Dot-map-fingerprint dystrophy--Cogan's microcystic dystrophy--normal reactions of the corneal epithelium?
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Basement Membrane↗
Biomedical subjects
N Ehlers
Publications and source records attributed to N Ehlers.
Diabetic retinopathy after 3 years' treatment with continuous subcutaneous insulin infusion (CSII).
Twenty-four insulin-dependent juvenile diabetics with no or minimal background retinopathy were randomly allocated to conventional insulin therapy (CIT) or continuous sc insulin infusion (CSII) administrated by a portable pump. At the present 3 year follow-up, there was one drop-out in the CSII group. Although the metabolic control was significantly better in the CSII patients, both groups improved significantly in metabolic control during the observation period. After 3 years, the HbA lc level was 7.4% +/- 1.2 (+/- SD) in the CSII patients and 8.6% +/- 1.6 in the CIT patients (P less than 0.01). As compared to the status at the beginning of the study, a progression of diabetic retinopathy (criteria: development of more than 2 microaneurysms) was observed in 4 of 11 in the CSII group and in 5 of 12 in the CIT group (P greater than 0.05). None of the patients were seen to develop soft exudates or neovascularisations. This study confirms the impression gained from a previous one-year follow-up of similar progression of retinopathy in patients on CSII and CIT.
Adult↗
Post mortem HLA-DR typing of donor corneas using DNA-hybridization technique.
With donor material kept under banking conditions, corneal grafting is today an elective routine surgical procedure. Increasing evidence suggests that the clinical results may be improved by HLA matching. However, serological tests require that a blood sample be taken while the donor is still alive or shortly post mortem. We report HLA-DR donor typing with a DNA hybridization technique using DNA isolated from the donor eye more than 24 h post mortem. The practical implications of this procedure are briefly discussed.
Choroid↗
Treatment of central corneal ulcers by à chaud transplantation of organ culture preserved donor tissue.
In the period 1979-83 a total of 232 penetrating corneal transplantations were performed with organ culture preserved donor material. Forty-two operations were made à chaud for central corneal ulcerations. The results of these interventions are reported and discussed. The surgery presented no serious problems and on first post-operative day the anterior chamber was reformed in all cases, and pain was relieved. Patients were confined to bed only for 1 day. Graft deswelling was slightly retarded compared to planned surgery, but all functioning grafts obtained normal thickness. The overall graft survival rates after 6, 12 and 18 months were 66, 53 and 48%, respectively. For herpetic ulcers the survival after 18 months was 49% and for non-herpetic ulcers 47%. The grafts failed in all cases where it had been necessary to employ grafts of more than 10 mm. This latter group was comprised of the non-herpetic cases; were they excluded, the graft survival rate would increase to 60%. Among cases with a clear graft the median visual acuity after 18 months was 0.33 (range less than 0.1-0.67). Excluding cases with a non-corneal cause of visual reduction, the median visual acuity was 0.4 (range 0.33-0.67). It is concluded that grafting can be successfully employed in the treatment of central ulcers, as it not only restitutes tissue integrity, but also preserves useful vision.
Adolescent↗
Corneal transplantation using 4-week banked donor material. Long-term results.
Thirty-six corneal transplantations employing banked donor material maintained during prolonged storage (mean: 29.5 days) in organ culture at 31 degrees C were followed for 5 years. The overall graft survival was 80% , and graft failures were almost exclusively found in a pre-operatively defined risk group where the survival rate was 49.6% compared with 95.5% in the non-risk group. Five years after transplantation the mean central thickness of surviving grafts was 0.52 mm and the mean endothelial cell density 862 cells/mm2. All grafts were optically clear judged by slit-lamp appearance even though a higher degree of light-scatter was demonstrated compared with controls. The functional results were satisfactory with an over-all mean visual acuity of 0.67 cc. Excluding cases where low visual performance had non-corneal causes, 88% of patients obtained 0.5 cc or better. The median spherical equivalent of corneal curvature was 8.23 mm and the median astigmatism 4 diopters. Intraocular pressure was normal, and all grafts had obtained some degree of sensibility, although reduced compared with controls. The study demonstrates that banked donor material can be successfully employed for corneal transplantation achieving favourable long-term results.
Astigmatism↗
Effects of ionizing radiation on retinoblastoma and on the normal ocular fundus in infants. A photographic and fluorescein angiographic study.
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Combined Modality Therapy↗
Corneal transplantation using long-term cultured donor material.
