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Anselm Kampik

Publications and source records attributed to Anselm Kampik.

At least 91 records · Page 5Linked to original sources
PubMed2003

Tele-screening for diabetic retinopathy with the retinal thickness analyzer.

OBJECTIVE: To compare the effectiveness of tele-screening using a novel enhanced retinal thickness analyzer (RTA) with onsite routine ophthalmologic examination for diabetic retinopathy. RESEARCH DESIGN AND METHODS: A consecutive series of 31 eyes from diabetic patients were included. All underwent ophthalmologic examination, including stereoscopic dilated funduscopy and scanning with the RTA. The RTA reports consisted of a wide-angle, red-free fundus photograph and a macular-region retinal thickness map. Reports were graded by three independent graders in a masked manner. The diagnoses of proliferative retinopathy, macular edema, and treatment decisions made by the RTA graders and the clinical examiner were compared. RESULTS: On clinical examination 5 of 31 eyes were diagnosed with proliferative diabetic retinopathy (PDR). All five were referred for treatment by two graders and four eyes by one grader. All eyes with PDR and 12 of the 26 eyes with nonproliferative diabetic retinopathy showed severe macular edema. Seven of the 12 eyes with macular edema were clinically eligible for focal laser treatment, and all of them were detected by all RTA graders. Macular thickening was detected in eight eyes by RTA where no treatment was necessary, as judged by clinical examination. Thus, sensitivity was 93% (mean) for detecting PDR and 100% for detecting macular edema, with a specificity of 58-96% depending on the grader. The RTA did not allow valid assessment due to poor image quality in only one case. CONCLUSIONS: Screening for diabetic retinopathy with a combination of wide-angle fundus photography and macular thickness mapping by an objective method, such as optical coherence tomography or the RTA, offers the prerequisites for establishing a successful tele-screening program.

Aged↗
PubMed2002

Consenting to cornea donation: influencing factors.

BACKGROUND: The purpose of the study was to determine factors influencing the decision of the next relative being asked for consent to cornea donation in a prospective, non-comparative case series. METHODS: Interviews with the relatives of 264 potential cornea donors to the eye bank of the Ludwig-Maximilians-Universität, Munich, were documented following a standardized protocol. The influence of sociological factors on the frequency of obtained consents was investigated by uni- and multivariate analysis. RESULTS: During a 9-month period, 214 relatives of 264 possible donors were interviewed for consent to cornea donation. In total, 144 consents (67%) and 70 refusals (33%) were obtained; 50 relatives could not be reached. Analysis showed a higher consent rate for donors with a university degree (72%) versus those without (68%). Consent was more often obtained from relatives of donors that were divorced (71%) than from unmarried ones (63%). Husband and wife (71%) consented more frequently to cornea donation than children of age (62%) or parents (58%). Examination of residential area postal codes indicated more frequent refusals from donors of rural (56% consent rate) than urban Munich populations (67% consent rate). The situation was the opposite concerning the residential area of the consenting relative. Postal codes of both the donor and the relative were statistically significant factors in a multiple logistic regression model. There was relatively high willingness to donate in suicides (70%), but not significantly different from other causes like natural deaths (70%) and traffic accidents (66%). CONCLUSIONS: Some socioeconomic factors such as - in particular - the permanent address of the potential donors and their relatives reflecting a different background and status play an important role in the willingness to donate. A better understanding of this decision making can help the physician to ask more empathically for consent and inform the public more specifically about the donation process.

Adolescent↗
PubMed2002

Intravenous imipenem prophylaxis in experimental endophthalmitis.

