[Unilateral macular hemorrhage of unknown origin].
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Adult↗
Biomedical subjects
H G Sachs
Publications and source records attributed to H G Sachs.
Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green.
AIM: To investigate macular function and morphology after surgical removal of idiopathic epiretinal membrane (IEM) with and without assistance of indocyanine green (ICG). METHODS: A retrospective study as a consecutive case series, of 39 patients with IEM. 39 patients, 23 female, 16 male, mean age 67 years, underwent standard three port pars plana vitrectomy with removal of epiretinal membrane. Two groups of patients were consecutively operated: in 20 patients ICG 0.1% in glucose 5% was used to stain the epiretinal membrane. 19 patients underwent the identical procedure but without use of ICG. Postoperative follow up was 1-92 months (mean 15.5 months). Functional outcome was assessed with subjective improvement, best corrected visual acuity (BCVA), Amsler grid test, 10 degrees and 30 degrees automated perimetry (Heidelberg visual field analyser) (HFA), and Goldmann kinetic perimetry. Macular morphology was assessed with stereoscopic biomicroscopy and optical coherence tomography (OCT). The main outcome measures were macular function as determined by BCVA, presence of visual field defects, and metamorphopsia as determined by Amsler grid test, macular morphology as determined by slit lamp biomicroscopy, and OCT. RESULTS: BCVA improved in 28 patients, remained unchanged in eight patients, and decreased in three patients. Improvement of BCVA was statistically significant in both groups (p = 0.003). Mean BCVA in patients operated with ICG improved from 0.33 preoperatively to 0.53 postoperatively. Mean BCVA in patients operated without ICG improved from 0.32 preoperatively to 0.54 postoperatively. Reduction of macular oedema as measured by OCT was statistically significant in both groups (p<0.01). There was no statistically significant difference in postoperative BCVA, macular oedema as measured by OCT, postoperative Amsler grid test, and subjective improvement between the two groups. The incidence of residual or recurrent epiretinal membrane was greater in the group operated without ICG (p = 0.014). Visual field defects were detected in one patient operated with ICG and in three patients operated without ICG. CONCLUSIONS: Removal of epiretinal tissue with or without assistance of ICG improved visual function and reduced macular oedema in most patients. Adverse effects clearly attributable to the use of ICG were not observed but further investigation is warranted.
Adult↗
[Central retinal artery occlusion. Importance of selective intra-arterial fibrinolysis].
BACKGROUND: Conventional treatment of a central retinal artery occlusion usually has a poor prognosis but intra-arterial fibrinolysis (IF) of the ophthalmic artery is an invasive treatment option. The importance of IF was evaluated in 62 patients with central retinal artery occlusion and in addition the risk spectrum for this disease was considered. MATERIAL AND METHODS: Data from charts of 62 patients were retrospectively analysed. Visual recovery after IF (n = 17) was compared to conventional treatment (e.g. decrease of IOP, improvement of rheological conditions, n = 45). Patients were excluded from IF if the occlusion was present for more than 8 h, if there was a history of bleeding and previous operations, or if they were older than 85 years. IF was performed using either urokinase (n = 7) or tPA (n = 10). RESULTS: Out of 62 patients, 22 (35%) with central retinal artery occlusion underwent catheterisation. Stenosis of the carotid artery excluded IF in 5 out of these 22 cases, therefore only 17 patients were treated by IF. Of the patients, 40 (65%) were excluded from IF for various reasons: 47% (19/40) arrived later than 8 h after occlusion, 17% (7/40) did not consent to IF, 15% (6/40) had medical contraindications and 13% (5/40) were over 85 years of age. Two patients required no IF because of a cilioretinal anastomosis with moderate visual acuity and another patient showed spontaneous visual recovery during ophthalmic examination. Of the 17 patients treated with IF, 4 achieved an improvement of visual acuity by more than 2 lines, no change of visual acuity was observed in 12/17 patients and 1/17 lost more than 2 lines after treatment. Of the 45 conservatively treated patients, 16 achieved improvement by more than 2 lines and no change occurred in 29/45 patients. Three patients treated with IF suffered from a stroke during treatment. The main risk factor for central retinal artery occlusion was high blood pressure in 32% of all cases and nicotine abuse in 16%. CONCLUSIONS: Many patients presented too late for IF. However, there was no statistical difference between patients with IF and conventional treatment with regards to the improvement of visual acuity. Additionally there is an increased risk of a stroke from IF, therefore a prospective study is necessary to evaluate the importance of IF. Stabilisation of high blood pressure may be the best prophylaxis for preventing a central retinal artery occlusion.
