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T Reinhard

Publications and source records attributed to T Reinhard.

At least 55 records · Page 3Linked to original sources
PubMed2001

[FK 506 ointment 0.1 % - A new therapeutic option for atopic blepharitis. Clinical trial with 14 patients].

BACKGROUND: Severe atopic blepharitis is difficult to treat, as topical steroids offer only a limited therapeutic benefit with increasing side effects by time. Topical FK 506 was found to be efficient and safe for treatment of atopic dermatitis in dermatologic studies. The use of topical FK 506 in atopic blepharitis has not been reported so far. PATIENTS AND METHODS: Fourteen patients with severe atopic blepharitis were treated with topical FK 506 0.1 %. The ointment was applied twice daily on the eye lids. Ophthalmologic examinations were scheduled at two weeks, two months and five months after onset of treatment. A score was defined for the skin of the lid (edema, erythema, lichenification, oozing, excoriation and crusting) and for the eye lid margin (erythema, thickening, crusting) respectively. Every patient graded pruritus on a visual analogue scale. RESULTS: The mean skin score prior to treatment was 25.6 +/- 5.8, after two weeks 7.9 +/- 4.8 (p < 0.001), after two months 5.8 +/- 5.0 (p < 0.001) and after five months 5.3 +/- 5.3 (p < 0.001). The mean score for the eye lid margin prior to treatment was 12.3 +/- 4.0, after two weeks 4.6 +/- 2.7 (p < 0.001), after two months 3.8 +/- 2.4 (p < 0.001) and after five months 4.3 +/- 2.6 (p < 0.001). The mean score for pruritus prior to treatment was 8.1 +/- 1.3, after two weeks 2.0 +/- 1.4 (p < 0.001), after two months 1.3 +/- 0.8 (p < 0.001) and after five months 0.8 +/- 0.7 (p < 0.001). All patients assessed the overall situation under therapy as markedly improved. CONCLUSIONS: Topical FK 506 0.1 % ointment turns out to be an excellent therapeutic option for treatment of severe atopic blepharitis. Long-term efficacy and safety have to be evaluated in long-term follow-up studies.

Administration, Topical↗
PubMed2001

Accelerated chronic endothelial cell loss after penetrating keratoplasty in glaucoma eyes.

PURPOSE: Accelerated chronic endothelial cell loss may be the main reason for limited prognosis of penetrating corneal grafts in glaucoma eyes. This hypothesis, however, has not yet been proven and is examined in this article. METHODS: Three groups of normal-risk keratoplasty patients were followed up prospectively. Group I consisted of 172 patients (without glaucoma history and without postoperative increase in intraocular pressure), group II comprised 15 patients (with glaucoma history, but without postoperative increase in intraocular pressure), and group III consisted of seven patients (with glaucoma history and with postoperative increase in intraocular pressure). Immune reactions in the postoperative course were an exclusion criterion. Follow-up periods averaged 2.7 +/- 1.7 years (group I), 2.8 +/- 1.7 years (group II), and 2.6 +/- 2.0 years (group III). Only patients with at least three postoperative endothelial cell density values were included in the study. Loss of endothelial cells. mm-2. d-1 was derived from the postoperative endothelial values of each patient by calculating the slope of the regression line for each scatterplot of endothelial cell density values plotted against time. RESULTS: During the follow-up period 0.82 +/- 0.97 cells. mm-2. d-1 were lost in group I, 1.01 +/- 1.04 cells. mm-2. d-1 were lost in group II, 2.67 +/- 2.16 cells. mm-2. d-1 were lost in group III (ANOVA and Gabriel post-hoc test: I/II P = 0.82, I/III P < 0.001, II/III P = 0.004). CONCLUSIONS: Postoperative increase in intraocular pressure may be a possible cause for accelerated endothelial cell loss in glaucoma eyes, but this result is tentative because of the small number of patients included in the two glaucoma groups. Confirmation by long-term observation of larger patients groups is desirable. The result implies good control of intraocular pressure after penetrating keratoplasty. Whether this method is the correct means by which to prevent accelerated endothelial cell loss in such eyes must be shown in future studies.

Aged↗
PubMed2000

Coadministration of the new macrolide immunosuppressant RAD and mycophenolate mofetil in experimental corneal transplantation.

