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Biomedical subjects

R Sundmacher

Publications and source records attributed to R Sundmacher.

At least 127 records · Page 7Linked to original sources
PubMed1994

Anterior capsular shrinkage and intraocular pressure reduction after capsulorhexis.

A significantly lower intraocular pressure level was found 2 months after in-the-bag implantation of 4 different posterior-chamber lenses in a consecutive series of operations involving 401 eyes. The anterior capsular opening was achieved with either an intact continuous circular capsulorhexis (349) or a capsulorhexis with one radial tear (52). The typical shrinkage of the anterior capsule following a continuous capsulorhexis was hypothesized to be an essential part of the pressure-lowering mechanism by traction on the ciliary body via the zonula. However, a direct correlation between the degree of anterior capsular shrinkage and the degree of pressure reduction in glaucomatous and non-glaucomatous eyes could not be established. The reduction was equal in all shrinkage subgroups. Thus, the most likely explanation for intraocular pressure reduction after intracapsular implantation should be sought not in mechanical but in non-mechanical (i.e. biochemical) alterations and influences.

Adolescent↗
PubMed1994

Black-diaphragm intraocular lens for correction of aniridia.

In cooperation with Morcher GmbH, we developed a black-diaphragm aphakia intraocular lens (IOL) designed to correct congenital and traumatic aniridia. Since June 1991, we have implanted this IOL into five eyes with congenital aniridia combined with cataract, and into eight eyes with traumatic aniridia combined with cataract or aphakia. Positioning the IOL was rather difficult, especially in the traumatic cases with inadequate capsular support, and in combination with penetrating keratoplasty. After up to 15 months' follow up, functional results are encouraging. However, slight persistent intraocular inflammation was observed in all of the eyes, more obviously in the traumatic cases. The effect of the IOL on the corneal endothelium is still being investigated. Cystoid macular edema was observed in one eye, but probably preexisted in this eye, following several earlier surgical procedures. Glaucoma was observed preoperatively in five eyes; postoperatively, in six. After surgery, it was controlled medically in 4 eyes, surgically in 1, and remained uncontrolled in 1.

Adolescent↗
PubMed1993

[Surgical technical principles of trans-scleral suture of posterior chamber lenses].

BACKGROUND: Most reports on transscleral suture fixation of posterior chamber lenses (PCL) do not mention the principal difficulty that the surgeon has no valid information which structures were perforated by the needle and where he happened to fix the PCL loops. To know this exactly is a "conditio sine qua non". Without it, no valid evaluation of longterm results of this method will ever be possible. MATERIALS AND METHODS: Thirtythree PCL were fixated by transscleral suturing. The results of the decisive surgical steps were controlled by intraoperative endoscopy. The experiences and insights gained thereby were used to develop step by step optimal surgical procedures for different conditions. The results of the endoscopically controlled group were compared with the results of 128 eyes with transscleral suture fixation of a PCL without endoscopic control between 6/88 and 4/91. RESULTS: On the basis of systematically performed endoscopic controls during surgery we have identified several faults and pitfalls which should be avoided. In consequence we have developed rules and items that should be fulfilled in order to arrive at an anatomically correct position of the PCL: 1. The transscleral suture should only penetrate the sulcus and no adjacent structures of the iris or the ciliary processes. 2. The PCL loops must be primarily directed into the sulcus, 3. PCL design must be adapted to the anatomical needs of the procedure and must provide a safe distance between iris and PCL to avoid iris-shafting. Detailed suggestions are given to fulfil these requirements. The most important point is the two-step implantation of the PCL out of the anterior chamber into the posterior chamber to avoid a steep and disadvantageous implantation angle. Up to date, no cases with chronic intraocular inflammation have occurred in the endoscopically controlled group in contrast to the earlier non-controlled group. CONCLUSIONS: Our results allow--even without endoscopic control--an exact positioning of the PCL hepatics in the sulcus, which is the most important step in the whole procedure. However, for a scientific evaluation of longterm results after transscleral suturing of PCL endoscopic control will further be needed to demonstrate or to rule out any potentially harmful compression of the ciliary body or iris structures and to see whether or not such irregularities will be associated with reduced longterm tolerance.

