The eye can become involved in immune-mediated diseases that affect it alone or as part of a multi-organ disease process. Much immunological attention has been focused on other organs affected by these processes and the subject of the immunology of eye diseases is a relatively new one. Many of these diseases that involve the eye are not life-threatening but can result in devastat ing loss of sight that if bilateral, will have major effects on the patient's life. Systemic immunological investigations are generally unhelpful in these patients and one of the major problems in this field has been the lack of diseased tissue available for examination to determine the pathological processes involved. Our poor understanding of basic mechanisms of disease in the eye has meant that treatment of many of these conditions is often inadequate. It has become possible to apply in the eye many ofthe techniques used to investigate the role of the immune system in other systems. Animal models of many of the disease processes have also allowed dissection of the immune response both within and outside the eye. It is my belief that a greater understanding of the mechanisms by which the structures in the eye become damaged will allow more specific and effective therapeutic strategies to be devised."

This report for the Belgian Ophthalmological Society concerns a number of fundus diseases, which most ophthalmologists only rarely encounter. Still it is of importance that they should be able to recognize them, not only because most of these eye diseases are treatable when they are diagnosed early enough, but also because they are sometimes associated with major visceral and neurological problems. The ophthalmologist may be the first practitioner to suspect a von Hippel-Lindau's disease or a neurofibromatosis. He should realize at that moment that his role is not only to treat the eyes but also to advise his patient, refer him to other specialists and consider the genetical implications of his diagnosis. Clinicopathologic correlations are of great importance and we felt that it was necessary to emphasize the histopathological aspect of these diseases. A report has to overview the literature on a specific topic. The literature on vascular tumors of the fundus is extremely vast and even if we tried to be as complete as possible, we must confess that we did not cite every author who published on such cases. A third aspect, which was considered as important, was to provide sufficient clinical and histopathologic examples of the various disease, which are reviewed. We are indebted to a large number of friends who kindly authorized the publication of their material. In particular we wish thank Prof. A. Brini (Strasbourg), Dr. D. de Wolff-Rouendaal (Leiden), Prof. P.

Amaurosis fugax, or "fleeting blindness," has been known as a clinical entity for hundreds of years (1). Since 1859, we also have understood that the phenomenon frequently is related to atheroembolic disease and that it is considered a classic manifestation of ocular transient ischemic attacks and a potential precursor to stroke. However, many questions about this syndrome have remained unanswered until quite recently, when a great deal of new information and thought has been directed to the subject. Transient monocular blindness (TMB) is only one manifestation of a complicated syndrome of ocular, systemic, and cerebral diseases that may include some degree of monocular blindness. The duration of blindness varies from very brief (seconds) to complete and permanent. The per manent type is referred to as ocular infarction or ocular stroke. Retinal infarction is the most severe degree of monocular blindness and usually is due to embolic occlusion of the central retinal artery or one of its branches. Varying types of arterial emboli have been described, including thrombus, cholesterol, platelets, and fibrin.

Nitric oxide (NO) is a simple gas with free radical properties. No one would have imagined a role for such a simple substance in the human body. In 1998, R. E Furchgott, E Murad, and L. J. Ignarro received the Nobel prize for their work on NO. Interestingly, Alfred B. Nobel, who invented dynamite by combining nitro glycerin with other substances, took nitroglycerin for his chest pain without realizing that NO mediates its action. Now, in addition to its vasodilating action, NO is known to possess many fundamental functions that include neurotrans mission, blood pressure control, blood clotting, and immune responses. These diverse functions, conversely, imply that the simple NO molecule may unite neuroscience, physiology, and immunology and may change our understanding of how cells communicate and defend themselves. In this context, the Inter national Symposium, Nitric Oxide and Free Radicals, was organized to address current thinking about the widespread distribution and variety of functions of NO in the eye. The symposium was held in Kyoto, Japan, September 28-29 as a Satellite Symposium of the XII International Congress of Eye Research, 1996. The Symposium was the first international gathering of leading scientists and ophthalmologists meeting to present and discuss their most recent results in a specialized area of research, specifically concerning the eye.

