The mean induced astigmatism early p. o. was 0.55 D +/- 0.97 D (n = 166) and late p. o. 0.37 D +/- 0.87 D (n = 121) (subtraction method). Utilizing vector analysis for calculation of the induced astigmatism we obtained 1.43 D +/- 0.86 D (n = 121) for the early p. o. situation and 1.22D +/- 0.88 D (n = 121) for the late p. o. situation, respectively. 80 % of the patients (n = 119) were satisfied with the results (highest rating), 3 % were unhappy (lowest rating). Conclusion The results of this study reveal that phacoemulsification is a safe and satisfactory procedure for patient, even during the training phase of a cataract surgeon.

Hintergrund: Das Pseudoexfoliationssyndrom (PEX) fuhrt zu einer Lockerung des kapsularen Aufhangeapparats. Deshalb besteht bei einer Kataraktoperation ein erhohtes Risiko fur intraoperative Komplikationen wie Kapselruptur und Zonulolyse und postoperativ fur eine Druckerhohung. Postoperativ auftretende Luxationen des Kapselsacks mit der in den Kapselsack implantierten Hinterkammerlinse sind bisher selten beschrieben. Patienten und Methode: Innerhalb eines Jahres wurde bei funf Patienten im Alter von 67, 74, 79, 90 und 92 Jahren mit Pseudoexfoliationssyndrom und Zustand nach Kataraktoperation eine Subluxation des Kapselsacks mit der kapselsackimplantierten Hinterkammerlinse beobachtet. Ergebnisse: Bei drei Patienten war vor 6, bei einem vor 3 Jahren und bei einem vor 11 Jahren eine komplikationslose extrakapsulare Kataraktextraktion mit Implantation einer Hinterkammerlinse durchgefuhrt worden. In vier Fallen war vor dem Auftreten der Subluxation der Nachstar mittels YAG-Kapsulotomie entfernt worden. Keiner der Patienten hatte abgesehen vom Pseudoexfoliationssyndrom einen weiteren Risikofaktor fur eine Schwache der Zonulafasern. Die Dislokationen der Hinterkammerlinsen waren ohne vorhergehendes Trauma aufgetreten, bei einem Patienten war es zu einer sekundaren Druckerhohung bei vorbestehendem Glaukom gekommen. Die subluxierte Hinterkammerlinse wurde in allen funf Fallen mit dem Kapselsack entfernt und durch eine kammerwinkelgestutze Vorderkammerlinse ersetzt. Schlussfolgerung: Moglicherweise besteht fur Patienten mit Pseudoexfoliationssyndrom nicht nur intraoperativ ein erhohtes Risiko fur Komplikationen bei Kataraktoperation, sondern auch fur eine spate spontane Zonulolyse. Diese erst in letzter Zeit beobachtete Spatkomplikation sollte bei der operativen Planung fur diese Patienten mitberucksichtigt werden. Eventuell konnten die Patienten von einer sulkusfixierten Hinterkammerlinse profitieren. Purpose: Pseudoexfoliation syndrome (PEX) is associated with zonular weakness and a higher frequency of intraoperative complications during cataract surgery, including rupture of the posterior lens capsule, zonular dialysis and a rise of intraocular pressure occurring postoperatively. Delayed dislocation of an IOL is a rarely reported phenomenon. Patients: Within one year, late dislocation of the lens capsule with the in the bag fixated IOL was observed following cataract surgery in five patients (67, 74, 79, 90 and 92 years old) with pseudoexfoliation syndrome. Results: All patients had an uneventful in the bag implantation of the IOL 6 (three patients), 3 and 11 years ago, respectively. Postoperatively occurring secondary cataract was treated by a YAG-capsulotomy in four cases. No patient had any other predisposing factors that would lead to zonular weakness besides the pseudoexfoliation syndrome. The dislocation of the IOL and capsule occurred spontaneously. In one patient with preexisting glaucoma, the dislocation was followed by an increase of intraocular pressure. All cases were successfully treated with IOL explantation, anterior vitrectomy and placement of an anterior chamber IOL. Conclusion: Patients with pseudoexfoliation syndrome undergoing cataract surgery may be at risk not only for intraoperative complications but also for delayed spontaneous dislocation of the IOL and capsule. This possible complication should be considered in surgical planning for patients with pseudoexfoliation syndrome. In these patients it may be better to implant the IOL in the ciliary sulcus.

Central serous chorioretinitis serosa is repeatedly brought into aetiological considerations with a rather unspecific concept of distress. Depressive disorder represents a specific stressor, which is known in cardiology or diabetology as a significant risk factor. In the present case report, the clinical correlation between a central serous chorioretinitis and a depressive disorder is shown from a psychosomatic point of view, comparing a sequentially-reactive understanding of the disorder complex with a preferable model of simultaneous entanglement.

