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T Klink

Publications and source records attributed to T Klink.

14 recordsLinked to original sources
PubMed2006

Long-term results of Erbium YAG-laser-assisted deep sclerectomy.

PURPOSE: To evaluate the long-term results of Erbium YAG-laser-assisted deep sclerectomy (DS). In this procedure, the delicate dissection of a deep corneoscleral lamella is greatly simplified by using the Erbium YAG-laser. METHODS: Data of 14 consecutive patients (10 male, four female, age 67.7+/-10.4 years), who underwent surgery from 1999 to 2000 were analysed retrospectively. The procedure was begun as a standard DS. The deep corneoscleral lamella was dissected with a pulsed Erbium YAG-laser (energy: 40-100 mJ, frequency: 5-10 Hz). Schlemm's canal was unroofed and the lamella thinned until aqueous percolated continuously through the membrane. RESULTS: The mean follow-up time was 50.4+/-6.8 months. The mean preoperative intraocular pressure (IOP) was 37.7+/-10.5 mmHg. The mean postoperative IOP was 16.1+/-3.9 mmHg at 1 month, 15.1+/-4.3 mmHg at 3 months, 16.4+/-4.5 mmHg at 12 months, and 17.6+/-8.7 mmHg at 50.5 months. The complete success rates (IOP< or =21 mmHg+IOP reduction > or =20% without glaucoma medication) were 83.3% at 3 months and 50% at 12 and 50.5 months. Rates for qualified success (IOP< or =21 mmHg+IOP reduction > or =20% with glaucoma medication) were 91.7% at 3 months, 92.9% at 12 months, and 78.6% at 50.5 months. The number of glaucoma medications was reduced from 3.07+/-0.92 preoperatively to 1.14+/-1.41 at 50.5 months. A single case of anterior-chamber penetration, requiring iridectomy, was the only intraoperative complication. CONCLUSIONS: Erbium YAG-laser-assisted DS has the advantage of a greatly simplified dissection, while offering a successful long-term IOP control comparable to conventional DS.

Adult↗
PubMed2006

Impact of low back pain on functional limitations, depressed mood and quality of life in patients with rheumatoid arthritis.

Low back pain (LBP) and rheumatoid arthritis (RA) are common orthopedic problems, but there is little information on the importance of LBP in RA patients. The aim of this study was to investigate how LBP affects functional limitations, depressed mood, and quality of life in patients with RA. A complex questionnaire was answered by 281 RA patients, including questions about their RA and their experience of LBP. Functional limitations were assessed using the Hannover Activities of Daily Living questionnaire (ADL), depressed mood using the Center for Epidemiological Studies Depression Scale (CES-D) and health-related quality of life using the Short Form 12 health questionnaire (SF-12). The prevalence of LBP in RA patients was 53.4%. RA patients with LBP displayed a significantly higher degree of disability and depression than RA patients without LBP. There were no differences between the two groups with regard to the duration of RA, the number of operations or medication. LBP is an important factor for the physical and psychological behavior of RA patients. Therefore, the onset of LBP should not be overlooked or underestimated.

Arthritis, Rheumatoid↗
PubMed2006

Metronomic trofosfamide inhibits progression of human lung cancer xenografts by exerting anti-angiogenic effects.

BACKGROUND: Recent studies of conventional chemotherapeutic drugs administered in metronomic therapy schedules showed remarkable inhibitory effects on tumor angiogenesis. Subsequent and prolonged tumor regression was achieved moreover by circumventing acquired drug resistance. In this study, metronomic and conventional trofosfamide were compared on human NSCLC xenograft "LX-1." MATERIALS AND METHODS: In vitro cytotoxicity of trofosfamide on tumor and human umbilical cord endothelial cells was determined under normoxic and hypoxic conditions. Additionally fractions and duration of cell cycles were analyzed by flow cytometry. In vivo LX-1 xenotransplanted nude mice were treated with trofosfamide in conventional and metronomic schedules (i.p./p.o.). Tumor sections were evaluated for microvessel density (MVD), relative growth fraction and apoptosis. RESULTS: In contrast to the rapid growth of conventionally treated lung cancer, long lasting tumor growth retardation over the total treatment period was achieved with metronomic treatment. While growth fraction and apoptotic rate of LX-1 cells remained unchanged, the MVD was significantly reduced (50%). CONCLUSION: Our results show advantages of a metronomic trofosfamide schedule compared to a conventional bolus therapy mainly due to inhibition of angiogenesis. In vitro data show that this mechanism works under normoxic and hypoxic conditions and suggest that this is in part a direct cytotoxic effect on endothelial cells.

Angiogenesis Inhibitors↗
PubMed2006

[Postoperative care after glaucoma filtration surgery].

