Biomedical subjects

H C Fledelius

Publications and source records attributed to H C Fledelius.

At least 37 records · Page 2Linked to original sources

PubMed1997

Ultrasound in ophthalmology.

The first ocular echogram was published in 1956. Since then, ophthalmic ultrasound has developed into a multifaceted diagnostic discipline, the basic methods being A-scan and B-scan, Doppler techniques and recently also three-dimensional approaches. Unique for ophthalmology is the newly invented, highly resolving equipment utilising ultrasound frequencies of 50 MHz and higher, so-called ultrasound biomicroscopy. During this development, the special ophthalmic items often kept colleagues from other fields at some distance. With a view to a fair balance between specific and more general information, the primary aim of the present overview is to provide insight for other medical branches employing diagnostic ultrasound. Regarding intraocular morphology, ultrasonic evaluation in experienced hands is superior to other imaging methods. As for orbital pathology, imaging by CT and MR appears more complete. Ultrasound is valuable, however, in particular as part of the initial clinical work-up, and for the follow-up of orbital disease. Furthermore, tissue differentiation by way of ultrasound is of great value with regard to certain entities.

Biometry↗

PubMed1997

Metastatic bacterial endophthalmitis. A report of four cases all leading to blindness.

PURPOSE: To draw attention to the rare but severe entity of endophthalmitis as encountered due to metastatic spread of bacteria. METHODS: We report our experience from four cases of metastatic bacterial endophthalmitis. RESULTS: Systemic infection (Pneumococcus meningitis) was evident in two cases, but in the other two there was no early clue to systemic infection. Eventually, however, endocardial vegetations were disclosed as the source of bacterial emboli (E.coli, peptostreptococcus). In the most atypical patient, magnetic resonance scanning had indicated disseminated brain tumours, and only autopsy revealed the infectious nature of the disease. Ocular ultrasonography being part of the work-up, the four eyes under study all showed marked morphological intraocular changes, including 'solid tumour' in the presumed neoplastic case. CONCLUSION: Our cases stress the severity of metastatic bacterial endophthalmitis and the easily missed early diagnosis, even where experienced clinicians are involved. The role of diagnostic ultrasound is discussed.

Aged↗

PubMed1996

Retinopathy of prematurity in a Danish county. Trends over the 12-year period 1982-93.

An analysis of the ophthalmic recordings from the pre-term infants born 1991-93 considered at risk of developing retinopathy of prematurity is added to three previous 3-year clinical surveys from the same Danish county. Out of the 203 subjects of the recent study 34 showed evidence of retinopathy of prematurity. In 27 the maximum retinopathy of prematurity stage was 1 or 2 prior to regression. Out of the seven subjects with stage 3, one progressed to bilateral blindness in spite of the cryotherapy given in this single case. Comparing with the four retinopathy of prematurity-blind born 1982-84, the trend over the 12 years appears to be towards a better overall ophthalmic outcome. Along with an increasing number of survivors of the low GA/BW groups, the retinopathy of prematurity percentage has shown a decline, and apparently with less serious sequelae. Together with other Danish experience, eventually the present data may lead to lower screening limits for retinopathy of prematurity regarding GA/BW. Prior to this, however, there should be support from the case data currently collected in the compulsory Danish register of visually impaired children. Hence our present basic recommendation is that gestational ages up to (and including) 31 full weeks qualify for serial eye examination.

Birth Weight↗

PubMed1996

Pre-term delivery and subsequent ocular development. A 7-10 year follow-up of children screened 1982-84 for ROP. 1) Visual function, slit-lamp findings, and fundus appearance.

An ophthalmic follow-up comprised 88 children aged 7-10 years who had regular screening for retinopathy of prematurity (ROP) after their pre-term delivery 1982-84. Mean values of birth weight and gestational age in the 88 were 1467 g and 31 weeks. Out of 28 with early evidence of ROP four had progressed to bilateral blindness; the remaining 24 had at least a corrected visual acuity of 0.4 at disposal. The corrected median binocular acuity for all 88 was 0.95; however, the cumulated frequency curve was significantly below a previously stated norm in full-terms. The same conclusion was valid for single eye vision. Within the material, the visual score of the 28 with early ROP was significantly lower than in the remaining 60 subjects. Ophthalmoscopy often showed tortuosity of vessels, but no specific central retinal or optic nerve lesion to explain the slight general depression of visual acuity, and opacities of media contributed in only two subjects. It is concluded, that very preterm delivery generally influences the potential for developing full visual acuity, also in individuals without evidence of early ROP. Evidence of CNS-damage negatively influenced visual acuity score.

