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Biomedical subjects

T Schlote

Publications and source records attributed to T Schlote.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Pseudohypopyon of cholesterol crystals occurring 16 years after retinal detachment in x-linked retinoschisis].

BACKGROUND: Cholesterol crystals of the anterior chamber can be found as a marked feature of advanced cholesterosis bulbi; typically following i. o. hemorrhage after severe trauma, retinal detachment or M. Coats. CASE REPORT: A 39-year-old male patient with longstanding (16 years) retinal detachment in his right eye due to x-chromosomal linked retinoschisis presented with a clinical picture of a hypopyon and mature cataract. Ultrasonography showed a retrolental mass. Phacolytic uveitis was suspected and pars plana lentectomy and vitrectomy was performed. Intraoperatively subretinal chrystals could be detected. A specimen of the aqueous humor and subretinal fluid was evaluated biochemically and histologically and revealed cholesterol crystals. CONCLUSIONS: Cholesterosis bulbi may be similar to lentogenic uveitis and should be included in the differential diagnosis of such processes. To our knowledge this is the first case of cholesterol crystals of the anterior chamber sixteen years after retinal detachment in x-linked retinoschisis.

Adult↗
PubMed2001

[Bee sting of the cornea - a case report].

BACKGROUND: Bee stings of the cornea are very rare, though its response can range from minimal inflammation to severe damage like lens dislocation, cataract formation, iris atrophy, ophthalmoplegia and optic neuropathy. We report on a patient with typical, severe findings. PATIENT: A 42-year-old patient presented with an acute, corneal bee sting of the left eye, after he was stung only a few hours ago. The patient suffered from pain, blurred vision and epiphora. The left eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, striate keratitis, a purulent infiltration of the cornea above the limbus at the 7 o'clock meridian and a massive hypopyon. Further examinations showed regular ophthalmological findings. Vision acuity was 1,0/0,4. Under therapy inflammation decreased quickly. One week after we could lokalize the stinger in the depth of the corneal infiltration and it was removed surgically. After one month the eye only showed a minimal infiltration of the cornea with fine neovascularisations. Visual acuity was 0,8. CONCLUSION: Clinical reactions to bee stings of the cornea are caused by toxical and immunological effects of different components of the bee venom. These toxical and/or inflammatory reactions can lead to severe intraocular damage. Treatment of choice is the systemic and local application of steroids and antibiotics as well as local therapy with antihistamins.

Adult↗
PubMed2001

[Neurological complications in acute posterior multifocal placoid pigmentepitheliopathy (APMPPE) - a review with case report].

BACKGROUND: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an ocular disease of young adults with a favorable visual outcome. Up to present the etiology and pathophysiology of APMPPE have not been thoroughly understood. Serious inflammatory systemic and neurological diseases have been described in association with APMPPE. CASE REPORT: We report a single case study of a 29-year-old male patient with APMPPE. Approximately four months after diagnosis of APMPPE the patient developed a temporary tetraparesis as initial symptom of chronic inflammatory cerebral disease. We give an overview of the stated theories of the pathogenesis of APMPPE in the literature. Moreover we account on concomitant systemic symptoms and diseases. We outline neurological complications in APMPPE and discuss the reported therapies. RESULTS: Neurological complications rarely accompany APMPPE and may occur even months after the initial ocular symptoms. There have been reports of meningoencephalitis and cerebral vasculitis and two patients died of neurological complications. The recommended therapeutic regime is high-dose corticosteroids. Relapses can appear during tapering of systemic corticosteroids therapy. The role of immunsuppressive treatment remains unclear. CONCLUSION: APMPPE can be associated with serious inflammatory systemic and neurological affection. Instruction of the patient is indispensable to guarantee early and adequate treatment.

Acute Disease↗
PubMed2001

Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma.

