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Biomedical subjects

A F Deutman

Publications and source records attributed to A F Deutman.

At least 19 recordsLinked to original sources

Familial congenital grouped pigmentation of the retina.

Congenital grouped pigmentation of the retina is an uncommon disorder characterized by a grouping together of round to oval spots of pigment in one or more quadrants of the retina, except for the macula. Detection is usually coincidental during routine ocular examination. We examined a mother and daughter with bilateral grouped pigmentation of the retina. Visual acuity, visual fields, and results of electrophysiologic examination were normal. Autosomal dominant inheritance with variable expression was likely.

Adult

Congenital arteriovenous communications and the development of two types of leaking retinal macroaneurysms.

We treated a patient with a rare combination of congenital arteriovenous communications and the development of leaking macroaneurysms of different types. Initially, leaking macroaneurysms developed in the shunt area of the arteriovenous communication; later, a preexistent fusiform macroaneurysm in the afferent arteriole of the congenital communication started leaking. Because exudates and fluid from the leaking macroaneurysms reached the fovea, laser treatment was performed to obliterate the macroaneurysms. We assume that after obliteration of the macroaneurysms with laser in the shunt area, the increase of hydrostatic pressure on the thin wall of the fusiform aneurysm of the afferent artery led to its leaking. We saw no signs of vascular occlusion after laser treatment.

Arteriovenous Fistula

[Peripheral vitelliform lesions in vitelliform macular dystrophy].

We report an unusual case of vitelliform macular dystrophy due to the presence of bilateral peripheral vitelliform lesions. Multiple forms involving posterior pole only and peripheral non specific lesions have already been described but this is the first case published, to our knowledge, showing typical vitelliform lesions in the periphery. These lesions developed in the same way as macular lesions, but they were complicated by a schisis in the left eye. In addition to other electrical and histopathological evidence, this case provides clinical evidence of the diffuse involvement of the retinal pigment epithelium in this disease. This involvement is linked to the accumulation of lipofuscin and granular substance, produced by photoreceptors. The macular predominance of vitelliform lesions can be partly explained by the metabolic and vascular particularities of the macula, but a genetic factor may be involved in the topographic determination of lesions. The development of a schisis on the edge of one of the described lesions encourages systematic search of peripheral lesions in cases of vitelliform macular dystrophy.

Aged

Fluorescein angiographic findings and results of laser treatment in circumscribed choroidal hemangioma.

We studied retrospectively 12 eyes with a solitary choroidal hemangioma in 12 patients over a period of 13 years. A peculiar, even hyperfluorescence of the tumor within the retinal venous phases occurred in all 12 cases. In all but four patients, laser therapy was performed to reduce subretinal fluid and partially destroy the tumor. Two of the three eyes without extensive retinal detachment or cystoid macular edema at the initial visit regained a final vision of 20/30 or better. The remaining 5 patients with the two major complications had a final vision of 20/80 or worse due to degenerative retinal changes. We believe that laser treatment is definitely advisable in the early stages of a circumscribed choroidal hemangioma.

Adult

Early findings in central areolar choroidal dystrophy.

We examined 69 members of two caucasian families with an autosomal dominant form of central areolar choroidal dystrophy using ophthalmoscopy and fundus photography. In five members who had a good visual acuity macular lesions were found. In three of them retinal function tests were performed, which turned out to be normal. These 5 patients underwent fluorescein angiography. Early symptoms of central areolar choroidal dystrophy are small parafoveal hyperfluorescent areas due to retinal pigmentepithelium loss and areas of pigment mottling in the macula. Until now the early lesions of central areolar choroidal dystrophy in patients with a good visual acuity in both eyes have not been described clearly.

Adult

Presumed ocular histoplasmosis syndrome and linear streak lesions.

Five cases of subretinal neovascular membranes in the macula associated with punched out chorioretinal scars and linear streaks were seen in five Dutch patients. Clinically the fundus lesions are consistent with those of presumed ocular histoplasmosis syndrome (POHS) seen in the United States of America. Cutaneous serological testing for histoplasmin reactivity was negative in the three patients tested. Of special interest is the presence of linear streaks in association with POHS. They have not been previously described in patients from Europe with this syndrome.

Adult

A long-term follow-up study of laser coagulation of neovascular membranes in angioid streaks.

We treated 30 eyes (24 patients) with angioid streaks and neovascular membranes using light coagulation. Of 30 eyes, 16 showed either ameliorated or unchanged visual acuity. Twelve of the remaining 14 eyes retained a visual acuity of 20/200 or better. In 11 patients, the fellow untreated eye showed central macular degeneration with loss of central vision. The follow-up period ranged from two months to 16 years (mean, 3.4 years).

Adult

Clinical evaluation of the Topcon CT10 tonometer.

We evaluated the clinical use of the Topcon CT10 non-contact tonometer in our outpatient clinic. Compared to the Goldmann applanation it is useful and reliable in screening glaucoma patients.

