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Biomedical subjects

A Kampik

Publications and source records attributed to A Kampik.

At least 127 records · Page 7Linked to original sources
PubMed1998

[Topical administration of metronidazole gel as an effective therapy alternative in chronic Demodex blepharitis--a case report].

BACKGROUND: Blepharoconjunctivitis is the commonest manifestation of ocular rosacea. Cilia epilation proves Demodex folliculorum, considered an etiologic factor in rosacea. Complications and differential diagnosis include dry eyes, seborrheic, bacterial and allergic blepharoconjunctivitis. Treatment involves lid scrubs and mercury ointment, its duration is limited to 6 weeks under frequent control due to corneal toxicity of mercury. HISTORY AND SIGNS: 30-year-old female with complaint of red, irritated eyes for 21 years, resistant to antibiotics and antiallergics. General medical history unremarkable, mercury allergy. Acuity: R/L 20/20. Biomicroscopy: red, thickened eyelid margins, crusty debris on rarefied, partially broken lashes, conjunctival telangiectasia, low tear meniscus, further ophthalmologic examination unremarkable. DIAGNOSIS: chronic Demodex blepharoconjunctivitis. THERAPY AND OUTCOME: Conventional treatment was contraindicated due to mercury allergy. Alternative oral minocycline 100 mg daily brought no subjective nor objective relief. Combination of lid scrubs and 2% Metronidazole gel relieved symptoms and halved number of mites after 1 month, lashes grew again after 2 months. Treatment was discontinued after 6 months as Demodex folliculorum proof remained negative. No relapse occurred during 1 year. CONCLUSIONS: Topical Metronidazole 2% proved to be an effective treatment of chronic Demodex blepharoconjunctivitis in our case and thus may offer a new and save alternative to existing therapies. Neither ocular nor systemic side effects occurred. Controversial theories on the aetiology of blepharitis are discussed.

Administration, Topical↗
PubMed1997

[Lisch nodules. Markers of neurofibromatosis 1 and immunohistochemical references for neuroectodermal differentiation].

Iris nodules in neurofibromatosis I have become an important tool in the differential diagnosis of phakomatoses. The clinical appearance and importance of these nodules first recognized by Karl Lisch in Munich in 1937. The diagnosis and differential diagnosis of Lisch nodules are illustrated. The importance of iris nodules in genetic counselling of patients and their relatives is discussed, with emphasis on monosymptomatic cases. Histologically Lisch nodules are formed by aggregations of oval to round cells that form dome-shaped papules on the anterior layer of the iris. Immunohistochemically these cells are characterized by positive staining with antibodies against vimentin and S-100 protein. This proves their ectodermal differentiation. Thus Lisch nodules can be seen as a direct manifestation of neuroectodermal disturbances in neurofibromatosis I.

Diagnosis, Differential↗
PubMed1997

[Local therapy in treatment of cytomegalovirus (CMV) retinitis in AIDS. The ganciclovir implant (pellet)].

BACKGROUND: Cytomegalovirus (CMV) retinitis with AIDS has been treated either systemically or locally by weekly intravitreous injections. An intraocular device now offers a new therapeutic approach. We investigated its efficacy in preventing progression of CMV retinitis without additional systemic therapy. Conversely, we also studied the risks and disadvantages of this method of drug administration. PATIENTS AND METHODS: In our study 46 devices were implanted in 28 patients. All patients were pretreated with systemic medication. Systemic treatment was stopped on the day of surgery. RESULTS: Severe perioperative complications occurred in one patient, who developed retinal detachment after surgery. Most patients showed no relapse of retinitis with the implant, though they did not receive systemic treatment for 8.1 months on average. Only 20% of our patients presented with extraocular CMV disease. Thirty-five percent (n = 17) of patients with unilateral retinitis developed CMV retinitis in the primary uninvolved fellow eye. After implantation of a device into this eye also progression could be stopped without additional systemic treatment. Two patients showed progression of retinitis due to an empty ganciclovir reservoir. A second device was implanted without removal of the first. CONCLUSIONS: The intraocular ganciclovir device appears to be an effective treatment for CMV retinitis with few disadvantages. Time to progression of retinitis tends to be prolonged compared to systemic treatment.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Dural carotid-cavernous sinus fistulas: clinical aspects, diagnosis and therapeutic intervention].

