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Biomedical subjects

A Kampik

Publications and source records attributed to A Kampik.

At least 55 records · Page 3Linked to original sources
PubMed2002

[Echographic differential diagnosis of optic nerve widening].

INTRODUCTION: Standardized echography is a well-established examination technique in ophthalmology. Among other things one of the more important uses is the evaluation of the optic nerve and its abnormalities. One aspect is the use of the stretch-test (originally called the "30 degrees-test") for the differential diagnosis of optic nerve widening. Such widening can be caused by solid thickening of the optic nerve and/or its sheaths or by solid infiltration of the subarachnoidal space. More frequent is a widening of the optic nerve as a consequence of sheath distension by increased subarachnoidal fluid. PATIENTS AND METHODS: We present various cases of widened optic nerve patterns and explain the technique and diagnostic value of standardized echography, especially of the stretch-test. RESULTS: In widened optic nerve patterns due to fluid around the optic nerve parenchyma, a decreased optic nerve thickness will be found when performing the stretch-test (positive test result), whereas in solid lesions of the optic nerve no change of optic nerve thickness will be seen (negative test result). CONCLUSION: The stretch-test provides a reliable tool for the differential diagnosis of widened optic nerves.

Adult↗
PubMed2002

[Correlation between ICG angiography verified networks in uveal melanomas and rate of tumor regression after brachytherapy].

INTRODUCTION: The post-irradiation regression rate of uveal melanomas is a prognostically significant factor for the development of metastases. Other predictive factors for metastases are histological networks which are imagable with confocal ICG angiography. The purpose of this study was to evaluate a possible connection of networks in the ICGA and tumor regression rates. METHODS: We compared the post-irradiation regression rates (as %) in 20 patients 1 year after brachytherapy with networks identified in pre-treatment indocyanine green angiography (ICGA). The ICG angiography was performed before irradiation, 10 patients were irradiated with Ru-106 and 10 were irradiated with Id-125. RESULTS: The mean preoperative maximum apical height was 5.2 mm [SD: 1.5 mm; Ru106 group: 5.7 mm (SD: 1.0 mm); Id-125 group: 5.0 mm (SD: 1.9 mm)]. In 11 patients (55%) (Ru-106: 5; Id-125: 6) we found networks in the preoperative ICG. The mean regression rate in tumors with networks was 51.3% (SD: 14.7%) and 28.0% (SD: 16.4%) in the group without networks. The difference between both groups was statistically significant (p = 0.003, Mann-Whitney test). No statistically significant difference in the regression rates was found between the two groups of brachytherapy Ru-106 and Id-125 (p = 0.165, Mann-Whitney test). DISCUSSION: Highly proliferative tumors are known to be more sensitive to irradiation. This may be one reason why tumors with a rapid post-irradiation regression are the more aggressive ones with regard to later development of metastases. Histopathological networks are also known to be a strong indication of more aggressive, metastasizing tumors. These networks are also imagable in ICG angiography. Our observation emphasizes a connection between networks in ICG angiography and regression rates of uveal melanomas after brachytherapy.

Adult↗
PubMed2002

[The Munich/San Diego/Iowa City Collaboration (MuSIC). MuSIC Report I: Design , characteristics of the collective and preliminary results].

