Biomedical subjects

J Stürmer

Publications and source records attributed to J Stürmer.

At least 19 recordsLinked to original sources

PubMed2005

[Pepper spray injuries of the anterior segment of the eye].

BACKGROUND: A wide variety of pepper sprays is currently available and gaining increasing popularity among both professional guardians and amateurs. Adverse side effects to the anterior segment of the eye are known but underestimated. HISTORY AND SIGNS: We present two cases with severe corneal and conjunctival damage after accidental self injury by a pepper spray (Jet Protector Guardian Angel), benzyl alcohol 90.1 %, capsaicinoids 2.6 %). THERAPY AND OUTCOME: Despite immediate and intensive irrigation, a complete epithelial defect, extensive ischemia to the limbus and the conjunctiva and a circular conjunctival chemosis were diagnosed. After slow re-epithelialization in both cases, a neurotrophic superficial keratitis, a reduced corneal sensibility and in one case deep stromal scarring were noted. CONCLUSIONS: Pepper spray application to the eye might result in severe and permanent damage to the corneo-conjunctival tissue which is not adequately addressed in the current literature. From the present case reports arise the discussion whether the irritative and lipophilic capsacin/benzyl alcohol mixture or the pyrotechnical additives nitrocellulose und sinoxide are responsible for the anterior segment injuries.

Administration, Topical↗

PubMed2005

[Cataract and combined cataract/glaucoma surgery as intraocular pressure-reducing procedure in eyes with relative anterior microphthalmos].

PURPOSE: Eyes with relative anterior microphthalmos (RAM) (normal [> 20.0 mm] axial length but disproportionally small anterior segment [horizontal corneal diameter < 11 mm]) often present with increased intraocular pressure. Under these difficult conditions cataract surgery alone or in combination with a glaucoma filtering procedure is often required. PATIENTS AND METHODS: We retrospectively reviewed the records of 71 patients (108 eyes) with RAM in whom cataract only (n = 72) or combined cataract/glaucoma surgery (n = 36) was performed. Preoperative clinical and biometric findings, intraoperative complications and postoperative results (visual acuity and intraocular pressure) were analysed. RESULTS: Median preoperative values were 7.46 mm for corneal curvature, 2.53 mm for anterior chamber depth and 22.44 mm for axial length. The implanted lens had a median 25.0 dioptric power. The IOP was reduced from 15.6 +/- 3.9 mm Hg to 13.5 +/- 3.1 mm Hg with cataract surgery alone and from 22.4 +/- 5.5 mm Hg to 15.4 +/- 4.0 mm Hg with combined surgery. Mean best corrected visual acuity improved from 0.4 +/- 0.2 to 0.79 +/- 0.25 with cataract surgery and from 0.5 +/- 0.3 to 0.81 +/- 0.24 with combined surgery. Intraoperatively only 3 eyes had a rupture of the posterior capsule and postoperatively 2 eyes developed malignant glaucoma in the combined group. CONCLUSIONS: The results show that, in eyes with RAM, cataract surgery alone or in combination with glaucoma surgery can be performed with excellent results and low complication rate if adequate precautions are taken (especially the use of hyperosmotic agents).

Adult↗

PubMed2004

[Filtering glaucoma surgery as outpatient procedure].

BACKGROUND: While cataract surgery is nowadays performed routinely as an outpatient procedure, performing filtering glaucoma surgery under these conditions remains questionable due to the more demanding perioperative management. PATIENTS AND METHODS: Outpatient filtering glaucoma surgery (trabeculectomy and combined phakoemulsification and trabeculectomy (phakotrab)) is performed at the Ophthalmology Department of Kantonsspital Winterthur when requested by the patient. This paper provides a retrospective review of all outpatient filtering glaucoma procedures performed in the last three and a half years. RESULTS: Forty-six filtering procedures (21 trabeculectomies and 25 phakotrabs) were performed in 45 eyes of 40 patients (50 - 84 years) as outpatient procedures. Mitomycin C was administered in 16/21 trabeculectomies and in 7/25 combined procedures. In the trabeculectomy group, intraocular pressure (IOP) was surgically lowered from 23.3 +/- 7.2 mm Hg (under 2.4 +/- 0.8 IOP-lowering medications) to 12.7 +/- 3.5 mm Hg (20/21 patients without medication). In the combined group, IOP was lowered from 20.8 +/- 6.3 (under 2.0 +/- 0.7 medications) to 13.7 +/- 2.7 mm Hg (only 5/25 patients still requiring IOP-lowering medications). In the latter group, the best corrected visual acuity was below 20/40 only in 2 eyes due to advanced glaucomatous optic atrophy. One patient developed relative intraocular hypotony (IOP 6 mm Hg), one patient required needling + 5-fluorouracil injection and one patient required surgical revision of the trabeculectomy after 14 months. DISCUSSION: Adequate patient selection and refined surgical technique (tight wound closure and releasable sutures or argon laser suturolysis) allow performing filtering glaucoma surgery as an outpatient procedure. Extended post-operative care during the first 2 months is the key for IOP-lowering success.

