Aim: To compare collared silicone punctal plugs to intracanalicular SmartPlugs for the treatment of moderate to severe dry eye.Materials and methods: In this prospective, randomized, single blind, clinical study, 30 patients (60 eyes) who had been diagnosed with moderate to severe dry eye syndrome were enrolled. Study group I (n = 30 eyes) received collared silicone punctal plugs and group II (n = 30 eyes) received intracanalicular SmartPlugs. Data for the Schirmer I test, tear break-up time, vital staining, subjective symptoms and frequency of artificial tear application were recorded at baseline and 3 months after punctal occlusion.Results: There was no statistical significant difference for these values between group I and II.Conclusions: Although published data show free flow with irrigation and probing after SmartPlug insertion, the clinical effect in the treatment of dry eye appears to be the equally well to collared silicone punctal plugs. It seems likely that difference of design and localization between the treatment groups were of minor importance concerning impeding of natural and supplemental moisture.

Die Leitlinien der Kommission für Okuloplastik (Orbita + Dakryologie) sollen einen systematischen Überblick über konservatives und chirurgisches Management von Lid-, Orbita-, und Tränenwegserkrankungen geben. Lidfehlstellungen sowie Tumoren der Lider und der Orbita werden klassifiziert und diagnostische Verfahren und Therapieformen der Lid-, Orbita-, und Tränenwegschirurgie werden dargestellt. Außerdem wird ein Überblick über die ästhetische Lidchirurgie und die Indikationen dafür gegeben, und die konservative und chirurgische Therapie der Endokrinen Orbitopathie beschrieben. Ein abschließendes Kapitel informiert über die aktuellen Therapiemöglichkeiten beim Trockenen Auge.

A 53-year-old woman with modest protrusion of the right eye was referred to our outpatient department from the ophthalmology department. She had been noticing blurred vision for the previous 2 years and was referred by her ophthalmologist because of optic nerve atrophy. The patient’s vision at the time was 20/20, and she reported moderate double vision. On examination, a loss of red/ green perception, decreased contrast sensitivity, and a small central scotoma in the visual field were observed. Magnetic resonance imaging (MRI) showed a 4.5 1.5 –cm intraconal mass medial to the lateral rectus muscle nd dorsal to the orbit, with extension to the superior rbital fissure (Fig 1). The optic nerve was displaced medilly but showed no morphologic alteration. However, intraranial changes could not be excluded. Computed tomogaphy was used to plan an interdisciplinary approach with he neurosurgeon. After a lateral orbitotomy was performed with a piezolectric osteotome, the Tenon capsule was opened through sharp incision. A firm elastic mass, which could be shifted ownward by blunt dissection, was palpated directly under he lateral rectus muscle. Directly beneath it, a vascularized, ncapsulated expansion surrounded by fat was seen (Fig 2). mmediate fresh-frozen sections were taken to confirm the enign nature of the lesion. Microscopic examination of the urgical specimens after hematoxylin-eosin staining showed ntoni A and B areas (Fig 3). The mass was dissected arefully along the enveloping tissue, up to the superior rbital fissure. To avoid further trauma to the abducens erve, the capsule was left in place. Immediately after the intervention, there was no amelioation of the ocular symptoms. Visual acuity remained at 0/20, the double vision was unchanged, the loss of color ision and decreased contrast sensitivity were still present, nd the scotoma in the visual field remained stable. For the ight eye, abduction was only possible 10° before the pri-

BACKGROUND:Intraconal tumors of the orbit are rare entities and surgical treatment is challenging. Endoscopic transnasal approaches to the orbit offer a new perspective for surgery, although only few reports exist in literature. This study displays the Graz experience with endoscopic approaches to intraorbital tumors between 2006 and 2010 introducing a novel endoscopic technique for temporary medialization of the medial rectus muscle facilitating access to the orbital cone.METHODS:A retrospective analysis of patients' charts was performed.RESULTS:For approaches to intraconal lesions a special endoscopic temporary medialization technique of the medial rectus muscle through applying transseptal sutures was developed. Six patients (four male and two female patients) have been included in this study presenting with intraconal/intraorbital tumors. Three patients underwent endoscopic surgery for two hemangiomas and one Schwannoma, respectively, and three patients were successfully biopsied endoscopically revealing one malignant melanoma, one malignant lymphoma, and one optic glioma each. Both hemangiomas were completely resected without any deterioration of vision. The Schwannoma was partially resected with postoperative imaging showing no tumor progression within 3 months. No intraoperative complications occurred. Five cases were performed with computer assisted surgery using CT/MR fusion navigation.CONCLUSION:Although technically challenging, the endoscopic approach to the orbit, even for intraconal lesions with medialization of the medial rectus muscle, can be safe and promising for well-selected cases. Good postoperative results and sufficient material acquisition for proper histological examination can be obtained. Advantages are good visualization of the surgical field and avoidance of external scars. Limitations to endoscopic techniques are tumors in the lateral superior and lateral inferior quadrant of the orbit.

