PubMed Health⌕ Search

Biomedical subjects

A Gandorfer

Publications and source records attributed to A Gandorfer.

At least 19 recordsLinked to original sources
PubMed2006

[Diagnostic and therapeutic options in diabetic retinopathy].

Diabetes mellitus is the systemic disease that most often leads to blindness. Since the diminishment of visual acuity is a late symptom of the disease, screening examinations are of particular importance, as only in this way can the optimal time point for treatment be determined. Stage-oriented laser therapy prevents blindness due to macular edema or proliferative diabetic retinopathy. For a number of years, vitreoretinal surgery has enabled the treatment of late ocular manifestations such as bleeding into the vitreous body and traction retinal detachment. With appropriate stage-oriented treatment, hopeless cases of diabetic retinopathy ending in blindness should become the exception. The only useful and confirmed effective medical treatment capable of delaying this late complication continues to be careful blood glucose and blood pressure control.

Adolescent↗
PubMed2005

[Surgical treatment of cataract].

Today, the most frequently performed of all operative interventions is considered to be surgery for cataract. Modern surgical techniques applied under local anesthesia, tiny incisions that close spontaneously, reliable biometric methods, and the availability of artificial lenses, all combine to produce excellent results. In view of the low complication rate, this procedure can be recommended even in very old patients.

Aged↗
PubMed2005

[Circulatory disorders of the retina].

Cardiovascular diseases lead to systemic vascular regression, which, among other consequences, may result in an impairment of retinal perfusion. In view of the high level of comorbidity observed in patients with circulatory problems affecting the retina, the early recognition of mild forms of vascular retinopathy is of considerable importance. A major prerequisite for an improvement in outcome is the recognition of the fact that most circulatory disorders of the retina are due to systemic vascular disease, and the eye is an important prognostic indicator of cardiovascular morbidity and mortality. As a result, effective communication between family physician/internist and ophthalmologist is basic to the successful treatment of these diseases of the eye.

Anti-Inflammatory Agents↗
PubMed2005

[Age-related macular degeneration].

In the western world, macular degeneration is the most common cause of severe loss of vision and blindness in persons older than 50. The underlying cause of the condition is a disturbance in the interaction between the retina and choroid of the macula. Apart from age itself, genetic disposition and smoking are confirmed risk factors. In the initial stages, the patient experiences merely a mild blurring of vision. The wet form, which is usually progressive, is experienced as an acute loss of vision or distortion of the objects viewed. Underlying this wet macular degeneration is of new vessel growth from the choroid, known as choroidal neovascularization, which as a result of exudation of fluid and bleeding into the macula, destroys central vision. Apart from the administration of vitamins to slow down progression, laser coagulation, photodynamic treatment or vitreoretinal surgery may be helpful in some cases. A specific causal therapy is, however, not available.

Aged↗
PubMed2005

Ultrastructure of vitreomacular traction syndrome associated with persistent hyaloid artery.

AIM: To demonstrate the ultrastructure of vitreomacular traction associated with persistent hyaloid artery. METHODS: Pars plana vitrectomy was performed in a 66-year-old man with progressive vitreomacular traction associated with a persistent hyaloid artery. Epimacular tissue was peeled and processed for transmission electron microscopy. RESULTS: Ultrastructural analysis revealed multiple sheets of cellular and collagenous components. Myofibroblasts and newly formed collagen were the predominant features. Fibrous astrocytes, fibroblasts, macrophages, and basement membrane were also present. CONCLUSION: The cellular composition of the epimacular tissue and high cellular activity suggest that persistence of the hyaloid artery may contribute to the development of vitreomacular traction.

Aged↗
PubMed2002

Epiretinal pathology of vitreomacular traction syndrome.

AIMS: To investigate the ultrastructure of the vitreoretinal interface in patients with vitreomacular traction syndrome. METHODS: 14 patients with vitreomacular traction syndrome underwent standard pars plana vitrectomy. After induction of posterior vitreous detachment, epiretinal tissue and the inner limiting membrane (ILM) of the retina were removed, and processed for transmission electron microscopy. RESULTS: Ultrastructural analysis revealed two basic patterns of vitreoretinal pathology in eyes with vitreomacular traction syndrome. Seven specimens showed mostly single cells or a cellular monolayer covering closely the vitreal side of the ILM, not resulting in a biomicroscopically detectable epiretinal fibrocellular proliferation. The other seven specimens revealed premacular fibrocellular tissue which was separated from the ILM by a layer of native collagen, resembling the clinical features of idiopathic epiretinal membranes. In both groups of eyes, the myofibroblast was the predominant cell type. Fibrous astrocytes and fibrocytes were less frequent. Retinal pigment epithelial cells and macrophages were absent. Deposits of newly formed collagen were present only adjacent to fibrocellular multilayers. CONCLUSIONS: There are two distinct clinicopathological features of vitreomacular traction syndrome which suggest different forms of epiretinal fibrocellular proliferation: (1) epiretinal membranes interposed in native vitreous collagen and (2) single cells or a cellular monolayer proliferating directly on the ILM. The presence of remnants of the cortical vitreous which remain attached to the ILM following posterior vitreous separation may determine the clinicopathological feature of the disease. The predominance of myofibroblasts may help to explain the high prevalence of cystoid macular oedema and progressive vitreomacular traction characteristic for this disorder.

