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Biomedical subjects

G E Lang

Publications and source records attributed to G E Lang.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Histological characterization and classification of surgically excised choroid neovascular membranes].

PURPOSE: This study was undertaken in order to histologically characterize surgically-excised choroidal neovascular membranes and to correlate theses histologic findings with the fundus and fluorescein angiographic appearance. MATERIAL AND METHODS: Surgically-excised subfoveal choroidal neovascular membranes submitted in the time period from November 1994 to July 1996 were included in this study. The membranes were processed and evaluated by light and transmission electron microscopy. Some membranes were oriented by the surgeon and marked on their inner surface with India ink and the configurations of these membranes were recorded and correlated with the fundus and fluorescein angiographic features. RESULTS: Sixty-two choroidal neovascular membranes were available for this study. In 74% age-related macular degeneration was the underlying disease. Retinal pigment epithelium and endothelial lined vascular channels were present in over 87.5% of cases. Basal laminar (linear) deposit was only present in membranes excised from patients with age-related macular degeneration. In six cases with Gass Type II choroidal neovascular membranes the histologic-clinical-fluorescein angiographic correlation showed well-defined (classic) neovascular membranes according to the criteria of the Macular Photocoagulation Study. Two membranes were not surrounded by retinal pigment epithelium and were classified as Type IIa membranes. Four membranes were surrounded by retinal pigment epithelium and classified as Type IIb membranes. CONCLUSIONS: Choroidal neovascular membranes represent a stereotypic, non-specific wound repair response to a specific stimulus. Retinal pigment epithelium may proliferate around and attempt to wall off choroidal neovascular membranes. We propose a new classification of surgically-excised choroidal neovascular membranes as Types I, IIa, and IIb.

Adult↗
PubMed1997

[Congenital retinal macrovessel].

PATIENT: A 18-year-old male was evaluated for vitreous floaters. Examination exhibited a large, aberrant retinal venule in the inferiortemporal macula. The venule crossed the horizontal raphe. Only slight retinal pigment epithelial changes were present. Fluorescein angiography transiting revealed no early filling and no evidence of arteriovenous anastomoses. The diagnosis of a congenital retinal macrovessel was made. CONCLUSION: This condition is a rare, usually unilateral retinal vascular anomaly which may be associated with arteriovenous anastomoses. Areas of capillary nonperfusion, foveal cysts, and associated vitreous hemorrhage have been described. The condition is, however, in most cases ophthalmoscopically stable, and the visual prognosis is excellent.

Adult↗
PubMed1997

Allergic diseases of the lids, conjunctiva, and cornea.

Allergic ocular diseases are frequently encountered in the ophthalmologic practice. The term covers a wide array of severity, ranging from seasonal allergic conjunctivitis to the sight-threatening variant of atopic keratoconjunctivitis. The pathophysiology of these diseases is complex. Recent studies showed that nerve growth factor and interleukin IV, seem to play a role in these mechanisms.

Allergens↗
PubMed1996

[Results of pan-retinal argon laser coagulation in proliferative diabetic retinopathy].

To minimize the risk of visual loss and to stop the progression of diabetic retinopathy argon laser treatment is the therapy of choice in proliferative diabetic retinopathy (PDR). The results after panretinal argon laser coagulation (ALC) were studied retrospectively considering visual outcome and frequencies of diabetic ocular complications. In all 95 patients were included in whom laser treatment had been performed due to clinically and angiographically diagnosed proliferative diabetic retinopathy at the Department of Ophthalmology between 1990 and 1994 with a follow-up of at least 1 year. The most frequent diabetic complications observed were vitreous haemorrhage in 9 (or 9.5%) and iris neovascularization in 10 cases (or 10.5%). Rare complications were neovascular glaucoma in 3 patients (or 3.2%) and tractional retinal detachment in 4 patients (or 4.2%). Nearly 70% of the patients maintained or improved visual acuity after laser treatment. The frequency of diabetic complications of PDR after ALC was significantly associated with older age, diabetes type II, longer duration of diabetes and elevated blood pressure.