Adult↗
Studies on the feasibility of a subretinal visual prosthesis: data from Yucatan micropig and rabbit.
BACKGROUND: To estimate the feasibility of the subretinal concept of a visual prosthesis, animal models and prototypes, each representing a certain aspect of the final prosthesis, were utilised to test for requirements for such a medical device: (1) the ability to elicit--by electrical stimulation--event-related central activity in the central visual system, and (2) the long-term biocompatibility and biostability of the implant within the subretinal space. METHODS: (1) In rabbit and Yucatan minipig, cortical evoked potentials were recorded with chronically implanted epidural electrodes during stimulation with light flashes as well as during electrical stimulation in the subretinal space. Voltage pulses ranging from -3 V to +3 V were applied via an acutely implanted electrode array on a wired prototype. (2) For biocompatibility studies a silicon-based micro-photodiode array (MPDA) was used that closely resembled the design and composition of the final prosthesis. Fourteen months after implantation, angiography was performed and the histological findings of the retina in the immediate vicinity of the implant were evaluated. RESULTS: (1) In both rabbit and minipig, subretinal electrical stimulation resulted in evoked cortical potentials that were comparable to visual evoked potentials. The lowest threshold levels for the subretinal stimulation were 0.6 V for rabbits and 2 V for minipigs. (2) Long-term stability of an implanted MPDA and its biocompatibility were proven for a postoperative period of 14 months. CONCLUSIONS: Data from animal experiments with certain prototypes of the final prosthesis suggest the feasibility of the concept of a subretinal visual prosthesis: Both requirements were met: (1) the functioning of the subretinal stimulation and (2) the biocompatibility of the MPDA implant.
Animals↗
[Invasive aspergillosis of the orbit in immunocompetence].
BACKGROUND: An isolated aspergillosis of the sphenoidal sinus is a difficult diagnosis because the often misleading clinical symptoms of this rare disease can develop late and first be presented to the ophthalmologist. Because of this even life-threatening disease in normally immunodeficient patients, fast diagnostics and treatment is indicated. CASE REPORT: We report about an immunocompetent man to suffer from an invasive aspergillosis involving the sphenoidal sinus after external operation of a mucocele. Aspergillus infiltrated the right orbit by bone erosion and led to an acute loss of vision on his right eye and a pathological visual field (visual acuity 0.1). A systemical antimycotic therapy was performed and the right orbit and the optical channel were operated to remove the mycosis. During operation the optical nerve was found to be completely surrounded by the mycosis. After surgery visual acuity recovered slowly but completely in about two weeks (visual acuity 1.0) and visual field examination revealed normal findings. These findings were stable now for one year. CONCLUSION: The main findings of unilateral acute visual loss and pre-operations of the paranasal sinuses in combination with persistent headache can lead to the suspect of an aspergillosis infection. It is important to establish correct diagnosis--especially in immunocompetent patients--early to prevent a probably irreversible visual loss and in an advanced stage to handle the life-threatening risk of this disease.
Aged↗
[Clinical results of intravitreal administration of tissue-type plasminogen activator (tPA) and gas for removal of subretinal hemorrhage in senile macular degeneration].