Researchers in recent decades have elucidated signal transduction in the retina and the function of the visual cortex. The highly flexible nature of neural circuits in the visual cortex especially during the critical period has been an interesting subject for studying neural plasticity and development. Recent advances in the visual neurosciences of the vertebrate retina and the visual cortex were discussed during the 12th Keio International Symposium for Life Science and Medicine, meeting jointly with Vision Forum 2002. Contributions to the symposium collected in this volume reflect the convergence of physiological, cell biological, molecular, mathematical, and clinical approaches. The book covers topics ranging from phototransduction to visual information processing in the primary visual cortex, and includes clinical studies on hereditary night blindness, creating a valuable source of information for researchers and clinicians in the visual neurosciences.

Enormous developments have been made in ophthalmology during the last century. Higher precision and newer instrumentation in surgery as well as better examination methods and progress in microbiology have given us access to much more information about the pathological physiology and anatomy that we are confronted with in our various fields of expertise. As we have approached a new millennium we decided to capture some of these new ideas and incorporate them into a conference where we could share our work and benefit from each others' experiences. This book is based on contributions nd presented at the "2 International Conference on Vitreoretinal Diseases" which was held in September 2002 in Vienna, Austria which focused on the retinal macula. The meeting was very fortunate to have the world's most renowned leaders in macular research attend and share their vast experience and expertise as well as their latest research and results. This meeting followed the "First International Conference on Vitreoretinal Diseases" which was held in Vienna, Austria in 1998, and focused on retinal transplantation and retinal microsurgery. nd After the great success of the "2 International Conference on Vitreoretinal Diseases" an overwhelming interest was expressed to gather all these new and innovative ideas that had been developed in a book in order to give colleagues and students access to a valu able collection of the information presented at the meeting. This international meeting was administrated by, Mrs. Tilly and Mr.

The value of Age-Related Macular Degeneration has stood the test of time, but progress in both basic and clinical ophthalmology has been relentless, mandating the need for an updated book. This second edition focuses on the pathophysiology and the epidemiology of age-related macular degeneration (AMD), the clinical features and management of dry and wet AMD, imaging techniques, and medical therapy for both non-neovascular AMD and neovascular AMD. It describes both clinically validated and experimental therapies as well as rehabilitation technology, and presents strategies to prevent the progression of non-exudative AMD. Results from current clinical trials are also included. New chapters in this edition cover: Genetics and treatment Oxidative stress and its relation to the pathophysiology of AMD and CNV (choroidal neovascularization-a common symptom of wet AMD) Polypoidal choroidal vasculopathy Microperimetry and psychophysical testing and ways to track geographic atrophy progression Non-VEGF pathways Retinal stem cells

ince 1985, it has been my privilege to be the Director of The - ciety of Byron Smith Fellows. During the years in which Byron SSmith was with us, his former fellows would meet at the Ame- can Academy of Ophthalmology's annual meeting. They would present to him, and to one another, interesting cases of their own compli- tions that had occurred or cases that had been sent to them that were complications to be repaired. This forum provided the fellows with an excellent format for evaluating their own problems and also for d- cussing how to treat extremely difficult cases. Shortly after Dr. Brian Brazzo completed his fellowship with me in 1998, he asked if I thought it would be appropriate for him to edit a new book on complications of ophthalmic plastic surgery. Certainly, during his fellowship, it became apparent that Dr. Brazzo was pr- ably the most gifted academician and writer that I had ever had the pleasure of training and meeting. I could think of no one more - propriate to continue the work initiated by Dr. Byron Smith and c- ried on by his students.

The sellar region and paranasal sinuses constitute the anatomical sections of the skull base in which pathological entities warrant interdisciplinary management. Processes originating in the paranasal sinuses can reach and involve the skull base in and around the sella, sometimes not respecting the natural dural boundary. On the other hand, lesions involving the sellar block, such as pituitary adenomas and meningiomas, can also extend downwards into the paranasal sinuses. The orbit and cavernous sinus may be subject to involvement and infiltration by both paranasal and sellar pathology. The advancement and new achievements of modern diagnostic procedures, such as high-resolution CT, three-dimensional reconstruc tion, MRI, and MRI angiography, as well as the detailed selective angiographic protocols and endovascular techniques, have increased the possibilities for surgical management of this type of pathology with extra- and intracranial involvement. Long-standing and intense inter disciplinary work has led to sophisticated operative approaches which for benign tumors allow total excision with preservation of structures and function, and for some malignant lesions permit an en bloc resec tion via a combined intracranial-extracranial approach. This volume reflects the work and scientific exchange which took place during the IV International Congress of the Skull Base Study Group, held in Hanover. Leading authorities in the basic sciences including anatomy joined with diagnosticians, clinicians, and surgeons from different fields to evaluate the state of the art of this topic in skull base surgery."