BACKGROUND: Carotid cavernous fistulas are cerebral artenovenous shunts which may present with ocular or orbital signs. Direct fistulas are distinguished from dural shunts with respect to the anatomical situation. PATIENTS: We report on two patients with spontaneous dural carotid cavernous fistulas with multiple feeding vessels. Both patients required endovascular embolization. RESULTS: Therapy was successful in both patients. We present an overview of the clinical picture, the diagnostic procedure, the differential diagnosis and the therapeutic possibilities in this clinical entity. CONCLUSION: Both patients prove the importance of an immediate differential diagnostical classification so that a specific neuroradiological diagnostic can be ensured. Today's advanced endovascular technology offers therapeutic options with less risk for the patient than in recent years.

Arteriovenous Fistula↗
PubMed1996

[Surgical management of complete macular foramina].

UNLABELLED: Recently, good functional and anatomical results have been reported in treating full thickness macular holes. Only a few studies describe a removal of a membrane at the vitreoretinal interface after having removal of the vitreous and its cortex. To demonstrate the beneficial effects of removing this membrane at the vitreoretinal interface we present our functional and anatomical results in this retrospective study. PATIENTS: Altogether, 42 patients (27 women, 15 men) with an average age of 66.7 years and full thickness idiopathic macular holes stage II and III/IV (21 patients respectively) were retrospectively analysed. The minimum follow-up was 6 months. To reattach the macular, an intraocular gas tamponade was used in 36 patients (15% C2F6) and 6 patients were treated with an 20% SF6 gas tamponade. RESULTS: Six months after operation, patients in the main group (42 patients) showed visual improvement in 53% (22 patients): 26% (11 patients) showed no change in visual acuity before and after operation. A deterioration was present in 21% (9 patients). In the group of patients in which a membrane at the vitreoretinal interface had been removal 68% (22 patients) showed improved visual acuity. In all 26% (8 patients) showed no change and in one case a deterioration was noticed. After removal of a membrane at the vitreoretinal interface no further macular hole was seen in 80% (25 patients). In this group, 90% (28 patients) complained of metamorphosia before operation. In the group of patients in which were no membrane at the vitreoretinal interface had been removed (11 patients), 73% (8 patients) showed a deterioration in visual acuity, no patient showed improved visual acuity and 27% (3 patients) retained the same level of visual acuity. No macular hole was noticed 6 months postoperatively in 27% (3 patients) in this group. In all 36% (4 patients) in this group complained of metamorphopsia before operation. CONCLUSION: Removal of a membrane at the vitreoretinal interface in patients with idiopathic macular holes stage II in IV improves functional and anatomical results. Metamorphosia is reduced significantly after removal of that membrane. According to our studies, metamorphosia is an indicator for the presence of a membrane at the vitreoretinal interface. Our results suggest that there are different types of idiopathic macular holes with a different pathogenesis in those where a membrane at the vitreoretinal interface could not be removed and those where it is possible to remove it. Cases where removal of this structure should be attempted show better functional and anatomical results. Studies using adjuvants, e.g. autologous platelet concentrate or transforming growth factor beta 2, should take into account that two different types of idiopathic macular holes exist.

Adult↗
PubMed1996

[Changes in the vitreomacular border of the partner eye in macular foramina].

The incidence of a macular hole in the fellow eye of patients with macular hole stage I-IV according to Gass is observed in 3-14% of cases. The development of a macular hole over a period of 19-54 months is reported to occur in 1-22% of patients. Our clinical impression made us suspect a much higher number of changes at the vitreomacular interphase in the generally asymptomatic "second eye" already at first presentation in the hospital. We retrospectively examined 88 patients who presented with a macular hole between January and October 1994. We investigated the frequency of a macular hole or macular pucker in the fellow eye, taking into consideration that many common pathogenetic factors were described for these changes of the vitreoretinal interphase. We further examined the difference in number and appearance of macular pathology in the fellow eye between patients who had macular hole surgery in their "first eye" and patients whose "first eye" was observed. The group of patients whose "first eye" was operated on showed a macular hole stage I or stage II in 8% each in the "second eye", and a macular hole stage III/IV in 6% of cases. Patients whose "first eye" was observed were found to have only early macular holes in 18% of fellow eyes. Altogether, the fellow eye of patients with macular hole exhibited also a macular hole in 21% of patients and a macular pucker in 7% of patients. The incidence of pathological changes at the vitreomacular interface in 28% of the fellow eyes of patients with macular hole is higher than ever reported in the literature. The presence of early macular holes as well as early macular puckers supports clinically the thesis of common factors in the pathogenesis of these two disorders. As we only reviewed the incidence of pathological charges in this study, a much higher number of developing macular holes and macular puckers has to be expected in the fellow eye of patients with macular hole over a certain time period.