BACKGROUND: Subretinal hemorrhage in age related macular degeneration (AMD) usually causes acute visual loss and is associated with poor visual prognosis. In order to prevent retinal damage and to perform laser treatment of the underlying choroidal neovascularization (CNV) the subretinal hemorrhage has to be removed from the macular region. This could be achieved by intravitreal injection of tissue plasminogen activator (tPA) and gas. PATIENTS AND METHODS: In 8 consecutive patients, suffering from a massive macular hemorrhage (duration of visual problems: mean 9 days), tissue plasminogen activator (tPA) (40 micrograms in 400 microliters BSS) and SF6-gas (0.75 ml) was transsclerally injected into the vitreous cavity to achieve liquification and displacement of the hemorrhage. RESULTS: In all patients liquification and displacement of the hemorrhage out of the macular region was achieved during follow up. During the first week after operation a significant increase of visual acuity was noticed in all patients, however ophthalmoscopically there was just little reduction of the hemorrhage in the foveolar area. After successful removal of the blood the choroidal neovascularization was treated successfully by laser coagulation in one patient. No laser treatment was performed in the other patients because of the subfoveal location of the neovascularisation or because of disciform scar. Visual acuity increased 4 lines after surgery. In one case the procedure was complicated by a persistent vitreous hemorrhage and vitrectomy had to be performed in another patient due to an endophthalmitis. CONCLUSION: Intravitreal injection of tPA assisted gas displacement of subretinal hemorrhage due to AMD leads to a significant increase of visual acuity during the first week after operation. Although a nearly complete removal of the hemorrhage out of the macular area could be achieved, it was difficult to differentiate this from the spontaneous course. Laser photocoagulation could be performed in only few cases.
Aged↗
[Eye involvement in circumscript scleroderma--manifestation of borreliosis?].
BACKGROUND: The circumscript cutaneous sclerosis is an inflammato-edematous erythema of the skin, usually leading to a plaque-like sclerosis and cutaneous atrophy. The etiology of this disease remains unknown, but some authors presume a systemic infection with Borrelia burgdorferi as the underlying pathological condition. PATIENT: We present a case of a 66-year-old male patient who suffered from episcleritis of his left eye. Funduscopy showed an unilateral papillary edema. Visual acuity was 1.0. The patient had multiple erythemata of the skin of the body-trunk and the arms. On histological examination the lesions were compatible with circumscript sclerosis. Neurological examination was normal. Brain imaging (MRI), CSF examination and serology showed no pathological findings, although the patient presented with raised antibodies against Borrelia burgdorferi (IgG positive, IGM negative). Intravenous antibiotic treatment and topical steroids for three weeks resulted in a complete recovery of the scleritis, but had no effect on the papillary edema. CONCLUSION: Inflammatory pathological findings of the eye can be associated with circumscript sclerosis, a disease, that is normally limited to the skin. The pathological mechanism remains unclear. The presumption of an underlying borreliosis could not be confirmed in this case.
Aged↗
[Eye injuries during a laser show].
BACKGROUND: Laser injuries are usually described in case reports concerning military personnel or scientists who had an accidental exposition to a laser. Today laser injuries to un-involved persons become more frequent. The potential danger for eye injuries was discussed by Birngruber and Gabel (2) in 1984. PATIENT: A patient presented 4 days after the accident with a monocular decline in vision and a scotoma after being hit by a ray of a discotheque laser. At the time of the accident the patient was standing on the dance floor watching a laser show. From that moment he reported a scotoma on the affected eye. The examination of the patient by an ophthalmologist 3 days later revealed a monocular decline in vision to 0.3 and a scotoma. Reading problems were reported. The fluorescence angiography confirmed the biomicroscopical barely visible line shaped defect next to the foveola which was according to our clinical experience caused by the ray of a laser. The vision defect and the scotoma remained stable during the follow up period. CONCLUSIONS: Before the first use of a show-laser unit it gets approved. Every change of the unit or the change of its position requires a new technical check by authorized institutions. At present many show lasers in use are not met with this requirement. Manipulations to the lasers are easy to perform and improve the intended show effect. The missing control practice provokes eye threatening situations for an enormous number of persons who are not aware of the danger.
