German journal of ophthalmology最新文献

{"title":"Results of combined trabeculectomy and phacoemulsification via tunnel incision.","authors":"T Ness,&nbsp;J Funk","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Currently a cataract is usually surgically treated by phacoemulsification via tunnel incision. In cases of coexisting cataract and glaucoma a combined surgical procedure is desirable. We combine cataract and filtering surgery by simply dissecting a 1 x 1-mm piece from the inner tunnel lamella of a standard corneoscleral tunnel. The results of treatment of the first 20 eyes by the proposed combined procedure were compared with the results of traditional phacoemulsification and traditional trabeculectomy. With regard to visual acuity, combined surgery was as good as traditional phacoemulsification via tunnel incision. In terms of the regulation of intraocular pressure, combined surgery was as good as traditional trabeculectomy. As with trabeculectomy, mild early postoperative complications occur frequently, which require intensive post-operative care. Thus, the combination of trabeculectomy and phacoemulsification via tunnel incision proved to be a successful technique for the surgical treatment of combined cataract and glaucoma.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"362-7"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20404495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of anterior-segment surgery in Rieger's anomaly.","authors":"T S Dietlein,&nbsp;P C Jacobi,&nbsp;G K Krieglstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Rieger's anomaly is characterized by a dysgenesis of the anterior ocular segment with peripheral iris strands, an abnormally prominent Schwalbe's line, and a stromal atrophy of the iris. Refractory secondary glaucoma frequently demands surgical intervention with an uncertain prognosis. The charts of 15 patients with Rieger's anomaly (11 male, 4 female; mean age 21 years) were reviewed with regard to surgical management and postoperative intraocular pressure (IOP). Micro-/sclerocornea, keratoglobus, and keratopathy, micro-/buphthalmia, glaucoma, cataract, spherophakia, retinal detachment, papillary drusen, strabismus, and amblyopia were found associated with Rieger's anomaly. Secondary glaucoma required glaucoma surgery in 12 patients. Trabeculectomy (with or without mitomycin) and cyclodestructive surgery (cyclocryotherapy or cyclophotocoagulation) yielded IOP regulation in 50% of the treated eyes at a follow-up of 1 year. Cyclodestructive interventions displayed a very limited prognosis in eyes with preoperative maximal IOP values of > 45 mmHg. An obvious decline in visual acuity was observed in all patients, depending on the duration of glaucoma.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"439-42"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20405609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of the corneal epithelium in excimer-laser photorefractive keratectomy.","authors":"C P Lohmann,&nbsp;A Patmore,&nbsp;U Reischl,&nbsp;J Marshall","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To evaluate the importance of the epithelium for postoperative regression we undertook excimer-laser photoreactive keratectomy (PRK) in six rabbits. After the epithelium had been removed mechanically, two rabbits underwent a -3.0 D procedure; two rabbits, a -6.0 D procedure; and two rabbits, a -9.0 D procedure. Refraction was monitored pre- and postoperatively using streak retinoscopy. Rabbits were killed at 3 weeks after PRK and the thickness of the corneal epithelium in the centre of the ablation zone and in an untreated area just outside the treatment zone was measured using light microscopy. At the time of killing, no stromal haze was visible on slit-lamp biomicroscopy. In all rabbits the thickness of the corneal epithelium over the untreated area was between 31.4 and 36.7 microns. In contrast, the thickness of the epithelium in the centre of the ablation zone in rabbits treated with a -3.0 D procedure was only slightly increased, and retinoscopy showed a change in refraction of around 3 D. All other rabbits showed a significant increase in epithelial thickness, whereas the amount of thickness correlated with the amount of myopic regression. One rabbit in the -6.0 D group showed an increase in epithelial thickness of 18.4 microns and a myopic regression of 1.5 D. In both rabbits in the -9.0 D group the amount of corneal tissue removed by the laser was nearly completely substituted by epithelial hyperplasia. Postoperative retinoscopy showed nearly the same refraction as had been obtained preoperatively. In summary, the postoperative control of epithelial thickness seems to be an important factor for the success of excimer-laser PRK and, in particular, for high degrees of myopia.