[Unilateral recurring opacity of the corneal epithelium].
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Corneal Dystrophies, Hereditary↗
Biomedical subjects
J M Rohrbach
Publications and source records attributed to J M Rohrbach.
[Congenital tumor of the temporal eyelid].
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Choristoma↗
[New tumor onset of the plica semilunaris in advanced age].
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Conjunctiva↗
[Corneal staphyloma-anterior chamber agenesia-microphakia syndrome].
CASE REPORT: Shortly after birth, a massive enlargement of the right eye was observed in an otherwise healthy male child. The cornea of the affected eye was vascularized and completely cloudy without a sharp border between cornea and sclera. The diagnosis of a congenital glaucoma was made but an operation was not undertaken because of the difficult anatomical situation and the lost function. When the child was almost 3 years old enucleation was performed to prevent complications due to corneal exposure, and to improve the cosmetic aspect. RESULTS: The morphological investigations of the enucleated eye disclosed findings typical of what is called in the literature "congenital anterior staphyloma" or "congenital corneal staphyloma", namely a massively staphylomatous cornea with superficial neovascularization, destruction of Bowman's layer, and absence of Descemet's layer as well as corneal endothelium. Angle structures were completely absent, and the corneal back-side was lined by a pigment epithelial layer and focally by an additional inner layer of non-pigmented epithelium. There was no anterior chamber. The lens was markedly diminished in size (microphakia) and partly embedded in the corneal stroma. Pars muscularis and pars ciliaris of the ciliary body were separated. Elongated, thin ciliary processes were extended towards the small lens while the pars muscularis was fully covered by the retina. CONCLUSIONS: This rare, complex malformation syndrome which can be easily distinguished from primary congenital glaucoma should not be reduced conceptually to the corneal staphyloma because this staphyloma constitutes only a part of the whole. Taking the leading morphological aberrations into consideration we would rather propose the new term " corneal staphyloma- anterior chamber agenesia- microphakia syndrome (CSAMS). We hypothesize that CSAMS may be due to a pathological fusion of the early anterior optic cup. As the posterior eye segment is often normal in CSAMS, a staphyloma excision along with a sclero-keratoplasty might be an alternative therapeutic option to avoid enucleation and restore ambulatory vision.
Aphakia↗
[On the socio-economic relevance of glaucoma].
About 800,000 people in Germany suffer from glaucoma. As the population ages, the prevalence of glaucoma will rise and the socio-economic impact of the disease increase. The costs of glaucoma include those of diagnosis, medical, laser and surgical treatment, and costs of blindness as a result of glaucoma. So far the costs of diagnosis and screening programs are not well known but there is substantial knowledge of the therapeutic costs. Daily therapy costs are about 0.50 to 1.00 euro per patient. Every year the German statutory health insurance system pays about 1,000 euro per glaucoma patient. In addition, blindness due to glaucoma costs the German government over euro 150 million annually in Social Security benefits, lost income tax revenues, and health care expenditures. Demographic changes and scientific progress will even aggravate the socio-economic burden of this disease.
Cost of Illness↗
[The German Ophthalmological Society (DOG) during the Period of National Socialism].
Sixty-one years after the end of the Hitler dictatorship, the history of the German Ophthalmological Society (DOG) has still hardly been investigated. According to different sources, especially the reports of the DOG congresses 1934, 1936, 1938, and 1940, the following picture can be drawn: 1. The seizure of power ("Machtergreifung") of Adolf Hitler was appreciated by most of the DOG members. 2. After a change of the constitution the DOG came under the control of the "Reichsinnenministerium". However, it escaped the egalitarianism ("Gleichschaltung") and remained relatively independent. 3. Approximately 40 % of the heads of the German university eye clinics who were the most influential DOG representatives were members of the national socialistic German working party (NSDAP). Almost all of these joined the party in 1933 or later. 4. Up to the last congress in Dresden, 1940, the DOG activities were quite extensive. After that time the activities strongly declined. 5. The "Law for the prevention of genetically disabled offspring" ("Gesetz zur Verhütung erbkranken Nachwuchses") from January 1st 1934 was intensely discussed by the DOG. Some prominent ophthalmologists and DOG members were at least in part responsible for the sterilisations because of "congenital blindness". However, as far as it is known, the DOG itself did not intervene directly concerning the practice of sterilisation. 6. Between 1932 and 1940, the DOG lost approximately 12 % of its members. Many of these stemmed from foreign countries, and many were German Jews. The latter left the DOG, as Walther Löhlein stated after the end of the war, "voluntarily". However, a main reason for leaving the DOG was very likely the feeling of being unwanted. The national socialism had several disastrous effects on ophthalmology. Although single DOG members participated in the excesses, the DOG as an organization was not directly involved. However, taking into consideration that more than 10 % of the members of the pre-Hitler era left their scientific society it is a matter of interpretation whether the DOG remained completely innocent between 1933 and 1945.
Eugenics↗
[About the frequency of excessive epithelial basement membrane thickening in keratoconus].
