Biomedical subjects

C Ohrloff

Publications and source records attributed to C Ohrloff.

At least 19 recordsLinked to original sources

PubMed2001

[LASIK with a superior hinge and scanning spot excimer laser ablation for correction of myopia and myopic astigmatism. Results of a prospective study on 100 eyes with a 1-year follow-up].

PURPOSE: Recently laser-in-situ-keratomileusis (LASIK) has been increasingly used to correct refractive errors. The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications using the scanning spot excimer LASIK technology. PATIENTS AND METHODS: The results of 100 consecutive LASIK operations carried out between 2/1998 and 2/1999 on 60 patients (mean age 37 years, range 20-55 years) have been evaluated. The Hansatome microkeratome with a superior hinge (flap diameter: 9.5 mm) and a scanning spot excimer laser (Technolas C-Lasik 217) were used in all cases. The mean spherical equivalent of the subjective manifest refraction was -6.96 +/- 2.87 diopters (D), the mean sphere was -6.47 +/- 2.71 D and the mean astigmatism was -0.98 +/- 0.94 D. In 6% of the eyes preoperative visual acuity was not better than 20/40. Examinations were performed preoperatively, after 1 and 7 days, after 1,4 and 12 months. Safety, efficacy, predictability, stability and complications were calculated using the datagraph software (version 1.11). RESULTS: All 100 eyes were examined after 1 day and 1 week, 96 after 1 month, 95 after 4 months and 92 after 1 year. Following 1 year none of the eyes lost 2 or more lines of best corrected visual acuity, 99% were within +/- 1 line and 1% gained 2 lines (safety index 1.03). In 92% of all eyes an uncorrected visual acuity of > or = 0.5 was reached, in 77% > or = 0.8 and in 51% > or = 1.0 (efficacy index 0.89). For 60 eyes (65.21%) a refractive correction of +/- 0.5 D was necessary, for 82 eyes (89.13%) +/- 1.0 D and for 91 eyes (98.91%) +/- 2.0 D. The mean spherical equivalent after 1 year was -0.15 +/- 1.31 D. Between 1 and 12 months a mean regression of -0.14 D occurred. On the request of the patients, 5 eyes were retreated during the study period for under- or over-correction. Complications due to the microkeratome did not occur. Corneal infections were not observed, a diffuse lamellar keratitis (DLK) was seen in 12 cases, but all cases healed with no loss of visual acuity. In 7 eyes a slight decentration of the ablation was observed using corneal topography, which in one case caused an increase in glare sensitivity. CONCLUSIONS: LASIK with superior hinge and scanning spot excimer photoablation is suitable for the correction of myopia (up to a maximum of -12 D) and for myopic astigmatism (up to a maximum of -5 D). The refractive results showed a high stability during the 12-month study period but there is still room for improvement of the predictability.

Adult↗

PubMed2001

[Photorefractive/photo-astigmatic refractive keratectomy in low myopia and myopic astigmatism. Broad beam versus scanning spot laser technology].

PURPOSE: The results of photorefractive/photoastigmatic refractive keratectomy (PRK/PARK) were compared between two patient groups treated consecutively with either broad-beam or scanning-spot technology. PATIENTS AND METHODS: PRK/PARK was performed with a broad-beam excimer laser VISX 20/20 in 46 eyes and with the scanning-spot laser system Keracor 217 in 49 eyes. Preoperative spherical equivalent (subjective manifest refraction) was < or =-6.0 diopter in both groups. Safety, efficacy, predictability, stability, and complications were investigated after 1,4 and 12, months postoperatively. RESULTS: In the broad-beam laser group no eye lost two or more lines of best-corrected visual acuity;in the scanning-spot laser group one eye lost two lines 12 months postoperatively. Efficacy, predictability, and stability were comparable between the two groups. CONCLUSIONS: Both the broad-beam and the scanning-spot laser provided good results after PRK/PARK for low myopia and myopic astigmatism. This study found no fundamental differences between the two laser systems.

Adult↗

PubMed2001

[Scheimpflug photographic imaging following implantation of anterior and posterior chamber phakic intraocular lenses: preliminary results].

