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Biomedical subjects

E Arocker-Mettinger

Publications and source records attributed to E Arocker-Mettinger.

At least 19 recordsLinked to original sources
PubMed1994

Different techniques of extracapsular cataract extraction: bacterial contamination during surgery. Prospective study on 230 consecutive patients.

This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE). Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique. All patients had posterior chamber intraocular lenses implanted. Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated. Samples of the aqueous humor were taken at the beginning and at the end of the operation. Cultures were incubated and held for 14 days. More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria. However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms. In no case did postoperative endophthalmitis develop. Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification. Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.

Adult↗
PubMed1994

Canaliculitis: difficulties in diagnosis, differential diagnosis and comparison between conservative and surgical treatment.

The most important clinical features of canaliculitis include a red, swollen eyelid in the area of the affected canaliculus, a unilateral conjunctivitis, a mucopurulent discharge and in some cases dacryoliths visible in the lacrimal punctum. Conservative therapy was found to be little effective: only 10% of the patients could be cured, 40% showed a recurrence after conservative treatment. 20 patients (50%) were treated by canaliculotomy: 16 of these were cured by this surgical treatment, 4 patients complained of epiphora, although diagnostic syringing showed free lacrimal pathways. The surgical treatment of canaliculitis in combination with conservative therapy yields far better results than conservative therapy alone.

Adult↗
PubMed1993

[Morphology of the anterior vitreous body membrane in congenital aniridia].

BACKGROUND: Hitherto no attention was paid to the prebasal vitreous body in children with congenital aniridia. Obviously there are, at least occasionally, two remarkable anomalies of the anterior hyaloid membrane. MATERIALS AND METHODS: Two children (one 3 years and the other 4 years old) with congenital anirida were examined in supine position at a special slitlamp in general anaesthesia. Both children were healthy besides their ocular malformation; pregnancy and delivery were unremarkable. RESULTS: Only the younger child showed bilaterally in symmetrical fashion a thin, circular, whitish ligament between lens zonulae and anterior hyaloid membrane (zonulo-vitreal ligament). The eyes of both children exhibited a circumferential simple detachment of the anterior hyaloid membrane in the region of the ciliary body. CONCLUSION: At least sometimes, the congenital aniridia can be associated with anomalies of the anterior hyaloid membrane: 1. Obviously the circumferential simple ciliary detachment of the anterior hyaloid membrane corresponds with the loss of physiological cilio-vitreal fibril systems. 2. The zonulo-vitreal ligament might be formed during the fetal time as a surplus connection between lens zonulae and anterior hyaloid membrane.

Aniridia↗
PubMed1993

Gore-Tex soft-tissue patch frontalis suspension technique in congenital ptosis and in blepharophimosis-ptosis syndrome.

The frontalis suspension technique is the surgical method of choice in ptosis patients with a levator function of 2 mm or less. This type of ptosis is found unilaterally or bilaterally in isolated congenital ptosis and mostly bilaterally in blepharophimosis-ptosis patients. The frontalis suspension technique is frequently used in children being operated on because of congenital ptosis, where the excision of the fasciae latae can be avoided so as not to risk scarring the donor area. Since the new heterologous material polytetrafluoroethylene (Gore-Tex soft-tissue patch) has been available (1986), it has been used on our ptosis patients with minimal levator function instead of the formerly much used fasciae latae. Thirty-seven frontalis suspension procedures have been performed in 26 patients, of whom 6 were children who suffered from bilateral blepharophimosis-ptosis syndrome. All ptosis procedures were performed as Fox pentagons, and in the combined cases, the medial canthoplasty was carried out as a bilateral one-stage procedure. The postoperative healing was free of complications. Three years postoperatively one patient did exhibit rejection of one of the two implanted Gore-Tex slings. In all other patients, the functional and cosmetic results were satisfying, and high biocompatibility of the Gore-Tex soft-tissue patch material could be shown.

Adolescent↗
PubMed1992

High incidence of asymptomatic urogenital infection in patients with uveitis anterior.

