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At least 757 records · Page 42Linked to original sources
PubMed2004

[Intraocular epithelial downgrowth - report on 14 cases from 1986 to 2000].

BACKGROUND: Diffuse and cystic epithelial downgrowth occur rarely, but they represent a mostly preventable potential cause of blindness as sequels to trauma and surgery. The aim of this study is to report on the etiology and course of disease in patients with histologically verified epithelial downgrowth. PATIENTS AND METHODS: From 1986 until 2000 the ophthalmopathological laboratory of the University Eye Hospital Hamburg-Eppendorf received 13 (4 external) referrals. Ten patients with cystic of diffuse intraocular epithelial downgrowth were treated and 9 eyes were operated on in the Hospital. RESULTS: At presentation 4/10 patients had a visual acuity of < or = 0.1, and 2/10 had no light perception. A cystic epithelial downgrowth was verified histologically in 9/13, and a diffuse form in 4/13 patients. Mucin production was proven histochemically in 1/9 intraocular epithelial downgrowth sections. In one case a spontaneous iris cyst was detected by the immunohistological examinations. Trauma (10/14) and surgery (3/14) were the most frequent causes and were symptomatic on average 17 years after the primary event. A curative surgery was done in 13/14 patients (5 x en bloc excision, 2 x penetrating keratoplasty, 1 x iridectomy, 2 x enucleations, 3 x external) resulting in no recurrences during the follow-up of 4(1/2) years (1 - 12 years). The postoperative visual acuity was ameliorated in 5/9, worsened in 2 patients, and 2 were enucleated. CONCLUSIONS: Epithelial downgrowth is a rare but preventable cause of blindness. The most important prophylaxis is meticulous primary surgery including a sufficient wound closure. The visual outcome depends on the preoperative conditions.

Adolescent↗
PubMed2005

[Differentiation between pupillary and ciliary block by means of the Orbscan II in a patient with angle block glaucoma].

BACKGROUND: A ciliary block is the rarer cause of angle block glaucoma. In order to choose the appropriate therapy, however, it is crucial to make the correct diagnosis. We report on a patient who suffered from recurrent increases of intraocular pressure while having renal dialysis. In his case the use of the Orbscan II made the differentiation between a pupillary and a ciliary block easier. CASE REPORT: In addition to basic ophthalmological examinations we performed a topographic analysis using Orbscan II before and after renal dialysis. Since intraocular pressure rise during renal dialysis had been proven, iridotomies on both eyes and an iridectomy on the left one had been performed before the patient was referred to us. In spite of these open shunts we measured an increase of intraocular pressure values of 10 to 12 mmHg directly after renal dialysis had been completed. The anterior chamber became shallower both at its centre and the periphery, thus its volume diminished analogously. Measurements by the Orbscan II showed that the lens swelled up and was displaced anteriorly as well, so that a ciliary block mechanism had to be assumed. CONCLUSIONS: Since the Orbscan II is capable of collecting topometric data of the cornea, anterior chamber and also lens, it is helpful in differentiating a pupillary from a ciliary block in angle block glaucoma.

Aged↗
PubMed2005

[Imaging of the anterior eye chamber with optical coherence tomography].

BACKGROUND: Optical coherence tomography (OCT) represents a high-resolution diagnostic method which can be used to precisely image the anterior eye segment. Further developments in scanning technology and data evaluation allowed to visualize the entire anterior eye segment in one image, and the purpose of this study was to clinically evaluate this new system. PATIENTS AND METHODS: The studied OCT system was adapted to a slit-lamp and allowed us to image the anterior segment with an axial resolution of 10 microm at a scanning rate of 200 Hz with a depth of 7 mm and a maximal width of 15 mm. In selected cases the clinical value of anterior segment OCT was assessed. The reproducibility and level of agreement of anterior chamber depth measurements were assessed during the preoperative examination in 49 cataract surgery patients and compared to ultrasound (US) biometry (10 MHz). RESULTS: The studied anterior segment OCT allowed the cross-sectional imaging of the entire anterior eye segment. Changes of the anterior chamber before and after cataract surgery or surgical iridectomy were visualised. Furthermore, the findings of the anterior chamber after implantation of an iris-fixated intraocular lens (IOL) and an iris prosthetic system could be assessed. The reproducibility of the anterior chamber depth measurement was +/- 22 microm (OCT) and +/- 76 microm (US). The mean difference between optical and acoustic values was 1 microm (0.03 % p = 0.921) and the limits of agreement (95 % confidence interval) were 260 microm (8.58 %). CONCLUSIONS: The anterior segment OCT proved to be a helpful diagnostic method. The cross-sectional visualisation of the entire anterior chamber allowed us to assess important values for the implantation of iris-fixated IOL and other changes after surgical procedures. The resolution and reproducibility were higher than for conventional ultrasound biometry.

