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Biomedical subjects

T Schlote

Publications and source records attributed to T Schlote.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Churg-Strauss syndrome].

BACKGROUND: The Churg-Strauss syndrome, also known as allergic granulomatosis with angiitis, is a rare necrotizing vasculitis with unknown pathogenesis. The necrotizing granulomatous vasculitis involves small and medium-sized arteries, capillaries and veins, leading to the characteristic changes of intra- and extravascular, eosiniphilic granulomas, accompanied by clinically symptoms: bronchial asthma, hypereosinophilia and fever. Ocular manifestations are rarely reported. CASE REPORT: A 53-year-old woman suffered from bronchial asthma, relapsing lung infiltrates and sinusites since 1994. In August 1997 she suddenly disclosed vasculitic skin manifestations on both legs and a mononeuritis of the left peroneus nerve. At the same time visual acuity of the right eye decreased, before she had shown some attacks of amaurosis fugax. The funduscopy showed a central retinal artery occlusion. LABORATORY FINDINGS: blood eosinophilia of 20%, elevated IgE value to 396 kU/l (normal value < 120 kU/l), and negative parameters for antineutrophil cytoplasmatic antibodies (p- and c-ANCA). CONCLUSION: The clinical and laboratory findings are characteristic signs for the Churg-Strauss syndrome. Without such typical manifestations the histologic examination leads to the diagnosis and helps to differentiate this disease from other necrotizing vasculitides, e.g. panarteriitis nodosa or Wegener's granulomatosis.

Azathioprine↗
PubMed1999

[Cyclocryocoagulation in treatment of therapy refractory glaucoma: a retrospective analysis of 185 cryocoagulation procedures].

BACKGROUND: For several years it has been discussed whether cyclocryotherapy is still an up-to-date treatment of resistant inadequately controlled glaucoma. This retrospective study investigates the clinical aspects of 185 cyclocryotherapies between 1988 and 1997. PATIENTS AND METHODS: At the University Eye Clinic of Tübingen, 114 patients received in 119 eyes (64.3%) one cyclocryotherapy, and in 66 eyes (35.7%) multiple cyclocryotherapies. The standard surgical techniques for cyclocryotherapy can be summarized as followed: probe placements per eye, 4 to 6; location of probe placement, inferior circumference (63.9%); distance of the applicator from limbus, 3 mm (50.7%); temperature of the probe tip, -70 degrees C (34.2%); and time of the treatment, 60 seconds (89.9%). RESULTS: Intraocular pressure was on average 33.8 mm Hg before treatment. In all analysed glaucoma types intraocular pressure was lowered to 10.2 mm Hg (30%). The most frequent type of glaucoma was the neovascular glaucoma (55%). One year after treatment, this type showed on average, relative to all other types of glaucoma, the highest intraocular pressure (28.1 mm Hg) and a lowering of intraocular pressure by 8.3 mm Hg (22.7%). Half a year after cyclocryotherapy, a highly significant (p < 0.002) reduction of antiglaucomatous medication was achieved in comparison to the preoperative medication. CONCLUSION: Despite the fact that cyclocryotherapy is not always effective, it is an ambulant surgical technique easy to apply, non-invasive, cost-effective and can be repeated to lower intraocular pressure in resistant chronic glaucoma. We conclude that cyclocryotherapy will remain useful until new techniques, like the diode laser cyclophototherapy (especially ultrasonic controlled), are developed as alternative therapies.

Adult↗
PubMed1998

Argon laser therapy of benign tumors of the eyelid.

