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Biomedical subjects

B Gloor

Publications and source records attributed to B Gloor.

At least 19 recordsLinked to original sources
PubMed1995

[Normal pressure glaucoma: a diagnostic challenge].

PURPOSE: Normal-tension glaucoma (NTG) is a frequently discussed optic neuropathy. The purpose of this retrospective study was to evaluate the final diagnosis of patients with presumed NTG and to select the best distinguishing examination methods. PATIENTS: All patients with presumed NTG hospitalized for diurnal IOP curves from 1987-1992 were studied. We evaluated retrospectively which diagnostic tests contributed most to the final diagnosis. RESULTS: In 26 out of 50 patients with presumed NTG the final diagnosis had to be changed, mainly because the diurnal IOP curve showed a dysregulation; often only the early-morning IOP in supine position was elevated. CONCLUSIONS: We suggest that early-morning IOP spikes are one of the important pathogenetic factors in patients with glaucomatous changes without other pathology. Early morning IOP measurement in supine position before rising should therefore be a mandatory part of diurnal IOP curves in patients with presumed NTG.

Blood Pressure↗
PubMed1995

Airbag deployment and eye perforation by a tobacco pipe.

Airbags have been shown to reduce injuries and save the lives of car occupants in a crash. Like any protection system, airbags potentially introduce some new risks if no appropriate countermeasures are taken. A case of a relatively moderate frontal impact is described where the driver of an airbag-equipped car suffered a severe penetrating eye injury after the airbag deployed. Since the airbag fabric itself was excluded as an injury-producing structure, other objects such as eyeglasses, a wrist-watch, a bracelet, and a large finger ring had to be assessed. The investigation of the car interior as well as the morphologic details of the injuries to the eye and the face revealed that the most likely candidate for the injury was a tobacco pipe, which was probably being held in one hand and was broken apart by the deploying airbag and projected into the face of the driver. This case illustrates the hazard of having any rigid object between the occupant and the deploying airbag. The desirability of warning car occupants of the potential hazards which can result from today's protection systems is also discussed.

Accidents, Traffic↗
PubMed1995

[Critical thoughts on current laser surgery of the cornea].

OBJECTIVE: To analyze critically refractive surgery of the cornea by excimer laser and to compare laser surgery with other methods of treatment of refractive errors of the eye. MATERIAL AND METHODS: This analysis has to be restricted to a comparison of the treatment of myopia by keratotomy and photoablation with the ArF excimer laser. Correction of hypermetropia and of astigmatismus has to be left out, along with all the other methods to correct myopia, such as glasses, contact lenses, keratomileusis, epikeratoplasty, alloplastic implants, implantation of intraocular lenses with negative power, and replacement of the clear lens by an posterior chamber lens. The essential literature is screened. For intrastromal ablation with the picosecond Nd:YLF laser we relay on own experiences, also with the use of the ArF excimer laser we are not without own experiences. RESULTS AND STATEMENTS: For comparison of refractive surgery of the cornea not only the PERK study and the recommendations of the American Academy of Ophthalmology have to be considered, but also the newest developments in radial keratotomy such as two-step incision and reoperation with reopening of the keratotomy wounds. With these techniques the same precision can be reached as with the excimerlaser, and also higher myopias can be corrected. The dangers of the procedure, such as infection, perforation at surgery or laceration by contusion remain much larger. Intrastromal photoablation did not reach clinical maturity. Superficial photoablation is an almost safe procedure. A reduction of 3 D of myopia can be reached with satisfying precision, although higher myopias are still a problem. Pain following the ablation is considerable. Haze and disturbed vision at night can be present; infectious keratitis is rare, but possible. CONCLUSIONS: The critical fact of both procedures, keratotomy and photoablation with excimer laser, remains that healthy eyes are treated; therefore, even rare complications weigh much heavier than if sick eyes are treated. Because this is cosmetic surgery, the individuum asking for this type of procedure has to pay for on his own. Olson demands: "In determining when new technology is acceptable, we must consider the financial cost and the expected benefit to society. Is it an equitable tradeoff?" If we look at refractive surgery, especially laser photoablation, in the context of the needs for ophthalmic care of the whole world, then this type of surgery is out of proportion. The balance could be restored if, with every laser application, funds were given for third-world projects. Excimer-laser surgery may be justified insofar as the research with these lasers leads to useful therapeutic methods.

Follow-Up Studies↗
PubMed1995

[Corneal ulcer after intraocular interventions and after cyclocryocoagulation].