Aged↗
PubMed1998

[Cataract surgery in nanophthalmic eyes with an axial length of less than 20.5 mm].

BACKGROUND: Aim of this study was to analyze the results of cataract surgery in nanophthalmic eyes with axial length of less than 20.5 mm. PATIENTS AND METHODS: From 1991 to 1996 extracapsular cataract extraction with posterior chamber lens implantation was performed in 20 eyes of 19 patients (mean age 70.2 +/- 12.7 years, 4 male, 16 female) with axial length of less than 20.5 mm. Mean preoperative visual acuity was 0.16 +/- 0.15, refractive error +5.1 +/- 3.8 dpt and intraocular pressure 18.7 +/- 10.3 mm Hg. The mean follow-up was 24.4 months. Patient data were collected prospectively with standardized "Erlanger Augenblätter" and the computer-aided automatized operation record system "OPERA". These data together with the biometrical data were analized in a retrolective manner. RESULTS: Preoperatively 6 of 20 eyes had angle closure situation, 7 of 20 eyes had undergone intraocular surgery previously (5 x iridotomy, 1 x surgical iridectomy, 1 x filtration procedure). Pseudoexfoliation syndrome was present in 3 eyes. The posterior chamber lens (mean refractive power 31.7 +/- 3.0 dpt, optic diameter 6.5 and 7.0 mm) was positioned 18 x intracapsular, 2 x into the sulcus and 1 x by scleral fixation due to capsular rupture without vitreous loss. In 16 of 20 eyes iris surgery was performed additionally, in one eye an anterior sclerotomy was necessary. Intraoperatively "vis a tergo" occurred in 10 eyes and anterior chamber hemorrhage in one eye. Visual acuity improved in 16 of 20 eyes. The mean visual acuity was 0.3 +/- 0.2. At the end of follow-up 13 eyes had an improvement of visual acuity. Mean intraocular pressure was 16.5 +/- 3.3 mm Hg, refractive error was +0.47 +/- 2.9 dpt and differed by -0.49 +/- 1.8 dpt from the preoperatively calculated refraction. Postoperatively angle closure glaucoma developed in one eye, a ciliopseudophakic angle closure glaucoma and recurrent iris bombata in one eye. Reoperations included cyclokryokoagulation in two eyes, pars plana vitrectomy in one eye and repeated Nd-YAG iridotomies in one eye. CONCLUSION: Regarding the special anatomic situation, the surgical procedure has to be planned individually, including the determination of sclera thickness, corneal diameter and lens volume/eye volume ratio.

Aged↗
PubMed1996

[Combined true exfoliation and pseudoexfoliation of the anterior lens capsule].

BACKGROUND: True exfoliation of the lens capsule is rare, and its occurrence with pseudoexfoliation in the same eye is very unusual. CASE REPORT: An 81-year-old female presented with bilateral cataracts and a history of working with ceramics in her home kiln. Slit-lamp examination revealed pseudoexfoliation. She underwent intracapsular cataract extraction and sector iridectomy in both eyes. Light and electron microscopy of the lenses revealed a central area of splitting of the anterior lens capsule into a thin anterior and a thicker posterior layer, and deposits pseudoexfoliation material on the anterior lens capsule, on the iris pigment epithelium, and in the iris stroma. CONCLUSIONS: We interpret our findings as representing a combination of true exfoliation and pseudoexfoliation, but we did not observe any signs that might indicate a correlation or a common pathogenesis of the two conditions. Although they may occur in one eye, true exfoliation of the lens capsule and pseudoexfoliation are two unrelated distinct entities.

Aged↗
PubMed1996

[Juvenile open angle glaucoma with microcornea in oculo-dento-digital dysplasia (Meyer-Schwickerath-Weyers syndrome)].

