Biomedical subjects

D Pauleikhoff

Publications and source records attributed to D Pauleikhoff.

At least 55 records · Page 3Linked to original sources

PubMed1994

Histopathologic findings in large uveal melanomas after brachytherapy with iodine 125 ophthalmic plaques.

Eyes of 25 patients among a series of 100 consecutive patients who underwent iodine 125 brachytherapy for extremely large uveal melanomas measuring more than 7-8 mm in height had to be enucleated after an average interval of 1.4 years. The dose delivered to the tumor apex was 120-150 Gy. Indications for enucleation were most frequently radiation-induced alterations in the anterior segment with loss of fundus visibility. Eight cases showed insufficient tumor regression, and two cases were suspicious for growth. Microscopically complete tumor necrosis was found in ten eyes. Six cases were classified as "uncertain tumor regression." Apparently "viable" tumor cells were seen in nine eyes. This group of eyes showed a significantly shorter interval between therapy and enucleation. One specimen showed extraocular tumor extension. Brachytherapy with iodine 125 may result in complete tumor necrosis, even in large uveal melanomas. The morphologic extent of tumor necrosis seems to be positively correlated with the interval after therapy.

Aged↗

PubMed1994

[Biochemical and histochemical analysis of age related lipid deposits in Bruch's membrane].

In histochemical studies the age-related deposition of different lipids in Bruch's membrane has been seen. This is important for the pathogeneses of age-related macular degeneration due to changes in diffusion characteristics. Because the specificity of histochemical results is limited, a correlation of histochemical lipid analysis with biochemical methods was performed. The macular Bruch's membrane of 27 donors (age 1-97 years) was analyzed. The results of this analysis demonstrated that the increasing histochemical staining for lipids in Bruch's membrane corresponded with an increasing amount of lipids extracted from Bruch's membrane in biochemical analysis. This lipid deposition progressed exponentially with age. However, a large variation in the type of lipid deposited could be observed, with predominant deposition of phospholipids in some eyes and of neutral lipids in others. Furthermore, the phospholipids extracted were differentiated into 50% phosphatidylcholine, 30% phosphatidylethanolamine and 20% phosphatidylinositol and phosphatidylserin. The deposition of lipids, especially neutral lipids, in Bruch's membrane may change its diffusion characteristics. This appears to be important for the pathogenesis of age-related pigment epithelium detachments. The composition of the phospholipids extracted from Bruch's membrane supports, furthermore, the concept that the material deposited is the result of metabolic limitations in the degradation of photoreceptor outer segment material.

Adolescent↗

PubMed1994

[Focal hemorrhagic chorioretinopathy. Clinical differentiation and visual prognosis].

Macular choroidal neovascularization in young adults without any known underlying diseases is referred to under the general term of focal hemorrhagic chorioretinopathy. In endemic areas of the USA an infection with Histoplasma capsulatum is thought to be the causative agent, but in Europe the pathogenesis of this condition is unknown. With the aim of finding how European patients with this disease might be detected by clinical examination and to estimate the prognosis for sight in the affected eye and the fellow eye, a follow-up examination (follow up 1-24 years, mean 7 years) of 88 patients (age 15-48 years, mean 33.6 years) was undertaken. Most patients were between 20 and 40 years of age and mildly myopic. The number of chorioatrophic scars associated with the choroidal neovascularization in particular varied widely between patients. Therefore, this characteristic is most useful for clinical differentiation between patients. In contrast, the development of an atrophic conus at the optic disc was predominantly correlated with worsening myopia. One-third of all patients experienced decreased vision during follow-up. In two-thirds of the group, however, the final vision was still 0.1 or better. The initial visual prognosis in the eye affected was predominantly dependent upon the location of the neovascular membrane in relation to the fovea and therefore upon the possibility of photocoagulation treatment. Long-term follow up in these patients revealed visual acuity decreased further only in eyes with increasing atrophy of the retinal pigment epithelium surrounding the disciform or laser scar. One-fifth of the patients also developed choroidal neovascularization in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Correlation between lipids extracted from Bruch's membrane and age.

BACKGROUND: There is increasing circumstantial evidence that the chemical composition of the deposits in Bruch's membrane influences the clinical outcome in age-related macular disease. In particular, it has been postulated that deposition of neutral lipids in Bruch's membrane may cause hydrophobicity and predispose to detachment of the retinal pigment epithelium and cause functional loss. METHODS: Analysis of the lipid extracted from Bruch's membrane of eye bank eyes from donors of different ages has been undertaken using thin layer and gas chromatography. No clinical information was available concerning any previous eye disease. RESULTS: It is shown that the lipid extracted increases with the age of the donor, and that the total quantity and ratio of neutral fats to phospholipids varies widely from one specimen to another from donors older than 60 years of age. The ratios of the different phospholipids imply that they are not derived from blood. CONCLUSION: The results are compatible with the concept of hydrophobicity developing with age in Bruch's membrane.

