Im Jahr 2000 wurden geschätzte 50 Millionen Menschen als blind entsprechend der Definition der Weltgesundheitsorganisation eingestuft. Die meisten Blinden leben in den Entwicklungsländern Asiens und Afrikas. Besonders infolge der längeren Lebenserwartung wird mit einer deutlichen Zunahme der Blinden gerechnet. Nur durch globale gezielte Programme zur Vermeidung von Blindheit können diese hohen Zahlen gesenkt werden.

Es wird über den Verlauf jener Patienten berichtet, welche nach Excimer-Laser-Behandlung gegen Myopie im Sommer 1994 schwere Entzündungen (3 × Ulcus corneae, 1× Endophthalmitis) erlitten hatten.

From October 1990 to March 1994, 90 patients entered a prospectively randomised trial in head and neck cancer. All patients had verified squamous cell carcinoma and were referred for primary radiation therapy. Tumours originated in the oral cavity in 25, oropharynx in 37, larynx in 15 and hypopharynx in 13 cases. Patients' stages were predominantely T3 and T4 (71/90) and had lymph node metastases (60/90). Seventy-nine male patients and 11 female patients, with a median age of 57 years (range 37-76 years) were treated. Patients were randomised to one of three treatment options: conventional fractionation (CF) consisting of 70 Gy in 35 fractions over 7 weeks or continuous hyperfractionated accelerated radiation therapy (Vienna-CHART) or Vienna-CHART with administration of a single dose of mitomycin C on day 5 of treatment (V-CHART + MMC). By the accelerated regimen a total dose of 55.3 Gy was given in 33 fractions within 17 consecutive days. Acute mucositis was the main toxicity recorded in those patients treated by accelerated fractionation, although the overall duration of mucosal reaction did not differ in the three treatment groups. There was no influence on local toxicity if MMC was added to radiation therapy or not. Those patients treated with additional MMC experienced a grade III/IV haematological toxicity in 4/28 cases. Complete remission (CR) was recorded in 48% following CF, 79% after Vienna-CHART (P < 0.05) and 71% after Vienna-CHART + MMC. The overall local failure rates were 73%, 59% and 42% (P = NS) for patients treated by CF, Vienna-CHART and Vienna-CHART + MMC respectively.

The effectiveness of accelerated fractionation and hyperfractionation in cancer of the head and neck has been confirmed by randomized studies. These new fractionation strategies are almost invariably accompanied by an increase of early normal tissue reactions, in particular mucosal reactions. This paper presents a survey of the available experimental and clinical mucositis data and aims to assess to what extent the upper aerodigestive tract mucosa is limiting to treatment intensification by altered fractionation.The rate of dose delivery is the most important determinant for early radiation reactions. With accelerated radiotherapy, relative to a conventional treatment of 7 weeks, the achievable gain in treatment time is 2 weeks at most with the mucosa being the limiting tissue. Any further acceleration requires a reduction of dose. Manipulations with the temporal distribution of dose, fraction dose, and optimization of interfraction intervals can improve tolerance but probably do not allow significant further intensification of the existing accelerated schedules. Dose escalation by hyperfractionation does not seem to be directly limited by early mucosal reactions. Late reacting tissues are more likely to limit intensification of these schedules.Suggestions for further improvement of treatment outcome include: the generation of a potent agent which can ameliorate radiation mucositis and so permit further intensification of radiotherapy schedules; combination of altered fractionation schedules with hypoxic modifiers; and tailoring of the treatment strategy based on patient and tumour characteristics.

In all patients SHFJV was performed without problems. Since the ventilation is delivered above any possible stenosis the danger of barotrauma is minimised. The surgeon obtains optimal visibility of the larynx and is not obstructed in the surgical procedure. SHFJV enables both the surgeon and the anesthetist to perform their respective duties and therefore increases the safety of the patient in the management of such a difficult problem as massive stenosis of the larynx.

The immune response with respect to immunoglobulin production in the tumor was investigated in 23 patients with advanced squamous cell carcinomas of the head and neck. Immunohistochemical staining with monoclonal antibodies against IgG, IgM, IgA, IgD and IgE in the tumor was compared to normal hypopharyngeal mucosa. For IgG, IgA and IgM no significant differences between tumor and control tissues could be found. In contrast, a high number of IgE-positive cells was counted in most squamous cell carcinomas compared to normal mucosa. Most of these cells appeared as plasma cells. Regarding IgD the differences between tumor and control tissues, were less pronounced but also significant.

