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Biomedical subjects

B Kirchhof

Publications and source records attributed to B Kirchhof.

At least 19 recordsLinked to original sources
PubMed1997

Flecked chorioretinopathy associated with Birt-Hogg-Dubé syndrome.

BACKGROUND: Birt-Hogg-Dubé's syndrome is a rare skin disease characterized by multiple trichofibromas of the skin and polyps of the intestine. Ophthalmologic manifestations associated with the syndrome have not been reported in detail. CASE REPORTS AND METHODS: Two siblings suffering from Birt-Hogg-Dubé syndrome were examined clinically. Electrooculography and electroretinography were performed according to international standards. Color fundus photographs were taken as well as fluorescein angiograms. The two patients showed multiple perifollicular fibromas and trichodiscomas of the skin of the head. Funduscopy and fluorescein angiography revealed a flecked chorioretinopathy in one patient with progressive constriction of visual fields and severely reduced electroretinographic responses. Ophthalmoscopy in his sister showed peripheral pigmentary changes with only minor functional abnormalities. CONCLUSION: These findings suggest that Birt-Hogg-Dubé syndrome may be associated with a progressive flecked chorioretinopathy with constricted visual fields and that patients with the syndrome should undergo ophthalmological examination.

Aged↗
PubMed1997

Management of fibrous histiocytoma of the corneoscleral limbus: report of a case and review of the literature.

BACKGROUND: Fibrous histiocytomas of the corneoscleral limbus are rare tumors. We present an additional case and review the treatment approaches in the literature. So far, only light and electron microscopic studies have been performed. We used immunohistochemical stains to further characterize the cellular composition. METHODS: The excised lesion was routinely fixed and processed for light microscopy and immunohistochemical studies. For comparison, three dermal fibrous histiocytomas were also examined and processed similarly. RESULTS: The corneolimbal tumor was mainly composed of fibroblasts and histiocytes with a large amount of interstitial collagen, arranged in a storiform pattern. Immunohistochemical stains were positive for histiocytes, fibroblasts, and a marker for mesenchymal cells. The staining pattern of the dermal lesions was similar. CONCLUSION: Fibrous histiocytomas of the corneolimbal region are morphologically benign, slowly growing and infiltrative tumors. Complete resection, especially of the deep margin, is suggested. The immunohistochemical staining pattern is similar to that of dermal fibrous histiocytomas, which behave in a benign manner.

Adult↗
PubMed1996

Histopathology of episcleral fibrosis after trabeculectomy with and without mitomycin C.

BACKGROUND: The aim of the study was to investigate the histopathologic features of scar tissue which have proliferated at the site of trabeculectomy of surgical failures after procedures with and without the use of the antimetabolite mitomycin C (MMC). METHODS: We obtained seven surgical specimens after trabeculectomy without MMC and five specimens after trabeculectomy with MMC, which were compared with 23 controls. Sections were stained with hematoxylin and eosin, Verhoeff-van Gieson, Grocott methenamine silver, and alcian blue. An immunohistochemical stain was performed for alpha-smooth muscle actin. RESULTS: Specimens from eyes operated without MMC showed dense scar tissue with many fibroblasts, much ground substance, parallel-oriented collagen fibers, and contractile intracellular proteins within the fibroblasts. Specimens from eyes operated with MMC consisted of tissue with only few fibroblasts which did not exhibit contractile proteins. Collagen fibers were arranged randomly with less ground substance. CONCLUSION: Even after 1-10 months, the scar tissue was distinctly different in the two groups. These results suggest that the use of MMC has long-term effects in vivo. Surgical failures related to scar formation are possible and not reduced to zero.

Actins↗
PubMed1996

Chronic basidiomycetous endophthalmitis after extracapsular cataract extraction and intraocular lens implantation.

BACKGROUND: Basidiomycetes are known as rare pathogens for meningitis, sinusitis, pneumonia, ulcerative lesions of the hard palate and onychomycosis. To our knowledge, no filamentous basidiomycete has been reported from a case of fungal endophthalmitis. PATIENT: We report on a 67-year-old man with delayed-onset endophthalmitis caused by an opportunistic basidiomycete. Tissue obtained during vitrectomy was cultured and examined by light and transmission electron microscopy. After enucleation the eye was examined by light microscopy. CONCLUSION: The patient had endophthalmitis from a sterile hyphomycete, harboured in remnants of lens capsule and a granuloma on the ciliary body. It was recognized as a Holobasidiomycete on the basis of its dolipore structure with perforated pore cap, seen with transmission electron microscopy. Species identification was not possible because fruiting bodies were absent. The patient failed to respond to intravitreal and systemic amphotericin B and systemic itraconazole. The eye was enucleated. This case demonstrates that filamentous basidiomycetes can cause endophthalmitis when inoculated during cataract extraction.

