Ophthalmic management of thyroid-associated orbitopathy.
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Germany↗
Biomedical subjects
R Guthoff
Publications and source records attributed to R Guthoff.
[Ultrasound biomicroscopy and therapy of malignant glaucoma].
BACKGROUND: Malignant glaucoma is a rarely diagnosed condition though it has been known since over one hundred years and understood to be based on an ciliary blockage since thirty years. Now it is possible to visualise pathomechanism of ciliary block by ultrasoundbiomicroscopy. PATIENTS AND METHODS: Between January 1994 and November 1998 thirteen patients with ciliary block glaucoma had been observed. Four underwent ultrasoundbiomicroscopy. RESULTS: Ciliary block glaucoma is caused by obliteration of the posterior chamber. Ultrasoundbiomicroscopy showed, that in phakic eyes the lens, in pseudophakic eyes the capsule together with the anterior vitreous membrane and in aphakic eyes the vitreous alone are the blocking agents. Hyperopia, a narrow iridocorneal angle and ciliary sulcus as well as plateau iris configuration and a history of miotics are the predisposing risks for ciliary block glaucoma, especially after additional surgery such as cataract extraction, iridotomy, iridectomy and trabeculectomy. Clinical features are always a raised intraocular tension accompanied with a flattening of the anterior chamber, which are to be differentiated from an angle closure glaucoma. This is easy, if iridectomy, irido-capsulovitreotomy or pseudophakia are present and difficult in the very rare spontaneous cases. Cycloplegics and YAG-laser iridectomy may break the ciliary block, but the most preferable therapy is lensectomy (phakic eyes) and partial removing of the anterior vitreous and a peripheral sector of lens capsule combined with an iridectomy. This is easily performed with the vitrector via pars plana. CONCLUSIONS: Ultrasoundbiomicroscopy starts to confirm the theories on ciliary block glaucoma and allows to assess the different modes of treatment. The most successful treatment is lens extraction and partial vitreo-capsulo-iridectomy via pars plana.
Aged↗
[Optic nerve sheath meningioma with intraocular invasion--a case report].
BACKGROUND: In case a sonographically high reflective intraocular tumor is detected, some different processes with calcium embedding could be considered. PATIENT: A 56 year-old female patient was seen in our department for the first time because of secondary glaucoma of the amaurotic right eye. The left eye has had no morphological changes and visual acuity was 5/5. CASE HISTORY: More than 20 years ago the patient had noticed decreased visual acuity of the right eye for the first time. 10 years ago in a first report from another eye hospital, a large white tumor in the area of the optic disc had been described. Sonographic size was 12 x 8 mm, 5.3 mm prominence. Visual acuity was perception of light with incorrect projection. A CT scan showed an inhomgeneous structure of calcification in the area of the right optic disc which continued along the optic nerve to intracranial structures. Enucleation was performed. Histopathological examination showed meningothelial meningeoma (grade I WHO) with its origin in the dural sheath of the optic nerve and intraocular growth. A postoperative MRI confirmed the intracranial spreading of the meningeoma along the dural sheath of the optical nerve. A meningeoma of the olfactorius region was found as a second independent tumor. CONCLUSION: The intraocular spread of an optical nerve sheath meningeoma is a rare case.
Calcinosis↗
Neuromyotonia of the abducens nerve after hypophysectomy and radiation.
The clinical signs of the rarely encountered ocular neuromyotonia consist of transient involuntary tonic contraction and delayed relaxation of single or multiple extraocular muscles, resulting in episodic diplopia. With a mean time delay of 3.5 years, this motility disorder frequently follows tumor excision or adjuvant radiation near the skull base. Ocular neuromyotonia may reflect inappropriate discharge from oculomotor neurons with unstable cell membranes because of segmental demyelinization by tumor compression and radiation-induced microangiopathy. In the present paper, the authors present the case of a 53-year-old patient with a history of transsphenoidal hypophysectomy and adjuvant radiotherapy, who underwent strabismus surgery for abducens palsy.
Abducens Nerve↗
[Imaging the tear film and in vivo cornea. Initial results with a modified confocal laser scanning ophthalmoscope].