The history of the use of ultrasound in medicine has been one of evolution of technology and innovative methods of applying this technology to imaging body structures. Many scientists and clinicians have contributed to this evolution. Ophthalmic ultrasound has become an indispensible tool in ophthalmic practice, with its own instrumentation and techniques. Ultrasound frequencies used in ophthalmology have generally been higher than those used in general medicine because of a requirement for higher resolution and a lesser need for deep penetration. Most ophthalmic diagnostic equipment uses frequencies in the 10 MHz range. The use of ultrasound frequencies in the 50-100 MHz range is a relatively new development in ultrasound imaging of the eye. This technique has been developed in our laboratories over the past several years. We have progressed from the theoretical description of the basic science required, past the first in-vitro experiments in eye bank eyes, to the construction of an instrument capable of clinical application. We have gained broad clinical experience with this instrument in normal patients and patients with ocular disease. A commercial instrument based on our original clinical scanner has recently become available, allowing other clinicians to apply this tool to ophthalmic research and clinical practice. We have applied the term ultrasound biomicroscopy to this new imaging technique because of similarities to optical biomicroscopy, i. e. , the observation of living tissue at microscopic resolution.

Retinal and choroidal vasculatures are easily affected by various systemic diseases, and changes in the retina can easily be observed with various procedures such as direct and indirect ophthalmoscopy, scanning laser ophthalmoscopy, fluorescein fundus angiography, and indocyanin green fundus angiography. Vascular changes are the major, most prominent, and most important fundus changes. The above-mentioned procedures can reveal vascular changes clearly, but mainly reveal changes in the superficial layer of the retina. In addition, these procedures cannot show the three-dimensional architecture of the retina. Usually we can barely obtain the view of that three dimensional architecture. At the same time, pathological findings are well described, but most of them are based on histological and cytological methods. Thus, three-dimensional description of pathology is rare. Vascular corrosion cast scanning electron microscopy can provide a very useful three-dimensional view of the microvasculature and can demonstrate the fine structural architecture of the capillary network. However, the application of this method to the retinal and choroidal vasculature is very difficult, especially in small eyes. We succeeded in making good corrosion casts of retinal and choroidal vessels in the rat. Using this method during the past 10 years we have examined the retinal and choroidal vascular architecture of rats with various systemic diseases such as aging, hypertension, diabetes mellitus, and arteriosclerosis."

As a garden is to a gardener, so a book is to its author. Nurtured out of love, both are a source of pride and hope. Microbiology, immunol ogy, infectious diseases, rheumatology, and ophthalmology are the seeds of this textbook on uveitis. Over the years, these branches of medicine have been cultivated and garnered to care for patients with inflammatory diseases of the eye, a most hardy species in the family of ocular maladies. The aim of this clinical manual is to give both a serviceable frame work and practical information on ocular inflammatory disease. The first section is devoted to general principles and commonly held sup positions in the field of uveitis. A system of diagnosis, based on the differential, is also offered. Traumatic uveitis is addressed in the sec ond section. The third part examines infectious diseases that have been identified with uveitis. These are frequently curable forms of ocular inflammation caused by replicating foreign antigens. The fourth section of this textbook considers inflammatory diseases of the eye with a presumed autoimmune mechanism. A disobedient, autoreactive immune response is postulated to playa role in these forms of uveitis. Masquerade and idiopathic conditions are dis cussed in the final chapters. Etiology, epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, treatment, and prognosis are provided for each disease syndrome. As with most gardens, there are many styles and delightful entrances to the field of uveitis.