BACKGROUND: We have previously shown that histologically described microcirculation patterns (MCP) can be visualized with indocyanine green (ICG) angiography. We have designed a prospective study to evaluate the prognostic value of these angiographically imaged MCP in small choroidal melanocytic lesions. In this report we describe the design of the study, characterize the patient collective, and present the first results. PATIENTS AND METHODS: In this prospective nonrandomized observational study, unilateral choroidal melanocytic lesions with 1.5-5.5 mm maximum apical height are observed until growth is determined according to defined criteria. Variables are demographic parameters, subjective symptoms, subretinal fluid, location and dimension of tumor, hemorrhage, color, orange pigment, and MCP determined by ICG angiography: normal, straight, parallel without crosslinking, parallel with crosslinking, arcs without branching, arcs with branching, loop, and network. RESULTS: Seventy patients (22 males, 48 females; age: 33-88 years, median: 64 years) have been included up to now: 19 tumors showed growth so far (time to growth: 51-946 days, median: 127 days). The following parameters were statistically significantly correlated with time to tumor growth: flashes (p = 0.082), orange pigment (p = 0.012), subretinal fluid (p < 0.001), maximum basal tumor diameter (p = 0.001), maximum apical tumor height (p < 0.001), parallel with crosslinking (p < 0.001), arcs with branching (p = 0.006), loop (p < 0.001), and network (p < 0.001). Of these, complex MCP (parallel with crosslinking, arcs with branching, loop and/or network) showed the strongest correlation with time to tumor growth in a Cox regression model. Based on our data, the positive predictive value of imaging complex MCP (for growth within 12 months) is 78% and the negative predictive value is 98%. CONCLUSION: Our patient collective demonstrates comparable prognostic parameters for time to growth as described in the literature. In addition, the ICG angiographic detection of complex MCP is more strongly predictive of the time to growth than other clinically determinable factors. Thus, we recommend this examination for patients with small choroidal melanocytic lesions, if the patient is to be counseled regarding the likely biologic behavior of his tumor.

Adult↗
PubMed2002

[New automated microkeratome for trepanation of lamellar keratoplasty].

BACKGROUND/PURPOSE: Lamellar keratoplasty is an established therapy of corneal pathologies without endothelial involvement and the lack of endothelial rejection is one of the major advantages compared to penetrating keratoplasty. The major disadvantages of manually prepared lamellar corneal grafts are the limited mechanical and optical quality but the automated lamellar therapeutic keratoplasty system ALTK (MORIA) is intended to overcome these disadvantages. The purpose of this preliminary work is to investigate histologically and in clinical cases, if the ALTK system can achieve this aim. PATIENTS AND METHODS: Corneas from two human donors were cut with a 300 microns trephine. After fixation, the stromal bed and the excised cup of one specimen were stained with PAS and examined by light microscopy and the other specimen was analyzed by scanning electron microscopy. In addition, follow-up data of two patients who received such a lamellar graft are reported for the first 9 and 7 months postoperation, respectively. RESULTS: The lamellar cut of homogeneous depth revealed only minor stromal trauma. Both clinical cases demonstrated only minimal interface haze during follow-up. Despite a remarkably clear cornea, visual acuity improved only slowly because the precise lamellar cut tended to partially reproduce any preexisting irregular astigmatism. CONCLUSIONS: The ALTK system simplifies and standardizes the trephination of lamellar corneal grafts but a longer follow up is necessary with respect to visual development and preservation of a clear graft.

Adult↗
PubMed2002

Melanoma inhibitory activity: a novel serum marker for uveal melanoma.

The aim of this study was to evaluate the tumour-associated antigen melanoma inhibitory activity (MIA) as a potential novel serological tumour marker in primary and metastatic uveal melanoma in both the laboratory and the clinical setting. In the laboratory setting, immunohistochemical staining with MIA antibody was performed in paraffin-embedded tissues from six amelanotic uveal melanomas and eight metastatic lesions of uveal melanomas. In the clinical setting, serum samples of 139 patients with uveal melanoma were examined; eight of these patients had overt metastatic disease. Sixty-one initially metastatic disease-free patients were followed over time (median follow-up 240 days, 95% confidence interval 60-883 days) and MIA levels were assessed repeatedly. A one-step enzyme-linked immunosorbent assay was used to quantify the MIA serum levels. In the laboratory setting, five of the six primary uveal melanomas and seven of the eight metastatic lesions stained immunohistologically positive for MIA. In the clinical setting, the 131 patients without overt metastatic disease demonstrated a median serum concentration of MIA of 6.6 ng/ml. In the eight patients with overt metastatic disease, the median serum concentration of MIA was 26.28 ng/ml. This difference was highly statistically significant (P < 0.001, analysis of variance). During follow-up, three initially metastatic disease-free patients developed overt metastatic disease, and the MIA level increased from a median of 6.6 ng/ml before to 29.2 ng/ml after clinical detection of metastatic disease. In the 58 other patients, the serum level remained stable during the entire follow-up period. In conclusion, MIA is expressed in primary and metastatic lesions of uveal melanomas, and a statistically significant elevation in MIA serum levels in patients who develop metastatic disease due to uveal melanoma indicates its promising role as a serum marker for monitoring uveal melanoma patients for metastasis.