BACKGROUND: As the slit-lamp technique is an restrictive method for the in-vivo examination and documentation of the multi-layer structure and the dynamics of the tear film and the cornea, e.g. during wound-healing processes, our aim was to find out whether it is possible to change the confocal laser scanning ophthalmoscope (CLSO; Zeiss) into a high-resolution confocal laser scanning microscope (CLSM) for the visualization of the anterior segments of the eye and the tear film by adapting a special objective system. In order to gain information concerning the function of such a cornea microscope we examined selected patients with erosion or pterygium before and after operation and subsequent phototherapeutic keratectomy (PTK), as well as some in-vitro corneal surfaces after photorefractive keratectomy (PRK). MATERIAL AND METHODS: We developed an objective adapter for the CLSO in order to focus the laser beam onto anterior segments of the eye to visualize the tear film and the layer structure of the cornea. By combining the long-distance objective or a contract objective with different zoom-optic lenses it was possible to alter the scan field size and so the magnification of the CLSM by a factor of up to 1000. RESULTS: The CLSM provides a new method for the in-vivo examination of the tear film and its dynamics as well as the thin layers of the cornea in real-time imaging technique with high contrast and resolution in non-contact or contact procedures. CONCLUSION: This system is a unique took for evaluating and monitoring the effect of excimer laser ablation after PTK and PRK on the corneal surface and the dynamics of the tear film. The application of this method causes no pain for the patient.
Cornea↗
[Cyclophotocoagulation with the diode laser. Study of long-term results].
UNLABELLED: To assess the clinical effectiveness of glaucoma therapy with diode laser cyclophotocoagulation, 106 eyes (51 eyes with primary open-angle glaucoma, 22 eyes with secondary glaucoma, 10 eyes with narrow-angle glaucoma, 23 eyes with other glaucomas) of 87 patients were treated. Using a diode laser coupled with a fiberoptic probe, ending in a focusing tip, all eyes were treated with 24-30 spots over 360 degrees and 2.8-3.5 J of energy, 1.5 mm posterior to the limbus. The intraocular pressure was obtained over a period of time until 8-24 months after operation. Additionally, morphological changes of the ciliary body were observed in 25 eyes by means of ultrasound biomicroscopy. RESULTS: The IOP decreased from a baseline mean of 25.0 +/- 5.7 mm Hg to 17.6 +/- 5.3 mm Hg directly after operation and increased slightly to 18.0 +/- 6.0 mm Hg in the following 24 months. Successful control of IOP (IOP constantly < 22 mm Hg or pain relief in blind eyes) occurred in 90 of 106 eyes (84.9%). In 23 eyes more than one treatment was given. In 6 eyes another IOP-reducing operation had to be performed. In 19 eyes slightly elongated intraocular inflammatory reactions were seen, without any serious complications. The morphological investigations showed in 22 of 25 cases temporary edema of the ciliary body. A temporary detachment of the ciliary body was seen in 8 eyes. CONCLUSIONS: Diode laser cyclophotocoagulation is an effective and safe procedure to reduce IOP in different types of glaucoma over a long time. Postoperatively, a temporary inflammatory reaction of the ciliary body was observed with no correlation to the degree of reduction of the IOP.
Adult↗
[Low dosage, fractionated, percutaneous teletherapy of subfoveal choroid neovascularization].
AIM: The effect of low-dose fractionated percutaneous teletherapy on visual acuity and the changes in subfoveal neovascular membranes (SNM) in age-related macular degeneration (ARMD) were studied. PATIENTS AND METHODS: Forty-four patients (aged from 56 to 86 years) were treated. Best distant and near visual acuity was assessed before (initial visual acuity; IVA) and 5 weeks, 3, 6 and 12 months after teletherapy. Fluorescein angiography was done before and 3 and 12 months after radiation. Patients were divided into different groups by IVA for analysis. Mean follow-up was 9 months. Teletherapy was done by a 9 MeV linear accelerator through a lateral port in the half-beam technique with a single dose of 2 Gy to a total dose of 20 Gy within 20 days. RESULTS: No severe negative side effects have been observed. Four patients reported epiphora. Visual acuity decreased one line in the group with an IVA of 0.05-0.2. The group with IVA 0.3-0.5 remained unchanged during the observation period. We found a tendency for increased visual acuity in group IVA > or = 0.6. CONCLUSIONS: Teletherapy seems to have an influence on visual acuity, SNM, and metamorphopsia. IVA and duration of thillness play important roles. We cannot say if there is a persistent effect, as these are preliminary results. The longest follow-up so far has been 12 months. In order to better evaluate the potential of radiotherapy, this study must be pursued and coupled with further studies analyzing the effect on SNM in ARMD.