Adolescent↗

PubMed1993

[Therapy of cystoid diffuse macular edema after uveitis and cataract surgery with the carbonic anhydrase inhibitor acetazolamide (Diamox)].

BACKGROUND: Observations made by Cox, Bird et al. (1988), who first used acetazolamide (Diamox) for treatment of macular edema of various origin in a higher number of patients, let assume a positive effect of this therapy on fluid accumulation specifically inside the inner retinal layers. Based on these studies 15 patients (20 eyes) with cystoid or cystoid-diffuse macular edema were treated with acetazolamide in a pilot-study. MATERIALS AND METHODS: Eleven patients (fifteen eyes) had postuveitic macular edema, four other patients (five eyes) had cystoid edema following cataract surgery. Patients with additional diseases causing macular edema of retinal vascular origin were excluded. The initial dose was 500 mg daily. In one patient responding to therapy the dose was gradually reduced after three weeks down to a minimum of 125 mg every second day. For evaluation of the therapeutical results fluorescein angiography and visual acuity were taken into account. RESULTS: Eleven patients (fourteen out of twenty eyes) showed a distinct therapeutical effect with decrease of macular edema in repeatedly controlled fluorescein angiography. All these patients had a subjective improvement of vision which correlated with an increase of visual acuity in exactly one half of all patients. Therapy was stopped, when the macular edema had still appeared unchanged in angiography after three weeks or when--in spite of fluid reduction in angiography--no improvement of visual acuity could be obtained in the next two months. The maintenance dose showed large individual variation with a minimum of 125 mg every second day and a maximum of 250 mg per day. Attempts to stop therapy resulted in a early reappearance of the edema of original extension with corresponding deterioration of visual acuity and sensitivity of central visual field. In a few patients even the reduction of the dose below the individual maintenance dose could be demonstrated angiographically. All patients were under continuous internal medical control, permanent side-effects of acetazolamide with the doses used in this study were not seen. CONCLUSIONS: The results show that acetazolamide is a basically effective agent against cystoid macular edema and that a therapeutical trial is justified based on the treatment criteria of this study. The factors limiting the therapeutical effect of acetazolamide cannot yet be evaluated on the basis of the small amount of patients in this pilot-study. Considering the patient data a time factor depending on the period between onset of edema-related symptoms and begin of treatment is likely. In the group of unsuccessfully treated cases we had the patients with the longest period of preexisting edema (more than one year) of the study.

Acetazolamide↗

PubMed1993

[Ocular complications of long-term survival of bone marrow transplantation. A prospective study with 21 patients].

BACKGROUND: Survival time after bone marrow transplantation is getting increasingly longer and secondary ocular complications need to be identified and deserve more attention as so far. PATIENTS AND METHODS: We evaluated the ocular complications of 21 not selected, long-term survivors after bone marrow transplantation in a prospective study. The ophthalmological examination consisted of visual acuity, slit lamp examination, tonometry and ophthalmoscopy. It included also determination of tears break-up-time, Jones-test, rose bengal staining and impression cytology of the conjunctiva. RESULTS: The major ocular complication was the development of a keratoconjunctivitis sicca syndrome in 14 of the 21 patients. This complication is probably due to the total-body irradiation in the preparative before and to the development of a chronic Graft-versus-Host-Disease after transplantation. 13 of the 21 patients developed a cataract. This might be a result of the total-body irradiation and a prolonged high steroid intake. CONCLUSION: The frequency and severity of ocular complications suggest that detailed ocular examinations should be performed routinely in patients after bone marrow transplantation.

Anemia, Aplastic↗

PubMed1992

Severe visual loss associated with retinal telangiectasis and facioscapulohumeral muscular dystrophy.

Facioscapulohumeral (FSH) muscular dystrophy is known to be associated with retinal telangiectasis. However, there are only few reports of severe visual loss due to exudative complications, so the risk to vision has not been established. Because of the possible therapeutic implications, we have described two cases of young girls who developed FSH muscular dystrophy and exudative retinal detachment due to telangiectasis. In the first patient, the severity of the disease precluded visual recovery despite extensive photo- and cryotherapy. In the other, visual acuity in both affected eyes was retained after treatment. Fundus examinations in young children at risk of having the gene for FSH muscular dystrophy may be justified so that retinal vascular disease can be detected before it becomes untreatable.

Blindness↗

PubMed1992

Correlation between biochemical composition and fluorescein binding of deposits in Bruch's membrane.

