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Biomedical subjects

A Kampik

Publications and source records attributed to A Kampik.

At least 19 recordsLinked to original sources
PubMed1999

Surgical extraction of subfoveal choroidal new vessels and submacular haemorrhage in age-related macular degeneration: results of a prospective study.

BACKGROUND: The surgical extraction of subfoveal choroidal new vessels (CNV) is one of several possibilities to treat subfoveal CNV or haemorrhages in age-related macular degeneration (ARMD). METHODS: Prospective study, follow-up 3-6 months. Clinical and angiographic differentiation of three subgroups: (1) subfoveal well-defined CNV (24 eyes); (2) subfoveal ill-defined CNV with or without well-defined components (10 eyes); (3) submacular haemorrhages (20 eyes). RESULTS: The mean and median visual acuity and the proportion of eyes with > or = 20/200 vision increased slightly in group 1 and decreased slightly in group 2; the differences were not significant. Group 3 demonstrated mean improvement but was heterogeneous, depending on the site and type of underlying CNV. The proportion of eyes with 3 or more lines of improvement after 3 months was 35.3% (7/17), 10% (1/10) and 38.9% (7/18) respectively. The proportion of eyes with a loss of 3 or more lines after 3 months was 5.9% (1/17), 20% (2/10) and 5.6% (1/18) respectively. The recurrence rate was 29.2% (7/24), 8.3% (1/11) and 25% (5/20). Intraoperative complications were iatrogenic central tears in 7.3% (4/55), peripheral tears in 14.5% (8/55) and peripheral retinal detachment in 3.6% (2/55). A postoperative retinal detachment was observed in 2 of 55 eyes (3.6%). All these complications could be managed without ill effect. CONCLUSION: Subfoveal surgery might preserve remaining retinal function in eyes with well-defined CNV. However, subgroups of the MPS subfoveal laser trials with comparable initial visual acuity demonstrated postoperative functional stabilisation and similar recurrence rates in well-defined CNV. Though selected cases of submacular haemorrhage did profit from surgery, TPA-assisted gas injection will probably be a better alternative. Unfortunately, surgery for ill-defined CNV, found in the vast majority of eyes with exudative ARMD, seems to worsen the natural course. Surgery has to be combined with restoration of Bruch's membrane before it can become a possible therapeutic option in ARMD.

Aged↗
PubMed1998

[Post-traumatic endophthalmitis after penetrating eye injuries. Risk factors, microbiological diagnosis and functional outcome].

BACKGROUND: Endophthalmitis associated with penetrating injury represents a distinct kind of intraocular infection. The preceding trauma, infective agents and inflammatory changes determine the functional outcome. MATERIALS AND METHODS: In a retrospective study, 18 patients with endophthalmitis were investigated and compared to a control group of 54 patients with penetrating ocular trauma. A number of clinical variables were evaluated for association with an increased risk of endophthalmitis. RESULTS: Risk factors found to be significant were: (1) a purely corneal wound, (2) surgical primary repair more than 24 h after injury and (3) initiation of intravenous antibiotic therapy later than 24 h after trauma. A two-fold increased relative risk was related to the presence of an intraocular foreign body, lens injury and a wound length less than 5 mm. Direct inoculation of surgical specimens and immediate microbiological processing succeeded in the presumptive identification of infective agents with preliminary therapeutic recommendations in 72% of the patients. CONCLUSIONS: In "risk eyes" particular attention should be paid to prophylaxis and signs of infection.

Bacteria↗
PubMed1998

[Choroid neovascularization in age-related macular degeneration. Correlation of histological and fluorescence angiography findings].

BACKGROUND: Recent studies have raised confusion about the fluorescein angiographical and histopathological correlation of CNV. MATERIAL AND METHODS: The preoperative fluorescein angiograms of four patients with subfoveal CNV due to ARMD extracted by pars plana vitrectomy were classified as wellor ill-defined CNV and were correlated to the histopathologically (in serial sections) verrified CNV-location (subneuroretinal (= type II according to Gass) versus sub-RPE (type I according to Gass)). RESULTS: The locations of all four CNV could be classified by histopathological landmarks as there were RPE, BLD/drusen, and inner Bruchs membrane. Angiographically welldefined membranes were type II membranes according to Gass, whereas the ill-defined membrane represented type I. The CNV with well- and ill-defined borders consisted of type II and type I parts according to Gass. CONCLUSION: We find subneuroretinal locations of the well-defined CNV examined (type II membranes according to Gass). Correspondingly, ill-defined CNV or ill-defined parts of a CNV seem to be beneath the RPE (type I). The correlation of fluorescein angiography and histopathology should be studied in greater numbers of well- and ill-defined CNV.