PURPOSE: To determine the effect of prophylactic intravenous imipenem on experimental Staphylococcus aureusendophthalmitis. METHODS: The right eyes of 36 New Zealand albino rabbits received an intraocular injection of 100, 1,000, or 10,000 colony-forming units (CFU) of S. aureus. Each of these three groups was subdivided into a control group (no antibiotic prophylaxis) and a prophylactic group, which received 37.5 mg/kg imipenem 8 h prior to inoculation of bacteria, 30 min prior to inoculation of bacteria, and 8 h after inoculation of bacteria. Eyes were observed daily by slit-lamp examination and funduscopy. The eyes were enucleated after 5 and 9 days for the control and prophylactic groups, respectively. Vitreous samples were cultured for bacteria, and the eyes were prepared for histologic evaluation. RESULTS: All eyes that received imipenem demonstrated significantly less inflammation (two-way analysis of variance; P<0.001) on clinical examinations than did control eyes. The prophylactic groups that had received 100 CFU and 1,000 CFU of bacteria also had significantly fewer positive vitreous cultures than the corresponding controls (chi(2) test; P<0.001 and P<0.01, respectively). Histologically, the prophylactic groups injected with 100 CFU and 1,000 CFU of bacteria had significantly less inflammation than the control groups (Student's t-test; P<0.00001 and P<0.0001, respectively). There was no significant difference in the number of positive vitreous cultures or histologically between the control and prophylactic groups that received 10,000 CFU of bacteria. CONCLUSIONS: Prophylactic intravenous imipenem can prevent or significantly reduce the severity of experimental endophthalmitis.

Animals↗
PubMed2002

Vitreoretinal morphology of plasmin-treated human eyes.

PURPOSE: To investigate the ultrastructure of the vitreoretinal interface following an intravitreal injection of plasmin. METHODS: Plasmin (2 U/0.1 ml) was injected into the vitreous cavity of five postmortem human eyes. The five fellow eyes received phosphate-buffered saline and served as controls. After incubation at 37 degrees C for 30 minutes, the globes were placed in fixative and hemisected. Specimens for scanning and transmission electron microscopy were obtained using a corneal trephine. RESULTS: All plasmin-treated eyes showed complete vitreoretinal separation with sparse collagen fibrils covering the inner limiting membrane. All control eyes showed an attached cortical vitreous. At the vitreous base, there was no cleaving effect. The retinal morphology of plasmin-treated eyes was unchanged. CONCLUSIONS: Plasmin induces a cleavage between the vitreous cortex and the inner limiting membrane without morphologic alteration of the retina.

Aged↗
PubMed2002

Toxic eosinophil granule protein deposition in corneal ulcerations and scars associated with atopic keratoconjunctivitis.

PURPOSE: Recurrent or persistent corneal erosions and ulcerations are typical complications of atopic keratoconjunctivitis. Toxic eosinophil granule proteins such as major basic protein (MBP) and eosinophil cationic protein (ECP) may be involved in this pathogenetic process. This study was designed to demonstrate the presence of toxic eosinophil granule proteins in corneal tissue from a patient with corneal complications of atopic keratoconjunctivitis. DESIGN: Observational case report. METHODS: Three corneal buttons of a patient with atopic keratoconjunctivitis associated ulcerations or scarring were examined by light microscopy and by immunofluorescence technique. RESULTS: A linear deposition of eosinophil granular substance was detected subepithelially above Bowman's membrane in all corneal buttons. Indirect immunofluorescence identified this material as MBP and ECP. The deposits were not limited to the area of ulceration, but were also found underneath intact corneal epithelium. Multiple eosinophils were present in the upper corneal stroma. Normal corneas and negative control sections of the pathologic buttons revealed only minimal nonspecific staining at the surface of the epithelium. CONCLUSIONS: Both MBP and ECP are known to affect human corneal epithelial cell viability and morphology in vitro. Moreover, MBP was shown to inhibit epithelial migration and protein synthesis. These toxic eosinophil proteins may also be responsible for corneal instability, recurrent and persistent corneal epithelial defects and ulcerations in patients with atopic keratoconjunctivitis.

Aged↗
PubMed2002

Long-term follow-up after macular hole surgery with internal limiting membrane peeling.