BACKGROUND: For the correction of refractive errors lenticular procedures are increasingly used in addition to corneal refractive surgery. One of those techniques is the implantation of intraocular lenses into phakic eyes (pIOL). Due to the close neighborhood of the implant to delicate intraocular structures, exact positioning and high postoperative stability are required. Scheimpflug photography has been shown to be a suitable instrument for the biometry of the anterior eye segment and the examination of IOL position. PATIENTS AND METHODS: Four anterior chamber phakic IOLs (pIOLs) (Bausch & Lomb NuVita) and 7 posterior chamber pIOLs (Staar ICL) were examined 1 week, 1 month and 3-6 months following implantation. At each examination 1 Scheimpflug slit image and 1 infrared retroillumination image were taken using the anterior eye segment analysis system EAS-1000 (Nidek Co., Gamagori, Japan). Evaluation of the images was performed with a personal computer and the software provided by the manufacturer. The distance of the pIOL to cornea and human lens was calculated and incidence and amount of pIOL rotation around the optical axis and potential crystalline lens opacification were assessed. RESULTS: The distance between the anterior chamber pIOL and the cornea 1 week after implantation was 1.61 +/- 0.10 mm. The distances between the myopic posterior chamber pIOL and the human lens were 0.34 +/- 0.11 mm and between the hyperopic posterior chamber pIOL and the human lens 0.26 and 0.29 mm, respectively. The values were constant over a period of 3-6 months. The pIOL showed no movement or change of position around the optical axis. There was no detectable cataract formation in the human lens. CONCLUSIONS: All implanted phakic anterior and posterior chamber IOLs showed a stable position in the eye within the observation period. Scheimpflug photography is proved to be a useful technique for the postoperative evaluation of the positioning of phakic IOLs.

Anterior Chamber↗

PubMed2000

[Intra-individual comparison of intraocular lenses of highly refractive silicone (Allergan SI40NB) and hydrophobic acrylate (Alcon Acrysof MA60BM). 1-year follow-up].

BACKGROUND: A prospective, randomized study was performed to evaluate intra-individually the biocompatibility of foldable, highly refractive silicone and hydrophobic acrylic intraocular lenses (IOL). MATERIALS AND METHODS: We studied 35 patients who underwent phacoemulsification using a self-sealing tunnel incision. In a randomized fashion one eye received a 6-mm optic IOL made of high-refractive index silicone (Allergan SI40NB) and the other eye a hydrophobic acrylic 6-mm optic IOL (Alcon AcrySof MA60BM). All patients were examined 7 days, 1-3 and 6 months, and 1 year postoperatively. RESULTS: The mean best-corrected visual acuity (BCVA) was 0.9 +/- 0.12 vs. 0.89 +/- 0.13 (SI40NB vs. MA60BM) after 1-3 months. One-year postoperatively BCVA was still 0.9 +/- 0.12 vs. 0.87 +/- 0.14. The flare values (photon counts/ms) increased slightly 7 days after surgery (14.2 +/- 8.68 vs. 15.49 +/- 7.2, n.s.). Three months after surgery these values were again in the normal range. The mean IOL decentration was 0.29 +/- 0.14 vs. 0.3 +/- 0.15 mm 1 year postoperatively. Scheimpflug slit photography showed 40% of MA60BM IOLs to have "glistenings." No significant difference regarding posterior capsular opacification was found. CONCLUSION: One year after implantation of foldable, highly refractive silicone and hydrophobic acrylic IOLs using a self-sealing tunnel incision and phacoemulsification, no significant functional or morphological differences between the two IOL types were observed.

Acrylates↗

PubMed2000

[[In vitro culture of iris cells].

BACKGROUND: The biological behaviour of iris cells in vitro was not yet completely investigated. For a more detailed study of the scope of cultivation of iris cells in vitro we isolated human iris pigment epithelium (IPE) cells and iris fibroblasts. MATERIALS AND METHODS: For the purpose of this study iris cells were isolated from 19 donor eyes. A method was established for isolation and cultivation of IPE cells by means of fibronectin coating and the use of a special cell culture medium. Additionally, a method was developed for the selection of fibroblasts from iris stroma (IS) in vitro by means of fibronectin coating, passaging and proliferation in cell culture medium. RESULTS: The IPE and IS cells could be cultivated successfully. The IPE cells started to divide after a mean interval of 5.4 +/- 0.7 days in culture. The mitosis of IS cells was observed after 3.3 +/- 0.87 days in culture. Confluency of IPE cells was reached after 14.7 +/- 4.92 days and by IS cells after 8.1 +/- 1.45 days. Immunocytochemical staining using two antibodies for cytoceratin and one for human fibroblast showed that the IPE cell culture was pure and that the IS culture consisted of fibroblasts. Furthermore, electron microscopy of IPE and IS cultures confirmed the results of the immunocytochemical staining. CONCLUSIONS: The use of human IS and IPE cells in vitro has established a novel model for the research on iris cells. The model might possibly be applied in the research of metabolic structures and diseases of the iris.