Adult↗
[Surgical worm extraction in loa loa ophthalmia].
BACKGROUND: Loa Loa is a chronic parasitemic disease which is endemic in the tropical rain forests of Western Africa. Vector of this disease is a mangrove fly with the name Chrysops. Besides the eye worm and skin affections a systemic infection with microfilariae is common. PATIENT: A West African tourist from Bangibe showed up at the university eye clinic. His complaints were a red eye and a mobile subconjunctival tumor (Fig. 1) that showed vermiform movements. The worm was transparent and 4-5 cm in length. After topical anaesthesia and the attempt to paralyze the worm (1) with Pilocarpine 2% it vanished. Two days later the patient showed up in the morning for the planned blood test. No worm was visible at that time but at noontime the blood test was carried out and at that time the worm was visible in the nasal conjunctiva. This time the worm was removed without delay under topical anaesthesia. The worm was fixed with a forceps through the conjunctiva which was opened for 0.5 cm. The worm was grasped with a second forceps and drawn out under massive vermiform movement. Systemic therapy was recommended with Hetrazan (Diethylcarbamazine) using Corticosteroides and Antihistamine to minimize allergic side effects by the therapy due to the systemic microfilariae blood load. Eosinophilia was 8%. CONCLUSIONS: A subconjuctival Loa Loa worm can be removed under topical anaesthesia by fixing it with a forceps through the conjunctiva and opening it and grasping the worm with a second forceps. According to our experience the paralyzation with Pilocarpine cannot be realized. Careful systemic therapy avoiding reported allergic side effects with Hetrazan which is not available in Germany is necessary.
Adult↗
[Intraocular pressure in sections with 2 microkeratomes in vitro].
BACKGROUND: The rapid integration of new technology into ophthalmologic practice, e.g. LASIK (laser in situ keratomileusis), is associated with new complications. The limitations of the new technology cannot be precisely determined. During lamellar cuts with microkeratomes intraocular pressure (IOP) elevations occur. The IOP elevation during the lamellar cut cannot be determined by conventional tonometry. MATERIALS AND METHOD: We examined the IOP rise during the complete microkeratome treatment. Fresh enucleated porcine eyes were cannulated and direct IOP measurement with a Statham manometer was carried out. Thus we evaluated the IOP during the complete treatment for two differently constructed microkeratome systems. RESULTS: IOP elevations (mean values) between 77 mm Hg for the Corneal Shaper and 229 mm Hg for the Keratek during the vacuum phase and 140 mm Hg for the Corneal Shaper and 360 mm Hg for the Keratek during the lamellar cut were monitored. A sudden IOP decrease to-5 mm Hg was registered for the post-vacuum phase. CONCLUSIONS: In our opinion unphysiologic high IOP values could be dangerous for risk eyes.
Animals↗
Age-dependent alterations in rat ventricular myocardium: a quantitative analysis.
A quantitative electron microscopic examination of the ventricular myocardium of the male Fischer 344 rat was undertaken to determine the extent of age-dependent changes in ultrastructure. Rats of 6, 16 and 30 months of age were examined using a non-biased stereological test system. Volume fractions of mitochondria, myofibrillar mass and lipid remained unchanged during aging. Dense body volume fraction increased four-fold over the period studied, while the sarcoplasmic reticulum volume increased only from 6 months to 16 months and did not change thereafter. Biochemical analysis of the specific activities of the two lysosomal enzymes, acid phosphatase and beta-glucuronidase demonstrated a differential response to aging, with acid phosphatase remaining constant and beta-glucuronidase increasing slightly. Neither enzyme activity correlated with the pronounced change in dense body volume fraction. This study provides clear evidence that the previously observed changes in cardiac performance associated with aging are not readily explicable on the basis of a degradation of cardiac ultrastructure.
Acid Phosphatase↗
Lymphocyte requirement for the functional development of follicle-associated epithelium.