Accommodation, Ocular↗

PubMed1996

Pre-term delivery and subsequent ocular development. A 7-10 year follow-up of children screened 1982-84 for ROP. 2) Binocular function.

Binocular function was assessed as part of a more extensive examining programme in 88 children now aged 7-10 years. Initially they joined a regional screening programme for retinopathy of prematurity (ROP) after pre-term delivery 1982-84; their mean values for gestational age and birth weight were 31 weeks and 1467 g, respectively. Binocularity was evaluated from cover test 6 m and 30 cm, Schober, Worth four dot, and Titmus stereo test. Excluding the four children with bilateral blindness due to ROP, 84 subjects were available, but occasional refusals were met also here. The overall frequency of 'strabismus' became 17.8%, as based on the combination of tests, and with emphasis on the sensory recordings. Binocularity patterns in subsamples were not significantly influenced by a) regressed ROP, b) gestational age 30 weeks and less. In contrast, c) the subgroup with severe CNS damage (n = 24) appeared more deviant, confirming the established association between brain damage and strabismus.

Birth Weight↗

PubMed1996

Pre-term delivery and subsequent ocular development. A 7-10 year follow-up of children screened 1982-84 for ROP. 3) Refraction. Myopia of prematurity.

Refractive findings are reported in a follow-up study comprising 88 children aged 7-10 years, who were submitted to regular control for retinopathy of prematurity (ROP) in the first months after their pre-term delivery 1982-84 (mean birthweight 1467 g, mean gestational age 31 weeks). The refractive range was -13 to +6.75 D. In four subjects with fully-blown ROP both eyes were left blind and dysmorphic. Twenty-four had had ROP with regression; myopia of prematurity (MOP) appeared in six (25%). At follow-up the myopia frequency in the remaining 60 without ROP was 5%. Out of the 9 subjects with uni- or bilateral myopia of prematurity three had no evidence of early ROP. With a median corrected acuity of 0.5 only, the eyes with MOP had a lower corrected visual score than in the rest of the material (median monocular acuity 0.9). The latter value is even a little lower than what was previously reported in full-terms of a similar age (median acuity above 1.0). Obviously, as a sequel to the pre-term delivery we are dealing not only with early myopia in some subjects; further, the potential for developing full vision appears influenced and reduced. This applies to the total group of ex-prematures, but in particular it is valid for myopia of prematurity.

Child↗

PubMed1996

Pre-term delivery and subsequent ocular development. A 7-10 year follow-up of children screened 1982-84 for ROP. 4) Oculometric - and other metric considerations.

Eighty-eight children of pre-term delivery 1982-84 (mean birthweight 1467 g, mean gestational age 31 weeks) with regular early control for retinopathy of prematurity (ROP) had ophthalmic follow-up at the age of 7-10 years. Bilateral blindness appeared in four out of the 28 in the regional survey who had ROP. In the remaining 60 there had been no ROP. In this article focus is on various size parameters, general (height, weight, head circumference, interpupillary distance) and ophthalmic (corneal transversal diameter and curvature radius, axial eye measurements by ultrasound). Comparing with available standards the group average for height was 2-3 cm below the norm for age. With regard to +/- ROP, growth parameters had lower values in the subgroup with ROP. Oculometrically, there was a more curved cornea and a shorter axial length than expected from refractive value. The average values for emmetropia (n = 23) and for myopia of prematurity (6 eyes) were: refraction + 0.54 D and -7.8 D, Crad 7.58 and 7.47 mm, and axial length 22.93 and 25.3 mm, respectively.

Anthropometry↗

PubMed1996

Cranio-orbital teratoma.

A new-born baby presented with a large, rapidly growing tumour. The tumour involved the right orbit, the anterior half of the right intracranial space and extended through the skull of the temporal region. The proptotic eye ruptured due to exposure. The tumour was extirpated when the patient was 12 days old. A large recurrence was extirpated two months later. The tumour was firmly bound to the medial aspect of the superior orbital fissure which probably was the location of origin of the tumour. Based on the size of the intracranial-and the orbital part of the tumour, it was classified as a secondary orbital teratoma. The tumour was macroscopically composed of cystic and solid areas. Microscopically it was seen to be a benign teratoma with tissue from all three germinal layers.

Brain Neoplasms↗

PubMed1996

Central nervous system damage and retinopathy of prematurity--an ophthalmic follow-up of prematures born in 1982-84.