Acute anterior uveitis (AAU) may be associated with systemic infectious or inflammatory disease. We examined 92 patients with the first attack of acute anterior uveitis; all patients were free of any extraocular symptoms. A thorough clinical examination did not reveal any systemic underlying disease. In the course of microbiological examination, however, a high incidence of asymptomatic infection of the urethra and/or cervix with ureaplasma urealyticum, chlamydia trachomatis and mycoplasma hominis was found. Infections with ureaplasma were significantly more frequent in patients with AAU when compared with a sex- and age-matched control group. There was no statistically valid association of these infections with the HLA-B27 phenotype in the patients. The higher rate of urogenital infections in patients with AAU may reflect a higher rate of sexual promiscuity. Transmission of infectious agents seems to be one possible factor in the pathogenesis of AAU.

Acute Disease↗
PubMed1992

[Corneal ulcer. Current analysis from specialized ambulatory care of a clinic].

A review of 115 cases of ulcerative keratitis that were diagnosed and treated at the specialized ambulatory care center for infectious eye diseases at the 2. Department of Ophthalmology over a period of eight years (January 1983-April 1991) is presented. In the analysis of the etiology nearly half (47.7%) were observed following a trauma to the epithelium, 38 (= 33.0%) were associated with contact lens wear and the third largest group (10.4%) was associated with lid problems. It is apparent that over the course of the last years the spectrum of microorganisms associated with this localized inflammation has shifted: the prevalence of Staphylococci (1983-1986 = 65%) has decreased, whereas the incidence of gram-negative rods increased (1987-1990 = 49%). In 19% Pseudomonas aeruginosa could be isolated, mostly associated with soft contact lens wear. A total of 37.5% of the staphylococci isolates were found to be resistant to gentamicin, most probably as a consequence of the widespread, indiscriminate use of this antibiotic. An updated treatment schedule is presented.

Ambulatory Care↗
PubMed1992

[Taenia crassiceps in the anterior chamber of the human eye. A case report].

An otherwise healthy 15-year-old girl developed an iridocyclitis in her right eye. A contractable living parasite measuring two millimeter could be detected in the anterior chamber, the other parts of the eye remained uninvolved. The patient had close contact with the young dog of the family. By using a viscoelastic substance the parasite could be removed alive without any complications. The tapeworm was found to be too young for having developed the characteristic scolex. Western-immunoblotting gave indirect evidence for infection with Taenia crassiceps, a dog's tapeworm. During an observation period of two years no evidence for any other ocular or general Taenia crassiceps infestations could be found.

Adolescent↗
PubMed1992

[Retinal lymphoma--simulating uveitis].

A rare form of malignant large-cell non-Hodgkin's lymphoma or reticulum cell sarcoma is confined to the eye and central nervous system (CNS). We report the case of a 62-year-old man, who presented with recalcitrant progressive uveitis in his right eye. Although lymphoma was suspected, the patient refused to undergo vitrectomy. Over one year he developed large blister-like solid scattered lesions of the retinal pigment epithelium (RPE) in the same eye. Repetitive neuroimaging detected no CNS involvement. After developing optic disc-swelling and discrete RPE-changes in the left eye also, the patient agreed to enucleation of his right eye. Histopathology and Immuno-histochemistry revealed malignant intraocular large cell-lymphoma invading all eye-tissues. Liquor cytology showed lymphomatous cells. Suffering from high grade malignant lymphoma with CNS ivolvement, the patient had to undergo radiation therapy of the orbits and neuroaxsis as well as intravenous and intrathecal chemotherapy. Papilledema of the left eye resolved quickly and completely, RPE-infiltrations disappeared and led to discrete punched out lesions with no scarring, the lens remained transparent over the whole observation period of 25 months. the patient has been surviving for more than 52 months after first suspicion of malignant lymphoma, he has retained full vision in his left eye until now.

Chemotherapy, Adjuvant↗
PubMed1992

Do HLA antigens play a role in intermediate uveitis?