Scarring of the filtering bleb is the main complication after glaucoma filtration surgery. Postoperative care most importantly determines success or failure of the operation. Both, preoperative antiinflammatory treatment and reduction or discontinuation of topical medication have a positive effect on postoperative conjunctival wound healing. After conventional postoperative care only about 40% of patients reach target pressures in the long-term without topical medication. Intensified postoperative care (IPC) increases the success rate by 25% after 5 years. Central to the concept of IPC is a wound modulating therapy which is adapted to the phases of wound healing of the filtering bleb. Evaluation of filtering bleb morphology is a prerequisite for the application of topical steroids and 5-fluorouracil. In addition, dedicated counseling of the patient and close follow-up are mandatory. In order to further increase the success rate of penetrating glaucoma surgery and decrease the side effects of the current antimetabolite therapy more research on wound healing as well as specific therapy to prevent scarring are necessary.

Administration, Topical↗
PubMed2005

Filtering bleb function after clear cornea phacoemulsification: a prospective study.

AIM: To evaluate the influence of clear cornea phacoemulsification on filtering bleb morphology, function, and intraocular pressure (IOP) in glaucomatous eyes with previously successful filtering surgery. METHODS: The clinical course of 30 patients (30 eyes) who underwent clear cornea phacoemulsification after successful filtering glaucoma surgery was prospectively evaluated. Mean IOP and filtering bleb morphology (standardised assessment criteria and score 0-12, 12 = optimum) were determined before surgery, and 3 days, 6 months, and 12 months after surgery. The control group consisted of 36 patients with glaucoma after clear cornea phacoemulsification without previous filtering surgery. RESULTS: Mean IOP increased after phacoemulsification by about 2 mm Hg (preoperatively 14.28 (SD 3.71) mm Hg, 12 months postoperatively 16.33 (3.31) mm Hg, p = 0.006). 15 patients (50%) showed an IOP increase of >2 mm Hg, 11 patients (36.7%) had no IOP difference (within 2 mm Hg), and in four patients (13.3%) IOP decreased >2 mm Hg. Mean score of filtering bleb morphology 1 year after surgery decreased from 9.5 to 9.0 (p = 0.154). In three of 30 preoperatively IOP regulated eyes the postoperative IOP was 21 mm Hg. The control group showed an average IOP decrease of 2.01 mm Hg (p = 0.014) 12 months after cataract surgery. CONCLUSION: An increase in IOP was found 1 year after phacoemulsification in half of the filtered glaucomatous eyes. IOP in glaucomatous eyes without previous filtering surgery decreased in the same period. Cataract extraction using clear cornea phacoemulsification may be associated with a partial loss of the previously functioning filter and with an impairment of filtering bleb morphology.

Aged↗
PubMed2004

[Combined glaucoma-cataract surgery].

Trabeculectomy is the most commonly used glaucoma procedure for combined glaucoma-cataract surgery. The results are, however, challenged by rather frequent exudation of fibrin into the auterior chamber. Therefore, two separate procedures can be recommended if there is no urgent need for a combined glaucoma-cataract operation. The other glaucoma procedures that were described in combination with cataract surgery are trabeculotomy, deep sclerectomy, viscocanalostomy, trabecular aspiration, and laser trabecular ablation. The IOP lowering effect of these procedures seems somewhat less effective. However, there is also a lower complication rate. In combined procedures, a separate temporal clear cornea approach for phacoemulsification is superior to a one-site approach. Nuclear expression techniques and corneoscleral incisions should no longer be used in combined glaucoma-cataract surgery.

Cataract↗
PubMed2001

Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein.

BACKGROUND: Treatment of choice for symptomatic carotid-cavernous and cavernous-dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization. METHODS: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, and secondary glaucoma. One patient had visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula was confirmed in two cases by color Doppler imaging and in all three cases with cerebral arterial angiography (two carotid-cavernous fistulas, one cavernous-dural fistula). After an unsuccessful transarterial attempt, embolization via the superior ophthalmic vein was chosen. RESULTS: In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by an approach via the femoral vein. All three patients had complete resolution of symptoms. There were no recurrences. CONCLUSION: Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients.

Aged↗
PubMed2000

[Findings of optical coherence tomography (OPT) before and after macular hole surgery].

PURPOSE: We used optical coherence tomography (OCT) for the staging of macular holes and compared our results with clinical and intraoperative findings. PATIENTS: Between 1 January 1997 and 15 October 1998, 80 patients underwent vitrectomy for idiopathic macular holes. In 36 cases we could record an OCT preoperatively and in 24 cases also postoperatively. OCT measurements were analyzed in a blind fashion independent of the clinical pre- and intraoperative findings. RESULTS: Preoperative OCT staging was in agreement with the intraoperative findings in 24 of 36 cases. However, in 8 cases, the macular hole was judged as stage 3 intraoperatively, while OCT revealed a stage 4 hole. Postoperatively, OCT results were consistent with the clinical findings in all 24 cases. CONCLUSION: OCT scans are a valuable adjunct for the pre- and postoperative analysis of idiopathic macular holes. As the posterior hyaloid surface cannot always be reliably identified in OCT, discrimination between stage 3 and 4 is difficult.