Bruch Membrane↗
PubMed1998

[Recurrent choroid neovascularization in age-related macular degeneration. Fluorescein angiographic morphology after surgical membranectomy].

UNLABELLED: The surgical removal of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) causes a retinal pigment epithelial defect (RPED) corresponding to the area of diffuse RPE damage. We describe angiographic features of recurrent CNV in AMD after surgical membranectomy in order to elucidate the nature of persistence and recurrence. METHODS: After digitalization of the pre- and postoperative fluorescein angiographic images of eight patients with recurrent CNV in AMD we determined the morphology (well or ill-defined) and the area of the CNV and of the subretinal hemorrhage preoperatively and of the recurrent CNV and of the RPE defect postoperatively. RESULTS: The nature of recurrences showed differences between preoperatively well- and ill-defined CNV. Four preoperatively well-defined CNV with surrounding subretinal hemorrhage showed recurrences in the entire area of the preoperative CNV excluding the retinotomy 8-9 weeks postoperatively. Four preoperatively ill-defined CNV with subretinal hemorrhage developed marginal recurrences at the rim of the RPED. There was no background fluorescence in the area of the RPED. CONCLUSION: The nature of recurrences extending over the entire area of the preoperatively well-defined CNV without loss of background fluorescence only a few weeks after surgical removal of well-defined CNV suggests partial persistence. The removal of the subretinal well-defined CNV could leave sub-RPE parts in locations that preoperatively cannot be visualized angiographically. The marginal recurrence of preoperatively ill-defined CNV weeks to months postoperatively shows angiographic similarities to recurrent CNV after laser coagulation.

Aged↗
PubMed1998

[Bacterial colonization of conjunctiva with Propionibacterium acnes before and after polyvidon iodine administration before intraocular interventions].

BACKGROUND: Propionibacterium acnes has been described as a causative agent of postoperative endophthalmitis. This gram-positive, immotile, non-spore-forming bacterium is highly pleomorphic and grows under conditions of low to no oxygen concentration. It is commonly found on the skin at the openings of sebaceous glands and on hairs. A near-symptomless postoperative endophthalmitis occurs particularly when Propionibacteria are enclosed in the capsular bag. We investigated to what extent the number of P. acnes in the conjunctival sac can be reduced by preoperative disinfection with polyvidone iodine (1%). PATIENTS AND METHODS: A total of 261 patients with intrabulbar surgery had two conjuctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after disinfection with polyvidone iodine before opening the conjunctiva. RESULTS: Of the 261 swabs, 60 (23%) taken prior to polyvidone iodine application were positive for Propinibacterium acnes. Following polyvidone iodine treatment, a further 5 (1.9%) remained culture-positive. After disinfection, 55 (92%) of the 60 positive swabs for Propionibacterium acnes remained culture-negative. CONCLUSIONS: We concluded that a significant reduction of P. acnes can be achieved by preoperative application of polyvidone iodine (1%) (P < 0.001).

Anti-Infective Agents, Local↗
PubMed1998

Ultrastructure of epiretinal membranes associated with macular holes.

BACKGROUND: The role of tangential traction exerted by epiretinal membranes in the pathogenesis of macular holes is not fully understood. Furthermore, the role of glial cells in the formation and/or closure of macular holes remains to be elucidated. METHODS: To better understand the pathogenesis of macular hole formation and to compare the ultrastructural features of epiretinal membranes associated with macular holes of primary and secondary etiology, we harvested 23 translucent epiretinal membranes associated with macular holes stages III-IV at the time of pars plana vitrectomy and examined them electron microscopically. Eighteen membranes were obtained from patients with idiopathic macular holes. 3 membranes from patients with myopic macular holes and 2 epiretinal membranes were associated with macular holes which had developed after retinal detachment surgery. RESULTS: Eighteen membranes contained a continuous undulating piece of inner limiting lamina (ILL). Sixteen of 18 epiretinal membranes at the margins of idiopathic macular holes, 2 of 3 membranes in myopic macular holes and both membranes associated with a macular hole after retinal detachment surgery demonstrated mono- or multilayers of fibrous astrocytes with single macrophage- or fibrocyte-like cells. Vitreous and newly formed collagen occupied the space between the ILL and the glial cells. Three macular holes were surrounded by rather firmly attached acellular ILL. CONCLUSIONS: Glial cells and newly formed collagen may play an important role in macular hole formation by exerting tangential traction regardless of the underlying disease process. Glial cells, however, may also be involved in healing of the retinal defect and pars plana vitrectomy with peeling of an epiretinal membrane, and/or the ILL may induce directed glial cell proliferation and migration. The similar ultrastructure of epiretinal membranes associated with macular holes and "simple epiretinal membranes" as described by Foos [8] suggests a common pathogenesis for macular holes and macular pucker.

