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Biomedical subjects

A Kampik

Publications and source records attributed to A Kampik.

At least 19 recordsLinked to original sources
PubMed2006

Cost utility for penetrating keratoplasty in patients with poor binocular vision.

PURPOSE: Cost-utility and cost-effectiveness analyses are of increasing importance to clinicians and health policy experts. This study determines the costs in Germany and other countries in relation to gain of utility for patients with bilateral poor vision owing to corneal disease undergoing penetrating keratoplasty (PK) in 1 eye. DESIGN: A cost-utility analysis was performed using retrospective clinical data and high-level evidence-based data. PARTICIPANTS: Sixty patients (mean age, 46.3 years) with bilateral poor vision who underwent PK for corneal disease. METHODS: Visual acuity and utility values were obtained before and 1 year after PK and after suture removal. A 10-year graft survival rate of 80% was assumed. Expenses included costs for the corneal transplant and surgery, medication, and optical rehabilitation. A discount rate of 5% was applied for costs and quality-adjusted life years (QALYs). Cost-utility analysis encompassed a 10-year period after surgery. MAIN OUTCOME MEASURES: The number of QALYs was calculated for the study group undergoing PK. This was divided into the cost of the procedure to get the number of euros spent per QALY gained. RESULTS: Median binocular preoperative visual acuity was -log mean angle of resolution (-logMAR) 0.91+/-0.53 (Snellen equivalent 20/160) yielding a utility value of 0.67. After suture removal and optical rehabilitation, binocular visual acuity increased to median -logMAR 0.36+/-0.36 (20/46) with a utility value of 0.79. Over the 10 years after surgery and considering graft survival and discounting, a cost utility of 9551 euros per QALY was gained (equivalent to US11,557 dollars). One-way sensitivity analysis yielded a range from 7706 euros to 12874 euros per QALY, highlighting the robustness of the model. CONCLUSIONS: Although an expensive procedure, PK is cost effective in patients with bilateral poor vision.

Adolescent↗
PubMed2006

Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation.

BACKGROUND: Recently, the entity of retinal angiomatous proliferation (RAP) as a subtype of exudative age-related macular degeneration was described, but no treatment options have been established as yet. The only two therapeutic modalities being discussed are surgical lysis of the feeding arteriole and draining venule, and the use of photodynamic therapy combined with intravitreal triamcinolone injection. AIM: To examine focal laser treatment of early extrafoveal intraretinal neovascularisation of RAP. METHODS: Prospective case series. We included 13 consecutive patients with an extrafoveal RAP stage I lesion. All patients underwent a complete ophthalmic examination, including fluorescein angiography and optical coherence tomography (OCT) III before treatment and at 2 weeks, 1, 2 and 4 months afterwards. In cases with marked macular oedema (>350 mum retinal thickening in OCT III, r = 12), intravitreal injection of 4 mg triamcinolone was given before focal laser treatment to reduce the oedema. RESULTS: This case series indicates anatomical improvement or stabilisation in patients with an extrafoveal RAP lesion after treatment. Initial visual acuity ranged from 0.1 to 0.6 on the Snellen chart. By calculating logarithmic values, visual acuity was seen to be improved in five cases (2 to 5 log lines), deteriorated in four cases (-2 to 5 log lines) and stabilised in four cases (-1 to +1 log line change). Exudation on fluorescein angiography was stopped in 11 cases. CONCLUSIONS: This preliminary case series suggests laser photocoagulation combined with prior intravitreal triamcinolone injection as a viable treatment option for RAP stage I. In cases with marked macular oedema, intravitreal triamcinolone injection improved visual acuity. For long-term stabilisation, additional laser treatment is mandatory. These preliminary results warrant a more detailed prospective clinical trial.

Aged↗
PubMed2006

[Visual quality of life after vitreoretinal surgery for epiretinal membranes].

PURPOSE: To date, the increase of visual acuity and morphological parameters have been used to assess the benefit of a surgical intervention. The aim of this prospective study was to evaluate changes in patients' visual quality of life due to vitreoretinal surgery for epiretinal membranes. PATIENTS AND METHODS: Twenty patients with unilateral epiretinal membrane and good visual acuity of the fellow eye were included. Best corrected visual acuity and visual quality of life assessed by the visual function index (VF-14) were obtained preoperatively and 3 months after pars plana vitrectomy and peeling. RESULTS: Median visual acuity increased from 0.28 to 0.4 postoperatively. Visual quality of life (VF-14 values) rose from 72.8+/-4.7 (SEM) to 83.3+/-2.9 (p<0.05). Analysis revealed that patients with preoperatively low VF-14 values and preoperatively low visual acuity notably profited from surgery. The increase of visual quality of life can be predicted better than increase of visual acuity. Combined cataract surgery had no significant influence. CONCLUSION: In addition to best corrected visual acuity, quality of life measurements are important predictive and outcome parameters to estimate the value of vitreoretinal surgery.