Adult↗

PubMed1999

Complications after implantation of intraocular devices in patients with cytomegalovirus retinitis.

PURPOSE: The authors report their surgical experience after sustained-release ganciclovir treatment, as well as replacing empty ganciclovir implants in patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. METHODS: Between November 1995 and August 1998, 79 eyes of 49 patients received 99 intravitreal ganciclovir implants. Patients were examined monthly after implant surgery. Follow-up periods ranged from 6 to 128 weeks. RESULTS: At the first 3-week postoperative visit, 73 eyes (97.2%) of 46 patients exhibited stable conditions. In 6 eyes (3.8%) of 3 patients, further progression was noted due to resistance to ganciclovir. The most common early complication (within 6 weeks after implantation) was cystoid macular edema, observed in 7 eyes receiving implants. Retinal detachment was the most common late complication (over 6 weeks after implantation) in 11 eyes. In almost all eyes with CMV retinitis and retinal detachment, involvement of more than 25% of the retina was observed. Additional severe complications included extrusion of the first pellet in 2 eyes and cataract as a late complication in 5 eyes. A total of 28 eyes (35.4%) of 16 patients receiving a second implant did not experience significant three-line loss by the end of the follow-up period. CONCLUSION: In the treatment of CMV retinitis, sustained-release ganciclovir implantation seems to be an alternative to intravenous ganciclovir. Early implantation and additional replacement of the device has the potential to decrease the risk of developing retinal detachment. We would recommend additional systemic antiviral CMV therapy to avoid infection of the fellow eye and CMV disease.

AIDS-Related Opportunistic Infections↗

PubMed1999

Stereopsis after primary in-the-bag posterior chamber implantation in children.

PURPOSE: The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children. PATIENTS AND METHODS: A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years). RESULTS: Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group. CONCLUSIONS: After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.

Capsulorhexis↗

PubMed1999

[Photoastigmatic refractive keratectomy for low, moderate, and high astigmatism using a broad beam excimer laser: evaluataion according to new international criteria].

BACKGROUND: Photorefractive keratectomy (PRK) is an accepted procedure to correct myopia in Germany. The purpose of this study was to evaluate photoastigmatic refractive keratectomy (PARK) for myopic astigmatism. MATERIAL AND METHODS: PARK using the VISX 20/20 excimer laser was performed in 50 eyes of 36 patients (25 female, 16 male) aged 22 to 68 years (mean 38 +/- 10 years) in the period of 1995 to 1996. Retrospective evaluation was done after dividing the patients into three astigmatic groups between -0.5 diopters (D) and -1.5 D (group I, n = 28), between -1.75 D and -3.0 D (group II, n = 16) und between -3.25 D and -5.5 D (group III, n = 6). The correction of myopic astigmatism was assessed concerning the criteria safety, efficacy, predictability and stability. Mean follow-up was 12 months (8-15 months). RESULTS: Seventy-eight % of all eyes achieved an uncorrected visual acuity of > 0.5. Sixty-eight % of the eyes were within +/- 1.0 D of the desired correction. Loss of 2 or more lines of best corrected visual acuity occurred in 6 eyes (12.0%). We observed in group I an astigmatic reduction of 36.0%, in group II of 66.5% and in group III of 68.0%. The surgically induced astigmatism was calculated with 1.29 +/- 1.0 D. Mean axis rotation of the refractive cylinder was 22.12 +/- 23.05 degrees. CONCLUSIONS: PARK using the VISX 20/20 excimer laser is an acceptable procedure to correct myopic astigmatism. However, the study revealed that astigmatic reduction with a broad beam laser is not yet perfect in terms of efficacy, predictability and safety.