BACKGROUND: This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation in refractory, advanced glaucoma. PATIENTS AND METHODS: One hundred eyes of 100 patients with advanced glaucoma refractory to medical treatment were consecutively treated by transscleral diode laser cyclophotocoagulation. Success was defined as a final intraocular pressure between 5 and 21 mm Hg in eyes with a visual acuity of more than hard movements, relief of pain in eyes with a visual acuity of hand movements or less including blind eyes, and reduction of carbonic anhydrase inhibitor use in all eyes. RESULTS: Ninety-three patients were followed up for 1 year after initial treatment. The overall success rate was 74.2%. Of 60 eyes with a visual acuity of more than hand movements, intraocular pressure between 5 and 21 mm Hg was achieved in 41 (68.3%) eyes. Relief of pain was achieved in 28 (84.8%) of 33 eyes. Reduction of systemic carbonic anhydrase inhibitor use was highly significant (P < 0.0001). Within 1 year, 173 laser procedures (mean, 1.9 per patient) were performed. The probability of success increased significantly (P = 0.004) with the age of the patients, from 55% for patients younger than the age of 50 years to 83% for patients older than the age of 50 years. Previous ocular surgery decreased the success probability from 95% to 68% (P = 0.02). A high success rate was achieved in inflammatory glaucoma (75%), primary open-angle glaucoma (89.5%), and neovascular glaucoma (86.7%). The results were relatively poor in traumatic glaucoma (57.1%), aphakic glaucoma (57.1%), and congenital or juvenile glaucoma (62.5%). No significant relationship between loss of visual acuity and failure of treatment (P = 0.3) could be detected. No phthisis bulbi or persistent hypotonia developed. CONCLUSIONS: Transscleral diode laser cyclophotocoagulation is an effective and safe method for the treatment of advanced, refractory glaucoma. However, repeated treatments are often necessary. Success of treatment depends on the age of patients, previous surgery, and the type of glaucoma.

Adolescent↗
PubMed2000

[Cogan I syndrome: clinical aspects, therapy and prognosis].

BACKGROUND: Cogan I syndrome is a rare, inflammatory, systemic disease that is typically characterized by severe audiovestibular dysfunction and various inflammatory eye changes. PATIENTS AND METHODS: Between 1978 and 1996 ten patients with Cogan I syndrome were treated at the eye hospital, ENT clinic and medical clinic of the University of Tübingen. Retrospectively, the clinical picture, course of the disease and outcome were investigated by reviewing the charts of these patients. RESULTS: Patient ages ranged from 18 to 78 years (mean 37 years) at the time of disease manifestation. Eight patients were female. Inflammatory ocular changes were observed in nine patients in both eyes. Uveitis was found in six patients, keratitis in five, episcleritis in three and scleritis in two patients. Both patients with scleritis showed a severe, partially sight-threatening course of the disease despite immunosuppressive therapy. Severe hearing loss was seen in all patients. Further manifestations of Cogan's syndrome included pericarditis associated with arthritis, and polyserositis in one patient, and fibromyalgia in two patients. CONCLUSION: In Cogan I syndrome, typically both eyes are affected by the disease process. Various ocular inflammatory changes may occur including uveitis, scleritis, keratitis and episcleritis. The visual prognosis is mostly good, although severe sight-threatening scleritis may occur.

Adolescent↗
PubMed2000

[Cyanoacrylate injuries of the eye].

BACKGROUND: Cyanoacrylates are contained in nail glues, instant glues, and tissue adhesives such as Histoacryl. Cyanoacrylates may inadvertently contaminate the conjunctival sac and cause massive loss of visual function and serious discomfort to the patient. PATIENTS: Over a 10-year period five patients with a cyanoacrylate lesion of the ocular surface have been observed. Four were injured by instant glue and one by Histoacryl. Therapy included moderate rinsing. In the most severely affected patient parts of the glue were removed mechanically; spontaneous rejection of the glue was awaited in the other four. After the glue had been rejected, four patients showed corneal erosion which healed without problems. Visual function returned to normal in all patients, and there was no persistent tissue damage. CONCLUSIONS: Cyanoacrylates exert no substantial thermal, chemical, or toxic effects on the ocular surface when inadvertently entering the conjunctival sac. Cyanoacrylate trauma therefore has a very favorable prognosis. The conservative approach of awaiting spontaneous glue rejection is appropriate.

Adolescent↗
PubMed2000

[Transient blindness after subconjunctival anesthesia for diode laser cyclophotocoagulation].