BACKGROUND: In spite of a huge amount of morphological and biochemical findings the aetiology of keratoconus (KC) is still unclear. While the primary changes are seen and found mainly within the anterior corneal stroma, some authors believe that the corneal epithelium plays the major role in KC formation. Consequently, the epithelial basement membrane (BM) has become a matter of interest in KC research. MATERIAL AND METHODS: The study included 55 consecutive patients who had a perforating keratoplasty performed because of KC. The corneal explants were processed for light microscopy in the usual manner. Slides were stained with PAS. The whole explant was investigated although the focus of interest was put on the epithelial BM. 10 normal corneas of eyes which had to be enucleated because of a choroidal melanoma served as a control. RESULTS: In 3 patients (5.5 %) there was a significant linear thickening of the BM (thickness of the BM more than 5 % but less than 30 % of the thickness of Bowman's layer). Only in one patient (1.8 %) there was an excessive BM thickening (thickness of the BM more than 30 % of that of Bowman's layer) with focal (central) BM warts directed against the epithelium ("inverse cornea guttata"). In general, thickening of the BM was most pronounced paracentrally. None of the control corneas had a significantly thickened BM. CONCLUSIONS: A massively thickened epithelial BM can be occasionally observed in KC but is rare on the whole. It is most likely an unspecific secondary phenomenon and not a prerequisite for KC development. The "inverse cornea guttata" was a unique finding.
Adult↗
[The different opacity patterns of Lisch corneal dystrophy].
BACKGROUND: Lisch corneal dystrophy is an epithelial corneal dystrophy where diffuse gray corneal opacifications are seen in direct illumination that appear in different patterns. Examination in retroillumination shows that these gray changes do consist of multiple densely crowded clear microcysts according to the opacity units. We wanted to investigate if one single case of Lisch corneal dystrophy can be differentiated easily from the other epithelial corneal dystrophies by exact analysis of the opacity units. PATIENTS AND METHODS: We examined three non-related patients with Lisch corneal dystrophy at the slit-lamp. The epithelial corneal opacities were documented photographically with direct slit-lamp illumination and retroillumination. RESULTS: All three patients showed the characteristic intraepithelial densely crowded clear microcysts in retroillumination. Diffuse gray radial opacities were noted in both corneas of a 15-year-old female patient. A club-shaped opacity was noted in one cornea of a 35-year-old female patient and a feathery gray opacity pattern was found in one cornea of a 49-year-old male patient. All three patients showed the characteristic densely crowded clear microcysts of Lisch corneal dystrophy in retroillumination. CONCLUSION: Taking the previous literature into account, five different opacity patterns can be summarised: radial, band, flame/feathery, whorled and club-shaped gray epithelial corneal opacities. A single case of Lisch corneal dystrophy can be differentiated from other epithelial corneal dystrophies by means of an exact analysis of the opacity pattern and units by slit-lamp examination.
Adolescent↗
[Effect of timolol on central corneal thickness and endothelial cell density].
BACKGROUND: The measurement of corneal thickness plays an increasing role in glaucoma screening and diagnosis. The influence of a variety of drugs on corneal thickness is well established. Especially for antiglaucomateous drugs this effect seems to be important. However, little is known about the influence of beta receptor antagonists on corneal thickness. The aim of this study was to provide evidence of the effect of timolol on central corneal thickness and endothelial cell density. MATERIALS AND METHODS: Ten healthy volunteers (five women and five men) with a mean age of 29 years (range 25 to 56 years) were examined in a double-blind, prospective and randomised pilot study. Intraocular pressure, corneal thickness and endothelial cell density was estimated before as well as fifteen minutes, 24, 48, 72 and 96 hours after application of timolol 0.5 % eye drops twice daily. The partner eye received sodium hyaluronate eye drops twice daily and served as a control. RESULTS: The application of timolol showed a decrease of intraocular pressure from initially 12 mmHg to 9 mmHg after four days (p = 0,0188) as well as an increase of corneal thickness from 537 microm to 557 microm after four days (p = 0,0659). There was no change of intraocular pressure (p = 0,9935) or corneal thickness (p = 0,9998) in the control eyes. There was also no effect of timolol (p = 0,2782) or sodium hyaluronate (p = 0,1940) on endothelial cell density. CONCLUSIONS: The study provides evidence of the influence of beta receptor antagonists on corneal thickness. This effect may be caused by receptor mediated influences on corneal ion and fluid transport. Further studies are needed to show if the increase of corneal thickness after application of topical timolol has clinical importance.
Adult↗
[Protein kinase C isoforms in corneal epithelium and endothelium].
BACKGROUND: Protein kinase C (PKC) plays a key role in cell metabolism. Three subgroups and 12 isoforms have been isolated so far, catalysing specific functions in cell metabolism. The demonstration of PKC subtypes in corneal tissue has been inconsistent. The aim of this study was to verify the expression of several PKC subgroups and isoforms in human and bovine corneal epithelial and endothelial cells. MATERIALS AND METHODS: PKC subgroups and isoforms were studied using polyclonal antibodies. RESULTS: Antibodies to PKC-alpha, -delta, -epsilon and -zeta, representing all three PKC subgroups, bound in human and bovine corneal epithelium and endothelium. No binding was found for antibodies to PKC-beta2. CONCLUSIONS: For the first time the presence of all three PKC subgroups was demonstrated in human and bovine corneal epithelial and endothelial cells. Further studies are needed to show the role of these subgroups in cellular functions such as cell proliferation and differentiation.