Das trockene Auge ist eine der schwerwiegendsten Komplikationen von Bindehauterkrankungen verschiedenster Genese, von Stellungs anomalien, Lahmungen und Narbenbildungen an Lidern und Binde haut. Fundierte Kenntnisse hierzu erbrachten erstmals die Unter suchungsergebnisse von Sjogren aus den dreifSiger Jahren, vorwie gend aber die wissenschaftlichen Ergebnisse zahlreicher Forscher gruppen der letzten zehn Jahre. Diese zu sichten, Zusammenhange, Gemeinsamkeiten und Verlaufe der zahlreichen Schadigungen und Entziindungen des Auges, die zum Syndrom des trockenen Auges fiihren, zu erarbeiten, urn eventuell neue Impulse fiir die Diagno stik, Klinik und Therapie zu geben und urn den Augenarzt Richt Iinien zum Erkennen und Behandeln derartiger Augenerkrankungen darzuIegen, wurde der Workshop "Chronische Conjunctivitis - Trockenes Auge" durchgefiihrt, an dem Ophthalmologen, Anatomen, AllergoIogen, Elektronenmikroskopiker und Biochemiker, die auf diesem Gebiet seit Jahren gearbeitet haben, teilnahmen. Allen diesen gilt mein Dank, nicht zuIetzt der Firma Dr. Mann, Berlin, welche die Durchfiihrung des Workshops iiberhaupt erst ermoglichte. UIm, im Mai 1982 Rolf Marquardt Inhaltsverzeichnis T eilnehmerliste des Workshops . . . . . . . . . . . . . . . . . . . . . . XI . . . . . . Einleitung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Pathophysiologie Rohen, J. W., Steuhl, P., Arnold, W. H.: Zur funktionellen Morphologie der Conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Liitjen-Drecoll, E., Steuhl, P., Arnold, W. H.: Morphologische Besonderheiten der Conjunctiva bulbi . . . . . . . . . . . . . . . . . 25 . . . Brewitt, H., Honegger, H.: Morphologische Befunde des Horn hautepithels bei Starung des praecornealen Filmes und nach Applikation von Augenmedikamenten. Eine raster- und transmissionselektronenmikroskopische Untersuchung . . . . . . 35 Marquardt, R.: Untersuchungen zur Tranenfilmstabilitat . . . . . 58 Janssen, P. T., van Bijsterveld, O. P.: Pathophysiology of the Tear Film: Protein Patterns in Health and Disease. . . . . . . . ."

This book has been conceived to aid eye care practitioners such as ophthalmologists and optometrists as well as other eye care or research professionals such as biologists, biochemists and medical doctors interested in the Ocular Surface. This text is divided into four main sections. The first section is dedicated towards the anatomy and physiology of the ocular surface (defining ocular surface concept, tear film structure, corneal and conjunctival anatomy, etc.). The second section covers the most common ocular surface disorders (dry eye, anterior and posterior blepharitis, keratitis, ocular allergy, cicatricial conjunctivitis, and the ocular surface alterations related with Glaucoma treatment). The third section delineates the therapeutic care of these disorders, including topical, systemic and surgical treatment options and the fourth section addresses the relationship of the ocular surface and contact lenswear (describing the indications for contact lenses wear, their complications and managing the adverse effects related with contact lens-wear).

There have been greater advances in our knowledge of the visual function and its disabilities in the past 50 years than had accumulated in all of the previous years. This applies not only to the basic science of biochemistry, physiology, physiopathology, and cytopathology but also to the diagnosis and treatment of visual dysfunction and ocular disease. These advances have been aided by a proliferation of ingenious instruments. When I began my residency in ophthalmology at The Wilmer Institute in 1938, one was supposed to learn not only the physiology of vision but also how to diagnose and treat all phases of ophthalmology including disabilities of the orbit, sclera, retina, lens, and cornea. In addition he or she was supposed to understand neuro-ophthalmology, ophthalmic genetics, and so-called uveitis. It soon became evident that no one could adequately comprehend all of these areas and, therefore, most young trainees today take a year or two of fel lowship in a specialized area following their three-to five-year residency train ing. Following this they join a group of other ophthalmologists and specialize. Thus, they become more expert in the diagnosis and treatment in a limited area in ophthalmology. When I returned to The Wilmer Institute in 1955 as Head of the Department I was the only full-time member of the staff. To date we have some 28 full-time ophthalmologists working in highly specialized areas of our institution.