Adult↗
PubMed2002

Macular hole size as a prognostic factor in macular hole surgery.

BACKGROUND/AIM: In 1991 there was a series of successful closures of a macular hole after vitrectomy and membrane peeling. Today this technique has become a standard procedure. The aim of this study was to evaluate the role of optical coherence tomography in diagnosing and staging, as well as in predicting, the functional and anatomical outcome after macular hole surgery. METHOD: In a prospective study 94 consecutive patients (20 male, 74 female) with a mean age of 67.6 (SD 6.0) years and a macular hole stage II (n = 8), III (n = 72), and IV (n = 14) according to the classification by Gass were examined with optical coherence tomography (OCT) before pars plana vitrectomy. Macular hole diameters were determined at the level of the retinal pigment epithelium (base diameter) and at the minimal extent of the hole (minimum diameter). Calculated hole form factor (HFF) was correlated with the postoperative anatomical success rate and best corrected visual acuity. The duration of symptoms was correlated with base and minimum diameter of the macular hole. RESULTS: In eyes without anatomical closure of the macular hole after one surgical approach (13/94) the base diameter (p1) and the minimum diameter (p2) were significantly larger than in cases with immediate postsurgical closure (p1 = 0.003; p2 = 0.028). There was a significant negative correlation between both the base and the minimum diameter of the hole and the postoperative visual function (p1 = 0.016; p2 = 0.002). In all patients with HFF >0.9 the macular hole was closed following one surgical procedure, whereas in eyes with HFF <0.5 anatomical success rate was 67%. Better postoperative visual outcome correlated with higher HFF (p = 0.050). There was no significant correlation between the duration of symptoms and base or minimum diameters (p1 = 0.053; p2 = 0.164), respectively. CONCLUSION: Preoperative measurement of macular hole size with OCT can provide a prognostic factor for postoperative visual outcome and anatomical success rate of macular hole surgery. The duration of symptoms did not correlate with the diameters measured. Base and minimum diameters especially seem to be of predictive value in macular hole surgery.

Aged↗
PubMed2002

Epiretinal pathology of vitreomacular traction syndrome.

AIMS: To investigate the ultrastructure of the vitreoretinal interface in patients with vitreomacular traction syndrome. METHODS: 14 patients with vitreomacular traction syndrome underwent standard pars plana vitrectomy. After induction of posterior vitreous detachment, epiretinal tissue and the inner limiting membrane (ILM) of the retina were removed, and processed for transmission electron microscopy. RESULTS: Ultrastructural analysis revealed two basic patterns of vitreoretinal pathology in eyes with vitreomacular traction syndrome. Seven specimens showed mostly single cells or a cellular monolayer covering closely the vitreal side of the ILM, not resulting in a biomicroscopically detectable epiretinal fibrocellular proliferation. The other seven specimens revealed premacular fibrocellular tissue which was separated from the ILM by a layer of native collagen, resembling the clinical features of idiopathic epiretinal membranes. In both groups of eyes, the myofibroblast was the predominant cell type. Fibrous astrocytes and fibrocytes were less frequent. Retinal pigment epithelial cells and macrophages were absent. Deposits of newly formed collagen were present only adjacent to fibrocellular multilayers. CONCLUSIONS: There are two distinct clinicopathological features of vitreomacular traction syndrome which suggest different forms of epiretinal fibrocellular proliferation: (1) epiretinal membranes interposed in native vitreous collagen and (2) single cells or a cellular monolayer proliferating directly on the ILM. The presence of remnants of the cortical vitreous which remain attached to the ILM following posterior vitreous separation may determine the clinicopathological feature of the disease. The predominance of myofibroblasts may help to explain the high prevalence of cystoid macular oedema and progressive vitreomacular traction characteristic for this disorder.