Die Standardchemotherapie des fortgeschrittenen Plattenepithelkarzinoms des Kopfes und Halses mit Cisplatin-plus-5-Fu-Cisplatin ist eine nephrotoxische Substanz mit einem sehr hohen emetogenen Potential. Carboplatin, ein Platinanalog der 2. Generation, ist nicht nephrotoxisch und weniger emetogen als Cisplatin. Interferon-α und Interleukin-2 wirken immunstimulierend, haben einen direkten antiproliferativen Effekt und verstärken die Wirkung der Chemotherapie. Interleukin-2 induziert auch hämatopoetische Wachstumsfaktoren und unterstützt dadurch die hämatopoetische Regeneration nach Verabreichung eines Chemotherapiezyklus. Wir untersuchten daher die Effektivität einer Kombination von Interferon-a und Interleukin-2 mit Carboplatin/5-Fu bei rezidivierten und/oder disseminierten sowie primär inoperablen Tumoren des Kopf/Halses. Da die Plasmakonzentration von Carboplatin von der renalen Ausscheidung abhängt, gaben wir Carboplatin in Abhängigkeit von der glomerulären Filtrationsrate nach der Formel von Calvert et al. (1989).

Die Deckung von großen Schleimhautdefekten des oberen aerodigestiven Traktes ist eines der Hauptprobleme sowohl der Tumor- als auch der präprothetischen Chirurgie. Zur Deckung dieser Defekte wurde eine Vielzahl von Rekonstruktionsverfahren entwickelt. Jedoch sind all diese Techniken mit gewissen Nachteilen bzw. Risiken behaftet. Vor diesem Hintergrund streben wir die Kultivierung einer artifiziellen autologen Mukosa an, die die primäre Rekonstruktion vereinfachen würde.

Massive stenosis of the larynx may present a potentially life-threatening situation for the patient, requiring immediate measures to ensure a patient's airway. The aim of this prospective study was to evaluate potential benefits of Superimposed High Frequency Jet Ventilation (SHFJV) in patients requiring microlaryngeal surgery due to massive stenosis of the larynx. Patients and methods: 23 patients (age range 1,5 to 90 years) with laryngeal stenosis grade 2 and 3 according to the Cotton scale were ventilated using SHFJV The duration of the SHFJV was 12 to 116 minutes. SHFJV was performed using a Bronchotron Respirator via a jet-laryngoscope. Results: Arterial blood gases demonstrated paO2 between 71 and 295 mmHg and paCO2 of 28 to 81 mmHg. The mean FiO2 applied was 61,75 +/- 19,26. The airway pressure was measured at the tip of the jet-laryngoscope and was between 6 and 15 mmHg, and PEEP was 1 to 5 mmHg. In 13 patients a CO2 laser was utilised during surgery. Discussion: In all patients SHFJV was performed without problems. Since the ventilation is delivered above ans possible stenosis the danger of barotrauma is minimised. The surgeon obtains optimal visibility of the larynx and is not obstructed in the surgical procedure. SHFJV enables both the surgeon and the anesthesist to perform their respective duties and therefore increases the safety of the patient in the management of such a difficult problem as massive stenosis of the larynx.

We have treated 27 patients with cancer of the head and neck (18) or esophagus (9) according to the following protocol: day 1 carboplatin i.v. {dose in mg = 5 × (glomerular filtration rate + 25)} followed by 120 hrs of 5-FU at 750 mg/m2/24 hrs. During the first week of treatment interferon alpha-2b (Intron A) was given 3 times s.c. at 5 Mio. I.U./m2. In week 2 and 3 of each treatment course 2 Mio. I.U./m2 (in locally advanced head and neck tumours) or 5 Mio. I.U./m2 (in disseminated head and neck and esophagus cancers) of interleukin-2 (Proleukin) was administered s.c. 3 times per week. Cycles were repeated every 3 weeks. 5 women and 22 men were treated. Median age of the patients was 59 years (range: 41–78). Toxicities observed were mainly hematological with grade 3 & 4 in 12 % of cycles. The only other major toxicities were grade 3 mucosities in 2 cycles and grade 3 pulmonal toxicity, infection and constipation in 1 cycle each. Patients’ quality of life during treatment was assessed weekly by visual analogue scales and showed no change over time. 20 patients received at least 3 cycles of treatment and were thus evaluable for response. 1 CR, 9 PR, 2 NC and 1 PD were found in head and neck and 5 PR and 2 NC in esophagus cancer patients. This is an effective treatment that caused significant toxicity but patients’ quality of life was not compromised.