Ocular manifestations can be the presenting symptom of hematological diseases. Ocular changes can be found in up to 90% of the patients depending on the underlying disease. Most patients with ocular manifestations however are asymptomatic. Hematological disorders can manifest in all structures and adnexa of the eye. The most common manifestations are conjunctival pallor and hemorrhages, intraretinal hemorrhages and cotton wool spots. Retinal infiltrates, manifestations in the lids, anterior segment, optic nerve, orbit and adnexa are rare. Different ocular manifestations in anemia, leukemia, malignant Non-Hodgkin lymphoma, Hodgkin's disease, chronic myeloproliferative diseases, plasmocytoma, myelodysplastic syndromes, coagulopathies, and reticulo-histiocytic diseases are described. Not only the underlying disease but also chemotherapy, bone marrow transplantation can lead to ocular complications.

Background Pseudoexfoliation syndrome (PEX) is associated with an increased risk for the development of capsular fibrosis including capsular phimosis. A complete occlusion of the anterior capsular opening is, so far, a rarely reported phenomenon. Patient Here we report the case of a 75-year-old female patient who suffered from a secondary open-angle glaucoma caused by PEX. Three months after an uneventful cataract surgery with capsulorhexis, phakoemulsification and implantation of a posterior chamber lens (PMMA) the anterior capsular opening of her left eye was completely occluded. Results The patient reported a slow loss of vision (20/40 immediately after cataract surgery to 20/200 at the follow-up visit three months later). The examination revealed a complete closure of the capsulorhexis with thick, central fibrous material. The diameter of the capsulorhexis was extensively diminished. Reopening of the anterior capsular opening utilizing a YAG laser was achieved and visual acuity increased to 20/40. Additionally, the fibrotic, secondary cataract of the posterior capsule was removed, again with a YAG laser, five weeks after the first intervention and, now with a free optical axis, the patient's visual acuity increased further to 20/30. Conclusion The excessive production of fibrosis and the tendency towards a shrinkage of the diameter of the capsulorhexis postoperatively in patients with PEX may lead to a complete occlusion of the capsulorhexis. Even in such extreme cases, the reopening of the anterior and posterior capsule by a YAG laser is possible and, as demonstrated here, leads to a morphologically and functionally satisfying result.

Hintergrund Die Dokumentation und Qualitatssicherung bei der Behandlung von ca. 9000 ambulanten sowie uber 3000 stationaren Patienten pro Jahr erfordert eine Standarderfassung und eine einfache Auswertungsmethode mit Einbeziehung aller behandlungsrelevanten Daten. Die ca. 3000 Laserbehandlungen und die vorausgehenden ca. 1100 fluoreszenzangiographischen Untersuchungen pro Jahr in der Augenklinik Ulm setzen ein flexibles EDV-System voraus.

This article reviews literature regarding tumors and tumor-like lesions of the conjunctiva and cornea as published in 1995. Causative and prognostic factors, as well as treatment options, are discussed. Ocular surface squamous neoplasia has been suggested as an "umbrella" term for dysplastic and carcinomatous lesions of the cornea and conjunctiva. Squamous cell carcinoma shows a higher incidence in patients with AIDS. A high prevalence (36%) of primary acquired melanosis is reported in one article, and the need for biopsy of all these lesions is questioned. Reviews of conjunctival myxoma, corneal pyogenic granuloma, and limbal juvenile xanthogranuloma are also included. The pathogenesis and newer treatment options for pterygia are discussed. Simple excision or resection of the pterygium followed by conjunctival autografting or intraoperative or postoperative mitomycin C application seems to be equally effective in reducing the rate of recurrence.

Foldable intraocular lenses (IOLs) are established in ophthalmic surgery and increasingly more complex geometries are available. This study investigates different designs of the optics of the IOL as well as the imaging quality of these optics utilizing electron microscopic photographs and mathematical approximations.Included in this study were two different lens powers of common IOLs (+ 13 D and + 26 D). All studied IOLs were processed depending upon their water content: Aqueous IOLs with up to 25 % water content were fixed with 2.5 % glutaraldehyde in 0.1 M phosphate buffer (mPP), and then contrasted with 2 % OsO (4) and processed in an alcohol series of 30 - 100 % propanol. Subsequently, the IOLs were transferred into EPON (epoxy resin) and polymerization took place at 60 degrees C. After hardening, the samples were cut out with a leaves saw and divided into halves. Afterwards these were polished with glass and diamond knifes at the ultramicrotom (Ultracut, Rückert-Jung). After coal vaporization measurement took place in the scanning electron microscope (DSM 962, Zeiss). In the case of dry stored IOLs, the samples were sputtered with Au-Pd 20 nm and afterwards measurement was performed as described above. The measurement of the optical imaging quality was performed with correctly and inversely oriented IOLs according to the standard EN ISO 11979 -- 2 by means of a measuring system which works on the basis of the point spread function (PSF) and/or the modulation transfer function (MTF). From this the Strehl ratio was computed in each case.Utilizing a correlation of the electron microscopic investigation of the optics of different IOLs with their imaging quality (Strehl ratio), we were able to show that the optical design of the IOL has substantial influence on the imaging quality of an intraocular lens. In particular, with non-symmetrical designs of the optics (e. g., AR40 e; AMO) the orientation of an IOL in the eye is crucial; i. e., the Strehl ratio increased thereby from 0.68 to 0.87.The design of asymmetrical optics is crucial and much attention should be paid to the fact that the imaging quality can substantially be affected. A correct orientation of the lens within the eye is very important with these asymmetrical optics.