PURPOSE: The fluorescence of drusen during fluorescein angiography is believed to have important prognostic and pathogenetic implications in age-related maculopathy. It is believed that deposits containing predominantly neutral lipids would be hydrophobic, resulting in hypofluorescence on fluorescein angiography, while the presence of polar phospholipids would be indicated clinically by hyperfluorescence because of its hydrophilic properties. To identify the potential determinants of fluorescence of drusen and Bruch's membrane, a series of macular specimens from human donors older than 60 years of age was examined. No clinical information was available concerning any previous eye disease. METHODS: In vitro fluorescein binding was recorded microscopically, and the presence of fibronectin was sought by immunohistochemistry. The results were correlated with the proportions of phospholipids to neutral lipids identified by histochemical and biochemical studies. RESULTS: It was found that high content of neutral fats was associated with lack of both fluorescein binding and fibronectin, and, conversely, in those specimens with high proportions of phospholipids, fluorescein binding was strong and fibronectin was present. CONCLUSIONS: These observations support the central hypothesis concerning biophysical changes in Bruch's membrane with age and the potential importance of fluorescein angiography in the characterization of Bruch's membrane deposits.

Aged↗

PubMed1992

[Drusen in Bruch's membrane. Their significance for the pathogenesis and therapy of age-associated macular degeneration].

The drusen found in Bruch's membrane represent precursors for the development of age-related macular degeneration. The pathogenetic concepts are summarized: 1. As a result of aging changes in the metabolism of the pigment epithelium with age, the normal structure of Bruch's membrane is destroyed. This process is associated with lipid accumulation and the development of drusen. The lipids deposited are predominantly phospholipids or neutral lipids. 2. The clinical appearance of drusen can also vary from one person to another, but individually a significant symmetry of drusen characteristics can be seen, demonstrating that drusen are the results of specific metabolic dysfunctions rather than non-specific aging products. 3. The development of specific forms of age-related macular degeneration corresponds with different drusen. Larger, more confluent and hypofluorescent drusen are associated with the development of pigment epithelium detachments. In eyes with smaller, scattered and hyperfluorescent drusen, choroidal neovascularizations are more likely. 4. Histochemically, larger, hypofluorescent drusen contain predominantly neutral lipids. In contrast, smaller, hyperfluorescent drusen consist predominantly of phospholipids. 5. The accumulation of neutral lipids in Bruch's membrane is therefore associated with Pigment epithelium detachments. These apolar lipids may produce a hydrophobic barrier in Bruch's membrane for the water transport from the retina towards the choroid. A pigment epithelium detachment can develop. 6. The deposition of polar phospholipids predisposes to the development of choroidal neovascularization. These lipids in association with the changed structure of Bruch's membrane may induce an inflammation--like reaction, resulting in the in-growth of choroidal capillaries under the pigment epithelium. The analysis of the relationship between subclinical aging changes in Bruch's membrane and different forms of age-related macular degeneration may help to identify specific risk factors and to predict the future outcome in individual eyes. This may result in differentiated treatment concepts adapted to the specific aging changes in each person.

Adolescent↗

PubMed1992

Macular disease in an elderly population.

In order to obtain more accurate information concerning the prevalence of macular diseases in an elderly population, a clinical study was undertaken on a sample of 430 members of the general population over the age of 65 years in London. Degenerative age-related macular changes were clinically visible in about 25%, and 2.8% had a lesion causing loss of visual acuity due to macular disease. Age was the only risk factor identified for age-related changes. No correlation was identified with the prevalence of hypertension, smoking, or diabetes mellitus between groups. In addition, symmetry was shown in the number of drusen, as well as their size, density and fluorescence in the central and peripheral areas between the eyes of affected subjects. The prevalence data from this study represent a baseline for the interpretation of hospital-based data and for the planning of health care.

Aged↗

PubMed1992

[The Bruch membrane and choroid. Angiography and functional characteristics in age-related changes].

Age-related changes in the retinal pigment epithelium and Bruch's membrane are believed to play an important role in the pathogenesis of age-related macular degeneration. Ophthalmoscopically visible drusen in the macular area may precede the complications causing visual loss. In addition to these localized depositions of debris in Bruch's membrane, histological methods could demonstrate linear deposits in Bruch's membrane which may also profoundly influence the development of complicated macular aging changes. It is difficult to identify linear deposits clinically, but as an indirect criterion for diffuse thickening and linear deposits in Bruch's membrane regression of the choriocapillaris with consequent prolongation of the choroidal filling phase in fluorescein angiography is suggested. This feature was observed in 26% of elderly patient. In association with these areas of regressed choroidal capillaries, loss of visual function was found in fine matrix perimetry.

Aged↗

PubMed1992

Functional loss in age-related Bruch's membrane change with choroidal perfusion defect.