Aged↗
PubMed2006

[Value-based medicine in ophthalmology].

PURPOSE: Value-based medicine (VBM) unifies costs and patient-perceived value (improvement in quality of life, length of life, or both) of an intervention. Value-based ophthalmology is of increasing importance for decisions in eye care. METHODS: The methods of VBM are explained and definitions for a specific terminology in this field are given. The cost-utility analysis as part of health care economic analyses is explained. RESULTS: VBM exceeds evidence-based medicine by incorporating parameters of cost and benefits from an ophthalmological intervention. The benefit of the intervention is defined as an increase or maintenance of visual quality of life and can be determined by utility analysis. The time trade-off method is valid and reliable for utility analysis. The resources expended for the value gained in VBM are measured with cost-utility analysis in terms of cost per quality-adjusted life years gained (euros/QALY). Numerous cost-utility analyses of different ophthalmological interventions have been published. CONCLUSION: The fundamental instrument of VBM is cost-utility analysis. The results in cost per QALY allow estimation of cost effectiveness of an ophthalmological intervention. Using the time trade-off method for utility analysis allows the comparison of ophthalmological cost-utility analyses with those of other medical interventions. VBM is important for individual medical decision making and for general health care.

Consumer Behavior↗
PubMed2006

[Long-term functional results after macular hole surgery. Results of a prospective study].

PURPOSE: This study reports on the long-term results of macular hole surgery with peeling of the ILM. METHODS: A total of 88 consecutive patients (71 female, 17 male, mean age 67 years) were prospectively evaluated. All patients underwent a standard pars plana vitrectomy with removal of the ILM and an intraocular gas tamponade. Preoperatively, as well as on each follow-up visit, a clinical examination including measurement of best corrected visual acuity, Goldman perimetry, and OCT was performed. RESULTS: The mean postoperative follow-up was 49 months; 83 (94%) patients were pseudophakic at the last examination. Anatomic closure was achieved in 84 (95%) patients. No late reopening of the macular hole was observed. Best corrected visual acuity improved in 82 patients (93%), remained unchanged in 2, and deteriorated in 4 patients. Best corrected visual acuity improved from a median of 0.2 preoperatively to a median of 0.6 postoperatively (p<0.001). Duration of symptoms as well as low preoperative visual acuity had no significant impact on anatomic and functional success. CONCLUSIONS: Macular hole surgery leads to good functional and anatomical results, even in the long term. A long history of visual impairment and low visual acuity before surgery are not contraindications to surgical intervention.

Aged↗
PubMed2006

[Staining techniques in macular surgery].

Over recent years, evolving surgical experience and the development of techniques in surgery for macular hole, macular pucker and other vitreoretinal diseases have improved anatomic and functional success rates. Today, there is common agreement by many surgeons that removal of the internal limiting membrane (ILM) is an effective and safe treatment option for conditions that involve the vitreoretinal interface.However, the ILM is a delicate and barely visible structure and its removal represents a challenge to the vitreoretinal surgeon. The introduction of vital dyes for ILM staining has led to better visibility of the ILM and epiretinal membranes, potentially making ILM peeling more controllable, easier and safer. It has opened the door, especially for the less experienced surgeon, to follow the principle of ILM removal in macular surgery. While the use of trypan blue and triamcinolone during such surgery seems to be safe, questions of the potential toxicity of indocyanine green (ICG) are currently being discussed. However, the underlying pathomechanisms are not yet completely understood. Whether the observations made on ICG-related toxicity will be sufficient to call ICG a "toxic adjunct" is currently under investigation. Further studies are required to better understand the safety margins of ICG and to investigate other vital dyes offering equal staining characteristics and a better safety profile.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2006

[Lysis therapy vs. conservative therapy: randomised and prospective study on the treatment of acute central retinal artery occlusion (EAGLE study)].

