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Biomedical subjects

H Freyler

Publications and source records attributed to H Freyler.

At least 37 records · Page 2Linked to original sources

[Use of the neodymium YAG laser following posterior chamber lens implantation].

The authors report on the neodymium-YAG laser used after extracapsular cataract extraction with the implantation of a posterior chamber lens in 1726 patients. The most common indication was capsular fibrosis necessitating posterior capsulotomy. The alternative to the YAG laser would be a bulbus-opening procedure via pars plana using a Sato knife. The advantage of the YAG laser in comparison with capsulotomy with a Sato knife is that there is no danger of intraocular infection or bleeding (which may result from tension on the fibers with the first method). A disadvantage of the YAG laser method is a possible transitory increase in intraocular pressure and an endothelial cell loss. In 1726 cases with posterior chamber lenses 45 capsulotomies using the YAG laser were necessary. A further indication for the YAG laser are posterior chamber lenses decentered by capsular fibrosis (3 cases). A third indication is chorepraxia after posterior chamber lens implantation. In three cases with posterior chamber lenses a flattening of the pupil occurred because remnants of the anterior capsule had shifted into the anterior chamber. In two cases a pupil became decentered for no apparent reason. In these cases YAG laser therapy is indicated. In at least three cases pupillary membranes were cut with the YAG laser. The authors treated their patients with the Lasertec model 135 YAG laser (Q-switched mode).

Humans↗

[Vitrectomy in uveitis].

Between January 1976 and December 1983, at the First University Eye Clinic in Vienna, 568 vitrectomies and 287 lensectomies were carried out; in 69 of these interventions (20 lensectomies and 49 vitrectomies) the diagnosis was uveitis. In 24 cases the indication for vitrectomy was an intermediary uveitis, a post-traumatic uveitis in 4 and a sympathetic uveitis in 6 cases as well as suppurative endophthalmitis in 7 patients. Indications for surgical removal of pathological tissue from the anterior chamber by the use of vitrectomy instrumentation were, in 4 cases each, hypopioniritis and a hemorrhagic uveitis, and in 12 cases a phacogenic uveitis. In about two thirds of this very heterogeneous patient material, employing vitrectomy made it possible to achieve regression of uveitis. In the remaining third of the patients, at least a stationary state of the disease was achieved and a reduction of corticosteroid and immunosuppressive therapy were made possible. The best functional results were achieved in all surgical interventions in the anterior ocular segment and in vitrectomies for intermediary uveitis. In suppurative endophthalmitis, however, these results were unfavorable.

Humans↗

Increased angiotensin-converting enzyme activities in diabetes mellitus: analysis of diabetes type, state of metabolic control and occurrence of diabetic vascular disease.

Serum angiotensin-converting enzyme activities were measured in 41 type 1 diabetics (16.4 +/- 4.0 U/ml), in 40 type 2 diabetics (15.0 +/- 5.2 U/ml) and in 52 controls (13.0 +/- 2.7 U/ml, mean +/- SD). Twenty six (32%) of 81 patients presented with serum angiotensin-converting enzyme activities above the normal range. No relation between serum angiotensin-converting enzyme activities and the presence or lack of diabetic vascular diseases in type 1 and type 2 diabetics could be detected. No significant differences in serum angiotensin-converting enzyme activities were found when comparing various types of diabetic vascular disease (retinopathy, neuropathy, renal failure, arterial vascular disease, diabetic vascular disease, coronary artery disease). However, mean serum angiotensin-converting enzyme activities were significantly increased in diabetics with retinopathy when compared with controls (p less than 0.0005). Correlation between metabolic long term control as determined by measuring glycohaemoglobin (HbA1) concentrations and serum angiotensin-converting enzyme activities could not be established. Serum angiotensin-converting enzyme activities did not show any correlations with duration of diabetes, age or sex of patients. A representative number of diabetics (32%) showed elevated serum angiotensin-converting enzyme activities, but a correlation with diabetic vascular disease, metabolic control or type of disease could not be established.

Adult↗

[Continuous subcutaneous insulin infusion: long-term treatment in an unselected group of insulin-dependent diabetics].

Long-term ambulatory continuous subcutaneous insulin infusion was undertaken under serial blood-glucose control in nine insulin-dependent diabetics. Before this treatment was started, haemoglobin A1 was increased (more than 13%), diabetic lipoid necrosis was present in three, proliferative diabetic retinopathy in one, treatment-resistant Candida oesophagitis in one and Addison's disease in one. During the total of 630 weeks (range 6-135 weeks) of continuous subcutaneous insulin infusion it was found that (1) the metabolic state of the patients improved significantly, the previously non-responding oesophagitis healed and one of three patients with diabetic lipoid necrosis was markedly improved; (2) the risks of insulin treatment, hypoglycaemia (especially with Addison's disease) and keto-acidosis (for technical reasons) remained; and (3) in long-standing diabetes of type I even good control of blood glucose levels (mean 113 mg/dl) could neither prevent the occurrence of proliferative diabetic retinopathy nor loss of sight.