Endoscopes↗
PubMed1993

[5-fluorouracil injection treatment after fistulating glaucoma operations].

BACKGROUND: Since 1984 subconjunctival 5-Fluorouracil injections have been applied with success after filtering surgery. It was the purpose of this retrospective study to find out whether the results justify this treatment in view of all side effects. MATERIALS AND METHODS: Between 2/1991 and 1/1993 twenty-nine eyes of 11 female and 16 male patients with high-risk glaucoma (unsuccessful previous filtering surgery and a high risk of scarring) were treated with subconjunctival injections of 5-Fluorouracil after filtering surgery in the University Eye Hospital Düsseldorf. The mean age of the patients was 58 (11-84) years and the mean follow-up period was 16 (4-24) months. The mean amount of injected 5-Fluorouracil was 43 (5-85) mg. Glaucoma was regarded as controlled when intraocular pressure levels were reduced by more than 20% of the preoperative level and stayed consistently below 21 mm Hg. RESULTS: 26 (89.6%) of the eyes had controlled intraocular pressure during the follow-up period. Two eyes were controlled only after additional cyclocrycoagulation, and 1 glaucoma has remained uncontrolled. Postoperatively we observed fistulas of the conjunctiva in 24% of the eyes and 69% of the eyes had corneal epithelial breakdown problems. It is unlikely that subconjunctival injections of 5-Fluorouracil work only by inhibiting scarring of the filtration bleb. Long-lasting e-vacuo-symptoms in single cases with no functioning bleb at all as well as scarred blebs in 9 of 26 eyes with controlled glaucoma must be interpreted as a probable sign of 5-Fluorouracil toxicity on the ciliary epithelium. CONCLUSIONS: Subconjunctival injections of 5-Fluorouracil after filtering surgery are helpful to control high-risk glaucoma, but there are several disadvantages of this treatment as fistulas of the conjunctiva, corneal surface problems, discomfort for the patient, difficult follow-up and a potential toxicity on the ciliary epithelium that may be pronounced in some cases. Therefore, subconjunctival injections of 5-Fluorouracil after filtering surgery are a useful means for eyes with a high risk of scarring. However, 5-Fluorouracil should not be applied for primary normal glaucoma surgery.

Adolescent↗
PubMed1993

[Corneal puncture in recurrent corneal erosion].

On the long term, conventional therapy of recurrent erosion (posttraumatic, dystrophic, idiopathic) by patching, bandage lenses and debridement often does not avoid recurrences. Between February 1990 and June 1992 we performed anterior stromal punctures in 47 eyes of 45 patients with recurrent erosion which had not responded to conventional therapy. Our current results during an average follow-up period of 12 months are: 1. Anterior stromal puncture is a safe procedure if exerted under the operation microscope. In our patients perforations did not occur. 2. Neither early postoperative complications, e.g. corneal ulcers, nor long-term postoperative complications, e.g. vision limiting severe stromal scars, could be observed. 3. About 81% of our patients experienced no further recurrence. Another 11% benefitted from significant reduction of recurrences. Therapeutic response was equally good in patients with dystrophic as well as in patients with posttraumatic recurrent erosion. Therefore anterior stromal puncture, if exerted properly, represents a safe and effective therapy in patients with recurrent erosion. For a final judgement much larger groups of patients must be treated in controlled studies and a much longer follow-up period is necessary.

Adult↗
PubMed1993

[Mitral valve prolapse. A possible cause of retinal vascular occlusion in young patients].

Retinal vessel occlusion in the elderly is considered to be of arteriosclerotic etiology, but in young patients the reasons for retinal vessel occlusions are manifold and much more obscure. We report on five patients under the age of 45 years who had retinal artery occlusion or retinal vein obstruction. A detailed general investigation revealed nothing but an identical cardiac abnormality in all five cases: mitral valve prolapse (MVP). A potential explanation for the coincidence of retinal vessel occlusion and MVP might be local hyperaggregability of platelets generated by the prolapsing mitral valve. In conclusion, to prevent retinal vessel occlusion from recurring in patients with proven MVP, medication containing platelet aggregation inhibitors should be given.

