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A Händel

Publications and source records attributed to A Händel.

At least 19 recordsLinked to original sources
PubMed2004

[Quality management in ophthalmology. Putting it into practice in the clinical routine].

Though quality assurance has been an integral part of modern patient care for many years, this topic has gained in importance in German health policy. The introduction of a new reimbursement system for inpatients according to diagnosis-related groups (DRG) as well as the continuous cutbacks in public financial resources in the German health system raise concern that the quality of patient care will decline. To prevent this, comprehensive quality assurance measures as well as the implementation of professional quality management systems in German healthcare organizations are required by law (Section 135-137 SGB V). In the following, generally accepted concepts and methods of quality management are described.

Cost Control↗
PubMed2002

[Microsurgical quality assurance exemplified by cataract surgery].

BACKGROUND: The new German laws demand comprehensive quality assurance in all hospitals. The prerequisite for this in ophthalmic microsurgery is the complete documentation of all relevant surgical details including patient comorbidity. METHODS: Since 1989 we have documented all microsurgical procedures using a computer-based surgery recording system. To analyze the changing spectrum of cataract surgery in a university eye hospital, we evaluated 12,653 consecutive cataract extractions divided into 5 periods between 1990 and 1999. RESULTS: Within these periods the patients' age changed significantly (p < 0.001), whereas the gender showed no significant change (p = 0.34). Furthermore, there was an increase in the number of simultaneous surgical procedures (p < 0.01) as well as the frequency of the pseudoexfoliation syndrome (p < 0.001). In addition the mean duration of cataract procedures decreased (p < 0.001) and the occurrence of vitreous loss also decreased (p < 0.001). CONCLUSIONS: Long-term documentation of all relevant patient data enables valid evaluation of the patient spectrum. Furthermore, this monitoring helps to manage the challenge of quality assurance in ophthalmology.

Aged↗
PubMed2001

[Quality management according to DIN EN ISO 9001 at a university eye hospital].

BACKGROUND: Quality assurance is an integral part of modern microsurgical ophthalmology. Health care laws also mandate overall quality management. MATERIALS AND METHODS: In recent years we have standardized the preexisting features of quality management according DIN EN ISO 9001 and have integrated previously missing features. RESULTS: Establishing quality management according to ISO 9001 is possible even at a university eye hospital and department of ophthalmology. Certification according to ISO 9001 specifications was granted in April 1999. The major difficulty was in translating industrial norms to the context of an eye hospital. It was also difficult to overcome skepticism towards quality-assurance measures that lie beyond ophthalmological quality control. CONCLUSION: It is useful and feasible to establish a quality management system at German university eye hospitals and departments of ophthalmology. Certification according to ISO 9001 is one possibility to make a quality management system transparent and evaluable both inside and outside the hospital.

Certification↗
PubMed2000

Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome.

PURPOSE: To look for associations of preoperative A-scan ultrasound ocular dimensions with complications during phacoemulsification in eyes with pseudoexfoliation. METHODS: A total of 174 eyes with pseudoexfoliation of 135 patients undergoing planned cataract surgery were included in a prognostic study based on the review of a clinical database. Preoperatively, A-scan ultrasound examination with measurement of anterior chamber depth, lens thickness, and total axial length was performed. Phacoemulsification with implantation of a posterior chamber intraocular lens was performed by a total of five surgeons. Intraoperative complications (zonular dialysis and/or vitreous loss) were correlated with preoperative findings including ultrasound dimensions. Multivariate logistic regression analysis with a generalized estimating equations method was used for statistical analysis. RESULTS: Intraoperative complications occurred in 12 eyes (6.9%) of 11 patients. The anterior chamber was significantly shallower in eyes with than in eyes without complications (mean, 2.36 +/- 0.44 mm vs 2.74 +/- 0.52 mm; P =.013). The differences in lens thickness (4.93 +/- 0.55 mm vs 4.72 +/- 0.54 mm; P =.30) and the differences in axial length (22.92 +/- 1.09 mm vs 23.66 +/- 1.36 mm; P =.07) between the two groups did not reach statistical significance. In eyes with pseudoexfoliation, an anterior chamber depth of less than 2.5 mm was associated with a risk of 13.4% for intraoperative complications compared with an overall incidence of intraoperative complications of 6.9% and an incidence of 2.8% for an anterior chamber depth of 2.5 mm or more. CONCLUSIONS: A small anterior chamber depth may indicate zonular instability in eyes with pseudoexfoliation syndrome and should alert the cataract surgeon to the possibility of intraoperative complications.