Adult↗

PubMed1999

[Intravitreal endoscopic visualization of intraocular ganciclovir devices: improved long-term treatment of CMV retinitis].

BACKGROUND: The recent development of 20- and 19-gauge diameter endoscopes allows an excellent direct intravitreal visualization of intraocular morphology. A gradient index (GRIN) endoscope (Insight Instruments, Lake Mary, FL, USA), which combines a small diameter (0.89 mm, 20 gauge) and an exceptional optical resolution, can be used as a diagnostic tool for the assessment of the safety and vitreous interaction of sustained release intraocular devices which have been designed to deliver ganciclovir (Vitrasert) over a period of 8-12 months and were successively implanted in several eyes. PATIENTS AND METHODS: 78 eyes of 49 patients received 100 ganciclovir implants between November 1995 and July 1998. In six patients who received additional implants, the GRIN endoscope was used as an optical control of wound healing processes and Vitrasert positioning after implantation of prior devices (two-point suturing technique). RESULTS: In all of these six eyes, a clinical stabilization of the cytomegalovirus retinitis was noted. Endoscopic observation of the scleral 5-mm incision revealed no gaps after two-point suturing of the device. Only one of six eyes showed significant vitreous tractions around the Vitrasert. However, the struts of all pellets were completely covered by a fibrous membrane. Occasional fibrous plaques were noted on the surface of devices which presumably had been damaged by surgical manipulations. In one case, the endoscopic examination disclosed the suprachoroidal implantation of a device. In this eye, no signs of retinal toxicity or recurrence of CMV retinitis were observed. CONCLUSIONS: High resolution endoscopy of the vitreous cavity appears to be an effective method for the control of intraocular drug delivery devices. Basically, the repeated implantation of intraocular ganciclovir implants can be considered a safe method in the management of relapsing CMV retinitis. However, the endoscopic observation of fibrous membranes covering the struts suggest that the explanation of an intraocular device has the potential for various intraoperative complications (e.g. hemorrhages, traction, tears, retinal detachment). Therefore, we would recommend the additional implantation of further implants rather than a replacement.

Cytomegalovirus Retinitis↗

PubMed1999

Visual outcome after treatment with low-dose recombinant tissue plasminogen activator or hemodilution in ischemic central retinal vein occlusion.

The ischemic type of central retinal vein occlusion (CRVO) is associated with a poor visual and ocular prognosis. Although several reports have indicated that hemodilution or thrombolytic therapy may be of benefit, there is still no consensus among ophthalmologists about the management of this disorder. In our study, we retrospectively evaluated the visual outcome after medical treatment in 58 patients with ischemic CRVO and severe visual loss (< or = 20/50). We separately investigated three different groups, depending on the following criteria: onset of symptoms within 11 days prior to admission and thrombolytic treatment with 50 mg of recombinant tissue plasminogen activator (rtPA) and intravenous heparinization (n = 23) or hemodilution therapy (n = 22) or onset of symptoms >11 days before the initial visit and hemodilution (n = 13). An advancement of 2 or more lines on the logarithmic visual acuity chart was noted in 10 cases (44%) in the rtPA group and in 3 subjects (14%) in the early-phase hemodilution group, whereas only 1 patient in the late-phase hemodilution group showed a comparable improvement. Our findings suggest that treatment with low-dose rtPA or hemodilution aimed at early restoration of blood flow has the potential to improve the visual prognosis in ischemic CRVO. The finding that thrombolysis had a favorable outcome supports the hypothesis that specific subgroups of patients may benefit from this therapeutic approach. Further investigation will be required to definitively prove the effectiveness of fibrinolytic agents.

Adult↗

PubMed1999

Image analysis of implanted rigid and foldable intraocular lenses in human eyes using Scheimpflug photography.

We evaluated the quality of imaging posterior chamber intraocular lenses (PC IOL) by Scheimpflug photography. We took photographs of 190 rigid or foldable PC IOLs using the Scheimpflug system EAS-1000 from Nidek and provided digital image analysis. We found a good imaging of PC IOLs and the cristalline lens capsule, data obtained by digital image analysis were reliable and reproducible and Scheimpflug photography could be demonstrated as a sensitive tool to show any irregularities of IOL material. Thus, we found in foldable IOLs 'glistenings', which did not have any influence on functional results and we could distinguish them from lens damage. We propose to use Scheimpflug tests regularly for the examination of implanted new types of IOLs.