Today, for the preparation of donor and recipient cornea during keratoplasty either single-use or reusable metal trephines are commonly used although excimer and femtosecond laser systems are available. Due to the surgical techniques as well as the configuration of metal trephine's cutting edge irregular corneal surfaces may be induced. These will result in a postoperative astigmatism. Contemporary manufacturing processes do allow for the production of minimal cutting edge diameters (400 nm -- 1 microm), however, this is related with a reduced mechanical stability of such delicate cutting edges. It has been observed that the cutting edge of metal blades is immediately bent with the first exposure to tissue. As a result, the cutting forces are increasing and the wound configuration is negatively effected. Due to the complex geometry of trephine cutting edges, no diamond trephines are currently available. We are investigating the cutting performance of conventional trephines that were modified using nanotechnology.Different metal trephines were characterised using a scanning electron microscope (SEM). The diameter of the cutting edge was measured. Pig cornea were studied histologically after trepanation. Selected trephines were ion-forged in a modified PVD (physical vapour deposition) reactor using highly accelerated ions which are concentrated by magnetic fields at low temperature. The consecutive processing steps were controlled by SEM analysis of the cutting edge diameters. Randomly chosen areas of treated trephines were analysed. After processing the trephines, pig cornea were cut and analysed by histological and SEM examination. Additionally, the relevant mechanical cutting parameters of untreated as well as treated trephines were measured when penetrating into a PU (polyurethane) foil.Preliminary microscopic analysis already reveals differences in the quality of the cutting edges. The nanotechnological modification of the cutting edges does not result in larger diameters. Compared with the initial cutting edges, the optical analysis of the modified trephine cutting edges reveals subjectively smoother surfaces. The force measurements prove a reduction of cutting forces for the treated trephines compared to the untreated ones. The SEM analysis show for the cornea treated with the modified trephines a subjectively smoother surface. Histology reveals that the surfaces of the treated cornea do not exhibit a smooth and unidirectional structure. This divergence became larger when untreated trephines were used. The mechanical characterisation of the treated trephines resulted in harder and longer-lasting surfaces.The newly developed ion-forging of trephines in combination with nanostructured carbon coatings yield complex cutting edges of higher stability with diamond-like properties. This study shows that the performance of laser trepanation cannot be reached; however, the use of nanotechnology can further improve manual trephine techniques.

The subjective and objective results during the training phase of phacoemulsification using a 6 mm sclero-corneal tunnel incision at 12 h were evaluated.In a prospective study we evaluated the first 221 cases of phacoemulsification by a cataract surgeon during his training phase. Objective parameters which were analyzed included intraoperative complications, preoperative, early postoperative (p. o.) (1 - 13 days) and late p. o. (to the third month) assessment of refraction, visual acuity and corneal astigmatism. Calculation of the induced astigmatism was performed using the subtraction method and the vector analysis according to Jaffé. For evaluation of subjective results we used a questionnaire in the late p. o. phase. The questionnaire contained questions concerning satisfaction with the explanation of the surgical procedure, the medical personnel, the procedure itself and the result of the operation.During surgery, 6 posterior capsular ruptures (2.7 %) and 3 zonular dialyses (1.4 %) occurred. In 6 cases (2.7 %) an anterior vitrectomy was necessary, in two cases (0.9 %) an anterior-chamber lenses had to be implanted. Preoperatively, the average visual acuity was 0.5 +/- 0.14 (n = 221), the early p. o. visual acuity was 0.49 +/- 0.23 (n = 220) and the late p. o. visual acuity was 0.73 +/- 0.31 (n = 121). The average spheric equivalent was early p. o. 0.04 D +/- 1.18 D (n = 208) and late p. o. 0.11 D +/- 1.08 D (n = 118). The difference to the planned refraction was early p. o. 0.68 D +/- 1.13 D, and late p. o. 1.39 D +/- 1.18 D. The mean induced astigmatism early p. o. was 0.55 D +/- 0.97 D (n = 166) and late p. o. 0.37 D +/- 0.87 D (n = 121) (subtraction method). Utilizing vector analysis for calculation of the induced astigmatism we obtained 1.43 D +/- 0.86 D (n = 121) for the early p. o. situation and 1.22D +/- 0.88 D (n = 121) for the late p. o. situation, respectively. 80 % of the patients (n = 119) were satisfied with the results (highest rating), 3 % were unhappy (lowest rating).The results of this study reveal that phacoemulsification is a safe and satisfactory procedure for patient, even during the training phase of a cataract surgeon.

