PubMed Health⌕ Search

Biomedical subjects

Anselm Jünemann

Publications and source records attributed to Anselm Jünemann.

16 recordsLinked to original sources
PubMed2006

Expression of bone morphogenetic proteins (BMPs), their receptors, and activins in normal and scarred conjunctiva: role of BMP-6 and activin-A in conjunctival scarring?

Bone morphogenetic proteins (BMPs) and activins are multifunctional growth factors, which also affect wound healing and tissue fibrosis. To determine their putative role in conjunctival wound healing and scarring, we investigated the expression of various BMPs, BMP receptors, and activins in normal and scarred human conjunctival tissue and in cultured human Tenon's capsule fibroblasts on the mRNA and protein level. Messenger RNA expression of BMP-2, BMP-3, BMP-4, BMP-5, BMP-6, BMP-7, the BMP receptors type I (BMPR-IA, BMPR-IB) and II (BMPR-II), and of activin A and B was investigated by semi-quantitative RT-PCR in normal conjunctival specimens and in scarred filtering blebs as well as in cultured Tenon's capsule fibroblasts obtained from patients with primary open-angle glaucoma (POAG), pseudoexfoliation (PEX) glaucoma and cataract. Immunohistochemistry was used to study the protein expression of BMP-2, BMP-4, BMP-6, BMP-7, and activin A in normal and scarred conjunctival tissue as well as in cultured Tenon's capsule fibroblasts. BMP-2, BMP-3, BMP-4, BMP-6, BMP-7, all BMP receptors, and activin A were expressed on the mRNA and protein level in conjunctival biopsies without showing any differences between groups of patients. The mRNA and protein expression of both BMP-6 and activin A was found to be significantly increased in scar tissue compared with normal conjunctiva and could be immunolocalized to epithelial cells, vascular endothelia, stromal fibroblasts, and macrophage-like cells. However, no significant increase in receptor gene expression was observed in scar tissue. With the exception of BMP-7, all growth factors and receptors were also expressed in cultured Tenon's fibroblasts without showing any differences between cultures derived from normal and scarred conjunctival specimens. These findings suggest various BMPs and activin A as components of the conjunctival cytokine meshwork regulating tissue homeostasis and wound healing and provide evidence that alterations in the expression of BMP-6 and activin A, in particular, are associated with conjunctival scarring. Modulation of BMP/activin activities may, therefore, be explored as new approaches for managing postoperative conjunctival scarring responses in glaucoma patients.

Activins↗
PubMed2006

Pattern reversal ERG and VEP--comparison of stimulation by LED, monitor and a Maxwellian-view system.

PURPOSE: Pattern stimulation is widely used to detect inner retinal dysfunction. In this work we describe a pattern stimulation technique with LEDs and compare the results with conventional methods. METHODS: PERG and VEP were derived from three normal subjects. Three different techniques were used to generate a checkerboard pattern reversal stimulus: a 70 Hz monitor, a Maxwellian-view system equipped with a Xenon-arc lamp and a mechanical mirror system, and a LED array (Roland Consult) consisting of 100 white LEDs. Two kinds of luminance (125 and 340 cd/m2) and four temporal frequencies (4, 8, 12 and 24 reversals per second) were studied on three healthy subjects. Additionally, a luminance tuning experiment (30, 60, 90, 125 and 340 cd/m2) was performed on one subject. RESULTS: Comparison of different stimulation techniques shows reproducible responses of PERG and VEP with all three methods. The LED array leads to slightly smaller amplitudes than both other techniques, which we ascribe to the design of the LED field. No difference of peak times or phases was noticed between different stimulation techniques. A luminance dependency of PERG and VEP is noticeable using stimulation with LED: with decreasing luminance we measured increasing peak times of PERG and VEP and decreasing amplitude of PERG. CONCLUSION: We conclude that central retinal stimulation with checkerboard pattern reversal is possible with LED. It gives comparable results to monitor and Maxwellian-view system.