We report about two patients who developed neuroparalytic ulcera in the eye two months after cyclocryocoagulation due to secondary glaucoma after intraocular lens implantation. In the first patient, explantation of an anterior chamber lens and implantation of a posterior chamber lens was performed because of development of Irvine-Gass Syndrome after cataract operation. The second patient developed secondary glaucoma after cataract operation with implantation of an anterior chamber lens followed by trabeculectomy. The first patient underwent lamellar keratoplasty and at the second patient perforating keratoplasty.

Aged↗
PubMed1994

[Damage to the vessel wall by the Fogarty balloon catheter].

Thromboembolectomy with the Fogarty balloon-catheter is a well-established surgical therapy for the treatment of acute ischemia with generally good results. However, arterial injuries caused by balloon embolectomy occur in up to 6%. The different types of injury are mentioned, the role of myointimal hyperplasia as a result of endothelial denudation is discussed. We conclude that after balloon-catheter thromboembolectomy an early angiographic control should be performed and repeated 3 months postoperatively.

Aged↗
PubMed1992

Protracted ruthenium treatment of recurrent pterygium.

By combining excision with 106ruthenium irradiation in 17 patients previously operated on for persistently recurrent pterygium, we have devised an effective therapy that produces virtually no side effects and further prevents events recurrence. The ruthenium applicator shell was left in place for 2-3 h, yielding a total dosage of 2000 cGy. Only 2 of 17 patients suffered even slight recurrences, and 2 more had either motility disturbance or corneal haze. Through application of the internationally accepted total dosage of 2000 cGy, but at a relatively low dose rate, which especially protects the tissue responsible for proper healing, strong support is provided for the principle of protracted irradiation in recurrent (and possibly even primary) pterygium, permitting milder treatment and fewer recurrences.

Adult↗
PubMed1992

[Importance of standardized photos for planimetry].

In a series of 30 patients we compared the optic disc measurements. Disc photographs were either taken centric or excentric. Pictures with excentric discs showed significantly smaller measurements. However, the C/D-ratio demonstrated a good correlation (r = 0.95). For follow-up studies even not standardized photos can be useful, especially if the same examinator makes all the measurements.

Fluorescein Angiography↗
PubMed1992

[The fate of corneal transplants from the Zurich eye bank].

In a retrospective study, we investigated the survival of transplanted corneal material, which had been sent between 1988 and 1989 from the Zurich Eye Bank to both domestic and foreign physicians and clinics. A questionnaire was used to determine diagnosis, transplant survival, cause of any opacification, the occurrence of problems of epithelialisation, loosening of sutures, as well as vascularization of the host cornea. Of a total of 416 corneas, 327 or 79% could be evaluated. The mean follow-up periods of the various diagnostic groups ranged from 11 to 20 months, with a range of 1 to 35 months. After 18 months, the rate of clear transplants was 96% in the keratokonus group. This rate was significantly better than that of the bullous keratopathy group (77%, p less than 0.013) or that of all other diagnosis groups (72%, p less than 0.001). The difference to the 81% survival rate of the group with Fuchs' endothelial dystrophy was not significant. The most frequent cause of transplant opacification was primary transplant failure. Analysis of possible risk factors further confirmed that transplant opacification occurs more frequent in the presence of vascularization of the host cornea.

Adolescent↗
PubMed1992

[Correction of astigmatism after penetrating keratoplasty].

Nine patients had a surgical correction of high astigmatism following perforating keratoplasty. In seven of them the reason for the perforating keratoplasty was keratoconus, in two of them Fuchs' endothelial dystrophy. The correction was performed in the seven 31-69 yrs old keratoconus patients 4-19 years (median 10 yrs) after the transplant, in the patients with Fuchs' dystrophy 13 month and 1 year following corneal transplant. In eight cases two circular shaped relaxing incisions of 60 degrees were performed in the steeper meridian, seven times combined with sutures in the opposite meridian. Once a wedge resection was performed. The astigmatism before correcting surgery was 8-19 dpt (median 13 dpt), 3-24 month (median 11 month) 1.75-13 dpt (median 8 dpt). The reduction of astigmatism was 3-10 dpt (median 8 dpt). In 5 of 9 patients the astigmatism could be corrected by spectacles, in two more patients no spectacles were prescribed because of cataract. After this series of astigmatic correction we think that incisions without sutures are superior. This method could replace rekeratoplsty in the future.

Adult↗
PubMed1992

[Neoplastic space-occupying lesions of the orbit. I. Review; hemangioma, lymphangioma and embryonal rhabdomyosarcoma].