In the prospective, randomised and multicenter EAGLE study, the therapeutic efficiency of local intra-arterial fibrinolysis (LIF) versus conservative treatment is being tested in patients with an acute central retinal artery occlusion (CRAO). The most important inclusion criteria are: (1) age between 18-75 years, (2) CRAO not older than 20 h, and (3) visual acuity <0.32. The primary study endpoint is the visual acuity before and 1 month after therapy. The study was started in 2002. To August 2006, 63 of the 200 required patients have been included in the study at 17 medical centers in Germany, Switzerland and Austria.

Europe↗
PubMed2006

[Susac syndrome: case reports and review of the literature].

BACKGROUND: Susac syndrome is a rare disease of unknown pathogenesis. It consists of retinal arterial occlusion, hearing loss and encephalopathy (triad). PATIENTS: The features of two cases of this syndrome are presented. CONCLUSION: A high percentage of patients do not have the clinical triad at the time of onset of symptoms and, therefore, this disease may be under-diagnosed. Any patient with unexplained encephalopathy should thus be examined by an ophthalmologist and have an audiogram performed.

Adult↗
PubMed2006

[Clinical aspects of retinopathy of prematurity. Results following diode laser coagulation].

Retinopathy of prematurity (ROP) represents a disease of the immature retina of preterm infants due to irregular vascularisation. The present article gives information about different parameters of the newborns (gestational age, birth weight, need of oxygen, stage of ROP) and shows the results concerning anatomical and functional aspects following diode laser treatment in 61 prematurely born babies, diagnosed and treated in a period of 5S years in the Hospital of the Ludwig Maximilians University. The mean +/- SD gestational age was 24.9 (+/- 1.59) weeks, the mean +/- SD birth weight was 683 (+/- 174) grams. Diode laser treatment was performed at a mean +/- SD age of 36.14 (+/- 2.04) weeks. Stage 3 retinopathy with "plus disease" was diagnosed in 95.5 % of the infants. In comparison to term born babies or preterm infants without ROP, the diode laser-treated newborns showed a higher incidence of myopia (59 %). An unfavourable outcome in term of the anatomic situation was seen in 9.8 % of these babies.

Child, Preschool↗
PubMed2005

"Melanoma inhibitory activity" (MIA): a promising serological tumour marker in metastatic uveal melanoma.

PURPOSE: To assess the role of "melanoma inhibitory activity" (MIA) as a potential serum marker for screening and detection of metastatic uveal melanoma. DESIGN: Prospective, clinical study. MATERIAL AND METHODS: Serum samples of 305 patients with uveal melanoma were collected. Serum samples were analysed by a one-step enzyme-linked immunosorbent assay (ELISA) to quantify the MIA serum levels. All patients underwent a standardized echography of the globe to evaluate maximum tumour height and were checked for systemic metastasis of the tumour by liver enzyme tests and ultrasonography of the liver. RESULTS: Twenty patients (6.6%) had proven metastatic disease; eight of them developed it during follow-up. The mean serum concentration of MIA in the 285 patients without metastasis was 6.72 ng/ml, whereas the mean serum concentration of MIA in the 20 patients with metastasis was 13.03 ng/ml (P<0.001). The eight patients who developed metastatic disease during follow-up showed an MIA of 5.92 ng/ml before detection of metastasis and 12.21 ng/ml afterwards (P<0.001). MIA serum levels did neither correlate with the tumour height or to whether local therapy had been applied. CONCLUSION: The elevation of MIA serum levels in patients with metastatic disease from melanoma supports its promising role as a serum marker for monitoring patients with uveal melanoma.

Adult↗
PubMed2005

[Evaluation of portable TGDc-01 tonometers and comparison with the Goldmann applanation tonometer].

PURPOSE: The aim of this study was to evaluate patients' acceptance and intraocular pressure (IOP) readings of a new digital mobile tonometer (TGDc-01) and compare it to Goldmann applanation tonometry. METHOD: Measurements repeated five times with the TGDc-01 and three times with Goldmann tonometry were performed in 100 eyes of 100 patients by two independent investigators. Patients' acceptance of both techniques was evaluated by a visual analogue scale (VAS). RESULTS: The mean IOP with the TGDc-01 yielded 15.4 mmHg for investigator 1 and 12.7 mmHg for investigator 2 (range: 4-43 mmHg). Results of the measurements with Goldmann tonometry showed 17.6 mmHg for investigator 1 and 17.3 mmHg for investigator 2 (9-42 mmHg). The IOP difference of the two tonometry methods was highly significant (p<0.001). The intraobserver variability was 29% for investigator 1 and 8% for investigator 2. Mean IOP values of the two investigators taken with the TGDc-01 differed significantly (p<0.01) from each other by a mean of 2.6 mmHg. CONCLUSIONS: The new mobile tonometer TGDc-01 is better accepted by patients but IOP values are significantly lower compared to Goldmann tonometry and variability is high. Regarding glaucoma diagnostics it seems to be less suitable than Goldmann tonometry.