Aged↗
PubMed2001

[Preoperative scanning laser ophthalmoscopy: findings in idiopathic macular foramen].

BACKGROUND: The aim of our study was a detailed morphological and functional assessment of macular foramen stages II-IV by scanning laser ophthalmoscopy (SLO) and fundus perimetry including a correlation with clinical findings. METHODS AND MATERIALS: Included in this prospective study were 78 patients where SLO imaging and fundus perimetry were performed with the SLO-105 (Rodenstock) prior to pars plana vitrectomy for macular foramen on one eye. Both the size and shape the of macular foramen were assessed. Deep (0 dB) and relative (12 dB) scotomata were tested using the Goldmann II stimulus in the 20 degrees field of the SLO. Imaging was performed with the infrared laser and confocal aperture C2. RESULTS: The size of macular foramen ranged from 140 microns to 800 microns (median: 420 microns) and 20 (26%) had irregular, polycyclic borders. In 21 patients (27%) a bright sector could be seen just outside the hole. Deep scotomata were notably smaller than the visible macular hole in 4 patients (6%) and 18 deep scotomata (25%) extended beyond the hole. There was a weak inverse correlation between the size of deep, relative scotomata and the diameter of the macular holes with the visual acuity (r = -0.46; r = -0.39 or r = -0.53), but no correlation with the duration of symptoms could be demonstrated. CONCLUSION: Polycyclic borders were seen as a new feature of some idiopathic macular foramen. This may be due to asymmetric traction or adhesions on the macular area. Also, deep scotomata either smaller or larger than the visible macular hole were found.

Aged↗
PubMed2001

[Application of diagnosis related groups (DRGs) in ophthalmology in Germany].

Starting on 01.01.2003 the hospital reimbursement system in Germany will be transferred completely to a diagnosis-related groups (DRG) system based on the data of 2001. As the reimbursement system is of vital importance for the development of a speciality, current information is given about the impact of the new payment system on ophthalmology. The Australian AR-DRG system to be adopted in Germany distinguishes 20 DRGs for ophthalmology. The patients are grouped into the DRGs according to their principal diagnoses and comorbidities and the procedures coded by electronic data processing. Errors in coding and missing data may cause reductions in the hospital budget as do economically inhomogeneous DRGs. The tight timetable given by the legislation requires completion of determining DRG groups and weightings by 31.12.2001. However, important prerequisites such as the mapping tables of the Australian DRGs are still missing, which means that hospitals have to prepare for the new system like a pilot flying blind with no instruments.

Cost Control↗
PubMed2001

[Cornea donation. Factors influencing consent].

BACKGROUND: The purpose of the study was to determine factors that influence the decision of the next living relative of a deceased for consent on cornea donation. METHODS: The interviews with the relatives of 94 potential cornea donors of the Eye Bank of the Ludwig-Maximilians-Universität, Munich were analysed. The influence of sociological factors on the frequency of obtained consent was investigated. RESULTS: During a 3-month-period, 77 relatives of 94 possible donors were asked for consent to cornea donation and 56 consents (73%) and 21 refusals (27%) were obtained. In 17 (18%) of the cases the relatives could not be reached. Analysis showed a higher consent rate for donors with a university degree (82%) versus those without (71%). Consent was more often obtained for donors who were divorced (88%) than from those who were single (62%). Children of full age (83%) consented more frequently to cornea donation than husbands and wives (78%) or the parents of the deceased (60%). Examination of the postal codes of the residential area indicated more frequent refusals for donors from the rural (54% consent rate) than the urban Munich population (77% consent rate). The situation was the opposite for the residential area of the consenting relative where there was a higher willingness to donate in cases of suicide (93%) in contrast to other causes such as natural deaths (78%) and traffic accidents (71%). CONCLUSION: Socio-economic factors such as education, marital status, residential area and situational factors such as the cause of death, play an important role on the willingness to consent to donate. This study can improve the understanding of the donor family's decision making and as such help the physician asking for consent and improve information to the public which may increase the number of cornea donors in Germany.