Aged↗

PubMed2002

Axonal loss from acute optic neuropathy documented by scanning laser polarimetry.

BACKGROUND/AIMS: Retinal nerve fibre layer analysis by scanning laser polarimetry has been shown to facilitate diagnosis of glaucoma while its role in glaucoma follow up is still unclear. A major difficulty is the slow reduction of retinal nerve fibre layer thickness in glaucomatous optic neuropathy. Eyes of patients were studied after acute retrobulbar optic nerve lesion in order to evaluate the usefulness of scanning laser polarimetry in documenting retinal nerve fibre layer loss over time. METHODS: Five patients who suffered severe retrobulbar optic neuropathy have had repeated measurements of the retinal nerve fibre layer using scanning laser polarimetry at various intervals, the first examination being within 1 week of injury. RESULTS: All eyes showed a marked decrease in peripapillary retinal nerve fibre layer thickness, which followed an exponential curve and occurred predominantly within 8 weeks of injury. Compared to a previous study using red-free photographs, scanning laser polarimetry showed retinal nerve fibre layer loss earlier in the course of descending atrophy. CONCLUSION: Scanning laser polarimetry is useful for early detection and documentation of retinal nerve fibre layer loss following acute injury to the retrobulbar optic nerve. It seems to be a promising tool for follow up of individual glaucoma patients.

Acute Disease↗

PubMed2000

[Dysgenetic changes of the angle of the anterior chamber in patients with glaucoma or suspected glaucoma acquired before age 40].

OBJECTIVE: The aim of this study is to determine percentage and degree of dysgenetic changes in the chamber angle in glaucoma suspects and in patients who acquired glaucoma before the age of fourty and to compare the primary classification with the classification after reexamination. PATIENTS AND METHODS: 200 eyes of 104 patients (59 males, 45 females, 0-40 yrs old (median 29) at time of detection) could be examined or reexaminded by gonioscopy and photography with the CGA-1 goniolens. The angles were documented by drawing and by goniophotography. The different features of dysgenesis served to establish a point-scale. RESULTS: Out of 200 eyes in 24 eyes (12%) a slight, in 81 (40.5%) an intermediate and in 49 (24.5%) a severe goniodysgenesis was found. By reexamination the dysgenesis rate rose from 48 to 77%. CONCLUSIONS: The high frequency of dysgenetic changes in the chamber angle of glaucoma patients affected under the age of fourty suggests, that in this age group developmental glaucoma is predominant and has to be separated as a special entity from POAG. Two questions arise: 1. Were these dysgenetic changes overlooked most of the time in the newer genetic studies of patients with GLC1A, or, if not, 2nd: Do glaucoma suspects and patients with open angle glaucomas before the age of 40 with and without dysgenetic changes belong to groups with different glaucoma genes, the "with" to genes IRID 1 and IRID 2 and the "without" to genes GLC1A to GLC1F?

Adolescent↗

PubMed2000

Membrane formation in the chamber angle after failure of argon laser trabeculoplasty: analysis of risk factors.