Adult↗
PubMed2006

Pattern reversal ERG with LED-stimulation using cyclic summation technique.

PURPOSE: Multifocal pattern reversal stimulation can be used to detect inner retinal dysfunction. Commonly, the stimulus is generated on a monitor using m-sequence technique. We describe a pattern reversal ERG evoked by LED arrays using cyclic summation (CS). METHODS: One eye of eight healthy subjects was examined with an arrangement of 13 LED arrays. Each array consisted of 100 LEDs separated by thin walls. One of the fields was placed centrally, three fields each were placed above, below, left and right of the central field. CS technique at a temporal frequency of 16 reversals per second (RPS) was used for stimulation. Viewing distance was 30 cm, check size was 0.58 cyc/deg. Luminance of the bright fields was 340 cd/m2. RESULTS: Fourier analysis was performed. Centrally, the amplitude of the 2nd harmonic wave was highest (0.87 microV). In the first paracentral fields, amplitudes were 0.28 microV (nasally), 0.21 microV (superior, inferior and temporally). In the second paracentral fields, amplitudes were 0.11 microV (nasally), 0.09 microV (superior), 0.13 microV (inferior) and 0.15 microV (temporally). With exception of the temporal field (0.1 microV), in the outermost fields no reproducible ERG response could be recorded. CONCLUSION: Peripheral ERG responses to a pattern reversal stimulus can be recorded with LED stimulation using CS technique up to an eccentricity of 30 degrees. Responses are highest centrally and decrease with increasing distance to the centre.

Adult↗
PubMed2006

Absence of blood and lymphatic vessels in the developing human cornea.

PURPOSE: The normal human cornea is devoid of both blood and lymphatic vessels and actively maintains this avascularity (corneal angiogenic privilege). Whether and when corneal angiogenic privilege is achieved during development is unknown. METHODS: This study analyzed whether the cornea is primarily devoid of both blood and lymphatic vessels during intrauterine development or whether secondary regression of pre-existing vessels occurs before delivery. Indirect double immunohistochemistry was performed on 4-microm serial pupil-optic disc sections of paraffin-embedded human eyes stillborn at gestational ages of 17 to 41 weeks with antibodies against von Willebrand factor (vWF; factor VIII-associated antigen) as a panendothelial marker and with antibodies against lymphatic vessel endothelial hyaluronate receptor 1 (LYVE1) as a marker specific for lymphatic vascular endothelium. RESULTS: Human corneas were devoid of both vWF+++/LYVE-1(-) blood vessels and vWF+/LYVE-1+++ lymphatic vessels at all time-points analyzed. In contrast, there were numerous blood and lymphatic vessels detectable in the adjacent conjunctiva. CONCLUSION: The normal human cornea is primarily avascular and devoid of both blood and lymphatic vessels. Corneal angiogenic privilege is already achieved very early during fetal intrauterine development. This suggests early and strong expression of both antiangiogenic and antilymphangiogenic factors in the human cornea during development.

Blood Vessels↗
PubMed2006

Pupillographic measurements with pattern stimulation: the pupil's response in normal subjects and first measurements in glaucoma patients.

PURPOSE: This study was undertaken to characterize the influence of contrast, luminance, and spatial frequency of a pattern stimulus on the pupil reaction of healthy subjects. First measurements with this technique in patients with glaucoma were compared with those in a control group. METHOD: Grating patterns were presented using a Maxwellian-view system to study series of contrast, luminance, and spatial frequency in three healthy subjects. The best two stimulus conditions were determined and were then used to examine 19 patients with open-angle glaucoma and 16 control subjects. RESULTS: In healthy subjects, an increasing contrast led to an increase in amplitude and a decrease in latency of the pupil reflex. Increasing luminance also resulted in an increase in the amplitude. The offset component of the pupil reflex was most pronounced at low spatial frequencies and the onset component at high spatial frequencies. When healthy subjects were compared with patients with glaucoma, control subjects generally had higher amplitudes, velocity, and acceleration of pupil constriction than did the patients with glaucoma. These differences were significant when the test was performed with a spatial frequency of 6.25 cyc/deg. CONCLUSIONS: Best stimulus conditions to elicit a pupil response to a pattern grating stimulus are 100% contrast and 55 cd/m(2) mean luminance. The choice of the spatial frequency determines which component of the pupil reflex is more pronounced. Differences between patients with glaucoma and healthy control subjects are demonstrable.

