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Biomedical subjects

P Niesel

Publications and source records attributed to P Niesel.

At least 19 recordsLinked to original sources

[Physiologic principles of studying visual functions].

The retinal coding system for visual information comprises three important steps: 1) hyper- and depolarization of the sensory cells as the active basis for perception of light and dark; 2) reaction solely to changes in the bipolar cell on/off system, as a consequence of the action of the horizontal cells with the receptive fields, as a basis for adaptation to brightness and glare; and 3), under the influence of the amacrine cells, important time-space functions as a basis for visual perception of movement. The signal form, which changes over from analog to digital in the ganglion cell system, also results from this last step. therefore, both latencies and amplitudes (VEP) are important criteria for long signal response paths. Taking the examples of "statistical perimetry", visual acuity testing, and examination of contrast sensitivity, clinically relevant methodological problems from signal detection theory are illustrated: there are no "certain" measured values. This uncertainty and the age-dependence of normal values make it difficult to identify pathologic conditions, though trend analyses can help. As the sizes of the retinal areas examined by these methods differ so widely, correlations between the various examination methods are theoretically possible; but one method can never be substituted by another. In routine practice, to detect pathology early, one will sometimes deviate from the prescribed examination method (vision tests with low contrast for visual acuity).

Dark Adaptation

Quantification of choroidal blood-flow parameters using indocyanine green video-fluorescence angiography and statistical picture analysis.

A method for indocyanine green video-fluorescence angiography of the human choroid is described using a 30 degrees fundus camera (C. Zeiss) with external light supply, a low-light-level TV camera, and a video recorder. Bloodflow parameters for the choroid were obtained from the video recording using a picture-analysis system (IBAS, Kontron). These included: the mean time for arterial, capillary and venous filling and a parameter corresponding to the amount of perfused capillaries in the choroid. Angiograms were performed on normal, healthy subjects at normal and increased intraocular pressures and on patients with dry senile macular degeneration. Examples of the results are shown and discussed.

Aged

[Quantification of senile cataract in split-lamp images of the Zeiss SLC measurement system].

The Zeiss SLC measuring system for examining the anterior segment in slit light permits direct digital image storage and analysis. For long-term studies the reproducibility of individual images can be improved. Furthermore, the data can be quickly processed to yield indices which can be used to characterize the cataract: 1) the integral of an axial densitogram as a criterion of average lens opacity, and 2) the difference between the linear regressions of the densitograms of the anterior and posterior lens halves as a criterion of cataract form (e.g., nuclear vs. cortical cataract).

Adolescent

The relationship between the visual field and the optic nerve head in glaucomas.

In a retrospective study of 50 eyes with chronic open-angle glaucoma we compared the findings obtained using stereochronoscopy (Sc), papillometry (Pm) and visual-field measurements. We found relationship between the neuroretinal-rim area and the visual-field findings measured using the Octopus glaucoma program, G1. There was only a weak relationship between the Sc findings and the visual-field measurements. This suggests that Sc detects a type of damage that is not detectable either using Pm or by visual-field examinations. Our results also suggest that quantitative perimetry detects the same kind of damage as that revealed by Pm. The neuroretinal-rim area was best correlated with short-term fluctuation, but was also very significantly correlated with mean damage and corrected loss variance.

Adolescent

Inflow and outflow relations after intraocular fluid-Healon exchange in a case of chronic ocular hypotension.

A 47-year-old patient was legally blind in her only eye for months due to long-lasting ocular hypotension following chronic uveitis and several operations for cataract and secondary glaucoma. With injections of 0.7 to 2.5 cc 1% Healon into the anterior chamber and vitreous cavity at intervals of 2 to 12 months, intraocular pressure levels between 5 and 12 mmHg could be maintained resulting in an improvement of the visual acuity up to 25/100. The treatment has been continued for over 5 years. A positive correlation was found between the volume of injected Healon and the integral of intraocular pressure over time, and between visual acuity and pressure level. Reduced aqueous flow, high trabecular outflow resistance, and a low rate of clearance of Healon from the vitreous cavity is obviously responsible for the long-lasting elevation of low intraocular pressure levels and for the restoration of useful vision.

