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Biomedical subjects

C Althaus

Publications and source records attributed to C Althaus.

At least 55 records · Page 3Linked to original sources
PubMed1996

Rifabutin-associated anterior uveitis in patients infected with human immunodeficiency virus.

Iridocyclitis, arthralgia, and pseudojaundice have been identified as dose-dependent adverse effects in patients with acquired immunodeficiency syndrome (AIDS) who are treated orally with rifabutin for Mycobacterium avium intracellulare complex (MAC) infections. Nine episodes of acute anterior uveitis of varying severity ranging from mild iridocyclitis to anterior uveitis with fibrin or hypopyon, mimicking endogenous metastatic endophthalmitis, occurred in seven patients. At the time of presentation, all seven patients were receiving rifabutin at a dose ranging from 300 to 600 mg daily. Iridocyclitis was bilateral in four of seven patients, in two cases simultaneously and in two cases successively. Inflammation resolved rapidly on treatment with systemic and topical antibiotics, on corticosteroid therapy, and on discontinuation of rifabutin. In two cases of mild iridocyclitis, cessation of rifabutin alone led to resolution of the uveitis. The combination of rifabutin, clarithromycin, and fluconazole may increase the risk for anterior uveitis in patients with AIDS. All of our patients were treated with fluconazole, with clarithromycin, or with a combination of both substances in addition to rifabutin. Identification of rifabutin-induced uveitis is important because hypopyon uveitis in the immunocompromised patient generally evokes intensive and, sometimes, invasive ophthalmic and systemic workup and therapy. We suggest it to be sufficient for resolution of the inflammatory signs to discontinue rifabutin medication.

AIDS-Related Opportunistic Infections↗
PubMed1996

Endothelial precipitates and laser flare photometry in patients with acquired immunodeficiency syndrome: a screening test for cytomegalovirus retinitis?

Patients with acquired immunodeficiency syndrome (AIDS) who present with cytomegalovirus (CMV) retinitis show pathognomonic endothelial precipitates suggestive of primary anterior uveitis or secondary changes due to a spill-over from the posterior chamber. Laser flare photometry allows quantification of the intensity of anterior affection. We wanted to establish anterior-chamber flare values in AIDS patients with and without CMV retinitis and to find out whether CMV retinitis is preceded by an elevation of the flare value. In all, 25 men with AIDS who presented with CMV retinitis and 27 who did not have CMV retinitis but showed a CD4 count of < or = 200 cells/microliter blood were enrolled in a prospective study. Slit-lamp examination was performed, followed by indirect ophthalmoscopy and laser flare photometry after dilation of the pupil with tropicamide eye drops. Patients with CMV retinitis were followed every 10 days and the others, every 4 weeks. A group of 51 human immunodeficiency virus (HIV)-negative men served as a control group. AIDS patients with CMV retinitis showed a significantly higher flare count in the affected eye (12.4 photons/ms; n = 26) as compared with the unaffected partner eye (4.2 photons/ms; P < or = 0.0001; n = 18) and with eyes of AIDS patients without CMV retinitis (4.1 photons/ms; P < or = 0.0001; n = 50). The count in the latter eyes was also significantly higher than the control value (3.1 photons/ms; P < or = 0.0001; n = 102). Typical reticulate endothelial precipitates were found in 92% of AIDS patients with CMV retinitis. During the study, five eyes of three patients developed a fresh CMV retinitis, but a preceding rise in the flare count was not observed. Laser flare photometry follows the occurrence of pathognomonic reticulate endothelial precipitates. It lags behind the development and the extension of CMV retinitis. Therefore, it cannot be used as a screening test for early detection of CMV retinitis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Postoperative ultrasound biomicroscopic evaluation of the haptic position in transsclerally sutured posterior-chamber lenses as compared with the intraoperative endoscopic position.