Adult↗
[Tumor of the caruncle of uncertain malignancy].
CASE REPORT: A sixty year old woman presented with a tumor of the caruncle that had persisted for one year. Ophthalmologic history was unremarkable. Physical examination disclosed an indolent, tight elastic, highly vascularizated tumor. The lesion measured five millimeter in diameter. Histopathology revealed tall columnar cells with small round nuclei. The cytoplasm stained positive with hematoxylin and eosin. The typical histopathologic features were consistent with an oncocytoma. CONCLUSION: Tumors of the caruncle are very heterogenous because the caruncle contains tissues of the conjunctiva and the epidermis. Therefore to exclude a malignant process an excisional biopsy should always be performed even so in general tumors of the caruncle are benign. The most frequent tumors of the caruncle are papilloma, nevi, pyogenic granuloma, epithelial inclusion cyst and chronic inflammation. In only 4 % of the cases oncocytomas are found even the oncocytoma is considered to be a typical tumor of the caruncle.
Adenoma, Oxyphilic↗
[Neoplastic secondary glaucomas].
With few exceptions all intraocular tumours can principally induce elevation of intraocular pressure (IOP). The frequency of IOP-elevation is mainly dependent on the biologic behaviour of the neoplasm (benign / malignant), its dimensions, localization, and its ability to provoke secondary changes like retinal detachment, hemorrhages, inflammation, and necroses. There are many and diverse pathomechanisms which may cause a "neoplastic glaucoma". The leading mechanisms are direct invasion of the chamber angle by tumour cells, rubeosis iridis, and forward displacement of the iris-lens-diaphragm with (lens induced) pupillary block. As intraocular tumours may have pressure-lowering effects too, eyes bearing a tumour may also be hypotonic or normotonic inspite of a "glaucomatous chamber angle morphology". The therapy of the tumour-induced glaucomas is hardly validated and generally follows the treatment of the other secondary glaucomas. However, filtration procedures are contraindicated when a malignant tumour is diagnosed or suspected. Because of the progress of tumour therapy with salvation of eyes which had to be enucleated in former times and prolongation of survival in some tumour entities (like Non Hodgkin's lymphoma and metastases) the significance of tumour-induced glaucomas will probably further increase in the future.
Eye Neoplasms↗
[Eye trauma in childhood and youth].
Childhood trauma of the eye and its adnexa represents approx. 4 - 20 % of all eye injuries. Due to ambiguous patient history and limited cooperation a comprehensive diagnosis of pediatric eye trauma is often difficult. The weakness of the infantile cornea, the thin and elastic anterior lens capsule, and the firm vitreous with its strong adherence to the retina bear particular intra- or postoperative problems. Moreover, the quick development of secondary cataract and the high risk of PVR may complicate the posttraumatic and postoperative course. Small infants represent a special subgroup in various regards mainly because of the risk of amblyopia which often causes functional loss in spite of a good anatomical reconstruction. The relative frequency of certain injuries differs between children and adults. The ocular manifestation of child abuse as well as bite and fireworks injuries are characteristic for childhood and will be discussed more in detail.
Adolescent↗
[Intraocular non-Hodgkin's lymphoma and its therapy-- a case series of ten patients].
BACKGROUND: The timely and correct diagnosis of intraocular non-Hodgkin's lymphoma represents a huge challenge to clinicians. Two thirds of intraocular lymphomas are a manifestation of a primary CNS lymphoma (PCNSL) arising outside the lymphatic system and are localized in the brain, the meninges or the spinal chord. Ten to twenty percent commence as vitreous or retinal infiltrates mimicking uveitis. Ninety five percent of PCNSL are B cell lymphomas. PATIENTS: Three exemplary cases from a group of ten patients treated between 1998 and 2002 are presented. A table provides a summary of the relevant details of all ten patients. RESULTS: The mean age at presentation was 63.5 years with a female to male ratio of 6 to 4. Nine patients were diagnosed as having intermediate or posterior uveitis, in one patient choroidal metastases were suspected. Six patients had a concomitant CNS lesion while four patients showed isolated intraocular lymphoma only. The presence of a highly malignant B cell lymphoma was proven by vitreous biopsy in nine cases and by stereotactic biopsy of a CNS lesion in one patient. All patients were treated by intravenous chemotherapy, however, no binding recommendations with regard to treatment exist to date. CONCLUSIONS: We give an overview of all current treatment regimens and their pitfalls. At present it is recommended that all patients with proven PCNSL be entered in a multicenter randomized study under the auspices of the Department of Internal Medicine III of the Benjamin-Franklin-University-Hospital, Berlin and the Department of Neurology of the University Hospital of Tuebingen.
Aged↗
[Visual impairment in bilateral arcus lipoides. Schnyder's corneal dystrophy].
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Adult↗
[Unilateral glaucoma with progressive changes to the cornea and iris].
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Antihypertensive Agents↗