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Biomedical subjects

A J Mueller

Publications and source records attributed to A J Mueller.

50 records · Page 3Linked to original sources
PubMed1998

The effect of deep posterior subtenon injection of corticosteroids on intraocular pressure.

PURPOSE: To investigate the effect of posterior subtenon injections of corticosteroids on intraocular pressure in a variety of ocular diseases. METHODS: We retrospectively analyzed 202 consecutive posterior subtenon corticosteroid injections (148 of methylprednisolone acetate, 80 mg, and 54 of triamcinolone acetonide, 40 mg) in 63 eyes of 55 patients (26 male, 29 female; mean age +/- SD, 60.17 +/- 26.55 years). All patients had received topical or systemic corticosteroids before the injection, and no rise in intraocular pressure had been noted. Preinjection and postinjection intraocular pressure measurements were compared by two-tailed paired t test. Statistical analysis was performed separately by patient (first injection of first injected eye), by eye (first injection of each eye), and by all injections. To detect increase in intraocular pressure during follow-up, statistical analysis was performed separately 14 to 90 days, 91 to 150 days, and 151 to 270 days after injection. RESULTS: No statistically significant difference was found between preinjection and postinjection intraocular pressure measurements. A power calculation in the most stringent subanalysis (by patient) proved that there is only a 3.87% chance to statistically miss a clinically significant rise in intraocular pressure from 15 to 21 mm Hg. CONCLUSIONS: Posterior subtenon injection of corticosteroids does not cause an increase in intraocular pressure. All patients in our study had been treated previously with topical or systemic corticosteroids and did not react with an excessive increase in intraocular pressure. This safety of repository corticosteroids may therefore not apply to patients whose status in responding to corticosteroids is not known.

Adolescent↗
PubMed1998

Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure.

OBJECT: The syndrome of retinal or vitreous hemorrhage in association with subarachnoid hemorrhage (SAH) is known as Terson's syndrome. The authors' purpose was to determine whether intraocular hemorrhage occurs with similar incidence when caused by severe brain injury accompanied by acutely raised intracranial pressure (ICP). METHODS: Prospective ophthalmological examination was performed in 22 consecutive patients with SAH or severe brain injury and elevated ICP. Thirteen patients were admitted for SAH (World Federation of Neurological Surgeons Grades II-IV) and nine for severe brain injury (Glasgow Coma Scale scores 3-10). Monitoring of ICP was performed at the time of admission via a ventricular catheter. Initial ICP exceeded 20 mm Hg in all patients. Indirect ophthalmoscopy without induced mydriasis was performed within the 1st week after the acute event. Retinal or vitreous hemorrhage was seen in six (46%) of 13 patients with SAH and in four (44%) of nine patients with severe brain injury. Ocular bleeding was found bilaterally in three patients with SAH and in one patient with severe brain injury (18%). Six of the 10 patients with Terson's syndrome died as a result of their acute event. CONCLUSIONS: The present results indicate that Terson's syndrome may be related to acute elevation of ICP, independent of its causes, and may occur with similar incidence in patients with severe brain injury and those with SAH. Because recognition and treatment of Terson's syndrome may prevent visual impairment and associated secondary damage to the eye, increased awareness of this entity in all patients with acute raised intracranial hypertension is recommended.

Acute Disease↗
PubMed1997

Analysis of visual dysfunctions in HIV-positive patients without retinitis.