Contrast Sensitivity↗
PubMed2005

Single intraocular pressure measurements and diurnal intraocular pressure profiles.

PURPOSE: To evaluate the probability of a single intraocular pressure measurement to be the highest measurement within a diurnal intraocular pressure profile. DESIGN: Hospital-based clinical, observational study. METHODS: The study included 3,025 day-and-night intraocular pressure profiles measured on 1,072 eyes of 547 Caucasian glaucoma patients or glaucoma suspects. Applanation tonometry was performed at 7 am, noon, 5 pm, 9 pm, and midnight. RESULTS: Intraocular pressure measurements were highest at 7 am, noon, 5 pm, 9 pm, and midnight, respectively, in 20.4%, 17.8%, 21.3% 13.9%, and 26.7% of the profiles, respectively. The measurement taken at 7 am was significantly (P < .001) closest to the maximal value of the profile. CONCLUSIONS: Any single intraocular pressure measurement taken between 7 am and 9 pm has a higher than 75% chance to miss the highest point of a diurnal curve. Intraocular pressure may be measured at different times of the day to have the best chance of observing the maximal value.

Circadian Rhythm↗
PubMed2005

Selective upregulation of the A3 adenosine receptor in eyes with pseudoexfoliation syndrome and glaucoma.

PURPOSE: Adenosine is increasingly released in metabolic stress conditions, like hypoxia or ischemia, and regulates many physiologic processes, such as aqueous humor secretion and intraocular pressure, via activation of four adenosine receptors. In the current study, the role of the adenosine system in the pathophysiology of pseudoexfoliation (PEX) syndrome, which is typically associated with anterior chamber hypoxia and elevated intraocular pressure, was examined. METHODS: RT-PCR, Northern hybridization, in situ hybridization, and immunohistochemistry were applied to analyze the mRNA and protein expression of the adenosine receptor subtypes A1, A2A, A2B, and A3 in anterior segment tissues of PEX eyes, without and with glaucoma, in comparison to eyes with primary open-angle or angle-closure glaucoma and normal control eyes. Real-time PCR was used to study the effect of hypoxia and oxidative stress on adenosine receptor expression by nonpigmented ciliary epithelial cells in vitro. Levels of adenosine and its catabolites inosine, hypoxanthine, and xanthine were measured in cell culture supernatants and aqueous humor samples by HPLC. RESULTS: All four adenosine receptor subtypes (A2A > A1 > A2B > A3) were coexpressed but differently distributed in the ciliary epithelium of control eyes, with the A3 receptor being localized to the basolateral membrane infoldings of the nonpigmented epithelial cells. A selective, approximately 10-fold upregulation of A3 receptor mRNA and protein was consistently found in the nonpigmented ciliary epithelium of all PEX eyes, with and without glaucoma, compared with the normal and glaucomatous control eyes. Significant upregulation of A3 receptor message in nonpigmented epithelial cells was induced by both hypoxia and oxidative stress in vitro, together with increased levels of inosine, hypoxanthine, and xanthine in the supernatants. Levels of adenosine and its catabolites, however, were not significantly elevated in the aqueous humor of patients with PEX. CONCLUSIONS: Considering the known role of the A3 adenosine receptor in modulating aqueous humor secretion, its selective, probably hypoxia-induced upregulation in the ciliary epithelium may not only confer cytoprotection but also influence aqueous humor dynamics and may be accessible to therapeutic intervention in patients with PEX.

