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Biomedical subjects

R Kuckelkorn

Publications and source records attributed to R Kuckelkorn.

33 records · Page 2Linked to original sources
PubMed1993

[Tarsoconjunctival advancement--a surgical procedure in cicatricial entropion with marginal tarsus deformation].

BACKGROUND: After severe chemical and thermal burns, and in chronic inflammatory conditions of the conjunctiva frequently scarring of the tarsal plate with distortion of the eyelid margin and keratinization of the tarsal conjunctiva could be found. This condition is accompanied with chronic inflammation and malposition of the eyelids resulting in entropion and trichiasis. PATIENTS AND METHODS: A surgical procedure is introduced separating the scarred and shortened tarsal plate from the cutis-muscle sheet. After excision of tarsal scar tissue and of the marginal metaplastic tarsus a new eyelid margin is formed by tarso-conjunctival advancement, correcting trichiasis and cicatricial entropion. During the time from August 1984 to December 1991 this surgical procedure was conducted on 16 patients, correcting 18 upper and 4 lower eyelids. 11 patients suffered from severe chemical and thermal burns, 2 patients from Stevens-Johnson-syndrome, 2 patients from ocular pemphigoid and 1 patient from herpes zoster infection. RESULTS: All patients were examined at least once in the first 6 postoperative months, 11 patients are still under continuing outpatient review. The mean follow-up time is 27 months, the minimum follow-up period is 7 months. In 7 patients the surgical procedure prepared conditions for a successful keratoplasty and in 5 other cases the keratopathy healed. In 4 cases a recurrence of the entropion occurred (18% recurrence rate). CONCLUSIONS: The presented surgical procedure is a promising alternative to more complicated procedures for correcting cicatricial entropion with keratinization of the marginal tarsus.

Adult↗
PubMed1993

[Clinical experiences with adhesive hard contact lenses].

BACKGROUND: Persistent epithelial defects of the cornea are difficult to treat and can lead to severe complications such as melting processes. Therefore the application of a glued-on hard contact lens as an artificial epithelium has been recommended for many years, to protect the denuded corneal stroma. MATERIALS AND METHODS: This paper presents a 7-year retrospective study on the application of a hard contact lens as an artificial epithelium. 46 patients with 50 eyes were treated with this method from january 1985 to march 1992. The majority of the patients suffered from most severe burns of the whole anterior eye segment (group I: n = 29 eyes) or of the cornea alone (group II: n = 13 eyes). A smaller number of patients (group III: n = 8 eyes) presented corneal melting processes associated with other diseases. RESULTS: The patients of group II and III showed the best outcome concerning spontaneous epithelialization and prognosis for a penetrating keratoplasty. The treatment with a glued-on hard contact lens was limited by the high rate of complications (92%) in group I and II. In one third of the cases of group I these complications led to further surgical interventions (e.g. conjunctivoplasty of the globe). The results also show, that the application of a glued-on hard contact lens in patients with most severe eye burns is a long-term treatment (> one year). CONCLUSION: The poor prognosis of corneas with severe healing problems of the epithelium can be improved by the application of a glued-on hard contact lens as an artificial epithelium. In severe burns of the whole anterior eye segment however, the treatment with an early keratoplasty should be considered.

Burns, Chemical↗
PubMed1993

[Chemical and thermal eye burns in the residential area of RWTH Aachen. Analysis of accidents in 1 year using a new automated documentation of findings].