Aged↗
PubMed2000

[Mid- and long-term results after trabeculectomy in patients with juvenile and late-juvenile open-angle glaucoma].

BACKGROUND: To determine success rate of trabeculotomy in patients with juvenile and late-juvenile glaucoma in a retrospective study. PATIENTS AND METHODS: 46 eyes of 41 juvenile glaucoma-patients (24 female, 17 male) were submitted to trabeculotomy during the period of 1980-1997. Patients age at the time of surgery was 30.2 +/- 10.5 years (11-49 years, median 21 years). Follow-up time was 35 +/- 46 months (1-155 months). RESULTS: Median preoperative visual acuity was 1.0 (range 0.002 to 1.25), postoperative visual acuity at the end of the follow up period was 0.8 (median) with a range from 0.002 to 1.2. In all patients preoperative intraocular pressure was elevated and a glaucomatous configuration of the optic disc was noticed. Preoperative intraocular pressure (IOP) ranged from 30.5 +/- 13.2 mm Hg, after surgery IOP was 16.2 +/- 5 mm Hg. Mean decrease of the IOP postoperatively was 54.4%. In 37% of the eyes IOP was lower than 23 mm Hg without additional medication, in 47% of the eyes IOP was lower than 23 mm Hg with additional medication. In 8 eyes additional antiglaucoma-surgery was necessary. After a follow-up time of 60 months 81% of the patients (n = 37 eyes) had an IOP below 23 mm Hg, after 120 months in 80% of the patients (n = 29 eyes) IOP was below 23 mm Hg. CONCLUSION: The success rate of trabeculotomy (defined as the ability to lower intraocular pressure lower than 23 mm Hg with or without antiglaucoma medication) in our patients is 84%. After second operation, success rate is 89%. Trabeculotomy for patients with juvenile open angle glaucoma is a safe procedure and avoids problems and complications of filtering procedures.

Adult↗
PubMed1999

[Expulsive hemorrhage in perforating keratoplasty--incidence and risk factors].

BACKGROUND: Expulsive hemorrhage is a severe complication of intraocular surgery. In a retrospective study we looked up surgical records of all penetrating keratoplasties (PK) performed in our department between 1989 and 1998. In all patients suffering from expulsive or preexpulsive choroidal hemorrhage we intended to find out possible risk factors and to report on the final outcome of these eyes. PATIENTS AND METHODS: Between January 1989 and November 1998 a total of 2421 PKs were performed. Nine preexpulsive and three expulsive hemorrhages occurred. The group of patients with preexpulsive hemorrhage consists of four females and five males (mean age 57 +/- 6.5 years). Three patients (one female, 2 males; mean age 67 +/- 8.5 years) suffered from expulsive hemorrhage. RESULTS: Incidence of expulsive hemorrhage was 0.1% (preexpulsive hemorrhage 0.4%). All twelve operations were performed under general anesthesia. Risk factors for preexpulsive hemorrhage were: previous ocular surgery (three patients), ocular trauma (2 patients) and internal diseases (five patients): arterial hypertension, coronary heart disease, diabetes. Preoperative visual acuity was light perception to 4/20, visual acuity at the last postoperative examination after a mean follow-up of 41.0 +/- 22.6 months ranged from light perception to 12/20. Risk-factors for expulsive hemorrhage were: previous ocular surgery (two patients), primary open angle glaucoma (two patients), coronary heart disease (one patient) und asthma bronchiale (one patient). One of the patients awoke from general anesthesia during the "open-sky" situation. Preoperative visual acuity was light perception to 2/400, visual acuity at the last postoperative examination (mean follow-up 14.0 +/- 1.0 months) was light perception in all eyes. CONCLUSION: The incidence of an expulsive hemorrhage was 0.1% in 2412 Pks. Risk factors are ocular and internal predispositions which can hardly be controlled, although arterial blood pressure was not significantly elevated during opening of the globe.

Adult↗
PubMed1998

[Results of implantation of transsclerally sutured posterior chamber lenses in combination with penetrating keratoplasty].