Adult↗
PubMed1996

Effect of cataract extraction with intraocular lens implantation on ocular hemodynamics.

PURPOSE: To investigate the effect of cataract extraction on ocular hemodynamics. SETTING: University Eye Clinic of Ulm, Germany. METHODS: In 51 consecutive patients assigned for cataract surgery, pulse amplitude, pulse volume, and pulsatile ocular blood flow were measured 1 day before and 3 days and 12 months after cataract extraction using an ocular blood flow tonograph. Statistical analysis was performed with Student's t-test and Wilcoxon signed-rank test. RESULTS: In the study eyes, 3 days after cataract surgery pulse amplitude, pulse volume, and pulsatile ocular blood flow had decreased from 2.5 to 2.1 mm Hg (P = .0014), 5.0 to 4.4 microliters (P = .0059), and 836.2 to 728.0 microliters/min (P = .0017), respectively. No statistically significant change between preoperative and 3 day postoperative measurements occurred in the fellow eyes. There was no significant difference in systemic blood pressure, heart rate, or IOP in study and fellow eyes before and 3 days after cataract surgery. The early reduction of pulse amplitude, pulse volume, and pulsatile ocular blood flow in the study eyes was not present 1 year postoperatively. CONCLUSION: Uncomplicated cataract extraction is associated with a temporary ipsilateral impairment of ocular hemodynamics. A neural mechanism triggered by cataract extraction may be involved in these temporary changes.

Adult↗
PubMed1996

[Ocular side effects of deferoxamine therapy in aplastic anemia with transfusion-induced hemochromatosis].

BACKGROUND: Deferoxamine, an iron chelating agent, has been used for the treatment of hemochromatosis for more than 30 years. Ocular toxicity has begun to be reported only in the last few years. In most cases differentiation of the true etiology, i.e. the underlying disease versus the toxicity of the substance, is not clear. We report a patient with development of severe ocular toxicity during treatment with deferoxamine for transfusional hemochromatosis. HISTORY AND SIGNS: An 8-year-old boy was routinely evaluated in the eye clinic before initiation of treatment with deferoxamine. Over the last three years the boy had developed a transfusional hemochromatosis after multiple blood transfusions for his aplastic anemia. Ophthalmologic examination displayed normal anterior segments with the exception of a unilateral small opacification of the posterior lens cortex, bilateral tortuous vessels, and mottling of the retinal pigment epithelium. After four months the patient developed a decrease in visual acuity, distortion of color vision, visual field defects, alteration of electrophysiological parameters, and severe changes of the retinal pigment epithelium. THERAPY AND OUTCOME: The deferoxamine was discontinued. Over a period of 3 months the patient displayed a normalization of visual acuity and visual fields. The changes of the retinal pigment epithelium and electrophysiological parameters showed further deterioration and did not return to normal. The patient subsequently was restarted on an adequate treatment dose of deferoxamine and maintained an essentially uneventful course with close ophthalmologic followup. CONCLUSION: Deferoxamine can cause severe ocular toxicity with incomplete recovery. Measurement of dark adaptation was especially valuable for follow-up examination.

Anemia, Aplastic↗
PubMed1996

The cornea and systemic diseases.

Multiple systemic diseases imply corneal involvement. Corneal pathology may also be a presenting sign or may herald a forthcoming relapse of chronic disease. The presence of ulcerative keratitis in patients with rheumatoid arthritis can be associated with systemic lethal vasculitis. Epithelial fragility of the cornea is correlated to the presence of diabetic retinopathy. Rarely, interstitial keratitis may be the presenting sign of sarcoidosis. Corneal involvement in oculomucocutaneous syndromes continue to present a therapeutic challenge. Infectious and possibly drug-induced corneal pathology is a recurrent problem in patients with AIDS.

Corneal Diseases↗
PubMed1996

[Risk factors and clinical fluorescein angiography findings in anterior ischemic optic neuropathy].