BACKGROUND: Until now there were no statistical data on the incidence and the prevalence of eye burns. Therefore we studied all patients coming to our hospital from the area of Aachen with eye burns during the time from September 1990 until August 1991. PATIENTS AND METHODS: All patients underwent a standardized examination including special history of the burning agent, industrial medical aspects and the employers liability insurance association. The documentation of the anterior eye segment pathology was scored separately for each eye encoded by location and special items. This documentation was worked up by the aid of a database (Filemaker II). 171 patients with eye burns were documented during one year. 65 patients had both eyes burned resulting in 236 documented records. RESULTS: The 171 accidents can be divided in 104 (61%) industrial accidents and 64 (37%) housework accidents. 3 accidents were of unknown origin. Classification of burns was scored according to Reim 1991. 208 (88%) eyes showed score I burns, 27 (11.5%) score II and only one patient showed a score III eye burn. We saw 121 (70%) male patients, 39 (23%) female patients and 11 children (7%). The main age group ranged from 16-45 years. 28% (n = 30) of all accidents happened in machine factories, which have thereby in our study the highest incidence of industrial accidents. CONCLUSION: By means of a one-year statistic we found that over 60% of all eye burns were industrial accidents, 28 in machine factories and 20% in service industries. 37% houseworks accidents are very difficult to prevent because of a deficit of safety rules.

Accidents, Home↗
PubMed1993

[Retrospective study of severe alkali burns of the eyes].

BACKGROUND: Alkali burns are of special interest because of the rapid and deep penetration of alkali into the ocular tissues. PATIENTS AND METHODS: This report examines the epidemiology, management and outcome of 42 cases of alkali burns of the eye admitted to the eye clinic of the RWTH Aachen from 1985 to 1992. Aspects examined were the nature of accident, type of alkali, treatment and complications. The intention was to use this information for improvement of prevention and treatment of these cases. RESULTS: The age analysis showed the greatest at-risk population were the 20-40 year-old patients. 73.8% were industrial accidents, 30% happened to builders and labourers, 20% in the chemical industry and 20% in machine factories. At home most of the injuries were caused by lime and drain cleaners. Sodium and potassium hydroxide produced more extended and deeper damages than lime due to their rapid penetration through the ocular tissues. A delayed surgical intervention led to a longer time of stay in hospital and to a higher number of operations. All eyes could be prevented from melting, but an optical rehabilitation (visual acuity > 0.3) was achieved only in a few cases (14.5%). CONCLUSION: There is a need to ensure adequate public awareness of the danger of alkali burns to the eye. Beside the primary prevention, adequate first aid with immediate and continuous irrigation is of paramount importance. A uniform concept for the management of these severe cases is necessary including an antiinflammatory medical and surgical treatment.

Accidents, Occupational↗
PubMed1993

[Keratoplasty with 11-12 mm diameter for management of severely chemical-burned eyes].

Up to now 73 patients with 101 very severe eye burns have been operated on in our clinic. Thirty-nine patients were treated by a penetrating keratoplasty. More than 1 year after the accident 8 patients were treated with keratoplasties, 11-12 mm in diameter. These large diameters were necessary, because 6 patients developed widespread progressive corneal ulcerations, and in 2 patients the artificial epithelium failed to protect the denuded corneal stroma and sloughed off because of deep stromal defects. The long-term follow-up in these cases is now at least 1 year. Six grafts remained clear with a healthy epithelial layer. The resulting visual acuity in these cases ranged from 0.1 to 0.5. Five patients developed a cataract secondary to the application of steroids. Two grafts were rejected in a very early period 2-3 months after transplantation. In corneal melting processes including the limbal region, treatment with large keratoplasties seems to be a possibility for long-lasting healing and rehabilitation in very severe eye burns. Important for the prognosis of the graft obviously is the restoration of an intact limbal region.

Adolescent↗
PubMed1993

[Surgical therapy of pterygium. Incidence of recurrence after free conjunctival transplant and surgical techniques without transplantation].

A retrospective examination was conducted on 104 patients who had undergone operations for a pterygium over a time period of 2-73 months. Thirty-one patients were operated on with a free autologous conjunctival transplant; in 40 cases a conjunctival suture was performed and in 33 cases the bare sclera technique was used. The pterygium and any recurrences were scored clinically from 0 to 4. Small recurrences with a score less than 3 and a small conjunctival corpus were called "calm" recurrences. A bigger corpus and a head with a score > or = 3 and parallel vessels were called "active" recurrences. The recurrence rates were taken as the total calm and active recurrences. Autologous conjunctival transplant had a recurrence rate of 32.3%, excision with conjunctival suture 58.5%, and the bare sclera technique had a recurrence rate of 66.7%. Excision techniques cause high rates of recurrences, severe conjunctival scarification and irritation for a long time. A free autologous conjunctival transplant from the same or other eye to the place of excision improves the rate of recurrences even when the condition is more severe initially. Even though more complicated operation methods decrease the rate of recurrence, but 20-35% recurrence rates are still not satisfactory.