HISTORY: An 8-year boy underwent bilateral repeat trabeculectomies with iridectomies at age 4 and 5 and cyclocryocoagulation of the right eye at age seven for glaucoma. FINDINGS: The first examination in our department revealed a visual acuity of OD light perception, OS 0.2. The right eye was exotropic and hypotropic. The intraocular pressure was 30 mm Hg in both eyes. The corneal diameters were OD 9.0 x 7.0 and OS 8.5 x 6.5 mm, while the axial length was OD 25.3 and OS 23.6 mm. Both eyes had slightly prominent filter blebs with uveal incarceration. The chamber angles were open in both eyes and partly covered with uveal tissue, the E/P ratio was OD 1.0, OS 0.9. Extraocular changes were: dysplastic teeth, dental enamel hypoplasia, thickened jaw, small nose with pronounced nose bridge. Both hands showed shortening of the metacarpals and of the IVth digits as compared to the IInd and IIIrd digits. Syndactylic digits IV and V had been surgically separated earlier. DIAGNOSIS: Our diagnosis was juvenile open-angle glaucoma in oculo-dento-digital dysplasia. THERAPY: After trabeculotomy and cyclocryocoagulation IOP remained around 10 mm Hg. CONCLUSIONS: Despite small corneal diameters, congenital glaucoma needs to be ruled out early in patients with oculo-dento-digital dysplasia. These patients should be treated in close cooperation with pediatric neurologists, orthopedic surgeons, dentists and otorhinolaryngologists.

Abnormalities, Multiple↗
PubMed1996

[Clinical experiences after implantation of various lens types in silicon oil tamponade].

BACKGROUND: A tamponade of the vitreous space with silicone oil will obligatory lead to cataract after 6 to 12 months. Today it is easily possible, to implant an artificial lense in silicone oil filled eyes. However the combination of an artificial lense and silicone oil will lead to a strong inflammation in the anterior segment of the eye. PATIENTS AND METHODS: 22 pseudophacic patients with silicone oil tamponade were examined 2 to 6 months after the operation. In 12 patients simple artificial lenses were implanted, in 10 patients heparin modified lenses were implanted. In 10 cases the lens was implanted followed by the insufflation of silicone oil in the vitreous cavity, in 2 cases a lens was implanted in a silicone oil filled eye and the silicon oil was not removed. In 8 cases the implantation of the artificial lens has been performed some months to years before the insufflation of the silicone oil. The indication for the silicon oil tamponade was a PVR retinal detachment in all cases. The following parameters were examined: Reaction of the pupil to light, pupil round or oval in miosis, examination of the fundus peripherie possible after mydriasis, fixation of the iris with parts of the capsula or with the anterior surface of the lens? In addition in 12 cases the postoperative refraction was compared with the results of the biometry, which was performed before the operation. RESULTS: In the cases with a simple lens in about 50% an incomplete miosis or an oval pupil because of fixation of the iris with parts of the capsula or with the anterior surface of the lense could be observed. In the cases with heparin modified lenses these complications could be observed in 20%. In all cases a strong opacification of the capsula was seen. In 8 of 12 cases with combined procedure a small hyperopia was measured, in 4 cases a large deviation was measured. CONCLUSIONS: The implantation of an artificial lens in silicone oil filled eyes is an alternative to the aphacic status with an Ando Iridectomy. Obviously heparin modified lenses have advantages in these cases. Because of the strong cataract formation we suggest to remove the anterior and the posterior capsula in the first operative session and to implant the haptics of the lens into the sulcus. Because of the high rate of complications generally first a stable retina condition should be reached before the implanation of an artificial lens is performed.

Aged↗
PubMed1993

[Melanoma of the iris with recurrent hyphema--course over 32 years].

BACKGROUND: The differential diagnosis of melanocytic iris tumours is very difficult. Signs of malignancy such as pupil distortion, ectropium uveae, secondary cataract and secondary glaucoma can also occur with benign iris nevi. However, spontaneous hyphemata occur in 6.9% to 13% of melanomas, while anterior chamber hemorrhages are extremely rare with nevi. PATIENT AND METHOD: A 69 year old man with a pigmented iris tumor of the right eye strictly refused surgical treatment. Therefore the tumor was followed clinically over 32 years. Over this period the tumor showed a very slow increase in size. Twenty-seven years after the initial presentation for the first time a spontaneous anterior chamber hemorrhage occurred. In the following period, the patient experienced recurrent hyphemata at last approximately every two months. An excisional biopsy consisting of a sector-iridectomy and localized excision of Descemet's membrane was performed. Histologically, the tumor was classified as a melanoma of the iris. CONCLUSION: A careful documentation cannot be overemphasized in the follow up of patients with pigmented iris lesions. In case of spontaneous hyphema histological evaluation is required even in the absence of evident tumor growth.