PURPOSE: To report the therapy of benign eyelid tumors with an argon laser as an alternative to surgery. METHODS: Forty-one patients with 47 benign tumors of the eyelid were included in this study. In all patients, the eyelid tumor was eliminated by argon laser. In 24 cases the lower eyelid and in 23 cases the upper eyelid was involved, including the lid margin in 17 cases. Laser spot size ranged from 150 to 500 microm. Argon laser power density varied between 4.1 and 61.1 W/mm2. Spots were counted between 40 and 1204. Twenty-seven of 41 patients treated were followed up; the mean follow-up period was 5.8 months (range, 3 to 24 months). Postoperatively, histologic confirmation was obtained in 42 cases of the 47 treated tumors. RESULTS: All patients were satisfied regarding the laser therapy and the cosmetic result. Remarkably, the wounds were dry after argon laser therapy. No infections of the wounds occurred; wounds were epithelialized after 2 to 3 weeks by a normal-appearing epithelium. The area of argon laser treatment was less pigmented than the surrounding skin and showed no obvious remarkable notches. As a complication, one patient developed a viral conjunctivitis. No relapses occurred during follow-up. CONCLUSIONS: Argon laser therapy of benign eyelid tumors may result in very satisfactory wound healing. Taking the short follow-up and the limited number of cases into account, it seems to be a useful alternative to traditional surgery, especially for tumors positioned close to the lacrimal papillae.

Adolescent↗
PubMed1998

[Multifocal electroretinography in acquired macular dysfunction].

BACKGROUND: Multifocal electroretinography allows physiological mapping of the central retina. The purpose of this study was to describe the spatial distribution of ERG-activity in patients with impairment of macular function which usually do not exhibit a pathologic Ganzfeld-ERG. SUBJECTS AND METHODS: 6 patients with macular lesions due to uveitis (4), retinitis centralis serosa (1), and contusio bulbi (1) were examined using the multifocal ERG technique. RESULTS: In normal volunteers the response density of the multifocal ERG decreased with eccentricity according to cone density distribution. In eyes with impaired central vision the foveal and macular responses were markedly diminished while surrounding signals were of normal or moderately decreased amplitudes. CONCLUSIONS: With the multifocal ERG disturbances of macular function due to oedema and secondary structural changes were detected in the presented cases and the extension of the central lesions was estimated.

Adolescent↗
PubMed1998

[Wolfgang Stock, his ophthalmopathologic collection and progress in glaucoma treatment in the 2nd half of the 20th century].

BACKGROUND: As long as Wolfgang Stock was head of the University Eye Clinic Tübingen (1921-1952), he founded a voluminous collection of ophthalmopathological slides, which reflect the knowledge about and possible therapies for various eye diseases at that time. MATERIAL: The "Collection Stock" contains ca. 450 glaucoma specimens. Of these, 50 were chosen at random and investigated macroscopically and microscopically. Each specimen was supplied with a (main) diagnosis. For comparison, 50 eyes with glaucoma enucleated between 1992 and 1997 were examined. RESULTS: Nowadays, "glaucoma enucleation" is performed nearly exclusively because of secondary angle closure glaucoma. In contrast, the "Collection Stock" contains various eyes with 1. primary glaucoma without previous operation, 2. congenital glaucoma, 3. lens induced glaucoma, 4. aphakic glaucoma, and 5. complications after glaucoma surgery. No case of diabetic neovascular glaucoma or PEX-glaucoma was found. CONCLUSIONS: Due to improvement in ophthalmological care, development of various pressure-lowering and anti-inflammatory drugs, new surgical techniques and, probably most important, introduction of the operation microscope, major advances concerning glaucoma therapy and avoidance of complications have been achieved in the last 50 years. Thus, the spectrum of "glaucoma enucleations" has changed dramatically, and certain types of (open angle) glaucoma Wolfgang Stock was very familiar with have in modern ophthalmopathological practice almost fallen into oblivion.

Eye Enucleation↗
PubMed1998

[Conjunctival cysts of the orbits: clinical aspects and histology in 4 patients].

BACKGROUND: Only a few reports concerning congenital conjunctival cysts of the orbit (primary nonkeratinized epithelial cysts) have been published. PATIENTS: We describe four further cases of conjunctival cysts of the orbit, which were observed between 1995 and 1997 in Tübingen and Vienna. Histologically, all cysts were lined by nonkeratinizing epithelium with goblet cells. Epidermal appendages were found in the wall of one cyst. The patients' age was between 1 and 32 years. Clinically, the prominent symptom was swelling of the upper eyelid, persisting in three patients for more than several years. In one patients diplopia and restriction of eye movements developed within several weeks. CONCLUSIONS: The cases we described are in accordance with the cases reported in the literature. Often a swelling of the upper eyelid persisted for several years, before the cyst has become symptomatic predominantly in an adult patient. In contrast to dermoid or epidermoid cysts, there is no bony erosion and the cysts are located in the superior to nasal orbit. These cysts are probably more common as it is represented in the literature.

