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Biomedical subjects

C Haritoglou

Publications and source records attributed to C Haritoglou.

At least 37 records · Page 2Linked to original sources
PubMed2003

Scanning laser ophthalmoscope-evoked multifocal ERG (SLO-mfERG) in patients with macular holes and normal individuals.

AIMS: A scanning laser ophthalmoscope (SLO) has been used for multifocal electroretinography (mf ERG) measurements under simultaneous fundus monitoring. The aim of this study was to prove if the SLO-mfERG measurement reflects reliably the clinically registered underlying disease, and to demonstrate the importance of its main advantage, fixation monitoring. METHODS: In all, 10 patients with macular hole stage II/III were included in the study, and 19 normal individuals served as the control group. The mf ERG device was combined with an SLO, which was used both as a stimulus and trigger unit as well as a fundus-monitoring system. Monitoring of the fundus was guaranteed by an infrared laser (780 nm). The stimulus matrix consisted of 61 hexagonal elements, covering 24 degrees of the posterior pole. We examined both, patients with macular holes and healthy individuals. RESULTS: Compared to normal controls, patients with a macular hole (Gass stage III) showed a significant decrease in response density in the centre of the stimulus array, which correlated well with the morphological alteration observed by clinical examination. However, variation of response density of the central hexagonal area has been proved to be high. CONCLUSIONS: SLO-mfERG is a feasible and reliable new technique to investigate macular function under simultaneous fundus control. The main advantage is that control of fixation can be used in order to obtain more reliable results that correlate well with visible fundus abnormalities such as in patients with macular holes. However, further investigations have to be performed in order to overcome sufficiently the problem of fixation instability.

Adult↗
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

Interobserver and intraobserver variability of measurements of uveal melanomas using standardised echography.

AIMS: To report on the intraindividual and interindividual variability of tumour size (height and base diameter) measurements using standardised echography in a masked prospective study. METHODS: 20 consecutive eyes of 20 patients were examined on four different visits by three experienced examiners using standardised echography. As common in standardised echography, tumour height was evaluated with A-scan technique, while transverse and longitudinal base diameter were calculated with B-scan. RESULTS: Tumour height measurements using A-scan were more accurate than base diameter measurements using B-scan. The standard deviation for tumour height over all visits/measurements was 0.18 mm (A-scan), 0.79 mm for transverse, and 0.69 mm for longitudinal base diameters (B-scan). The interclass correlation coefficient (ICC) was much higher for tumour height measurements with A-scan (0.7735 for three examiners on one visit) than for transverse (0.6563) or longitudinal (0.4522) base diameter measurements with B-scan techniques. CONCLUSIONS: A-scan techniques for tumour height measurements provide very reproducible results with little intraindividual and interobserver variability. As B-scan techniques for tumour base evaluation are less accurate they should be used for topographic and morphological examinations.

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↗
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

[LEOPARD syndrome with iris-retina-choroid coloboma. Discordant findings in monozygotic twins (MIM # 151 100)].

INTRODUCTION: The LEOPARD syndrome is an autosomal dominant inherited disease with severe lentiginosis associated with various abnormalities such as electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of the genitalia, retardation of growth and deafness. Ocular manifestations such as coloboma of the iris, the retina and the choroid have not been reported so far. PATIENTS: We report the cases of two 10-year-old identical twins and their mother, showing typical manifestations consistent with the LEOPARD syndrome. Additionally, colobomas of the iris, the retina and the choroid were detected. RESULTS: In addition to the findings typical for the LEOPARD syndrome, we observed unusual ocular abnormalities in all three patients. It represents a discordant phenotype in monozygotic twins. CONCLUSION: LEOPARD syndrome is a disease with multiple alterations and abnormalities. Although ocular malformations seem to be rare, an ophthalmological examination is recommended in order to initiate early visual rehabilitation.

Adult↗
PubMed2001

Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage.

PURPOSE: To demonstrate possible retinal damage caused by indocyanine green dye for staining of the internal limiting membrane in surgery for idiopathic macular hole. METHODS: Consecutive interventional case series. We report on the ultrastructural findings of the internal limiting membrane in 10 eyes of 10 patients. RESULTS: All specimens revealed not only the internal limiting membrane, but also some small amounts of retinal elements, such as the plasma membrane of Müller cells and other undetermined structures. This indicates a cleavage plane not exactly at the inner undulating aspect of the internal limiting membrane but within the innermost retinal layers. CONCLUSION: Dilutions of indocyanine green as recommended in the literature may alter the structure of the retina to some degree. Possible factors responsible for this inadvertent action may include (1) concentration, (2) osmolarity pH, (3) time of tissue contact, and (4) mechanical factors from more forceful traction during peeling. Although functional consequences of these findings remain unclear as yet, factors that may induce damage to the innermost retina should be elucidated.

Basement Membrane↗
PubMed2001

Macular changes after peeling of the internal limiting membrane in macular hole surgery.

PURPOSE: To report the incidence of macular changes following pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DESIGN: Prospective consecutive series. METHODS: In a prospective study 105 eyes of 105 patients underwent vitrectomy for idiopathic macular holes. Surgery consisted of a standard three-port vitrectomy, induction of a posterior hyaloid detachment, removal of epiretinal membranes including the ILM, fluid-air exchange and intraocular gas tamponade (15% hexafluoroethane (C2F6) gas mixture) followed by head-down positioning for at least five days. No adjuvants were used during surgery. In addition to the clinical examination, static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105) was performed pre- and 6 or 12 weeks postoperatively. The stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. For all tests, 20-degree fields were used. RESULTS: Anatomic closure of macular holes was achieved in 92 (87.6%) of 105 patients by one operation. Eight patients underwent a successful second procedure. The closure rate after two operations was 95.2%. Best corrected visual acuity increased from a median of 0.2 (range 0.05 to 0.5) preoperatively to a median of 0.5 (range 0.05 to 1.0) postoperatively. Anatomical macular changes were found in 8 (7.6%) patients: There were two cases of macular edema following secondary cataract extraction and six cases of retinal pigment epithelium changes. Formation of postoperative epiretinal membranes or late reopenings were not noted. Small, mostly asymptomatic paracentral scotomata were seen in 59 (56.2%) of 105 patients. CONCLUSION: Anatomical changes of the macula following vitrectomy with removal of the ILM are infrequent. However, paracentral scotomata observed in our series might be caused by a trauma to the nerve fibers during ILM peeling. To achieve reliable results a standardized procedure for microperimetry should be developed.