PURPOSE: To report long-term anatomical and functional results after pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DESIGN: Prospective, nonrandomized, consecutive series. METHODS: Ninety-nine patients with a follow-up of at least 12 months were included. The surgical technique consisted of a standard pars plana vitrectomy, removal of the ILM, and an intraocular gas tamponade (15% hexafluoroethane [C(2)F(6)] gas mixture) followed by head-down positioning for at least 5 days. Follow-up examinations included a clinical examination, Goldmann perimetry, optical coherence tomography, and static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105). Stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. Twenty-degree fields were used for all tests. RESULTS: Mean period of review was 32 months (median 34). Anatomic closure was achieved in 86 (87%) of 99 patients by one surgical procedure. Nine patients underwent a successful second operation with an improvement of visual acuity in 7 patients. The closure rate after two surgical interventions was 96%. Best-corrected visual acuity improved from a median of 20/100 preoperatively to a median of 20/40 postoperatively (P <.001). An improvement of visual acuity was achieved in 94% of patients. In 13 of 99 patients (13%) a combined vitrectomy and cataract surgery with intraocular lens implant was performed; 72 patients (73%) underwent cataract surgery later. Ninety of 99 patients (91%) were pseudophakic on last presentation. Paracentral scotomata did not change in size, density, or shape over time. Its incidence was not correlated with the stage of the macular hole. No postoperative epiretinal membrane formation or late reopening of the macular hole was observed. One patient presented with a peripheral visual field defect after vitrectomy. CONCLUSIONS: Macular hole surgery with peeling of the ILM without the use of adjuvants or ILM staining leads to good functional long-term results. Paracentral scotomata remained subclinical in most cases and may be due to a mechanical trauma of the nerve fiber layer.

Aged↗
PubMed2002

Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation.

PURPOSE: To report the ultrastructure of the internal limiting membrane (ILM) after macular hole surgery with indocyanine green (ICG) staining and to investigate an association with the postoperative functional outcome. DESIGN: Retrospective, noncomparative analysis of a consecutive case series. METHODS: Twenty eyes of 20 patients after macular hole surgery with ICG staining were included. Visual acuity and Goldmann perimetry were obtained before and after surgery. The ILM was obtained during three-port pars plana vitrectomy for idiopathic macular hole. Twenty-five milligrams of sterile ICG powder was dissolved in 5 ml of sterile water as recommended by the manufacturer and then diluted in balanced salt solution. The ultrastructure of the ILM was analyzed using light and transmission electron microscopy. Osmolarity and pH of the ICG solution were measured preoperatively. RESULTS: There was no statistically significant improvement of postoperative visual acuity after ICG-assisted peeling (P =.755). In seven patients, postoperative visual field defects occurred. Indocyanine green-stained specimens revealed cellular elements resembling the plasma membrane of Müller cells and other undetermined retinal structures adherent to the retinal side of the ILM. Histologic findings disclosed no difference between patients with and without visual field defects after the use of ICG. The osmolarity of the ICG solution applied was 275 mOsm; pH was 7.5. CONCLUSIONS: Intravitreal application of ICG may cause retinal damage by altering the cleavage plane to the innermost retinal layers. That may result in less improvement of visual acuity and unexpected visual field defects. The underlying mechanisms of action remain unclear and are the subject of ongoing investigations.

Aged↗
PubMed2002

Rapid direct antibiotic susceptibility testing in endophthalmitis.

OBJECTIVE: To compare a new rapid antibiotic susceptibility test (RAST) to the conventional method in patients with endophthalmitis. DESIGN: Prospective nonrandomized comparative trial. PARTICIPANTS: Intraocular aspirates from 24 consecutive patients with endophthalmitis were tested. METHODS: Approximately 0.25 ml of vitreous or anterior chamber aspirate was obtained and tested for antibiotic sensitivity using the Kirby-Bauer agar disk diffusion method. Using this conventional testing method, the aspirates were cultured for bacterial growth before antibiotic susceptibility testing (AST). In contrast, for direct RAST, the aspirates were inoculated directly onto agar plates with antibiotic disks without first culturing for bacterial growth. RESULTS: Of the 24 endophthalmitis aspirates studied, 4 (17%) could not be tested by direct RAST because either more than one bacterial species was present or no bacteria were cultured. The remaining 20 cases provided 467 antibiotic-microorganism combinations. The two methods yielded identical susceptibility results in 409 (88%) of the 467 tests. In 42 tests (9%), a minor discrepancy occurred between the conventional method and RAST, in which one resulted in intermediate susceptibility, whereas the other was either resistant or sensitive. Significant discrepancy, defined as a bacterial sample reported as sensitive in one method yet resistant in the other, occurred with 16 samples (3%). Results of the RAST were available within 6 to 10 hours compared with more than 24 hours for the conventional method. Of clinical significance, the results of the RAST revealed that in 11 cases of epidemic Stenotrophomonas maltophilia endophthalmitis, the bacteria were resistant to the antibiotics prescribed, and change of antibiotic therapy was made on the basis of the RAST results. CONCLUSIONS: RAST provided accurate antibiotic susceptibility results in a much shorter time than did the conventional method. We suggest that conventional AST be performed for confirmation of the RAST results, but initial antibiotic therapy can quite reliably be based on the results of RAST.