Our objective was to evaluate the long-term stability of transsclerally sutured posterior-chamber lens (PCL) haptics. A total of 22 patients (26 eyes) were examined 29-50 months postoperatively by ultrasound biomicroscopy (UBM) to determine the exact haptic position in relation to the iris base, ciliary sulcus, pars plicata, and pars plana. In all eyes, endoscopy had been performed intraoperatively immediately after PCL insertion and suture fixation of the haptic. We could locate all 52 haptics by UBM. Intraoperative haptic localization was compared with the postoperative position. UBM confirmed the endoscopic position in 81% of cases; 19% of the haptics showed a clinically undetectable dislocation. Secondary dislocations were analyzed in correlation with the intraoperative endoscopic transscleral suture penetration site and the primary position of the two haptics of one PCL. Loosening of the fixation suture together with primary asymmetry of the two haptics of one PCL apparently contributes to a slight dislocation.

Ciliary Body↗
PubMed1995

[Treatment of toxoplasmosis retinochoroiditis with atovaquone in an AIDS patient].

BACKGROUND: Treatment of ocular toxoplasmosis in HIV-infected patients with standard drug regimens (Pyrimethamine, Clindamycine, Sulfonamides) is very often complicated by side-effects and adverse reactions. On the other hand, maintenance therapy must be continued life long, because of the high recurrence rates. Atovaquone (Hydroxynaphthoquinon) is tolerated excellently and is very effective against tachyzoits of toxoplasma gondii and its cysts. PATIENT HISTORY AND CLINICAL FINDINGS: A 49-year-old homosexual man with AIDS developed an allergic rash after being treated with a course of Pyrimethamine and Clindamycine for unilateral, bifocal ocular toxoplasmosis for 13 days. Therapy with Atovaquone 3 x 750 mg/d was instituted and within 8 days the infiltrates healed leaving retinochorioidal scars. THERAPY AND CLINICAL COURSE: During maintenance therapy with Atovaquone (3 x 750 mg/d) two relapses occurred, the first after 2 months and the second after 8 months. The recurrences were successfully treated by increasing the dosage of Atovaquone to 4 x 750 mg/d and the addition of Trimethoprime/Sulfamethoxazol and Clindamycine/Pyrimethamine respectively. Reexposition was tolerated without an allergic reaction. Under maintenance therapy with Pyrimethamine the patient was free of recurrences for another 4 months until he died. CONCLUSIONS: Atovaquone is an effective and well tolerated substance for the treatment of ocular toxoplasmosis. In contrast to earlier reports, two recurrences occurred under maintenance therapy. It cannot be excluded that the patient was incomplient and did not take the tablets according to our prescription. Future clinical investigations have to control the efficacy of Atovaquone in the therapy of ocular toxoplasmosis.

AIDS-Related Opportunistic Infections↗
PubMed1995

[AIDS: infections of the retina and choroid].

Various viral, bacterial, parasitic and fungal agents have been found to cause infections of retina and choroidea in HIV-infected patients. Usually these infections are opportunistic infections caused by the profound immunodeficiency, which is a result of the decay of lymphocytes by HIV. Before the HIV epidemic only rare cases of cytomegalovirus (CMV) retinitis were known in the literature. Now CMV retinitis has become the most common infection of the eye in AIDS patients. Ocular toxoplasmosis in HIV-infected patients can have a severe clinical appearance without treatment. Spontaneous recovery, as it usually occurs in otherwise healthy patients, does not take place in HIV-infected patients, so that a lifelong maintenance therapy is mandatory. Pneumocystis carinii chorioiditis was unknown before the HIV epidemic. In 1987 Pneumocystis carinii were found in the choroidea and two years later the clinical appearance could be described. Infections of choroidea and retina associated with AIDS may not be seen as isolated diseases. Commonly other organs are infected by the same or another organism. In case of AIDS-associated eye infections other organs should be checked for opportunistic disease. Diagnosis can be difficult. Because most of all intraocular infections associated with AIDS are CMV retinitis, an effective therapy can be initiated in most cases and in the follow-up a diagnosis can finally be made. Serological testing may be inconclusive because of occasional false-negative findings. Treatment often only suppresses the infections and so ongoing maintenance therapy may be necessary, as in the cases of CMV retinitis and Toxoplasma retinochorioiditis. A variety of different diseases, which can be treated by a multitude of different substances with a lot of adverse effects and contraindications, can complicate the therapeutic modalities used for the management of each individual disorder. Additionally HIV-infected patients suffer from at least two or three different diseases and must be treated lifelong with plenty of substances, which often are given with higher doses than usual. Only by cooperation of HIV-experienced doctors of different specialities in hospitals and offices the complex subject of HIV infection can be managed.