Aged↗
PubMed1996

Pyogenic granuloma of the cornea: report of a case and review of the literature.

BACKGROUND: Pyogenic granulomas are ulcerated vascular proliferations, often accompanied by inflammatory infiltrates, which rarely affect the eye. Only few reports on pyogenic granulomas of the cornea have been presented. METHODS: The enucleated globe containing the corneal tumor was examined histopathologically, and special immunohistochemical stains were performed. RESULTS: The lesion had a yellowish appearance with marked vascularization. The inflammatory infiltrate was mainly composed of mononuclear cells, with no multinucleated giant cells, and was located anterior to Bowman's layer, leaving the corneal stroma unaffected. Immunohistochemical studies outlined the high vascular content, even in dense cellular areas, and confirmed the inflammatory nature of the mononuclear infiltrates. CONCLUSIONS: Pyogenic granuloma of the cornea represents a clinical and morphological entity developing in a traumatized eye with corneal vascularization. Although the origin of these lesions remains obscure, there have been no signs of malignancy. Therefore, enucleation of an eye with a pyogenic granuloma should be avoided.

Aged↗
PubMed1996

Prognostic factors associated with the visual outcome after vitrectomy for endophthalmitis.

BACKGROUND: Functional results following vitrectomy with intraocular and systemic antibiotic treatment for endophthalmitis are influenced by numerous factors. METHODS: A retrospective study of 65 cases of endophthalmitis treated between October 1988 and May 1994 at the Department of Ophthalmology, University of Cologne, Germany was conducted. All eyes underwent pars plana vitrectomy and intraocular and systemic antibiotic treatment. RESULTS: Vision of 20/400 or better could be obtained in 66% of eyes following extracapsular cataract extraction and intraocular lens implantation (ECCE + IOL), in 62% after severe eye injury, in 36% of eyes after intraocular surgery for other reasons than cataract extraction with lens implantation and in 33% of patients with endogenous endophthalmitis. Vision of 20/50 or better could be achieved in 41% of eyes following ECCE + IOL and additional systemic steroid treatment. In 22% of cases primary silicone endotamponade was performed; 57% of these eyes obtained visual acuity of 20/400 or better. Fifteen patients (23%) suffered diabetes mellitus; 20/400 vision or better could be achieved in 73% of these eyes. Visual acuity of hand movements or better before vitrectomy was associated with 20/400 vision or better in 69% of cases, whereas ambulatory vision could be attained in only 33% of patients with visual acuity of worse than hand movements at the initial presentation. Visual acuity of less than 20/400 was found in all eyes with haemolytic streptococcal infections. CONCLUSION: Prompt treatment of endophthalmitis is crucial. Additional treatment using systemic steroids and, if necessary, silicone oil can improve the functional outcome in some cases.

Adult↗
PubMed1996

[Risk factors for retinal redetachment by proliferative vitreoretinopathy after episcleral surgery for pseudophakic retinal detachment].

BACKGROUND: Conventional buckling procedures in pseudophakic eyes are more often than in phakic eyes complicated by proliferative vitreoretinopathy (PVR). PATIENTS: The records of 68 patients (68 eyes) suffering from pseudophakic retina detachment between January 1988 to March 1993 were evaluated. We analysed the frequency of PVR-redetachment and possible risk-factors. RESULTS: Thirteen eyes (19%) developed PVR-redetachment after external surgery. Within this group we were not able to find a retinal break before or during surgery in 70% of patients (9 eyes), compared to 25% of patients in the group without PVR complication. CONCLUSIONS: Uncertain visualisation of the retinal break prior to and during external surgery along with persistent retinal detachment represent risk factors for PVR. Also, extended indentation and cryotherapy during frustrane hole localisation is likely to reduce absorption of subretinal fluid and increase blood-ocular-breakdown. Both factors are known to raise the risk of PVR. Whether or not these severe disadvantages of "blind buckling" can be relieved by primary vitrectomy is subject of future investigations.

Adult↗
PubMed1996

[Pathogenesis of complicated cataract in herpetic kerato-uveitis].

