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Biomedical subjects

C L Trempe

Publications and source records attributed to C L Trempe.

At least 19 recordsLinked to original sources
PubMed1997

Quantitative analysis of macular holes with scanning laser tomography.

OBJECTIVE: The purpose of the study is to establish objective, quantitative, and reproducible three-dimensional analysis for macular holes with scanning laser tomography and to correlate measurements with visual acuity. DESIGN: The authors performed a cross-sectional, nonrandomized study. PARTICIPANTS: The authors examined 28 full-thickness macular holes of 23 patients aged 61 to 84 years. INTERVENTION: Confocal infrared imaging with scanning laser tomography using the TopSS (790 nm, 10 degrees field) three-dimensional measurements and macular hole analysis were performed. MAIN OUTCOME MEASURES: Area, depth, and volume parameters for both macular holes and rims were obtained in two ways: (1) reference plane for analysis equal to height of the retina (offset surface distance [OSD] 0) or (2) equal to height of the surrounding edematous rim of the hole (OSD user). Correlation of measurements with visual acuity and groups of macular holes was performed. Reproducibility from three image series per subject and intraobserver variability from ten measurements in four subjects were computed. RESULTS: Scanning laser tomography could detect macular hole and rim features in all subjects. Infrared images provided clinically useful information that may help explain macular hole pathophysiology. Based on quantitative, three-dimensional measurements, holes were assigned to four groups: large, small, shallow, and average. Groups varied significantly (P < 0.05) for the majority of measurements. Visual acuity correlated significantly (P < 0.05) with macular hole volume, depth, slope, and rim height with OSD user only, but not with hole area. Holes computed with OSD user were deeper and of greater volume. Reproducibility was excellent for hole area, slope, and rim area; good for hole volume and depth; variable for rim volume; and improved with OSD user. Intraobserver variability was low in each group. CONCLUSIONS: Scanning laser tomography is a reproducible three-dimensional imaging technique providing objective and quantitative clinical information in assessing, grouping, and managing macular holes. By setting the OSD to rim height, additional information of rim height and hole volume was provided and correlated with visual acuity. In addition, more reliable differences among macular hole groups were found. Axial measurements such as macular hole depth, volume, and rim height may be more important for visual acuity than hole area indicating their possible predictive value for outcome measures.

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PubMed1997

Role of the vitreous and macular edema in branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To determine the relationship between macular edema associated with branch retinal vein occlusion (BRVO) and the condition of the vitreous. PATIENTS AND METHODS: The authors retrospectively studied 58 patients (58 eyes) who underwent vitreous examination. The eyes were classified as having vitreomacular attachment (VMA) or vitreomacular separation (VMS), and were divided into two groups based on the mean age of the patients. RESULTS: Macular edema was found in 39 (67%) of the eyes. The prevalence of VMA was 81% (22 of 27 eyes) in group 1 (patients who were 64 years old or younger) and 45% (14 of 31 eyes) in group 2 (patients who were older than 64 years). Although no significant relationship was found, 77% (17 of 22) of the eyes with VMA in group 1 had macular edema. The incidence of macular edema was significantly higher in eyes with VMA (93%, 13 of 14) than in eyes with VMS (41%, 7 of 17, P = .009) in group 2. CONCLUSION: The authors' findings suggest that VMA may influence the presence of macular edema associated with BRVO.

Adult↗
PubMed1996

Evidence of cross-link formation of vitreous collagen during experimental ocular inflammation.

PURPOSE: To determine the mechanisms of vitreous changes during ocular inflammation. METHODS: We investigated vitreous changes, with special emphasis on collagen, in an experimental model of ocular inflammation induced by intravitreal injection of endotoxin (Escherichia coli) in rabbits. RESULTS: Inflammation caused gel contraction and loss of elasticity, accompanied by release of a water-like liquid from the gel, and increases in the amount of insoluble material and high-molecular-weight components of vitreous collagen, presumably due to extensive cross-links of the collagen molecules. Those changes were partially inhibited by intravitreal injection of superoxide dismutase. CONCLUSIONS: The cross-links of vitreous collagen may promote vitreous gel contraction and release of a water-like liquid from the gel. Superoxide anion may play a role in this process.