Adolescent↗
PubMed1998

[Diode laser cyclophotocoagulation of secondary glaucoma caused by anterior, necrotizing scleritis].

PATIENT: A 60-year-old female patient presented with recurrent anterior, necrotizing scleritis with inflammation and a newly developed secondary glaucoma in the right eye. Anterior uveitis occurred some years before. Severe scleral thinning was circumferentially present and focal scleral ectasia was found. Physical examination revealed no systemic association of scleritis. Immunosuppressive therapy with metotrexate was initiated and control of scleritis achieved. Intraocular pressure elevation persisted and was refractory to glaucoma medication. Diurnal pressure curve showed IOP-values of 40 mm Hg despite the use of systemic carbonic anhydrase inhibitors. Visual acuity was 20/50 in the right and 20/25 in the left eye. METHOD: Diode laser cyclophotocoagulation (Oculight SLx 810 nm, Iris Medical Instruments Inc. California, USA) was performed under general anaesthesia using reduced parameters for application (12 laser spots, 1 second, 1.25 W). No complications occurred during and after laser application. Postoperatively, intraocular pressure was within normal range between 14 and 18 mm Hg. No reactivation of scleritis or uveitis was seen. CONCLUSION: In our experience, diode laser cyclophotocoagulation is effective and safe in treating secondary glaucoma associated with anterior, necrotizing scleritis with inflammation and uveitis using reduced parameters for application.

Female↗
PubMed1998

Choroidal metastases and choroidal melanomas: comparison of ultrasonographic findings.

AIMS: The purpose of the study was to analyse, whether the shape and the height to base ratio in B-scan ultrasonography are appropriate to differentiate choroidal melanomas from metastases. METHODS: Between 1991 and 1996 16 eyes of 16 patients with choroidal metastases from breast carcinomas and 66 eyes of 66 patients with choroidal melanomas were evaluated ultrasonographically. The diagnosis of choroidal melanoma has been confirmed histologically in all eyes. Irradiated tumours were excluded from the study. Fisher's exact test and chi 2 test were used for statistical analysis. RESULTS: Choroidal metastases demonstrated a significantly lower height to base ratio in B-scan (mean 0.18, SD 0.08) than melanomas (mean 0.6 (0.16); p < 0.001). A polygonal tumour surface was significantly more frequent in metastases (13 out of 16 metastases and in six out of 66 melanomas, p < 0.001). A choroidal excavation could be demonstrated in 38 melanomas and in no metastatic tumour (p < 0.001). The reflectivity was significantly higher in metastases than in melanomas. CONCLUSION: The combined use of height to base ratio and reflectivity enables a highly significant discrimination between choroidal melanomas and metastases from the breast, thus probably constituting appropriate variables for the clinical differentiation.

Breast Neoplasms↗
PubMed1997

Mesopic vision in myopia corrected by photorefractive keratectomy, soft contact lenses, and spectacles.