Adult↗
PubMed1996

[Morphologic analysis of epiretinal membranes in surgically treated idiopathic macular foramina. Results of light and electron microscopy].

Anteroposterior and tangential traction on the central retina is an important factor in the pathogenesis of idiopathic macular hole formation. Histological studies have shown that macular holes of different stages can be associated with epiretinal membranes. Such membranes can be removed during surgery for macular holes. We investigated such tissue samples of 11 patients with macular holes in stages II-IV. Light microscopically, the tissue consisted of a thin collagen layer mostly covered by a thin layer of cells. Ultrastructural analysis revealed glial cells and macrophages as cellular components. The collagen can be ascribed to vitreous, inner limiting membrane and newly formed collagen. According to the morphological findings a multilayered tissue structure can be assumed. Macrophages were found on the retinal side of the inner limiting membrane and at the vitreal side of the tissue. Therefore, the macrophages probably originate from the retina as well as from the vitreous as so-called resident hyalocytes. Glial cells covered the inner limiting membrane forming pericellular collagen to which outer vitreous collagen fibrils can be attached. The multilayered membrane structure might possibly be the cause for only partial laminar surgical extraction so that contractile or potentially proliferative tissue residues might be one of the reasons for surgical failures after incomplete membrane peeling.

Aged↗
PubMed1996

Discordant monozygotic twins with the Schimmelpenning-Feuerstein-Mims syndrome.

The Schimmelpenning-Feuerstein-Mims syndrome (SFM), characterized by linear nevus sebaceous and ocular and neurologic abnormalities, is a sporadic condition without known familial cases or etiology. We report the occurrence of SFM in only one of two monozygotic (MZ) twins. After considering a variety of possible causative mechanisms, we suggest that a postzygotic dominant lethal mutation in mosaic form may best explain SFM and the discordancy for SFM in these MZ twins.

Abnormalities, Multiple↗
PubMed1996

Mathematical simulation of retinal image contrast after photorefractive keratectomy with a diaphragm mask.

BACKGROUND: Photorefractive keratectomy (PRK) using a dilating diaphragm mask engraves a delicate three-dimensional staircase pattern into a formerly smooth corneal surface. The created steps are later smoothed by tear film and wound healing processes. The present study investigates, in a mathematical simulation, the effects that such staircase patterns and their smoothing may have on retinal image contrast. METHODS: All simulations are based on the Gullstrand eye model and calculate retinal image contrast from point spread function (PSF) analysis of Gullstrand eyes treated by simulated PRK under various conditions. RESULTS: The simulations indicate that PRK can reduce retinal contrast markedly. The most critical factor for such a reduction is the step height of the ablation pattern. With step heights below 0.4 microns, loss of contrast due to the created staircase pattern is always moderate and should be restored during early wound healing. Complete wound healing may smooth out larger step heights. Micromovements during PRK also can lead to partial loss of retinal image contrast. CONCLUSIONS: Simulation of retinal contrast after PRK shows that step heights below 0.4 microns seem to be acceptable. A minimization of the micromovements during PRK can offset some of the reduction of retinal contrast.

Contrast Sensitivity↗
PubMed1996

[Recurrent vitreoretinal membranes in intravitreal silicon oil tamponade. Morphologic and immunohistochemical studies].

During intraocular silicon oil tamponade, recurrent vitreoretinal membranes can become clinically relevant and may need surgical excision. We investigated 40 PVR and 10 diabetic membranes which had formed during intraocular tamponade with highly purified silicone oil (5000 cs). The membranes were investigated by light and electron microscopy with respect to silicone oil-specific alterations. The participating cells were differentiated immunohistochemically. Mechanisms of intercellular growth regulation were analyzed by the use of antibodies against cell adhesion molecules and growth factor receptors (PDGFr-B). Most of the membranes showed typical signs of the underlying disease process. However, seven PVR and four diabetic membranes had specific interstitial and intracellular vacuoles which were considered to be silicone oil droplets. The phagocytosing cells were macrophages, partially embedded within vitreous residues. T-lymphocytes can be drawn to the area of macrophage activity by the expression of ICAM-1 and LFA-1. The residual parts of the membranes are typical vitreoretinal membranes. The receptors for PDGF, fibronectin and laminin were negative, but the receptors for collagen and vitronectin were positive within these membranes. The silicone oil-specific macrophage reaction might be supported by emulsified silicone oil droplets, which might get phagocytosed at a certain size. The secondary inflammatory reactions can further enhance silicone oil emulsification and start a vicious circle. Nevertheless, the underlying disease process seems to be much more important in stimulating recurrent membrane formation than silicone oil-specific cell reactions.