Animals↗
PubMed1996

Vitreomacular observations. II. Data on the pathogenesis of idiopathic macular breaks.

BACKGROUND: The pathogenesis of idiopathic macular breaks is still uncertain. Their formation has been ascribed to anteriorly oriented intravitreous traction and to shrinkage of the prefoveal cortical vitreous. The validity of both hypotheses is considered in this paper. METHODS: In order to clarify the pathogenesis of idiopathic macular breaks 127 consecutive patients had their vitreous examined and photographed with the El Bayadi-Kajiura precorneal lens and a slit-lamp microscope. RESULTS: A comparison with 127 matched controls demonstrated that the vitreous was significantly more often attached in eyes with a macular break than in controls (P < 0.01). In eyes with a macular break the vitreous was significantly more often attached in early cases (Gass stage 1) than in Gass stages 3 and 4 (P < 0.01). Still photographs and observation of the movements of the operculum demonstrated that, in some cases of stage 3 and also in stage 4, it moved inside the partially liquefied posterior vitreous, anteriorly to the retinal surface and frequently without evidence of posterior vitreous detachment over the macular area. The following anatomical features characterize the vitreomacular area: extremely thin hyaloid membrane (< 100 microns) and inner limiting lamina (10 nm) that adhere strongly to each other and to the underlying Mueller cells. There is no evidence that these structures can shrink selectively to cause a macular break. The premacular vitreous gel contains collagen fibers that attach posteriorly to the macula and anteriorly to the vitreous base. CONCLUSIONS: Our working hypothesis is that when detachment of the posterior vitreous is abnormally delayed, anteroposterior traction by collagen fibers may pull a foveal operculum off the retina. Our observations make this hypothesis attractive. However, the generally accepted hypothesis of Johnson and Gass cannot be entirely dismissed. In reality, since the two hypotheses are not mutually exclusive, they may both the partially correct.

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PubMed1996

[Role of the vitreous in central retinal vein occlusion].

To investigate the role of the vitreous in eyes with central retinal vein occlusion, especially in relation to neovascularization and macular edema, we conducted a retrospective chart review of the vitreous condition of 150 patients (150 eyes) with central retinal vein occlusion. Based on fluorescein angiography findings and color photographs, eyes with central retinal vein occlusion were classified as ischemic or nonischemic. In ischemic cases, retinal or optic disc neovascularization, or both, developed in eight (57%) of 14 eyes without complete posterior vitreous detachment at the final examination. The prevalence of neovascularization was significantly higher than in eyes with complete posterior vitreous detachment (0%, 0/43) at the final examination (p < 0.01). In nonischemic cases, the prevalence of no posterior vitreous detachment or partial posterior vitreous detachment with vitreomacular adhesion was significantly higher in eyes with macular edema (76%, 28/37) than in eyes without it (23%, 13/56) at the final examination (p < 0.01). Complete posterior vitreous detachment may protect against retinal or optic disc neovascularization in eyes with severe central retinal vein occlusion. Vitreomacular adhesion may cause persistent macular edema in eyes with mild central retinal vein occlusion.

Adult↗
PubMed1996

Ocular conditions associated with posterior vitreous detachment in young patients.

BACKGROUND AND OBJECTIVE: To investigate the ocular conditions associated with posterior vitreous detachment (PVD) in young patients. PATIENTS AND METHODS: The vitreous conditions of 861 patients younger than 30 years were studied retrospectively and examined biomicroscopically. RESULTS: In the first and second decades of life, retinitis pigmentosa, nondiabetic retinal vascular disorders, and a history of ocular contusion were most commonly associated with PVD. In the third decade of life, proliferative diabetic retinopathy was overwhelmingly the condition most commonly associated with PVD. CONCLUSION: This study delineated the ocular pathologic conditions associated with PVD in young patients. These findings may be useful in the management of PVD in patients younger than 30 years.