Retinopathy of prematurity (ROP) was observed in 28 of 185 pre-term infants born in 1982-84 and under regular ophthalmic surveillance after delivery; their gestational age (GA) range was 25-35 weeks; four became blind. All 28 attended ophthalmic reassessment at age 7-10 years and were compared with 60 pre-term subjects of the same cohort who had not developed ROP. Considering psychomotor development, 45 (51%) of the total 88 had evidence of central nervous system (CNS) damage; minor in 24 and major in 21 (cerebral palsy in particular). With correction for drop-outs, the regional frequency of severe CNS damage was 24% for birth weight below 1500 g and 29.6% for GA less than 32 weeks. Except for the selection due to initial inclusion for ROP surveillance, we have no explanation for the high frequency at the present follow-up. Statistically, the ocular damage of ROP appeared unassociated with CNS impairment. An analysis of perinatal factors based on matched pairs did not indicate any definite association with subsequent development of ROP and/ or CNS damage.

Central Nervous System Diseases↗

PubMed1996

Reappraisal of the human ocular growth curve in fetal life, infancy, and early childhood.

AIMS: The aim of this study was to find an algorithm of better fit for early eye growth than the linear regression usually advanced. METHODS: The analysis is based on previously published around term data, the main material being axial ultrasound measurements in preterm (n = 101) and full term infants (n = 25). The postconceptional age of the infants ranged between 36 and 54 weeks. Previously published Danish data from eyes of aborted fetuses were also used, as were averaged values from the literature regarding eye size at age 1 year (20 mm), 3 years (22 mm), and a presumed 13 year endpoint of 23 mm. RESULTS: A second order exponential function fitted with the basic data within a standard deviation of 2%. CONCLUSIONS: A simple symbolic expression and tabulated values for eye growth in infancy and childhood were derived. This is clearly of practical value, for example, when following the development of eyes treated for congenital glaucoma or assessing other developmental anomalies and early eye diseases.

Algorithms↗

PubMed1996

Ultrasonic evaluation of microphthalmos and coloboma. A discussion of 3 cases, with emphasis on microphthalmos with orbital cyst.

Three cases of ophthalmic malformations are discussed from the standpoint of the usefulness of ultrasound evaluation, however with respectful reference to the revised classification of microphthalmos and coloboma presented by Warburg 1993. The main findings were, (case 1): microphthalmos with iris coloboma, unilateral posterior orbital cyst, and mental retardation, karyotype normal, consanguineous parents, (case 2) trisomy 13 with extreme microphthalmos and cheilo-gnatho-palatoschisis, and (case 3) ringchromosome 14, posterior fundus colobomas, and malformation of the heart, with features corresponding to the CHARGE association.

Abnormalities, Multiple↗

PubMed1995

Myopia of adult onset. Can analyses be based on patient memory?

One hundred and fifty-one adult subjects (age 26-64 years) with simple myopia ('simple' = absence of significant astigmatism and anisometropia) were asked about their myopia onset, here defined as the age when first having spectacles to correct vision trouble for distance. A precise memory appeared in 148. Usually, they could substantiate their information by detailed accounts regarding how and when. Evidently, the first pair of glasses is a strong emotional experience. Accordingly, information appears to be reliable when properly asking the patient. The sample confirmed established knowledge: the earlier the onset, the higher the final myopia. Adult onset myopia is usually low, but occasionally intermediate or high myopia cases are encountered. Adult onset myopia appears more frequently than evident from textbooks and literature on refractive distribution. A frequency estimate based on Danish material thus suggests that at least 25-30% of all adult age myopia is also of adult onset.

Adult↗

PubMed1995

Adult onset myopia--oculometric features.

Adult onset myopia was investigated by ultrasound eye measurements and keratometry in 33 subjects (16 females, 17 males; age 32-62 years; age at myopia onset 18-50 years, mean value 26.2 years, SD 7.80). They were compared with 30 subjects (15 females, 15 males; age 29-62 years) with myopia onset age 4-16 years (mean value 11.1 years, SD 2.89). Excluded were subjects with cataract and corneal pathology. In the adult onset group, myopia ranged a little lower than in early onset myopia (mean values -3.24 and -4.91 D, respectively), but high myopia was encountered in both groups (peak values -10 and -10.5 D). In both groups axial elongation was the main oculometric event. There was no evidence of a corneal/lenticular background in adult onset myopia. In accord with the higher myopia in the early onset group the eyes were also larger (as for axial and vitreous length, mid lens depth) than in those of adult onset. Adult onset myopia being axial of nature, the findings confirm what has been suggested from recent reports by other authors: that the eye has a potential for re-starting growth, even years after the presumed normal ocular growth arrest during early teenage years.

