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Biomedical subjects

I Kremer

Publications and source records attributed to I Kremer.

At least 37 records · Page 2Linked to original sources
PubMed1997

The development and progression of diabetic retinopathy in type I diabetic patients: a cohort study.

To describe the course and risk factors for development and progression of retinopathy, we studied a cohort of 333 Israeli Jewish patients with Type 1 (insulin-dependent) diabetes mellitus. The median age at diagnosis was 9.5 (range 0.04-26.2) years and the median duration of follow-up was 14 (range 1.6-30) years. Evaluation of both retinae was performed yearly since referral and HbA1 values were tested every 3 months since 1978. During a follow-up of 4070 patient-years, 162 patients developed non-proliferative retinopathy. The median retinopathy-free interval was 14.9 years and after 30 years all patients were affected. Pre-pubertal duration of diabetes was relevant. Independent and significant risk factors for early onset of non-proliferative retinopathy were: poor cumulative glycaemic control (median retinopathy-free interval in the 1st vs 4th quartiles of mean HbA1 values over all years: 18.0 vs 12.5 years, p = 0.0001); onset of diabetes during or after puberty (median retinopathy-free interval in patients with onset of diabetes before, during or after pubescence: 16.3, 13.2 and 14.0 years, respectively, p = 0.0001); and non-Ashkenazi Jewish origin (median retinopathy-free interval 15.8 years in Ashkenazi vs 14.0 in non-Ashkenazi patients, p = 0.0004). Of 162 patients with non-proliferative retinopathy, progression to proliferative retinopathy occurred in 37, during 707 patient-years. The first event of proliferative retinopathy was diagnosed within the 1st year after non-proliferative retinopathy evolved, and at 6.3 years since onset of non-proliferative retinopathy 75% of the patients were still free of proliferative changes. Risk factors significantly and independently associated with an early progression to the proliferative stage were: poor glycaemic control in the last 3 years prior to the development of proliferative retinopathy and non-Ashkenazi Jewish origin. All patients in the 4th quartile of HbA1 values were affected by proliferative retinopathy within 11.6 years after onset of non-proliferative retinopathy.

Adolescent↗
PubMed1997

Candida tropicalis multifocal endophthalmitis as the only initial manifestation of pacemaker endocarditis.

PURPOSE: To document a case of Candida tropicalis endophthalmitis as the only manifestation of pacemaker endocarditis. METHODS: We examined a 75-year-old man with diabetes mellitus who was initially examined for bilateral multifocal endophthalmitis complicating endocarditis 2 years after a permanent pacemaker for sick sinus syndrome was implanted. RESULTS: Transesophageal echocardiography showed a large vegetation with a 3-cm diameter attached to the pacing electrode in the right ventricle. Six consecutive blood cultures grew C tropicalis. CONCLUSIONS: Ocular involvement, including multifocal endophthalmitis, may occur as the only manifestation of C tropicalis endocarditis, complicating an intravenous permanent pacemaker.

Aged↗
PubMed1997

Sulfur hexafluoride injection for Descemet's membrane detachment in cataract surgery.

Extensive Descemet's membrane detachment persisted after small incision cataract surgery in three patients. Unfolding and repositioning of Descemet's membrane by sodium hyaluronate (Healon) were followed by injection of sulfur hexafluoride 20% gas mixed with air to fill the anterior chamber. Initially, the gas bubble filled most of the anterior chamber; it disappeared over 7 to 9 days. Descemet's membrane remained attached, and the corneal edema cleared.

Aged↗
PubMed1997

Excimer phototherapeutic keratectomy for corneal subepithelial cryoglobulin deposits.

A 64-year-old man with a history of cryoglobulinemia and repeated scraping of immunoglobulin deposits from both superficial corneas presented with gradual decrease in vision and progressive hyperopia caused by circumferential redeposition of the cryoglobulins in his corneas. He had debridment of the deposits combined with phototherapeutic keratectomy to smooth the corneal surface. Visual acuity and reading capacity markedly improved, and hyperopia regressed by 5.75 diopters (D) in the right eye and 5.25 D in the left. Follow-up was 3 years.

Corneal Diseases↗
PubMed1997

Combined PRK and PTK in myopic patients with recurrent corneal erosion.

AIM: To study the results of combined photorefractive keratectomy (PRK) and phototherapeutic keratectomy (PTK) in myopic patients with recalcitrant recurrent corneal erosion. METHODS: PRK was performed in 16 eyes with the Visx 20/20 excimer laser at a central 6.0 mm zone, following total epithelial scraping. Subsequently, confluent 3.0 mm zones of PTK were ablated at a depth of 6.0 microns, surrounding the zone of PRK. The follow up period ranged from 26 to 42 months. RESULTS: Complete alleviation of symptoms was demonstrated and there was no recurrence of corneal erosion. Visual acuity (VA) improved slowly following treatment, with a final uncorrected VA ranging between 6/9 and 6/12. A final myopic spherical equivalent < or = -1.0 D was found in 14 out of 16 eyes. CONCLUSIONS: A combination of PRK and PTK is effective in the alleviation of symptoms and prevention of recurrences of corneal erosion. It is suggested that recalcitrant recurrent corneal erosion is a diffuse disease, although it often manifests as a local problem, and therefore extensive excimer laser ablation is required to prevent recurrence and to alleviate symptoms completely.