Our study presents the results with a silicone disc-lens (Adatomed 90D) over a postoperative period of 18 months. It includes 47 patients, 42 could be reexamined. The implantation was done after continuous circular capsulorhexis and phacoemulsification with a Faulkner-folder directly into the capsular bag. The implantation was sometimes difficult. Skill and experience of the surgeon are required. The IOL springs forth of the implantation forceps, which can lead to traumatization of the capsule and the iris. Three times the posterior capsule ruptured, in two cases the implantation was stopped because of vitreous pressure and the risk of rupturing the capsule. In 6 cases the rim of the anterior capsule ruptured during the implantation. Postoperatively one IOL had a sulcus position, all other IOLs were in the capsular bag. A deposit of viscoelastic substance (Healon) between the IOL and the posterior capsule in 34 cases (72%) was remarkable. In 14 cases (33%) it remained for 18 months. 16 times (38%) regeneratory after-cataract reached the central part of the capsule. The visual disturbance was different, in 6 cases (14%) a YAG-laser-capsulotomy was performed. An influence of the deposit of viscoelastic substance on the development of posterior capsule opacification could not be proved. 17 IOLs (40%) were minimally decentrated upwards. Only 11 cases (26%) had an excellent mydriatic pupillary reaction. The reason is not clear. 10 eyes (24%) developed iridocapsular synechia, 22 eyes (52%) foreign body giant cells and 20 eyes (48%) dispersed pigment on the IOL surface. The giant cells did not diminish.(ABSTRACT TRUNCATED AT 250 WORDS)

Our study presents the results with a silicone disc-lens (Adatomed 90D) over a postoperative period of 18 months. It includes 47 patients, 42 could be reexamined. The implantation was done after continuous circular capsulorhexis and phacoemulsification with a Faulkner-folder directly into the capsular bag. The implantation was sometimes difficult. Skill and experience of the surgeon are required. The IOL springs forth of the implantation forceps, which can lead to traumatization of the capsule and the iris. Three times the posterior capsule ruptured, in two cases the implantation was stopped because of vitreous pressure and the risk of rupturing the capsule. In 6 cases the rim of the anterior capsule ruptured during the implantation. Postoperatively one IOL had a sulcus position, all other IOLs were in the capsular bag. A deposit of viscoelastic substance (Healon) between the IOL and the posterior capsule in 34 cases (72%) was remarkable. In 14 cases (33%) it remained for 18 months. 16 times (38%) regeneratory after-cataract reached the central part of the capsule. The visual disturbance was different, in 6 cases (14%) a YAG-laser-capsulotomy was performed. An influence of the deposit of viscoelastic substance on the development of posterior capsule opacification could not be proved. 17 IOLs (40%) were minimally decentrated upwards. Only 11 cases (26%) had an excellent mydriatic pupillary reaction. The reason is not clear. 10 eyes (24%) developed iridocapsular synechia, 22 eyes (52%) foreign body giant cells and 20 eyes (48%) dispersed pigment on the IOL surface. The giant cells did not diminish.(ABSTRACT TRUNCATED AT 250 WORDS)

From May 1990 to May 1991, 23 patients with advanced, inoperable squamous cell cancers, clinically staged as III or IV, were treated by unconventional fractionation radiotherapy. Treatment consisted of a continuous hyperfractionated accelerated radiotherapy, delivering a total dose of 55.3 Gy within 17 consecutive days. In ten patients radiation therapy was combined with chemotherapy; 20 mg mitomycin C/m2, administered by intravenous bolus injection on day 5 of treatment. Apart from a confluent mucositis, treatment tolerance was good. Haematological toxicity from mitomycin C was minor and did not require any specific therapy. The mucosal reaction lasted six weeks (median duration) and was not thought to be increased by additional chemotherapy. In twelve of 23 patients a complete remission of the primary tumour was seen, in patients with lymph node metastases there was a complete response in 14 out of 20 patients. After a median follow-up of 18 months, ten of 23 patients have survived (8/23 without evidence of disease). Eleven patients have died due to local tumour progression and one patient died with distant metastases, being without evidence of local tumour. The advantage of this unconventional fractionation, which takes the described short potential tumour doubling time for head and neck cancers into account, is discussed.

30 patients with T3 and T4 tumours of the upper aerodigestive tract had their tumours resected by pharyngolaryngectomy. This was followed by reconstruction of a gullet or creation of a siphon as a tracheohypopharyngeal shunt for voice restoration with a free jejunal autograft. All patients were treated postoperatively with 60Co gamma radiation, 6 MeV photons or 7.5 to 10 MeV electrons of a beta-tron, with a dose of 50-65 Gy in the area of the primary tumour and 50-65 Gy to the neck. 4 patients refused further treatment after a depth dose of between 16 and 32 Gy. Local recurrence occurred in 40% of cases. The survival rate was 36.6% (11/30) after a mean follow-up time of 21.5 months, although 2 patients died of intercurrent diseases without recurrence of their tumours. The results obtained justify active surgical intervention with postoperative irradiation even at an advanced stage of the tumour.

In patients with corneal disease and cataract, the combined surgical approach yields quick rehabilitation and excellent visual results. Working on an open eye for cataract removal and posterior chamber lens implantation, however, makes the procedure risky and difficult. Using a temporary keratoprosthesis and a small-incision technique, surgery can be performed in a fully closed system, optimizing the safety and precision of the procedure.