PURPOSE: To evaluate contrast vision and glare sensitivity under mesopic conditions in eyes having uncomplicated excimer laser photorefractive keratectomy (PRK) for myopia and in eyes corrected by disposable soft contact lenses, soft contact lenses, and spectacles. SETTING: Division of Experimental Ophthalmic Surgery, University of Tübingen, Germany. METHODS: The Mesoptometer II test was used to evaluate mesopic vision (glare sensitivity and contrast vision) in 28 eyes of 14 patients wearing disposable soft contact lenses, 20 eyes of 10 patients wearing soft contact lenses, 39 eyes of 20 patients wearing spectacles, 30 eyes of 15 emmetropic patients, and 33 eyes of 22 patients after PRK with 5.0 mm optical zone. Follow-up was between 15 and 60 months after PRK (mean 34.5 months). RESULTS: The guidelines of the German Ophthalmologic Society state that patients must recognize Mesoptometer II contrast levels of 1:5 or better with and without glare to meet the minimum legal night-driving standards for private cars. All eyes with disposable soft contact lenses and soft contact lenses, all emmetropic eyes, and 38 eyes corrected by spectacles recognized contrast levels of 1:5 or better without glare. In contrast, 18 eyes in the PRK group were unable to recognize contrast level 1:5 without glare. With glare, 1 eye in the disposable soft contact lens group, 1 in the soft contact lens group, and 7 with spectacles were unable to recognize the 1:5 contrast level. All emmetropic eyes recognized contrast levels of 1:5 or better; 22 PRK eyes were unable to recognize contrast level 1:5 with glare. CONCLUSION: Myopic PRK may lead to long-term impairment of mesopic vision, while soft contact lens use does not seem to markedly influence mesopic vision in eyes with low to moderate myopia.

Adolescent↗
PubMed1997

[Massive foreign body reaction after intraocular penetration of hot, liquid plastic].

PATIENT: A 32-year-old male had an injury of his right eye by hot liquid plastic (Ultradur R). Intraoperatively, the eye was found broadly penetrated and filled up by more than 50% with ragged pieces of plastic. Computed tomography three days after wound closure revealed remaining foreign body material. As function was totally lost no further operation was considered. Seven weeks after the trauma, the eye was enucleated because of a painful phthisis. Histology showed numerous giant cells. CONCLUSIONS: Hot liquid plastic may perforate the eye and fill it up to a great extent. Due to intraocular cooling, pieces with sharp edges may develop, thus producing further (mechanical) tissue damage. Intraocular plastic is able to induce a massive foreign body reaction. It may be detected easily by computed tomography.

Adult↗
PubMed1997

[Lens coloboma and lens dislocation in Stickler (Marshall) syndrome].

BACKGROUND: Both, Stickler and Marshall syndrome are dominantly inherited, connective tissue disorders with highly variable individual manifestations. Probably, both syndromes represent the same entity with occasional partially different clinical manifestations. PATIENT: We are reporting on a female patient with typical ocular and systemic manifestations of both syndromes: high myopia, glaucoma and goniodysgenesis, submucosal cleft palate, sensorineural hearing loss, and "flat" mid-face. Additionally, we observed subluxation of the ocular lens in one eye which was previously described in only a few cases. In our case, subluxation was combined with nasal coloboma of the lens and congenital cataract. This represents the first report of coloboma of the ocular lens as a manifestation of Stickler (Marshall) syndrome. In both children of the patient manifestations of the syndrome were present (high myopia, cleft palate, sensorineural hearing loss). CONCLUSION: Coloboma and subluxation of the lens have to be regarded as possible manifestations of the Stickler (Marshall) syndrome. The syndrome(s) should be included in the differential diagnosis of ectopia lentis-associated systemic diseases.

Abnormalities, Multiple↗
PubMed1997

[Diode laser cyclophotocoagulation in treatment of therapy refractory glaucoma].

BACKGROUND: It has been suggested that Nd:YAG laser cyclophotocoagulation significantly lowers the intraocular pressure in refractory glaucoma. However, only limited information is currently available concerning the cyclodestructive effects of diode laser cyclophotocoagulation. PATIENTS AND METHODS: Twenty eyes of 17 patients had undergone diode laser cyclophotocoagulation if previous glaucoma surgery including cyclocryocoagulation was unsuccessful or the patients were blind. Nine eyes had secondary glaucoma, 5 neovascular glaucoma, 5 congenital glaucoma, and 1 eye chronic open angle glaucoma. Treatment was applied in two quadrants using a 810 nm diode laser (600 qm diameter quartz fiber, 2 sec, 1.75-3 W, 6 to 10 pulses). Seven eyes required retreatment. RESULTS: In 19 eyes the baseline IOP was 32.1 +/- 10.1 mm Hg and at the patient's last examination 21.0 +/- 8.4 mm Hg. Median follow up was 11 months (3 to 19 months). In 4 of 5 eyes with a visual acuity of less than 1/50 IOP was decreased under 30 mm Hg, while 9 of 14 eyes with a visual acuity of at least 1/50 IOP revealed a decrease of IOP under 20 mm Hg, resulting in a success rate of 68%. Complications included acute severe anterior uveitis in one eye and bulbus hypotonia in another for several months. After three weeks, one eye was enucleated because of persisting high IOP and pain. Histopathologically, coagulation necrosis of the ciliary body stroma and separation of epithelial layers were observed. CONCLUSIONS: This study suggests that contact diode laser cyclophotocoagulation is an effective method and a valid alternative to cyclocryocoagulation in the treatment of refractory glaucoma including congenital glaucoma.