AIM: Membrane formation in the chamber angle induced by argon laser trabeculoplasty (ALT) can be a cause of treatment failure. Identification of risk factors for membrane formation was the primary aim of this retrospective study. METHODS: Semithin sections of trabeculectomy specimens obtained in a 2 year period were examined by light microscopy. 122 eyes which were treated with one or more ALTs before trabeculectomy were identified. In 46 eyes, a sufficient amount of trabecular meshwork was obtained to permit morphological analysis. RESULTS: Eyes treated with ALT had a significantly higher incidence of membrane formation (p=0.001). In 23/46 specimens a cellular and collagenous membrane was observed covering the entire trabecular meshwork. In 14/23 specimens (61%), this membrane was readily visible at low power magnification (x40). Comparison of these eyes with those without membrane formation revealed a significant difference in the number of ALTs (mean 2.07 (SD 0.73) v 1.48 (0.59); p=0.026) and in preoperative IOP (32.0 (9. 7) v 26.2 (8.4) mm Hg; p=0.04). CONCLUSIONS: Membrane formation in the chamber angle is a frequent cause of ALT failure. The major risk factor is the number of ALTs performed.

Aged↗

PubMed1999

[Bilateral cystoid macular edema after successful treatment of AIDS-associated cytomegalovirus retinitis].

BACKGROUND: Cystoid macular edema (CME) in AIDS patients with inactive cytomegalovirus (CMV) retinitis is an uncommon but potentially sight-threatening complication. The pathogenesis of CME in these patients is unclear. This study tries to identify possible risk factors by analyzing the charts of five patients. METHODS: Ten eyes of 5 patients that finally developed CME were followed for an average of 18 months. The initial retinal lesions, their response to antiviral treatment, the development of CME, and the patients' immune status were prospectively monitored. RESULTS: CMV retinitis was diagnosed at a median CD4+ count of 3 cells/mm3 (range 0-11). All eyes responded to the initial systemic anti-viral treatment. At the onset of CME, CMV retinitis was controlled by antiviral maintenance therapy in all patients [ganciclovir (n = 2), cidofovir (n = 2), foscarnet (n = 1)]. The median time between diagnosis of CMV retinitis and onset of CME was 11.5 months (range 5-24). Development of CME was associated with significant visual loss: acuity ranged from 0.05 to 0.7 when CME was first noticed, compared to 0.8-1.25 at diagnosis of CMV retinitis. Duration of inflammation, size or zone of retinal necrosis did not favor the development of CME, neither did the antiviral therapy. A weak correlation of CME development and immune status (expressed as increase of CD4+ cells) was found. Due to systemic corticosteroids CME resolved. CONCLUSIONS: CME is a new visual threat to AIDS-patients with CMV retinitis whose immune status improved under the latest combined antiretroviral therapy. Therapy with oral corticosteroids may positively influence this condition.

AIDS-Related Opportunistic Infections↗

PubMed1998

[Livedo reticularis, acral necroses and renal failure. Cholesterol crystal embolisms].

In a 67 year old patient with multiple cardiovascular risk factors a livedo reticularis, ischemic acral lesions as well as deterioration of renal function five weeks after cardiac catheterism and aorto-coronary bypass surgery led to suspicion of cholesterol embolism. Fundoscopy revealed cholesterol crystals in retinal vascular branches thus delivering important diagnostic information. Atheromatous lesions of the entire aorta and the ilio-femoral arteries were possible sources for embolism. The outcome was favorable. The lesions of the toes regressed and renal failure did not progress to dialysis. The diagnostic steps taken, the clinical picture of cholesterol embolism, the use of imaging and therapeutic options are discussed.

Aged↗

PubMed1998

[Risk factors for trabeculectomy failure].