Blindness

Influence of intraocular lenses on ultrasound axial length measurement: in vitro and in vivo studies.

Refraction affects ultrasound as it passes obliquely through tissues or materials with different propagation speeds. Therefore, axial length measurements could theoretically be affected after implantation of an intraocular lens which has a propagation speed that exceeds those of the ocular humors by a factor of 1.8 (2718 m X s-1 vs. 1532 m X s-1). The in vitro studies we report clearly demonstrate that ultrasound axial length measurements were not affected significantly by inclining the IOL up to 25 degrees or varying the transducer-lens distance from 0 to 25 mm. However, length measurements were found to be directly proportional to the lens power. A 27-diopter lens induced a 0.032-mm increase in the apparent axial length for a lens-reflector plate distance of 20 mm (P less than 0.05). In vivo the retina's curvature counterbalances this apparent increase: axial lengths measured in 26 patients were virtually the same after IOL implantation. From these data we conclude that axial lengths can be accurately measured by ultrasound after IOL implantation if the different propagation speeds are considered for calculation.

Humans

[Reproducibility of perimetric study results].

Theoretical and experimental aspects of the reproducibility of visual fields in static automated perimetry are described. Special emphasis was placed on factors which could potentially influence reproducibility, such as cooperation, the patient's age and the size of his/her pupils, learning and fatigue effects, the depth of scotomas and the influence of drugs.

Diagnosis, Differential

[Malignant non-Hodgkin's lymphoma with visual disorders and nephrotic syndrome].

A favourable outcome is reported in a 65-year-old patient with malignant non-Hodgkin lymphoma, in whom early manifestations were papillitis and nephrotic syndrome due to membranoproliferative glomerulonephritis. The pathogenesis of the ophthalmologic and renal disease may be associated with the malignant lymphoma. Under cytostatic treatment (prednisone, chlorambucil, vincristine) the malignant lymphoma went into still-lasting remission accompanied by a normalization of the ophthalmologic and renal functions.

Antineoplastic Agents

Measurement of the optical density of the optic nerve head I: the pallor of the papilla in artificial ocular hypertension.

The pallor of the optic disc during acute raise of intraocular pressure can be shown on the negatives of orthochromatic film and is measured by a photoscanner. When raising intraocular pressure from normal values to ablut 40 mm Hg, ten young persons showed an increase in optical density from 0.28 log units +/- 0.04 SEM to 0.38 log units +/- 0.04 SEM. When raising IOP to 65 mm Hg, the optical density was 0.43 log units +/- 0.04; with 110 mm Hg the optical density was 0.44 log units +/- 0.04 SEM. Above values of 40 mm Hg IOP, the pallor does not remain constant but may also decrease in some cases. The higher the intraocular pressure, the more contradictory the response. The phenomenon may be shown on various parts of the rim simultaneously. The amount of maximum pallor is directly related to the value of optical density with normal intraocular pressure. After restoring IOP to normal values, optical density decreases again, the amount of decrease being related to initial value. The contradictory response with higher IOP may be due to autoregulation of the capillaries of the optic nerve head.

Humans

Measurement of the optical density of the optic nerve head II: short-time fluctuations of the optical density of the nerve head.

The fluctuation of pallor with increasing IOP could be due to either insufficient reliability of the method or to an unrecognized pulsating phenomenon. A better arrangement should eliminate imperfection of the method. Coupling the release with the ECG should reveal a relationship to the arterial pulse rate. Neither condition could be demonstrated as the reason for the fluctuation. The connection of the fluctuation and its possible relationship to central venous pressure is discussed. The margin of error is shown, which is 9% on average.

Electrocardiography

[Planimetric evaluation of kinetic perimetry with the Goldman perimeter (author's transl)].