Adult↗
PubMed2005

[Screening for diabetic retinopathy and optic disc topography with the "retinal thickness analyzer" (RTA)].

BACKGROUND: The RTA features a fundus photography mode and optic disc topography. Those two new modes were investigated regarding their clinical use. METHODS: First, the combination of wide-field photography with a retinal thickness map was assessed for tele-screening for diabetic retinopathy in 31 eyes. Second, normal values of the optic disc were collected on 30 non-glaucomatous probands in the non-mydriatic mode and compared to the results of the mydriatic mode, for which reproducibility was also investigated. RESULTS: For diabetic retinopathy, the RTA yielded mean 93% sensitivity for proliferative diabetic retinopathy and 100% sensitivity for detecting diabetic macular edema compared to clinical examination at specificities ranging from 58 to 96%. Regarding the measurements of the optic disc, the normal values in mydriasis coincided with those in miosis in all but 4 of 12 parameters. CONCLUSIONS: The RTA is suitable for application in tele-screening for diabetic retinopathy. The topography of the optic disc is highly reproducible and may be used for glaucoma diagnostics.

Diabetic Retinopathy↗
PubMed2005

Ocular manifestations of keratitis-ichthyosis-deafness (KID) syndrome.

OBJECTIVE: Keratitis-ichthyosis-deafness (KID) syndrome is a rare congenital ectodermal dysplasia characterized by the association of hyperkeratotic skin lesions, moderate to profound sensorineural hearing loss and vascularizing keratitis. Mutations in the GJB2 gene coding for connexin 26, a component of gap junctions in epithelial cells, have been observed in several KID patients. Variable ocular manifestations of the disease in 3 patients with molecular genetically confirmed KID syndrome are reported. DESIGN: Retrospective case series. METHODS: Clinical examination and molecular genetic analysis for mutations in the GJB2 gene were performed in 3 patients with KID syndrome ages 5, 13, and 41 years. RESULTS: Visual acuity ranged from normal to severe visual loss. The ocular signs included loss of eyebrows and lashes, thickened and keratinized lids, trichiasis, recurrent corneal epithelial defects, superficial and deep corneal stromal vascularization with scarring, keratoconjunctivitis sicca, and, in one patient, presumed limbal insufficiency. Whereas ocular surface integrity could be maintained with artificial tears in one patient, and an epithelial defect healed under conservative treatment in the second patient, multiple surgical procedures including superficial keratectomies, limbal allograft transplantation with systemic immunosuppression, amniotic membrane transplantation, lateral tarsorrhaphies, and lamellar keratoplasty could not preserve useful vision in the third patient. CONCLUSIONS: KID syndrome may affect the ocular adnexae and surface with variable severity independent of the age of the patient. Lid abnormalities, corneal surface instability, limbal stem cell deficiency with resulting corneal complications, and dry eye are the main ocular manifestations.

Adolescent↗
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↗
PubMed2005

[Ocular changes in tropical malaria with cerebral involvement--results from the Blantyre Malaria Project].

INTRODUCTION: Malaria is a tropical disease causing an estimated 300 million infections and one million deaths per year. In sub-Saharan Africa, most infections are due to Plasmodium falciparum. The hallmark of the clinical syndrome of cerebral malaria is coma, and the associated mortality rate, even in appropriately treated patients, is 15 - 50 %. Funduscopy plays a major role for the ophthalmologist in the differential diagnosis because of the characteristic changes. METHODS: To date more than 1000 children who satisfied the standard clinical case definition of cerebral malaria were admitted to the Blantyre Malaria Project (Malawi, Africa) for inpatient treatment and examined using indirect ophthalmoscopy through fully dilated pupils. The gender distribution was homogeneous and the children were between 2 and 14 years old. The optic nerve head, central and peripheral retina and central and peripheral vessels were described and photographed using a hand-held fundus camera (KOWA). RESULTS: The spectrum and severity of findings of the ocular fundus in children with CM include the following distinct entities: haemorrhages (with and without a white centre), cotton wool spots, papilloedema, retinal whitening and retinal vessel abnormalities that may appear to be orange or white. Most of the retinal haemorrhages (in 40 %) have white centres and resemble Roth spots. Cotton wool spots were seen in only 5 %. Papilloedema was also not commonly seen (8 %) but is a poor prognostic sign. Retinal whitening (in 50 %) is seen more commonly at the posterior pole than in the periphery. 20 % of patients show retinal vessel abnormalities that may be orange or white in colour. CONCLUSION: Ocular fundus changes in CM can be detected by the ophthalmologist using simple means and are decisive for the prognosis and timely therapy for this potentially lethal disease.