BACKGROUND: Trabeculectomy is today the filtering procedure of choice, because complications are rare and success-rates high. A modification of our technique (fornix-based conjunctival flap closed by a running suture) introduced 3 years ago, has lead us to this retrospective assessment of complications and success-rates. Some of the risk factors for failure are known, others however remain obscure. This retrospective series was also used to further identify some of these risk factors for trabeculectomy failure. PATIENTS AND METHODS: All 388 trabeculectomies performed between January 1992 and June 1994 at our hospital were included in the study. Important pre- and postoperative data were retrospectively assessed from patients case notes, with a special interest in the course of post-operative intra-ocular pressure (IOP). Two major groups were differentiated: Those with open-angle glaucoma (OAG) (i.e. primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX) and pigment dispersion syndrome (PDS)), and other various glaucoma diagnoses. Risk factors were assessed using Cox-proportional hazard model adopting three different criteria for success. RESULTS: The best success-rate after 12 months of follow-up had patients with narrow angle glaucoma (93.1%)(at least those suitable for filtering surgery), followed by patients with POAG (92.8%), 2 degrees open-angle glaucoma (81.8%), aphakic (75%), juvenile (70.6%) and PDS (52.9%). Pseudophakia and development of an encapsulated bleb (Tenon' cyst) were identified as significant (p < 0.05) risk factors for failure. In addition, YAG-Laser Iridotomy in OAG-group and Aphakia in the group of various glaucoma diagnoses were identified as risk factors for successful post-operative IOP control. CONCLUSIONS: Filtering surgery (trabeculectomy) is a potent method to reduce IOP. Pseudophakia and an encapsulated bleb are the main risk factors for surgical failure. Because of amazingly high success-rates we tend to perform filtering surgery today earlier than ten years ago, especially as previous long-term topical antiglaucoma treatment may reduce filtering surgery success.

Adolescent↗

PubMed1998

Retinal degeneration in the rd mouse in the absence of c-fos.

PURPOSE: Apoptosis is the final common death pathway of photoreceptors in light-induced retinal degeneration and in several animal models for retinal dystrophy. To date, little is known about gene regulation of apoptosis in the retina. The expression of the immediate early gene c-fos is upregulated concomitant with apoptosis in light-induced photoreceptor degeneration and in the rd mouse, an animal model for inherited retinal degeneration. In a recent study it was shown that c-Fos is essential for light-induced apoptosis of photoreceptors in vivo. To determine whether c-Fos is also involved in the apoptotic pathway of inherited retinal degeneration, rd/rd, c-fos -/- double-mutant mice have been generated. METHODS: Double-mutant mice (rd/rd, c-fos -/-) were crossbred from c-fos+/- mice and rd/rd mice. Their genotype was determined by polymerase chain reaction analysis of genomic DNA. Wild-type control mice and homozygous rd mice were killed at 2-day intervals from postnatal day (P)9 through P21. Double-mutant mice were killed at postnatal days P9, P11, P13, P15, and P21. To determine levels of apoptosis in the retina, eyes were enucleated and processed for light microscopy and in situ nick-end labeling. Total retinal DNA was extracted from isolated retinas for DNA fragmentation analysis. RESULTS: Morphologic, histochemical, and biochemical analyses showed that the time course of apoptosis and the outcome of photoreceptor degeneration in rd/rd, c-fos-/- double-mutant mice was indistinguishable from that in rd mice carrying functional c-fos. CONCLUSIONS: These data suggest that in contrast to its role in light-induced photoreceptor degeneration, c-Fos is not essential for apoptosis in the rd mouse.

Animals↗

PubMed1996

Reversal of topical antiglaucoma medication effects on the conjunctiva.

OBJECTIVE: To determine whether the adverse effects of antiglaucoma medications could be reversed before filtration surgery, potentially reducing the risk of subsequent failure. METHODS: One month before surgery, 30 patients who were receiving multiple antiglaucoma medications underwent an inferior bulbar conjunctival biopsy, ceased using sympathomimetic drops, and began treatment with topical corticosteroid, (1% fluorometholone four times daily). At the time of surgery two conjunctival biopsy specimens were obtained, one from the operation site (superior bulbar region), and one from the inferior bulbar region. The biopsy specimens were quantitatively analyzed by light microscopy. In addition, the outcome of first trabeculectomy for 16 of these patients was compared with that of 16 matched patients who had not undergone an altered preoperative regimen of topical therapy. RESULTS: During a 1-month period a notable decrease occurred in the number of fibroblasts and inflammatory cells throughout the conjunctiva. Inferior bulbar conjunctiva was found to be representative of superior bulbar conjunctiva with respect to these changes. Furthermore, evidence comparing the matched patients suggested that the altered preoperative regimen may have improved the success rate of trabeculectomy. CONCLUSIONS: The preoperative regimen used reversed the adverse conjunctival effect of topical medication. The regimen may be of clinical benefit in improving the success rate of trabeculectomy.