Aged↗
Effect of surface modifications of intraocular lenses on the adherence of Staphylococcus epidermidis.
The development of polymers with different surface properties and surface modifications of intraocular lenses (IOL) should reduce foreign body reactions after implantation by reducing the surface hydrophobicity of the lenses. It was examined how far such surface variations influenced the adhesiveness of bacteria. The most common organism isolated from cases of postoperative endophthalmitis is Staphylococcus epidermidis. For this reason, three strains of this species, the type strain ATCC 14990 and two clinical isolates (8687, 6579 I), with different hydrophobic surfaces, were studied. IOL made of PMMA, silicone, and a copolymer as well as PMMA lenses with modified surfaces (unpolished, polished, silanized, and heparinized) were used. Bacteria were radiolabelled with 3H-thymidine and the adherent bacteria were calculated per mm2 of lens surface. The three strains adhered better to the unpolished surface of silicone than to PMMA. Treatment of PMMA surface by polishing diminished the differences between the strains. An influence of hydrophobic interactions on the adherence of S. epidermidis ATCC 14990 was demonstrated. The adherence of this hydrophobic type strain was clearly reduced by heparinization of the PMMA surface. In contrast, the hydrophilic catheter isolate 6579 I adhered better to modified surfaces. This strain differed clearly in its PFGE pattern from both hydrophobic strains. Hydrophobic interactions play a role in the bacterial adherence to intraocular lenses in vitro and in vivo. Modifications of polymer surfaces, however, can result in rather different effects depending on the bacterial surface composition and properties.
Bacterial Adhesion↗
[Keratinocyte density of the cornea in vivo. Automated measurement with a modified confocal microscopy MICROPHTHAL].
BACKGROUND: The MICROPHTHAL is a confocal slit light scanning microscope for a non-invasive in-vivo examination of corneal structures of human eyes. With this instrument even thin layers of corneal tissue can be imaged in good quality. Otherwise, blurring of single frames and deviations from the z-axis in video-sequences caused by high speed movements of the eye would normally prevent a measurement the density of keratocytes in the cornea. The goal of the investigation was optical pachymetry, the automatical measurement of the keratocytes density and a 3D-dimensional reconstruction of the central cornea in-vivo under constant imaging conditions. MATERIALS AND METHODS: We developed a low-vacuum suction cup system for stabilizing the eye in front of the microscope objective during the z-scan through the cornea. A stepmotor shifting system for the objective locates inside the suction cup with a central hole was installed underneath them icroscope. Control of this system via computer facilitated shifting the focal plane along the z-axis. The layer images were recorded using a S-VHS-tape and saved on the PC. The digital analysis was performed using a special software to automatically and off-line evaluate the density of keratocytes in combination with the 3D-reconstruction. The software also corrected the background illumination and small axial jitter. After this procedure the keratocytes density and the 3D-reconstruction in 70 images of the z-scan were calculated. We examined 47 corneas of 25 healthy probands. The range of age was 25-56 years. Independent control evaluation of the video sequences were taken manually on an INDIGO HIGH IMPACT workstation. RESULTS: By assign all keratocytes to the corneal measurement volume we found a averaged density of 15,730 cells/mm3 in the central cornea. The averaged thickness of the cornea was 0.556 mm. The control valuation of identical video-sequences on the workstation accomplished the same result of 16,000 keratocytes/mm3, also similar the result of the automatically measurement with the modified software. CONCLUSIONS: This modification of the microscope is a promising in-vivo tool for optical pachymetry and quantitative examination of corneal microstructures. The stabilization effect of the low-vacuum suction cup system in the front of the microscope for computer-controlled valuation of the density profile of keratocytes and the 3D-reconstruction of a central corneal volume element has produced encouraging results. Characterization of pathophysiological changes in the distribution of keratocytes after excimer laser ablation for phototherapeutic or photorefractive keratectomy, for example, can be estimated without pain for the patients.
Adult↗
[Corneal penetration of various aminoglycosides and quinolones].