Adolescent↗
PubMed1996

Vitreous changes during ocular inflammation induced by interleukin 1 beta.

To determine the mechanisms of vitreous changes during ocular inflammation, we investigated these changes, focusing on the collagen, in an experimental model of ocular inflammation induced by intravitreal injection of interleukin 1 beta in rabbits. Inflammation caused gel contraction, with release of a watery liquid from the gel, and increases in the amount of insoluble material and high-molecular-weight components of the vitreous collagen, presumably due to extensive cross-links of the collagen molecules. The cross-links of vitreous collagen may promote vitreous gel contraction and the release of watery liquid from the gel.

Animals↗
PubMed1995

Prognosis of stage 2 macular holes.

PURPOSE: We ascertained the natural course of stage 2 idiopathic macular holes to determine better treatment possibilities. METHODS: We reviewed 48 eyes with stage 2 idiopathic macular holes and followed them up for more than two years. At each examination, best-corrected Snellen visual acuity was measured by a physician masked to the hypothesis of the study. RESULTS: Stage 2 lesions progressed to stage 3 or 4 during the follow-up period in 32 (67%) and 14 (29%) of 48 eyes, respectively; two eyes (4%) remained in stage 2. In 41 (85%) of 48 eyes, the hole size enlarged during the follow-up: 32 (94%) of 34 eyes had vitreomacular attachment and nine (64%) of 14 eyes had vitreomacular separation at the final examination, for a statistically significant difference in prevalence (P = .03). Visual acuity decreased two or more Snellen lines during the follow-up period in 34 (71%) of 48 eyes, the prevalence of which was significantly higher in eyes with vitreomacular attachment at the final examination (28 of 34, 82%) than in eyes with vitreomacular separation at the final examination (six of 14, 43%) (P = .01). CONCLUSION: Even though vitreomacular separation may improve the prognosis of a macular hole, stage 2 lesions usually will develop an enlarged hole and decreased visual acuity.

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PubMed1995

Spontaneous resolution of foveal detachments and macular breaks.

PURPOSE: To evaluate the mechanism of spontaneous resolution of foveal detachments and idiopathic macular breaks. METHODS: We reviewed the records of 139 consecutive eyes (94 patients) with either a foveal detachment or a macular break in patients who were examined between 1989 and 1992. There were 26 men and 68 women (mean age, 66.9 +/- 6.9 years). They were either unoperated on or observed during the period that preceded surgery. Each patient underwent complete ophthalmic examination in addition to slit-lamp photography of the vitreomacular interface and microperimetry with the scanning laser ophthalmoscope. RESULTS: Eight eyes demonstrated spontaneous resolution. A foveal detachment was noted in five eyes (five patients) and a stage 2 macular break in three eyes (three patients). The mean duration of observation was 33 months (range, one to 144 months). Resolution of the foveal detachments occurred without the development of posterior vitreous detachment. In each eye, the presence of a pseudo-operculum, indicating vitreofoveal separation, was accompanied by flattening of the foveal detachment without detectable posterior vitreous detachment. The three eyes with stage 2 macular break resolved after premature development of a posterior vitreous detachment. CONCLUSIONS: Foveal detachment and macular break resolution seem to result from the release or weakening of vitreous traction on the fovea. Reattachment of the foveal retina preserves fair to good visual acuity. Surgical intervention is contraindicated (1) in eyes in which foveal detachment flattens and develops a pseudo-operculum and (2) when a posterior vitreous detachment develops in an eye with a stage 2 macular break. Careful biomicroscopic vitreous examination and microperimetry with the scanning laser ophthalmoscope are extremely useful methods for adequate examination of these patients.

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PubMed1995

Course of vitreomacular traction syndrome.