BACKGROUND: Retro- and parabulbar anaesthesia can be associated with severe sight-threatening and life-threatening complications and may compromise optic nerve function, especially in eyes with advanced optic neuropathy. Subconjunctival anaesthesia usually does not influence optic nerve function. We report on two patients who developed transient amaurosis after subconjunctival anaesthesia. PATIENTS: In two patients (75 and 77 years old) with advanced refractory glaucoma a diode laser cyclophotocoagulation was performed to lower the increased IOP. For local anaesthesia, 2 ml of 2% mepivacaine was placed beneath the conjunctiva. The needle was placed at least 6 mm from the limbus to avoid bleeding at the injection site near the limbus. After 10 minutes, both patients observed a decrease of their vision of the treated eyes. A few minutes later, an amaurosis of the treated eyes was found in both patients, which was fully reversible after 2 to 3 hours. At fundus examination, no vessel occlusion was seen. CONCLUSIONS: Subconjunctival anaesthesia may cause transient blindness in patients with advanced optic neuropathy. The incidence of this side effect seems very low.

Aged↗
PubMed2000

[Carcinoma-associated retinopathy: a review with clinical examples].

Cancer-associated retinopathy (CAR) is a rare paraneoplastic syndrome. In this survey we report about two further patients with CAR, who were referred to the University Eye Hospital of Tuebingen within a few months. The most common primary tumor associated with CAR is small cell carcinoma of the lung. Case reports about rhabdomyosarcoma, carcinoma of the endometrium, prostate and mamma were also described. The exact pathogenesis of CAR is still unknown. Specific autoantibodies were found against the photoreceptor protein recovering (23-kd retinal CAR antigen). However, this reaction is not present in all patients, and probably other antigens are also involved. Most of the patients experience symptoms of CAR before the primary tumor is detected. Besides glare sensitivity and flashing lights, a rapidly progressive, often asymmetric visual loss may occur. Although paracentral and mid-peripheral scotomas can be found frequently, visual field defects are often quite heterogeneous. Typically, the responses in the electroretinogram (ERG) are markedly reduced, but normal ERGs were also described. The fundus picture in CAR shows sheathing of the retinal vessels, narrowing of the arterioles and clumbing of the retinal pigment epithelium. The prognosis is poor. Frequently there is progression to bilateral loss of vision within a few months. Treatment of the primary tumor does not seem to alter the ocular prognosis. Systemic corticosteroids may be helpful in some patients. Nevertheless, no proven therapeutic regimen is currently available.

Aged↗
PubMed2000

[Eye injury caused by superglue].

BACKGROUND: Eye lesions caused by superglue (instant glue) are relatively rare, and hence therapeutical experiences are limited. PATIENT: A female intended to treat a mild conjunctivitis by herself with anti-inflammatory eye drops. Inadvertently she took a tube of instant glue which then filled most of the conjunctival sac. After intensive rinsing the hardened glue was mechanically removed as far as possible. Remaining glue was spontaneously rejected within a few hours. After four days the resulting subtotal corneal erosion had healed, and visual function had returned almost to normal. CONCLUSIONS: Inspite of the dramatic, acute aspect the clinical course after superglue lesions is usually benign. Therapeutically, vigorous manipulations seem to be more harmful than useful. Spontaneous rejection of the glue should be awaited instead.

Adhesives↗
PubMed2000

[Hallermann-Streiff syndrome: should spontaneous resorption of the lens opacity be awaited?].

BACKGROUND: As the lens may become absorbed spontaneously extraction of the congenital cataract in the Hallermann-Streiff syndrome is controversial. PATIENT: A male newborn with Hallermann-Streiff syndrome was referred to the eye clinic because of a bilateral mature cataract. The risks of an operation seemed too serious because the eyes were extremely microphthalmic (a-p diameter approx. 10.5 mm). Instead, it was decided to await spontaneous lens absorption which then occurred slowly and completely between the beginning of the 2nd and the end of the 3rd year of life without considerable inflammatory responses. In the meantime, the child has a good orientation and is able to paint and to discriminate colours without optic correction. CONCLUSIONS: The critical investigation of the literature reveals that the frequency of spontaneous lens absorption in the Hallermann-Streiff syndrome is probably (widely) underestimated. It can be estimated with up to 50% (or even more) if patients which were operated on are excluded and if untreated patients are followed up till the end of the 5th year of life. Functional results seem to be quite similar for treated and untreated eyes. Therefore we would recommend to await the spontaneous lens absorption in the Hallermann-Steiff syndrome especially when the cataract is combined with considerable microphthalmia.