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"368-72"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20404384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-sensitivity testing with scanning-laser ophthalmoscope stimulation in normal, ocular hypertensive, and glaucomatous patients.","authors":"F Horn,&nbsp;W Budde,&nbsp;M Korth","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to test the usefulness of the scanning laser ophthalmoscope (SLO) as a stimulator for localized contrast-sensitivity (CS) measurements under visual control in normals and glaucomatous patients. The helium-neon laser (630 nm) of a Rodenstock SLO was used to generate a localized square-wave stripe pattern and a fixation mark while an infrared laser (780 nm) visualized the eye's fundus. Thus, measurements with unstable fixation could be discarded. The spatio-temporal CS was determined with a localized alternating pattern as follows: 5 Hz, 2.88 cycles/degree; stimulus diameter 2 degrees; test location central, temporal upper, and temporal lower retinal area. The subjects included 47 controls, 23 ocular hypertensive patients (intraocular pressure > 21 mmHg, normal optic disc, no visual field defect), 27 \"preperimetric\" glaucoma patients (intraocular pressure > 21 mmHg, early glaucomatous optic disc damage, no visual field defect), and 41 \"perimetric\" glaucoma patients with glaucomatous defects of the optic disc and perimetric losses. Nonparametric tests (Wilcoxon, Spearman) were used for statistical analyses. Among the three locations tested, CS values recorded for the temporal lower retinal areas showed the strongest reduction in glaucomas (\"preperimetric\" P = 0.002, \"perimetric\" P < 0.0001) and a significant correlation with the perimetric mean defect of the stimulated area (r = 0.65, P < 0.001). In all, 95% of glaucomatous eyes with extensive visual field losses were recognized as pathologic at a specificity of 80%. Spatiotemporal CS of temporal retinal areas is sensitive to glaucoma. The present study confirms the feasibility of using the SLO system for localized CS measurements, in normals and patients.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"428-34"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20405607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of YAG-laser iridotomy in pigment dispersion syndrome.","authors":"W D Lagrèze,&nbsp;M Mathieu,&nbsp;J Funk","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We determined iris configuration and posterior-chamber depth before and after YAG-laser iridotomy in 20 eyes with pigment dispersion syndrome using high-resolution ultrasound and measured the intraocular pressure after a mean of 9.1 months. The iris configuration and posterior-chamber depth of our patients were compared with those of an age- and refraction-matched control group of 20 eyes without pigment dispersion. In the patient group, 8 eyes had a concave iris configuration with shallow posterior chambers and 12 eyes had planar irides. In the former group the posterior-chamber depth increased significantly after treatment. In the latter group it did not change. In the normal control group, three subjects also had concave irides. There was a significant correlation between posterior-chamber depth and refraction in patients with pigment dispersion syndrome, but not in the normal control group. After the follow-up period the intraocular pressure of treated eyes was not significantly lower than that of untreated eyes. Iris concavity can also occur in normal individuals and may therefore be only a pathogenetic cofactor in the pigment dispersion syndrome. Laser iridotomy proved to flatten irides but did not significantly decrease the intraocular pressure.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"435-8"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20405608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial precipitates and laser flare photometry in patients with acquired immunodeficiency syndrome: a screening test for cytomegalovirus retinitis?","authors":"C Althaus,&nbsp;J Best,&nbsp;A Hintzmann,&nbsp;M Schimkat,&nbsp;T Hudde,&nbsp;A Cepin,&nbsp;R Sundmacher","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with acquired immunodeficiency syndrome (AIDS) who present with cytomegalovirus (CMV) retinitis show pathognomonic endothelial precipitates suggestive of primary anterior uveitis or secondary changes due to a spill-over from the posterior chamber. Laser flare photometry allows quantification of the intensity of anterior affection. We wanted to establish anterior-chamber flare values in AIDS patients with and without CMV retinitis and to find out whether CMV retinitis is preceded by an elevation of the flare value. In all, 25 men with AIDS who