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Biomedical subjects

E Scherfig

Publications and source records attributed to E Scherfig.

At least 19 recordsLinked to original sources

[Cryotherapy of retinal prematurity in Denmark 1992-1996].

Retinopathy of prematurity (ROP) is a vasoproliferative disorder often met in infants of very preterm delivery. Lower stages usually regress spontaneously, but progression to so-called threshold-ROP should lead to anterior retinal ablation therapy, by cryopencil or laser. Fifty-three Danish infants born 1992-96 were evaluated in the University eye clinic of Rigshospitalet for the disease; 65 eyes of 36 infants had cryotherapy; eight infants developed severe bilateral visual handicap (22%). The reason for not giving cryotherapy to the remaining 17 was: too late referral in five, and ROP below threshold in 12; seven of the 17 later appeared in the (mandatory) national register for childhood visual handicap. Perusing these data the other way round, 15 of the registered 18 cases were thus known to us, while three had escaped referral. With reservation for the small numbers included, the national trend at present is an increasing annual number of subjects receiving retinal ablation therapy for ROP, and a decrease in severe visual impairment due to the disorder. Obviously all preterm infants at risk should be under early regular ophthalmic surveillance for ROP.

Child

Human retinal pigment epithelial cell-induced apoptosis in activated T cells.

PURPOSE: The immune privilege of the eye has been thought to be dependent on physical barriers and absence of lymphatic vessels. However, the immune privilege may also involve active immunologic processes, as recent studies have indicated. The purpose of the present study was to investigate whether human retinal pigment epithelial (RPE) cells can induce apoptosis in activated T cells. METHODS: Fas ligand (FasL) expression was detected by flow cytometry and immunohistochemistry. Cultured RPE cells were cocultured with T-cell lines and peripheral blood lymphocytes for 6 hours to 2 days. Induction of apoptosis was detected by 7-amino-actinomycin D and annexin V staining. RESULTS: Retinal pigment epithelial cells expressed FasL and induced apoptosis in activated Fas+ T cells. Blocking of Fas-FasL interaction with antibody strongly inhibited RPE-mediated T-cell apoptosis. Retinal pigment epithelial cells induced apoptosis in several activated T-cell populations and T-cell lines, including T-cell antigen receptor (TCR)-CD3-negative T-cell lines. In contrast, RPE cells induced little or no apoptosis in resting peripheral T cells. Major histocompatibility complex (MHC) class II monoclonal antibodies, which block alloactivation, had no inhibitory effect on RPE-mediated T-cell apoptotic responses in MHC class II-specific CD4+ T-cell lines. CONCLUSIONS: Retinal pigment epithelial cells express FasL and induce TCR-independent apoptosis in activated human T cells through Fas-FasL interaction. Retinal pigment epithelial cells may constitute an immunologic functional barrier against potentially harmful T cells.

Apoptosis

[Retinal detachment. The vitrectomy technique].

One hundred and ten eyes from 110 patients who in 1992 had undergone vitrectomy for regmatogenous retinal detachment were included in a retrospective study. Two year follow-up was obtained for 97 eyes. At the end of follow-up 45% of the eyes had complete anatomical success. Fifty-five percent had attachment of the macula. Anatomical success after a single operation was obtained in 33%. A visual acuity of more than 0.05 was obtained for 35% of the eyes at the end of follow-up. Eighty patients had a follow-up interview; of these 56% stated that the advantages of the operation outweighed the disadvantages.

Adolescent

[Retinal detachment. The scleral buckling technique].

Eighty-four eyes from 83 patients who in 1992 had undergone scleral buckling surgery for rhegmatogenous retinal detachment were included in a retrospective study. Two year follow-up was obtained for 72 eyes. At the end of follow-up 93% of the eyes had complete anatomical success. A visual acuity of 0.5 or more was obtained for 45% of the eyes at the end of follow-up. Sixty-three patients stated that the advantages of the operation outweighed the disadvantages.

Adolescent

Transvitreal retino-choroidal biopsy of suspected malignant lesions of the choroid. Follow-up of cases over 7 years.

The cases of transvitreal retino-choroidal (TVRC) biopsy from 1987 to 1994 were assembled in order to examine the efficiency, complications and risks to patients. Of 92 biopsies 91 had sufficient material for diagnosis. Eighty (87%) contained malignant tissue, whereas 10 cases were negative and two unsuccessful. Tumours of appropriate size were treated by brachytherapy. Twenty-three large tumours were enucleated primarily. Eight irradiated eyes had to be removed. In 31 cases, therefore, it was possible to examine the whole tumour for changes caused by the biopsy and to compare the typing of the biopsy with that of the whole tumour. In the irradiated eyes histologically viable tumour cells remained mostly in the inner part of the tumour. Scleral necrosis was not found. The technique used appears to be safe. Histological verification is highly recommended before any conservative therapy, inter alia to obtain true statistics of therapeutic results.

