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Biomedical subjects

R Dannheim

Publications and source records attributed to R Dannheim.

At least 19 recordsLinked to original sources

[Quality management, possibilities and chances in ophthalmology].

German legislation introduced in 1988 called for obligatory quality assurance (QA) practice to be initiated by health care providers. In 1992 the scope of the legislation was extended. Opportunities for introducing quality assurance practice in ophthalmology are demonstrated through examples. A necessary preliminary step to QA is to identify priority areas requiring action. A second necessary action entails the definition of quality indicators. Through their monitoring, these quality indicators allow identification of problem areas as reflected in the collected data. The final important phase of QA practice involves development of strategies to counteract identified problems. This process implies one or more cycles of: problem analysis, establishment of rectifying targets, actual intervention and finally evaluation of interventions made. Compulsory inter-hospital comparison of QA data calls for agreed standards within health care fields. In conclusions, QA practices in ophthalmology (with special reference to the pilot project on QA in cataract surgery) suggest that QA measures are well accepted by health care providers in this field.

Cataract Extraction

[Ophthalmological experiences with automobile drivers with inadequate vision].

A total of 369 ophthalmological practices were asked to report the number of patients seen within one test week who drove their cars but did not satisfy minimum legal requirements for diurnal visual acuity applicable for applicants for a West German Class 3 driver's license. There were 471 such patients. From this number it can be calculated that approximately 570 000 individuals (+/- 9%) drive cars in the Federal Republic of Germany with inadequate visual acuity. An analysis of the questionnaire produced the following results: Fifty percent of these patients are less than 62 years of age. The main cause of inadequate visual acuity is age. In younger drivers refractive errors were the prime cause and in most cases correction with glasses was possible. In older drivers the loss of acuity was mainly due to opacities of the lens which for the most part could not be corrected by spectacles. Two-thirds of the drivers with inadequate visual acuity consider their vision to be "sufficient" or "good" for driving; younger drivers are more self-critical than older ones. Only 31% of these drivers stopped driving at night of their own accord. As many as two-thirds of the drivers who consider their acuity to be "insufficient" drive their cars during darkness. The authors show that the findings in patients suffering from severe loss of visual acuity must in principle also be valid for patients with minor visual impairments who still meet the minimum legal requirements. This agrees well with published statistical investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[Reasons for postoperative deterioration of visual fields in cases of advanced primary open-angle glaucoma (author's transl)].

In 86 patients suffering from advanced glaucomatous field defects visual functions were evaluated up to 12 years postoperatively. There was a 50% deterioration in visual acuity in 29 eyes (34%). This was mainly caused by new cataract formation. Visual fields were examined on the Tübingen perimeter. In 12 out of 80 eyes there was suspected deterioration and in another 28 eyes (35%) confirmed deterioration. In no case did surgery cause the preoperative field to disintegrate. The deterioration, which usually accelerates slowly, is a consequence of general vascular diseases such as diabetes mellitus, arteriosclerosis or hypertonia.

Diabetes Complications

[Visual acuity and intraocular pressure after surgery in congenital glaucoma (author's transl)].

In 124 eyes (82 patients) a total of 152 trabeculotomies were performed. Re-examinations were done after three and six months and then every year. After at least three years pressure was controlled in 67 out of 80 eyes (84%). Less favorable results were achieved in secondary glaucomas, in cases with previous surgery, if age at surgery was more than one year and in cases of known heredity. Corneal diameter and preoperative pressure did not influence the postoperative pressure. In 24 out of 60 eyes (44%) the final visual acuity was 0.4 or more. Vision and refraction were independent of the corneal diameter.

Female

[The influence of healing on the long-term effect of trabeculotomy in primary open angle glaucoma (author's transl)].

83 eyes underwent a re-examination 3-7 years after trabeculotomy. By surgery alone the diurnal curve in 58 out of 74 eyes (78 percent) was regulated. In the majority of the other eyes additional medication controlled the i.o. pressure. There was no secondary cataract or other late complication. In 5 eyes there was a moderate deterioration of glaucomatous field defects without a decrease of visual acuity. The average i.o. pressure increased 2 mm Hg during the first 6 months postop., later on it was constant. The scarring processes in the chamber angle known from experimental surgery seemed to come to an end usually 6 months postoperatively. To judge the final result of trabeculotomy a postoperative follow-up of 6 months is necessary.

Cicatrix

[Trabeculotomy and cataract-extraction: simultaneously or step by step? (author's transl)].

In 64 eyes the combined procedure (group I) and in 67 aphacic eyes a trabeculotomy (group II) was performed. There were different types of glaucoma. Re-examinations wer done 6 months and 1--10 years postoperatively. No definite differences of operative or postoperative complications existed between the two groups. In eyes suffering from primary open angle glaucoma intraocular pressure was controlled in 65--91% in both groups. In group I visual acuity was slightly better. On the other hand in these eyes more often a deterioration of the visual field was observed inspite of i. o. pressure not exceeding 21 mm Hg with a single exception. In group II further glaucoma surgery was necessary in more eyes than in group I.