From 1987 to 1990 182 patients were treated for orbital lesions in the Department of Ophthalmology of the University of Zürich. 37% were tumors (without tumors of the vascular system), 20% inflammatory lesions, 12% lesions of the vascular system and tumors of it, the rest was not diagnosed. On this background the first of two chapters on orbital tumors deals with diagnosis, differential diagnosis, therapy and follow up of the capillary hemangioma, cavernous hemangioma, lymphangioma and embryonal rhabdomyosarcoma. Although ultrasound echography, CT, MRI and angiography have greatly changed the diagnostic work up of orbital lesions, diagnosis is by far not made straight forward but often only after errors. To enhance diagnosis in the future this study is meant to analyse our misinterpretations. In the case of capillary hemangioma only complications justify an active treatment, normally the lesion resolves spontaneously. The infiltration of the upper eyelid with ptosis needs to be treated because of the risk of amblyopia. Our cases demonstrate, that the attempt of treatment with steroids is justified. Embolisation in the region of the a. ophthalmica is quite dangerous. The cavernous hemangioma only needs treatment in the case of compression of the optical nerve and total excision is not mandatory. The lymphangioma, although classified as benign tumor, can only be excised subtotally and with the danger of traumatising important structures of the orbit. The infiltrative growth and tendency of recurrence in fact is dangerous. It is important to diagnose the tumor without biopsy and to wait with surgical treatment as long as possible. The embryonal rhabdomyosarcoma itself is rare but it is the most frequent primary malignant tumor in childhood. Even accounting for being familiar with mimikri-false history of trauma, inflammation, hemangioma-like angiography-the diagnosis is often made rather late. Our cases demonstrate this and also the change of treatment in the last 30 years. Unfortunately the prognosis of the good results of chemotherapy in combination with radiation if necessary is clouded by the occurrence of secondary malignant tumors.

Adolescent↗
PubMed1992

[Neoplastic space-occupying lesions of the orbits. II. Space-occupying lesion in the area of the lacrimal gland].

In part two of this paper about orbital tumors, neoplasms of the lacrimal gland are discussed: These have to be properly separated from inflammations. While inflammatory affections of the lacrimal gland make up the majority of private practice consultations, in cases referred to an eye clinic the relation between inflammatory diseases and neoplasms is about equal (between 1987 and 1990, 14 neoplasias and 14 inflammations were seen at the University Eye Clinic, Zurich). The benign pleomorphic adenoma of the lacrimal gland should be removed in toto in its capsule. For this procedure a lateral orbital fenestration is required. An excisional biopsy is considered the method of choice while an incisional biopsy should be avoided because of the risk of recurrence. On the other hand, incisional biopsy is used in the cases of adenoidcystic carcinoma and lymphoma. After confirmation of an adenoidcystic carcinoma by biopsy, orbital exenteration has to follow as soon as possible. In cases of lymphoma, possible oncological treatment has to be evaluated. In order to differentiate histologically between a reactive lymphoid hyperplasia and a malignant lymphoma, immunofluorescent studies on non-fixed tissue are necessary in close collaboration with an immuno-pathologist. Because the benign pleomorphic adenoma of the lacrimal gland has to be treated by a different surgical approach than the adenoid cystic carcinoma, a proper diagnosis has to be made before any intervention; a requirement we could not always fulfill. Those mistakes made us conclude that even in the era of CT scan, MRI and angiography, the radiological diagnoses are often hypotheses which have to be confirmed by discussion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1991

[Are eyeglasses obsolete, or what can we expect from refractive surgery?].

Ametropia can be corrected by means of spectacles, contact lenses, or surgical alteration of the corneal curvature. Here, the pros and cons, as well as the performance of the various methods are presented along with an explanation for the continuing need for spectacles: worn by the millions, contact lenses can, if improperly used, lead to severe irritation of the conjunctiva and cornea and, if the storage fluid becomes contaminated, to infectious corneal ulceration and even to blindness. The curvature of the cornea can be changed by making incisions with a diamond-knife or laser, by performing tissue ablation with a laser, or by placing shrinking scars. When treating nearsightedness with radial keratotomy, that is, by causing lesions with a diamond-knife, the individual results are quite difficult to predict reliably. Considerable operative complications are possible. Extreme, visually impairing myopia cannot be completely corrected. This is true for the treatment of myopia by means of excimer lasers and the like. Here, long-term results from larger groups are still lacking. The current methods for refractive surgery can be considered experimental. In addition to basic research applications in the laboratory, their further development, if critically applied on a restricted clinical basis, has a promising future.

Contact Lenses↗
PubMed1991

[Healed (?) amoebic keratitis].