PURPOSE: Although the course of vitreomacular traction syndrome is necessary to treat patients or to establish the value of the surgical technique, little information is available about its course. In this study, we ascertained the natural history of vitreomacular traction syndrome. METHODS: We retrospectively studied 53 consecutive symptomatic eyes with vitreomacular traction syndrome. RESULTS: In 43 (81%) of 53 eyes with cystoid macular changes at the diagnostic examination, 29 (67%) of 43 had cystoid changes that persisted during the median follow-up period of 60 months. The visual acuities at the time of the final examination decreased two Snellen lines or more from the initial measurement in 34 (64%) of 53 eyes. During the follow-up period, six (11%) of 53 eyes developed complete posterior vitreous detachment. The number of eyes with resolved cystoid changes or stable visual acuity was significantly higher when complete vitreomacular separation occurred (six of six) than when it did not (three [8%] of 37, P = .01; 13 [28%] of 47, P = .01). CONCLUSIONS: Most symptomatic eyes with vitreomacular traction syndrome underwent a further decrease in visual acuity. Complete vitreomacular separation, which occurs infrequently in eyes with the disorder, allows resolution of cystoid changes and improvement of visual acuity.

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PubMed1995

Risk of bilateral idiopathic preretinal macular fibrosis.

To ascertain the risk of the development of bilateral idiopathic preretinal macular fibrosis, we retrospectively studied 380 consecutive patients with idiopathic preretinal macular fibrosis. Eighty (21%) patients had bilateral involvement. Sixteen (39%) of 41 patients with diabetes, 40 (28%) of 144 with hypertension, and 12 of 21 (57%) with bilateral high myopia had bilateral involvement. The prevalence of bilateral involvement was significantly higher in patients with these three pathologies than in patients without these conditions (p < 0.01, p < 0.02 and p < 0.01, respectively). In patients with diabetes or hypertension, no significant difference was found in the prevalence of posterior vitreous detachment (PVD) between involved or uninvolved eyes. Diabetes, hypertension even without retinopathy, and high myopia may be risk factors for bilateral involvement of idiopathic preretinal macular fibrosis. Factors other than PVD may be involved in the development of idiopathic preretinal macular fibrosis in patients with diabetes or hypertension.

Adolescent↗
PubMed1995

Role of the vitreous in central retinal vein occlusion.

PURPOSE: The role of the vitreous in eyes with CRVO and its relationship to neovascularization and macular edema, in particular, were investigated. METHODS: A retrospective chart review of the vitreous condition of 136 patients (136 eyes) with CRVO was performed. Based on fluorescein angiography findings and color photographs, eyes with CRVO were classified as either ischemic or nonischemic. RESULTS: In ischemic cases, retinal or optic disc neovascularization or both developed in 8 (57%) of 14 eyes with no or partial posterior vitreous detachment (PVD) at the final examination. The prevalence of neovascularization was significantly higher than in eyes with complete PVD (0%, 0 of 38) at the final examination (P < 0.01). No significant relationship was found between iris neovascularization development and the vitreous condition or between the prevalence of PVD and macular edema. In nonischemic eyes, the prevalence of no PVD or partial PVD with vitreomacular attachment was significantly higher in those with macular edema (76%, 25 of 33) than in eyes without (25%, 13 of 51) at the final examination (P < 0.01). CONCLUSION: Complete PVD may protect against retinal or optic disc neovascularization in eyes with severe CRVO. Vitreomacular attachment may cause persistent macular edema in eyes with mild CRVO.

Adult↗
PubMed1995

Relationship between premacular cortical vitreous defects and idiopathic premacular fibrosis.