Aged↗
PubMed1993

[Stromal iris cyst].

A 50-year-old female developed a cyst of the iris stroma in her right eye. Because of slight enlargement within 10 weeks sector iridectomy was performed. Histology showed that the cyst was lined by a cellular layer resembling conjunctival or corneal epithelium. The benign clinical course (normal function, normal intraocular pressure and no recurrence after 4 years) and the intrastromal rather than epistromal localization hold evidence for a spontaneous origin. Spontaneous cysts of the iris stroma especially in adults are rarely described in the literature. The question still to be answered is whether these lesions are really spontaneous in origin or whether they represent only an intraocular epithelial invasion due to an occult perforation of the eye.

Cysts↗
PubMed1992

[Leiomyoma of the iris--a clinicopathologic case report].

A 20-year-old white man demonstrated a 2-3 mm in diameter ball like, grey white vascularized tumor at 12h in the iris stroma adjacent to the sphincter pupillae OD. The tumor was excised by sector iridectomy. Light microscopically the tumor consisted of densely packed spindle-shaped cells with oval nuclei with granular eosinophilic cytoplasm. Electronmicroscopically numerous 9nm-filaments in parallel configuration were found, fusiform dense formations, basal membranes and pinocytotic vesicles. Positive immunohistochemical reaction for Actin, Desmin and Vimentin, negative for S100.

Actins↗
PubMed1991

[Secondary angle-block glaucoma in posterior scleritis].

Posterior scleritis is an often misdiagnosed disease of the eye. Mainly it appears in elderly women and tends to be recurrent. Symptoms leading to diagnosis are swelling of the eye lids, a red eye, disturbances of the motility and protrusio bulbi. In rare cases you find exudative choroidal or retinal detachment, edema of the macula, or the optic nerve head, and secondary angle closure glaucoma. Often posterior scleritis is associated with general illness as herpes zoster, mixed connective tissue diseases, or Boeck's disease. Differential diagnosis are choroidal tumors as for example, melanoma, hemangioma, and metastases. The typical uveal effusion can also be caused by an arterio-venous fistula, panretinal photocoagulation, buckling procedure for retinal detachment, and by intraocular surgery in general. Especially cyclitis anularis pseudotumorosa has to be considered and shut out. Most important diagnostical means are ultrasound, and CT-scan. The underlying case describes an 81 years old woman that presented with acute angle closure glaucoma, and exudative choroidal detachment of the right eye. The ultrasound and CT-scan investigations confirmed the diagnosis of scleritis posterior. The acute angle closure glaucoma, and the choroidal detachment regressed immediately under the treatment with steroids given locally and systemically. There was no impact of miotics and peripheral iridectomy which both could not avoid recurrence of angle closure glaucoma.

Aged↗
PubMed1990

[Secondary glaucoma after silicone oil surgery].

In spite of advances in surgical technique and the development of purified silicone oils, secondary glaucoma still develops in 10-20% of cases following silicone oil surgery. In the first part of this study it is shown by life-table analysis that factors such as early lens removal, inferior iridectomy, early silicone removal or the use of purified silicone oil have little or no influence on the development of glaucoma. In the second part an attempt is made to pinpoint possible causes of secondary glaucoma by re-examining all cases in which elevated intraocular pressure developed some time after silicone oil surgery. It was found that a multitude of factors (e.g., inflammation, angle-block, anterior peripheral synechiae and emulsification) were involved in the pathogenesis of temporary or persistent secondary glaucomas. In most cases pre-existing pathology was found to be responsible rather than the silicone oil itself. The majority of the cases in which the silicone oil caused secondary glaucoma by emulsification responded well to medication alone or removal of the silicone oil.

Aphakia↗
PubMed1990

[Dominant inheritance of pupillary pigment cysts. A follow-up study].