Adult↗
PubMed1993

Cerebral complications in acute posterior multifocal placoid pigment epitheliopathy.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a self-limited ocular disease with a favorable visual outcome. Regarding its pathogenesis, there is increasing evidence of a vascular disorder of the precapillary choroidal arterioles that causes ischemic edema of the overlying retinal pigment epithelium. Systemic and neurological abnormalities associated with APMPPE have been documented. The development of severe cerebral vasculitis simultaneously or after a period of months or even years has been described in only a few cases. We present two new well-documented cases that developed several months after manifestation of the characteristic findings of APMPPE. A thorough medical and neurological workup is recommended, as is careful information of the patients and their families about the signs and symptoms of potential associated cerebral complications so as to facilitate early and adequate treatment.

Acute Disease↗
PubMed1993

[Endoscopically controlled optimization of trans-scleral suture fixation of posterior chamber lenses in the ciliary sulcus].

Two technical difficulties have to be overcome in transscleral suture fixation of posterior chamber intraocular lenses (PCL) in the ciliary sulcus: first, exact needle penetration through the sulcus, and second, exact positioning of the PCL haptics in the sulcus. Incongruence of the two may lead to long-term complications by compression or even strangulation of ciliary processes. Intraocular endoscopy was used intraoperatively to visualize the site of needle penetration and the final location of the haptics in patients. It turned out that with our previously described standard techniques the precision was far less than anticipated. Thus, new technical ways had to be sought to improve the precision of positioning. In secondary implantation without perforating keratoplasty we achieved the best results when the needle was passed ab externo before opening the eye and before anterior vitrectomy, taking advantage of a precisely prepared sclerocorneal zone. Passing the needle ab externo in an already hypotonic eyeball gives much less precise results. In combination with perforating keratoplasty with an open-sky approach, needle penetration ab interno is reliable. Correct positioning of the PCL haptics is at least as difficult as correct needle penetration, a fact which up to now has mostly been ignored. In 33 consecutively operated eyes the technique of implantation and PCL design was varied under endoscopical control.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1993

Four years' experience with triple procedures in herpes-afflicted eyes.

Keratoplasties are performed relatively frequently in herpes-afflicted eyes. However, intraocular lenses (IOLs), for eyes with intraocular recurrent herpes simplex virus (HSV) disease remain a verdict in most surgical centers. As most herpetic disease is uniocular and cataract is a frequent complication in the long run, a real need exists for triple procedures in such eyes so as to achieve their full visual rehabilitation. Taking full advantage of systemic aciclovir therapy and prophylaxis, we started with triple procedures in herpes-afflicted eyes in 1987. Up to July 1991, we operated on 29 eyes, and 28 could be optically rehabilitated. One eye was given up and received a conjunctival cover for sociomedical reasons. Three repeat keratoplasties (10%) were necessary, and a considerable number of complications had to be overcome; ten eyes suffered from sustained fibrinous exsudations (35%), ten were threatened by one or more endothelial immune therapy reactions (35%), and ten experienced one or more herpes recurrences (35%), mostly intraocular recurrences. As this study was not performed as a randomized, placebo-controlled, double-blind study, no absolute scientific proof of aciclovir's value in these patients can be presented. Nonetheless, we would conclude from the exceedingly good rehabilitation rate of 96% observed during an average follow-up period of 19 months that in all probability, systemic aciclovir was in the first rank responsible for this success rate. Thus, there is good clinical evidence that systemic aciclovir prophylaxis and therapy is indeed the most important key for successful triple procedures in eyes afflicted with herpetic disease.

Acyclovir↗
PubMed1992

[Risk factors for fibrinoid reaction after posterior chamber lens implantation--a retrospective study].