Adult↗
PubMed1996

One-year follow-up results of photorefractive keratectomy for low, moderate, and high primary astigmatism.

OBJECTIVE: To study the efficacy of excimer laser photorefractive keratectomy (PRK) for high, moderate, and low degrees of primary myopic astigmatism. PATIENTS AND METHODS: Ninety-two eyes of 54 patients with different degrees of compound myopic astigmatism underwent PRK. The eyes were divided by degree of refractive astigmatism into three groups-high (-2.75 to -5.0 diopters [D]), moderate (-1.25 to -2.50 D), and low (< or = 1.0 D). Refraction, corneal topography, slit-lamp findings, and visual acuity with and without correction were assessed. RESULTS: At 12 months, the mean reduction from the preoperative refractive cylinder was 80.7% in the high astigmatism group, 68.4% in the moderate astigmatism group, and 47.6% in the low astigmatism group. The post-treatment residual cylinder axis remained stable in 23 (38.3%) of 60 eyes and deviated in 37 (61.7%) of 60 eyes. The maximal deviation of the residual cylinder axis was 15 degrees. Of the 89.2% of eyes with low cylinder, 81.8% had moderate cylinder, and 85% of the eyes with high cylinder achieved a final uncorrected visual acuity between 20/20 and 20/35 at 12 months. CONCLUSIONS: A statistically significant reduction in the refractive cylinder was found in the high, moderate, and low astigmatism groups. The difference between the mean reduction of the high and moderate cylinders compared with the mean reduction of the low cylinders also was found to be statistically significant. The laser used in this study is an efficient tool for correcting high and moderate astigmatism. However, regarding low astigmatism, it was found to be less effective.

Adult↗
PubMed1996

Extracapsular cataract extraction and intraocular lens implantation in eyes filled with silicone oil.

Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed in five phakic eyes filled with silicone oil following vitreoretinal surgery. Silicone oil migration was prevented during surgery using an anterior chamber maintaining system and a self-sealed corneoscleral tunnel incision. The posterior capsule opacified within 3 months in all patients, and neodymium:YAG capsulotomy or surgical discission was performed in a diamond-shaped pattern. No silicone-related complications were found, including silicone oil migration into the anterior chamber. There were no difficulties visualizing the peripheral retina during funduscopy.

Cataract↗
PubMed1996

Bell's phenomenon in newborns and premature babies.

AIMS: To evaluate the development and course of Bell's phenomenon (BP) in premature and normal neonates. METHODS: Twenty seven preterm infants and 42 healthy full term infants were studied. Mean birth weight, gestational age, and head circumference were recorded. BP was graded from no response to full response. The premature group was examined in the first week of life, and then at 4 and 8 weeks after birth. The full term group was initially examined at the age of 3 days until a full response was observed. RESULTS: No preterm infants exhibited BP during the first week of life, while 8/28 (29.6%) exhibited a weak to full reflex at 8 weeks of age. In the full term group 15/42 neonates (35.7%) demonstrated a mature reflex at age of 3 days and 36/37 (97.3%) at age 16 weeks. A significant correlation was observed between BP, sex, and birth weight, as well as gestational age in the premature group. No such correlation was found in the full term infants. CONCLUSION: BP has a longitudinal course. It is an important clinical marker for evaluation and follow up of neuro-ophthalmic maturation in neonates.

Age Factors↗
PubMed1996

[Results of photorefractive keratectomy for myopic astigmatism].

In 54 patients, 92 eyes with different degrees of compound, myopic astigmatism underwent photorefractive keratectomy with the VISX 20/20 excimer laser. The eyes were grouped by degree of refractive astigmatism into: high (-2.75 to -5.0 diopters), moderate (-1.25 to -2.50 diopters), and low (< -1.0 diopter) astigmatism. At 6 months after the procedure the mean reduction from the preoperative refractive cylinder was 80.7% in the high, 68.4% in the moderate, and 47.6% in the low astigmatism group. 89.2% of the eyes with low, 81.8% with moderate, and 85% with high cylinders had achieved a final, uncorrected visual acuity of between 6/6 and 6/10. The VISX laser is an effective tool for the correction of high and moderate astigmatism, but is less effective for low astigmatism.

Adult↗
PubMed1996

The influence of the mobility in the cervicothoracic spine and the upper ribs (shoulder girdle) on the mobility of the scapulohumeral joint.