Adult↗

PubMed1995

Myopia of prematurity, clinical patterns. A follow-up of Danish children now aged 3-9 years.

A discussion of myopia of prematurity is based on 16 low-birth weight children now aged 3-9 years. During their first months after delivery, retinopathy of prematurity had been observed in all but one subjects-here possibly missed due to incomplete control. Two subjects had cryotherapy. Two eyes out of 32 got blind; another 4 eyes became weak-sighted. The primary aim of the longitudinal study was to describe the variation in-and the course of-refraction, as apparent from serial examinations, the natural history so to say, to add new facets to our concept of myopia of prematurity and possibly to identify subgroups. Transient and fluctuating myopia being physiological in the first postnatal months, the diagnosis "myopia of prematurity' should not be forwarded too early. Some cases of early myopia which did not regress as usual over the first 6 months, later showed a reduction in degree of myopia over 1-2 years. Others pertained to the classical description of a stationary myopia, often of high degree, diagnosed in early childhood. Even in the favourable tail of the present distribution corrected visual acuity appeared subnormal according to age norms.

Child↗

PubMed1994

[Exophthalmometry and thyroid disease. The value of the Hertel measurement evaluated by a group of patients with thyroid diseases and a control group].

Exophthalmometry values from routine referrals to a hospital eye clinic are analysed, including adult patients with and without thyroid disease. In thyroid disease without eye motility complaints (n = 90) the median exophthalmometry value was 18 mm (range 12-28 mm). Thyroid patients with eye muscle involvement (diplopia, n = 47) had significantly higher values (median 22 mm, range 15-31 mm) but did not differ significantly from a subgroup of 51 patients without thyroid disease, but with "big eyes" as a (presumably) physiological finding (median value 20 mm, range 16-25 mm). The above three categories were all excluded from the control group (n = 203) which had 16 mm as median value, range 11-23 mm. Mean values were 16.0 +/- 1.8 mm in the females and 16.5 +/- 2.3 mm in the male controls. A side difference in exophthalmometry value > or = 2 mm appeared in 34% of thyroid patients with eye muscle involvement. This appeared in only a few per cent in the three other groups. Due to the wide overlap between groups, the solitary exophthalmometry reading is of limited diagnostic value, while the importance of exophthalmometry is evident when following the individual patient with orbital disease.

Adolescent↗

PubMed1994

[Retinopathy of prematurity in Denmark 1974-1991. Analysis of the data from the Danish Registry of Diseases].

This study deals with registered Danish children with visual handicap due to retinopathy of prematurity (ROP) born between 1974 and 1991. There are 141 such children, corresponding to a frequency of 13.1 per 100.000 liveborn. The data was analysed for trends in time by chronologically subdividing the material into thirds, each group comprising 47 subjects. Birth weight and gestational age showed a decline over the period, median values in the three groups in chronological order being respectively 1.250 g, 1.100 g, and 960 g and 30, 28, and 27 weeks. Associated CNS handicaps were recorded in 17, 38, and 34%. Visual impairment was severe in all groups, the median corrected acuity of the better eye being below 1/60. Geographically there was a significant shift from an even distribution nationwide towards there being a preponderance of severe ROP cases in the Copenhagen area.

Denmark↗

PubMed1994

Atypical visual loss in giant cell arteritis.

Three patients with atypical ocular involvement due to histologically verified giant cell arteritis are reported. Prior to diagnosis, the first patient had periods of amaurosis fugax. He presented with normal vision. In spite of high-dose systemic corticosteroid therapy, he became blind in the terminal stage of his disease due to bilateral occipital cortex infarctions, verified by CT-scan. Autopsy revealed involvement of several intracranial arteries. In case No. 2 there was severe unilateral visual loss and cotton-wool exudates in both eyes. Central vision recovered after corticosteroid therapy; in our experience this is unusual. In case No. 3 irreversible unilateral visual loss was typical for GCA, but the association with polyneuropathy unique. Neurological remission coincided with systemic corticosteroid therapy.

Aged↗

PubMed1994

Retinal maculopathy possibly associated with amiodarone medication.

A report is given on a 59-year-old female who acquired a wet maculopathy in her only seeing eye during amiodarone therapy given for a cardiac disorder. After withdrawal of the drug and subsequent central retinal laser therapy her visual acuity stabilized at 0.7 (follow-up time 6 years). With no similar reports in literature, it is suggested that the association between amiodarone therapy and the central retinopathy was accidental only.

Amiodarone↗