Previous ocular diseases (e.g. herpetic keratouveitis), glaucoma, previous ocular surgery and surgery longer than normal turned out to be the main risk factors for a fibrinoid reaction after an extracapsular cataract extraction with posterior chamber lens implantation in patients of the Universitäts-Augenklinik Düsseldorf between June 1989 and March 1990. This result was obtained from a retrospective study of the medical records. No special risks could be concluded neither from the presence of general diseases (e.g. diabetes mellitus, consumptive basic diseases), immuno-suppressive treatment, constitutional factors, nor from age, sex, operative method nor from the surgeon. Preoperative antiexsudative prophylactic treatment is suggested for patients with one or more risk factor.

Adult↗
PubMed1992

[Perforating keratoplasty in endogenous eczema. An indication for systemic cyclosporin A--a retrospective study of 18 patients].

Endogenous eczema represents a considerable risk for perforating keratoplasty because of the associated chronic surface disorders and complex immunological disturbances. Between December 1986 through October 1991 we performed 24 perforating keratoplasties in 20 eyes of 18 patients with endogenous eczema suffering from keratokonus, atopic keratokonjunctivitis and bullous keratopathy after intracapsular cataract extraction. During the follow-up period of 16 (3-48) months 6 transplants failed mostly due to surface problems as well as immune reactions and bacterial transplant infections. Systemically administered ciclosporin A was found to eliminate many of the previously unsolved problems. In summary, 18 out of 20 eyes achieved an improved visual acuity with clear transplants.

Adult↗
PubMed1992

Transscleral suture fixation of posterior chamber intraocular lenses through the ciliary sulcus: endoscopic comparison of different suture techniques.

Two technical difficulties exist in transscleral suture fixation of posterior chamber intraocular lenses (PCL) in the ciliary sulcus: first, exact needle penetration of the sulcus and second, exact positioning of the PCL haptics in the sulcus. We used, for the first time, intraocular endoscopy to visualize the site of needle penetration and the final location of the haptics in patients. It turned out that with our previously described standard techniques, precision was far less than anticipated. Thus, new technical ways had to be sought to improve the precision of positioning. In secondary implantation, we achieved best results when the needle was passed from the outside before opening the eyeball, taking advantage of a precisely prepared blue-white line. Passing the needle in an already hypotonic eyeball gives much less precise results. In combination with perforating keratoplasty, passing the needle from the inside by feeling one's way into the sulcus with the needle tip gives the best results. Correct positioning of the PCL haptics is at least as difficult as is needle penetration, a fact which up to now has mostly been ignored. More suitable lens designs may offer a solution for this problem. Their clinical value has to be established by intraocular endoscopy.

Cataract Extraction↗
PubMed1992

[Surgical correction of astigmatism after perforating keratoplasty].

Microsurgical control of astigmatism after perforating keratoplasty has widely remained an unsolved problem in spite of many sophisticated suggestions and inventions. The frequent irregularity in the recipient cornea and poor predictability with respect to wound healing are the major obstacles. If spectacles or contact lenses cannot provide useful vision, postoperative surgical correction is needed. Ablative or thermal laser techniques have not been sufficiently tried for such cases to be justified, and one may hesitate anyway to apply destructive methods in transplants. We therefore still use T-incisions and wedge resections, which are said to be rather imprecise. Only 3 out of more than 700 keratoplasties performed in our clinic from 1987 through July 1991 required such procedures. Two more cases were referred by surgeons outside the hospital. All five surgical corrections resulted in a good longterm effect with considerable improvement of vision. Thus, as long as alternative methods for surgical correction of postkeratoplasty astigmatism have not proved to be superior, we should continue to practice these "old" methods, which, indeed, are not bad if properly applied.

Adolescent↗
PubMed1992

Six years' experience with systemic cyclosporin A prophylaxis in high-risk perforating keratoplasty patients. A retrospective study.