AIDS-Related Opportunistic Infections↗
PubMed1994

Prevalence of cholinergic urticaria in young adults.

BACKGROUND: Cholinergic urticaria is primarily seen in young adults, but little is known about its prevalence. OBJECTIVE: A prospective study was designed to investigate the frequency and severity of cholinergic urticaria in this age group. METHODS: Four hundred ninety-three high school and university students (15 to 35 years of age) were examined for cholinergic urticaria by means of a questionnaire and partly by exercise provocation tests. RESULTS: The overall prevalence of cholinergic whealing was 11.2%, with most of the affected persons being older than 20 years. The highest prevalence was observed in the age group of 26 to 28 years (20%). Apart from a small group of severely afflicted persons with systemic symptoms (11%), reactions were mostly mild and restricted to fleeting, pinpoint-size wheals (76%). Eighty percent of affected subjects were not troubled by their condition, and only 22% had ever sought medical attention. CONCLUSION: The study shows a high prevalence of cholinergic urticaria, but the condition is mostly mild.

Adolescent↗
PubMed1994

[Iris black diaphragm intraocular lenses in traumatic Aniridia].

PURPOSE: In this study we wanted to gain experiences with a new black diaphragm IOL concerning surgical postoperative difficulties in traumatic aniridia. PATIENTS: Since June 1991 we have implanted the IOL prototype and the modifications into 13 eyes with traumatic aniridia. The IOL was transsclerally sutured in 11 eyes without capsular support and it was positioned in front of capsular remnants in two eyes. In eight eyes penetrating keratoplasty was necessary. The mean follow-up period was 17 (1-34) months. RESULTS: The seventh IOL modification can be implanted safely now. Persistent intraocular inflammation (Tyndall +) has been observed in all eyes postoperatively but it seems to disappear slowly. Its effect upon the corneal endothelium and the development of cystoid macula edema is still under investigation. Secondary glaucoma has been the greatest postoperative problem: It could be controlled medically in five eyes, surgically in two eyes, but remained uncontrolled in one eye. Implantation of the IOL improved visual acuity in 11/13 eyes. CONCLUSION: Rehabilitation of eyes with traumatic aniridia by implanting the new black diaphragm IOL still presents some unsolved problems, especially uncontrolled secondary glaucoma and prolonged intraocular inflammation. In spite of many encouraging aspects we advise to be rather cautious and self-restrictive in this group of patients.

Adolescent↗
PubMed1994

Black diaphragm intraocular lens in congenital aniridia.

Beginning in June 1991, we implanted a newly designed, black diaphragm intraocular lens (IOL) into 13 eyes with congenital aniridia after cataract surgery. To the best of our knowledge, this is the first group of patients to receive a black diaphragm IOL. With the first prototype we experienced various difficulties, which prompted four design modifications. The latest IOL with a diaphragm diameter of 10 mm can be guided safely into the ciliary sulcus. IOL implantation improved visual acuity in 9 of 13 eyes; 4 of these exhibited considerably less nystagmus than was observed preoperatively. During the mean follow-up-period of 7.9 months (range, 1-27 months), a slight, persistent intraocular "inflammation" [Tyndall (+)] was observed in all eyes. Glaucoma occurred postoperatively in 4 eyes and was controlled medically in 2 eyes but remained uncontrolled in 2 other eyes that had the condition preoperatively. This pilot study indicates that most patients with congenital aniridia and cataract benefit considerably from the implantation of this newly designed, black diaphragm IOL. However, preexisting glaucoma may herald severe postoperative glaucoma-related problems and should be considered a contraindication until more information has been gained about the long-term tolerance of this IOL.

Adolescent↗
PubMed1994

Anterior capsular shrinkage and intraocular pressure reduction after capsulorhexis.