Postoperative hyperopia is a frequent result of cataract surgery in eyes after previous myopic kerato-refractive surgery. One reason for the underestimation of intraocular lens (IOL) power is the wrong corneal refractive power measurement obtained by keratometers and corneal topography systems after LASIK. The aim of this study was to compare the precision of measurements of three different keratometers after LASIK.We studied 58 eyes of 34 refractive patients aged between 20 and 51 years. The preoperative measurements and the measurements one month after LASIK were performed with the Keratometer (Zeiss), the corneal topograph (EyeSys Technologies) and the IOL-Master (Zeiss). We compared our postoperative measurement results obtained with the three keratometers with the results obtained by using the clinical history method (chm).The smallest mean deviation was achieved with the IOL-Master (measured mean +/- SD: 38.94 +/- 1.88 D, vs. chm: 38.35 +/- 2.13 D). The Keratometer (Zeiss) showed a larger deviation (measured: 39.12 +/- 1.76 D, chm 38.34 +/- 2.07 D) and the largest deviation was shown with the corneal topograph (measured: 39.84 +/- 1.85 D, chm: 38.86 +/- 2.10 D), which measured in mean one diopter higher than what was obtained utilizing the chm. A positive correlation between corrected myopia and the postoperative difference between the measured and calculated value for each keratometer was found.This study demonstrates that with common keratometers central corneal power is measured too high after LASIK. For IOL calculation in patients after LASIK, the wrongly positive deviation from measured central corneal power has to be taken into account.

Pseudoexfoliation syndrome (PEX) is associated with an increased risk for the development of capsular fibrosis including capsular phimosis. A complete occlusion of the anterior capsular opening is, so far, a rarely reported phenomenon.Here we report the case of a 75-year-old female patient who suffered from a secondary open-angle glaucoma caused by PEX. Three months after an uneventful cataract surgery with capsulorhexis, phakoemulsification and implantation of a posterior chamber lens (PMMA) the anterior capsular opening of her left eye was completely occluded.The patient reported a slow loss of vision (20/40 immediately after cataract surgery to 20/200 at the follow-up visit three months later). The examination revealed a complete closure of the capsulorhexis with thick, central fibrous material. The diameter of the capsulorhexis was extensively diminished. Reopening of the anterior capsular opening utilizing a YAG laser was achieved and visual acuity increased to 20/40. Additionally, the fibrotic, secondary cataract of the posterior capsule was removed, again with a YAG laser, five weeks after the first intervention and, now with a free optical axis, the patient's visual acuity increased further to 20/30.The excessive production of fibrosis and the tendency towards a shrinkage of the diameter of the capsulorhexis postoperatively in patients with PEX may lead to a complete occlusion of the capsulorhexis. Even in such extreme cases, the reopening of the anterior and posterior capsule by a YAG laser is possible and, as demonstrated here, leads to a morphologically and functionally satisfying result.

Pseudoexfoliation syndrome (PEX) is associated with zonular weakness and a higher frequency of intraoperative complications during cataract surgery, including rupture of the posterior lens capsule, zonular dialysis and a rise of intraocular pressure occurring postoperatively. Delayed dislocation of an IOL is a rarely reported phenomenon.Within one year, late dislocation of the lens capsule with the in the bag fixated IOL was observed following cataract surgery in five patients (67, 74, 79, 90 and 92 years old) with pseudoexfoliation syndrome.All patients had an uneventful in the bag implantation of the IOL 6 (three patients), 3 and 11 years ago, respectively. Postoperatively occurring secondary cataract was treated by a YAG-capsulotomy in four cases. No patient had any other predisposing factors that would lead to zonular weakness besides the pseudoexfoliation syndrome. The dislocation of the IOL and capsule occurred spontaneously. In one patient with preexisting glaucoma, the dislocation was followed by an increase of intraocular pressure. All cases were successfully treated with IOL explantation, anterior vitrectomy and placement of an anterior chamber IOL.Patients with pseudoexfoliation syndrome undergoing cataract surgery may be at risk not only for intraoperative complications but also for delayed spontaneous dislocation of the IOL and capsule. This possible complication should be considered in surgical planning for patients with pseudoexfoliation syndrome. In these patients it may be better to implant the IOL in the ciliary sulcus.