UNLABELLED: Implantation of transsclerally sutured posterior chamber lenses is one possibility of surgical visual rehabilitation of eyes with pseudophacic or aphacic bullous keratopathy without zonular-capsular support. We analyzed the results and complications of the surgical procedures performed in our institution. PATIENTS AND METHODS: Out of 1567 penetrating keratoplasties and 220 transsclerally sutured posterior chamber lenses that were performed at our institution between 1991 and 1996, patients that underwent penetrating keratoplasty and sutured posterior chamber lens implantation in whom sufficient clinical information was available were selected and analyzed in a retrospective, nonselective study. Surgery was performed by a total of four surgeons and included anterior vitrectomy, inside-out suturing and synechiolysis if necessary. Detailed pre- and intraoperative data, postoperative course and complications were recorded and analyzed. RESULTS: A total of 96 eyes were analyzed (patient age 17-92 years, 49 male, 46 female). Penetrating keratoplasty was performed for pseudophacic (63) oder aphacic (15) bullous keratopathy or for corneal scars following penetrating injury (18). Mean follow-up was 22 months. In 82 of 96 eyes, visual acuity improved following surgery. Complications included rhegmatogenous retinal detachment in 4 eyes, graft rejection in 5 eyes, secondary angle-closure glaucoma caused by preexisting anterior synechiae in 7 eyes, and persisting cystoid macular edema in 19 eyes. Luxation or subluxation of the IOL and endophthalmitis were not observed in any of the patients. CONCLUSION: Implantation of transsclerally sutured posterior chamber lenses appears to be a safe procedure and is considered by us to be the procedure of choice to correct aphacia during penetrating keratoplasty in eyes with absent zonular-capsular support. The majority of postoperative complications is apparently caused by preexisting problems related to previous surgery and/or trauma, such as peripheral anterior synechiae, vitreous incarceration or cystoid macular edema.

Adolescent↗
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↗
PubMed1998

Cataract extraction in eyes with diabetic iris neovascularization.

BACKGROUND AND OBJECTIVE: Iris neovascularization used to be considered a strict contraindication to intraocular surgery, especially intraocular lens implantation. In this study, the authors analyzed whether cataract extraction and posterior chamber lens implantation is associated with unacceptable intraoperative and early postoperative complications in patients with proliferative diabetic retinopathy and rubeosis iridis. PATIENTS AND METHODS: Using a computerized data retrieval system, the authors identified all the patients with manifest iris neovascularization and proliferative diabetic retinopathy who underwent cataract extraction in their institution between 1989 and 1995. The preoperative, intraoperative, and early postoperative data were analyzed retrospectively with regard to complications and visual results. RESULTS: Thirty-nine eyes of 33 patients (mean age 64.6 +/- 10.9 years) with manifest pupillary rubeosis iridis were analyzed. All but 3 of the eyes had undergone previous retinal laser treatment, with dense cataracts preventing additional photocoagulation. Additional chamber angle neovascularization was present in 11 eyes. Posterior chamber intraocular lenses were implanted in 35 eyes. Intraoperatively, iris hemorrhage was noted in 10 eyes and was significantly more frequent in eyes that underwent nuclear expression (50%) than in those that underwent phacoemulsification (12%; P = .019). Postoperatively, spontaneously resolving hyphema was observed in 7 eyes as well as reversible fibrin formation in 6 eyes. No severe sight-threatening complications occurred. Visual acuity improved in 33 (85%) of the eyes. CONCLUSION: Cataract extraction with posterior chamber lens implantation does not appear to be associated with unacceptable intraoperative or early postoperative complications. However, adequate treatment of underlying diabetic retinopathy prior to cataract extraction (and if necessary, postoperatively) is essential to prevent the progression of retinal and iris neovascularization.

Adult↗
PubMed1997

[Pseudoexfoliation syndrome in patients with retinal vein branch and central vein thrombosis].

BACKGROUND: Pseudoexfoliation syndrome is a frequent cause of secondary open-angle glaucoma due to deposition and in situ-production of abnormal extracellular matrix proteins in the trabecular meshwork. Glaucomas itself are a known risk factor for retinal vein thrombosis. In this retrospective study the prevalence of pseudoexfoliation syndrome in patients with branch and central retinal vein thrombosis was investigated. PATIENTS AND METHODS: The records of 332 unselected patients with branch retinal vein thrombosis and 159 with central retinal vein thrombosis, which were seen in our laser out-patient clinic between January 1990 and July 1996, were analysed retrospectively. RESULTS: 6.0% of patients with branch and 6.9% of patients with central retinal vein thrombosis revealed pseudoexfoliation syndrome. The full picture of pseudoexfoliation syndrome was seen in 4.2% of patients with branch and in 4.4% of patients with central retinal vein thrombosis. The prevalence of pseudoexfoliation syndrome increased with age. Twenty percent of patients with branch and 27% of patients with pseudoexfoliation syndrome and branch or central retinal vein thrombosis. The branch retinal vein thrombosis was significantly more often localised at the disk in patients with glaucoma and in patients with pseudoexfoliation syndrome. CONCLUSIONS: Pseudoexfoliation syndrome is a risk factor for retinal vein thrombosis. Pathogenetically the secondary open-angle glaucoma caused by pseudoexfoliation syndrome could be causative for the venous thrombosis.

