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Biomedical subjects

A Kampik

Publications and source records attributed to A Kampik.

At least 91 records · Page 5Linked to original sources
PubMed2000

[Multifactorial analysis of therapeutic outcome of pseudophakic retinal detachment surgery].

BACKGROUND: Pseudophakic retinal detachment is one of the most severe complications after cataract surgery and is a common cause of permanently reduced visual acuity. We evaluated parameters predicting reduced functional outcome by a model of stepwise regression analysis. PATIENTS AND METHODS: A series of 102 consecutive patients with pseudophakic retinal detachment were analyzed for various parameters regarding cataract surgery, retinal surgery, and retinal detachment features. First, univariate analysis determined the correlations with reduced functional outcome. Secondly, a stepwise regression model analyzed statistically significant variables for their predictive value of a reduced visual outcome. RESULTS: The overall reattachment rate was 99%. In 69% of the patients there was an improvement of more than two lines at the end of the follow-up period. The most predictive factors for reduced functional outcome were the need for a silicone oil tamponade and the visual acuity prior to retinal detachment surgery. When silicone oil tamponade was not needed, the requirement of more than two retinal surgeries was the most predictive factor for reduced visual outcome. CONCLUSION: In our series the strongest predictive factors for a reduced functional outcome were the necessity of silicone oil, reduced visual acuity at the time of retinal detachment, and the requirement of more than two retinal surgeries. These findings suggest that first-line procedures should not be necessarily minimally invasive measurements but rather procedures that result in a stably attached retina in the first instance without permanent silicone oil tamponade, even if this first operation consists of an extended pars plana vitrectomy.

Adult↗
PubMed2000

[Stereotaxic precision irradiation of large uveal melanomas with the gamma knife].

BACKGROUND: We report our experience with stereotactic radiosurgery using the Gamma-knife in large uveal melanoma unsuitable for brachytherapy (Ru106). PATIENTS AND METHODS: We treated 35 patients (16 male, 19 female; age: median 59 years (95% Confidence interval (CI): 31-84 years; 18 right eyes, 17 left eyes). 7 tumors were located juxtapapillary, 16 tumors were located in the mid-periphery and 12 tumors were located in the ciliary body, The localization and/or the dimension of the tumors did not allow for radiation brachytherapy (Ru106). All patients underwent regular clinical, echographical and neuroradiological follow-up examinations. RESULTS: The follow-up time was median 12 months (95% CI: 4-20 months). A local tumor control defined as either continuous tumor regression or stopping of tumor progression was achieved in 34 (97%) of the 35 treated patients within the observation period. The eye of one patient was enucleated due to tumor regrowth. Maximum apical tumor height according to standardized A-scan before treatment was median 9.1 mm (95% CI: 3.2-13.9 mm) and after treatment median 6.4 mm (95% CI: 2.1 bis 11.9 mm). The difference was statistically highly significant (p < 0.001, one-tailed paired t-test). CONCLUSIONS: Our results in 35 patients indicate that radiosurgery using the Gamma-knife is beneficial in retaining the eyes of patients with large uveal melanomas that are not suitable for brachytherapy (Ru106).

Adult↗
PubMed2000

[Melanoma inhibitory activity (MIA). Evaluation of a new tumor-associated antigen as a serum marker for uveal melanomas].

BACKGROUND: Currently no serological marker for the monitoring of uveal melanoma and its metastases is available. The novel tumor associated antigen Melanoma inhibitory activity (MIA) is expressed in the uveal melanoma and it's metastatic lesions. METHOD: We report about the serum samples of 38 patients with uveal melanomas. 4 of these patients had overt metastatic disease. A nonradioactive one step ELISA was used to quantify the MIA serum levels. RESULTS: In the 34 patients without overt metastatic disease the serum concentration of MIA was mean (+/- 1 SD) 3.6 +/- 1.0 ng/ml. In the 4 patients with overt metastatic disease the serum concentration of MIA was mean (+/- 1 SD) 27.7 +/- 3.0 ng/ml. The difference was statistically highly significant (student t test: p = 0.0001). CONCLUSION: MIA is expressed in primary and metastatic lesions of uveal melanomas. The elevation of MIA serum levels in patients with metastatic disease from melanomas suggests a promising role as a serum marker for monitoring patients with uveal melanoma.