BACKGROUND: Nonarteritic anterior ischemic optic neuropathy (AION) is the most common cause of visual loss in older patients with optic disc swelling. METHOD: In our study all patients with acute AION examined clinically and by fluorescein angiography between 1986 and 1994 were retrospectively reviewed. The prevalence of associated systemic diseases and the results of Doppler sonographic examinations of extracranial vessels were investigated. RESULTS: The records of 86 patients (60 male, 26 female) with AION were available. The mean age at the time of onset of AION was 61 years (range 41 to 85 years, SD = 11.9 years). In 50 patients the right and in 36 the left eye was involved. In 36% of the patients optic atrophy of the other eye because of AION was found. The median visual acuity was 0.25 (range, light perception to 1.25). Fluorescein angiography showed diffuse edema of the optic disc in 23% (20/86) of patients and localized segmental edema in 77% (66/86). Statistical analysis revealed a predominant involvement of the temporal quadrants. Ninety-three percent of patients with AION showed underlying systemic diseases. In 15% of these patients the systemic diseases were unknown at the time of onset of the AION; 58% (50/86) of the patients had hypertension, 28% (24/86) had diabetes mellitus, and 37% (32/86) had disorders of lipid metabolism. Seven percent (6/86) of patients showed no risk factors. Doppler sonographic examinations of extracranial vessels revealed hemodynamic relevant stenosis in 11% (6/56), and non stenotic plaques in 28% of patients (16/56). CONCLUSION: Because of the high percentage of associated systemic diseases in patients with AION a general examination and adequate treatment are necessary.

Acute Disease↗
PubMed1996

Morphometric analysis of the choroid, Bruch's membrane, and retinal pigment epithelium in eyes with age-related macular degeneration.

PURPOSE: To quantify morphologic changes in the choroid, including choriocapillaris and larger choroidal vessels, Bruch's membrane, and retinal pigment epithelium in eyes with age-related macular degeneration (AMD) and late ARM (age-related maculopathy). METHODS: The authors analyzed 40 eye bank eyes with late ARM (21 with the neovascular AMD and 19 with nonneovascular AMD) and compared them with 40 age-matched eyes without signs of late ARM (AMD). The eyes were processed for light microscopy, and seven variables were measured in the macular and peripheral regions with a digital filar micrometer. RESULTS: There were no statistically significant differences observed between eyes with neovascular versus nonneovalcular AMD. The single most important difference between eyes with and without AMD was the amount of basal laminar deposit (P < 0.001). Eyes with AMD displayed fewer large choroidal vessels in the submacular choroid than eyes without AMD (3.5 +/- 1.5 mm-1 and 5.7 +/- 1.6 mm-1; P < 0.001). The submacular choriocapillaris density was higher in eyes with AMD (0.62 +/- 0.06) than in eyes without AMD (0.51 +/- 0.08; P < 0.001). The diameter of the large choroidal vessels in the peripheral choroid was increased in eyes with AMD (30 +/- 8 microns) compared to eyes without AMD (21.4 +/- 6.2 microns; P < 0.001). The peripheral choriocapillaris density displayed the same pattern as in the macular region in eyes with and without AMD. CONCLUSIONS: The amount of basal laminar deposit strongly correlates with the histologic presence of AMD. Eyes with AMD show differences of the density and diameter of choroidal blood vessels compared to eyes without AMD.

Aged↗
PubMed1995

Metastatic adenocarcinoma to the retina in a patient with Muir-Torre syndrome.

PURPOSE/METHODS: A 74-year-old woman had multiple tumors including a retinal mass. Her medical history included cutaneous sebaceous adenomas, adenocarcinoma of the breast, and colonic adenocarcinoma. Her involved eye became painful and was enucleated. RESULTS/CONCLUSIONS: Examination of the enucleated eye disclosed metastatic adenocarcinoma to the retina with retinal detachment. The patient described has a retinal metastasis of an unknown primary tumor site with Muir-Torre syndrome, characterized by an association of a sebaceous gland tumor with an internal malignancy.