Adolescent

Differential diagnosis of choroidal melanomas and nevi using scanning laser ophthalmoscopical indocyanine green angiography.

Fluorescein angiography is one of several standard ancillary diagnostic techniques in the evaluation of suspected malignant choroidal melanoma. Indocyanine green choroidal angiography has improved visibility of the choroidal circulation in comparison with fluorescein angiography. Studies concerning the use of indocyanine green angiography in the differentiation between nevi and melanomas have been few and the results inconclusive. A case of a choroidal melanoma (verified by histopathological examination) and a nevus in the same eye is documented by fluorescein and indocyanine green choroidal angiography performed by scanning laser ophthalmoscopy. This modality may be considered in the evaluation of a suspected malignant choroidal melanoma.

Aged

Gas gangrene panophthalmitis. A case from Greenland.

A case of clostridium perfringens gas gangrene panophthalmitis developed after a penetrating eye injury. The affected eye became amaurotic, but the panophthalmitis was controlled by minimal surgical debridement and systemic antibiotic therapy with penicillin, fucidic acid and metronidazole. Elective enucleation was performed 15 days after the trauma for cosmetic reasons. The enucleated eye was examined histopathologically and showed massive retinal necrosis but no signs of bacteriae.

Anterior Chamber

Eye surgery in severe retinopathy of prematurity. Experience from the Copenhagen University Eye Clinic of Rigshospitalet 1986-91, with emphasis on cryotherapy.

Data concerning observation of 40 pre-term infants referred to the Copenhagen University eye clinic 1986-91 for evaluation of ROP, predominantly of advanced stages, have been analysed. Twenty-one eyes in 13 subjects underwent cryotherapy at stage 3 (-4), on day 50-172 after delivery (median 72 days). Out of 19 eyes available for follow-up 10 obtained good of fair function; nine eyes ended with no L. Four subjects with ROP stage 4-5 at referral underwent vitrectomy and one trabeculectomy, all in eyes where surgery on beforehand was considered palliative or 'mainly experimental'. No indication for therapy was recorded in 22 infants; they mainly appeared for evaluation rather late in the course of ROP, to have the feasibility of reconstructive anatomy considered. The mean age of the infant at first discovery of ROP was 55 days when only stage 1-2 was found, 63 days when stage 3, and 69 days when at least stage 4 was described. Altogether, the range was 30-100 days. The inhomogeneity of the data is stressed. Though the possible benefit of earlier recognition cannot be proven, the investigation clearly indicates the need of uniform observation schedules nationwide and clearer indications for referral to the vitreo-retinal department.

Child, Preschool

An unusual ophthalmic tumour in a 5-year-old boy.

A rare tumour in a 5-year-old boy is presented and discussed. In time and location the story had two parts (Fig. 1): 1) a conjunctival granuloma at the nasal limbus of the right eye was surgically removed. 2) a few months later a huge lesion presented in the posterior segment of the same eye. Was it an ocular tumour with extension to the orbit or an orbital process with impression or invasion of the eye? Repeated surgical biopsies have indicated nodular scleritis of the posterior eye segment as the definitive diagnosis.

Child, Preschool

Transvitreal retinochoroidal biopsy.

Biopsies from retina and/or choroid were performed through a transvitreal approach in 14 patients during the 2-year period 1984-1986. A 20-gauge fine needle was used. The transvitreal approach was chosen because exact location of the biopsy could be documented by video recording and/or by photography. The needle was guided either by a stereotactic micromanipulator or by hand. Immediately after biopsy laser burns were placed around the biopsy hole. Light microscopical and, in selected cases, transmission electron microscopical examination of the material obtained showed malignant melanoma, choroidal haemorrhage, leukaemic infiltration of the choroid, intraretinal fibrosis in detached retina, atrophic retina after vasculitis and malignant lymphoma of the uvea. More than 2 years after biopsy, no retinal detachment due to the biopsy or any tumour-seeding has been observed. Two cases of vitreous haemorrhage cleared spontaneously. No visual impairment was related to the biopsies.

Adolescent

Treatment of age-related macular degeneration by laser photocoagulation. Visual results 2-8 weeks and 2-4 years after initial laser treatment.