A total of 52 nonrelated Caucasian patients (21 male, 31 female, age at onset of the disease: 7-74 years, average: 31.6 years) suffering from intermediate uveitis were tissue typed for 56 different HLA-A, -B, -C and -DR-antigens. No significant association between any specific HLA-antigen and the disease, both when comparing the total patient group with a large, healthy control population, or any of the different subgroups (male vs. female, early vs. late onset, mild vs. severe course) could be demonstrated.

Adolescent↗
PubMed1992

Acquired dacryocystitis: microbiology and conservative therapy.

The dacryocystitis in adults is mainly caused by postsaccal stenosis of the lacrimal ducts. The banking up of the lacrimal fluid leads to an accumulation of germs and following infection. This report describes the clinical and microbiological findings in a large consecutive series of patients that presented at the outpatient clinic of the 2nd Department of Ophthalmology of the University of Vienna with the signs of acute, chronic recurrent or chronic infections of the lacrimal system between 1983 and the end of 1990. Within the bacterial genus Staphylococci (S. aureus, S. epidermidis and S. saprophyticus) were the most frequently isolated organisms (74 cultures = 50% out of samples with positive cultures). It was quite interesting that a significant number of gram-negative rods (37 = 25.5%) could be isolated. Of these microorganisms Escherichia coli was most frequently growing on special media (17 cases = 11.7%) when cultures were obtained from acute inflamed lacrimal sacs of patients who suffered from chronic recurrent infections. Conservative therapy of purulent dacryocystitis constitutes the last possible preparation for a necessary surgical intervention and therefore the authors want to point out the importance of microbiological examinations so as to optimize antibiotic therapy.

Acute Disease↗
PubMed1992

Ulcerative blepharitis in atopic patients--is Candida species the causative agent?

A total of 50 patients suffering both from atopic skin disease and different clinical forms of blepharitis have been included in this study. Microbiological investigations (for bacteria and fungi) of the lid margins were performed in all cases. In 21 (42%) of the patients an ulcerative blepharitis which heavily involved the follicles of the lashes was diagnosed. The remaining 29 cases presented with blepharitis of the squamous type. The cultures revealed that 19 of the 21 patients with ulcerative blepharitis were found to grow Candida species, whereas fungi could not be detected in any of the other cases of blepharitis. The frequencies of concomitant bacterial organisms found in the cultures were similar in both groups. As atopic patients are known to exhibit a defect in their cell-mediated immunity and possibly also a defective IgA antibody response it is a widely accepted assumption that these immunological changes are contributing factors to the development of a localised inflammation of the lids which is initiated by a variety of micro-organisms. We postulate that when Candida species happen to coincide with severe inflammation in atopic patients a blepharitis of the ulcerative type will develop or deteriorate thereby implying that these microorganisms may play an important role in the development or deterioration of this severe chronic inflammation. It is therefore advisable to perform repeated scrapings and cultures in every case of recalcitrant blepharitis.

Adult↗
PubMed1992

[Treatment of Ocular Chlamydial Infection: Comparison of Tetracyclines and Norfloxacin].

The unilateral follicular conjunctivitis with corneal marginal infiltrates represents a clinical picture typical for two different types of bacteria: chlamydiae may cause a keratoconjunctivitis always combined with urethritis or colpitis; on the other hand staphylococci may be the reason for the same clinical features, whereas the marginal corneal infiltrates are caused in these cases by immunological reactions to the bacterial toxins. After harvesting material for bacterial investigations or direct immunofluorescence test for the detection of chlamydial antigen, 2-3 days are necessary until the results of the examinations are ready. From January 1991 until the end of 1991 a total of 60 patients with the diagnosis of chlamydial infection underwent ophthalmological investigations at our outpatient clinic. In our study we compared the efficacy and safety of topical tetracyclines and 0.3% norfloxacin solution in the treatment of chlamydial keratoconjunctivitis. Within the bacterial genus, staphylococci (S. aureus, S. epidermidis and S. saprophyticus) were the most frequently isolated organisms (60%). Nearly one third of the staphylococci were resistant to tetracyclines. Therefore there are two indications to postulate norfloxacin as a practicable alternative: at the beginning of therapy until the results of the bacterial investigation are available and in the case of persisting bacterial superinfection.