Adult↗

[Ophthalmosurgical treatment possibilities in diabetic retinopathy].

On my being appointed to the Chair of Ophthalmology at the oldest university eye department in the world, the importance of ophthalmosurgery and research in the field of diabetic retinopathy at the 1st Department of Ophthalmology at the University of Vienna is presented against the background of a historical review of this department from its inception to the present day, in homage to my predecessors. The currently valid concept of the pathogenesis of diabetic retinopathy is outlined. The most effective treatment techniques in diabetic retinopathy, namely photocoagulation and vitrectomy or membranectomy, are described in detail with particular regard to the indications, success rates and complications.

Austria↗

[Vitrectomy in inflammatory diseases of the posterior segment of the eye].

Eight patients with chronic endogenous uveitis, chorioretinitis, toxoplasmosis and infective endophthalmitis underwent pars plana vitrectomy mainly to improve vision by clearing the media or removing membranes. Beyond this it turned out that in eyes with chronic endogenous uveitis vitrectomy might also alter or diminish the severity as well as the frequency of attacks. The role of the vitreous as an autoimmune agent is discussed.

Adult↗

Collagen types in keratoconus.

Collagen types in normal human and keratoconus corneas were separated by salt fractionation and thermal gelation in the pepsin-soluble fraction of the lyophilized tissues. Peptic digestion indicated no significant differences between normal and keratoconus corneas. Further collagen characterization was performed using SDS-PAGE. Collagen concentration were determined via hydroxyproline. Soluble collagens from normal human cornea represent 85% collagen type I, maximally 10% collagen type III and 5% collagen type V. Soluble collagens of keratoconus corneas consist of 90% type I collagen and maximally 5% type II and type V collagen.

Chemical Fractionation↗

[Photocoagulation supplementing pitting surgical procedures in amotio retinae].

In cases of incomplete closure of the retinal defect following retinal detachment surgery photocoagulation may render a second surgical intervention unnecessary. The premise for its applicability is a retinal defect resting on an adequate scleral buckle. Indications are incompletely sealed breaks causing a recurrent or residual detachment of the retina. Massive vitreous traction should be absent. The results of 32 cases (out of a total of 692 retinal detachment operations performed within the past five years) in which postoperative photocoagulation was applied are very encouraging: in 28 cases it was possible to complete the closure of the retinal defect, resulting in healing of a residual detachment or redetachment of the retina, respectively. In the course of daily applied photocoagulation (over a period of two to six days) starting from a zone of extremely flat detachment of the defect's border one may gradually achieve adhesion even of higher detached portions of the defect area.

Humans↗

[Coagulation technic in diabetic maculopathy].

One hundred thirty-six eyes with diabetic maculopathy, which had been operated on by photocoagulation between 1976 and 1980, were followed up with regard to the morphology of the retinal changes and compared with 246 untreated eyes. Of the treated eyes, 77% showed no further progression of the microangiopathy, whereas in 80% of the untreated eyes the development of a diabetic maculopathy was observed.

Adult↗

[A method of standardizing the results of quantitative chemical investigations on material gained from vitrectomy (author's transl)].

In this study a method is described which allow conclusions to be drawn from the concentration of chemical substances in the material gained from vitrectomy in relation to the content of these substances in the whole vitreous body. In 16 pairs of human postmortem eyes enucleated 3-5 h after death one eye of each pair was subjected to vitrectomy under constant suction and infusion pressure and cutting rate; the duration of surgery varied (3-9 min) and in each fellow eye the whole vitreous body was removed. Comparison of the different concentrations of chemical substances in the samples showed that they could be correlated.

Eye Proteins↗

[A new classification scheme of non-proliferative diabetic retinopathy (author's transl)].

The correlation of the topography of certain areas of the fundus, which exhibit relentless progression of microangiopathy (within the framework of general fluctuations in the course of the disease), as well as the degree of predominance of capillary perfusion and permeability disturbances in these respective areas justifies a classification of non-proliferative diabetic retinopathy into three distinct types: (1) pre-maculopathy/maculopathy in non-proliferative diabetic retinopathy (DR), (2) nonproliferative DR, and (3) non-proliferative DR lacking a tendency towards vasoproliferation or maculopathy. These results are based on regular biannual angiographic examinations of six different standard fundus areas in a total of 365 patients with non-proliferative DR. This scheme of classification has prognostic as well as therapeutic consequences.

Capillary Permeability↗

[Topographic aspects of the progression of diabetic retinopathy (an experimental set-up for the evaluation of medical influencability) (author's transl)].