Administration, Topical↗

PubMed1996

[Value of scanning laser ophthalmoscopy and polarimetry compared with perimetry in evaluating glaucomatous changes in the optic papilla and nerve fiber layer].

The aim of the study was to establish quantitative correlations between morphological changes at the optic nerve head (ONH) and the retinal nerve fiber layer (NFL) and functional abnormalities i.e. visual field alterations in glaucoma. A cross-sectional study of open-angle glaucoma patients of various stages was performed. Scanning laser tomographic (TopSS) assessment of the ONH and scanning laser polarimetric (Nerve Fiber Analyzer) measurements of the peripapillary NFL thickness (NFLT) were compared to results of computerized static perimetry (Octopus G-1). One eye from each of 157 glaucoma suspects (n = 58) and patients with established open-angle glaucoma (n = 99) was assessed. The parameter "modulation" (difference between maximum and minimum of NFLT) gave the best correlation (r2 = 0.23) to the visual field index for mean sensitivity. Tomography gave the best correlation between the neuroretinal rim area at the inferior and superior pole of the ONH and the visual field index loss variance (r2 = 0.20). Conventional planimetric data of the ONH and clinical assessment of the NFL yielded slightly better correlations to the visual field data than the scanning laser tomography or polarimetry. Although NFL parameters are more complicated to obtain, they yield better correlations to diffuse visual field loss than parameters of the ONH. The new scanning laser techniques do not improve these correlations between morphology and function; however, they allow objective assessment of ONH and NFL parameters without mydriasis.

Adolescent↗

PubMed1996

[Risk factors for development of argon laser trabeculoplasty failure producing membrane in the chamber angle].

INTRODUCTION: The major cause of ALT failure is membrane formation in the chamber angle. The aim of this retrospective study was to identify possible risk factors. MATERIAL AND METHODS: We studied sections from the surgical specimens from all trabeculectomies at our department within 2 years. We identified 122 eyes with at least one preoperative ALT. In 46 specimens enough trabecular meshwork for morphological analysis was present. RESULTS: Half of the patients showed a membrane covering the trabecular meshwork. In 14 of 23 eyes we could see this membrane even at low-power magnification (40 x). Various possible risk factors were evaluated, but none showed a significant correlation. When we compared only these eyes with membranes visible at low-power magnification with eyes without, however, we found a significant difference in the number of ALTs (mean +/- SD 2.07 +/- 0.73 vs 1.48 +/- 0.59; P = 0.026) and preoperative intraocular pressure (32.0 +/- 9.7 mmHg vs 26.2 +/- 8.4 mmHg; P = 0.04). CONCLUSION: We found no distinct risk factor for membrane formation, but it becomes more frequent with every additional laser treatment.

Adult↗

PubMed1995

[Normal pressure glaucoma: a diagnostic challenge].

PURPOSE: Normal-tension glaucoma (NTG) is a frequently discussed optic neuropathy. The purpose of this retrospective study was to evaluate the final diagnosis of patients with presumed NTG and to select the best distinguishing examination methods. PATIENTS: All patients with presumed NTG hospitalized for diurnal IOP curves from 1987-1992 were studied. We evaluated retrospectively which diagnostic tests contributed most to the final diagnosis. RESULTS: In 26 out of 50 patients with presumed NTG the final diagnosis had to be changed, mainly because the diurnal IOP curve showed a dysregulation; often only the early-morning IOP in supine position was elevated. CONCLUSIONS: We suggest that early-morning IOP spikes are one of the important pathogenetic factors in patients with glaucomatous changes without other pathology. Early morning IOP measurement in supine position before rising should therefore be a mandatory part of diurnal IOP curves in patients with presumed NTG.

Blood Pressure↗

PubMed1995

[Follow-up of a pilot study of trabeculectomy with low dosage mitomycin C (0.2 mg/ml for 1 minute). Independent evaluation of a retrospective nonrandomized study].