Adult↗
PubMed1998

[Topical administration of metronidazole gel as an effective therapy alternative in chronic Demodex blepharitis--a case report].

BACKGROUND: Blepharoconjunctivitis is the commonest manifestation of ocular rosacea. Cilia epilation proves Demodex folliculorum, considered an etiologic factor in rosacea. Complications and differential diagnosis include dry eyes, seborrheic, bacterial and allergic blepharoconjunctivitis. Treatment involves lid scrubs and mercury ointment, its duration is limited to 6 weeks under frequent control due to corneal toxicity of mercury. HISTORY AND SIGNS: 30-year-old female with complaint of red, irritated eyes for 21 years, resistant to antibiotics and antiallergics. General medical history unremarkable, mercury allergy. Acuity: R/L 20/20. Biomicroscopy: red, thickened eyelid margins, crusty debris on rarefied, partially broken lashes, conjunctival telangiectasia, low tear meniscus, further ophthalmologic examination unremarkable. DIAGNOSIS: chronic Demodex blepharoconjunctivitis. THERAPY AND OUTCOME: Conventional treatment was contraindicated due to mercury allergy. Alternative oral minocycline 100 mg daily brought no subjective nor objective relief. Combination of lid scrubs and 2% Metronidazole gel relieved symptoms and halved number of mites after 1 month, lashes grew again after 2 months. Treatment was discontinued after 6 months as Demodex folliculorum proof remained negative. No relapse occurred during 1 year. CONCLUSIONS: Topical Metronidazole 2% proved to be an effective treatment of chronic Demodex blepharoconjunctivitis in our case and thus may offer a new and save alternative to existing therapies. Neither ocular nor systemic side effects occurred. Controversial theories on the aetiology of blepharitis are discussed.

Administration, Topical↗
PubMed1997

[Lisch nodules. Markers of neurofibromatosis 1 and immunohistochemical references for neuroectodermal differentiation].

Iris nodules in neurofibromatosis I have become an important tool in the differential diagnosis of phakomatoses. The clinical appearance and importance of these nodules first recognized by Karl Lisch in Munich in 1937. The diagnosis and differential diagnosis of Lisch nodules are illustrated. The importance of iris nodules in genetic counselling of patients and their relatives is discussed, with emphasis on monosymptomatic cases. Histologically Lisch nodules are formed by aggregations of oval to round cells that form dome-shaped papules on the anterior layer of the iris. Immunohistochemically these cells are characterized by positive staining with antibodies against vimentin and S-100 protein. This proves their ectodermal differentiation. Thus Lisch nodules can be seen as a direct manifestation of neuroectodermal disturbances in neurofibromatosis I.

Diagnosis, Differential↗
PubMed1997

[Local therapy in treatment of cytomegalovirus (CMV) retinitis in AIDS. The ganciclovir implant (pellet)].