Cataract↗
PubMed2000

[Tübingen 1895-1899. Incidence, diagnosis and therapy of selected optic nerve, uveal and retinal diseases 100 years ago].

BACKGROUND: The records of the University Eye Clinic are almost completely preserved at the historical archive of the University of Tübingen since 1865 and shell now be reduced. MATERIALS AND METHODS: 150 records from the historical archive of the University of Tübingen were selected. We were interested in those patients treated for the first time at the University Eye Clinic between 1895 and 1899. Only diseases of the optic nerve, the uveal tract and the retina were considered. The records were distributed into groups following historical classification and statistics of the same period. These statistics were also used to compare our selection with all patients treated. For information about frequency, diagnostics and therapy a questionnaire was developed. RESULTS: Glaucoma: The data of the subgroup "Glaucoma simplex" showed high correspondence with the historical data regarding the frequency (24.3 vs. 25.5%). The data of the subgroup "Glaucoma secundaria" differed (34.5 vs. 25.5%). Testing the visual acuity was the first step of examination here and in all groups (100%). Measurement of intraocular pressure with digital palpation followed (86.3%). First of all Eserin eye drops were applicated (76.5%). Iritis: The frequency of acute iritis was 16.8 vs. 25.0%, and of chronic iritis 59.6 vs. 52.2%. As typical symptoms ciliar injections, fixed anisocore pupil and exudation were often seen (80.0%). Chronic iritis showed as typical symptom posterior synechia (80.9%). Atropin eye drops were firstly applied in acute iritis (100%), chronical iritis was treated by iridectomy (57.1%). Myopia: In all subgroups our data differed from the historical data. Staphyloma posticum was the characteristic diagnosis (65.8%). Myopia was treated by decision of the lens. Retinal detachment: The frequency 37.2 vs. 28.0%. In nearly all cases retinal detachment was described after ophthalmoscopic examination (92.8%). The first therapeutical step was to keep the patients staying in bed (53.8%). CONCLUSIONS: As expected, diagnostic and therapeutical options were strongly limited in Tübingen 100 years ago. Nevertheless, therapeutic successes were achieved in certain cases.

Germany↗
PubMed2000

[Walker-Warburg syndrome in adulthood?].

BACKGROUND: Walker-Warburg-Syndrome (WWS) comprises malformations of the brain and the eyes with muscle dystrophy. Its course is usually lethal within the first 60 weeks of life. As far as we know there are no reports in the literature dealing with WWS in adults. CASE REPORT: A 70-year old female died because of cardio-pulmonary failure while she had an infection of the respiratory tract. The patient had been mentally deficient and had suffered from recurrent single convulsions. 17 years before death funduscopy had revealed an optic atrophy. Diabetes mellitus was known for ca. 15 years. The neuropathologists found a lissencephaly with a typical histology and a cerebellar malformation. Histologically, the eyes showed diabetic changes like vacuolization of the iris pigment epithelium and a thickening of basement membranes. There were marked deposits in the Pars plicata of the ciliary body and drusen formation in Bruch's membrane. The nerve fiber layer of the retina seemed to be thinned, and there was a considerable rarefication of optic ganglion cells. CONCLUSIONS: Taking the clinical and especially the morphological data into account, a Walker-Warburg-Syndrome was assumed. Within the eyes developmental and diabetic changes were combined. Because the cerebral and ocular malformations were comparably mild, the patient became unusually old, and visual function allowed at least good orientation. References were searched by medline and by the indices of known papers.

Abnormalities, Multiple↗
PubMed2000

Transscleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases.