Aged↗
PubMed2000

Stereotactic radiosurgery of large uveal melanomas with the gamma-knife.

OBJECTIVE: To present our experience with the Gamma-knife in treating large uveal melanomas with stereotactic radiosurgery. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Fifty-eight patients with unilateral uveal melanomas were treated from 1996 through 1999 with stereotactic radiosurgery using the Gamma-knife. From these we report the results of 35 patients who had a follow-up of more than 1 year after irradiation. INTERVENTION: Stereotactic radiosurgery with the Gamma-knife. MAIN OUTCOME MEASURES: Tumor control, maximum apical tumor height, eye retention rate, and visual acuity. RESULTS: In 34 eyes (97%), local tumor control was achieved. The maximum apical tumor height decreased from a median of 9.1 mm (95% confidence interval [CI], 3.2-13.9 mm) before treatment to 6.2 mm (95% CI, 2.1-11.9 mm) at 1 year after treatment (P<0.001, paired t test). The tumor volume decreased from a median of 0.8 cm(3) before treatment to 0.5 cm(3) 1 year after treatment (P<0.001, paired t test). Two eyes required enucleation (one radiation failure, one secondary glaucoma). The median visual acuity decreased from 20/60 (95% CI, hand movement [HM] to 20/20) before treatment to 20/200 (95% CI, HM to 20/30) at 1 year after treatment (P = 0.001, paired t test). CONCLUSIONS: Stereotactic radiosurgery using the Gamma-knife is an alternative to enucleation in treating large uveal melanomas. The visual function may be preserved in selected cases.

Adult↗
PubMed2000

Automated surgical equipment requires routine disinfection of vacuum control manifold to prevent postoperative endophthalmitis.

PURPOSE: Contamination of automated surgical equipment is a potential source of postoperative endophthalmitis. The effect of disinfecting the unsterile vacuum control manifold (VCM) on contamination of the aspiration fluid was studied. DESIGN: Comparative prospective microbiologic contamination study. SPECIMENS AND CONTROLS: The 37 aspiration fluid specimens studied or examined consisted of 25 from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 from one system equipped with a modified external VCM (control group). In addition, the tubings of two internal VCMs were investigated. METHODS: We investigated aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. After tracing the source of contamination to the internal VCM, the system was modified, creating an external VCM with the possibility for disinfection, and the study was continued. Whereas no sterilizing rinsing procedures were applied to the hidden internal VCM, the modified external VCM was regularly rinsed and filled overnight with 70% isopropanol. All samples were collected under sterile conditions, centrifuged, and cultured for bacterial growth on blood agar and MacConkey agar for 24 to 48 hours at 37 degrees C. The samples of the two internal VCMs were cultured for fungi as well. MAIN OUTCOME MEASURES: Bacterial growth was quantified, and bacteria and fungi were isolated and identified according to standard microbiologic procedures. RESULTS: In all aspiration fluid specimens from internal VCM-systems, 2+ to 4+ bacterial growth was found. Pseudomonas-related genera (Stenotrophomonas maltophilia, 17x; Comamonas acidovorans, 8x; Chryseomonas spp., 3x), Agrobacterium radiobacter (1 3x), Flavobacterium spp. (3x), and Micrococcus luteus (7x) were found most frequently. The tubing of the two VCMs contained biofilms exhibiting several of these bacteria and fungi. All specimens from the modified external VCM-system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between the experimental and control groups (chi-square: P = 0.0001). CONCLUSIONS: The technical modification described herein allows facile hygienic measures, by which contamination of aspiration fluid by the VCM can be eliminated, which otherwise can be a significant source of contamination.

Aqueous Humor↗
PubMed2000

[Minimally invasive therapy for clinically complete central retinal artery occlusion--results and meta-analysis of literature].