Twenty-seven corneal transplantations with a mean duration of donor incubation of 14.3 days (group 1) and 36 transplantations with a mean duration of incubation of 29.8 days (group 2) were followed for 18 months. No significant difference was found in graft survival between the two groups (81 versus 80%). Almost all graft failures were found among pre-operatively defined high-risk cases, i.e. previously transplanted and/or vascularized recipient cornea. The profile of the corneal thickness curve was almost identical in the two groups, and normal values were reached in both. Visual acuity was 0.5 or better in 23% of the cases in group 1, and 35% in group 2. These figures were highly influenced by co-existing and complicating eye disease i.e. amblyopia, cataract, macular degeneration and glaucoma. The results show that 2 weeks and 4 weeks cultured cornea do not differ with respect to graft survival and thickness. The over all results indicate that long-term cultured donor material is suitable for corneal transplantation and fully comparable to material stored by other methods.
Adolescent↗
No additive effect of tranexamic acid and naproxen on corneal deswelling. A study on oedema after uncomplicated intracapsular cataract extraction with anterior chamber lens implantation.
The influence of systemic antifibrinolytic and antiprostaglandin medication on post-operative central corneal thickness was studied. Thirty patients underwent uncomplicated intracapsular cataract extraction with implantation of anterior chamber lens. The patients received either tranexamic acid, naproxen or both. The post-operative oedema did not differ significantly between the three groups studied. Models for studying changes in central corneal thickness are discussed. A review of the influence of drugs on corneal thickness is presented.
Aged↗
Early treatment of granular dystrophy (Groenouw type I).
Eight patients with dystrophia corneae (Groenouw type I) were studied. Fifteen eyes in 8 patients were treated with epithelial abrasion, and 5 eyes in 3 patients obtained improvement of visual acuity. In the remaining 10 eyes, the elements were localized so deep in the stroma that they were not altered by the abrasion. Five patients had been treated by corneal grafting. Evident recurrence along the suture lines was observed in 3 eyes and suspected in 2 eyes. It may be concluded that Groenouw type I changes are affected by epithelial abrasion. Early stages obtain visual improvement. Repeated therapeutic epithelial abrasions would seem to be a treatment possibility for patients with incipient changes.
Adolescent↗
Diabetic retinopathy after one year of improved metabolic control obtained by continuous subcutaneous insulin infusion (CSII).
Twenty-four insulin dependent juvenile diabetics, with no or minimal background retinopathy, were randomly allocated to conventional insulin therapy (CIT) or continuous subcutaneous insulin infusion (CSII) administrated by means of a portable pump. The metabolic control was significantly improved in the CSII group as compared to the CIT group. After one year, a progression of diabetic retinopathy (criterion: development of more than 2 microaneurysms) was observed in 3 of 12 patients in the CSII group and in 4 of 12 patients in the CIT group (P greater than 0.05). A tendency to more severe progression was observed in the CIT group. None developed soft exudates or retinal proliferations. Although no significant beneficial effect of pump treatment could be demonstrated, it seems safe to conclude that pump treatment does not accelerate progression of diabetic retinopathy in patients with no or minimal background retinopathy.
Adolescent↗
The combined effect of haematoporphyrin derivative and light on the normal mouse retina.
Combined treatment with haematoporphyrin derivative (Hpd) and light irradiation has been reported to be an effective method of killing cancer cells. This would be a very suitable treatment of intraocular tumours because the light can be controlled by the refractive media of the eye. Light and electron microscopy of Hpd and light treated normal mouse retina showed that only the irradiated area was damaged. Tissue destruction increased with greater concentrations of Hpd and longer light exposure. The outer layers of the retina were most sensitive. Hpd was retained in the tissue for 6 days.
Animals↗
Long term results of corneal grafting in Fuchs' endothelial dystrophy.
The long term results of grafting for Fuchs' endothelial dystrophy are reported in 25 patients with 33 penetrating keratoplasties, with a mean observation period of 50 months, 33% of the cases showed a visual acuity of 0.5 or better, while 42% had a visual acuity less than 0.1. The cause of visual acuity less than 0.1 was largely permanent corneal oedema, which was observed to develop in 39% of the cases. Some of the causes of oedema were accounted for by graft rejection, glaucoma and other obvious causes, but in a significant number of cases (12% of all cases), the oedema developed as a quiet, slowly progressive oedema without any obvious aetiology. It is tentatively suggested that the recurrence of oedema might be associated with the primary disease in patients with Fuchs' endothelial dystrophy.
Aged↗
The thickness of the human cornea as determined by a specular method.