The European Glaucoma Society was founded in the spring of 1978 at the initiative of Drs Fran ois, Leydhecker and Greve. Representatives of most European countries met in Ghent and agreed to create a society that would promote the contacts and exchange of knowledge between European glauco matologists. The European Glaucoma Society serves to stimulate glaucoma research and diffuse specific knowledge to general ophthalmologists. The European Glaucoma Society would like to cooperate closely with similar glaucoma organizations in other continents. The first symposium of the EGS was held in April 1980 in Brighton, England. No proceedings were published. The second symposium took place in May 1984 in Hyvinkiiii, Finland. A great number of participants enjoyed a well organized scientific programme of attractive quality. The local organization was in the able hands of Raitta and her colleagues, Raivio and Lehto. The scientific programme was coordinated in Amsterdam where a great amount of work was done by Stella Ompi, secretary to the general secretary. The contents of the meeting have been summarized in this book. This second symposium of the EGS, which took place in an atmosphere of great enthusiasm and friendship, has shown great promise for the future of the European glaucoma."

When seen from an outsider's vantage point, the development of knowledge in the sensory sciences must appear massive and the result of some carefully followed master plan. In reality, it is the result of numerous relatively independent human endeavors shaped by application of the scientific method. The comprehensive construction of quantitative theories of sense organ function has occurred only recently -but at an explosive rate prefaced by centuries of expansion in the physical sciences. Predicated on this growth, the twentieth century may become known as the age of the biological sciences. With the exception of a modest number of intellectual giants, there were few contributors to the foundations of the sensory sciences before the dawn of this century. At least 90% of existing knowledge has been produced by scientists working in laboratories founded since 1920. If any single scientist and his laboratory may be identified with the growth in the sensory sciences, it is EDGAR DOUGLAS ADRIAN, First Baron of Cambridge and leader of the Physiological Laboratory at Cambridge University, England. Lord ADRIAN'S influence upon the sensory sciences was great, not only in terms of his contribution to knowledge itself but also through the influence which he exerted upon numerous young scientists who spent weeks or years at the Cambridge laboratory and who later returned to their homelands and colleagues with the seeds of vigorous research and quantitative inquiry firmly implanted.

Among the many intense light sources, excimer lasers have a unique set of properties that place them at the forefront of tooling for material processing. Their extreme versatility means that they can be used in many areas of materials science and medicine. But three conditions need to be fulfilled in order that their versatility be truly appreciated and exploited: the characteristics and limitations of the sources must be known; the basic excimer laser processes should become reasonably widely known; and problems in search of a solution should be clearly identified. Excimer Lasers covers all three of these points in an instructive and logical way. Probably for the first time, both instrumental and fundamental aspects of excimer laser interaction with matter are presented side-by-side, with examples drawn from the widest range of materials. The articles gathered here are tutorial in their nature, thus making them suitable for a wide readership, from recent graduates and postgraduate students to those established scientists entering the field, all of whom could not find a better, nor more authoritative work with which to start their reading.

It is with great pleasure that I write this Foreword to the Proceedings of the International Conference on Behcet's Disease which was held in Berlin in June 2002. This was the first International Conference held under the auspices of the International Society for Behcet's Disease which was founded in 2000 in Seoul. First, I congratulate our colleagues in Berlin, led by Professor Christos Zouboulis of the Department of Dermatology at the Free University of Berlin, for having organised a most successful conference and for having compiled these proceedings so rapidly. It will be realised immediately on scanning the contents of this book that the conference was truly international with 210 participants from 26 countries, as Professor Zouboulis has noted in his preface. These included basic scientists, epidemiologists, pathologists, clinicians and, importantly, representatives from patient organisations. The latter held their own conference alongside the scientific-medical conference to mutual benefit. The combined session of patients and doctors (abstracts on pp 601 - 626) gave the opportunity for an exchange of information and fruitful discussion. The wide ranging scope of the communications is evident from the index and it was most encouraging to see their origin - from all parts of the world, from senior and junior colleagues and, from many different disciplines. Many communications may be regarded as preliminary reports of research in progress and we look forward to seeing the definitive publications in appropriate journals in due course."