In 1969 Meyer described in this journal a family suffering from multiple congenital pigmented pupillary cysts with dominant mode of inheritance. The therapy--total iridectomy and photocoagulation of the cysts--resulted in only a temporary improvement in visual acuity. The cysts were between 1.5 and 5.0 mm in diameter. The present author recently examined a member of this family with severe contusion of the left eyeball. The trauma had evidently opened the residual embryonal ring sinus of the fetal iris system (von Szily). While the traumatic mydriasis persisted, the cysts did not refill.

Adolescent↗
PubMed1990

[Ablation of the trabecular meshwork].

In an experimental investigation we examined the possibility to create an open pathway between the anterior chamber and Schlemm's canal by excimer laser ablation of the trabecualr meshwork (AT) in enucleated eyes. A quartzfiber was directed through the anterior chamber to the opposite chamber angle. With an energy of 0.3-1.5 mJ and wavelengths of 248 and 308 nm pores were easily made into the trabecular meshwork leading to a direct connection between the anterior chamber and Schlemm's canal. This result was confirmed by histologic examination of the globes. The trabecular meshwork has disappeared completely. The surrounding tissue reveals only minimal thermal effects due to the laser burns. With the same method cyclodialysis and basal iridectomy may be performed. The operation is simple and effects can be placed with great accuracy.

Animals↗
PubMed1988

[Secondary glaucomas caused by intraocular epithelial invasion. A clinico-pathologic study of 30 patients].

The clinical data of 30 eyes with intraocular epithelial invasion were correlated to the histopathological findings (15 iridocyclectomies, four diagnostic iridectomies, one corneal button, ten globes). The diffuse (46.7%) and cystic (53.3%) types occurred with equal frequency. The correlation to the clinical data makes the relationship between the type of epithelial invasion and the pathogenetic mechanism clear: the cystic type occurs more frequently after perforating injuries (nine out of 13 patients), the diffuse type after intraocular surgery (nine out of 14 patients). Sixteen patients with intraocular epithelial ingrowth had secondary glaucoma preoperatively. In this group diffuse epithelial invasion predominates: of 14 patients with the diffuse type 12 had high intraocular pressure, while this was only the case in four out of 16 patients with cystic epithelial invasion. The multifactorial genesis of secondary glaucoma in eyes with epithelial ingrowth in discussed.

Adult↗
PubMed1987

[Direct optic nerve and retinal injury caused by retrobulbar injections].

The authors report on 2 patients with direct damage to the optic nerve and retina: In a 25-year-old deaf-mute patient a peripheral iridectomy was performed after lid and retrobulbar anesthesia. The amaurosis noticed immediately after surgery was caused by direct injury to the optic nerve. A 69-year-old patient with high myopia was treated with retrobulbar steroid injections. The globe was perforated and a series of 4 retinal defects from the periphery to close to the optic nerve head were created. An unhealed retinal detachment developed. The importance of informing the patient preoperatively about these extremely rare complications of retrobulbar injections is emphasized.

Adult↗
PubMed1987

[Special indications for endocapsular artificial lens implantation].

Report on the successful endocapsular fixation of a posterior chamber lens in two young patients with ocular anomalies (lamellar cataract and large total iridectomy; nuclear cataract and normotensive congenital glaucoma), in whom lens with chamber angle or sulcus fixation lens would have been contraindicated. Further special indications for endocapsular IOL implantation--in patients with congenital coloboma, traumatic defects of the iris, aniridia, megalocornea with enlarged anterior segment, glaucoma, and following glaucoma surgery, cystoid macular edema of the fellow eye, diabetes mellitus, blood dyscrasias, anticoagulation therapy, and progressive atrophy of the iris--are discussed.

Adult↗
PubMed1986

[The history of glaucoma].

Glaucoma has been known in medicine since Antiquity. Hippokrates described "glaykoseis" as blindness which occurs in the elderly. The English ophthalmologist Banister was the first to establish the connection between increased tension of the eyeball and glaucoma. The important invention of the ophthalmoscope by von Helmholtz (1850) made it possible to diagnose glaucomatous changes in the fundus. In 1862, Donders discovered that high intraocular pressure caused blindness and called the disease "Glaukoma simplex." Further progress in the diagnosis of glaucoma was made by the invention of the tonometer and the perimeter, and the use of cocain. The first effective surgical treatment of glaucoma, an iridectomy, was carried out by von Graefe in 1856. Drug treatment started in 1875 with the discovery of pilocarpine.

Europe↗