The thickness of the human cornea was measured by a simple accurate method which entails measurement of the distance between the anterior and the posterior corneal reflections when the cornea is illuminated at an angle. As compared to methods measuring the width of the optical section, the advantage of this method is that the end-points of measurement are clearly defined, providing a better basis for an exact estimation of the corneal thickness. The optical principle of this specular method is presented in a general form. The influence of physiological variation in corneal curvature and index of refraction is analysed and shown to cause an insignificant error on the standard thickness estimate. Using this method, the corneal thickness was measured in a random population sample of 115 normal subjects, aged 10-90 years. The corneal thickness was found to approximate a normal distribution with a mean value (+/- SD) of 0.515 mm (+/- 0.033). A significant decrease in corneal thickness with age of 0.0045 mm per decade was found.
Adolescent↗
Importance of age in management of retinoblastoma of the first eye.
The possible treatments of retinoblastoma are briefly discussed, and the different situations when one or two eyes are affected is stressed. The age at onset is an important factor in distinguishing between uni and bilateral cases. By an analysis of 59 cases it is shown that below the age of 12 months, the risk of bilaterality is above 90 per cent whereas above the age of 18 months the risk is almost zero. It is recommended that in retinoblastoma, uni- as well as bilateral cases, the possibility of a conservative treatment is seriously considered. Radiation is today the basic modality of treatment. The acute management by the mutilating enucleation is a procedure of the past.
Age Factors↗
Ultrastructure of cryopreserved, functioning human corneal endothelium.
The endothelium was studied by light- and electronmicroscopy in a cryopreserved cornea transplanted to a woman with herpetic keratitis and removed after 18 months because of wound dehiscence and epithelialization of the anterior chamber. The graft was perfectly transparent and of normal thickness. Light microscopy revealed the existence of a continuous layer of endothelial cells, showing pronounced pleomorphism when examined in flat preparation, with large multinuclear cells between smaller more normal looking mononuclear cells. The heterogeneous cell pattern resembled that observable in vitro after freezing and 24 h of culture. The cells therefore are not considered to be in a steady state. The ultrastructure of the majority of the cells was similar to that of non-cryopreserved endothelium. Cell cohesion took place by tight junctions, the intercellular spaces were of normal width. Ultrastructurally there was, however, a cellular heterogeneity, due to the occurrence of light cells with few organelles, but always with intact cell membranes. These cells probably represent slow death of endothelial cells, demonstrated by falling cell density during the 18 months between grafting and examination. We conclude from this study that cells surviving the freezing can maintain a clinically normal endothelial function for 18 months by forming a continuous quasistatic monolayer of tightly bound living cells.
Adult↗
Cataract extraction in the 'nineties'.
A total of 55 cataract extractions were performed on 53 patients aged 90 years or more in the period 1972 to 1982. Assessment of the outcome was based on data from hospital records and on questionnaires to the patient's ophthalmologist and general practitioner. Cataract surgery had improved visual acuity in 42 patients. Only 25 patients (47%) could, however, utilize the improved visual acuity, and obtain some practical benefit from the cataract extraction. Thus, the benefits of cataract surgery seem to be reduced in this age group. The reasons appear to be a high frequency of severe macula degeneration, some degree of senility hindering the adaptation to aphakic spectacles, and a somewhat higher frequency of per- and post-operative complications. This suggests that indications for cataract surgery in very old patients should be limited, at least if rehabilitation with aphakic spectacles is planned. An earlier surgical intervention would probably have been advantageous in the majority of these patients.
Age Factors↗
Hereditary bilateral retinoblastoma, pinealoma and normal chromosomes. A case report.
We report a boy with bilateral, familial retinoblastoma recognized at the age of 3 months. At the age of 2 1/2 years the patient developed a tumour in the pineal region. Both tumours were successfully treated by radiation. The chromosomes were normal when examined by the prophase technique, in particular there was no deletion of band q14 of chromosome 13. We consider the simultaneous occurrence of retinoblastoma and pinealoma as more then a pure coincidence, probably a consequence of a generally increased susceptibility to cancer and of the histogenetic similarities of retina and pineal body.
Brain Neoplasms↗
Long term results of corneal grafting in keratoconus.
Fifty-four corneal grafts in 45 keratoconus patients have been followed for 3 to 12 years (average 5.8 years). The corneal clarity, visual acuity, incidence of immune rejections, relation to HLA compatibility, corneal thickness and endothelial cell density are reported. At the follow-up 98% (53 out of 54) of the grafts were clear. Visual acuity was greater than or equal to 0.67 in 72% of the cases. Suboptimal vision was due to cataract or large astigmatism. Rejection had occurred in 5 cases (10%). The graft thickness was found to decrease steadily, reaching subnormal values about 1/2 year after the operation. Six years after grafting, however, the thickness did not differ from that of normal corneas. The endothelial cell density in uncomplicated cases ranged from 450 to 3000 cells/mm2, decreasing with length of post-operative period. The HLA compatibility could not be shown to influence the endothelial cell density.
Adult↗