Clinical Trials as Topic

Immune responsiveness to retinal S-antigen and opsin in serpiginous choroiditis and other retinal diseases.

The immune responsiveness to bovine retinal S-antigen and opsin has been investigated in some retinal disorders by means of in vitro lymphocyte proliferation, leukocyte migration inhibition and enzyme linked immune sorbent assays (ELISA). Sensitisation to S-antigen was observed in serpiginous choroiditis, but not in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) or retinitis pigmentosa. No significant immune responsiveness was detected to opsin in any of the three diseases. Elevated antibody titers to S-antigen were observed in some individual patients and healthy subjects. However, none of the patient groups exhibited an elevated antibody titer as compared to the control group. Although serpiginous choroiditis and APMPPE share some prominent clinical characteristics, the sensitisation in the former disease may perhaps be attributed to more severe and prolonged damage of the photoreceptor cells and blood-retina barrier. A combination of previous and present results suggests that in immunological investigations of retinitis pigmentosa patients it is more effective to use human than bovine S-antigen as test antigen because a species specific epitope seems to be involved.

Antibody Formation

X-linked cone dystrophy. An overlooked diagnosis?

The cone dystrophies can be subdivided into 3 functional stages: central cone disease, peripheral cone disease and diffuse cone disease, respectively. In the patient material of our clinic the sex distribution of patients presenting with te diffuse cone disease stage was abnormal: 22 males and 3 females. The authors suggest that the diagnosis X-linked cone dystrophy often is overlooked.

Color Vision Defects

Ligneous conjunctivitis.

The case history is given of a woman of 65 (in 1973) with a granulomatous conjunctival inflammation in the right eye and chronic recurrent polyps on the vocal cords. Several times, granulomatous tissue was removed from the conjunctiva of the right eye but the result was recurrences at shorter intervals. Seven years after the onset in the right eye the left eye became affected. Various treatments, both systemic and local, were tried without success. The histological diagnosis of ligneous conjunctivitis was not made until 1981. Treatment with the known remedies for ligneous conjunctivitis was not successful. At the end of 1984 treatment with Imuran (azathioprine) was started. Since that time the patient has been practically free of recurrent granulomatous tissue on the conjunctiva and vocal cords. The treatment of ligneous conjunctivitis with Imuran has not previously been reported in the literature.

Aged

Atypical sector pigmentary dystrophy.

The authors describe a family with atypical sector shaped pigmentary dystrophy in two generations with transmission from father to son. A review of the literature is given.

Adult

Idiopathic sub-retinal neovascular membranes in the macula (hemorrhagic macular choroidopathy of young adults). Clinical report and effectiveness of laser treatment.

Twenty-six patients with idiopathic sub-retinal neovascular membranes (INVMs) located within the posterior pole were examined. Clinical and fluorescein angiographic features of these patients are described. Follow-up ranged from 2 to 96 months (mean 16.5 months). Laser treatment was performed according to the location of the neovascular membrane: 7 out of 9 eyes (77%) increased their final visual acuity or stabilized after Argon blue-green laser photocoagulation (INVMs further than 200 microns from the center of the fovea). Krypton red light laser treatment was performed in 13 eyes with juxta-foveal and sub-foveal INVMs: following treatment 10 eyes (77%) improved by 2 or more Snellen lines or maintained their pre-treatment visual acuity. Because of the fact that the Krypton laser was not yet available, 5 patients were not treated: all of them had sub-foveal (3) or juxta-foveal INVMs (2). The natural history of 4 cases (80%) showed an increase in the final visual acuity in 3 eyes and a steady state in one eye. Pathogenesis and treatment outcome of the disease are finally discussed.

Adolescent

Evolution of benign concentric annular macular dystrophy.

In 1974, Deutman described a family with an autosomal dominantly inherited macular dystrophy that he termed "benign concentric annular macular (bull's-eye) dystrophy." Ten years later, we performed a follow-up examination. Some patients complained of deterioration of visual acuity, night vision, and color vision. The macular dystrophy had progressed. The fundus periphery was more involved and in two patients there were bone corpuscle-like pigmentations. Electrophysiologic examination showed increased photoreceptor dysfunction with equal involvement of the rod and cone system. The patients had an acquired type III blue-yellow color vision defect with pseudoprotanomaly.

Adult

Rips of the retinal pigmentepithelium.

A rip or rupture of the detached retinal pigment epithelium (RPE) with subsequent retraction of that layer is an often misdiagnosed affection of the posterior pole of the eye. The histologic appearance of this entity has to our knowledge not yet been published, but the fundus aspect and fluorescein angiography show that the focal absence of the pigmentepithelial layer is very likely. A rip is only seen in older age and it always appears in a detached RPE that often exists in combination with other features of a senile macular degeneration. Mostly the rip arises spontaneously but it may develop sometimes directly after laser coagulation of the detached RPE.

Aged