Aged↗
PubMed2001

Indocyanine green selectively stains the internal limiting membrane.

PURPOSE: To demonstrate whether indocyanine green stains the inner limiting membrane of the retina or residual vitreous cortex. METHODS: We report on the intraoperative staining patterns of the vitreomacular interface in 10 eyes of 10 consecutive patients who underwent vitrectomy with indocyanine green staining for macular hole formation and diffuse diabetic macular edema. RESULTS: In five eyes of five patients with macular holes, indocyanine green staining of the macula after posterior vitreous detachment resulted in an immediate visibility of a discernable membrane that was not previously seen. In five eyes of five patients with diffuse diabetic macular edema and adherent cortical vitreous, indocyanine green failed to stain the vitreomacular interface. After peeling off the residual vitreous cortex, however, a discernable membrane could be identified using indocyanine green dye again. Light and transmission electron microscopy revealed the inner limiting membrane as the membrane that had been stained and removed in all specimens. CONCLUSION: Indocyanine green selectively stains the inner limiting membrane. Staining of the vitreomacular interface using indocyanine green as a vital dye enables the surgeon to distinguish between the residual vitreous cortex and the inner limiting membrane, and it allows safer and easier removal of the inner limiting membrane.

Basement Membrane↗
PubMed2001

Macular hole surgery in an eye with an optic pit.

PURPOSE: To report an eye with a full-thickness macular hole and an associated optic pit and the noteworthy intraoperative findings. METHODS: Case report. A 56-year-old woman presented with visual acuity LE: 20/100, a full thickness macular hole, and an optic pit. Optical coherence tomography and ophthalmic examination were performed preoperatively and postoperatively. RESULTS: Although usually a macular hole associated with an optic pit tends to be a lamellar and characterized by outer layer defects within preexisting macular detachments or schisis-like cavities, this type of macular hole was not presented in this case. Although the macular hole resembled the idiopathic type on clinical examination as well as on optical coherence tomography, it could only be closed in the third surgical attempt after using silicone oil as a long-standing tamponade. Peeling of an epiretinal membrane or the internal limiting membrane was not possible during any of the three surgeries. CONCLUSION: Our observations suggest that in cases of macular hole in association with optic pit, instillation of silicone oil should be considered in the first surgical procedure, especially if no epiretinal membrane or internal limiting membrane peeling is possible intraoperatively.

Diagnostic Techniques, Ophthalmological↗
PubMed2001

Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage.

PURPOSE: To demonstrate possible retinal damage caused by indocyanine green dye for staining of the internal limiting membrane in surgery for idiopathic macular hole. METHODS: Consecutive interventional case series. We report on the ultrastructural findings of the internal limiting membrane in 10 eyes of 10 patients. RESULTS: All specimens revealed not only the internal limiting membrane, but also some small amounts of retinal elements, such as the plasma membrane of Müller cells and other undetermined structures. This indicates a cleavage plane not exactly at the inner undulating aspect of the internal limiting membrane but within the innermost retinal layers. CONCLUSION: Dilutions of indocyanine green as recommended in the literature may alter the structure of the retina to some degree. Possible factors responsible for this inadvertent action may include (1) concentration, (2) osmolarity pH, (3) time of tissue contact, and (4) mechanical factors from more forceful traction during peeling. Although functional consequences of these findings remain unclear as yet, factors that may induce damage to the innermost retina should be elucidated.

Basement Membrane↗
PubMed2001

Macular changes after peeling of the internal limiting membrane in macular hole surgery.

PURPOSE: To report the incidence of macular changes following pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DESIGN: Prospective consecutive series. METHODS: In a prospective study 105 eyes of 105 patients underwent vitrectomy for idiopathic macular holes. Surgery consisted of a standard three-port vitrectomy, induction of a posterior hyaloid detachment, removal of epiretinal membranes including the ILM, fluid-air exchange and intraocular gas tamponade (15% hexafluoroethane (C2F6) gas mixture) followed by head-down positioning for at least five days. No adjuvants were used during surgery. In addition to the clinical examination, static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105) was performed pre- and 6 or 12 weeks postoperatively. The stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. For all tests, 20-degree fields were used. RESULTS: Anatomic closure of macular holes was achieved in 92 (87.6%) of 105 patients by one operation. Eight patients underwent a successful second procedure. The closure rate after two operations was 95.2%. Best corrected visual acuity increased from a median of 0.2 (range 0.05 to 0.5) preoperatively to a median of 0.5 (range 0.05 to 1.0) postoperatively. Anatomical macular changes were found in 8 (7.6%) patients: There were two cases of macular edema following secondary cataract extraction and six cases of retinal pigment epithelium changes. Formation of postoperative epiretinal membranes or late reopenings were not noted. Small, mostly asymptomatic paracentral scotomata were seen in 59 (56.2%) of 105 patients. CONCLUSION: Anatomical changes of the macula following vitrectomy with removal of the ILM are infrequent. However, paracentral scotomata observed in our series might be caused by a trauma to the nerve fibers during ILM peeling. To achieve reliable results a standardized procedure for microperimetry should be developed.