Acanthamoeba keratitis was seen in two contact-lens wearers. In both cases, this finding was verified by microbiological examination of conjunctival swabs and of the lens solution. One patient had perforating keratoplasty. While neither vital amoebae nor cysts could be detected in the host corneal explant, immunohistochemical examination revealed fluorescence-positive fragments which probably correspond to incomplete cycstic walls.

Acanthamoeba Keratitis↗
PubMed1990

[Measuring the optic papilla with planimetry and the optic nerve head analyzer in glaucoma and suspected glaucoma. II. Correlations of the results of both methods with changes in the visual field, studied with the Octopus automatic perimeter].

Sixty-seven optic nerve heads of 40 patients with proven or suspected glaucoma were measured by planimetry and with the Rodenstock Optic Nerve Head Analyser (ONHA). The results were compared to visual field indices obtained with the Octopus program G-1. Good correlation of the results obtained by the two measurement procedures has been shown (Stürmer et al. 1989), between values for the disk area, the excavation area, and the cup/disk ratio. However, there is only weak correlation of values for the neuroretinal rim. The planimetrically measured neuroretinal rim area in the total population examined proved to be significantly correlated only with the visual field index for mean retinal sensitivity (MS; r2 = 0.106; P = 0.007) and short-term fluctuations (SF; r2 = 0.066; P = 0.036). After division of the population examined into different diagnostic groups, further statistically significant correlations between optic nerve head parameters and the various visual field indices were shown; here, the cup/disk ratio of both measurement procedures in two subgroups showed the best correlation with the visual field indices MS and mean defect (MD). Neither in the total population nor in any of the subgroups was a statistically significant correlation found between the volume of the excavation and one of the visual field indices. Comparing only the data for the temporal quadrant of the optic nerve head with the visual field did not improve the correlations. The best, i.e. highly significant, correlations were between optic nerve head parameters and the age of the patient. The correlation factors are much lower than other published data. A variety of factors could be responsible for these weak correlations: different optic nerve head configurations on the one hand, and localized or diffuse visual field defects on the other. In unselected cases it appears impossible to predict the visual field of a given optic nerve head. Both methods are suitable for follow-up, but not all anatomical configuration of the optic nerve head permit this.

Adolescent↗
PubMed1990

[Treatment of acute and chronic endophthalmitis following posterior chamber lens implantation].

Nine cases of postoperative endophthalmitis following extracapsular cataract extraction with implantation of a posterior chamber lens are presented -5 acute cases which occurred 3 to 5 days after surgery, and 4 subacute to chronic cases which occurred between 7 weeks and 18 months postoperatively. Experience has shown that in acute cases it is advisable, in addition to massive topical and parenteral therapy with antibiotics, to perform an emergency extraction of the posterior chamber lens and anterior or pars plana vitrectomy. In the subacute to chronic cases a step-by-step approach appears sensible: conservative treatment with massive topical and parenteral antibiotics and topical steroids; if this fails, removal of the lens, leaving the diaphragm in situ provided that the vitreous is not excessively infiltrated; if this also fails or there is extensive infiltration of the vitreous, removal of the posterior chamber lens with the capsular bag and vitrectomy with protection by antibiotics.

Aged↗
PubMed1990

[Comparison of tonometry with the Keeler air puff non-contact tonometer "Pulsair" and the Goldmann applanation tonometer].

Intraocular pressure (IOP) readings were performed with the Keeler Air-Puff Non-Contact Tonometer "Pulsair" in 126 patients before (NCT1) and after (NCT2) applanation-tonometry with the Goldmann device (GAT). For the whole population of 126 patients, in each of whom only one eye was selected, there was a significant difference of the mean IOP measurement, but the difference between the two measurement methods was only slightly significant when the NCT was applied before the GAT, and highly significant vice versa. Also the variation of the NCT-measurements was significantly larger than that for the GAT, while the before- and after GAT measurements had equal variations. If only the measurements under 18 mmHg mean GAT are taken into account (n = 101), the difference between GAT and NCT1 was not significant (p = 0.437), as opposed to the GAT-measurements above 18 mmHg, where a highly significant difference between the means was found (p = 0.0033). In most cases, the IOP-readings were underestimated using NCT. The Non Contact Tonometer "Pulsair" could be used for IOP-readings in patients with increased risk of infection, as well as in those with known allergic reactions to topical anesthetic agents, with poor or absent fixation ability, with corneal edema, and postoperative after anterior-segment surgery. The possibility of IOP-measurement in a reclined position is a true advantage of the Non-Contact Tonometer presented here. A measuring strategy for the above-mentioned applications is presented.

Adult↗