Infectious endophthalmitis is a serious complication following cataract surgery, since it often induces a substantial reduction of visual acuity.We retrospectively evaluated the clinical data of 53 patients with endophthalmitis following cataract surgery who were treated at the department of ophthalmology of the University Hospital in Ulm between 1995 and May 2001. Of these patients, 50 had been referred. Clinical presentation, infecting organism, treatment and visual outcome were analysed with a followup ranging from 2 weeks up to 42 months (median: 6 months).In 52 patients endophthalmitis was preceeded by cataract extraction and IOL implantation, in one case by secondary IOL implantation. Confirmed microbiologic growth was demonstrated from intraocular specimens in 26 out of 41 operated eyes (63%), the most frequent causative organisms were coagulase-negative Staphylococci (50%). All isolated bacteria were sensitive to a combination of the antibiotics vancomycin and amikacin or vancomycin and ceftazidime. 13 patients were treated with intravenous antibiotic therapy alone. In 46% of patients, who were initially treated with intraocular antibiotic injections alone, required further therapeutic intervention for recurrent infection. Only 7.7% of the patients who initially underwent intraocular antibiotic injections combined with IOL removal or pars plana vitrectomy with or without IOL removal, required further surgical intervention. Initial visual acuity was hand movements (median) only but improved during follow-up to 0.2 (median).In this series all tested bacteria were susceptible to the combination of vancomycin with either amikacin or ceftazidime. Aggressive initial treatment including IOL removal may be associated with a lower frequency of recurrent disease.

It is thought that a high optical density of xanthophyll has a protective effect against the development of aggregated macular degeneration. The aim of this study was to investigate whether an increase of the optical density of xanthophyll in the macula after a supplementation of lutein can be proven by objective methods. Most methods applied for the determination of the macular pigment require the co-operation of the proband and the ability for foveal fixation.Imaging spectrometry and the evaluation of laser scanner images taken at 488 nm will be presented. In contrast to psychophysical methods, both methods are independent of the patients ability for foveal fixation.Even by evaluation of laser scanner images taken as in fluorescence angiography but without inserting the blocking filter, the 2-dimensional distribution of xanthophyll can be determined. In 10 probands taking 6 mg lutein daily over 40 days, an increase of the optical density could be determined at least in some probands. The optical density reached a plateau 30 days after starting the supplementation of lutein.The assumed protective effect of xanthophyll against age-related macular degeneration can be influenced by supplementation of lutein under objective control.

Klassifikationsbemuhungen zur Bestimmung der quantitativ festgestellten Resttumorgrose sind in der Neuroonkologie derzeit ungebrauchlich. Die klinischen Angaben benutzen in der Regel die Ausdrucke totale oder partielle Entfernung. Als Nachweis eines Resttumors gilt die postoperative Darstellung durch bildgebende Verfahren, moglichst am 1. postoperativen Tag. In der Regel wird eine weitgehende Tumorentfernung angestrebt, aber auch dann wird bei den genuinen Hirntumoren davon ausgegangen, dass der Tumor nicht vollstandig entfernt ist. Eine partielle Resektion wird durchgefuhrt, wenn der Tumor in vitale und/oder eloquente Regionen reicht. Zur Bestimmung dieser Regionen sind neben der allgemeinen Loka- lisationslehre auch moderne Methoden gebrauchlich. Wird ein Tumor stereotaktisch angegangen, kann durch die operative Methode allein keine nennenswerte Volumenreduktion erzielt werden.

Als Tumoren der Orbita sind jene der Weichteile der Orbita, jedoch ohne Augapfel, N. opticus und Augenanhangsgebilde (Tranendruse und ableitende Tranenwege) und jene der knochernen Wand der Orbita (einschl.Periost) zusammengefasst.

Wichtigste Prognosefaktoren sind histologischer Typ und anatomische Ausbreitung. Die beste Prognose haben Basalzellkarzinome. Plattenepithelkarzinome, Karzinome der Haarfollikel und Schweisdrusen-Adenokarzinome weisen eine intermediare Prognose auf. Die schlechteste Prognose zeigen Talgdrusen- und Merkelzell-Karzinome.

Wichtigste Prognosefaktoren sind Lokalisation, anatomische Ausbreitung und Melanomtyp. Irismelanome sind prognostisch am gunstigsten (Mortalitat nur 3-5%), Ziliarkorpermelanome ungunstiger als solche der Choroidea (Zehnjahresuberlebensraten ca. 50 vs. ca. 70%). Die Prognose ist am gunstigsten beim Typ B und nimmt in der Reihenfolge gemischtes Epitheloid-Spindelzellmelanom und Epitheloidzellmelanom ab (Zehnjahresuberlebensraten ca. 80, ca. 60 und ca. 40%).

Bereits 1977 wurde vom American Joint Commitee for Cancer Staging and End Results Reporting in der 1. Auflage des Manual for Staging of Cancer (American Joint Committee 1977) eine TNM-Klassifikation fur Hirntumoren publiziert. 1987 hat auch die UICC erstmals in der 4. Auflage des TNM- Systems eine mit dem American Joint Comittee on Cancer (AJCC) abgestimmte TNM-Klassifikation fur Hirntumoren veroffentlicht (UICC 1987). In der derzeit gultigen 5. Auflage des TNM-Systems (American Joint Committee 1997; UICC 1997) wurde mit folgender Begrundung darauf verzichtet, die Hirntumoren aufzunehmen: „Die Klassifikation der Hirntumoren, die in der 4. Auflage erstmals aufgenommen wurde, ist in dieser Auflage gestrichen worden, da sie nicht sehr hilfreich fur die Vorhersage der Prognose war. Die Tumorgrose (T) ist weit weniger wichtig als die Tumorhistologie und Lokalisation. Das Alter der Patienten, die Funktion, der neurologische Status und das Ausmas der Resektion werden ebenfalls fur wichtige Prognosefaktoren gehalten“.