Adolescent↗
PubMed2005

[Changes in the G-DRG System from 2003 to 2005 in Ophthalmology--Ophthalmologic G-DRG 2003 to 2005].

BACKGROUND: The objective of the study was to illustrate the effect of the extensive changes of the German DRG System on reimbursement of clinical ophthalmology during the years 2003, 2004 and 2005. METHODS: All ophthalmologic patients treated as in-patients at the Department of Ophthalmology at the University Munich during the year 2003 served as a reference data basis. By means of appropriate software those cases were then re-grouped according to the G-DRG classification of the years 2003, 2004 and 2005. This resulted in different reimbursements caused only by system changes for an exemplary hospital of maximum medical care. In addition, the same calculations were performed for four virtual, typical clinics based on the calculation data of the "Institut für Entgeltsysteme (InEK)". For those four clinics it was assumed that 80 % of the cases came from one of the subspecialties retina, glaucoma, cataract or strabismus surgery. RESULTS: Changes in the G-DRG system caused the sample hospital of maximum care to loose 8.5 % case mix index (CMI) during the period of 2003 to 2005. For three of the four virtual, typical ophthalmological clinics the theoretic reimbursement conditions also deteriorated: retina surgery -- 10.6 %, glaucoma surgery - 15.8 % and cataract surgery -- 17.9 % CMI. Only strabismus surgery showed an increase of + 5.6 % in CMI during the period examined. CONCLUSION: Over the years 2003 to 2005 the CMI clearly deteriorated for many ophthalmological subspecialties given otherwise identical conditions. To calculate the changes specifically for an individual hospital, the individual base rates have to be considered.

Computer Simulation↗
PubMed2005

[In vivo confocal microscopy in blepharitis].

BACKGROUND: Dysfunction of the meibomian glands with inflammation and obstruction has been suggested to be an important factor in the pathogenesis of chronic blepharitis. Few objective tests are, however, available to examine the meibomian glands directly. PATIENTS AND METHODS: Nineteen patients with anterior blepharitis, meibomitis, meibomian gland dysfunction or severe keratoconjunctivitis sicca associated with blepharitis as well as 10 patients with normal lid margins were examined with the HRTII/RCM in vivo confocal microscope. Scans of the tear film, the tarsal conjunctiva, the hair follicles and the meibomian glands were analysed by a masked observer. RESULTS: Patients with normal lid margins exhibited a minimal round cell infiltrate in the tarsal conjunctival epithelium and largely normal ducts of the meibomian glands lined with a multilayered epithelium as well as normal gland acini. In patients with anterior blepharitis, blepharitis associated with autoimmune peripheral ulcerative keratitis and blepharitis in the context of severe dry eye, confocal microscopy disclosed normal meibomian glands. In 12 patients with blepharitis/meibomitis or meibomian gland dysfunction, profound pathology was visible with dilatation and obstruction of the meibomian gland ducts. In 15 of 19 patients with blepharitis/meibomitis, but not in meibomian gland dysfunction, an intense inflammation was observed in the tarsal conjunctival epithelium and stroma. In one patient, demodex folliculorum was evident in vivo. In patients with normal lid margins as well as in patients with blepharitis, hair follicles appeared within normal limits. CONCLUSIONS: In vivo confocal microscopy allowed the examination of the tear film, the tarsal conjunctiva, the lid margin including the lash follicles and the meibomian glands. In patients with meibomian gland disease pathological changes could be visualised and documented objectively. The presence of an inflammatory infiltrate permitted us to differentiate between meibomitis and meibomian gland dysfunction. Changes of the lash follicles do not seem to play an important role in blepharitis. Thus, in vivo confocal microscopy represents an objective technique in the classification and follow-up of patients with blepharitis.

Adult↗