The HF A is a computerized perimeter with a very comprehensive set of test point patterns, strategies and custom tests. The instrument employs several solutions which have proved useful in earlier computerized perimeters and several new concepts. The construction with stimulus generation through a projection system, input through a CRT, programmes stored in PROMs and a double disc drive for storage of test results makes it simple to adapt the instrument to future needs, whether these are new test algorithms or point patterns, different input or display screens or new statistical analysis programmes. All these changes could be made without modification of actual instrument hardware. REFERENCES 1. Dannheim, F. and Drance, S.M. Psycho visual disturbances in glaucoma. A study of temporal and spatial summation. Arch. Ophthalmol. 91: 463 -468 (1974). 2. Fankhauser, F. and Hiiberlin, H. Dynamic range and stray light. An estimate of the falsifying effect of stray light in perimetry. Documenta Ophthalmol. 50: 143-167 (1980). 3. Fankhauser, F., Hiiberlin, H. and Jenni, A. Octopus programs SAPRO and F. Two new principles for the analyses of the visual field. Graefes Arch. Klin. exp Ophthal- mo1216: 155-165 (1981). 4. Gramer, E. and Krieglstein, G.K. Zur Spezifitiit der iiberschwelligen Computer- perimetrie. Klin. Mbl. Augenheilk. 181; 373-375 (1982). 5. Gramer, E., Kontic, D. and Krieglstein, G.K. Die computerperimetrische Dar- stellung glaukomatoser Gesichtsfelddefekte in Abhangigkeit von der Stimulus- grosse. Ophthalmologica 183: 162-167 (1981).

Proceedings of the International Symposium at the Katholieke Universiteit Leuven, Belgium, May 17-19, 1984

Evoked potentials are potentials that are derived from the peripheral or central nervous system. They are time locked with an external stimulus and can be influenced by subjective intentions. Evoked potentials have become increasingly popular for clinical diagnosis over the last few years. Evoked potentials from the visual system are used by ophthalmologists in order to localize the abnormalities in the visual pathway. The otologists are mainly involved in brainstem auditory evoked potentials, while the pediatricians, neonatologists, neurologists and clinical neurophysiologists make use of multimodal stimulation. The psychiatrists and psychologists, generally, examine the slow potentials such as P300 and CNV. Anesthesiologists use short latency somatosensory and visual evoked potentials in order to monitor the effectiveness of the anesthesia. Pharmaco evoked potentials are very promising measures for the quan tification of the effectiveness of drug action on the cerebral cortex. Urologists are more and more involved in pudendal somatosensory evoked potentials and in the intensive care unit evoked potentials are used in order to monitor the functional state of the central nervous system of the patient. This overwhelming number of examinations and exam ina tors clearly demonstrates the need for guidelines and standardization of the methods used. The evoked potential metholody is restricted by the relative poor signal to noise ratio. In many diseases this signal to noise ratio decrease rapidly during the progression of the illness. Optimal technical equipment and methodology are therefore essential."

Progress in vitreo-retinal surgery is mercurial. Since this series is dedicated to new developments the reader is presented with a motley list of topics. The advancements described here may represent generally accepted progress in the field: New instruments, Macular hole surgery, Tumor biopsy. New ideas are set out to be tested for their benefit, for example: AMD surgery, Adjunctive pharmacotherapy. Reflections on incessant clinical problems in vitreo-retina surgery require superior scrutinization of established surgical techniques and indications: Posterior slippage, Inferior breaks, Subclinical retinal detachments. The editors will expand this list in future editions with topics like: new support for buckling surgery, enzyme assisted vitrectomy, new tamponades and other yet unknown fields of progress.

Retinopathy of Prematurity presents a review of the current knowledge of this disease, which tragically renders many premature infants blind. First, the volume covers the natural history, classification and histopathology of ROP, followed by examination techniques, recommendations for follow-up and therapy and finally a panel discussion providing answers to frequent questions and areas of legal concern.