Grundsatzlich ist bei den Tumoren des zentralen Nervensystems zwischen Tumoren kranialer und spinaler Lokalisation zu unterscheiden. Es ist selbstverstandlich, dass dies Implikationen fur die Diagnostik hat. Eine Zwischenstellung nehmen die Tumoren des kraniozervikalen Ubergangs ein, die ein Mischbild aus zerebraler/kranialer und medullarer/spinaler Symptomatik bieten konnen und daher ein weniger charakteristisches klinisches Bild bewirken.

Die Symptomatik der Lungenkarzinome ist uncharakteristisch und unterscheidet sich zunachst nicht von der vieler anderer Lungenkrankheiten. Diagnostik und Staging des Lungenkarzinoms erfordern ein Untersuchungsprogramm, das die individuelle subjektive und objektive Belastbarkeit des Patienten berucksiehtigen muss. Es dient nieht nur der Sieherung der Diagnose und der Beurteilung der Tumorausdehnung, sondern ermoglicht zusatzlich eine Beurteilung der Belastbarkeit des Patienten fur das zu wahlende Therapieverfahren. Eine Unterteilung der diagnostischen Verfahren in eine standardi sierte Basisdiagno stik und eine weiterfuhrende Diagnostik hat sich bewahrt (Deutsche Krebsgesellschaft 2002a, b).

Sowohl bei Biopsien als auch bei Tumorresektionen empfiehlt sich fur die Information des Pathologen das in Abb. 7.1 dargestellte Formblatt.

Karzinome der Appendix werden (ausgenommen gut differenzierte EC-Zell-Karzinome [maligne Karzinoide]) nach UICC (2001,2002) in gleicher Weise wie Karzinome von Kolon und Rektum im TNM-System klassifiziert, jedoch soll die statistische Auswertung getrennt von den kolorektalen Karzinomen erfolgen. Nach AJCC (Fleming et al. 1997) soll das TNM-System fur Appendixkarzinome nicht angewendet werden. Als Ursache fur diese Sonderstellung ist die besondere Ausbreitungsweise in Form des Pseu-domyxoma peritonei bei den haufigsten Appendixkarzinomen, den gut differenzierten muzinosen Adenokarzinomen, anzufuhren. Das Pseudomyxoma peritonei ist nach der TNM-Klassifikation als Fernmetastasierung (Ml bzw. pMl) zu klassifizieren, jedoch ist die Prognose hierbei im Vergleich zu allen anderen Patienten mit Fernmetastasen ganz auffallig gunstiger (Funfjahresuberlebensraten 51 vs. 0% (Thomas u. Sobin 1995).

Als maligner Tumor des extrakraniellen N. opticus (Lokalisations-Code-nummer C72.3) wird in der WHO-Klassifikation der Tumoren des Auges und seiner Anhange (Campbell 1998) nur das Glioblastoma (multiforme) (Synonym High-grade-Astrozytom, ICD-O-Codenummer 9440/3) ange-fuhrt. Naheres hierzu s. S. 33. Es handelt sich urn einen seltenen hochmalignen Tumor (WHO-Grad IV) des Erwachsenen. Stets sollte ausgeschlossen werden, dass es sich nicht urn die Ausbreitung eines entsprechenden Prirnartumors des Frontallappens in den N. opticus handelt. Eine TNM-Klassifikation ist fur diesen Tumor nicht vorgesehen.

Jede pathologische Untersuchung exzidierter Tumoren hat Aussagen zur Beschaffenheit der Resektionsrander zu liefern. Zur Identifikation der tatsachlichen Resektionsrander in den histologischen Schnitten empfiehlt sich deren Markierung durch Tipp-Ex oder Tusche. R1 wird diagnostiziert, wenn sich Tumorgewebe direkt am Resektionsrand befindet. Nach den Regeln der UICC wird Rl nur diagnostiziert, wenn histologisch Tumor direkt an der Resektionslinie gefunden wird (Schnitt durch Tumorgewebe) (UICC 2001). Es empfiehlt sich aber bei R0-Fallen,bei denen der Tumor nur 1 mm oder weniger von der Resektionslinie entfernt ist, diesen Befund zu dokumentieren (Tumor „nahe an Resektionsrand“). Als invasiver Tumor an den Resektionslinien werden sowohl kontinuierliche Primartumorauslaufer als auch diskontinuierliche Tumorherde (sog. Satelliten) und etwaige durchtrennte Lymphknotenmetastasen berucksichtigt. Tumorzellen in Lymph- und Blutgefasen am Resektionsrand werden nur dann als R1 klassifiziert, wenn sie Kontakt mit dem Endothel oder Invasion der Gefaswand zeigen. Andernfalls werden sie als in Lymphe oder Blut frei zirkulierende Tumorzellen in der R-Klassifikation nicht erfasst (Wittekind et al. 2001). Werden fur die R-Klassifikation spezielle Methoden verwendet, z. B. zusatzliche Imprintzytologie der Resektionsrander, soll dies gesondert dokumentiert werden. Der Nachweis isolierter (disseminierter) Tumorzellen in regionaren Lymphknoten, Knochenmarkbiopsien, anderen Fernorganen oder Blut beeinflusst die R-Klassifikation nicht. Entsprechende morphologische (z. B. zytologische oder immunhistochemische) Befunde werden durch den Zusatz „(i-)“ oder „(i+)“, molekularpathologische Befunde durch den Zusatz von „(mol-)“ oder „(mol+)“ dokumentiert, z. B. R0(i+) oder R0(mol-) (Hermanek et al.1999; UICC 2001).