PURPOSE: To investigate visual dysfunctions in ophthalmoscopically normal human immunodeficiency virus (HIV)-positive patients and to correlate the results to the stage of HIV disease and neuropsychological status. METHODS: Fifty-one randomly selected eyes (26 right, 25 left) of 51 HIV-positive patients with visual acuity measurements of 20/20 or better and no ophthalmoscopically detectable disorders were prospectively examined using achromatic and short-wavelength automated perimetry, color vision testing, and contrast sensitivity testing. CD4+ T-lymphocyte count, presence of systemic infection, hemoglobin, hematocrit, serum beta 2-microglobulin levels, and results of neuropsychological testing were also analyzed. RESULTS: On achromatic automated perimetry, 21.6% (11/51) of patients performed abnormally according to the mean defect and 27.5% (14/51) according to the Glaucoma Hemifield Test; 29.4% (15/51) performed abnormally on short-wave-length automated perimetry according to the mean defect and 23.5% (12/51) according to the Glaucoma Hemifield Test. On contrast sensitivity, 5.9% (3/51) of patients performed abnormally in the 1.5-cycles per degree (cpd) line, 2.0% (2/51) in the 3-cpd line, 23.5% (12/51) in the 6-cpd line, 25.5% (13/51) in the 12-cpd line, and 33.3% (17/51) in the 18-cpd line. On the Farnsworth-Munsell 100-hue test, 29.4% (15/51) of patients performed abnormally. After correction for multiple correlations, two statistically significant correlations were found: sum of log contrast sensitivity with achromatic automated perimetry and sum of log contrast sensitivity with the Farnsworth-Munsell 100-hue test. CONCLUSIONS: A significant percentage of HIV-positive patients with visual acuity of 20/20 or better and no ophthalmologic evidence of retinitis performed abnormally on visual psychophysical tests. The severity of visual dysfunction was not correlated with the stage of HIV infection or the degree of neuropsychological dysfunction.

Adult↗
PubMed1997

Adverse events and autopsy findings after intravitreous cidofovir (HPMPC) therapy in patients with acquired immune deficiency syndrome (AIDS).

OBJECTIVE: The purpose of the study is to evaluate the adverse events and autopsy findings in a series of consecutive 20-microg intravitreous cidofovir injections at a single institution. DESIGN: The study design was a nonrandomized, consecutive case series. PARTICIPANTS: Seventy-six patients with acquired immune deficiency syndrome with cytomegalovirus retinitis were studied prospectively. Sixty-three patients had 1 month's follow-up or longer, and this comprised the study group. In addition, histopathologic findings from 18 eyes of 9 patients were studied at autopsy. INTERVENTION: A total of 296 injections of 20 microg cidofovir were given in 115 eyes. Sixty-three patients who had 246 injections in 93 eyes had 1 month's follow-up or longer for the evaluation of adverse events. MAIN OUTCOME MEASURES: Postinjection chronic hypotony associated with permanent visual loss, transient hypotony, iritis, and its long-term sequela (posterior synechia and cataract, retinal detachment, extraocular cytomegalovirus involvement) were the outcomes of interest in this study. Additionally, light and electron microscopic studies of human eyes were performed. RESULTS: The most severe adverse event was postinjection chronic hypotony. This phenomenon was associated with permanent visual loss. This was observed in 1% of the injections and 3% of the eyes of the patients (95% confidence interval, 0%-6%). Transient hypotony associated with mild-to-moderate visual loss developed in 14%, but vision recovered to baseline levels in these eyes subsequently. Analysis showed that transient hypotony in the injected eye could predict postinjection chronic hypotony in the fellow eye (two-tailed Fisher's exact test, P = 0.02). The incidence of iritis was 32%; posterior synechia and cataract were the long-term sequela of the iritis and developed in 19% and 11% of the eyes, respectively. The incidence of retinal detachment was lower (6%). Histopathologic evaluation of the eyes showed mild-to-moderate atrophy of the nonpigmented epithelium of the ciliary body and no other evidence of intraocular toxicity. CONCLUSIONS: The most serious adverse event was postinjection chronic hypotony, which occurred in 3% of eyes. Episodes of transient hypotony appear to indicate that the fellow eye was predisposed to chronic hypotony. Therefore, it may be prudent to give intravitreous injections at least 2 weeks apart in the fellow eye to evaluate the clinical response of the injected eye.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Incidence of ophthalmologic complications in acute intracranial hypertension].