Conjunctiva↗
PubMed1993

[Reconstructive surgery of extremely severe chemical eye burn with perforation].

A 23-year-old female received a very severe burn in the anterior eye segment of both eyes from hydrochloric acid. During medical treatment over a period of 4 weeks in an outpatient clinic, the left eye perforated because of corneal and scleral ulceration. In the first emergency operation the necrotic tissue was excised in both eyes. Scleral ulceration in the right eye was treated by a tenonplasty. In the left eye a tenonplasty was carried out in all quadrants. Because of the large amount of ulceration in the cornea, a keratoplasty with a scleral rim was performed. On this occasion a fibrinous membrane was pulled off the iris. The cataractous lens released spontaneously. Finally an anterior vitrectomy was carried out. Two weeks later endophthalmitis occurred. Therefore, a vitrectomy was performed. Microbiological examination yielded mold fungus. Seven days after this operation another infiltration of the vitreous could be detected sonographically. During the third operation 10 mm of the first 16-mm transplant was trephined for another keratoplasty. An open-air vitrectomy was carried out as well. Nevertheless, the bulbus became phthisic afterwards. Amazingly the tenonplasty led to complete regeneration of the conjunctiva and healing of the scleral ulceration. It was possible to take an autologous transplant of the conjunctiva from the eye and graft it on the right eye to relieve a nasal superior symblepharon. After successful keratoplasty visual acuity of the right eye is 0.5.

Adult↗
PubMed1992

Further evidence that acanthosis nigricans maligna is linked to enhanced secretion by the tumour of transforming growth factor alpha.

The pathogenesis of cutaneous paraneoplastic syndromes is still under discussion. Since many of these syndromes, including acanthosis nigricans, are proliferative skin disorders it is believed that products secreted by the tumour stimulate the keratinocytes to proliferate. Growth factors like transforming growth factor alpha (TGF-alpha) are known to be highly mitogenic for keratinocytes in vitro. Here we report on a patient with a poorly differentiated gastric cancer and a full clinical picture of acanthosis nigricans characterized by diffuse hyperkeratosis and multiple papillomatous lesions of the skin with involvement of the conjunctivae. In Southern blot analysis of the tumour tissue from this patient amplification of the epidermal growth factor (EGF) receptor, the common ligand for TGF-alpha and EGF, was shown. Immunohistochemically, prominent staining was found throughout the tumour using anti-TGF-alpha antibodies. In a series of 25 investigated gastric tumour biopsies, four tumours showed amplification of the EGF receptor and one additional biopsy was positive for TGF-alpha. Since there is no other report describing the link between TGF-alpha and acanthosis nigricans, except that of Ellis et al. 1987, we present a new case suggesting a possible link between growth factors and acanthosis nigricans maligna.

Acanthosis Nigricans↗
PubMed1992

[A family with blepharophimosis, ptosis, epicanthus inversus and telecanthus. Occurrence of the hereditary marker in five generations].

The condition with blepharophimosis, ptosis, epicanthus inversus and telecanthus is reported in one family over five generations. The syndrome is transmitted as an autosomal-dominant characteristic with a very high penetrance and expressivity, preferentially affecting and being transmitted by males. Affected females were infertile. There were no other accompanying systemic disorders. A three-year-old boy, who develops deprivation amblyopia, was first treated by levator attachment according to Friedenwald's method. Medical canthal surgery followed two years later to correct the epicanthus and telecanthus. A good clinical result was achieved by performing Mustardè's Z-plasty and shortening of the medial canthal ligament. Alternative techniques are reviewed briefly.