Adolescent↗
PubMed2001

X-linked ocular albinism (Nettleship-Falls): a novel 29-bp deletion in exon 1. Carrier detection by ophthalmic examination and DNA analysis.

BACKGROUND: Mutations in the OA1 gene on the short arm of the X chromosome are known to cause X-linked ocular albinism (x1OA) in males. A four-generation family with this disorder, including asymptomatic carrier females, was investigated by molecular analysis of the OA1 gene. METHODS: DNA samples were available from 22 individuals of this family, including 6 affected males and 6 obligate carriers. The nine exons of the OA1 gene were amplified and further analyzed by SSCP and sequencing. RESULTS: A detailed clinical examination of the index patient and two female carriers showed the typical signs of ocular albinism. Visual evoked potential responses showed markedly asymmetrical responses from the two hemispheres in the affected person as well as in the carriers, as a result of misrouting and decussation of optic nerve fibers. Molecular genetic analysis demonstrated a previously undescribed 29-bp deletion at position 225-253 in exon 1 of the OA1 gene, which segregated in the family. CONCLUSION: Clinical examination combined with molecular genetic analysis enhances the potential for a precise diagnosis for persons at risk of x1OA and provide an accurate basis for genetic counseling.

Adult↗
PubMed2001

Preoperative evaluation of limbal dermoids using high-resolution biomicroscopy.

BACKGROUND: Only a few case reports have described the ultrasound biomicroscopic features of limbal dermoids. It remains unclear whether examination by ultrasound biomicroscopy (UBM) can detect the corneal depth of penetration which would improve planning of surgery. METHODS: Eight consecutive patients [two female, six male, 1-24 years old (median 8.5 years)] examined by UBM (Zeiss-Humphrey, 50 MHz) were retrospectively studied. Five of the dermoids were excised without corneal grafting and histopathological evaluation was obtained. RESULTS: Seven out of eight dermoids were located in the temporal lower quadrant. A Goldenhar syndrome was known in three cases. In all cases but one, UBM showed a more reflective and predominantly homogeneous lesion compared with the unaffected corneal stroma, so that the lateral margins of the lesion could be clearly identified. Incomplete stromal penetration of the dermoid was noticed in four cases; one eye showed a corneal full thickness dermoid. An intraocular protrusion was seen in one eye. Two more cases remained unclear because of reduced compliance. Descemet's membrane beneath the dermoid could not be visualized in most cases (seven out of eight) because of strong sound attenuation inside the lesion. Histopathological evaluation of five cases revealed the typical signs of a limbal dermoid. CONCLUSION: UBM improves the preoperative evaluation of limbal dermoids. Subtle examination technique for the depth of corneal penetration is required because of the strong sound attenuation in this tissue, reducing the visibility of deep corneal structures.

Adolescent↗
PubMed2001

Indocyanine green selectively stains the internal limiting membrane.

PURPOSE: To demonstrate whether indocyanine green stains the inner limiting membrane of the retina or residual vitreous cortex. METHODS: We report on the intraoperative staining patterns of the vitreomacular interface in 10 eyes of 10 consecutive patients who underwent vitrectomy with indocyanine green staining for macular hole formation and diffuse diabetic macular edema. RESULTS: In five eyes of five patients with macular holes, indocyanine green staining of the macula after posterior vitreous detachment resulted in an immediate visibility of a discernable membrane that was not previously seen. In five eyes of five patients with diffuse diabetic macular edema and adherent cortical vitreous, indocyanine green failed to stain the vitreomacular interface. After peeling off the residual vitreous cortex, however, a discernable membrane could be identified using indocyanine green dye again. Light and transmission electron microscopy revealed the inner limiting membrane as the membrane that had been stained and removed in all specimens. CONCLUSION: Indocyanine green selectively stains the inner limiting membrane. Staining of the vitreomacular interface using indocyanine green as a vital dye enables the surgeon to distinguish between the residual vitreous cortex and the inner limiting membrane, and it allows safer and easier removal of the inner limiting membrane.

Basement Membrane↗