A significantly lower intraocular pressure level was found 2 months after in-the-bag implantation of 4 different posterior-chamber lenses in a consecutive series of operations involving 401 eyes. The anterior capsular opening was achieved with either an intact continuous circular capsulorhexis (349) or a capsulorhexis with one radial tear (52). The typical shrinkage of the anterior capsule following a continuous capsulorhexis was hypothesized to be an essential part of the pressure-lowering mechanism by traction on the ciliary body via the zonula. However, a direct correlation between the degree of anterior capsular shrinkage and the degree of pressure reduction in glaucomatous and non-glaucomatous eyes could not be established. The reduction was equal in all shrinkage subgroups. Thus, the most likely explanation for intraocular pressure reduction after intracapsular implantation should be sought not in mechanical but in non-mechanical (i.e. biochemical) alterations and influences.

Adolescent↗
PubMed1994

Black-diaphragm intraocular lens for correction of aniridia.

In cooperation with Morcher GmbH, we developed a black-diaphragm aphakia intraocular lens (IOL) designed to correct congenital and traumatic aniridia. Since June 1991, we have implanted this IOL into five eyes with congenital aniridia combined with cataract, and into eight eyes with traumatic aniridia combined with cataract or aphakia. Positioning the IOL was rather difficult, especially in the traumatic cases with inadequate capsular support, and in combination with penetrating keratoplasty. After up to 15 months' follow up, functional results are encouraging. However, slight persistent intraocular inflammation was observed in all of the eyes, more obviously in the traumatic cases. The effect of the IOL on the corneal endothelium is still being investigated. Cystoid macular edema was observed in one eye, but probably preexisted in this eye, following several earlier surgical procedures. Glaucoma was observed preoperatively in five eyes; postoperatively, in six. After surgery, it was controlled medically in 4 eyes, surgically in 1, and remained uncontrolled in 1.

Adolescent↗
PubMed1993

Pontine infarction in acute posterior multifocal placoid pigment epitheliopathy.

In a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), a pontine infarction occurred about 6 months after the ophthalmological manifestation. We report the first case with histopathologically proven vasculitis shown by muscle biopsy and the first positron emission tomographic documentation in APMPPE. The ophthalmological and cerebral symptoms responded well to steroid treatment. Long-term immunosuppression (e.g. azathioprine 1-2 mg/kg) seems to decrease the risk of recurrent systemic vasculitis.

Acute Disease↗
PubMed1993

[Surgical technical principles of trans-scleral suture of posterior chamber lenses].

BACKGROUND: Most reports on transscleral suture fixation of posterior chamber lenses (PCL) do not mention the principal difficulty that the surgeon has no valid information which structures were perforated by the needle and where he happened to fix the PCL loops. To know this exactly is a "conditio sine qua non". Without it, no valid evaluation of longterm results of this method will ever be possible. MATERIALS AND METHODS: Thirtythree PCL were fixated by transscleral suturing. The results of the decisive surgical steps were controlled by intraoperative endoscopy. The experiences and insights gained thereby were used to develop step by step optimal surgical procedures for different conditions. The results of the endoscopically controlled group were compared with the results of 128 eyes with transscleral suture fixation of a PCL without endoscopic control between 6/88 and 4/91. RESULTS: On the basis of systematically performed endoscopic controls during surgery we have identified several faults and pitfalls which should be avoided. In consequence we have developed rules and items that should be fulfilled in order to arrive at an anatomically correct position of the PCL: 1. The transscleral suture should only penetrate the sulcus and no adjacent structures of the iris or the ciliary processes. 2. The PCL loops must be primarily directed into the sulcus, 3. PCL design must be adapted to the anatomical needs of the procedure and must provide a safe distance between iris and PCL to avoid iris-shafting. Detailed suggestions are given to fulfil these requirements. The most important point is the two-step implantation of the PCL out of the anterior chamber into the posterior chamber to avoid a steep and disadvantageous implantation angle. Up to date, no cases with chronic intraocular inflammation have occurred in the endoscopically controlled group in contrast to the earlier non-controlled group. CONCLUSIONS: Our results allow--even without endoscopic control--an exact positioning of the PCL hepatics in the sulcus, which is the most important step in the whole procedure. However, for a scientific evaluation of longterm results after transscleral suturing of PCL endoscopic control will further be needed to demonstrate or to rule out any potentially harmful compression of the ciliary body or iris structures and to see whether or not such irregularities will be associated with reduced longterm tolerance.