INTRODUCTION: The effect of RAD, a new macrolide immunosuppressant, was examined as mono- and combination therapy with mycophenolate mofetil (MMF) in prevention of acute allograft rejection in murine corneal transplantation. METHODS: Both drugs were administered orally for 18 days beginning at the day of transplantation. The inbred strains Fisher and Lewis were used as donors and recipients, respectively. Five groups were involved: syngeneic control, allogeneic control, 2.5 mg/kg RAD, 40 mg/kg MMF, and double drug therapy with 1.5 mg/kg RAD and 20 mg/kg MMF. RESULTS: The median transplant survival time in the allogeneic combination was 12 (+/-0.3) days. Monotherapy with 2.5 mg/kg RAD and 40 mg/kg MMF led to a statistically significant prolongation of transplant survival to 25.5 (+/-12.5, P=0.0001) days and 19.5 (+/-13.9, P=0.0053) days, respectively. Combination therapy was superior to both monotherapies (100+/-15.8 days, P=0.03). There was a significant reduction in the number of CD4+, CD8+, as well as CD45RA+ cells in the RAD- and double drug-treated animals when compared with the allogeneic control. This significant reduction in graft-infiltrating lymphocytes has not been found in the MMF monotherapy. CONCLUSIONS: The unique finding of this first study on the combination of RAD and MMF in murine corneal transplantation is that double drug therapy produces a highly synergistic effect in prevention of acute allograft rejection without a higher incidence of complications related to drug toxicity or overimmunosuppression.

Animals↗
PubMed2000

[Local cyclosporin A in nummuli after keratoconjunctivitis epidemica. A pilot study].

BACKGROUND: Recurrences are common after discontinuing topical steroids against nummular infiltrates following adenoviral keratoconjunctivitis (AK). To avoid the potentially serious side effects of resumed steroid treatment at increased doses we tested topical 2% cyclosporin A (CSA). PATIENTS: We applied four drops of CSA daily to 70 eyes (48 patients) with persistent nummular infiltrates after AK. Treatment began 18.5 months (3-72) after the acute phase of AK. Dose reduction depended on resolution of the nummuli in the individual patients. RESULTS: Of the 70 eyes 40 responded positively to therapy, 16 showed no change, therapy was stopped in 4 because of ocular discomfort (burning), and in 10 eyes follow-up is still less than 3 months. CONCLUSIONS: CSA was effective in eliminating or reducing nummuli in the majority of patients. More than one-half of the responding eyes had a complete cure and did not experience recurrences after stopping therapy. We therefore consider topical CSA to be a safe and effective alternative to topical steroids for treating nummular infiltrates after AK.

Adult↗
PubMed2000

[Impression and applanation tonometry in irregular corneas. Comparison with intraocular needle tonometry].

PURPOSE: During the past 4 years we have demonstrated in eyes with corneal pathology that applanation tonometry (Goldmann, Perkins) generally delivers falsely low measurements in comparison to intraocular needle tonometry. The aim of this study was to evaluate whether impression tonometry (Schioetz) is more precise than applanation tonometry in determining the intraocular pressure in eyes with corneal disorders. PATIENTS AND METHODS: In 75 eyes with suspected glaucoma and various corneal disorders, we performed applanation tonometry and impression tonometry before intraocular needle tonometry. Applanation tonometry was repeated after impression tonometry to unveil a possible tonography effect. Intraocular needle tonometry was performed thereafter. RESULTS: Applanation tonometry results were 4.1 +/- 5.3 mmHg below intraocular pressure as determined by intraocular needle tonometry. Impression tonometry results were also lower: 4.3 +/- 6.8 mmHg (5.5 g), 4.3 +/- 6.4 mmHg (7.5 g), and 4.8 +/- 7.0 mmHg (10.0 g). The differences between applanation tonometry and impression tonometry were statistically not significant. In contrast, all the differences between extraocular tonometry procedures and intraocular needle tonometry were statistically highly significant (P < 0.001). CONCLUSION: In corneal pathology both, applanation tonometry and impression tonometry do not deliver reliable results on an average. Only intraocular needle-tonometry delivers reliable results in these eyes.

Corneal Diseases↗
PubMed2000

Black diaphragm aniridia intraocular lens for congenital aniridia: long-term follow-up.