BACKGROUND: Goal of our study was the comparison of the efficacy of various minimal invasive therapeutic regimens for clinically complete central retinal artery occlusion (CRAO) and the comparison with the literature. PATIENTS AND METHODS: In a retrospective study 93 patients treated for CRAO during the period 1994-1998 were identified. 65 of these patients with clinically complete occlusion without a cilioretinal artery were included in the study. Analysis focused on the results of different therapies and the duration of visual impairment till starting treatment. RESULTS: The following therapies were used: acetazolamide (65%), aspirin (60%), bulbus massage (45%), hemodilution (34%), oral pentoxifylline (28%), topical beta blockers (9%), paracentesis (8%), heparin (6%). In 15% of all cases an improvement of at least 3 visual acuity gradations was achieved. No significant positive influence of any treatment method could be identified. Also, a correlation between duration of visual impairment and final visual acuity could not be shown. In the literature very different criteria for inclusion of patients to the studies and for visual acuity improvement are found. When applying comparable criteria to ours most studies show similar results for the therapies listed above as well as for paracentesis and the use of carbogen (95% O2 and 5% CO2). CONCLUSION: The minimal invasive treatments given above do only improve natural course of CRAO in occasional cases. Thus a therapy (-combination) should be chosen, which is adapted to the individual risk factors and is exposing the patient to a low risk by therapy itself.

Acetazolamide↗
PubMed2000

Corneal manifestations of X-linked ichthyosis in two brothers.

PURPOSE: To report the unusual manifestation of X-linked ichthyosis in two brothers. METHODS: Leukocyte separation and sterylsulfatase assay are performed to show the deficiency of sterylsulfatase. RESULTS: Two brothers presented in our clinic with cutaneous alterations consistent with X-linked ichthyosis. Ocular examination disclosed fine, flour-like, punctate, evenly, and diffusely distributed opacities of the posterior corneal stroma, close to Descemet membrane in both patients. In one patient, superficial, small, granular opacities were detected. They were gray in color and seemed to involve the epithelium and the subepithelial and anterior stromal layers. In both patients, the deficiency of sterylsulfatase could be shown and confirmed the diagnosis. CONCLUSIONS: Flour-like opacities in the posterior stroma have been shown to be a common manifestation of X-linked ichthyosis. Though the underlying biochemical defect in X-linked ichthyosis has been discovered, the question of how these opacities develop is still a subject of debate. Subepithelial stromal keratopathies or epithelial irregularities are uncommon and are rarely described in the literature. The superficial corneal changes seen in one of our patients are unusual and are not similar to those reported by other authors.

Adult↗
PubMed2000

Choroidal melanoma microcirculation with confocal indocyanine green angiography before and 1 year after radiation brachytherapy.

PURPOSE: The authors previously demonstrated that confocal indocyanine green (ICG) angiography is capable of imaging the microcirculation of choroidal melanomas. The purpose of this study is to report their observations regarding the response of the microcirculation using confocal ICG at 1 year after radiation brachytherapy. METHODS: Thirteen patients with unilateral choroidal melanoma were examined once before and several times up to 1 year after radiation brachytherapy (Iodine-125 or Ruthenium-106 plaque). At each visit, a complete ophthalmologic examination including standardized echography and fluorescein and ICG angiography was obtained, the latter using a confocal scanning laser ophthalmoscope. RESULTS: In 10 patients (77%), the tumor microcirculation changed considerably within 1 year after treatment. Distortion, thickening, thinning, and complete obliteration of vessels could be observed. In the other 3 patients (23%), no changes in the microcirculation were noticed within the observation period. CONCLUSIONS: Follow-up with confocal ICG of choroidal melanomas after treatment with local radiation brachytherapy allows for visualization of the microcirculation reaction following radiation brachytherapy. This provides the clinician with additional information for the posttreatment monitoring of these patients. Confocal ICG might also be a useful tool to monitor the effects of future antiangiogenesis-based tumor therapies in choroidal melanomas.