Cell Division↗
PubMed1996

[Decrease of retinal image contrast after photorefractive keratectomy, improvement within the scope of surface restitution].

Photorefractive keratectomy (PRK) with the ArF excimer lasers in current use usually approximates the intended corneal curvature by a mean of a delicate step-type pattern that is smooth off afterwards by reepithelialization and tear film. The present study was based on a model eye with axial myopia of -6 D but otherwise the optical and geometric properties of the Gullstrand model eye and was designed to investigate to what extent. (1) corneal step patterns can reduce retinal image contrast and (2) smoothing effects can restore such a loss. METHODS. The corneal surface resulting from PRK in the case of a myopia of -6 D (optical zone diameter 6 mm) is calculated for the parameters of the model eye. The retinal image contrasts of bar patterns are calculated by PSF (point spread function) analysis: varying size of pupil, wavelength, bar width, ablation step height and degree of smoothing. RESULTS. Step height influences retinal image contrast crucially. With step heights above 0.4 micron a massive loss of retinal image contrast must be expected, which can, however, be corrected to a useful extent by surface-smoothing effects. CONCLUSION. This study indicates that PRK with excimer lasers should be performed with low fluence and correspondingly low corneal step heights.

Computer Simulation↗
PubMed1995

Efficacy of apraclonidine ophthalmic solution (Iopidine) in presumed silicon oil-induced glaucoma and primary open-angle glaucoma.

BACKGROUND: This pilot study evaluated the acute effects of topical ocular apraclonidine 1% (Iopidine) in 10 patients with presumed silicone oil-induced secondary glaucoma (SOIG) and in 10 patients with high-pressure primary open-angle glaucoma (POAG) despite maximum tolerated medical therapy. METHODS: Intraocular pressure (IOP) measurements were carried out before and 1, 2 and 3 h after a single drop of apraclonidine. RESULTS: Patients with SIOG presented with a mean IOP of 30.0 +/- 2.8 mmHg, which was reduced to 21.7 +/- 2.9 mmHg (P < 0.001) after 1 h, to 20.4 +/- 2.3 mmHg (P < 0.001) after 2 h and to 20.0 +/- 2.5 mmHg (P < 0.001) after 3 h. In the POAG group, IOP was reduced from 25.9 +/- 1.9 mmHg before treatment to 18.9 +/- 1.4 mmHg after 1 h (P < 0.001), 17.7 +/- 1.2 mmHg after 2 h (P < 0.001) and 16.9 +/- 0.9 mmHg after 3 h (P < 0.001). There were no significant changes in blood pressure or pulse rate. CONCLUSION: This study confirmed the activity of apraclonidine as an IOP suppressant.

Adolescent↗
PubMed1995

[Risk factors for surgical failures in rhegmatogenous retinal detachment].

BACKGROUND: The evaluation of further risc factors predesposing failure in retinal detachment surgery than those already known to be associated with PVR was the goal of this retrospective study. PATIENTS AND METHODS: The data from 130 cases with unilateral rhegmatogenous retinal detachment treated initially with buckling procedures, were retrospectively reviewed to investigate pre-, intra- and postoperative factors which may predispose anatomical failure in retinal detachment surgery. None of the selected consecutively operated eyes had risk factors, which have already been associated with an unfavourable outcome, such as the presence of preoperative macular holes, PVR or assumed PVR-inducing factors, such as ocular trauma, giant retinal tears, vitreous hemorrhage, previous vitrectomy, cryopexy and laser photocoagulation. RESULTS: The anatomic success rate after scleral buckling procedures was 78.5% and the overall success rate after multiple surgery including vitrectomy increased to 94.6%. 102 (78.5%) cases, treated with a maximum of two scleral buclking operations were statistically compared to the 28 cases which needed further vitreoretinal surgery. The statistical analysis revealed as preoperative risk factors for failure in rhegmatogenous retinal detachment surgery 1) retinal detachment exceeding two retinal quadrants (p < 0.05) and 2) size of the retinal tear larger than 60 degrees (p < 0.05), whereas postoperative risk factors were 1) presence of subretinal hemorrhage (p < 0.01) and 2) persistent subretinal fluid at least two days after surgery (p < 0.01). Eyes with preoperative visual acuity less than 0.1, pseudophacic eyes with posterior chamber intraocular lenses and eyes with severe intraoperative hypotony also showed a tendency to unfavourable outcome, but without a statistically significant level. CONCLUSIONS: Possible ways of interfering in the retinal reattachment process and the clinical importance of these evaluated factors are discussed. They should be taken in consideration for the prognosis of the postoperative anatomical result and treatment modalities if further surgery is required.