Blepharophimosis↗
PubMed1992

Chemical and thermal lesions in the orbital region.

In severe chemical and thermal burns the surroundings of the globe are frequently affected. Longstanding inflammatory reactions and severe scar formation around the globe are consequences from such damage. Lids, tarsi, conjunctival and subconjunctival tissues down to the fornices and the anterior orbit are destroyed. Beside medical therapy various operations are necessary to restore an environment for the globe to allow its survival.

Burns↗
PubMed1992

[Keratoplasty with stored tissue. Initial results of a prospective study].

The first results of a prospective study on 50 patients who were followed up 2, 4, 6, and 12 months after keratoplasty are reported. The patients received a human cornea transplant, which had been cultured in a modified MEM medium for up to 28 days. We observed that the loss of epithelium during organ culture leads to delayed regeneration after keratoplasty. This is especially important for patients who have had this problem almost before transplantation. The slower increase of visual acuity after keratoplasty with organ-cultured material is due to increased folding of Descemet's membrane. Nevertheless the best vision was usually reached within 6 to 12 months. We saw seven immune reactions by which five transplants were lost. A comparatively low rejection rate was observed especially in the group of high-risk patients (27.2%). Organ culture may therefore have some additional positive effects for these patients.

Adult↗
PubMed1992

[2 years experiences with Tenon-plasty].

Tenon plasty proved useful in eye burns, especially in cases involving corneoscleral ulceration. This surgical procedure was carried out in 24 severely burned eyes of 21 patients. A total of 75 Tenon flaps were prepared, each of them covering one quadrant of the anterior eye segment. In 13 cases the burns were fresh, showing necrotic and ischemic areas in the sclera. In seven eyes an extended corneoscleral ulceration had developed and was covered with Tenon plasty. In four cases, when highly inflamed tissue was removed from the limbus the proximal conjunctiva retracted and exposed large areas of the sclera. Again, Tenon plasty was carried out. In all cases, the damage was so extensive that no conjunctiva was available to form flaps for plastic repair. Besides, the extensive ischemia would not allow free transplants. The duration of postoperative observation after Tenon plasty ranged from 6 to 42 months. In 14 of 24 eyes the denuded corneal stroma was covered with an artificial epithelium. In 11 cases keratoplasty was performed. The conjunctival epithelium regenerated in 10 eyes within 10 days, in another 10 eyes within 20 days, and in 4 eyes within 50 days. In all cases, the corneoscleral ulceration healed. Although some symblephara formed, and in a number of cases the cornea became more turbid and vascularized, Tenon plasty was very helpful in shortening the period of intensive inpatient treatment and provided a sound foundation for further reconstructive surgery.

Adult↗
PubMedDate not supplied

[Fluorescence angiography of the anterior eye segment in severe eye chemical burns].

BACKGROUND: Severe eye burns usually result in extensive necrosis of the conjunctiva and subconjunctival tissue. To reduce the reactive inflammatory response excision of the necrotic tissue is necessary. PATIENTS AND METHOD: Between August 1990 and December 1994 fluorescein angiograms of the anterior eye segment were performed in 13 (17 eyes) patients with most severe eye burns. The angiographies were carried out 1-4 days after the accident. Conventional photo angiography was performed using a fundus camera (NF 505-AF Nikon). RESULTS: The angiograms revealed characteristic patterns that provided exact information on the perfusion of burned conjunctival and underlying tissue. It was particularly useful in the detection of clinically not recognisable subconjunctival ischemia. In addition, perfusion of the episcleral vessels and the extent of scleral ischemia could be quantified. According to the angiographic findings subtile excision of the necrotic tissue was performed and vascularized tissue was preserved. CONCLUSION: Anterior segment angiography is a valuable method in assessing the extent of necrosis of the conjunctiva and underlying tissue and in determining scleral ischemia. It provides a basis for deciding the extent of surgical debridement of necrotic tissue in the acute phase of the burn. The quantification of limbal and scleral ischemia may give useful information for early plastic-reconstructive procedures.

Adult↗