Adult↗
PubMed2000

Effect of alcohol and light on the retinal pigment epithelium of normal subjects and patients with retinal dystrophies.

BACKGROUND: Light absorbed by photoreceptors causes oscillations in the voltage across the retinal pigment epithelium (RPE). This is the basis of the clinical test, electro-oculography (EOG). We have previously shown that alcohol causes a sequence of voltage changes which are so precisely the same as those caused by light that they must be produced by the same RPE machinery. There is good evidence that alcohol produces its effect by a direct action on the RPE. Consequently, in diseases associated with loss of photoreceptors, alcohol should continue to produce the voltage changes of the EOG unless secondary changes have occurred in the RPE. METHODS: The alcohol response in patients with retinitis pigmentosa (RP) was investigated using EOG. RESULTS: In no patient with RP was there any alcohol rise. CONCLUSION: In patients with RP secondary abnormalities of function of the RPE must occur.

Adult↗
PubMed2000

Silicone oil removal strategies.

Although it is widely accepted to use silicone oil in the treatment of very complex retinal detachments, there is no definite agreement on when and why silicone oil should be removed. Frequently found is a statement on the necessity of silicone oil removal after a certain period of time. However, the rate of retinal redetachment after silicone oil removal varies widely and appears to correlate with the underlying disease process and its severity. The literature on strategies of silicone oil removal, the rate of complications, and, thus, the risk-benefit ratio is scant. Therefore, for the discussion of silicone oil removal we rely on personal experience and the rather rare studies on silicone oil removal. Regarding the data given in the literature, the rate of vitreoretinal complications after silicone oil removal, even in cases with a clinically stable-appearing retinal situation, is rather high in severe proliferative vitreoretinopathy (PVR) and lower in most advanced cases of severe proliferative diabetic retinopathy (PDR) requiring silicone oil tamponade. The benefits of silicone oil removal are better in cases of cytomegalovirus retinitis or other situations without a PVR component. Silicone oil removal has to be considered a procedure of ill-defined risks, especially if silicone oil is really used as a last therapeutic resort in most severe cases of complicated retinal detachment. Further, exact criteria for the timing and safe removal of silicone oil in these complex vitreoretinal disorders still needs to be defined. A strategy for the removal of silicone oil is discussed.

Humans↗
PubMed2000

Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane.

PURPOSE: To evaluate the surgical results of pars plana vitrectomy with peeling of the inner limiting membrane (ILM) in a preliminary series of 12 eyes with diffuse diabetic macular edema. PATIENTS AND METHODS: Pars plana vitrectomy with peeling of the ILM was performed in 12 eyes with diffuse diabetic macular edema. In 10 eyes, the posterior hyaloid was attached and thickened. Six eyes had undergone macular photocoagulation previously, and two other eyes had been vitrectomized previously. Light and electron microscopy of the specimens obtained during vitrectomy was performed. Visual acuity and retinal thickening were monitored. RESULTS: Intraoperatively, the posterior hyaloid was found to be thickened and completely attached to the macula in 10 eyes. Two previously vitrectomized eyes showed a glistening reflex of the vitreoretinal interface but no premacular membrane. The posterior hyaloid and the ILM were removed from the macula. Postoperatively, retinal thickening resolved or decreased in all eyes. Visual acuity improved by at least two lines in 11 eyes. Best-corrected postoperative visual acuity developed within 4 to 12 weeks. No recurrence or deterioration of macular edema or epiretinal membrane formation were observed during the entire period of review (mean, 16 months; range, 8-31 months). Light and electron microscopy showed the presence of the ILM associated with sparse and mostly single-layered fibrous astrocytes. CONCLUSION: Vitrectomy including removal of the ILM leads to expedited resolution of diffuse diabetic macular edema and improvement of visual acuity without subsequent epiretinal membrane formation. Complete release of tractional forces and inhibition of reproliferation of fibrous astrocytes seem to be prudent in the eyes of patients with diabetes and advanced vitreoretinal interface disease of the macula.