Although Terson's syndrome has been diagnosed more frequently since the early 1960s because of improved intensive-care facilities, these reports are single case reports or retrospective studies. Therefore, we examined prospectively 20 patients (11 male, 9 female), aged between 23 and 77 years, with subarachnoid hemorrhages or rapid increase in intracranial pressure (ICP) of other origin (tumor-associated, post-traumatic) to evaluate ocular changes. In all patients the increase in ICP was confirmed by computed tomography. Additionally, in 16 patients permanent monitoring of ICP was performed. Twelve patients presented with subarachnoid hemorrhage, 6 had a post-traumatic increase in ICP, and 2 more presented with a tumor-associated intracranial hemorrhage. A total of 8 patients (40%) presented with intraocular changes; 6 presented with uni- or bilateral intraretinal hemorrhage, 1 patient had a bilateral papilledema and 1 more patient had bilateral vitreal hemorrhage. When ocular hemorrhage occurred, the mortality was 2.5 times as high as in patients without ocular hemorrhage. For this prognostic feature of the ophthalmological status all patients with rapid increase in ICP should be monitored early for intraocular hemorrhage. The possibility of intraocular hemorrhage is elevated in high-degree subarachnoid hemorrhage, whereas a rapid increase in ICP also found when the pressure has other causes (tumor-associated, posttraumatic).

Adult↗
PubMed1994

[HIV-1 and tears. Results of virus isolation and polymerase chain reaction (PCR)].

Beside the threat of infection via HIV-containing blood, the ophthalmologist is especially interested in the possibility of HIV infection via the tears of HIV-positive persons. In a first step, we tried to isolate HIV-1 from the peripheral blood lymphocytes (PBL) of 50 HIV-1-antibody-positive persons in different stages of disease and to detect reverse transcriptase (RT) and p24 antigen (p24-Ag) in the supernatant. Simultaneously we carried out the same tests on tears of these patients. In 10 persons tears were collected using Schirmer strips, in 40 persons by means of microcapillaries. In a second step 10 sample pairs (PBL and tears) were tested with the polymerase chain reaction to detect proviral sequences of HIV-1 (gag, pol, env). In the first step it was not possible to isolate HIV-1 from tears, nor was it possible to detect RT or p24-Ag from the supernatant. In contrast, this was successful in 32 of the 50 examined cases for the PBL. In the second step, it was possible to detect gag, pol and env in all 10 PBL samples, while gag and pol could be detected only in one tear sample and env not at all. Our results show that the tears of HIV-positive persons contain extremely low quantities of tissue-infectious units of HIV. In addition, proviral sequences seem to occur in much lower frequency in tears than in PBL. Infection with HIV via tears therefore appears very unlikely. These findings make it possible to assign tears a place in a semiquantitative ranking of different body fluids by HIV-1 concentration.

Adolescent↗
PubMed1993

Main sources of infection in 145 cases of epidemic keratoconjunctivitis.

Epidemic keratoconjunctivitis (EKC) is a combination of conjunctivitis and keratitis induced by an adenovirus that is found especially in eye clinics and in eye hospitals. In Bavaria, EKC represents a common eye disease and occurs in epidemics in the spring and early autumn. We report on 145 patients who presented with EKC in our hospital between March 17 and September 12, 1991, and who were evaluated prospectively (67 men and 78 women ranging in age from 4 to 85 years). The recent patient history was noted using a standardized protocol to analyze possible sources and pathways of the infection. Overall, 44 of the EKC patients (30%) remembered having undergone eye treatment during the incubation period of 2 weeks before the onset of symptoms. In all, 18 patients (12%) recalled that a family member had also had conjunctivitis during that time, and 4 patients (3%) reported the infection of a workmate during the 2 weeks prior to the onset of symptoms. In 82 patients (55%), no presumed source of infection was apparent. A total of 24 patients (17%) presumably acquired the infection during examination or treatment in our hospital. The main cause was the removal of foreign body, followed by cataract operation. In all, 20 patients (14%) had been treated in private practice during the incubation period; 14 of these remembered having had tonometry, and 4 patients had undergone contact-lens fitting. In 18 patients, virus isolation and serotyping from a conjunctival smear was conducted. In 12 of these patients an adenovirus could be isolated; in all cases it proved to be serotype 8.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenovirus Infections, Human↗
PubMed1992

Multiple-stimulus presentation and voice control in automated perimetry.