Adenosine↗
PubMed2004

Bilateral optic neuropathy and unilateral tonic pupil associated with acute human herpesvirus 6 infection: a case report.

BACKGROUND: Human herpesvirus 6 (HHV-6), a widespread virus and causative agent of exanthema subitum in children, has been associated with a number of neurologic disorders including cranial nerve palsies, seizures, encephalitis, meningitis, and multiple sclerosis. PATIENT: A 31-year-old man presented with bilateral optic neuropathy, disc edema, and unilateral tonic pupil, which were found to be associated with acute HHV-6 infection. The patient had been suffering from juvenile diabetes for 5 years. One week after onset of intravenous antiviral therapy with foscarnet, disc edema subsided, and tonic pupil reaction was no longer detectable. CONCLUSIONS: HHV-6 infection may play a role as a causative agent in patients with optic neuropathy and tonic pupil.

Adult↗
PubMed2004

Frequency and clinical features of visceral malignancy in a consecutive case series of patients with periocular sebaceous gland carcinoma.

PURPOSE: To report the frequency and clinical features of internal visceral malignancy in an unselected series of patients with sebaceous gland carcinoma (SGC). METHODS: A non-comparative retrospective case series of consecutive patients with a histologically proven diagnosis of periocular sebaceous cell carcinoma treated at the University Eye Hospital, University of Erlangen-Nürnberg between 1981 and 2000. RESULTS: Twenty-three patients were identified, each with one tumor. Men and women were almost equally affected with a mean age at diagnosis of 62 years (range 37-83 years). The majority of tumors were located in the upper lid, but five tumors were situated in the lower lid or caruncle. In 22 of the 23 patients the diagnosis at referral was either incorrect or not suspected. In all cases, the SGC was treated by surgical excision. In the systems review, 11 of the 23 patients (48%) had evidence of previous systemic malignancy, the most common being colorectal cancer followed by liver and bronchial carcinoma. Forty-five percent of patients with SGC and internal visceral malignancy eventually died as a result of their tumors. CONCLUSION: Periocular SGC remains an underdiagnosed entity for which a high level of clinical suspicion is critical for early recognition. Almost half the patients additionally had an internal visceral malignancy. Internal visceral malignancy in unselected patients with SGC may be more common and have a more guarded prognosis than has been appreciated.

Adult↗
PubMed2004

Predictive factors of the optic nerve head for development or progression of glaucomatous visual field loss.

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for the development or progression of visual field loss in chronic open-angle glaucoma. METHODS: The prospective observational clinical study included 763 eyes of 416 white subjects with ocular hypertension and chronic open-angle glaucoma. During the follow-up time (mean, 67.4 months; median, 65.1; range, 6.2-104.5), all patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs and white-on-white visual field examination. Progression of glaucomatous visual field damage was defined by point-wise regression analysis for each of the 59 locations in the visual field. Outcome measures were qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Development or progression of glaucomatous visual field defects was detected in 106 (13.9%) eyes. At baseline of the study, neuroretinal rim area was significantly (P < 0.002) smaller, the beta zone of parapapillary atrophy (P < 0.003, nasal sector) was significantly larger, and age was significantly higher (P < 0.003) in the progressive study group than in the nonprogressive study group. Both study groups did not vary significantly in size of the optic disc and the alpha zone of parapapillary atrophy. Cox proportional hazard regression analysis revealed that the progression of glaucomatous visual field loss depended significantly on the area of the neuroretinal rim (P < 0.001) and age (P < 0.001), but was independent of diameter of the retinal arterioles and veins. CONCLUSIONS: Morphologic predictive factors for development or progression of glaucomatous visual field defects in whites are small neuroretinal rim area and large beta zone of parapapillary atrophy. Age is an additional nonmorphologic parameter. Progression of glaucomatous optic nerve head changes is independent of the size of the optic disc and alpha-zone of parapapillary atrophy and retinal vessel diameter.

