Tricuspid papillary fibroelastoma causing syncopal episodes.
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Aged↗
Biomedical subjects
G E Lang
Publications and source records attributed to G E Lang.
Effect of cataract extraction with intraocular lens implantation on ocular hemodynamics.
PURPOSE: To investigate the effect of cataract extraction on ocular hemodynamics. SETTING: University Eye Clinic of Ulm, Germany. METHODS: In 51 consecutive patients assigned for cataract surgery, pulse amplitude, pulse volume, and pulsatile ocular blood flow were measured 1 day before and 3 days and 12 months after cataract extraction using an ocular blood flow tonograph. Statistical analysis was performed with Student's t-test and Wilcoxon signed-rank test. RESULTS: In the study eyes, 3 days after cataract surgery pulse amplitude, pulse volume, and pulsatile ocular blood flow had decreased from 2.5 to 2.1 mm Hg (P = .0014), 5.0 to 4.4 microliters (P = .0059), and 836.2 to 728.0 microliters/min (P = .0017), respectively. No statistically significant change between preoperative and 3 day postoperative measurements occurred in the fellow eyes. There was no significant difference in systemic blood pressure, heart rate, or IOP in study and fellow eyes before and 3 days after cataract surgery. The early reduction of pulse amplitude, pulse volume, and pulsatile ocular blood flow in the study eyes was not present 1 year postoperatively. CONCLUSION: Uncomplicated cataract extraction is associated with a temporary ipsilateral impairment of ocular hemodynamics. A neural mechanism triggered by cataract extraction may be involved in these temporary changes.
Adult↗
Xanthomonas maltophilia keratitis associated with contact lenses.
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Adult↗
Metastatic adenocarcinoma to the retina in a patient with Muir-Torre syndrome.
PURPOSE/METHODS: A 74-year-old woman had multiple tumors including a retinal mass. Her medical history included cutaneous sebaceous adenomas, adenocarcinoma of the breast, and colonic adenocarcinoma. Her involved eye became painful and was enucleated. RESULTS/CONCLUSIONS: Examination of the enucleated eye disclosed metastatic adenocarcinoma to the retina with retinal detachment. The patient described has a retinal metastasis of an unknown primary tumor site with Muir-Torre syndrome, characterized by an association of a sebaceous gland tumor with an internal malignancy.
Adenocarcinoma↗
[Juvenile xanthogranuloma of the corneoscleral limbus: report of a patient and review of the literature].
BACKGROUND: Juvenile xanthogranuloma is an uncommon benign skin disease primarily affecting infants and young children. Ocular involvement is rare and most often affecting the iris. Isolated xanthogranulomas of the corneoscleral limbus are reported in the literature in only a few patients. HISTORY AND FINDINGS: A 10-year-old boy presented in October 1993 with a yellow solid tumor at the limbus of his left eye. The other ocular and extraocular structures were normal. Furthermore, he showed a preauricular nodular skin lesion. THERAPY AND OUTCOME: We suspected a dermoid of the corneoscleral limbus and performed an excision of the tumor. Histological examination revealed a juvenile xanthogranuloma. The tumor had regrown to its original size 2 months after excision. Treatment with topical corticosteroids resulted in an acceptable but incomplete regression of the tumor. CONCLUSION: Juvenile Xanthogranulomas of the corneoscleral limbus are rare tumors. The majority of previously reported cases showed a recurrence of the tumor at the original site after simple excision. In the case of unsuccessful therapy with topical corticosteroids a lamellar graft is recommended.
Child↗
[Ocular findings in Desferal therapy].
Desferrioxamine (DFO) is the most important drug in the treatment of thalassemia major and other hematological diseases requiring regular transfusion. It eliminates excessive ferritin by building up chelate complexes. Different mechanisms of possible DFO toxicity are induction of oxidation, damage of the blood-retina barrier, or reduction in other metalloions (Cu2+, Zn2+). The objective of the present study was to evaluate the ocular side effects of DFO treatment. We prospectively examined 17 patients aged 5 to 25 years, all of them treated with DFO. Visual acuity, pupillary reaction, anterior segment, lens and fundus were checked. If possible, visual fields, color vision, dark adaptation, stereoscopic vision, and contrast sensitivity were investigated. Lens opacities were found in 41% (7/17), changes in the retinal pigment epithelium in 35% (6/17), tortuosity of retinal vessels in 24% (4/17), dilation and sheathing of the retinal vessels in 18% (3/17), defects in color vision in 29% (5/17), and abnormal dark adaptation in 18% (3/17) of the patients. The oculotoxicity of DFO is dose-dependent. Major side effects like depression of the visual acuity are partially reversible after discontinuing the therapy. Regular ophthalmological check-ups are therefore necessary.