OBJECTIVE: To examine the influence of the cervicothoracic spine and upper ribs (shoulder girdle) on glenohumeral mobility and the development of shoulder complaints. DATA COLLECTION AND SYNTHESIS: Literature was collected by a search in Medline and Embase for English, German and Dutch publications, by further checking references in the articles found and by perusal of already collected literature regarding shoulder research. Articles referring directly or indirectly to a mutually influencing anatomical connection between the cervicothoracic spine, upper ribs (shoulder girdle) and scapulohumeral joint were selected during a consensus meeting of all reviewers. RESULTS: Eight relevant articles, differing strongly in supposition and objective, were found and subsequently classified and presented according to the anatomical relations indicated in the articles. Indications were found that suggested anatomical relations between the mobility in the shoulder girdle and the scapulohumeral joint, between the mobility in the spinal column and the first rib (shoulder girdle) and between the spinal column and the scapulohumeral joint. No relevant indications regarding the development of shoulder complaints were found. CONCLUSIONS: Although no direct evidence was found, a comparison of the results of this study with theories postulated by other researchers on this subject suggests that a certain relation does exist.

Cervical Vertebrae↗
PubMed1996

Ultrasonographic findings of the optic disc in congenital glaucoma.

A 2-month-old female infant with intractable congenital glaucoma and diffuse corneal opacification underwent trabeculectomy with 5-fluorouracil (5-FU) injection in both eyes followed by penetrating keratoplasty (PKP) combined with partial cyclocryotherapy in the right eye. The latter procedure was undertaken despite the B-scan ultrasonographic finding of extensive optic disc cupping in order to provide the infant with some degree of improved visual function. The anatomic and functional results are discussed.

Antimetabolites↗
PubMed1996

Effect of green argon (514 nm) laser exposure on rose bengal-stained guinea pig cornea.

Our purpose was to study the effect of continuous wave (CW) green argon laser (514 nm) exposure on rose bengal-stained cornea. Following staining with rose bengal (1%), the corneas of 48 albino guinea pigs were exposed to different power levels of argon laser, ranging between 0.04 and 0.8 W. The beam diameter ranged between 50 and 200 microns, and exposure time was 0.1 sec. Histology revealed minimal tissue coagulation at 0.05 W and 50 microns. Moderate coagulation of the anterior stromal lamellae was found at power levels of 0.07-0.6 W and a beam diameter of 100-200 microns. At power levels of 0.7 and 0.8 W, lamellar disruption was also noted. Our data indicate that 1% rose bengal is a good photosensitizer for superficial corneal stromal photocoagulation.

Animals↗
PubMed1995

Histologic evidence of recurrent keratoconus seven years after keratoplasty.

PURPOSE/METHODS: A 42-year-old patient with keratoconus developed clinical signs of recurrent keratoconus in her right corneal graft seven years after the first keratoplasty was performed. She underwent successful corneal regrafting. RESULTS/CONCLUSIONS: The histopathologic examination of the corneal button disclosed typical findings of keratoconus, including breaks in Bowman's layer filled with connective tissue or epithelium. These histologic findings in the corneal graft support our clinical diagnosis of keratoconus. However, the pathogenesis of this complication is still not clear and further research is needed.

Adult↗
PubMed1995

Myopic keratomileusis in situ combined with VISX 20/20 photorefractive keratectomy.

We present the results of myopic keratomileusis in situ combined with photorefractive keratectomy (PRK) in five eyes with high myopia and low astigmatism. Follow-up ranged from 10 to 12 months. A hinge was used to perform subtotal lamellar keratectomy and the spherical component of myopia was corrected by three-zone PRK. The mean preoperative spheroequivalent was -21.00 diopters (D) and the postoperative spheroequivalent was -1.50 D. In four eyes the best corrected visual acuity was unchanged or improved; in one eye it decreased because of epithelial ingrowth in the lamellar interface. Persistent oblique longitudinal folds were noted in the corneal disc in one eye, and induced cylinder was found postoperatively in one eye.

Adult↗
PubMed1995

Intraocular intrusion of sutures after retinal detachment buckling surgery.

BACKGROUND: Intraocular intrusion of tight encircling silicone band is a major complication of retinal detachment surgery leading to subretinal and vitreous hemorrhage, retinal detachment, and phthisis bulbi. Intrusion of the sutures into the eye has only been reported as an adjunct to buckle intrusion. METHODS: Seven patients (9 eyes) are presented in whom intrusion of sutures occurred as a late complication of retinal detachment surgery using the extrascleral buckling technique. Their complications and treatments are discussed. RESULTS: Eleven anchoring sutures were observed under the retina and two sutures penetrated into vitreous cavity. In five eyes (55.5%), small subretinal or vitreous hemorrhages were noted and in one of them perforation with total detachment occurred. In four eyes, no complications were detected. In four eyes, the silicone band was cut and left in place and the hemorrhages were spontaneously absorbed. The perforated eye underwent replacement of the silicone band with a wide silicone sponge, followed by vitrectomy and silicone oil injection. CONCLUSIONS: Intrusion of sutures into the eye can rarely be seen years after retinal detachment surgery and usually do not require surgical intervention. When hemorrhage occurs, cutting of the silicone band only, with no attempt to remove the band or the sutures, is recommended.

Foreign-Body Migration↗