BACKGROUND: Cytomegalovirus (CMV) retinitis with AIDS has been treated either systemically or locally by weekly intravitreous injections. An intraocular device now offers a new therapeutic approach. We investigated its efficacy in preventing progression of CMV retinitis without additional systemic therapy. Conversely, we also studied the risks and disadvantages of this method of drug administration. PATIENTS AND METHODS: In our study 46 devices were implanted in 28 patients. All patients were pretreated with systemic medication. Systemic treatment was stopped on the day of surgery. RESULTS: Severe perioperative complications occurred in one patient, who developed retinal detachment after surgery. Most patients showed no relapse of retinitis with the implant, though they did not receive systemic treatment for 8.1 months on average. Only 20% of our patients presented with extraocular CMV disease. Thirty-five percent (n = 17) of patients with unilateral retinitis developed CMV retinitis in the primary uninvolved fellow eye. After implantation of a device into this eye also progression could be stopped without additional systemic treatment. Two patients showed progression of retinitis due to an empty ganciclovir reservoir. A second device was implanted without removal of the first. CONCLUSIONS: The intraocular ganciclovir device appears to be an effective treatment for CMV retinitis with few disadvantages. Time to progression of retinitis tends to be prolonged compared to systemic treatment.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Dural carotid-cavernous sinus fistulas: clinical aspects, diagnosis and therapeutic intervention].

BACKGROUND: Carotid cavernous fistulas are cerebral artenovenous shunts which may present with ocular or orbital signs. Direct fistulas are distinguished from dural shunts with respect to the anatomical situation. PATIENTS: We report on two patients with spontaneous dural carotid cavernous fistulas with multiple feeding vessels. Both patients required endovascular embolization. RESULTS: Therapy was successful in both patients. We present an overview of the clinical picture, the diagnostic procedure, the differential diagnosis and the therapeutic possibilities in this clinical entity. CONCLUSION: Both patients prove the importance of an immediate differential diagnostical classification so that a specific neuroradiological diagnostic can be ensured. Today's advanced endovascular technology offers therapeutic options with less risk for the patient than in recent years.

Arteriovenous Fistula↗
PubMed1996

[Surgical management of complete macular foramina].

UNLABELLED: Recently, good functional and anatomical results have been reported in treating full thickness macular holes. Only a few studies describe a removal of a membrane at the vitreoretinal interface after having removal of the vitreous and its cortex. To demonstrate the beneficial effects of removing this membrane at the vitreoretinal interface we present our functional and anatomical results in this retrospective study. PATIENTS: Altogether, 42 patients (27 women, 15 men) with an average age of 66.7 years and full thickness idiopathic macular holes stage II and III/IV (21 patients respectively) were retrospectively analysed. The minimum follow-up was 6 months. To reattach the macular, an intraocular gas tamponade was used in 36 patients (15% C2F6) and 6 patients were treated with an 20% SF6 gas tamponade. RESULTS: Six months after operation, patients in the main group (42 patients) showed visual improvement in 53% (22 patients): 26% (11 patients) showed no change in visual acuity before and after operation. A deterioration was present in 21% (9 patients). In the group of patients in which a membrane at the vitreoretinal interface had been removal 68% (22 patients) showed improved visual acuity. In all 26% (8 patients) showed no change and in one case a deterioration was noticed. After removal of a membrane at the vitreoretinal interface no further macular hole was seen in 80% (25 patients). In this group, 90% (28 patients) complained of metamorphosia before operation. In the group of patients in which were no membrane at the vitreoretinal interface had been removed (11 patients), 73% (8 patients) showed a deterioration in visual acuity, no patient showed improved visual acuity and 27% (3 patients) retained the same level of visual acuity. No macular hole was noticed 6 months postoperatively in 27% (3 patients) in this group. In all 36% (4 patients) in this group complained of metamorphopsia before operation. CONCLUSION: Removal of a membrane at the vitreoretinal interface in patients with idiopathic macular holes stage II in IV improves functional and anatomical results. Metamorphosia is reduced significantly after removal of that membrane. According to our studies, metamorphosia is an indicator for the presence of a membrane at the vitreoretinal interface. Our results suggest that there are different types of idiopathic macular holes with a different pathogenesis in those where a membrane at the vitreoretinal interface could not be removed and those where it is possible to remove it. Cases where removal of this structure should be attempted show better functional and anatomical results. Studies using adjuvants, e.g. autologous platelet concentrate or transforming growth factor beta 2, should take into account that two different types of idiopathic macular holes exist.

Adult↗
PubMed1996

[Changes in the vitreomacular border of the partner eye in macular foramina].