Adolescent↗
[Results of perifoveal argon laser coagulation of subfoveal choroid neovascularization in age related macular degeneration].
BACKGROUND: The treatment of patients with subfoveal choroidal neovascular membrane in age-related macular degeneration is unsatisfactory because only a limited number of patients are eligible. The aim of this study was to prospectively evaluate a new perifoveal treatment technique in patients with subfoveal choroidal neovascular membrane. METHODS: Between April 1992 and January 1994, 385 patients underwent clinical examination and fluorescein angiography. Eligibility criteria were met by 21 (5.5%) patients (22 eyes): well or poorly defined subfoveal choroidal neovascular membrane (< or = 3.5 disc diameters), without fibrosis, with visual acuity < or = 0.25. Visual acuity, morphological findings and complications were studied. The follow-up period was 12-32 months. RESULTS: The visual acuity before laser treatment ranged from counting fingers up to 0.25 (median 0.06). At the end of the follow-up (median 18 months) 28% (6/21) of patients showed a better visual acuity, whereas 44% (9/21) were unchanged and 28% (6/21) had deteriorated compared to visual acuity before treatment. In 71% (15/21) of eyes, resolution of the choroidal neovascular membrane was achieved with development of an atrophic laser scar. CONCLUSION: The visual outcome and the morphological findings after perifoveal laser treatment of subfoveal choroidal neovascular membrane in age-related macular degeneration show it to be an alternative method of treatment with favourable results. Due to inclusion criteria it is suitable only for a limited number of patients.
Aged↗
Severe occlusive retinal periphlebitis with vitreous hemorrhage in multiple sclerosis.
Severe ocular complications in multiple sclerosis are rare. A 43-year-old patient had a history of diplopia episodes and optic neuritis in the right eye between 1979 and 1980. In 1984, multiple sclerosis had been diagnosed. The patient presented with visual deterioration in the right eye in 1992. Ophthalmoscopy and fluorescein angiography showed severe occlusive retinal periphlebitis with diffuse retinal hemorrhages and large areas of nonperfusion. At the time of presentation the patient was in general good health and presented no neurological sign. Examinations for other causes of periphlebitis were negative. Although treatment with laser therapy and corticosteroids was initiated, the patient developed recurrent vitreous hemorrhages that required pars plana vitrectomy. In 1993 the patient suffered from a general deterioration of the disease course and was treated with systemic immunosuppressive medication. Vitreous hemorrhage is a rare complication of multiple sclerosis.
Adult↗
[Corneal ulcer in chronic graft-versus-host disease: treatment with collagen shields].
BACKGROUND: After bone marrow transplantation various ocular diseases have been described. Ocular involvement is very common in patients with chronic Graft-versus-Host Disease (GvHD). These patients show clinical and histological evidence of a dry-eye condition in 60-100 per cent. A severe complication is the development of a corneal ulcer with possible corneal perforation. Two patients with a severe dry-eye condition and development of corneal stroma ulceration are described. The corneal ulcers healed after treatment with collagen-shield. HISTORY AND SIGNS: In a 13-year-old boy an allogeneic bone marrow transplantation was performed in April 1989 because of Fanconi's anemia. In November 1989 a severe dry-eye condition occurred due to GvHD with skin, liver, and gastrointestinal tract manifestation. In April 1991 he presented with corneal stroma ulceration of the right eye. In a 24-year-old patient an allogeneic bone marrow transplantation was performed because of chronic myeloid leukemia in August 1989. In December 1989 he developed dry-eye condition due to GvHD with skin, mucosa and liver involvement. In December 1991 a corneal ulcer of the left eye occurred. THERAPY AND OUTCOME: Repeated conjunctival and corneal smears were negative. Local antibiotic and antiviral treatment showed no effect. Corneal ulcers deteriorated progressively with corneal thinning. Both patients were therefore treated with daily collagen-shields and hourly polyvinyl-pyrrolidon eye-drops resulting in healing of the corneal ulcer within 3 and 2 weeks respectively. CONCLUSION: Treatment of corneal stromal ulceration in dry eye condition caused by chronic GvHD is difficult. In noninfectious ulcers daily application of collagen-shields and hourly artificial tears may prevent severe ocular complications like corneal perforation.