Metastatic cancer of the iris is rare. We report a case of breast carcinoma which metastasized to the iris and a review of the literature.A 60-year-old woman with a history of breast carcinoma presented with lesions of the iris 5 years after diagnosis and tumor excision. In addition to slit-lamp examination including gonioscopy, ultrasound biomicroscopy, positron-emission tomography and fluorescein angiography of the iris were used for diagnosis. Furthermore, the literature was searched using the medline database.The iris metastasis exhibited multiple whitish to pink nodules on the inferior half of the iris and infiltration of the chamber angle. The main tumor mass was prominent and highly vascularized. Best corrected visual acuity was 20/40 and the intraocular pressure was 7 mmHg. Ultrasound biomicroscopy showed lobular masses characterized by mid to low reflectivity and there was no distinct border to the surrounding tissue. Fluorescein angiography of the iris showed tumor vessels with dye leakage. The positron-emission tomography displayed metastatic lesions to the liver, lung, bones and lymph nodules in addition to the lesion of the iris. The review of the literature revealed that breast carcinoma leads to choroidal metastases in 5% of cases and iris metastases are even rarer. In twothirds of these cases the lesions form unilateral whitish to red clumps at the horizontal meridian and in the inferior quadrants of the iris. The preferred treatment is chemotherapy and/or radiation therapy.Breast carcinoma is rarely associated with iris metastasis. Positron-emission tomography is a sensitive diagnostic tool to identify metastatic lesions and is a useful method for planning therapeutic approaches. Radiation therapy, argon laser treatment and block excision are therapeutic options with an isolated metastasis of the iris.

Evulsion of the optic nerve is a rare form of traumatic optic neuropathy. It is a rupture of the optic nerve at the disc without damage of its sheaths occurring in association with a blunt skull trauma or a blunt bulbar trauma.We searched the literature using Medline database for all articles with evulsion of the optic nerve. The bibliographies of the papers found therein were used to get a complete review. The data were analyzed with special regard to age, sex, mechanism of injury, and (if available) defects of visual field.Sixty-three patients with a mean age of 22 years (range 4 to 60 years) were included in the study. In 22 patients (35 %) a partial and in 41 patients (65 %) a complete evulsion was present. In 31 patients (49 %) the cause was a small blunt object or finger that stroke the eye or entered the orbita. In 19 patients (30 %) a severe blunt skull trauma had occurred. The analysis of visual fields in eyes with partial evulsion of the optic nerve revealed a defect in the superior visual field in 6 of 12 patients and a defect in the inferonasal visual field in 3 of 12 patients.Our review suggests that the most common mechanism of injury is a severe rotation of the eye leading to rupture of the optic nerve fibers and an anterior displacement of the bulbus, possibly with deformation of the posterior eye walls.

Ferry et al. (8) showed that 35 % of eyes which have been enucleated because of a clinically suspected malignant iris lesion did not reveal a histologically malignant iris tumor.A 43-year old male presented with a blind, painful left eye, which has developed over a time period of 6 months. Ophthalmologic examination revealed the presence of pigmented iris stromal lesions associated with diffuse pigmentation of the chamber angle and the development of absolute glaucoma. A diffuse iridociliary malignant melanoma (ring melanoma) was suspected and the blind painful eye was enucleated. Histologic examination revealed the presence of a benign melanocytic lesion, i.e. a spindle cell nevus of the iris with surface plaques causing diffuse extension of the chamber angle, trabecular meshwork, Schlemm's canal, and the ciliary body.The malignant potential of iris lesions may be difficult to assess on clinical grounds only. Histologically, benign melanocytic proliferation may cause diffuse extension into the ciliary body as well as the chamber angle leading to an increase in intraocular pressure. In order to reach a final diagnosis a biopsy of the lesion is necessary.