PURPOSE: To present long-term results of implantation of a black diaphragm aniridia intraocular lens (IOL) in eyes with congenital aniridia. SETTING: Eye Hospital, Heinrich-Heine-University, Düsseldorf, Germany. METHODS: Cataract surgery was performed in 19 eyes of 14 patients with congenital aniridia. The black diaphragm aniridia IOL was implanted in front of the capsular bag in the ciliary sulcus. Mean patient age was 30 years (range 10 to 59 years) and mean follow-up, 46 months (range 12 to 84 months). Before surgery, corneal epithelial disorders; corneal pannus; cataract; hypoplasia of the macula, optic nerve, or both; and nystagmus were present in all 19 eyes. Clinically detectable glaucoma was present in 5 eyes. RESULTS: Despite the presence of amblyopia and nystagmus, visual acuity improved in 14 of the 19 eyes. The main postoperative problems were glaucoma deterioration (4 of 19 eyes) or development (4 of 19 eyes), cystoid macular edema (2 of 11 eyes), chronic endothelial cell loss (3 of 11 eyes), and progression of corneal epithelial disorders (4 of 19 eyes). Glaucoma was controlled by medical or surgical therapy in all patients. Intraocular lens explantation was performed in 2 eyes with glaucoma. CONCLUSION: Implantation of the black diaphragm aniridia IOL improved visual acuity in the majority of patients with a variety of endogenous problems in addition to aniridia.

Adolescent↗
PubMed1999

Beneficial effect of preoperative mycophenolate mofetil in murine corneal transplantation.

To investigate the effect of preoperative mycophenolate mofetil (MMF) on allograft survival in a murine corneal transplantation model. Corneal grafting was performed from Brown Norway to Lewis rats. Groups were divided as follows: Rats that received syngeneic or allogeneic grafts without therapy served as controls. MMF treatment was either started 7 days prior to transplantation and continued for 14 postoperative days (POD) or started at the day of corneal grafting until POD 14. MMF (20 mg/kg) administered postoperatively had no significant beneficial effect on corneal graft survival when compared with controls. However, the group receiving 40 mg/kg MMF postoperatively showed a statistically significant prolonged graft survival. A 1-week preoperative administration of 20 mg/kg MMF allowed superior graft survival. Priming the immune system of corneal transplant recipients preoperatively with MMF proved to be a beneficial therapeutic regimen for prolonging corneal allograft survival in rats.

Animals↗
PubMed1999

[More than 4 years' experience with electronic intraocular needle tonometry].

BACKGROUND: Applanation tonometry in eyes with pathological corneae can often not be performed or delivers rather questionable results. We report on our 4-year experience with electronic intraocular needle tonometry. PATIENTS AND METHODS: After since 1994 developing and calibrating a system for intraocular needle tonometry, we have performed 395 measurements in 252 eyes with irregular corneae and suspicion of glaucoma. If applanation tonometry values could be obtained, they were compared with the true intraocular pressure. RESULTS: Depending on the kind of corneal pathology, applanation tonometry values were lower and sometimes much lower than true intraocular pressure. No serious complications occurred as a result of intraocular needle tonometry. CONCLUSIONS: Intraocular needle tonometry is a safe procedure and is the only way to measure intraocular pressure precisely in eyes with pathological corneae.

Adolescent↗
PubMed1999

Topical cyclosporin A in Thygeson's superficial punctate keratitis.

BACKGROUND: Since September 1994 we have administered topical cyclosporin A 2% (CSA) in a prospective study to patients with Thygeson's superficial punctate keratitis (TSPK). After our promising short-term results we now present medium-term data of a larger patient group. PATIENTS AND METHODS: Topical CSA was administered to 52 eyes of 28 patients with TSPK. Forty-two were adult eyes (group I), 10 children's eyes (group II). Starting with 3 drops daily during the 1st month, CSA was reduced to 1 drop every 2nd day within 4 months and stopped after 6 months. RESULTS: Complete suppression of the typical epithelial and supepithelial opacities could be achieved in 71.5% of cases in group I and 40% in group II as long as therapy was administered; the other patients responded only partially or not at all. Recurrences were a problem during tapering off or shortly after cessation of therapy, but they could again be treated effectively with the initial CSA regime. Thirty-one percent of all adult eyes and 20% of all pediatric eyes seemed to have completely healed during the observation time. CONCLUSIONS: In more than two thirds of our adult patients topical CSA 2% suppresses the epithelial and subepithelial opacities for as long as this non-steroid therapy is administered. Definite healing seems to be achieved in almost one third of all adult patients. In another one third, long-term low-dose CSA therapy is necessary before complete healing may be expected. Children probably do not respond to therapy as well as adults. Whereas the only therapeutic alternative, i.e. steroid eye drops, have a significant potential for side effects in the long run, no side effects have been known from low-dose CSA eye drops. We regard CSA eye drops as a significant progress in the symptomatic treatment of TSPK.