In all, 55 eyes of 55 patients were examined prospectively in random order with the Humphrey field analyzer [central field 76 points, full threshold strategy, single-stimulus presentation, response-button control (HFA 1); central field 76 points, defect-depth strategy, response-button control (HFA 2)] and the Dicon TKS-4000 [central field 76 points, defect-depth strategy, multiple-stimulus presentation, response-button control (DIC 1); central field 76 points, defect-depth strategy, multiple-stimulus presentation, voice control (DIC 2)]. Some 26 patients (47%) had glaucomatous field defects, 7 patients (13%) had lesions of the visual pathway, 5 patients (9%) had normal fields. The other 17 patients (31%) had field defects due to vascular lesions of the retina or the optic nerve, retrobulbar neuritis, cataract, dysthyroid optic neuropathy, disorders of the macula, or human immunodeficiency virus (HIV) retinopathy. The mean testing time for the whole study population was 5.2 +/- 2.7 min for DIC 1. The difference from the mean testing time for HFA 2 (6.4 +/- 2.7 min) is statistically significant (p = 0.0013). DIC 2 reduces the mean testing time to 4.9 +/- 2.6 min. The difference from DIC 1 is not statistically significant (p = 0.8110). A multiple-stimulus presentation and voice control seem to be useful methods to reduce the testing time in automated perimetry without a loss of accuracy. Voice control, as used in the DICON TKS 4000, still has to be improved, however.

Adult↗
PubMed1991

[Electro-ophthalmologic studies in HIV patients].

We examined 44 HIV-positive patients in different disease stages with electroretinogram (ERG), pattern-electroretinogram (PERG), and visually evoked cortical potentials (VECP). Sixty-eight of the 88 eyes examined had a normal fundus and full central vision. Twelve eyes showed cotton-wool ecudates and 8 eyes CMV retinitis. Fifty-four eyes with normal fundus were examined by ERG. Of these 28 (52%) showed marked reduction of the amplitude. In the PERG, 20 eyes out of 50 examined (40%) showed an amplitude reduction. In the VECP, 12 out of 65 eyes (19%) had a reduced amplitude. In the ERG, 7 of 11 eyes (64%) with cotton-wool exudates showed marked pathological findings, as opposed to 4 of 10 cases (40%) in the PERG and 3 of 12 (12%) in the VECP. Seventy-five percent of the eyes with CMV retinitis (6 of 8 cases) showed pathological findings in the ERG and VECP and 100% (all 7 cases examined) in the PERG. These electrophysiological findings suggest that there are diffuse disorders in the retina of HIV-positive patients. It is possible that these findings are based on direct infection of the retina with HIV, or that they represent a vascular disorder, subclinical infection or are related to side effects of the drugs used for the HIV infection.

Adult↗
PubMedDate not supplied

Infrequent detection of HIV-1 components in tears compared to blood of HIV-1-infected persons.

Beside the risk of infection via HIV-1-contaminated blood, ophthalmologists are especially interested in the possibility of HIV-1 infection via tears. Therefore we tried to isolate HIV-1 from tears of 50 HIV-1-infected persons in different stages of disease by reverse transcriptase (RT) and by p24-antigen (p24-AG) in the cultures. Simultaneously we tried to isolate HIV-1 in the supernatant from peripheral blood lymphocytes (PBL), which was successful in 32 of the 50 examined specimens. HIV-1 could not be isolated from the tears of these persons. In addition, polymerasechain-reaction (PCR) was performed to detect proviral sequences (gag, pol, env) of HIV-1 in tears and blood of ten HIV-1-infected patients. While in all the examined patients gag, pol and env could be detected in the blood samples, only one tear sample was found positive for gag and pol DNA fragments. These results indicate that tears of HIV-1-positive contain extremely low quantities of tissue culture infectious doses (TCID) of HIV-1 in contrast to PBL. HIV-1 infection via tears therefore appears to be unlikely.

Adolescent↗