BACKGROUND: Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical intervention is always associated with a high risk of failure or reactivation of the inflammatory disease. In this study we prospectively examined the value of transscleral diode laser cyclophotocoagulation (TDLC) for the treatment of refractory inflammatory glaucoma. METHODS: 22 eyes of 20 consecutive patients with inflammatory, medically uncontrollable, glaucoma secondary to chronic uveitis/trabeculitis (n = 18), chemical injury (n = 2), episcleritis (n = 1), and necrotising scleritis with inflammation (n = 1) were treated by TDLC. Nine eyes (41%) had had previous failed glaucoma surgery (trabeculectomy, cyclocryocoagulation) and 15 eyes (68.2%) had had previous anterior segment surgery. All patients were followed for 1 year after the initial treatment. RESULTS: Within 12 months of the first treatment the intraocular pressure was controlled in 77.3% of all eyes (72.2% of those with uveitic glaucoma). No serious side effects such as activation of the inflammatory process, phthisis bulbi or persistent hypotonia were observed, except one patient with a temporary fibrin reaction. More than one treatment was necessary in 63.6% of the patients. The use of systemic carbonic anhydrase inhibitors was reduced from 68.2% before treatment to 27.3% after 1 year. CONCLUSION: TDLC seems to be a safe and effective procedure for the treatment of inflammatory glaucoma and may become an alternative to trabeculectomy with antimetabolites in uveitic glaucoma. TDLC may become the surgical procedure of choice in treating secondary glaucoma caused by chemical injury and also in scleritis associated glaucoma, using reduced parameters for application.

Adolescent↗
PubMed1999

[Orbital hemorrhage as a sequela of heparin-induced thrombocytopenia].

BACKGROUND: Spontaneous orbital hemorrhage is a rare but sight threatening incident. Several causative factors are known. Infrequently, hemorrhagic ocular complications can be associated with heparin therapy. The mechanism can involve a immunologically caused thrombocytpenia. In every hemorrhagic ocular complication which occurs in patients treated with heparin Heparin-induced thrombocytopenia (HIT) must be taken into consideration. PATIENT: A 76-year-old woman who underwent hip surgery three weeks prior to a spontaneous orbital hemorrhage had been treated with subcutaneous heparin. CT scan of the right orbit showed peribulbar hemorrhage with the main focus retro-lateral of the bulbus. Retrobulbar expansion of the hemorrhage was only slight with no compression of the optic nerve. There was no sign of tumor or anomaly of blood vessels. Blood cell count revealed a marked thrombocytopenia with 8000/microliter. After discontinuation of heparin therapy, thrombocytes' cell counts rised rapidly with 114,000/microliter after three days. Parallel to the normalization of the thrombocytes' cell counts the clinical symptoms disappeared quickly. CONCLUSIONS: Heparin-induced thrombocytopenia as a cause for spontaneous orbital hemorrhage has never been reported before. For differential diagnosis in patients with hemorrhagic ocular complications, HIT must taken into account. The most important measure is counting thrombocytes. In thrombocytopenia, heparin therapy must be discontinued before hemorrhagic or thromboembolic complications occur.

Aged↗
PubMed1999

[Impairment of mesopic vision following photorefractive keratectomy of myopia].

PURPOSE: Halos, glare disability and problems during night driving are significant side effects of photorefractive keratectomy, caused by increasing optical aberrations under reduced conditions of luminiscence. In a previously performed retrospective study an impairment of mesopic vision in most of the investigated eyes was found. To prove these results, a prospective study was conducted. METHODS AND PATIENTS: In a prospective, consecutive study mesopic function was investigated in 41 myopic patients, who were interested in PRK. 26 patients underwent surgery (Summit ExciMed UV200LA, optical zone 5 mm), which was performed in 30 eyes. Mesopic function (contrast vision, glare sensitivity) was measured by using the Mesoptometer II test in all 30 eyes preoperatively and 6 to 9 months postoperatively. Additionally, 21 eyes were examined after 12 to 15 months of follow up. RESULTS: There was a statistically significant reduction of contrast vision and increase of glare sensitivity after 6 to 9 and 12 to 15 months. The Mesoptometer II contrast level of 1:5 (with and without glare) can be used as a critical parameter for the decision, whether mesopic function is markedly reduced or not. Before surgery, contrast level of 1:5 without glare was not recognized in 30%, with glare in 40%. After 6 to 9 months, this contrast level was not recognized in 73% of the 30 eyes without glare, with glare in 80%. Out of these 30 eyes, 21 eyes were followed over 12 to 15 months. Whereas 38% of these eyes (with glare 48%) did not recognized the critical contrast level before surgery, this rate increased to 67% (with glare 81%) 12 to 15 months after surgery. CONCLUSIONS: Impairment of mesopic function has to be considered as a possible side effect of PRK (optical zone 5 mm). Although further investigations are needed, the indication for PRK in special professions (pilots, professional drivers) should be very critical discussed.

Adult↗