Chronic Disease↗
PubMed2003

Sequential classification in glaucoma diagnosis.

BACKGROUND: Large-scale screening in glaucoma diagnosis is expensive and time consuming. Sequential classification strategies can provide an effective combination of time-efficiency and diagnostic accuracy for glaucoma screening. METHODS: In a cross-sectional clinical study, a sequential diagnostic strategy, based on several psychophysical and electrophysiological tests, was evaluated on measurements from 595 eyes from 310 patients with primary open-angle glaucoma, and 419 eyes from 213 control subjects (age range 18-70 years in each group). Patients and controls successively underwent up to five psychophysical and electrophysiological diagnostic tests. Optic disc morphometry was taken as gold standard. Adapting group sequential techniques, sensitivity and specificity for the whole diagnostic program were controlled, allotting overall error rates of 10%. The criteria for the diagnostic process were developed in a learning sample (677 eyes) and verified in a validation sample (337 eyes). RESULTS: In the validation sample, 62.0% of the examined eyes could be classified, using a sequential 15-min two-step program. An overall 13.6% "gain" of saved time, compared to non-sequential discriminant analysis, was achieved without loss of diagnostic accuracy. A sequential 45-min five-step program classified 68.8% of the whole sample before morphometry, saving approximately 39% of examination time, compared to taking the complete discriminant score. CONCLUSION: Especially in screening, where the use of time-consuming and complicated diagnostic procedures is restricted, the implementation of testing programs based on group sequential strategies might be a promising means of saving personnel resources and reducing inconvenience for patients.

Adolescent↗
PubMed2003

A statistical model for the evaluation of sensory tests in glaucoma, depending on optic disc damage.

PURPOSE: To analyze the sensitivity of various sensory tests adjusted for glaucomatous optic disc damage. METHODS: In a cross-sectional study, the results of testing of 196 control subjects (age range, 18-69 years) and 308 patients with chronic open-angle glaucoma (age range, 18-70 years) were included. The perimetric mean defect (MD), a temporal contrast sensitivity test (TCS), a spatiotemporal contrast sensitivity test (STCS), the peak time of a blue-on-yellow visual evoked potential (BYVEP), and the amplitude of a pattern-reversal electroretinogram (PERG) were evaluated by a specific logistic regression model. This model included glaucomatous damage, quantified by neuroretinal rim area corrected for disc size, as a covariate of sensitivity. RESULTS: Sensitivity of diagnostic tests increased for all procedures with increasing loss of neuroretinal rim area. With progressing optic disc damage, MD and STCS showed higher sensitivity than did TCS. BYVEP showed a higher sensitivity than PERG in all disease stages. In general, the psychophysical tests were more sensitive than the electrophysiological ones. CONCLUSIONS: The specific model used in this study was an appropriate tool to analyze the sensitivity of several sensory glaucoma tests in relation to disease stage. Moreover, tests that were more sensitive in early disease stages (TCS) and others that were more sensitive in more advanced stages (MD, STCS) were identified.

Adolescent↗
PubMed2002

Multiple bilateral eyelid molluscum contagiosum lesions associated with TNFalpha-antibody and methotrexate therapy.

PURPOSE: To demonstrate a patient developing multiple bilateral eyelid molluscum contagiosum lesions after initiation of TNFalpha-antibody therapy for rheumatoid arthritis. DESIGN: Single interventional case report. METHODS: Clinical, histopathologic, and immunologic-serological findings are presented. RESULTS: A 67-year-old patient with a 5-year history of rheumatoid arthritis had been treated with prednisone and methotrexate for the last 5 years. After initiation of additional TNFalpha-antibody treatment, complaints from rheumatoid arthritis subsided, but multiple bilateral molluscum contagiosum lesions of upper and lower eyelids occurred despite normal or only slightly reduced CD(4) (420-178/ microl) and CD(8) counts (143-58/microl). Histopathologic evaluation of the excised warts confirmed the clinical diagnosis. Under continued therapy, the warts have been recurring for 12 months. CONCLUSION: TNFalpha-antibody treatment for rheumatoid arthritis may compromise the host response to molluscum contagiosum, especially if methotrexate is given additionally. Patients should be informed about this potential complication.