Adenocarcinoma↗
PubMed1995

[Juvenile xanthogranuloma of the corneoscleral limbus: report of a patient and review of the literature].

BACKGROUND: Juvenile xanthogranuloma is an uncommon benign skin disease primarily affecting infants and young children. Ocular involvement is rare and most often affecting the iris. Isolated xanthogranulomas of the corneoscleral limbus are reported in the literature in only a few patients. HISTORY AND FINDINGS: A 10-year-old boy presented in October 1993 with a yellow solid tumor at the limbus of his left eye. The other ocular and extraocular structures were normal. Furthermore, he showed a preauricular nodular skin lesion. THERAPY AND OUTCOME: We suspected a dermoid of the corneoscleral limbus and performed an excision of the tumor. Histological examination revealed a juvenile xanthogranuloma. The tumor had regrown to its original size 2 months after excision. Treatment with topical corticosteroids resulted in an acceptable but incomplete regression of the tumor. CONCLUSION: Juvenile Xanthogranulomas of the corneoscleral limbus are rare tumors. The majority of previously reported cases showed a recurrence of the tumor at the original site after simple excision. In the case of unsuccessful therapy with topical corticosteroids a lamellar graft is recommended.

Child↗
PubMed1995

[Ocular findings in Desferal therapy].

Desferrioxamine (DFO) is the most important drug in the treatment of thalassemia major and other hematological diseases requiring regular transfusion. It eliminates excessive ferritin by building up chelate complexes. Different mechanisms of possible DFO toxicity are induction of oxidation, damage of the blood-retina barrier, or reduction in other metalloions (Cu2+, Zn2+). The objective of the present study was to evaluate the ocular side effects of DFO treatment. We prospectively examined 17 patients aged 5 to 25 years, all of them treated with DFO. Visual acuity, pupillary reaction, anterior segment, lens and fundus were checked. If possible, visual fields, color vision, dark adaptation, stereoscopic vision, and contrast sensitivity were investigated. Lens opacities were found in 41% (7/17), changes in the retinal pigment epithelium in 35% (6/17), tortuosity of retinal vessels in 24% (4/17), dilation and sheathing of the retinal vessels in 18% (3/17), defects in color vision in 29% (5/17), and abnormal dark adaptation in 18% (3/17) of the patients. The oculotoxicity of DFO is dose-dependent. Major side effects like depression of the visual acuity are partially reversible after discontinuing the therapy. Regular ophthalmological check-ups are therefore necessary.

Adolescent↗
PubMed1995

[Results of perifoveal argon laser coagulation of subfoveal choroid neovascularization in age related macular degeneration].

BACKGROUND: The treatment of patients with subfoveal choroidal neovascular membrane in age-related macular degeneration is unsatisfactory because only a limited number of patients are eligible. The aim of this study was to prospectively evaluate a new perifoveal treatment technique in patients with subfoveal choroidal neovascular membrane. METHODS: Between April 1992 and January 1994, 385 patients underwent clinical examination and fluorescein angiography. Eligibility criteria were met by 21 (5.5%) patients (22 eyes): well or poorly defined subfoveal choroidal neovascular membrane (< or = 3.5 disc diameters), without fibrosis, with visual acuity < or = 0.25. Visual acuity, morphological findings and complications were studied. The follow-up period was 12-32 months. RESULTS: The visual acuity before laser treatment ranged from counting fingers up to 0.25 (median 0.06). At the end of the follow-up (median 18 months) 28% (6/21) of patients showed a better visual acuity, whereas 44% (9/21) were unchanged and 28% (6/21) had deteriorated compared to visual acuity before treatment. In 71% (15/21) of eyes, resolution of the choroidal neovascular membrane was achieved with development of an atrophic laser scar. CONCLUSION: The visual outcome and the morphological findings after perifoveal laser treatment of subfoveal choroidal neovascular membrane in age-related macular degeneration show it to be an alternative method of treatment with favourable results. Due to inclusion criteria it is suitable only for a limited number of patients.

