Background/aims: Liquid nitrogen spray freezing has been successfully applied for basal cell carcinomas in the eyelid region, but is not yet in general use. The reasons for this were analysed and the development of a more reliable, safer cryosurgical technique aimed for. Methods: New cryosurgical apparatus, contact probes with increased freezing power, and a special application technique were developed and clinically tested in a consecutive series of 221 patients with primary basal cell carcinomas of the lid region. Special efforts yielded follow up reports of 220 out of the 221 patients. Results: Experimental measurements and clinical results demonstrated that this cryosurgical technique was at least as effective as spray freezing, with lower risks. The rate of recurrent tumours in patients followed up for 5 years or longer was 5.1% (surgeons first result) respectively 0.6% (result after optimised second cryosurgery). The figures were 6.8%, respectively max 2.7%, when including all patients, independent of follow up time. Conclusion: Traditional surgery and histopathology, still used at numerous places, resulted in higher recurrence rates despite extended loss of healthy eyelid tissues and should be abandoned. Micrographic surgery is considered mandatory to save more of the healthy structures and to obtain lower recurrence rates. Cost and time require worldwide restriction of micrographic surgery to selected cases. Updated cryosurgery provides a low cost option to micrographic surgery and results in preservation of eyelid structures and lacrimal pathways, tarsal plate, lid margin. It provides excellent cosmetic results. Thus, primary basal cell carcinomas in the eyelid region of suitable size and location should receive updated cryosurgery, and tumours beyond its range micrographic surgery.

Experimental research demonstrated that a concentrate of human fibrinogen could successfully be used to close wounds of the lens capsule with sufficient mechanical strength and barrier function. Progression of lens opacification was stopped, and healing took place with a circumscribed scar and an otherwise clear lens. This method has now been employed successfully for the first time in clinical practice: A construction worker presented with a steel foreign body in his eye which had caused a double perforation of the lens. Thirty hours after the accident the gaping lens capsule wound showed no tendency for spontaneous closure. Following closure of this capsule wound with fibrinogen glue the extensive subcapsular posterior rosette opacities regressed markedly and visual acuity improved from 0.1 to 0.7. The same technique was applied more recently in a 13-year-old boy suffering from a double perforation of the lens. Up to the time of writing (eighth postoperative day) the course was as favorable as in the case described above.

The treatment of Graves' ophthalmopathy is symptomatic because the etiology remains unknown though evidence supports an aberrant immune response. Orbital radiotherapy, combined with corticosteroids, is indicated for rapidly progressive ophthalmopathy and troublesome soft tissue symptoms. In case of sight-threatening manifestations operative decompression is the method of choice. However, radiotherapy seems to be a safe and effective method as a good to excellent response in 60-70% of patients can be expected. The treatment results of 15 patients with a long term follow-up are presented.

By means of long-term follow-ups of large numbers of patients it has been established that nitrogen cryotherapy for lid basaliomas produces very good results with regard to the cure rate, as well as having considerable advantages over other treatment methods. In contrast to other authors we did not employ the spray method, but a very high-performance nitrogen cryo unit with a closed probe. Experimental measurements showed that this unit is capable of generating at least the same temperatures as with the spray method. The cryoapplication technique is described. The cure rate and causes of recurrence in the first series in the total of 84 patients treated from 1979 to 1983 were evaluated by long-term follow-up. If cryobiological principles are observed and the recommended application technique is adhered to, the same cure rate can be achieved as with the spray method and other forms of treatment. There are considerable functional and cosmetic advantages, also as regards the patency of the lacrimal ducts.

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