The incidence of a macular hole in the fellow eye of patients with macular hole stage I-IV according to Gass is observed in 3-14% of cases. The development of a macular hole over a period of 19-54 months is reported to occur in 1-22% of patients. Our clinical impression made us suspect a much higher number of changes at the vitreomacular interphase in the generally asymptomatic "second eye" already at first presentation in the hospital. We retrospectively examined 88 patients who presented with a macular hole between January and October 1994. We investigated the frequency of a macular hole or macular pucker in the fellow eye, taking into consideration that many common pathogenetic factors were described for these changes of the vitreoretinal interphase. We further examined the difference in number and appearance of macular pathology in the fellow eye between patients who had macular hole surgery in their "first eye" and patients whose "first eye" was observed. The group of patients whose "first eye" was operated on showed a macular hole stage I or stage II in 8% each in the "second eye", and a macular hole stage III/IV in 6% of cases. Patients whose "first eye" was observed were found to have only early macular holes in 18% of fellow eyes. Altogether, the fellow eye of patients with macular hole exhibited also a macular hole in 21% of patients and a macular pucker in 7% of patients. The incidence of pathological changes at the vitreomacular interface in 28% of the fellow eyes of patients with macular hole is higher than ever reported in the literature. The presence of early macular holes as well as early macular puckers supports clinically the thesis of common factors in the pathogenesis of these two disorders. As we only reviewed the incidence of pathological charges in this study, a much higher number of developing macular holes and macular puckers has to be expected in the fellow eye of patients with macular hole over a certain time period.

Adult↗
PubMed1996

[Morphologic analysis of epiretinal membranes in surgically treated idiopathic macular foramina. Results of light and electron microscopy].

Anteroposterior and tangential traction on the central retina is an important factor in the pathogenesis of idiopathic macular hole formation. Histological studies have shown that macular holes of different stages can be associated with epiretinal membranes. Such membranes can be removed during surgery for macular holes. We investigated such tissue samples of 11 patients with macular holes in stages II-IV. Light microscopically, the tissue consisted of a thin collagen layer mostly covered by a thin layer of cells. Ultrastructural analysis revealed glial cells and macrophages as cellular components. The collagen can be ascribed to vitreous, inner limiting membrane and newly formed collagen. According to the morphological findings a multilayered tissue structure can be assumed. Macrophages were found on the retinal side of the inner limiting membrane and at the vitreal side of the tissue. Therefore, the macrophages probably originate from the retina as well as from the vitreous as so-called resident hyalocytes. Glial cells covered the inner limiting membrane forming pericellular collagen to which outer vitreous collagen fibrils can be attached. The multilayered membrane structure might possibly be the cause for only partial laminar surgical extraction so that contractile or potentially proliferative tissue residues might be one of the reasons for surgical failures after incomplete membrane peeling.

Aged↗
PubMed1996

Discordant monozygotic twins with the Schimmelpenning-Feuerstein-Mims syndrome.

The Schimmelpenning-Feuerstein-Mims syndrome (SFM), characterized by linear nevus sebaceous and ocular and neurologic abnormalities, is a sporadic condition without known familial cases or etiology. We report the occurrence of SFM in only one of two monozygotic (MZ) twins. After considering a variety of possible causative mechanisms, we suggest that a postzygotic dominant lethal mutation in mosaic form may best explain SFM and the discordancy for SFM in these MZ twins.

Abnormalities, Multiple↗
PubMed1996

Mathematical simulation of retinal image contrast after photorefractive keratectomy with a diaphragm mask.

BACKGROUND: Photorefractive keratectomy (PRK) using a dilating diaphragm mask engraves a delicate three-dimensional staircase pattern into a formerly smooth corneal surface. The created steps are later smoothed by tear film and wound healing processes. The present study investigates, in a mathematical simulation, the effects that such staircase patterns and their smoothing may have on retinal image contrast. METHODS: All simulations are based on the Gullstrand eye model and calculate retinal image contrast from point spread function (PSF) analysis of Gullstrand eyes treated by simulated PRK under various conditions. RESULTS: The simulations indicate that PRK can reduce retinal contrast markedly. The most critical factor for such a reduction is the step height of the ablation pattern. With step heights below 0.4 microns, loss of contrast due to the created staircase pattern is always moderate and should be restored during early wound healing. Complete wound healing may smooth out larger step heights. Micromovements during PRK also can lead to partial loss of retinal image contrast. CONCLUSIONS: Simulation of retinal contrast after PRK shows that step heights below 0.4 microns seem to be acceptable. A minimization of the micromovements during PRK can offset some of the reduction of retinal contrast.

Contrast Sensitivity↗