presented with CMV retinitis and 27 who did not have CMV retinitis but showed a CD4 count of < or = 200 cells/microliter blood were enrolled in a prospective study. Slit-lamp examination was performed, followed by indirect ophthalmoscopy and laser flare photometry after dilation of the pupil with tropicamide eye drops. Patients with CMV retinitis were followed every 10 days and the others, every 4 weeks. A group of 51 human immunodeficiency virus (HIV)-negative men served as a control group. AIDS patients with CMV retinitis showed a significantly higher flare count in the affected eye (12.4 photons/ms; n = 26) as compared with the unaffected partner eye (4.2 photons/ms; P < or = 0.0001; n = 18) and with eyes of AIDS patients without CMV retinitis (4.1 photons/ms; P < or = 0.0001; n = 50). The count in the latter eyes was also significantly higher than the control value (3.1 photons/ms; P < or = 0.0001; n = 102). Typical reticulate endothelial precipitates were found in 92% of AIDS patients with CMV retinitis. During the study, five eyes of three patients developed a fresh CMV retinitis, but a preceding rise in the flare count was not observed. Laser flare photometry follows the occurrence of pathognomonic reticulate endothelial precipitates. It lags behind the development and the extension of CMV retinitis. Therefore, it cannot be used as a screening test for early detection of CMV retinitis.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"443-8"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20405610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular production of interferon-gamma and lack of major histocompatibility complex molecules induce immunological changes in the intraocular environment.","authors":"K D Geiger,&nbsp;N E Sarvetnick","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The intraocular immune privilege includes the absence of delayed-type hypersensitivity (DTH) to intraocularly presented antigens. To study the role of major histocompatibility complex (MHC) molecules in relation to the activity of the proinflammatory cytokine interferon-gamma (IFN-gamma) in the maintenance of the intraocular immune privilege, we tested DTH to intraocularly presented antigens in MHC class I- or class II-deficient mice and in transgenic mice with production of IFN-gamma in the retina (rho-gamma). MHC class I- and class II-deficient mice and rho gamma mice with or without additional MHC deficiency developed hypersensitivity to intraocularly presented antigens and increased ocular pathology, whereas control animals did not. The abrogation of the intraocular immune privilege by IFN-gamma was independent of MHC expression and was probably due to disturbance of the blood-retina barrier. The sole lack of MHC class I or II expression produced similar effects, confirming the importance of IFN-gamma and MHC molecules for the development of uveitis.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"309-14"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20403246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of endotoxin in media from sterile corneal organ cultures.","authors":"A C Ventura,&nbsp;E Pels,&nbsp;K Engelmann,&nbsp;G Richard,&nbsp;M Böhnke","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Lipopolysaccharides (LPS) are elements of the cell wall of gram-negative bacteria. They are also called endotoxins and are known to stimulate various inflammatory reactions by interaction with cytokines and macrophages. Additionally, they may have a direct effect on other cells. As contamination of sterile organ-culture media with bacterial substances may influence the donor-tissue prognosis, we investigated a series of culture media drawn from organ culture for the presence of endotoxin. A total of 341 samples of sterile organ-culture media from 3 different cornea banks using either organ culture or the refrigerated-storage technique were tested for endotoxin. The assay was performed using the Limulus amebocyte-lysate test. A level of endotoxin above the background threshold was found in 99/341 (29%) culture media. The incidence of endotoxin ranged from 14% up to 50%, depending on the cornea bank and culture system used. Endotoxin detected in sterile corneal organ cultures probably derives from nonreplicating bacterial postmortem donor-tissue contamination. The presence of endotoxin-positive cultures varied between the eye banks but was not related to a given storage method. As endotoxin may directly influence graft viability or trigger inflammatory host responses, these findings may have significance for the clinical results of corneal grafting.