BACKGROUND: Keratitis, retinitis and secondary cataract are well known complications of ocular herpes simplex infection. We report on a case of herpetic keratouveitis and cataract. Acute and inflammatory pathogenesis of cataract formation resemble a phacoanaphylactic reaction. CASE REPORT: A 15-year-old girl with recurrent herpes keratitis was referred for acute spontaneous cataract formation accompanied by iridocyclitis and hypotony. Visual acuity was decreased from 0.4 to light projection. During cataract extraction the anterior chamber was tabbed for immunological analysis. The thickened anterior lens capsule was examined by light microscopy. We found a significant local synthesis of herpes antibodies in the aqueous. Histologically the lens capsule depicted a defect and a granulomatous inflammatory infiltrate towards the basal membrane material. The specimen was not suitable to judge on eventual additional phacoanaphylaxis. After cataract extraction and systemic acyclovir and corticosteroids the keratouveitis subsided. Visual acuity improved to 0.4, but was limited by the disciform corneal scar. CONCLUSION: The granulomatous response towards lens capsule shown here, resembles the granulomatous reaction towards Descemet's membrane in advanced herpetic corneal ulcer. We speculate on the pathogenesis of the lens capsule defect as a, so far unknown, herpes-associated autoimmun response against the basal membrane material of the lens. The acuteness of cataract formation may be a consequence of contact of aqueous with lens fibres. Additional phacoanaphylaxis combined with secondary glaucoma is possible.

Acyclovir↗
PubMed1996

Primary vitrectomy for pseudophakic retinal detachment.

AIM/BACKGROUND: Viewing the peripheral retina is the major problem in the repair of pseudophakic retinal detachments. Conventional buckling procedures in pseudophakic eyes are complicated by persistent retinal (re-) detachment and proliferative vitreoretinopathy (PVR) more often than in phakic eyes. METHODS: Primary vitrectomy was performed in 33 consecutive cases for pseudophakic retinal detachment with the help of liquid perfluorocarbons and a wide angle viewing system, following a standardised procedure. All eyes have passed the 12 month follow up examination. RESULTS: The primary reattachment rate was 94%. PVR was observed in one case (3%). Seventy nine per cent (26 eyes) regained vision of 20/50 or better, with a median visual acuity of 20/30. The most frequent complication was transient glaucoma during the early postoperative period in 48% (16 eyes) requiring carboanhydrase inhibitors. CONCLUSION: The main advantage of primary vitrectomy over conventional buckling seems to be the better intraoperative sight to the most peripheral retinal holes, controlled removal of vitreous traction, and focused endolaser coagulation. This may explain the low rate of PVR after primary vitrectomy. Also, visual results tended to be better compared with conventional surgical techniques possibly because of removed vitreous opacities, and because of a superior retinal reattachment rate as well as the reduced rate of PVR.

Adult↗
PubMed1996

Severe congenital lagophthalmos with tarsal aplasia.

Congenital elongation of the palpebral fissure associated with large eyelids was named euryblepharon after Desmarres in 1854. In some cases the length of the lower lid margin exceeded that of the upper lid margin by more than 3 mm. The lids are lax and the elongated lid margin of the lower lid is only partially in contact with the globe. In marked cases of euryblepharon there may be an additional minor vertical shortening of the upper lid. However, the abnormalities described by Desmarres did not produce severe kerato-conjunctival xerosis. We speculate that euryblepharon as originally described is merely a mild manifestation of congenital lagophthalmos. More severe forms show additional malformations, leading to pronounced insufficiency of lid closure. We report on four patients with severe congenital lagophthalmos. The appearance differs from that of euryblepharon by the following details: (a) a symmetrical congenital retraction of both the lower and the upper lid margins; (b) a marked vertical shortening of the lids (case 1 was referred for bilateral descemetoceles); (c) tarsal aplasia; and (d) severe kerato-conjunctival xerosis after insufficient surgical treatment, leading to different degrees of disability. The surgical approach involved bilateral shortening of the lid margins and free transplantation of retroauricular skin. Stabilization of the lax lower lid margin was achieved by lyodura strips applied with medium tension and in contact with the lid margin. At 5 years after the first operation a petty horizontal shortening of the lower lids was necessary because of circumscribed trichiasis. The dura strip remained present. The long-term result as evaluated at more than 8 years following the first operation was very satisfactory.

Adult↗
PubMed1995

Detection of herpes simplex virus after penetrating keratoplasty by polymerase chain reaction: correlation of clinical and laboratory findings.

BACKGROUND: The study was carried out to investigate the possible correlation of clinical findings, histopathologic features and detection of herpes simplex virus DNA in corneal buttons obtained after penetrating keratoplasty. METHODS: We examined 47 consecutive corneal buttons sent for histopathologic examination by light microscopy and using the polymerase chain reaction for the detection of HSV1 and HSV2. Twenty-one corneal buttons from eyes with bullous keratopathy served as controls. RESULTS: The 47 cases were graded from the clinical information available as unproven, suspected and clinically proven cases of herpetic keratitis. This grading did not correlate to specific histopathologic features or to the results of HSV1 DNA testing. None of the cases were positive for HSV2 DNA. CONCLUSION: HSV DNA was detected in some of the cases of clinically unsuspected herpetic keratitis. This technique of demonstrating the presence or absence of HSV in the cornea after keratoplasty is more reliable than clinical data or histopathologic findings and may be important in cases of recurrent inflammatory episodes involving grafts after keratoplasty.

