Karl Lisch

This biography was submitted by Arun D. Singh, MD. Singh is affiliated with Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania.

Karl Lisch was born in Kirchbichl, a village in North Tyrol, Austria, the son of a General practitioner. After completing his schooling in Kufstein, he traveled to the famous universities of Europe to study medicine in Vienna, Zurich, and Innsbruck, graduating from the University of Innsbruck in 1931. That year he began his residency in Ophthalmology at the First University Eye Clinic in Vienna under professor Josef Meller (1874-1968), and he continued at the University Eye Clinic in Innsbruck under professor Richard Seefelder (1875-1949). From 1935 to 1945, Lisch worked as an assistant and later as senior physician at the University Eye Clinic in Munich, Germany under professors Karl Wessely (1874-1953) and Wilhelm Meisner (1881-1956).

Karl Lisch revered above all the memory of his two teachers: Josef Meller and Karl Wessely, with whom he carried on an intensive correspondence up to the time of their death. In 1947 he became Chief Physician of the Eye Department of the hospital of Wörgl, a small town close to his birth place. He remained in this position until his retirement in 1980. He was a well known ophthalmologist and his patients came from all parts of Austria, Germany, and Italy. In the region of North Tyrol he was called "Ophthalmological Pope".

Besides general ophthalmology Lisch was interested in scientific research. He published more than 120 scientific papers, mostly in the German literature.

Karl Lisch received many awards, most notably the title of Senior Advisor in Medical Affairs (Obermedizinalrat) from the President of Austria in 1989 in recognition of his outstanding work as a physician. In 1992, he received the Medal of Honor of the American Neurofibromatosis Society and the First Class Cross Honor for Science and the Arts of the Austrian Ministry for Science and the Arts. Besides ophthalmology Lisch enjoyed swimming, bicycling, and skiing.

Lisch's nodules
He is most recognized for the description of the iris nodules of Neurofibromatosis type 1, now termed as "Lisch nodules". In 1937, while at the University Eye Clinic in Munich, he published an article in the German ophthalmic journal "Zeitschrift fur Augenheilkunde" titled "Ueber Beteiligung der Augen, insbesondere das Vorkommen von Irisknotchen bei der Neurofibromatose (Recklinghausen)" (About the involvement of the eyes, especially the appearance of iris nodules in neurofibromatosis [Recklinghausen])".

The report described his observations in 3 patients with neurofibromatosis: Patient #1 was a 39 year old male who had been affected with several nodules and pigmented lesions on the skin, typical of neurofibromatosis, since the age of 15 years. His mother and his sisters had a similar disorder. Lisch observed several brown nodules on the surface of the iris. The nodules could be seen even without the slit lamp due to the greyish-blue color of the iris. A color drawing of iris nodules of this patient was published in color (Figure 4). Similar cutaneous and iris lesions could be detected in another 27 year old patient with a family history of neurofibromatosis. In comparison to the first patient the iris nodules were much more pigmented. The third patient, a 44 year old male suffered form bilateral optic nerve gliomas with chiasmal involvement. The slit lamp examination revealed tiny iris nodules in both eyes.

In his article Karl Lisch acknowledged prior observations of Ananias Gabrielides (born 1867) and the use of the term "Warzeniris" meaning multiple nodules or warts of the iris by Petrus Johannes Waardenburg (1886-1979). Jan van der Hoeve (1878-1952) in his Doyne memorial lecture in 1932 presented a family observed by Waardenburg to have neurofibromatosis and iris tumors. Other observers such as S. Snell and Edward Treacher Collins (1862-1932), Ernst Fuchs (1851-1930), I. Goldstein and D. Wexler, and T. Sakurai had also reported pigmented nodules on the iris surface in patients with neurofibromatosis before publication of Lisch's paper in 1937.

In his work on four types of phakomatoses in 1942, Lisch described changes in the eye in neurofibromatosis. Once again, he pointed out that iris nodules might in fact be constant sign of neurofibromatosis and that a diagnosis of neurofibromatosis can be presumed from the mere presence of the nodules. His observations seem all the more remarkable today when we realize that the usefulness and prevalence of nodules in neurofibromatosis type 1 was first investigated in 1981 in a prospective study by Lewis and Riccardi. They found Lisch nodules in 92% of 77 patients aged six or older.

Interestingly, the suggestion to designate iris nodules in neurofibromatosis as "Lisch nodules" as was probably made by the late Frederick C. Blodi (1917-1996) of Iowa City (written communication from W. Lisch, Hanau, Germany).

Acknowledgements:
I gratefully acknowledge the assistance of Anna K. Junk, MD Columbia University, New York, USA, Sylvia Breiden, MD, University of Marburg, Germany, Professor Gerald Langmann, MD, University of Graz, Austria, and Professor Dr. med. Walter Lisch, Hanau, Germany, in compilation of the manuscript.
Arun D. Singh

• S. Snell, E. Treacher Collins:
  Plexiform neuroma (elephantiasis neuromatosis) of temporal region, orbit, eyelid and eyeball. Notes of three cases.
  Transactions of the Ophthalmological Societies of the United Kingdom, London, 1903, 23: 157-177.
  Probably the first cases reported of true Lisch' nodules.
• E. Fuchs:
  Naevus pigmentosus und Naevus vasculosus der Iris.
  Albrecht von Graefes Archiv fur Ophthalmologie, 1913, 86: 155-169.
• I. Goldstein, D. Wexler:
  Melanosis uveae and melanoma of the iris in neurofibromatosis (Recklinghausen).
  Archives of Ophthalmology, Chicago, 1930, 3: 288-296.
• J. Van der Hoeve:
  The Doyne Memorial Lecture. Eye Symptoms in phakomatoses.
  Transactions of the Ophthalmological Societies of the United Kingdom, London, 1932, 52: 380-401.
• T. Sakurai:
  Multiple neurofibroma patient showing multiple flecks on the anterior surface of the iris.
  Acta Societatis ophthalmologicae Japonicae, Tokyo, 1935, 39:87-93.
• K. Lisch:
  Ueber Beteiligung der Augen, insbesondere das Vorkommen von Irisknotchen bei der Neurofibromatose (Recklinghausen).
  Zeitschrift für Augenheilkunde, Basel, 1937, 93: 137-143.
• K. Lisch:
  Die vier Phakomatosen.
  Münchener medizinische Wochenschrift, München, 1942, 25: 564-566.
• Richard A. Lewis, Vincent M Riccardi:
  Von Recklinghausen neurofibromatosis: Incidence of iris hamartomata.
  Ophthalmology, Philadelphia, 1981, 88: 348-354.
• Arun D. Singh:
  Karl Lisch, MD: Remembered July 24, 1907 - February 5, 1999.
  Ophthalmic Genetics, 2000, 21 (2): 129-131.