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"404-7"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20404390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological response to UV-B irradiation after excimer-laser photorefractive keratectomy.","authors":"Z Z Nagy,&nbsp;P Hiscott,&nbsp;B Seitz,&nbsp;U Schlötzer-Schrehardt,&nbsp;I Süveges,&nbsp;G O Naumann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to evaluate the morphological effects of UV-B exposure on the outcome of photorefractive keratectomy (PRK). A total of 42 pigmented rabbits were used in the study. In all, 1 eye of 12 rabbits received a 193-nm and 45-micron-deep (-5.0-D) excimer-laser PRK, 1 eye of 12 rabbits received a 135-micron-deep (-15.0-D) excimer-laser PRK and 1 eye of 12 rabbits received a 270-micron-deep (-30.0-D) excimer-laser PRK. At 21 days after PRK, six of the laser-treated eyes from each group were exposed to 100 mJ/cm2 UV-B (280-320 nm) light by placement of the rabbits in a standard clinically used \"dermatological chamber\" for 7 min. One eye of six rabbits received only UV-B light, serving as a control. The other six rabbits from the PRK groups received no further treatment. Subepithelial \"haze\" was evaluated before and after UV irradiation. Corneal morphology was assessed at 4, 8 and 12 weeks after UV-B exposure by light microscope and transmission electron microscope techniques (TEM). Eyes exposed to 100 mJ/cm2 UV-B light exhibited only keratitis for 2 days but showed no haze and were histologically normal at all time points. The PRK-treated, UV-B-irradiated rabbit eyes exhibited a significant increase in stromal haze as compared with the eyes receiving PRK alone; this phenomenon correlated with the depth of photoablation. Histologically, the main difference observed between the UV-B-irradiated and nonirradiated post-PRK eyes was the presence of anterior stromal extracellular vacuolization in the UV-B-exposed eyes. The vacuolated foci were confined to the PRK treatment area, contained increased numbers of keratocytes and showed a disorganization of normal collagen lamellae. TEM revealed activated keratocytes containing abundant rough endoplasmic reticulum, prominent Golgi zones and extracellular vacuoles filled with amorphous material. The haze and morphological changes showed a tendency towards incomplete resolution over a period of 12 weeks. UV-B exposure during post-PRK stromal healing exacerbates and prolongs clinical symptoms and the stromal healing response in rabbits, which is manifested biomicroscopically by augmentation of subepithelial haze. The findings suggest that excessive ocular UV-B exposure should be avoided during the period of post-PRK stromal repair (at least 3 months) and that UV-B light may modulate the response of tissues to 193-nm excimer and, perhaps, other laser energy in general.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"352-61"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20404494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Might the refractive state in oculocutaneous albino patients be a clue for distinguishing between tyrosinase-positive and tyrosinase-negative forms of oculocutaneous albinism?","authors":"B Käsmann,&nbsp;K W Ruprecht","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In oculocutaneous albinism (OCA), one can distinguish between a tyrosinase-negative form (no residual activity of the enzyme tyrosinase) and a tyrosinase-positive form (with detectable residual enzymatic activity) and their respective subtypes. In infancy and early childhood the clinical discrimination between tyrosinase-positive OCA and tyrosinase-negative OCA can be very difficult. To date, only the hair-bulb L-dopa incubation test has been helpful in discriminating between the tyrosinase (ty)-negative and ty-positive forms of OCA. In 68 patients with albinism of the eye, 24 had an oculocutaneous form of albinism. We determined the ty relationship either by the L-dopa incubation test (younger patients) or by clinical appearance (older patients). We determined the full cycloplegic refraction in all patients and looked for a possible correlation of the refraction with the ty relationship. Our data suggest that an OCA patient with a hyperopic refractive error of > 4.0 D might have a ty-positive form of OCA. A patient with a moderate to high degree of myopia is more likely to have a ty-negative form of OCA. Determination of ty relationship is more reliable in patients with high degrees of hyperopia and, therefore, in patients with a ty-positive form of OCA. Statistical evaluation of the data was not possible in a sensible way due to the small number of patients involved in the present study.</p>","PeriodicalId":77146,"journal":{"name":"German journal of ophthalmology","volume":"5 6","pages":"422-7"},"PeriodicalIF":0.0,"publicationDate":"1996-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20405606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}