Adolescent↗
PubMed1996

[Cyclosporin A in therapy of chronic uveitis in childhood].

Four children, 4 to 10 years old, with chronic uveitis were treated with cyclosporin A (CsA; starting dosage 2 mg/kg per day) and prednisolone. All children had previously received systemic steroids and/or cytotoxic agents, which resulted either in a poor therapeutic effect or in intolerable side effects. In one child, suffering from uveitis in combination with juvenile rheumatoid arthritis, a complete reduction of intraocular inflammation was achieved. In a second child treatment resulted in a marked reduction of inflammatory activity with stabilization of visual function, although a temporary increase in the steroid dosage was necessary at one stage. In the remaining two cases therapy failed to improve the intraocular inflammation. During the time of treatment, ranging from 11 to 26 months, no serious side effects were observed. All patients developed moderate hypertrichosis and one child gingival hyperplasia. In our experience, cyclosporin A (CsA) combined with low-dose systemic steroids is useful as a therapeutic alternative to steroids alone and to other immunosuppressive agents in severe cases of chronic uveitis in childhood.

Child↗
PubMed1995

[Glaucoma in Marfan syndrome: position-dependent measurement of intraocular pressure as a diagnostic criterium].

PATIENT: A 35-year-old female patient with Marfan's syndrome presented with fast progressive reduction of visual acuity (hand movements) of her right eye and lens-related glaucoma on both eyes. On examination, subluxation of the lens and nuclear cataract were seen on both eyes. Diurnal pressure curve showed great fluctuations in pressure with normal IOP in the morning and elevated pressure in the evening. Pressure measurement revealed great fluctuations depending on positioning. Because of cataractous lens in the right eye blocking the visual axis and uncontrollable, phacogenic glaucoma removal of the lens by cryoextraction was necessary. Visual acuity increased to 0.5 and IOP was normal after three weeks. To improve safety of topical medication of lens-related glaucoma in Marfan's syndrome regular measurement of IOP at different times of the day is especially important. Measurement of IOP at different positions seems to be an effective provocation test in cases of phacogenic glaucoma in Marfan's syndrome. Examination of all members of a family with Marfan's syndrome should include regular measurement of IOP at different times of the day. In suspected cases, measurement of IOP at different positions that may provoce IOP-increase could be useful in the early detection of lens-related glaucoma.

Adult↗
PubMedDate not supplied

Cataract surgery at the end of the 19th century at Tübingen.

Cataract extraction with a Graefe knife incision was the most important development in cataract surgery during the 19th century. To determine the indications, visual outcome, complications, and problems of cataract surgery performed a century ago, we reviewed patient records from the year 1895. With use of Graefe's technique of cataract extraction, the early postoperative visual acuity was 20/200 or better in 63% and 20/40 or better in 5%. A secondary cataract developed in about 30% of eyes. A flat anterior chamber persisted for more than two days in about 20% of eyes. Astigmatism was not regularly measured, but was markedly increased after surgery. Surgery for secondary cataract was performed in only 20 eyes. There was a complication rate of nearly 50% in secondary cataracts. These results demonstrate some of the major problems of cataract surgery 100 years ago: secondary cataract, insufficient wound closure, high astigmatism, and aphakia as a refractive problem.

Cataract Extraction↗