Adult↗
PubMed1996

[Transplant reaction after keratoplasty for keratoconus. Frequency and risk factors].

BACKGROUND: Graft rejection is a leading cause of graft failure in keratoplasty for keratoconus. PATIENTS AND METHODS: A consecutive series of 274 keratoplasties performed between 1980 and 1991, for keratoconus was studied, some cases retrospective and others prospectively with postoperative monitoring up to 1993. Excluded from the study were 22 eyes with previous intraocular surgery, simultaneous cataract operations, or eccentric grafts. The mean follow-up was 26.3 months. RESULTS: Endothelial graft rejection was seen in 19 of the 274 eyes (6.9%), and in 4 of these eyes (1.4%) the graft failed. After 1 year the rejection-free transplant survival rate (Kaplan-Meier survival analysis) was 93.9% ( +/- 1.5% standard error) and after 4 years, 89.3 +/- 2.9%. Younger age of recipient and loosening of the suture were significant risk factors (p < 0.05 for each) for graft rejection episodes. Suture loosening was significantly more frequent in younger recipients (p < 0.001). Recipient's age was not a risk factor in eyes in which suture loosening did not occur. CONCLUSION: Younger patients are at greater risk of graft rejection in keratoconus, not only because of their more "active" immune system but also because of a higher risk of suture problems. More attention must be paid to suture problems, especially in younger patients, to decrease the risk of graft rejection in keratoconus patients.

Adolescent↗
PubMed1993

[Results of laser coagulation of retinal branch vein occlusions].

BACKGROUND: The benefit of laser treatment in patients with branch retinal vein occlusion (BRVO) is established in the literature. We investigated the relationship of morphological and fluorescein angiographic findings with the results of laser treatment. PATIENTS AND METHODS: Of 211 examined patients with BRVO argon-laser coagulation was performed in 121 (57%). Laser treatment was done in all patients with preretinal neovascularization and in patients with macular edema 3 months or more after the onset of occlusion with visual acuity < or = 20/40. Follow up examinations were performed in 3 months intervals with the last examination 11.7 months on average after treatment. Statistical analysis was done by Wilcoxon-test. RESULTS: Mean visual acuity before laser coagulation was 20/60, after laser treatment 20/50. Visual acuity in all patients improved significantly after laser treatment (p = 0.0001). A significant improvement occurred when treatment was performed within 3 to 4 months after onset (p < 0.0001), in patients with macular edema in the ischemic (p = 0.0005) and non ischemic type (p = 0.036), in patients without preretinal neovascularization (p < 0.0001) and without vitreous hemorrhage (p = 0.0001), in patients between 51 and 60 years (p = 0.0001) and between 41 and 50 years of age (p = 0.0086), in vein occlusions with intraretinal hemorrhages ++ (p = 0.0001), with hard exsudates + (p = 0.0047) in vein occlusions of the temporal superior (p = 0.0016) and the temporal inferior branch (p = 0.028) and in patients with diffuse dye leakage + (p = 0.0036) and ++ (p = 0.007). No significant visual improvement was found in patients with ischemic maculopathy, hard exsudates ++, preretinal neovascularization and vitreous hemorrhage, diffuse intraretinal dye leakage , dye leakage ++ and from retinal vessels and in patients < or = 40 and > 60 years of age. CONCLUSIONS: Laser treatment in BRVO according to the criteria of the study is beneficial and results in significant visual improvement.

Adult↗
PubMed1992

[Clinical and fluorescein angiography changes in patients with central retinal vein occlusion. A unicenter study of 125 patients].

Between January 1986 and December 1989 we prospectively studied 125 patients with central retinal vein occlusion (CRVO). Documented by fundus photography and fluorescein angiography clinical and angiographic findings were analysed. The age of the patients was between 22 and 89 years with a mean of 60 years. 74 (59%) were male and 51 (41%) female. 63 (50.4%) right and 62 (49.6%) left eyes were affected. Arterial hypertension was found in 34 (37.2%) and diabetes mellitus in 18 (14.4%) of the patients. Glaucoma was present in 14 (11.2%). 11 (8.8%) patients had bilateral CRVO. Preretinal neovascularisation was found in 5 (4%), vitreous hemorrhage in 6 (4.8%) and a retinal detachment in 2 (1.6%) patients. Iris neovascularisation at time of first presentation was found in 8 (6.4%) of all patients, related to the number of ischemic type of CRVO in 17.7%. Cystoid macular edema was found in 77 (61.6%), ischemic maculopathy in 24 (19.2%) patients, and a combination of cystoid and ischemic maculopathy in 11 (8.8%). Mean visual acuity was 20/100. A non ischemic type was present in 80 (64%) an ischemic in 45 (36%) of patients. Mean visual acuity in the non ischemic type was 20/60 and highly significant better (p < 0.0001) than in the ischemic type with a mean visual acuity of 20/400 (Mann-Whitney test). The density of intraretinal hemorrhages (p = 0.0005) and type of maculopathy (p < 0.0001) were highly significant related to the ischemia type (chi-square method).