Starting with single cases in 1985, we have routinely applied systemic cyclosporin A since 1987 in high-risk keratoplasty patients for a period of up to 37 months postoperatively. In all, 69 eyes undergoing 74 perforating keratoplasties have thus far been treated. A considerable percentage of them initially suffered from chemical burns or from endogenous eczema associated with chronic atopic inflammation. All patients were followed closely and their courses were reevaluated retrospectively. Our current conclusions are that (1) immune reactions are efficiently inhibited with constantly effective blood levels of cyclosporin A, which has enormously increased the rate of keratoplasty successful in these patients; (2) if drug blood levels fall too low due to noncompliance of the patient or to metabolic disturbances, immune reactions may occur, especially during the early postoperative months; (3) serious chronic surface problems, which are especially associated with chemical burns, atopic inflammation, and other chronic kerato-conjunctival diseases, are partly ameliorated but not completely eliminated (surface disorders are presently ranked as the number one cause of transplant failure, whereas immune reactions can be effectively suppressed by cyclosporin A); and (4) close medical follow-up has revealed no serious systemic complication of cyclosporin A prophylaxis over periods of up to 37 months. The present study was not conducted in a prospective, double-blind, controlled fashion.

Adolescent↗
PubMed1991

[Kidney function of patients with healthy kidneys during cyclosporin treatment].

Long-term administration of ciclosporin has been complicated by side-effects, the predominant being nephrotoxicity. We performed renal function studies on 20 patients treated with ciclosporin (group 1) and on 12 patients serving as controls (group 2). Only patients with serum creatinine less than 1.3 mg/dl entered the study. The renal function studies consisted of: Inulin clearance, PAH clearance, sodium sulphate loading, sodium bicarbonate loading. Plasma renin activity (PRA), inactive renin (IR) and aldosterone (ALDO) were measured basally and after stimulation with 40 mg furosemide i.v. Serum creatinine was not significantly impaired under ciclosporin with 1.1 +/- 0.1 mg/dl vs 0.9 +/- 0.1 mg/dl in the control group (ns). Glomerular filtration rates as measured by creatinine and inulin clearance were significantly impaired in group 1 as compared to group 2. Inulin clearance was impaired by ciclosporin with 93.5 +/- 4.4 ml/min/1.73 m2 as compared to 121 +/- 6.6 ml/min/1.73 m2 (p less than 0.05) in patients of group 2. The PAH clearance in ciclosporin treated patients was impaired, with 379 +/- 22.1 ml/min/1.73 m2 in group 1 as compared to 605 +/- 39 ml/min/1.73 m2 (p less than 0.001) in group 2. Mean arterial pressure and renovascular resistance were significantly increased in ciclosporin treated patients. We demonstrated, by means of sodium sulphate and bicarbonate loading, incomplete distal tubular acidosis in 3 patients from group 1 but in none of group 2. There was no difference in basal plasma renin activity (PRA), but during volume contraction induced by furosemide there was only blunted response by PRA in patients receiving ciclosporin with 2.7 +/- 0.3 ng/ml/h as compared to 7.7 +/- 0.5 ng/ml/h in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1991

Experience with transscleral fixation of posterior chamber lenses.

A total of 83 eyes with transsclerally sutured PCLs were followed for an average of 10.5 months (range 2-23 months). The vast majority of patients benefitted considerably from the procedure; 8% of cases experienced a reduction in visual acuity and 2% suffered monocular visual loss. General vascular risk factors seemed to be important in bringing about long-term complications. Patients presenting such a risk must be better identified in the future. The solution of some remaining surgical problems and questions will also add to the safety of the procedure in the future.

Adult↗
PubMed1991

[Recurrent and persistent nummuli after epidemic keratoconjunctivitis].

Three observations of typical patients with persistent and recurrent nummuli after epidemic keratoconjunctivitis serve--pars pro toto--to demonstrate that longterm therapy with high-dosed topical steroid offers no therapeutic solution. This experience and other disadvantages of steroids in KCE (dry eyes) lead us to recommend not to apply topical steroids in KCE unless an adenovirus specific antiviral agent has become available for basic antiviral therapy.

Acyclovir↗