Humans↗

PubMed1998

[Comparative laser tyndallometry and fluorophotometry in anterior and posterior uveitis].

UNLABELLED: Recent studies have sought to quantify aqueous flare by laser flare measurement. An increase in aqueous flare caused by a rise of protein concentration was frequently found both in anterior and posterior segment disease. This has been interpreted as a break-down of the blood--aqueous barrier (BAB). By measuring the diffusion coefficient of the BAB compared to the aqueous flare value in patients with anterior and posterior uveitis, the extent to which the increase in flare value was related to a possible break down of the BAB was examined. PATIENTS: Thirty-nine normal eyes (23-78 years; 41.6 +/- 18.6), 18 eyes with anterior uveitis (iritis, iridocyclitis; 18-57 years; 35.2 +/- 12.4) and 29 eyes with posterior uveitis (chorioretinitis or retinochorioditis; 18-51 years; 31.7 +/- 10.5). The diffusion coefficient P(a) of the BAB was measured fluorophotometrically, while the flare value was quantified by laser flare measurement. RESULTS: Flare values (1/ms) were found to be significantly increased (p < 0.001) compared to normal eyes (4.6 +/- 1.7) both in anterior uveitis (20.9 +/- 8.5) and in posterior uveitis (17.4 +/- 8.3) but did not significantly differ between them (p = 0.43). The diffusion coefficient P(a) (10(-3)/min) of the BAB was not significantly different (p > 0.05) between normal eyes (0.5 +/- 0.2) and eyes with posterior uveitis (0.9 +/- 0.7), whereas it was significantly increased (p < 0.001) in anterior uveitis (6.5 +/- 5.4) compared to the other groups. CONCLUSIONS: (1) In posterior uveitis, an increased flare value is not necessarily correlated with a breakdown of the BAB; proteins may enter the aqueous from posterior. (2) Assessing the function of the BAB in posterior segment disease using laser measurement should be carried out with caution; if possible, permeability measurements of the BAB should be undertaken separately.

Adolescent↗

PubMed1998

[Capsular sack-fixed IOL implantation in pediatric cataract. Visual prognosis and complications].

BACKGROUND: The aim of the study was to evaluate results of visual acuity and binocularity and complications after cataract surgery with primary capsular bag-fixated IOL implantation in children. MATERIALS AND METHODS: Thirty-three children [mean age (+/- SEM) 6.9 +/- 2.9 years, range 3-12 years] accounting for 43 eyes, were examined before and after surgery (15 traumatic, 19 developmental, and 9 congenital cataracts, of the latter two groups 9 unilateral and 19 bilateral cataracts). RESULTS: All eyes had a best corrected postoperative visual acuity of 0.5 +/- 0.05. The postoperative visual acuity of the traumatic cataracts was 0.6 +/- 0.07, of the developmental cataracts 0.5 +/- 0.07, and of the congenital cataracts 0.2 +/- 0.05. Of the 43 eyes, 17 (40%) showed a best corrected visual acuity of 0.5 or better. There was a positive correlation between morphology (lamellar versus subcapsular opacification) and visual acuity (0.7 +/- 0.07 versus 0.5 +/- 0.05; P < 0.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (0.7 +/- 0.07 versus 0.2 +/- 0.05 P< 0.001) Stereopis was found postoperatively in 62% of the children. In one eye a capsular bag-fixated IOL implantation was not possible, and so the IOL was inserted in the sulcus. Four children presented with postoperative fibrin formation. Posterior capsule opacification occurred in 19% of the eyes in which a primary posterior capsulotomy had been performed. CONCLUSIONS: The prognosis of visual acuity and the results of stereopsis in children older than 3 years following capsular bag-fixated IOL implantation are very good. Both the intraoperative and postoperative complication rates were low.

Cataract↗

PubMed1998

[Correction of myopic astigmatism with the VISX 20/20 excimer laser. An overview of treatment outcome].