Endoscopes↗
PubMed1993

Cerebral complications in acute posterior multifocal placoid pigment epitheliopathy.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a self-limited ocular disease with a favorable visual outcome. Regarding its pathogenesis, there is increasing evidence of a vascular disorder of the precapillary choroidal arterioles that causes ischemic edema of the overlying retinal pigment epithelium. Systemic and neurological abnormalities associated with APMPPE have been documented. The development of severe cerebral vasculitis simultaneously or after a period of months or even years has been described in only a few cases. We present two new well-documented cases that developed several months after manifestation of the characteristic findings of APMPPE. A thorough medical and neurological workup is recommended, as is careful information of the patients and their families about the signs and symptoms of potential associated cerebral complications so as to facilitate early and adequate treatment.

Acute Disease↗
PubMed1993

[Endoscopically controlled optimization of trans-scleral suture fixation of posterior chamber lenses in the ciliary sulcus].

Two technical difficulties have to be overcome in transscleral suture fixation of posterior chamber intraocular lenses (PCL) in the ciliary sulcus: first, exact needle penetration through the sulcus, and second, exact positioning of the PCL haptics in the sulcus. Incongruence of the two may lead to long-term complications by compression or even strangulation of ciliary processes. Intraocular endoscopy was used intraoperatively to visualize the site of needle penetration and the final location of the haptics in patients. It turned out that with our previously described standard techniques the precision was far less than anticipated. Thus, new technical ways had to be sought to improve the precision of positioning. In secondary implantation without perforating keratoplasty we achieved the best results when the needle was passed ab externo before opening the eye and before anterior vitrectomy, taking advantage of a precisely prepared sclerocorneal zone. Passing the needle ab externo in an already hypotonic eyeball gives much less precise results. In combination with perforating keratoplasty with an open-sky approach, needle penetration ab interno is reliable. Correct positioning of the PCL haptics is at least as difficult as correct needle penetration, a fact which up to now has mostly been ignored. In 33 consecutively operated eyes the technique of implantation and PCL design was varied under endoscopical control.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1992

Transscleral suture fixation of posterior chamber intraocular lenses through the ciliary sulcus: endoscopic comparison of different suture techniques.

Two technical difficulties exist in transscleral suture fixation of posterior chamber intraocular lenses (PCL) in the ciliary sulcus: first, exact needle penetration of the sulcus and second, exact positioning of the PCL haptics in the sulcus. We used, for the first time, intraocular endoscopy to visualize the site of needle penetration and the final location of the haptics in patients. It turned out that with our previously described standard techniques, precision was far less than anticipated. Thus, new technical ways had to be sought to improve the precision of positioning. In secondary implantation, we achieved best results when the needle was passed from the outside before opening the eyeball, taking advantage of a precisely prepared blue-white line. Passing the needle in an already hypotonic eyeball gives much less precise results. In combination with perforating keratoplasty, passing the needle from the inside by feeling one's way into the sulcus with the needle tip gives the best results. Correct positioning of the PCL haptics is at least as difficult as is needle penetration, a fact which up to now has mostly been ignored. More suitable lens designs may offer a solution for this problem. Their clinical value has to be established by intraocular endoscopy.

Cataract Extraction↗
PubMed1991

Experience with transscleral fixation of posterior chamber lenses.

A total of 83 eyes with transsclerally sutured PCLs were followed for an average of 10.5 months (range 2-23 months). The vast majority of patients benefitted considerably from the procedure; 8% of cases experienced a reduction in visual acuity and 2% suffered monocular visual loss. General vascular risk factors seemed to be important in bringing about long-term complications. Patients presenting such a risk must be better identified in the future. The solution of some remaining surgical problems and questions will also add to the safety of the procedure in the future.

Adult↗