Adult↗
PubMed1995

Vitreoretinal surgery in intermediate uveitis.

Between 1987 and 1992, vitrectomies were performed in 42 eyes with intermediate uveitis. Pre- and postoperative clinical and ophthalmological parameters were reviewed. Especially the pre- and postoperative time courses of visual acuity were analyzed. We looked for parameters influencing the final visual results. Furthermore, we revised pre- and postoperative recurrent exacerbations of the disease and the duration and dosage of postoperative corticosteroid therapy. The best final visual results were reached in eyes with the best preoperative visual acuities. Anatomic retinal findings and the preoperative duration of intermediate uveitis predominantly influenced the final visual results. Overall, 75% of our patients reached visual acuities of above 20/200. When asked to state their opinion about the final functional result, 80% of the patients were contented. We advocate vitrectomy in patients with intermediate uveitis after intensive follow-up and careful consideration. The anatomic integrity of the retina, a good preoperative visual acuity, and a short preoperative duration of intermediate uveitis are the most important factors influencing the final visual results.

Adolescent↗
PubMed1995

[Surgical extraction of subretinal pseudotumors in age related macular degeneration. Clinical, morphologic and immunohistochemical results].

We extracted massive disciform subretinal lesions in eight eyes of seven patients with age-related macular degeneration via pars plana access. The lesions were 4-12 mm. All eyes had additional pathological findings such as PVR detachments, vitreous hemorrhage or acute submacular hemorrhage, sometimes in combination with each other. In seven eyes the preoperative visual function was no better than perception of hand movements, in 1 eye 1/35. The postoperative visual acuity was in 1 eye 0.3, in 6 eyes between 1/50 and 1/10 and without improvement in 1 eye. An intraocular silicone oil tamponade (highly purified, 5000 cs) was used in all cases. In two eyes the postoperative complication was central submacular fibrosis, and in two eyes with large retinotomies over more than two quadrants there were PVR reactions that needed reoperation in one eye. One patient was operated on bilaterally with final visual acuities of 1/35 and 1/10. The morphological structure of the extracted disciform lesions was characterized by a central fibrotic zone surrounded by attached hematomas, which were organized from the central tissue. In the central parts histology showed single layers of pigmented cells arranged along a basal membranelike PAS-positive band. Cell differentiation revealed macrophages, fibroblasts, myofibroblasts, T-lymphocytes, and vascular cells with immunohistochemical positive stainings for CD 68, cytokeratin, vimentin, alpha-actin, UCHL-1, and factor VIII. The lesions were supplied by a main choroidal vessel with branches into the periphery of the tissue. This feeder vessel can cause severe intraocular hemorrhage when it ruptures during surgical tissue extraction. Further immunohistochemistry showed the presence of cell adhesion molecules such as fibronectin, VLA-2, VLA-5, and VLA-6, the vitronectin receptor, 1CAM-1, LFA-1, and the PDGF receptor B. Their presence reflects mechanisms of growth regulation. The surgical extraction of massive submacular disciform lesions is part of the treatment of selected cases of end stages in age-related macular degeneration.

Aged↗
PubMed1995

[Primary vitrectomy in rhegmatogenous retinal detachment].

For therapy of uncomplicated rhegmatogenous retinal detachment, a buckling procedure is the standard surgical technique today. In complicated cases, e.g., retinal redetachment after a failed buckling procedure, vitrectomy is established. Meanwhile it is being discussed whether or not certain retinal detachments, e.g., with atypically large tears, should be treated with primary vitrectomy. We studied retrospectively all primary vitrectomies for retinal detachment without proliferative vitreoretinopathy (PVR) that were operated upon during 1992 in Würzburg Eye Hospital (32 patients). In 56% (18 eyes) of the patients a subtotal or total retinal detachment was seen preoperatively; in 47% (15 eyes) the macular region was detached. In 25% (8 eyes) large retinal tears were seen (> 1 h). The other patients showed atypical horseshoe tears partly central to the equator or multiple holes. Seventy-eight percent (25 eyes) of all cases were successfully vitrectomized with one operation and revealed good results using intraocular tamponade (SF-6/air mixture). Seven patients needed further vitrectomy partly using silicone oil as an intraocular tamponade. In cases of rhegmatogenous retinal detachment with atypical tears or non-identified holes, vitrectomy without the buckling procedure is a good alternative, because the rate of successful results is as high as what is achieved with buckling procedure in uncomplicated cases.

Adult↗