BACKGROUND: The application of anti fibroses agents during glaucoma surgery leads to more satisfactory results with lower i.o. pressure, yet eliciting complications in wound healing, avascular filtering blebs and frequent chronic hypotonias. In patients with lower risk for failure a reduction of concentration and application time of Mitomycin C should minimise side effects while maintaining the beneficial effect of lower intraocular pressure. PATIENTS AND METHODS: 34 eyes of 32 patients (age 72 +/- 8) underwent trabeculectomy (14 combined with phacoemulsification and implantation of a foldable posterior chamber lens). During filtering surgery, Mitomycin C (0.2 mg/ml for 1 min) was applied after preparation of the scleral flap. An 11.5 +/- 5.0 (3-21), month followup, 30 (34) eyes (88.2%) had an i.o. pressure of < or = 21 mm Hg (14.0 +/- 4.3 mm Hg at the last control) without additional glaucoma medications. RESULTS: The majority of filtering blebs (30/34; 88.2%) were well vascularised, often showing polycystic degenerations near the limbus. Only 3 eyes developed an avascular filtering bleb. No persisting leaks were observed and only 2 of 34 eyes (5.9%) developed short transient hypotonia (IOP < 6 mm Hg). CONCLUSIONS: Adjunctive treatment with low concentration of Mitomycin C during filtering surgery results in good i.o. pressure with little risk of avascular bleb development. A prospective, randomised trial is required to assess the safety and efficacy of adjuvantive Mitomycin C treatment in low risk filtering surgery.

Aged↗

PubMed1995

Optic disc size and optic nerve damage in normal pressure glaucoma.

BACKGROUND: Recent reports indicate that eyes with normal pressure glaucoma have larger optic discs than eyes with primary open angle glaucoma or normal eyes. This study was performed to find whether, in normal pressure glaucoma, a large disc is associated with more optic nerve damage than a small disc. METHODS: Colour optic disc photographs of 74 patients with normal pressure glaucoma were assessed morphometrically. RESULTS: Taking the study group as a whole, the optic disc size decreased significantly (p = 0.04) with increasing visual field defect. In an intraindividual bilateral comparison, the side differences in the disc area of the right minus the left eye of the same individual were not significantly correlated with the side differences in the mean visual field defect. CONCLUSIONS: The results indicate that the eye with the larger optic disc, when compared with the contralateral eye with the smaller optic nerve head, showed neither a significantly more marked nor less pronounced glaucomatous optic nerve damage. It suggests that for a given patient the degree of glaucomatous optic nerve atrophy was not markedly associated with the optic disc size. The finding that patients with large visual field defects had smaller discs than patients with moderate perimetric loss may indicate that the results of previous cross sectional studies reporting on an unusually large disc size in normal pressure glaucoma may be due partially to selection.

Female↗

PubMed1994

The diagnosis of normal-tension glaucoma.

The diagnosis of normal-tension glaucoma includes optic nerve head and retinal nerve-fiber layer assessment, standard static computerized visual field testing, gonioscopy, and a diurnal (24-hour) intraocular pressure curve. In addition to a careful history to exclude previous phases of increased intraocular pressure, an internal medicine checkup including 24-hour ambulatory blood pressure measurements and neurological assessment are required. Additionally, carotid artery Doppler sonography, nailfold capillary microscopy, and a computed tomography scan of the brain may be performed.

Glaucoma↗

PubMed1994

Single intraoperative applications of 5-fluorouracil during filtration surgery: early results.

Experimental studies from our laboratory have suggested that single exposures to 5-fluorouracil (5-FU) would have a similar effect to subconjunctival injections of 5-FU and a less permanent effect on subconjunctival fibroblasts than mitomycin C (MMC). Thirty four eyes of 33 glaucoma patients with an increased risk of filtration surgery failure were treated with a single intraoperative 5 minute exposure of sclera and subconjunctival tissues to 5-FU, 25 mg/ml. The follow up period ranged from 3-9 months, during which two high risk eyes failed completely and one required topical beta blockers to control intraocular pressure. No low/moderate risk eyes failed. Single 5 minute intraoperative exposures to 5-FU are convenient, inexpensive, have no significant corneal side effects, and may be a useful adjunctive treatment to optimise the results of glaucoma filtration surgery, particularly in the large group of low/moderate risk patients.

Adolescent↗