Aged↗
PubMed2002

Small neuroretinal rim and large parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy.

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for progressive neuroretinal rim loss in chronic open-angle glaucoma. DESIGN: Prospective, observational case series. PARTICIPANTS: The study included 394 eyes of 257 white patients with chronic open-angle glaucoma. Mean follow-up time was 31.8 months (median, 39.7 months). Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Presence of optic disc hemorrhages was not taken into account. METHODS: All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Statistical analysis included Kaplan-Meier curves, and bivariate and multivariate Cox regression analysis adjusted for patients' ages. Dependency of left and right eyes from the same subject was taken into account. MAIN OUTCOME MEASURES: Qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Progression of glaucomatous optic nerve changes was detected in 42 eyes (11%). At baseline of the study, neuroretinal rim area (total area, P = 0.03) was significantly smaller, and beta zone of parapapillary atrophy (total area, P = 0.04) was significantly larger in the progressive study group compared with the nonprogressive study group. Neither study group varied significantly in size and shape of the optic disc, optic cup depth, alpha zone of parapapillary atrophy, and diameter of the retinal arteries and veins (P > 0.05). Multiple Cox regression analysis revealed that the progression of glaucoma depended significantly on the area of the neuroretinal rim (temporal sector, P = 0.003) and beta zone of parapapillary atrophy (temporal inferior sector, P = 0.02). CONCLUSIONS: Important morphologic predictive factors for progression of the glaucomatous appearance of the optic nerve head in white persons are small size of neuroretinal rim and large area of beta zone of parapapillary atrophy. Progression of glaucomatous optic nerve head changes is independent of size and shape of the optic disc, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth.

Adolescent↗
PubMed2002

[Impact of cataract surgery on intraocular pressure after filtering operation due to primary open angle glaucoma and secondary glaucoma in pseudoexfoliation syndrome].

PURPOSE: To analyse the impact of cataract surgery after filtering operation on the intraocular pressure (IOP) due to primary open angle glaucoma (pOAG) versus secondary open angle glaucoma in pseudoexfoliation syndrome (PEX). The regulation of IOP was evaluated on the basis of criteria of advanced glaucoma intervention study (AGIS). PATIENTS AND METHODS: Retrospectively 95 eyes of 95 patients (53 x pOAG, 36 x clear cornea approach [group 1] and 17 x corneoscleral tunnel [group 2]; 42 x PEX, 30 x clear cornea approach [group 3] and 12 x corneoscleral tunnel [group 4]) were included. The IOP and antiglaucomatous eye drops were analysed before filtering operation, before cataract surgery and on average 33 months after cataract surgery. RESULTS: In all groups there was a significant reduction of IOP after filtering operation by 8.7 mm Hg on average and no significant difference of IOP before and after cataract surgery. At no time there was a significant difference in IOP between the four subgroups. According to criteria of the AGIS study 34 % of group 1, 29 % of group 2, 36 % of group 3 and 17 % of group 4 had an IOP lower than 14 mm Hg before cataract surgery. After cataract surgery only 31 % of group 1, 18 % of group 2, 13 % of group 3 and 8 % of group 4 met this criterion. CONCLUSION: On first glance sequential cataract surgery after filtering operation seems to have no clinically relevant impact on the IOP, neither with regard to the type of glaucoma nor in respect of the approach for cataract surgery. However, if IOP is evaluated based on the criteria of the AGIS, primary open angle glaucoma with clear cornea approach appears to yield superior results in contrast to secondary open angle glaucoma in pseudoexfoliation syndrome with corneoscleral tunnel concerning the regulation of intraocular pressure.

Aged↗