Follicular development in the bursa of Fabricius was disrupted by testosterone treatment and chorioallantoic membrane grafting. Analysis by a quantitative histological technique demonstrated that testosterone treatment causes a dose dependent delay in development by inhibiting lymphoid proliferation. Inhibition of lymphoid development prevented the development of carbon transport ability by follicle associated epithelium. Reconstitution of follicular development by grafting treated bursae to the chorioallantoic membrane of untreated hosts results in the development of functional follicle associated epithelium. These results establish the lymphoid requirement for the development of transport ability by the follicle-associated epithelium.
Allantois↗
The development of transport ability by embryonic follicle-associated epithelium.
The development of transport ability by follicle-associated epithelium was studied in embryonic chick bursae. Developing lymphoid follicles were divided into three morphological types to determine the relationship of epithelial function to lymphoid development. Transport ability was first observed on day 13, two days earlier than obvious morphological evidence of follicle-associated epithelial development. Functional differentiation of the epithelium was, however, closely associated with lymphoid development rather than a day-specific developmental event. It is probable that the lymphoid cells have an inductive influence on the development of the overlying epithelium. Evidence of early embryonic transport by relatively undifferentiated epithelium also suggests that lymphoid development in the bursa may be influenced by epithelial transport.
Animals↗
The influence of embryonic testosterone treatment on bursal epithelial pinocytotic activity.
Developing White Leghorn chicks were treated with testosterone propionate in ovo to effect a partial chemical bursectomy. After hatching, birds were administered carbon particles or horseradish peroxidase via the cloaca, and the transport of these tracers by the bursal epithelium was examined. Uptake of both tracers was inhibited in the treated when compared to untreated birds. The degree of development of interaction between bursal epithelium and underlying lymphoid tissue appeared to play a major role in determining ability of the epithelium to transport these tracers. Epithelium associated with follicles possessing medullary and cortical divisions was able to transport, while intraepithelial follicles or regions of the epithelium overlying diffuse lymphoid tissue did not transport either carbon or horseradish peroxidase. Bursal function in regional defense of the gut may depend on a local interaction of bursal epithelium with lymphoid, and perhaps other cell types.
Animals↗
The effect of cyclophosphamide on the structure and function of the bursal epithelium.
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Animals↗
Post-natal development of the normal and cardiomyopathic Syrian hamster heart: a quantitative electron microscopic study.
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Animals↗
Species-related difference in calcium accumulation by cardiac mitochondria.
1. Mitochondria isolated from the ventricles of Cavia porcellus, Mesocricetus auratus, Rattus rattus and Mus musculus accumulate calcium in an energy-linked process. 2. Measurements of the initial velocity of accumulation by dual-wavelength spectrophotometry show species-dependent variation, with Cavia demonstrating the fastest rate and Rattus the slowest rate of accumulation. 3. Total amount of calcium accumulated per unit protein varied in a manner similar to rate of accumulation, with Cavia accumulating the greatest amount of calcium and Rattus the least.
Animals↗
Electrophysiological study of Syrian hamster hereditary cardiomyopathy.
This study was performed to determine if the intracellular electrical activity of adult cardiac papillary muscle from a strain of Syrian hamster (B10 14.6) with a genetically determined cardiomyopathy was different from that of a control strain (B10 RB). Muscles driven at rates from 1 Hz through the physiological range. Resting potentials of muscle from the two strains were not significantly different, except in increased [C2+]0, where the control was slightly hyperpolarised. Action potential overshoot was significantly greater in the myopathic at all frequencies, while the upstroke velocity was not significantly different, except at 8 Hz where the myopathic value was depressed. Action potential durations at 20, 50 and 95% repolarisation were significantly greater in the myopathic, at all rates and with increased [C2+]0. Response of the muscles to verapamil and D600 were complex, with a decrease seen in duration at 20% repolarisation and an increase in 50% duration at 1 Hz rate. No strain-related difference in sensitivity to the drugs was seen. The results supporty the hypothesis that a sarcolemmal defect is intimately related to the genesis of the cardiomyopathy.
Action Potentials↗