Anti-Bacterial Agents↗
PubMed2002

Complex microcirculation patterns detected by confocal indocyanine green angiography predict time to growth of small choroidal melanocytic tumors: MuSIC Report II.

PURPOSE: Multiple independent laboratories have confirmed the histologic observation that some tumor microcirculation patterns (MCPs) in uveal melanomas are associated strongly with death resulting from metastatic disease. Because these patterns are imageable with confocal indocyanine green angiography (ICG), we designed a prospective study to evaluate whether these angiographically detectable MCPs predict time to tumor growth. DESIGN: Observational case series, prospective, non-randomized. PARTICIPANTS: Ninety-eight patients with unilateral, small, choroidal melanocytic tumors. METHODS: The following information and tumor characteristics were recorded for each patient: demographic parameters, best-corrected visual acuity, intraocular pressure, related visual symptoms, location and dimension of tumor, pigmentation, orange pigment, drusen, tumor-associated hemorrhage, subretinal fluid, and confocal ICG angiographically determined microcirculation patterns-silent (avascularity), normal (preexisting normal choroidal vessels within the tumor), straight vessels, parallel without and with cross-linking, arcs without and with branching, loops, and networks. MAIN OUTCOME MEASURES: Time to growth of the tumor, with growth defined as an increase in the maximal apical tumor height of 0.5 mm measured by standardized A-scan ultrasonography, photographic documentation of an increase of the largest basal diameter of at least 1.5 mm, advancement of one tumor border of at least 0.75 mm, or a combination thereof. RESULTS: Twenty-eight of the 98 tumors in this study (29%) met the predetermined criteria for tumor growth. The median time to growth was 127 days (range, 51-625 days). The following tumor characteristics were significantly associated with time to tumor growth: flashes (P = 0.0224), orange pigment (P = 0.012), subretinal fluid (P < 0.001), maximum basal tumor diameter at initial examination (P = 0.015), maximum apical tumor height (P < 0.001), parallel with cross-linking MCP (P < 0.001), arcs with branching MCP (P = 0.006), loops (P < 0.001), and networks (P < 0.001). Of these, the angiographic documentation of any of the complex MCPs (parallel with cross-linking, arcs with branching, loops, networks, or a combination thereof) showed the strongest association with the time to tumor growth in a Cox proportional hazard model. CONCLUSIONS: The characteristics of our patient cohort are comparable by clinical and echographic parameters with cohorts for predicting tumor growth, described previously in the literature. In addition, we detected a novel clinical predictor of tumor growth: the confocal ICG angiographic detection of complex MCPs.

Adult↗
PubMed2002

[Application of the new coding standards for introducing diagnosis related groups (DRGs) in ophthalmology].

For all in-patients a fundamental change of hospital financing based only on diagnosis related groups (DRGs) is planned in Germany for 2004. Patients are grouped into different DRGs according to their coded diagnoses, operations and procedures. Hence, the quality of coding is essential for adequate reimbursement of cases and thus for hospital financing. The legal framework of coding is supplied by the so-called "general and special coding guidelines for coding diseases and procedures", presented jointly by the associations representing hospitals and public and private health insurance companies in early 2002. These German coding standards regulate how coding must be performed in daily practice and therefore have a major influence on the grouping of patients into DRGs. Because of their importance this paper describes the practical application of current coding standards. Specifically in Ophthalmology the problem exists that for many procedures adequate coding numbers are still missing, thus impairing further development of the DRG system.

Diagnosis-Related Groups↗
PubMed2002

Intraocular pressure-lowering effects of latanoprost and brimonidine therapy in patients with open-angle glaucoma or ocular hypertension: a randomized observer-masked multicenter study.