Adult↗
PubMed1991

[Results of pseudophakic retinal detachment surgery].

Between 8/81 and 9/89 2658 patients underwent retinal detachment surgery at the university eye hospital Erlangen/Nürnberg. From this number there were 30 (= 1.1%) pseudophakic retinal detachments consisting of 14 males and 16 females. Minimal age was 48, maximal 89 years, average age was 70.9 years. There were 4479 extracapsular cataract extractions with implantation of a posterior chamber lens performed in the same interval at our eye hospital. Out of this 4479 extracapsular cataract extractions we found 9 patients (= 0.2%) with pseudophakic retinal detachment. In our investigated group we found preoperative risk factors resulting in a pseudophakic retinal detachment consisting out of myopia, latticelike degeneration of the retina and contusion bulbi. Intraoperative risk factors are the rupture of the posterior capsule and vitreous prolapse. A postoperative risk factor is YAG-laser-capsulotomy. We observed a pseudophakic retinal detachment with patients undergoing YAG-laser-capsulotomy after minimal 30, maximal 880 and 372 days in average. Out of 30 patients 17 (= 66.6%) were treated successfully with the first operation. The success rate summed up to 83.2% after one re-operation. With 17 out of 30 patients we had to apply extensive endoophthalmic vitreous and retinal surgical techniques (cerclage, pars-plana-vitrectomy, silicone oil instillation).

Aged↗
PubMed1991

[Morphometric and qualitative changes in corneal endothelium in pseudoexfoliation syndrome].

In a prospective study begun in March 1986, in 182 eyes with pseudoexfoliation syndrome (PES) specular microscopic endothelial cell photographs were taken with direct and non-direct specular microscopy in non-selected patients who had not undergone intraocular surgery. Age-matched cataract eyes with normal intraocular pressure served as a control group. Standard specular microscopic examination (Bio Optics LSM 2000 A and Clinical Specular Microscope Camera) to evaluate the endothelial cell count and the morphology and quality of the endothelium yielded the following results. In 4432 control eyes with normal intraocular pressure the cell count was observed to be age-dependent and to have an average value of 2302 +/- 394 cells/mm2, the cells generally had a regular arrangement. In 123 eyes with pseudoexfoliation syndrome there was a significant (p less than 0.001) reduction in cell count to 1812 +/- 297 cells/mm2. In 59 eyes with PES and manifest glaucoma there was a significant (p less than 0.001) reduction of the corneal endothelium to 1482 +/- 267 cells/mm2. The cell picture was composed of enlarged, regularly arranged cells. In addition, such endothelial changes as incomplete cell lesions, cell detritus and appositions were six times as frequent as in normal eyes. In 32% of the eyes affected by PES we found manifest glaucoma. The statistical evaluation (matched age groups ect.) was carried out by means of the Mann-Withney-Wilcoxon rank test.

Adult↗
PubMed1991

[Morphometric and qualitative changes in corneal endothelium in primary chronic open angle glaucoma].

In a prospective study begun in March 1986, specular-microscopic endothelial cell photographs were taken in non-selected patients with primary, chronic, open-angle glaucoma who had not had intraocular surgery. Age-matched cataract eyes with normal intraocular pressure served as the control group. Standard specular microscopic examinations (Bio Optics LSM 2000 and Clinical Specular Microscope Camera) to evaluate the endothelial cell count, as well as the morphology and quality of the endothelium, revealed the following results. In 3204 normal eyes with normal intraocular pressure (10-20 mmHg), the cell count was observed to be age-dependent and to have an average value of 2293 +/- 394 cells/mm2; the cells generally had a regular arrangement. In 302 eyes with primary, chronic, open-angle glaucoma with intraocular pressures between 19 and 32 mmHg, there was a significant (p less than 0.001) reduction, in cell count to 1582 +/- 248 cells/mm2. The cell picture was composed of clearly enlarged, but regularly arranged cells. A statistical evaluation (matched age groups, etc.) was carried out using the Mann-Wilcoxon rank test.

Aged↗