PURPOSE: To determine the clinical value and relevance of punctal and proximal canalicular stenoses after punctal plug therapy in moderate to severe dry eye syndrome.DESIGN: Retrospective, observational case series.METHODS: Seventeen eyes were determined to have punctum or proximal canalicular stenoses after spontaneous loss of a collared silicone punctal plug. After initial diagnosis all patients had 12 months or more of follow,up (mean, 39; range, 12 to 87 months). The clinical data collected included gender and age of patients, localization of the stenosis, plug size, duration of punctal occlusion, subjective symptoms, objective ocular surface disease parameters, and occurrence of complications.RESULTS: A statistically significant correlation be, tween localization of the stenosis and plug size, and localization of the stenosis and duration of punctal occlusion could not be found. At follow-up, subjective symptoms (P < .01) and frequency of artificial tear application (P < .001) were significantly reduced compared to data before plug insertion. Schirmer I test results (P < .001), corneal fluorescein staining (P < .01), and rose bengal staining (P < .001) improved significantly, whereas tear break-up time (P < .2) and impression cytology scores of the conjunctival surface (P = .2) remained almost unchanged. Complications could not be found.CONCLUSION: Within the observation period of up to seven years, all stenoses remained asymptomatic. Additionally, subjective symptoms and most dry eye parameters in our study population improved. (Am J Ophthalmol 2008;146:968-972. (C) 2008 by Elsevier Inc. All rights reserved.)

dition to a mechanical, tractional relationship participates in macular hole formation, at least in some instances. The OCT images in the case reported here depict this apparently tractionless sequence more clearly than previously described. An alternative explanation is that the traction component is below the resolution of OCT. A possible mediator might be the outer wall of vitreoschisis as has been proposed by Sebag, and this may be depicted on the left side of Figure 2A and B as focal areas of minimal separation of what might alternatively be interpreted as the internal limiting membrane. Degenerative factors such as subtle defects or breaks in the internal limiting membrane (tractionally or senescently induced) may allow hydration of the fovea and distort tissue enough to form a full-thickness macular hole. This may explain why surgical removal of vitreofoveal traction does not uniformly prevent macular hole formation. The mechanisms of macular hole formation are still incompletely understood but may involve degenerative and tractional factors. A full understanding of pathogenetic mechanisms would likely optimize treatment and prevention of full-thickness macular holes.

Grundlagen: In dieser Arbeit werden die ophthalmologischen Aspekte bei Rekonstruktion von Orbitaverletzungen mittels CT-gestützten drei-dimensionalen Patientenmodell beschrieben.

Zusammenfassung Hintergrund. Eine endogene mykotische Endophthalmitis tritt meist als opportunistische Infektion im Rahmen einer Schwächung des Immunsystems sowie bei speziellen prädisponierenden Faktoren auf. Der Stellenwert einer Vitrektomie und die Kriterien der Therapiewahl werden anhand eines Falles diskutiert. Patient. Berichtet wird von einem 42-jährigen i. v. drogenabhängigen Patienten mit einseitiger Candida-Endophthalmitis. Bei der Erstuntersuchung war der Visus am betroffenen Auge 0,8, verschlechterte sich aber innerhalb von 14 Tagen trotz Therapie auf Handbewegungen. Eine Vitrektomie wurde durchgeführt. Durch Kultivierung des Vitrektomiematerials konnten die Erreger als Candida albicans typisiert werden. Die systemische antimykotische Therapie wurde weitergeführt. Die Entzündung klang vollständig ab, wegen einer postentzündlichen Narbe perifoveal konnte jedoch nur ein Visus von 0,25 erreicht werden. Schlussfolgerung. Eine Candida-Endophthalmitis stellt nicht selten eine fulminant verlaufende Erkrankung dar. Entscheidend für die Prognose sind eine rasche Diagnosestellung und eine aggressive medikamentöse Therapie, bei Notwendigkeit auch eine Vitrektomie.

Die Rhinosporidiose stellt ein in Europa sehr selten vorkommendes Krankheitsbild dar, wobei vor allem die Schleimhäute des Nasopharyngealtraktes von polypösen Veränderungen betroffen sind. Ist nur das Auge befallen, wird das Krankheitsbild als Okulosporidiose bezeichnet.

Several lines of evidence suggest that L-type calcium (Ca2+) channels play a role in excessive ethanol (EtOH) intake. In accordance with this, a considerable amount of antagonists for these ion channels has been found to suppress EtOH intake and preference in various animal models of alcoholism. The aim of the present study was to examine antialcohol effects of L-type Ca2+ channel antagonists in alcohol-preferring AA rats. These rats, a Wistar line selectively bred for a high 10% v/v EtOH preference in a free-choice situation, have thus far not been subjected to systematic investigations with Ca2+ channel antagonists. Therefore, effects on EtOH preference and intake, as well as on food and total fluid intake, were evaluated for the 1,4-dihydropyridine (DHP) derivatives nimodipine, felodipine, isradipine, nicardipine, nifedipine, and nitrendipine, as well as for the phenylalkylamine verapamil and the benzothiazepine diltiazem, utilizing a limited access, free-choice procedure. All DHPs were found to be highly effective in reducing both EtOH intake and preference, without affecting total fluid intake. Irrespective of route of application (IP or PO), the effective dose ranges were found to be very similar across compounds (10-30 mg/kg). Nevertheless, because food intake was also reduced, the effects were not completely selective. For nimodipine, the (-)-enantiomer seemed to be more effective as its (+)-enantiomer, possibly reflecting stereoselectivity at central binding sites. Compared to the DHPs, verapamil produced a similar profile of activity, but diltiazem was found to be ineffective. These results confirm and extend previous findings with L-type Ca2+ channel antagonists obtained in other models of alcoholism and suggest that this class of compounds offers an interesting approach for the pharmacotherapy of alcoholism.