During a prospective study of age-related macular degeneration, evidence of diffuse Bruch's membrane disease was sought using fluorescein angiographic evidence of a prolonged choroidal filling phase. Dark-adapted static perimetry was done on eight eyes with this angiographic sign and on six eyes with a similar number of drusen but no manifest choroidal perfusion abnormality. Scotopic threshold was measured using the Humphrey automated perimeter and fine matrix mapping. In eyes without delayed choroidal perfusion, no discrete areas of increased threshold were found compared with the background sensitivity. By contrast, in seven of the eight eyes with fluorescein angiographic evidence of prolonged choroidal filling, discrete areas of scotopic threshold elevation (up to 3.4 log units) were recorded; these corresponded closely to regions of choroidal perfusion abnormality. It was postulated that diffuse deposits of abnormal material might account for both the perfusion abnormality and functional loss by acting as a diffusion barrier between the choriocapillaris and the retinal pigment epithelium.

Aged↗

PubMed1991

[Indications for coagulation in diabetic maculopathy].

Macular changes of 333 eyes of 266 diabetic patients were analized regarding number of microaneurysms, area of intraretinal lipids and hermorrhages and the amount of leckage and capillary occlusion in fluorescein angiography. The changes were observed in a central and peripheral area centered around the fovea. The distribution of the changes observed were correlated with the visual acuity of the patients. Only the number of peripheral microaneurysms and the presence of foveal intraretinal edema correlated with a reduction in visual acuity. These parameters are therefore clinical indicators for the severity of diabetic maculopathy. Regarding the visual acuity after a minimal follow up of six months the presence of foveal intraretinal edema was the most important factor with a high risk of short term visual loss. The presence of fovealmacular edema might therefore be the most important indicator for macular photocoagulation treatment.

Adolescent↗

PubMed1991

Arteriovenous communications of the retina during a 17-year follow-up.

Arteriovenous communications of the retina are rare developmental malformations considered to have a relatively stationary appearance. We observed a young girl with an arteriovenous malformation over a period of 17 years. Episodes of spontaneous regression, marked dilatation, and elongation of previously normal vessels are described.

Arteriovenous Malformations↗

PubMed1990

Choroidal perfusion abnormality with age-related Bruch's membrane change.

Observation of patients with Sorsby's fundus dystrophy has shown that a prolonged choroidal filling phase on fluorescein angiography may indicate the presence of diffuse thickening of Bruch's membrane. We analyzed fluorescein angiography transit photographs in 100 eyes of 100 consecutive patients with age-related changes at the level of Bruch's membrane. Of these, 26 eyes had evidence of a prolonged choroidal filling phase during the initial dye transit. We suggest that this may represent a clinical correlate of diffuse thickening of Bruch's membrane, and that the two features are causally related.

Aged↗

PubMed1990

Drusen as risk factors in age-related macular disease.

In a study of 150 consecutive patients with age-related macular disease and unilateral visual loss, the drusen in the better eye were analyzed for size, number, density, and fluorescein angiographic appearance, and these characteristics were compared with the type of the lesion causing visual loss in the contralateral eye. In the fellow eye of an eye with avascular detachment of the retinal pigment epithelium, the drusen were more densely packed, larger, and less fluorescent than in the fellow eye of an eye with primary neovascularization. The characteristics of drusen in fellow eyes of those eyes with pigment epithelial detachments and evidence of subpigment epithelial new vessels were intermediate between the other two groups. Because there is significant symmetry of drusen between fellow eyes, these data imply that the characteristics of drusen are important in the determination of the form of the lesion complicating age-related macular disease.

Aged↗

PubMed1990

Bilaterality of drusen.

The characteristics of drusen in 81 patients with bilateral drusen as a manifestation of age related disease were analysed for symmetry between the two eyes. It was found that there was close concordance with respect to drusen size, number, density, and fluorescence which was greater than would have been expected by chance alone. This finding implies that drusen may result from metabolic malfunction specific to the patient rather than the non-specific result of aging.

Aged↗

PubMed1990

Aging changes in Bruch's membrane. A histochemical and morphologic study.

Using histochemical staining techniques and electron microscopy, the authors have examined the histochemical properties and ultrastructure of Bruch's membrane in 30 human eyes with an age range of 1 to 95 years. The results analyzed in three age groups (0-30 years, 31-60 years, and older than 60 years) show that there is a progressive accumulation of lipids in Bruch's membrane with relation to age. Differences were found in the specific types of lipids in individual eyes. Five eyes stained for neutral lipids alone, four stained predominantly for phospholipids, and nine stained intensely for both neutral lipids and phospholipids. The deposits were associated with the progressive destruction of the native architecture of Bruch's membrane but no correlation was identified between specific inclusions in Bruch's membrane with a particular lipid. These results are significant to age-related macular disease (ARMD), and the lipid rich barrier in Bruch's membrane is implicated as a cause of photoreceptor dysfunction and pigment epithelial detachment.

Adolescent↗