UNLABELLED: The advent of the excimer laser has brought about the potential for improved vision in many individuals with myopia and astigmatism. However, photoastigmatic refractive keratectomy (PARK) remains a matter of controversy. The purpose of our study was to determine the predictability of VISX 20/20 excimer laser photorefractive keratectomy in the treatment of myopic astigmatism. PATIENTS AND METHODS: Our study comprised 31 eyes of 22 patients with myopic astigmatism. All patients underwent treatment with a VISX 20/20 excimer laser and were followed up for 6 months. Complete 12-month follow-up data were available from 18 eyes. Park was performed in eyes with myopia between -1.5 and -10.0 D and with astigmatism between -0.5 and -5.5 D. Thus, the corresponding spherical equivalent ranged from -1.75 to -10.5 D. RESULTS: Six months postoperatively, 21/31 (62%) eyes were within +/- 1.0 D of the target refraction and 13/31 (42%) within +/- 0.5 D of the target refraction. In 13 of 15 eyes (87%) with myopia less than -6.0 D, an uncorrected visual acuity of at least 0.8 was noted. In eyes with myopia greater than -6.0 D, 9/16 (56%) showed an uncorrected visual acuity of at least 0.5. Six months after PARK, an increase of one line on the Snellen Visual Acuity Chart was observed in 8/31 (26%) and an increase of two lines was noted in eyes 3/31 (10%). One of 31 eyes (3%) showed an increase of three lines. A decrease in visual acuity of 1 line on the Snellen Visual Acuity Chart was found in 4/31 (13%), and in 3/31 eyes (10%) a decrease of 2-4 lines was noted. Overall, we observed a statistically significant reduction of astigmatism from 1.93 +/- 1.43 D to 0.93 +/- 0.63 D. Reduction of corneal astigmatism less than -1.25 D was not statistically significant. In eyes with astigmatism ranging from -1.25 to -2.5 D or greater than -2.75 D, a significant reduction of the mean astigmatism was noted. The postoperative regression of astigmatic correction was low. However, an axis shift of more than 15 degrees was found in 42%/35% of eyes by subjective refraction (miosis/cycloplegia) and in 33% in corneal topography. No central islands were noted. CONCLUSION: Photoastigmatic refractive keratectomy (PARK) constitutes a potential means of correcting myopic astigmatism. In eyes with astigmatism greater than -1.0 D a significant reduction of 60% of the mean astigmatism was noted. However, the considerable proportion of eyes with a postoperative axis shift greater than 15 degrees and a decrease in visual acuity of two or more lines indicates that further research is needed on excimer laser surgery to improve the reliability and safety.

Adult↗

PubMed1998

[Toxoplasmosis retinochorioiditis, a therapy comparison between spiramycin and pyrimethamine/sulfadiazine].

BACKGROUND: The treatment of toxoplasma retinochoroiditis with spiramycin is an alternative to sulfadiazine and pyrimethamine. The treatment with sulfadiazine is associated with multiple side effects. Sulfadiazine is contraindicated during pregnancy and breastfeeding period. Spiramycin has less side effects and is recommended during pregnancy and breastfeeding period. The efficacy of spiramycin in treatment of toxoplasma retinochoroiditis is still a matter of controversy. PATIENTS AND METHODS: In a retrospective study, side effects and outcome of therapy in 44 patients with toxoplasma retinochoroiditis treated with sulfadiazine and pyrimethamine (n = 30) or spiramycin (n = 14) were compared. We assessed duration of therapy and healing, ophthalmoscopic findings and observed side effects. RESULTS: The mean healing time in the group of spiramycin was 63.83 days in comparison to 88 days for the group of patients treated with sulfadiazine/pyrimethamine. The frequency of side effects was lower in the group treated with spiramycin. CONCLUSION: In comparison to a combined application of sulfadiazine and pyrimethamine the treatment with spiramycin alone requires a shorter duration of therapy and healing period. Additionally, side effects and contraindications appear to be less frequent. In view of these findings, spiramycin therapy must be considered as a promising approach in the treatment of toxoplasma retinochoroiditis.

Adult↗

PubMed1998

Fibrinolytic therapy with low-dose recombinant tissue plasminogen activator in retinal vein occlusion.