Aged↗
PubMed2001

Central retinal artery occlusion in association with an aneurysm of the internal carotid artery.

PURPOSE: To report an unusual case of central retinal artery occlusion in a 41-year-old woman. DESIGN: Interventional case report. METHODS: A 41-year-old woman presented with sudden and painless decrease of visual acuity of the left eye. Indirect ophthalmoscopy revealed the typical fundus findings of a central retinal artery occlusion. The fovea was spared by a cilioretinal arteriole. RESULTS: Cerebral angiography showed an aneurysm of the left internal carotid artery, measuring approximately 1.7 x 1.5 x 1.7 cm. The aneurysm was located in close proximity to the ophthalmic branch. CONCLUSION: Aneurysm of the intracranial arteries should be included in the differential diagnosis of central retinal artery occlusion in young patients.

Adult↗
PubMed2001

Paracentral scotomata: a new finding after vitrectomy for idiopathic macular hole.

AIMS: To report the occurrence of paracentral scotomata after pars plana vitrectomy for idiopathic macular holes. METHODS: In 15 patients static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105) was performed preoperatively and 6 or 12 weeks postoperatively (stimulus size 0.2 degrees (Goldmann II), employed intensity 0 and 12 dB, 20 degrees fields in all tests). Surgery consisted of standard three port vitrectomy including removal of epiretinal membranes and the inner limiting membrane. RESULTS: Postoperative paracentral scotomata were detected in areas that were tested normally before surgery. They were mostly located temporally and/or inferiorly and often appeared like nerve fibre bundle defects. The greatest dimension varied from 1.2 degrees to 4.0 degrees (360-1200 microm), smallest dimension from 0.25 degrees to 2.0 degrees (75-600 microm). In three patients more than one scotoma was observed. CONCLUSION: Small, mostly asymptomatic, paracentral scotomata as a complication after vitrectomy for idiopathic macular hole have not been reported in the literature so far. Whether they are caused by trauma to the nerve fibres during surgery or other factors remains unknown.

Aged↗
PubMed2001

Peripheral visual field defects after macular hole surgery: a complication with decreasing incidence.

AIM: To prospectively evaluate peripheral visual fields after vitrectomy for idiopathic macular holes. METHODS: Goldmann perimetry was performed in 105 patients before, as well as 6 weeks and 12 months after macular hole surgery. RESULTS: Only one patient (< 1%) with a stage III macular hole developed an asymptomatic postoperative visual field defect. The scotoma was wedge-shaped, peripherally located in the temporal quadrant, and remained unchanged during the following 12 months. CONCLUSION: Peripheral visual field defects after macular hole surgery can be a complication of very low incidence. A rather low pressure set during air-fluid exchange as well as special aspects of the surgical technique may be responsible for this low incidence of peripheral visual field defects.

Aged↗
PubMed2000

[Imaging of vitreoretinal adhesions in the partner eye of patients with penetrating macular foramina in optical coherence tomography].

BACKGROUND: Vitreoretinal adhesions play a crucial role in the development of a macular hole. To visualize vitreoretinal adhesion we used optical coherence tomography to investigate fellow eyes of patients with macular holes. METHODS: In a prospective study we scanned the retina in 188 patients with a macular hole stage III or IV (Gass classification). The foveal shape and vitreous were classified into grades. RESULTS: Of the 188 patients 45% showed no vitreous reflex, 45% a partial vitreous detachment with foveolar adhesions, and 10% a vitreous detachment with complete separation from the fovea. While eyes with normal foveolar shape displayed partial vitreous detachment in 33%, this figure rose to 66% in eyes with a macular hole stage I. CONCLUSION: Diffuse thickening of the fovea is followed by an intraretinal split and formation of a cyst. The shape of the foveolar adhesion suggests that continuing anteroposterior vitreal traction leads to a retinal break and formation of a full-thickness macular hole.

Aged↗
PubMed2000

[Ocular manifestation in dengue fever].

UNLABELLED: Dengue-Fever is a mosquito transmitted viral disease. It is endemic mainly in South-East Asia and Africa. The clinical manifestation is divided into different stages. Ocular manifestations in travellers have been rarely reported. PATIENTS: We present the cases of two patients, having just returned from a trip to Thailand. During their trip they had fallen ill with symptoms of classic dengue-fever. FINDINGS: On examination visual acuity had decreased in both patients. In one patient we detected a relative central scotoma in perimetry and reduced amplitudes in VEP. In indirect ophthalmoscopy we found intraretinal haemorrhages, foveal lesions in the pigment epithelium, cotton-wool spots and a maculopathy. The fluorescein angiographic findings included extravasation in the macular region and block fluorescence. The diagnosis was confirmed by a rise in Dengue-fever antibody titre and the detection of flavivirus IgM antibodies. CONCLUSION: Dengue-fever and its ocular manifestation in Europeans is a rare condition. Expanding tourism to tropical countries may lead to an increasing number of cases.

Adult↗
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↗