PURPOSE: To compare the effect of treatment with latanoprost or brimonidine on intraocular pressure in patients with glaucoma or ocular hypertension and intraocular pressure inadequately controlled by monotherapy or dual therapy. PATIENTS AND METHODS: Three hundred seventy-nine patients with primary open-angle glaucoma or ocular hypertension were recruited for this 6-month prospective, randomized, observer-masked multicenter study involving 30 eye clinics. All patients were receiving monotherapy or dual therapy that did not adequately control intraocular pressure. After appropriate washout periods, patients were randomized to treatment with latanoprost once daily or brimonidine twice daily. The main outcome measure was change in mean diurnal intraocular pressure after 6 months of treatment compared with baseline. RESULTS: Of the 379 randomized patients, 375 were included in the intent-to-treat analysis. From an overall baseline mean intraocular pressure of 25.0 mm Hg, latanoprost monotherapy reduced mean diurnal intraocular pressure by 7.1 +/- 3.3 mm Hg (mean +/- SD, P < 0.001), whereas brimonidine monotherapy yielded an intraocular-pressure reduction of 5.2 +/- 3.5 mm Hg (P < 0.001). This 1.9 mm Hg difference in intraocular-pressure reduction was significantly in favor of latanoprost (P < 0.001). Ocular allergy (P < 0.001) and systemic side effects (P = 0.005) were reported significantly less frequently by latanoprost-treated patients compared with brimonidine-treated patients. CONCLUSIONS: Both latanoprost and brimonidine reduced intraocular pressure in patients with glaucoma or ocular hypertension after 6 months of treatment. However, latanoprost once daily was significantly more effective than brimonidine twice daily in reducing mean diurnal intraocular pressure. Latanoprost was better tolerated with less frequently occurring ocular allergy and systemic side effects.

Aged↗
PubMed2002

Retinal pigment epithelium is protected against apoptosis by alphaB-crystallin.

PURPOSE: The degeneration of retinal pigment epithelial (RPE) cells is considered to be a crucial event in the pathophysiology of age-related macular degeneration (AMD). Cumulative oxidative damage has been implicated in the development of the changes seen in AMD. The present study was undertaken to evaluate the expression of the small heat shock protein alphaB-crystallin in the RPE in response to oxidative stress and to explore whether alphaB-crystallin expression confers an antiapoptotic cytoprotective effect on RPE cells. METHODS: Native human RPE cells from the macula and retinal periphery were analyzed by RT-PCR and Western blot analysis for expression of alphaB-crystallin. Monolayer cultures of human RPE cells were stressed by heat shock (42 degrees C for 20 minutes) or oxidant-mediated injury (50-300 micro M H(2)O(2) for 1 hour). Induction of alphaB-crystallin and the corresponding mRNA was assessed by Western and Northern blot analyses. To study the cytoprotective effect of alphaB-crystallin, human RPE cells were transfected with either a neomycin-selectable expression vector containing alphaB-crystallin cDNA or a control vector without alphaB-crystallin cDNA. Caspase-3 activity was determined by observing the cleavage of a colorimetric peptide substrate. Cell viability was quantified by combined propidium iodide and Hoechst 33342 staining. RESULTS: alphaB-crystallin is constitutively expressed in RPE under in vivo and in vitro conditions. Western blot analysis of freshly isolated RPE showed greater baseline expression levels in RPE derived from the macular area than in that from the more peripheral regions. Heat shock treatment and oxidative stress caused a significant increase in alphaB-crystallin mRNA and protein. Oxidant-mediated injury in RPE cells with baseline expression levels of alphaB-crystallin resulted in apoptotic cell death, as measured by caspase-3 activity, whereas RPE cells that had been stably transfected with alphaB-crystallin were more resistant to H(2)O(2)-induced cellular injury. CONCLUSIONS: alphaB-crystallin may function as a stress-inducible antiapoptotic protein in human RPE and is inducible by oxidative stress, a condition implicated in the pathogenesis of AMD. Overexpression of alphaB-crystallin may be an important mechanism for the RPE to prevent apoptotic cell death in response to cellular stress.

Adolescent↗