Kinetic perimetry was performed on 12 normal subjects. The perimetric results obtained with a Goldmann perimeter by 12 different investigators were statistically analyzed. Planimetry of areas outlined by a given isopter was done in order to reduce the amount of data. This led to a reduction in standard deviations of almost 50 percent. The statistical significance of field changes depends on individual variation and frequency of testing. If standard deviations are calculated in dB, variation becomes independent of given isopters. However, standard deviation may be increased by a factor of almost 2 as a result of the influence, of the investigator. Therefore, a standardization of test procedures by automatization seems meaningful, although standard deviations will not necessarily be lower with computerized perimetric methods.

Aged

Visible changes of the lens with age.

Slit lamp photographs taken along the optical axis of human eyes were examined with a microdensitometer. This showed an increasing opacity in the lens nucleus, an increased opacity and thickness of the cortex and the anterior lens capsule with age. However, the opacity and width of the anterior disjunction zones decreases with age. Patients with clear lenses but who had chronic uveitis, retinal detachment and glaucoma treated with medication, showed large deviations in the behavior of the disjunction zone as compared with other lenses of the same age. In incipient cataract in the aged, the fogging in the lens cortex is greatest when vestiges of the disjunction zone still remain. The cortex is less affected if the disfunction zone is absent.

Adolescent

Correlations between intraocular pressure, visual field and visual acuity, based on 11 years of observations of treated chronic glaucomas.

In a retrospective study of 114 patients under treatment for chronic glaucoma (81 without and 33 with visual field defect) over an 11-year period of observation, a highly significant correlation between intraocular pressure and progression of visual field defects could be demonstrated. This correlation could be shown for the visual field outer boundary in 81 eyes with ocular hypertension and for typical visual field defects in 33 eyes with chronic glaucoma. The relationship was, however, only significant when both the standard deviation of the annual intraocular pressure and the influence of cataract development upon visual acuity were considered. Quantitative analysis of the results of Goldmann perimetry was by planimetry and took into account only changes during the 11-year observation period.

Aged

[The Pola-test in asthenopia (author's transl)].

Seventy-three patients with asthenopia and 43 control subjects were examined with the Pola-Test. The two populations showed a significantly different frequency of pathologic results on the four test patterns. The so-called "stereo test" seems to be the most important test pattern. Patients with a pathologic stereo pattern reported asthenopic symptoms significantly more frequently than the control subjects who were questioned for similar symptoms. However, since 30% of the asthenopic patients showed normal results on the four Pola-Test patterns, the indication for treatment can be based only on a combined evaluation of binocular tests and asthenopic symptoms. In asthenopia visual and conjunctival symptoms are more prominent than headache. At times they may be masked by psychogenic factors. In a double-blind study on 12 asthenopic patients symptoms improved significantly during treatment with prisms.

Adult

[The hemodynamics of the uveal and retinal circulation and its clinical diagnosis (author's transl)].

Diagnosis and therapy of retinal and uveal circulatory disorders should be based mainly on two pathophysiologic principles: (1) an autoregulation is effective in the retinal circulation only but absent in the choroidal circulation and (2) circulatory disorders may be caused not only be a reduced but also by an increased blood flow. The clinical evaluation of an individual retinal circulatory disorder depends on the interpretation of the dynamics of visual disturbances, detection of vascular type or fiber bundle defects in the visual field, repeated estimation of blood flow velocity by direct ophthalmoscopy or fluorescence angiography, and detection of specific fundus signs such as focal ischemia (cotton wool spots) or development of a collateral circulation and true neovascularization. For the indirect assessment of disturbances of the choroidal circulation certain subjective symptoms, alterations of the pigment epithelium, and edema and focal defects of the choriocapillaries are of importance. The stereobiomicroscopy of the fundus with a slitlamp and fluorescence angiographic studies of the sectorial distribution of the choroidal filling are valuable diagnostic aids.

Choroid