Within the past five years fluorescein angiography of six different fundus areas was performed at intervals of six months on a total of 365 patients exhibiting non-proliferative diabetic retinopathy without diabetic maculopathy. Within that period, diabetic maculopathy was observed to develop in 195 eyes, vasoproliferation in 20 eyes. Within the general scope of fluctuation of the angiographic picture of retinal capillary perfusion disturbance, zones of continuous progression were encountered in 246 eyes. In 183 out of 195 eyes which developed diabetic maculopathy the distinct areas of relentless progression were located 2--6 PD's temporal to the macula; in the total 20 eyes which had advanced to the proliferative stage similar areas were encountered, located nasally 2--6 PD's above and below the optic disk.

Capillary Permeability↗

[Clinical experience with cryotherapy of lid tumors (author's transl)].

Eleven patients with lid tumors underwent cryotherapy. Of these, six suffered recurrence of the tumor following surgery or radiotherapy, respectively. The patients' average age was 66.1 years. The temperatures required for cryotherapy were obtained with fluid nitrogen. Two possible modes of treatment may be distinguished. In contact freezing (used in eight cases) the cryoapplicator is in direct contact with the surface of the tumor. In the second method, spray-freezing (used in three cases), fluid nitrogen is sprayed at a certain pressure directly on to the surface of the tumor. In all cases treatment was performed on outpatient basis. The indications for treatment, the technique applied and the results obtained hitherto are presented.

Adult↗

[Excision of the ciliary body (Sautter procedure) as a last resort in secondary glaucoma (author's transl)].

Within the past five years we have performed excision of one quadrant of the ciliary body (pars plicata) (e.c.b.) in 22 eyes with secondary narrow-angle glaucoma. Prior to e.c.b. numerous surgical procedures for glaucoma had been attempted. Sixteen of the eyes were aphakic, six phakic. In nine eyes secondary angle closure was due to rubeosis iridis. The observation period following e.c.b. averaged 27.4 months. The preoperative tensions ranged between 40 and 50 mmHg. In 12 out of 22 eyes e.c.b. alone was sufficient to lower the intraocular pressure permanently; in seven cases local therapy (Timolol, Eppystabil) and/or oral Diamox respectively had to be added. Two eyes became atrophic and blind between one and 1.5 years following e.c.b.

Adolescent↗

[Factors provoking the development of rubeosis iridis after vitrectomy in diabetics (author's transl)].

A retrospective study on 184 eyes of 167 diabetics which had been submitted to a vitrectomy because of various affections of the vitreous body and retina shows, that aphakic eyes, cases suffering from repeated bleeding into the vitreous cavity, and eyes with advanced stages of diabetic retinopathy are mostly preposed to the development of rubeosis iridis. Coincidence of two of these factors was found in more than two thirds of the eyes with post-operative rubeosis iridis. The stage of the diabetic retinopathy was preoperatively determined by means of ultrasonography.

Diabetic Retinopathy↗

[Late results of pars plana vitrectomy in diabetics (author's transl)].

Report on 82 consecutive cases in which pars plana vitrectomy was performed because of intravitreal hemorrhage. Postoperative follow-up ranged from 3 to 4 1/2 years. Although an incipient improvement of the visual acuity was achieved in 54%, recurrent hemorrhages as well as progression of the proliferative diabetic retinopathy lead to visual deterioration of blindness in 64% of the eyes.

Blindness↗

[Regression of florid proliferative diabetic retinopathy through achievement of normoglycaemic over five months by means of a portable insulin-dosage apparatus (author's transl)].

A portable insulin-infusion device (Siemens-Erlangen) was used by 24-year-old juvenile onset-type diabetic woman for a period of 5 months in order to achieve normoglycaemic conditions. The patient suffered from rapidly deteriorating florid proliferative retinopathy and was practically blind. Kidney function was serioudly impaired and severe neuropathy also existed. Insulin was infused through a polyethylene catheter inserted through the subclavian vein into a central vein. A continuous basal rate which was varied from day to night was infused with additional supplementary rectangular profiles of insulin at meals. Blood glucose was self-monitored with strip test apparatus in order to adjust insulin dosage to diet. HbA1 decreased from 16% during the pre-therapy phase to 8% (= normal range) at the end of the last phase. MBG decreased from 238 during the pre-therapy phase (6 24 hr profiles at 5 to 7 time points) to 97 during the latter phase (daily profiles from day 103 to day 150). After 3 weeks of this treatment the retinal bleeding had disappeared. During further treatment regression of the massive vascular proliferation was observed with fluorescein angiography, and perfusion of the retina improved. Vision also improved, so that the patient has now been able to resume her work as a bank employee. Albuminuria decreased and the neuropathic symptoms also disappeared. The originally planned hypophysectomy was, therefore, considered to be unnecessary.

Adult↗