Aged↗
PubMed2001

Ultrastructure of the vitreoretinal interface following plasmin assisted vitrectomy.

AIMS: To investigate the ultrastructure of the vitreoretinal interface following plasmin induced posterior vitreous detachment. METHODS: Plasmin (1 or 2 U/0.1 ml) was injected into the vitreous cavity of 24 eyes of freshly slaughtered pigs. The 24 fellow eyes received calcium-free and magnesium-free PBS and served as a control. After incubation at 37 degrees C for 30 and 60 minutes, the globes were placed in fixative and hemisected. Specimens for light, scanning, and transmission electron microscopy were obtained from the posterior pole, the equator, and the vitreous base using a corneal trephine. RESULTS: All plasmin treated eyes showed posterior vitreous detachment. However, the inner limiting membrane (ILM) was covered by remnants of cortical vitreous at the posterior pole and at the equator. There was a direct correlation between the concentration and exposure times of plasmin and the degree of vitreoretinal separation. Eyes exposed to 1 U plasmin for 30 minutes had a dense network of residual collagen fibrils while those exposed to 1 U plasmin for 60 minutes had only sparse collagen fibrils covering the ILM. Eyes treated with 2 U plasmin for 60 minutes had a smooth retinal surface, consistent with a bare ILM. At the vitreous base there was no vitreoretinal separation. In all control eyes the vitreous cortex was completely attached to the retina. There was no evidence of retinal damage in any plasmin treated eye. CONCLUSION: Plasmin induces a cleavage between the vitreous cortex and the ILM without morphological changes to the retina. In contrast with previous reports, plasmin produces a smooth retinal surface and additional surgery is not required in this experimental setting. The degree of vitreoretinal separation depends on the concentration and length of exposure to plasmin.

Animals↗
PubMed2000

[Diabetic retinopathy--screening is a requirement. Don't wait until vision becomes impaired].

Diabetic retinopathy is the most common systemic disease capable of leading to blindness. Laser treatment of diabetic retinopathy is standardized; in most cases it can prevent blindness, provided the diagnosis is made in good time. Since impairment of vision is a late complication, systemic screening examinations are of particular importance if we are to reliably determine the optimal time for treatment. Advances in vitreoretinal surgery make possible the treatment of such late manifestations as vitreous hemorrhage and tractive retinal detachment. Provided that stage-oriented and timely treatment is forthcoming, these formerly hopeless cases should become a rare exception. The currently sole confirmed medical treatment is optimal control of blood sugar--based on the HBA1c value--and of blood pressure. The clinical efficacy of inhibitors of angiotensin converting enzyme or protein kinase C is presently undergoing investigation.

Adolescent↗
PubMed2000

[Role of vitreoretinal interface in the pathogenesis and therapy of macular disease associated with optic pits].

PURPOSE: Although the relationship between optic pits and macular lesions was described nearly a century ago, the pathology and pathogenesis of macular detachment remain unclear. Recent OCT studies have shown schisislike spaces in connection with the disc. None of the hypotheses of pathogenesis proposed so far could have been proven. Besides the hypothesis of exudation, the role of the vitreoretinal interface is kept in the background of discussion. We describe a case of macular detachment associated with optic pit that regained full vision after pars plana vitrectomy with laser coagulation and gas tamponade over a follow-up of 26 months. The purpose of our case report is to emphasize the role of the vitreoretinal interface in the pathogenesis of macular detachment associated with optic pits. CASE REPORT AND THERAPY: A 32-year-Caucasian woman developed macular detachment associated with an optic pit on her right eye. The vision deteriorated to 24/60. A standard three-port pars plana vitrectomy was performed. After creating a posterior vitreous detachment, all vitreoretinal adhesions were removed carefully. Peripapillary laser coagulation and gas tamponade with 15% C2F6-air mixture followed. For 26 months after surgery the macula has been flat. The vision is 60/60. CONCLUSIONS: Besides the exudative component of macular detachment, the vitreoretinal interface seems to play an underestimated role in the pathogenesis of maculopathy associated with optic pits. Tractional forces could explain the delay of macular detachment in young adulthood and the frequency of treatment failure after laser coagulation and gas tamponade. Pars plana vitrectomy with complete removal of all vitreoretinal adhesions should be a suitable technique in the treatment of macular detachment associated with optic pits.

Adult↗