PURPOSE: To investigate the relationship between the defect in the premacular cortical vitreous detached from the retina and the development of idiopathic premacular fibrosis. METHODS: One hundred six consecutive patients (106 eyes) with posterior vitreous detachment but no other ocular disorders were prospectively studied. All follow-up periods were longer than 6 months. The vitreous condition was studied using an aspherical, +58.6-diopter preset lens with a slit-lamp. RESULTS: The detached premacular cortical vitreous was a continuous, unbroken sheet in 93 (88%) of the 106 eyes; in 13 (12%) eyes, the detached premacular cortical vitreous had an oval or round defect ranging from 4 to 7 disc diameters over the macula. At the study's conclusion, 36 (34%) of the 106 eyes had idiopathic premacular fibrosis; 70 (66%) eyes did not. The defect in the detached premacular vitreous was observed in 9 (25%) of the 36 eyes that eventually developed idiopathic premacular fibrosis and in 4 (6%) of the 70 eyes that did not undergo such development. The incidence of the defect in the detached premacular cortical vitreous was significantly higher in eyes with idiopathic premacular fibrosis than in eyes without (P = 0.011). Nine (69%) of thirteen eyes with the defect in the detached premacular cortical vitreous developed premacular fibrosis, whereas only 25% of eyes without the defect developed it. Twenty-seven (75%) of thirty-six eyes with premacular fibrosis did not have a defect in the detached premacular cortical vitreous. CONCLUSIONS: The defect in the detached premacular cortical vitreous probably occurs because the premacular cortical vitreous remains attached to the internal limiting lamina when a posterior vitreous detachment develops. The vitreous that remains attached to the macula may be related to the development of idiopathic premacular fibrosis.

Adult↗
PubMed1995

Natural outcomes of stage 1, 2, 3, and 4 idiopathic macular holes.

AIMS: A study was carried out to ascertain the natural outcome of each stage of idiopathic macular hole. METHODS: One hundred and fifty four eyes with different stages of idiopathic macular holes were retrospectively studied: stage 1 (40 eyes), 2 (25 eyes), 3 (58 eyes), and 4 (31 eyes). RESULTS: Of 27 of 40 eyes with a stage 1 lesion with posterior vitreous attachment to the macula initially, nine (33%) eyes developed a full thickness macular hole. No stage 1 lesions with posterior vitreous separation from the macula initially progressed to full thickness holes. Twenty one (84%) of 25 eyes with a stage 2 lesion, 32 (55%) of 58 eyes with a stage 3 lesion, and five (16%) of 31 eyes with a stage 4 lesion underwent macular hole enlargement during the median follow up period of 3 years. Visual acuity decreased two or more lines of Snellen equivalent during the follow up period in 12 (30%) eyes with a stage 1 lesion, 17 (68%) eyes with a stage 2 lesion, 17 (29%) eyes with a stage 3 lesion, and four (13%) eyes with a stage 4 lesion. The percentage was significantly higher in eyes with stage 2 lesions than the other stages (p < 0.01). CONCLUSION: The results suggest that the different stages of idiopathic macular holes have different natural outcomes, and the management depends on the stage at presentation.

Age Distribution↗
PubMed1995

[Natural outcome of idiopathic macular hole].

To ascertain the natural outcome of idiopathic macular holes, we studied 186 eyes with the disorder: stages 1 (48 eyes), 2 (30 eyes), 3 (71 eyes), and 4 (37 eyes), which were followed for over twelve months. In 11 (23%) eyes with stage 1 lesions full-thickness macular hole developed during the follow-up period, and in 12 (25%) eyes visual acuity decreased two or more Snellen lines. Twenty-five (83%) and 21 (70%) eyes with stage 2 lesions, 39 (55%) and 22 (31%) eyes with stage 3 lesions, and 7 (19%) and 5 (14%) eyes with stage 4 lesions had enlarged macular holes and decreased visual acuity during the follow-up, respectively. The present results suggest that different stages of macular holes have different natural outcomes and the treatment should be based on their stages.

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PubMed1995

[Observing idiopathic macular break by scanning laser ophthalmoscope vitreous videography].

We used vitreous videography in conjunction with the scanning laser ophthalmoscope (SLO) to evaluate the pathogenesis of idiopathic macular breaks. The fundamental aspect of this method is videographic documentation of the mobile posterior vitreous and an operculum. The high reflectivity from the vitreous gel using the SLO clearly showed the mobility of the operculum and the posterior vitreous in the idiopathic macular breaks. In some cases without posterior vitreous detachment, the operculum initially was suspended superior to the macular break and anterior to the retinal surface. Upon ocular movement, the operculum moved down smoothly in front of the macular break. The findings of these vitreous videographs using the SLO suggest that anteriorly oriented vitreous traction is one cause of idiopathic macular breaks.

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