Adult↗
PubMed1999

[Cytomegalovirus (CMV) retinitis in AIDS. Gancilovir implantation in comparison with systemic therapy].

INTRODUCTION: Untreated CMV retinitis with AIDS leads to blindness; therefore, a life-long virostatic treatment is required. It can either be administered systemically or locally, as there are different advantages and disadvantages. When treating patients we aim at therapy that preserves vision without diminishing quality of life. It should induce as few drug-induced side effects as possible and not shorten the patient's life expectation. METHODS AND RESULTS: A total of 111 patients (150 eyes) with systemic maintenance treatment were compared retrospectively with 33 patients (62 eyes) that received a ganciclovir implant only as maintainance therapy and no additional systemic treatment. Patients with an implant showed a prolonged interval of nonprogression of retinitis than patients receiving systemic treatment. Patients with unilateral retinitis are at higher risk of developing bilateral disease in the implant group than in the systemically treated group. Manifestation of extraocular disease was equal in both groups. Local treatment with the implant does not shorten patient survival time. CONCLUSION: Local treatment with the ganciclovir implant means quality of life for patients and also safe protection of the affected eye. Extraocular disease and survival time are not influenced adversely by local treatment. However, primarily unilateral involved patients show higher risk for bilateral disease in the implant group than in the systemically treated group.

AIDS-Related Opportunistic Infections↗
PubMed1999

[Surgical removal of subfoveal choroid neovascularization in senile macular degeneration].

UNLABELLED: The follow-up of central scotomas and fixation--next to visual acuity--are important parameters for the evaluation of new therapies in AMD. PATIENTS AND METHODS: Twenty-three patients (age 67 to 91 years) with subfoveal CNV had SLO fundus-controlled perimetry before and 6-8 weeks after surgical removal of the CNV. The size and location of deep (0 dB) and relative (12 dB) scotomas were measured. Stability and location of fixation were analyzed. RESULTS: Fifty-six percent of patients gained (10% lost) more than 2 lines of VA; 52% of deep scotomas decreased in size (26% increased). No relative scotoma increased, but 63% decreased, some remarkably. Most scotomas had steeper borders postoperatively. Five of 7 patients were able to fixate again. Fixation moved slightly more peripheral in 4 patients and was otherwise unchanged. None of 7 patients whose fixation was close to their fovea preoperatively lost that fixation. CONCLUSION: Subfoveal surgery may stabilize the course of subfoveal CNV in AMD at 6 weeks follow-up. In some patients the major benefit can be a reduction of relative scotoma due to reattachment of the retina. As the location of fixation changes little with surgery and is typically located within the area of relative scotoma, visual function can improve.

Aged↗
PubMed1999

[Bacterial keratitis. Microbiological analysis as a principle for therapeutic recommendations].

PURPOSE: The study presented differentiates between the aetiological agents of bacterial keratitis in patients with and without a history of contact lens wear. Based on these results, recommendations are given for optimal antibiotic primary therapy. PATIENTS AND METHODS: Swabs and corneal scrapings were taken from 218 patients referred to the University Eye Hospital in Munich with a diagnosis of bacterial keratitis from 1989 to 1997. Ninety-two of these patients had a history of contact lens wear; 126 had none. The germs were isolated and identified by staining and microscopy. Observing polymicrobial growth in 51 patients, a total of 275 germs was isolated. RESULTS: The most frequent pathogens were Staphylococcus epidermidis (44%), S. aureus (18%), Streptococcus spp. (10%), Propionibacterium acnes (7%) and Pseudomonas aeruginosa (6%). Gram-negative germs were nearly exclusively isolated from contact lens wearers, gram-positive germs were predominant in non-contact lens wearers. CONCLUSION: Keratitis in patients with a history of contact lens wear is often caused by aggressive gram-negative germs. Those cases should immediately be treated with quinolones and erythromycin. In keratitis caused by gram-positive pathogens, a combination with aminoglycosides and erythromycin is sufficient.

Adolescent↗