Aged↗
PubMed1995

Severe occlusive retinal periphlebitis with vitreous hemorrhage in multiple sclerosis.

Severe ocular complications in multiple sclerosis are rare. A 43-year-old patient had a history of diplopia episodes and optic neuritis in the right eye between 1979 and 1980. In 1984, multiple sclerosis had been diagnosed. The patient presented with visual deterioration in the right eye in 1992. Ophthalmoscopy and fluorescein angiography showed severe occlusive retinal periphlebitis with diffuse retinal hemorrhages and large areas of nonperfusion. At the time of presentation the patient was in general good health and presented no neurological sign. Examinations for other causes of periphlebitis were negative. Although treatment with laser therapy and corticosteroids was initiated, the patient developed recurrent vitreous hemorrhages that required pars plana vitrectomy. In 1993 the patient suffered from a general deterioration of the disease course and was treated with systemic immunosuppressive medication. Vitreous hemorrhage is a rare complication of multiple sclerosis.

Adult↗
PubMed1995

Retinal vasculitis in Lyme borreliosis.

We observed retinal vasculitis in seven patients with clinical and serologic evidence of Borrelia burgdorferi infection. Three patients presented with abrupt loss of vision due to acute retinal vasculitis. Funduscopy demonstrated engorged veins, hemorrhages, perivenous infiltrates and retinal white spots. Fluorescein angiography showed leakage from the veins, from the white spots and from the optic disc. Moreover arterial occlusions were observed in two patients. Four patients had signs of chronic uveitis with vitritis, cystoid macular oedema and retinal vasculitis, which was associated with neovascularization and vitreous hemorrhage in one patient, and with optic neuritis in another patient. Six patients received antibiotic treatment and three patients received systemic corticosteroids. Marked improvement in the three acute retinal vasculitis cases occurred within several weeks, the fundus changes disappeared in another few months, and no recurrences were observed. The final visual acuity was excellent in these patients, although optic disc pallor and visual field loss persisted in one case. In the four patients with chronic uveitis visual blurring improved following antibiotic treatment and the retinal vasculitis and vitritis slowly regressed. The proliferative retinopathy of one patient required panretinal laser treatment.

Adult↗
PubMed1994

[Corneal ulcer in chronic graft-versus-host disease: treatment with collagen shields].

BACKGROUND: After bone marrow transplantation various ocular diseases have been described. Ocular involvement is very common in patients with chronic Graft-versus-Host Disease (GvHD). These patients show clinical and histological evidence of a dry-eye condition in 60-100 per cent. A severe complication is the development of a corneal ulcer with possible corneal perforation. Two patients with a severe dry-eye condition and development of corneal stroma ulceration are described. The corneal ulcers healed after treatment with collagen-shield. HISTORY AND SIGNS: In a 13-year-old boy an allogeneic bone marrow transplantation was performed in April 1989 because of Fanconi's anemia. In November 1989 a severe dry-eye condition occurred due to GvHD with skin, liver, and gastrointestinal tract manifestation. In April 1991 he presented with corneal stroma ulceration of the right eye. In a 24-year-old patient an allogeneic bone marrow transplantation was performed because of chronic myeloid leukemia in August 1989. In December 1989 he developed dry-eye condition due to GvHD with skin, mucosa and liver involvement. In December 1991 a corneal ulcer of the left eye occurred. THERAPY AND OUTCOME: Repeated conjunctival and corneal smears were negative. Local antibiotic and antiviral treatment showed no effect. Corneal ulcers deteriorated progressively with corneal thinning. Both patients were therefore treated with daily collagen-shields and hourly polyvinyl-pyrrolidon eye-drops resulting in healing of the corneal ulcer within 3 and 2 weeks respectively. CONCLUSION: Treatment of corneal stromal ulceration in dry eye condition caused by chronic GvHD is difficult. In noninfectious ulcers daily application of collagen-shields and hourly artificial tears may prevent severe ocular complications like corneal perforation.

Adolescent↗