Adolescent↗
PubMed1992

Circulating ICAM-1 levels in serum of uveitis patients.

Intercellular Adhesion Molecule-1 (ICAM-1) is a cytokine-inducible adhesion molecule expressed on cells of multiple lineages at sites of inflammation. Recently a truncated form of ICAM-1 has been discovered to be circulating in serum. This study reports on circulating serum (cICAM-1) levels in 132 uveitis patients (HLA-B 27 pos. acute anterior uveitis (AAU); HLA-B27 neg. anterior uveitis (AU); intermediate uveitis (IU); heterochromic cyclitis Fuchs (HCF); sarcoidosis; Toxoplasmosis). Measurement of circulating ICAM-1 serum levels was performed using a monoclonal antibody based ELISA, with healthy blood donors serving as the control group. Applying multiple variance analysis and the Student Newmann-Keuls test we found a statistically significant elevation of serum cICAM-1 level in the HLA-B 27 neg. AU group (n:31), in the IU group (n:25) and in patients with sarcoidosis (n:18). Serum levels of HLA-B27 pos. AAU patients, patients with HCF and patients suffering from ocular toxoplasmosis did not differ significantly from levels of the control group.

Acute Disease↗
PubMed1992

Penetration of norfloxacin into the aqueous humor of the human eye.

Forty six patients received a topical application of a 0.3% norfloxacin (Zoroxin; MSD, Austria) solution into the lower fornix at different time intervals and frequencies before undergoing planned extracapsular cataract extraction. Aqueous humor was sampled at the beginning of surgery and assayed for the level of the antibiotic with high performance liquid chromatography. The highest aqueous humor level observed 30 min after the administration of the last drop in four patients who received five drops of norfloxacin into the lower fornix was 660.25 +/- 378.2 ng/ml. These concentrations are above the minimum inhibitory concentration of norfloxacin for 90% (MIC90) of most of the gram-negative microorganisms, but below the MIC90 of most of the staphylococci (coagulase negative Staph. and Staphylococcus aureus range between 0.25-1 mg/ml).

Administration, Topical↗
PubMed1991

[Capsular sack implantation of heparin-modified posterior chamber lenses].

In a prospective study, heparin surface modified posterior chamber lenses were implanted into the capsular bag in 50 patients. The exact positioning of the biconvex, one-piece lens in the bag is the prerequisite for good centration and for an optimal result. The hydrophilisation of the originally hydrophobic PMMA material is achieved by heparin surface modification and results in less inflammation. The aim of this study was to investigate the postoperative behavior of the HSM posterior chamber lens implanted in the bag, with special consideration given to intraocular inflammation. In the postoperative follow-up time of one to seven months, hundred percent of the patients with physiological fundus reached a postoperative visual acuity of 0.7 or better.

Aged↗
PubMed1990

[Lymphogenic dissemination of an epibulbar melanoma].

Conjunctival melanomas are considered to be malignant tumors, the prognosis of which depends on various factors such as the size and thickness of the tumor and the number of recurrences following excision. The authors report on a 47-year-old woman who, years after local excision of a recurrent limbal conjunctival melanoma, developed an epibulbar melanoma far from the site of the original scar. The authors attribute this recurrence to lymphogenic propagation.

Conjunctival Neoplasms↗
PubMed1990

[Pre-basal vitreous body after subtotal vitrectomy of aphakic eyes].

The anterior axial vitreous body of aphakic eyes is often severely liquefied. In a vitrectomy case, it was removed easily and completely. The behavior of the prebasal vitreous cortex after the procedure was not predictable. The postoperative biomicroscopic examination resulted in two different findings, are reported on here.

Cataract Extraction↗