Brachytherapy is a well established procedure for treatment of malignant choroidal processes. Approximately 5 % of the cases, will show local recurrences within 6 years. We report a patient who has developed a malignant transformation of an uveal nevus following brachytherapy of a non-contiguous uveal melanoma. In addition, we reviewed the literature concerning similar cases.In 1991 a Ruthenium application was performed on a 65-year old patient suffering of an equatorial malignant choroidal melanoma. At that time, a nevus at the posterior pole was present. From 1997 to 1998 the nevus continuously increased in size. Visual acuity decreased and a retinal detachment developed. Combining the clinical and the sonographic findings, the diagnosis of a malignant melanoma arising of a nevus was established. Enucleation was performed in 1998.Histologic examination revealed the diagnosis of an epithelioid-cell-type malignant uveal melanoma arising in a nevus. Till now, the patient is free of metastatic disease.Non-contiguous development of uveal melanomas in the same eye are extremely rare. We could identify in the literature 5 cases of non-contiguous melanomas following brachytherapy of an uveal melanoma. In none of these cases, the secondary melanoma has arisen in a nevus. Follow-up examination of patients with uveal melanoma treated with brachytherapy should include not only examination of the treated area, but also the whole fundus of the eye in order to recognize secondary tumours as early as possible.

The long-acting somatostatin analogue octreotide is used as a therapeutic option for patients with diabetic retinopathy and age-related macular degeneration. Growth factors, such as EGF, bFGF, VEGF, and PDGF, have been implicated in the pathogenesis of these diseases. The aim of this study was to investigate the effect of octreotide on the growth-factor-induced proliferation of bovine retinal pigment epithelial (RPE) cells in vitro.RPE cells were assayed for proliferation as measured by (3H)-thymidine uptake (ccpm). Bovine RPE cells at passage 3-8 were seeded in a 96-well plate and incubated for a 24-h period with a minimum medium followed by a 24-h incubation with the different growth factors at a concentration of 10 ng/ml with and without 5 x 10(-5) M octreotide. In a different assay the cells were incubated with octreotide at 5 x 10(-10)-5 x 10(-4) M. Afterwards the cells were pulsed with 5 microCi/ml (3H)-thymidine for 12 h, and the incorporated radioactivity was measured on glass fiber filters in a beta-counter (mean +/- SEM ccpm). The Wilcoxon Signed Rank test and the student's t-test were used for statistical analyses.There was a biphasic effect of octreotide on RPE cell proliferation. Exposure of RPE cells to PDGF (20,225 +/- 3304 ccpm) and bFGF (3441 +/- 539 ccpm) resulted in a significantly higher proliferation compared to control medium (1543 +/- 352 ccpm) (p0.05). No difference was found for EGF (2385 +/- 383 ccpm). For VEGF (776 +/- 83 ccpm) a significant reduction in RPE cell proliferation was found (P0.05). There was a significant reduction in proliferation of RPE cells with PDGF, bFGF, and EGF in combination with octreotide versus growth factors alone (octreotide in combination with PDGF 308 +/- 82 ccpm, with bFGF 229 +/- 88 ccpm, with EGF 2362 +/- 91 ccpm) (p0.005). VEGF in combination with octreotide resulted in a significant inhibition of RPE cell proliferation compared to VEGF alone (p0.0005).The data suggest that there is an inhibitory effect of octreotide on RPE cell proliferation of bovine RPE cells and on the increased proliferation of bovine RPE cells induced by PDGF and bFGF. An enhanced inhibitory effect is found for the combination of octreotide and VEGF.

In addition to elevated intraocular pressure, a compromised ocular blood supply has been implicated in the pathogenesis of primary open-angle glaucoma (PCOG).We analyzed 20 eyebank eyes with end-stage PCOG and compared these with 20 age-matched controls. The following variables were measured: density and diameter of large choroidal vessels in the macular and equatorial choroid; thickness of the choroid in the macular and equatorial region; and density and thickness of choriocapillaris in the macular, peripapillary, and equatorial choroid.Eyes with glaucoma displayed a lower density of the capillaries of the choriocapillaris than control eyes in the macular, temporal peripapillary, and equatorial choroid, with 0.50 vs. 0.55 (P = 0.018), 0.46 vs. 0.51 (P = 0.016), and 0.50 vs. 0.55 (P = 0.038), respectively. Assessment of large choroidal vessels in the macular choroid showed that eyes with glaucoma had less density of veins (11.7 vs. 38.9/mm2; P0.001) and arteries (7.7 vs. 12.4/mm2; P = 0.005) and arteries with a higher diameter (45.6 vs. 28.2 microns; P0.001) than control eyes. The large vessels in the equatorial choroid displayed no significant difference in diameter but a lower density (21.2 vs. 44.1/mm2; P = 0.017) in eyes with glaucomatous damage than controls.Eyes with advanced glaucomatous damage after long-standing PCOG exhibit many changes in the choroidal vasculature. We cannot conclude from our study whether the observed vascular changes in the choroid are primary pathogenic factors or secondary phenomena.