Cornea↗
PubMed1995

Posterior drainage of intraocular fluid: an experimental approach on bovine cadaver eyes.

We evaluated the posterior drainage of saline in cadaver bovine eyes using different experimental procedures. The saline perfusion via a pars plana infusion into the vitreous cavity was measured in the following 5 different groups of 20 enucleated bovine eyes: 1, control; 2, vitrectomy; 3, vitrectomy + retinectomy; 4, vitrectomy + retinectomy + removal of retinal pigment epithelium (RPE); and 5, vitrectomy + retinectomy + removal of RPE + choroidectomy. The mean values obtained for the facility of saline outflow were as follows group 1, 0.0458 microliter min-1 mmHg-1; group 2, 0.0393 microliter min-1; group 3, 0.1308 microliter min-1 mmHg-1; group 4, 0.2288 microliter min-1; and group 5, 0.9985 microliter/min-1 mmHg-1. The retina appeared to be the major barrier to fluid movement from the vitreous to the chorioid, perhaps due to the lack of extracellular space and to the tight and impervious structure of the retina. The barrier function of the retina may explain the hypotony seen after rhegmatogenous retinal detachment and the decrease in intraocular pressure observed after the removal of silicone oil in eyes that had undergone retinectomy. Our results suggest that the reduction in intraocular pressure occurring after retinectomy is attributable to the new drainage pathway.

Animals↗
PubMed1994

Is general anaesthesia necessary to record reproducible electroretinograms in rabbits?

In toxicity testing of intraocularly applied substances the flash electroretinogram (ERG) serves as an indicator of intact or reduced retinal function in the animal. Insufficiently monitored narcosis may be a source of puzzling ERG results. We performed electroretinography in 25 dark-adapted rabbits without general anaesthesia to evaluate the reproducibility of that method. Two recordings obtained at a mean interval of 26.87 days were compared. The scotopic a- and b-waves showed the same characteristics concerning shape, amplitude and implicit time known from other publications dealing with ERG recordings in narcotised rabbits. No statistically significant difference could be found between the test and retest recordings. It could be demonstrated that narcosis is not necessary for recording of stable and reproducible scotopic ERGs in rabbits.

Anesthesia, General↗
PubMed1994

Retinectomy lowers intraocular pressure in otherwise intractable glaucoma: preliminary results.

Surgery for glaucomas unresponsive to conventional surgical strategies has always been frustrating and puzzling. I present preliminary results achieved by partial retinectomy in nine eyes that had complete synechial closure of the chamber angle accompanied by very high intraocular pressure (IOP), debilitating pain, and poor vision. The aim of this surgical procedure was to lower IOP by rerouting aqueous humor to the absorbing compartment of the choriocapillaris through a large retinal hole. Since a retinal wound will not heal, this "filtration site" will remain open and functional. Follow up ranged from 2 to 12 months. Preoperative IOPs ranged from 38 to 70 mm Hg; final postoperative IOPs, from 2 to 50 mm Hg. IOP decreased in all of the nine patients. Phthisis developed in two eyes and hypotony in three; the latter three eyes were not phthisical. The procedure was complicated by retinal detachment in one eye. A technique for determining the optimum size of the retinectomy for specific patients remains to be developed.

Aged↗
PubMed1994

Anterior proliferative vitreoretinopathy in trauma and complicated retinal detachment. A histopathologic study.

Anterior vitreoretinal proliferations are frequent sequelae of retinal detachment repair and severe trauma. Cellular proliferations can form membranes extending anteriorly from the peripheral retina. These membranes have the capability to contract and may lead to detachment of both the peripheral retina and, in more advanced stages, the ciliary body. Because the vitreous base and vitreous remnants are leading structures for cellular proliferation, complete removal of the anterior vitreous base in particular is important in cases of severe trauma or complicated retinal detachment. In 11 cases of anterior proliferative vitreoretinopathy examined histopathologically, we found overlying membranes and cellular infiltration of the vitreous in close correlation with the amounts of vitreous remnants present. Visualization of the peripheral retina and pars plana can rarely be accomplished in the presence of the crystalline lens or pseudophakia. Therefore, the removal of the anterior vitreous is often incomplete. To achieve complete dissection of the anterior vitreous, we remove even a clear lens during the first surgical intervention in selected cases.

Adult↗