Fibrinolytic therapy aimed at early restoration of blood flow appears to be a promising therapeutic approach in haemorrhagic retinopathy. The risk of bleeding complications, a major problem with fibrinolysis, can be reduced by the use of low-dose thrombolytic regimens. In our study, 14 patients with ischaemic central (CRVO) or branch (BRVO) retinal vein occlusion who presented with severe visual loss and recent onset of symptoms were treated with a low dose (50 mg) of recombinant tissue plasminogen activator (rt-PA) and intravenous heparin. In 10 of 14 patients (7 CRVO, 3 BRVO), an increase in visual acuity of one line or more on the logarithmic visual acuity chart was noted and in 8 patients (6 CRVO, 2 BRVO) a reduction of areas of capillary non-perfusion was observed, suggesting that a restoration of retinal capillary blood flow can be achieved if fibrinolysis is initiated in the early phase of haemorrhagic retinopathy. In view of the poor prognosis in the natural course of haemorrhagic retinopathy and the potential haemorrhagic risk in fibrinolysis, the use of low-dose rt-PA appears to constitute an encouraging approach in the management of this disease.

Adult↗

PubMed1997

[Pars plana implantation of a ganciclovir drug carrier in patients with cytomegalovirus retinitis and AIDS. Indications, follow-up and postoperative complications].

UNLABELLED: We performed an open clinical trial to assess the safety and efficacy of a 1 microgram/h ganciclovir implant for the treatment of newly and pretreated cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS). PATIENTS AND METHODS: Thirty-two eyes (20 patients) received the ganciclovir intraocular device and were prospectively followed up from 30 to 365 days. We used a modified technique for fixation of the device in half of the patients. The modification improved the fixation of the implant with a two-hole technique in the strut. RESULTS: Thirty eyes showed stabilization of the retinitis over the time, but in two patients resistance against ganciclovir and other nucleoside analogue compounds developed. Postoperative complications included vitreous hemorrhage (n = 1), cataract (n = 1), and uveitis anterior (n = 1). Late retinal detachment was seen in five eyes (25%) at 30 to 60 days after implantation. Followup until 1 year after implantation did not show progression of CMV retinitis in 18 to 20 patients. All received antiviral CMV therapy to protect noninfected eyes and intestinum against CMV infection. CONCLUSIONS: The ganciclovir intraocular device seemed to be effective in most cases of CMV retinitis and offers a promising alternative for cytomegalovirus retinitis. Patients pretreated longer than 6 months with i.v. ganciclovir have to be carefully selected for implantation, because resistance against ganciclovir could be three times more likely than in i.v.-therapy naive patients.

AIDS-Related Opportunistic Infections↗

PubMed1997

Subretinal microsurgery with gradient index endoscopes.

State-of-the-art subretinal surgery involves a standard three-port pars plana entry, followed by an iatrogenic retinotomy to access the subretinal space. Subretinal manipulations through a small retinotomy are made possible by specially designed instruments. As the surgeon looks through the vitreous cavity, all subretinal maneuvers are obscured by the overlying retina. Consequently, the surgeon is operating 'blindly' and has to rely on 'feeling' rather than direct visualization. Micro-endoscopic viewing systems are the ideal solution for visualization during subretinal surgery. Until now, such endoscopes were either too large for intraocular use or lacked sufficient resolution, especially at a short working distance. Recently, a gradient index (GRIN) endoscope was developed (Insight Instruments, Inc., Lake Mary, Fla., USA) combining a small diameter (0.89 mm, 20 gauge) and incorporating excellent optical resolution, even at extremely close working distances. After ballooning a limited part of the retina without creating a retinal hole, the 20-gauge GRIN endoscope can be introduced into the subretinal space through the sclera and choroid, posterior to the pars plana. Surgical instruments can then be introduced into the subretinal space through a second neighboring sclerotomy. Thus, subretinal surgery can be performed under direct endoscopic control. As a result of direct visualization, the surgeon may perform certain surgical procedures with greater accuracy, i.e., subretinal neovascular membranes may be dissected meticulously from the neurosensory retina and retinal pigment epithelium, minimizing damage to both structures. The feeding choroidal vessel can be identified and directly coagulated, which is usually very difficult during conventional subretinal surgery. Endoscopic subretinal surgery is thus a significant improvement over conventional methods, avoiding the need for a retinotomy and increasing the safety and facility of the surgery itself.

Endoscopy↗