Humans↗
PubMed2000

[Early and late findings with optical coherence tomography (OCT) in patients with postoperative hypotonia].

PURPOSE: To study early and late findings of macular retinal thickness in patients with hypotony following filtering procedures. PATIENTS AND METHODS: 13 patients who had undergone trabeculectomy (9 with antimetabolites) developed ocular hypotony. The macular region appeared normal during biomicroscopy in 8 patients. In the hypotensive phase, macular thickness was measured using optical coherence tomography (OCT). Directly after attempted and successful normalization of intraocular pressure (7 spontaneous, 5 operative, 1 failure) as well as 6 months later, OCT measurements were repeated. Foveal thickness in the hypotonous eye was correlated with visual acuity and foveal thickness in the fellow eye. RESULTS: Intraocular pressure could be raised from a mean of 2.5 +/- 1.3 mmHg to 11.5 +/- 5.5 mmHg and later on to 13 +/- 3.7 mmHg (follow-up). Mean foveal thickness was reduced from 211 +/- 73 microns during hypotony to 170 +/- 44 microns after normalization of intraocular pressure and to 171 +/- 38 microns at late follow-up. Mean visual acuity improved from 0.17 to 0.33 and finally to 0.6. CONCLUSIONS: Despite normal appearance of the macula (8 patients) using biomicroscopy in patients with hypotony, retinal thickness in the fovea is increased. Apart from refractive changes, this retinal thickening can be held responsible for the deterioration of visual acuity in eyes with hypotony. OCT analysis and measurements may be useful to distinguish between retinal thickening that is reversible after normalization of intraocular pressure and cystoid macular edema that leads to permanent visual impairment.

Adult↗
PubMed2000

[CO2 and erbium YAG laser in eyelid surgery. A comparison].

BACKGROUND: Lasers are finding increasing use in cosmetic and reconstructive plastic surgery. We compared the erbium-YAG laser and the CO2 laser to conventional eyelid surgery with a scalpel. MATERIAL AND METHODS: We operated on 58 patients using the erbium-YAG laser and on 32 using the CO2 laser. Surgeries were benign tumor excisions and removal, xanthelasma removal, lower and upper eyelid blepharoplasties, and skin resurfacing in the area of the lower eyelid. RESULTS: Wound healing with the CO2 laser was significantly slower because of its larger thermal necrosis zone, but the hemostasis with the CO2 laser makes removal of deeper lesions easier. Advantages are the wide application spectrum for incisional and ablative surgery. The erbium-YAG laser is an excellent for ablating superficial benign lesions, including that in the area of the lid margin and close to the lacrimal puncta without scars. SUMMARY: The application spectrums of the erbium-YAG and CO2 lasers complement one another. The erbium-YAG laser is superior for esthetic skin resurfacing and ablation of superficial lesions, and the CO2 laser allows hemorrhage-free noncontact incisional surgery.

Blepharoplasty↗
PubMed2000

Erbium-YAG laser-assisted preparation of deep sclerectomy.

BACKGROUND: Deep sclerectomy and viscocanalostomy are becoming more and more popular as non-penetrating filtering procedures. The purpose of the present study was to simplify the technique of this procedure and to reduce the rate of unintended perforations during the preparation of the deep lamella. METHODS: 20 enucleated porcine eyes were used. A superficial lamellar scleral flap with an area of 5x5 mm as for trabeculectomy was surgically prepared. Using a pulsed erbium:YAG laser the deep lamella (220 +/- 40 microm) with an area of 4x3 mm was removed. Ablation was performed with an energy of 40-100 mJ, a frequency of 1-10 Hz and a spot size of 500 microm and 1 mm (divergent beam). During the procedure the intraocular pressure was kept constant by continuous infusion. Finally the eyes were analyzed histologically. RESULTS: After initial trials it was possible to ablate the remaining deep corneoscleral lamella with the erbium:YAG laser without perforating into the anterior chamber. Starting with an energy of 70-85 mJ and a reduction to 40-60 mJ when reaching deeper layers, a spot size of 500 microm and a 10 Hz repetition rate gave the highest safety and efficiency in preparation. After a learning curve it was possible to preserve Descemet's membrane and intact trabecular meshwork in 10 consecutive operations as demonstrated by histology. CONCLUSION: Erbium:YAG laser-assisted deep sclerectomy offers an alternative to microsurgical preparation of the deep scleral lamella. The thermal damage is minimal (10-40 microm) and scarring may therefore not be stimulated.

Animals↗
PubMedDate not supplied

Linear scleroderma 'en coup de sabre' associated with cerebral and ocular vasculitis.

Linear scleroderma 'en coup de sabre' (LSCS) has been reported in association with intracranial abnormalities. We report the case of an 11-year-old boy with LSCS who presented with recurrent headaches. Cranial magnetic resonance imaging (MRI) and angiography were consistent with the diagnosis of a cerebral vasculitis. In addition, retinal examination showed an exudative inflammatory lesion consistent with vasculitis.

Cerebral Angiography↗