Laser treatment with blue-green argon, green argon and/or krypton red was performed on 578 eyes in 443 patients with neovascular age-related macular degeneration (AMD). The visual acuity was examined in all eyes 2 to 8 weeks after initial treatment and in 204 eyes in 167 patients 2 to 4 years after initial treatment. The short term results were as follow: 91/578 eyes (16%) had improved (greater than or equal to 2 lines on Snellen's charge or equivalent steps), 445/578 eyes (77%) remained unchanged and 42/578 eyes (7%) had deteriorated visual acuity (greater than or equal to 2 lines on Snellen's chart or equivalent steps). The reduction in visual acuity, may in about half of the 42 eyes be caused by too intensive laser application in the beginning of this study in 1983 and 1984 where treatment was applied with blue-green argon, which has now been abandoned. In the group with an observation time of 2 to 4 years, 42/204 eyes (21%) had improved, 119/204 eyes (58%) remained unchanged and 43/204 eyes (21%) had a deteriorated visual acuity. In the 204 eyes the subretinal neovascular lesion(s) were located extrafoveally in 52 eyes, juxtafoveally in 114 eyes and subfoveally in 38 eyes. It is to be pointed out, that even patients with a pre-laser visual acuity of 6/60 or worse obtained an improvement of visual acuity in 12/27 eyes. About 40% of the eyes needed re-treatment from 1 to 8 times. It is unknown whether the obtained results are to be considered marginal or more substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors

Isolated leukemic choroidal relapse in a child with acute lymphoblastic leukemia one year off therapy, diagnosed through transvitreal retino-choroidal biopsy.

A serous retinal detachment and choroidal hemorrhagic infiltration developed in a 17-year-old girl with acute lymphoblastic leukemia one year after cessation of therapy without concurrent bone marrow (BM) or central nervous system relapse. A choroidal biopsy through a sclerotomy with simultaneous release of subretinal fluid revealed no malignant cells. Accordingly, she was treated with prednisone, topical corticosteroid and atropine with normalisation of vision and clinical findings. Five months later the retinal detachment and choroidal infiltration recurred. In order to re-attach the retina once more and obtain a representative choroidal biopsy, a pars plana vitrectomy followed by a retinotomy with removal of subretinal tissue was done revealing leukemic infiltration of the choroid. Simultaneously a BM relapse was diagnosed.

Adolescent

Trilateral malignant lymphoma: primary malignant B-cell lymphoma of the eyes and brain. Diagnosis by transvitreal retinochoroidal biopsy.

A 59-year-old woman with therapy-resistant bilateral involvement of posterior uvea and retina of some months' duration was examined. Diagnostic vitrectomy was inconclusive, but subsequent transvitreal retinochoroidal biopsy gave ample material for the immunohistopathological diagnosis of a malignant B cell lymphoma. Despite systemic and intrathecal cytostatics and ocular X-ray therapy, central nervous system involvement was observed 2 months later. The ocular lesions regressed after treatment and have not recurred.

B-Lymphocytes

Treatment of senile macular degeneration by laser photocoagulation.

117 eyes of 103 patients among 476 patients with senile macular degeneration fulfilled a criterion for treatment with blue-green Argon (n = 20 eyes), green Argon (n = 15 eyes) Krypton-red (n = 58 eyes) and combined treatment (24 eyes). In 50 consecutive treated eyes (= 50 patients) with an observation time exceeding one year a visual acuity greater than or equal to 6/18 was preserved in 34 eyes. This post-laser course differs from the spontaneous course of the disease reported in literature indicating that about 70% of eyes with perifoveal neovascular lesion will develop legal blindness within 2 years. Even though the spontaneous course in this material is unknown, and the comparability to patient material in literature is questionable, it might be concluded that a considerable part of the patients with senile macular degeneration with neovascular lesions might benefit from laser-treatment.

Aged

Flash visual evoked potential as a prognostic factor for vitreous operations in diabetic eyes.

In 116 diabetic eyes scheduled for vitreous surgery, the visual evoked potential (VEP) after flash stimulation was recorded prior to surgery. Latencies of the flash evoked potentials show a distribution suggestive of a Gaussian curve with an abnormal extension. Dividing the material into two groups based on a latency shorter or longer than 100 milliseconds revealed a highly significant difference in the visual improvement following surgery between patients with a short and patients with a long latency (P less than 0.001). With a latency longer than 100 millisec. most patients showed no visual change after operation, and among the few who did the change, consisted more often in visual reduction than improvement. Additional investigations in the study reveal that it is likely that the prolonged latency of the flash VEP is due to pathology of the retina or visual pathways.

Diabetic Retinopathy

Visual evoked potential as a prognostic factor for vitrectomy in diabetic eyes.

To determine whether or not the electrophysiological status of the eye can give information as to the result of vitreous surgery, the visual evoked potential to flash stimulation was measured prior to vitreous surgery. Seventy-four eyes were submitted to surgery. Latencies of flash evoked potentials showed a distribution suggestive of a Gaussian curve with an abnormal extension. Dividing the material into 2 groups based on a latency longer or shorter than 100 millisec revealed a highly significant difference in visual improvement after surgery between patients with long latency and patients with short latency (P less than 0.001). With a latency longer than 100 millisec the patient has an almost equal chance of visual improvement or visual reduction by surgery. The frequency of operative complications was twice as high in patients with latency longer than 100 millisec compared to patients with a latency shorter than 100 millisec.

Diabetic Retinopathy