BACKGROUND: Penetration of the aminoglycosides gentamicin and tobramycin and chinolones ciprofloxacin and ofloxacin applied as eyedrops and soaked disposable lenses (ACUVUE), used as antibiotic prophylaxis, was investigated. MATERIALS AND METHODS: 217 patients received before undergoing cataract extraction 0.3% solutions of these antibiotics as eyedrops or by soaked ACUVUE-lenses. During surgery 50-100 microliters aqueous humor was aspirated; concentration of gentamicin and tobramycin was analysed by fluorescence polarisation immuno assay, concentration of ciprofloxacin and ofloxacin was analysed by high pressure liquid chromatography. RESULTS: After application of gentamicin and ofloxacin as eyedrops and via soaked ACUVUE-lenses as drug delivery system (DDS) we found higher concentrations than after application of tobramycin and ciprofloxacin by the same modes. After using of soaked lenses as DDS the aqueous humor concentrations of all tested substances were higher than the concentrations after the frequent instillation of eyedrops. CONCLUSIONS: Penetration of gentamicin through normal human cornea is higher than penetration of tobramycin; penetration of ofloxacin through normal human cornea is higher than penetration of ciprofloxacin. The aqueous humor concentrations of ofloxacin applied as eyedrops and DDS, of ciprofloxacin and gentamicin applied as DDS allow their use as antibiotic prophylaxis in cataract surgery.
Anti-Bacterial Agents↗
[Collagen bionation of silicon, as a material for a lens epithelium coated capsular sack model].
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Animals↗
[Design of a test chamber for simulation of adhesion pressure of the anterior lens capsule on the intraocular lens].
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Actins↗
Penetration of ciprofloxacin, norfloxacin and ofloxacin into the aqueous humours of patients by different topical application modes.
OBJECTIVE: A prospective study was undertaken to determine the transcorneal penetration of three topically applied fluoroquinolones into aqueous humour. METHODS: Two hundred and twenty-four patients undergoing cataract extraction received 0.3% ciprofloxacin, norfloxacin or ofloxacin eye drops by two different administration modes with different frequencies and intervals of application. At the beginning of cataract extraction (0.5-3 h after the last drop), 50-100 microliters aqueous fluid was aspirated from the anterior chamber and immediately stored at -80 degrees C. Antibiotic concentrations were measured using high-performance liquid chromatography. RESULTS: Generally, topical ofloxacin and ciprofloxacin yielded aqueous humour levels higher than topical norfloxacin. The highest concentrations of all tested fluoroquinolones were measured after using an application mode, in which one drop was given every 15 min between 0600 hours and 0800 hours, prior to operation. When applied by this mode, ciprofloxacin achieved a mean aqueous level of 0.380 (+/- 0.328) microgram.ml-1 (range 0.033-1.388 micrograms.ml-1), norfloxacin 0.182 (0.118) microgram.ml-1 (range 0.038-0.480 microgram.ml-1) and ofloxacin 0.564 (0.372) microgram.ml-1 (range 0.064-1.455 micrograms.ml-1). These mean concentrations were above the minimum inhibitory concentration (MIC90), concentrations required for inhibition of 90% of pathogen strains in vitro of gram-negative bacteria, such as Proteus mirabilis and Escherichia coli. Therapeutic values above the MIC90 of Staphylococcus epidermidis, the pathogen causing eye infections most frequently, were reached by 67.5% of patients after ofloxacin and by 41% after ciprofloxacin, but never after norfloxacin treatment. CONCLUSION: Of the currently available topical fluoroquinolones, ofloxacin achieved the highest aqueous humour concentration. This fluoroquinolone may be an useful ophthalmic agent for topical antibacterial management, but it does not seem to be prophylactically effective against Streptococcus pneumoniae or Pseudomanas aeruginosa.
Administration, Topical↗
[In vivo imaging of corneal innervation in the human using confocal microscopy].
To date, descriptions of the structure of corneal innervation have only been possible on the basis of histological techniques. Confocal microscopy represents a new method for the structural examination of the cornea in vivo. Through our examinations we first defined the control group and then proceeded to record the reinnervation of donor tissue after perforating keratoplasty. We used the confocal slit-scanning video-microscope Microphthal to examine 40 corneas from 20 normal volunteers, 15 donor corneas and 5 eyes after enucleation for ocular tumors. These results were compared to our findings from postoperative checks on 14 patients after perforating keratoplasty (from 1 month to 2 years). With this system we were able to see nerves in the middle and in the superficial stroma. The course of these nerves can be followed, as well as their branching in the subepithelial plexus. Nerve fibers from superficial stromal nerves penetrate Bowman's membrane and create the basal epithelial plexus in the region of the basal epithelium. Seven months after perforating keratoplasty the first stromal nerves could be seen in the central corneal area. The first central reinnervation in the region of Bowman's membrane as well as in the basal epithelium was not detected until 15 months after operation. With confocal microscopy we have the potential to study the morphology of corneal innervation in vivo and in fresh donor tissue. For the first time it is possible to perform non-invasive morphological studies of reinnervation of the human cornea after surgical treatment.