Aged

[Contusion of the eye--secondary glaucoma and other late consequences (author's transl)].

24 patients were re-examined 19--20 years and another 37 patients 10--11 years after blunt injury to the eye. 24 eyes showed marked angle rears but there was not a single case of glaucoma. In case of initial a. c. hemorrhage these tears are significantly more ofter seen. 9 of the injured eyes had a reduction of visual acuity to 0.5 or less as a consequence of lens or central fundus changings.

Adult

[Tonographic and tonometric aqueous humor outflow tests after trabeculotomy (author's transl)].

In 10 eyes which trabeculotomy was performed because of primary open angle glaucoma preoperatively, 1 to 3 months and 12 months postoperatively the diurnal curves and tonographic results were compared. The i.o. pressure was reduced in all eyes. The ocular rigidity was decreased from 0.0206 +/- 0.0019 (s.d.) preoperatively to 0.0164 +/- 0.0015 after 1 to 3 months and to 0.0168 +/- 0.0017 after 12 months. Regarding the individual change of ocular rigidity, the outflow facility was improved on an average of from 0.13 +/- 0.02 preoperatively to 0.37 +/- 0.10 or 0.20 +/- 0.03 units postoperatively. This means a reduction of the resistance to aqueous outflow from 10.62 +/- 1.89 to 3.88 +/- 0.57 or 5.77 +/- 0.77 units. The differences are statistically significant. If the changings of ocular rigidity are not regarded there is no significant improvement of the conditions of aqueous humor outflow.

Aged

[Effect and complications of Vogt perforating cyclodiathermy in various forms of glaucoma].

In 178 eyes 223 perforating cyclodiathermies (PCD) have been performed. The technique described by Vogt was modified by additional coagulations around the insertions of the recti-muscles. This procedure was done if one or repeated glaucoma procedures (fistulas, iridectomies or trabeculotomies) were not successful of if these surgical methods were not reasonable because of the morphological conditions of the iris and the chamber angle. If one compares in this retrospective study the average diurnal curves of 60 eyes preoperatively and 7 days postoperatively the PCD has lowered the curve and removed the morning peak that was visible preoperatively. In 153 eyes (86%) the intraocular pressure could be lowered at least for some time. A new increase was seen in most cases during the first 6 months postoperatively. 116 eyes had a postoperative follow-up of 6 months up to 3 years. 45 (39%) of these eyes were controlled without and another 31 eyes (27%) with additional medical therapy (single measurement or average of the diurnal curve less than or equal to 21 mmHG). In some eyes a repetition of the PCD was necessary to be successful. The best results had been achieved in primary glaucoma, in secondary glaucoma after uveitis and in aphacic eyes. In congenital glaucoma only 12 out of 25 eyes could be controlled and this was similar in secondary glaucoma of the vascular type. There is no influence of the preoperative pressure level on the rate of success. But the effect correlates with the preoperative visual acuity: the worse the visual function, the lower the percentage of controlled eyes. The intra-operative complications are not important. The most important postoperative complication is a phthisis bulbi which was seen in at least 10 out of 178 eyes. Most of these eyes were suffering from a secondary glaucoma of the vascular type with high preoperative pressure. All eyes had a visual acuity of 1/50 or less. To repeat the PCD after a few weeks is another factor that facilitates this serious complication. After at least 3 months the repetition of a PCD seems to be without a special risk of phthisis bulbi.

Adolescent

[Tonography after trabeculotomy (author's transl)].

In 25 eyes suffering from primary open angle glaucoma the facility of outflow was measured before and 1 to 3 months after surgery in consideration of the rigidity. Trabeculotomy improved the facility on an average of 0.14+/-0.02 to 0.28+/-0.03 units. This means that the outflow resistance is decreased from 10.58+/-1.34 to 4.31+/-0.45 units. The statistically highly significant improvement of the outflow conditions must be a consequence of the surgical opening in the trabecular meshwork as the sclera had been closed watertightly at the end of the trabeculotomy. The coefficient of rigidity (graphically determined by applanation tonometry and Schiötz tonometry in recumbent position) was decreased from 0.0208+/-0.0010 to 0.0172+/-0.0008. This means that measuring the intraocular pressure postoperatively with a Schiötz tonometer results in data which are 3.08+/-0.65 mm Hg lower than the actual pressure level.

Glaucoma

[Tonometry and tonography for open Schlemm's canal (author's transl)].

In 13 eyes tonometry was performed during trabeculotomy at the beginning, after preparation of the outer scleral lamella and after the excision of the outer wall of the canal of Schlemm. In 4 eyes this was combined with tonography. There was no significant change of the averaged i.o. pressure and the resistance to aqueous outflow. Thus in primary open angle glaucoma the resistance to aqueous outflow must be located primarily in the trabecular meshwork.

Glaucoma