Administration, Topical↗
PubMed1999

Homologous penetrating central limbo-keratoplasty (HPCLK) in bilateral limbal stem cell insufficiency.

PURPOSE: Bilateral stem cell deficiency can be overcome only by keratoplasty plus additional homologous limbal transplantation. We have four years' experience with a new surgical one-stage procedure, homologous penetrating central limbo-keratoplasty (HPCLK). METHODS: A clinical trial was performed in order to evaluate the effectiveness of this new method. The first 25 eyes after HPCLK for limbal stem cell deficiency have been followed for more than 12 months. The eccentrically trephined unmatched grafts contained 40% limbus and were transplanted centrally in the host. Systemic cyclosporin A (CSA) was administered for at least one year. Central clear graft survival was the main outcome criterion. RESULTS: 18 grafts failed, mostly because of postoperative surface disorders. Seven grafts have remained centrally clear 12-41 months after HPCLK. CONCLUSIONS: In the majority of the grafts the transplanted limbal stem cells underwent immune destruction. The survival of seven grafts, however, shows that HPCLK is principally a promising new procedure. Further progress can be expected from the use of well HLA-matched grafts instead of unmatched grafts and from further improved systemic immune modulation.

Adolescent↗
PubMed1999

[Mycophenolate mofetil after penetrating high risk keratoplasty. A pilot study].

AIM: Mycophenolate mofetil (MMF, CellCept) has become a successful part of the standard immunosuppression regimes after solid organ transplantation. It was the aim of this study to compare the efficacy and the safety of MMF after penetrating high-risk keratoplasty with our standard immunosuppression, i.e. systemic cyclosporin A (CSA), in a pilot study. PATIENTS AND METHODS: Sixteen patients after penetrating high-risk keratoplasty were randomized to be treated either with MMF or with CSA for six months postoperatively. MMF was administered in an oral dose of two times 1 g daily whereas the CSA dose varied according to the blood trough levels of 120-150 ng/ml (monoclonal TDx) between 100 and 500 mg daily. RESULTS: During this first follow-up period of 11.4 (5-18) months neither in the MMF- nor in the CSA-group irreversible graft failure was observed. One serious acute endothelial immune reaction was observed in the CSA-group after systemic immunomodulation had been tapered. It was treated successfully with systemic and topical corticosteroids. In one patient CSA-prophylaxis had to be stopped five months postoperatively because of elevated liver enzymes. Side-effects did not occur in the MMF-group. CONCLUSIONS: Up to now MMF has been evaluated to be as efficacious as CSA and safe. If these results are confirmed in the long run in this study MMF may become an armament to avoid immune reactions in high-risk penetrating keratoplasty patients who must not receive systemic CSA.

Cyclosporine↗
PubMed1999

[Postoperative ultrasound biomicroscopic evaluation of the tangible position of black diaphragm posterior chamber lenses in congenital and traumatic aniridia in comparison with gonioscopy].

BACKGROUND: Ultrasound biomicroscopy (UBM) allows to determine the haptic position of posterior chamber lenses (PCL) in relation to adjacent structures. In transsclerally sutured PCLs, the comparison between intraoperatively endoscopically and postoperatively localized haptic positions via UBM showed a correspondence of only 81%. The different localisation of 19% of the examined haptic positions was explained with postoperative dislocation without any proof for this assumption. The purpose of this study therefore was the correlation of UBM results with simultaneously determined haptic positions via gonioscopy in aniridia after black diaphragm PCL implantation. PATIENTS AND METHODS: The haptic positions of black diaphragm PCL implants in 20 patients with congenital and 13 patients with traumatic aniridia were determined via UBM (50-MHz-probe) and gonioscopy 44.4 (6-75) months postoperatively. RESULTS: 39/66 haptic positions could be localized in gonioscopy as well as in UBM. 38 haptics (97.4%) showed the same position in both examination techniques. Determination of the haptic position through one of the two examination techniques was impossible in 27/66 haptics (11 haptics in gonioscopy, 16 haptics in UBM). Reasons for this were primarily haptic position behind iris remnants and corneal opacities in gonioscopy and scarring of the ciliary body in UBM. CONCLUSIONS: The validity of UBM in localization of PCLs was confirmed gonioscopically, which also confirms our prior assumption of postoperative displacement of IOL-haptics after transscleral suturing in about 20% of cases. Scarring of the ciliary body was the most important obstacle in the determination of PCL haptic positions in relation to adjacent structures.

Adult↗