Adolescent↗
[Detection of morphological corneal changes caused by chloroquine therapy using confocal in vivo microscopy].
BACKGROUND: Chloroquine keratopathy is known as a disease with epithelial deposits in the cornea. The appearance of corneal changes does not seem to be related to dose and duration of treatment. Chloroquine accumulates in lysosomes. The purpose of this study was to investigate microscopic changes of corneal morphology in patients treated with chloroquine in vivo. PATIENTS AND METHODS: Using the confocal slit scanning microscope, we examined 16 patients during chloroquine treatment and 4 patients after treatment. The patients' age was between 33 and 75 years. They were treated with chloroquine over a minimum period of 2 months up to a maximum period of 10 years. RESULTS: In 12 of 20 patients, corneal changes were visible. An atypical inverse reflectivity of basal cells in comparison to healthy volunteers was found. There were also deposits in the wing cell layer. We saw a higher density in the anterior stroma before the appearance of epithelial opacities, as well as in cases of keratopathy on slit-lamp examination and also after the cessation of chloroquine treatment. In one patient with long-term therapy, there were atypically shaped and branched nerves in the anterior stroma. CONCLUSIONS: Using confocal microscopy, it was in some cases possible to detect changes in the corneal morphology before these changes could be detected by slit-lamp examination. As a result of this study we found that chloroquine keratopathy is not limited to the epithelium but can affect the anterior stroma and possibly neural structures.
Adult↗
[Adherence of staphylococci of different hydrophobicity. Study of various intraocular lenses].
BACKGROUND: A major goal in research on intraocular lenses (IOL) is the development of new polymers and modifications to reduce foreign-body reactions after implantation. This effect may be achieved by a reduction in the surface hydrophobicity of the polymers. To illustrate the influence of surface modifications on bacterial adhesiveness, the most often isolated organism in "low-grade" postoperative endophthalmitis, Staphylococcus epidermidis, was used. MATERIALS AND METHODS: For this reason three strains of this species, the type strain ATCC 14990 and two clinical isolates (8687, 6579 I) with different hydrophobic surface properties were studied. IOL, used in the experiments were either made of PMMA or silicone with modified surfaces (unpolished, polished, heparinized). The adhesiveness of H3-thymidin-labeled bacteria was calculated/mm2 of lens surface. Each experiment was performed in triplicate and repeated three times. RESULTS: The hydrophobic-type strain showed stronger adherence to unpolished PMMA surface (8000 bacteria per mm2) compared to the polished (5200 bacteria/mm2). In contrast, the hydrophilic strain adhered with 2000 bacteria/mm2 to the unpolished and with 4200 bacteria/mm2 to the polished surface. Polishing PMMA lenses diminished the differences between the three strains. However, surface passivation of silicone lenses increased the adhesion rate of the hydrophilic strain up to 9600 bacteria/mm2. Treatment of PMMA lenses with heparin increased the adhesiveness of the hydrophilic strain and reduced the adhesion rate of the hydrophobic type strain to 250 bacteria/mm2. CONCLUSIONS: It was demonstrated that bacterial adherence to IOL also involves hydrophobic interactions. Obviously, however, that adherence reflects a complex of interactions between the two surfaces.
Bacterial Adhesion↗
[Ultrasound biomicroscopy as a criterium of functional assessment of the supra-choroidal cleft after chamber angle surgical interventions].
BACKGROUND: The new technique of ultrasonic biomicroscopy provides detailed information about the extension and width of suprachoroidal clefts during the follow-up period after cyclodialysis ab interno. PATIENTS AND METHODS: We examined a group of 9 patients suffering from dysgenetic glaucoma and secondary glaucoma. Ultrasonic biomicroscopy was performed before and after cyclodialysis ab interno. The results were compared to those of gonioscopy. RESULTS: These examinations revealed that even cyclodialysis clefts which appeared to be closed by gonioscopy were still open. This was proven by a broad choroidal cleft in the cyclodialysis area. CONCLUSIONS: Thus, ultrasonic biomicroscopy is a means of checking the outcome of cyclodialysis ab interno and may influence the indications for further surgical procedures.
Adolescent↗
Strategies for diagnosis and management of infiltrative orbital lesion.
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Antineoplastic Combined Chemotherapy Protocols↗