Adolescent↗
[Results of laser coagulation of retinal branch vein occlusions].
BACKGROUND: The benefit of laser treatment in patients with branch retinal vein occlusion (BRVO) is established in the literature. We investigated the relationship of morphological and fluorescein angiographic findings with the results of laser treatment. PATIENTS AND METHODS: Of 211 examined patients with BRVO argon-laser coagulation was performed in 121 (57%). Laser treatment was done in all patients with preretinal neovascularization and in patients with macular edema 3 months or more after the onset of occlusion with visual acuity < or = 20/40. Follow up examinations were performed in 3 months intervals with the last examination 11.7 months on average after treatment. Statistical analysis was done by Wilcoxon-test. RESULTS: Mean visual acuity before laser coagulation was 20/60, after laser treatment 20/50. Visual acuity in all patients improved significantly after laser treatment (p = 0.0001). A significant improvement occurred when treatment was performed within 3 to 4 months after onset (p < 0.0001), in patients with macular edema in the ischemic (p = 0.0005) and non ischemic type (p = 0.036), in patients without preretinal neovascularization (p < 0.0001) and without vitreous hemorrhage (p = 0.0001), in patients between 51 and 60 years (p = 0.0001) and between 41 and 50 years of age (p = 0.0086), in vein occlusions with intraretinal hemorrhages ++ (p = 0.0001), with hard exsudates + (p = 0.0047) in vein occlusions of the temporal superior (p = 0.0016) and the temporal inferior branch (p = 0.028) and in patients with diffuse dye leakage + (p = 0.0036) and ++ (p = 0.007). No significant visual improvement was found in patients with ischemic maculopathy, hard exsudates ++, preretinal neovascularization and vitreous hemorrhage, diffuse intraretinal dye leakage , dye leakage ++ and from retinal vessels and in patients < or = 40 and > 60 years of age. CONCLUSIONS: Laser treatment in BRVO according to the criteria of the study is beneficial and results in significant visual improvement.
Adult↗
[Results of laser coagulation of central retinal vein occlusion].
BACKGROUND: In the literature laser treatment in ischemic central retinal vein occlusion (CRVO) is established to prevent iris neovascularization. We investigated the relationship of morphological and fluorescein angiographic findings with the results of laser treatment. PATIENTS AND METHODS: In 70 (56%) of 125 examined patients with central retinal vein occlusion laser treatment was performed. Indications were either ischemic type of occlusion or macular edema with visual acuity < or = 0.5. RESULTS: The results compare visual acuity before and after laser treatment (three months and 11.5 months on average) examined by Wilcoxon-test. There was no significant improvement in visual acuity (p = 0.62). After laser treatment 3 (9%) patients with ischemic CRVO developed iris neovascularization and 2 (6%) neovascular glaucoma. There was no correlation between visual outcome and ischemia type (non ischemic type p = 0.61, ischemic type p = 0.67), maculopathy (cystoid macula edema p = 0.87, ischemic maculopathy p = 0.5) and internal diseases (hypertension p = 0.43, diabetes mellitus p = 0.74). CONCLUSIONS: The results of this study indicate that there is no significant visual improvement in patients with CRVO after laser treatment. There are no morphological and angiographic findings indicating a subgroup with good visual prognosis.
Fluorescein Angiography↗
[Clinical and fluorescein angiography findings in patients with retinal vein occlusion. A unicenter study of 211 patients].
Between january 1986 and december 1989 we prospectively studied 211 patients with branch retinal vein occlusion (BRVO). Documented by fundus photography and fluorescein angiography clinical and angiographic findings were analysed. The age ranged from 28 to 83 with a mean of 63 years. 104 (48.8%) patients were male, 107 (51.2%) female. 51.1% right and 48.9% left eyes were affected. Mean visual acuity was 20/60. A non ischemic type of BRVO was found in 46.9% and an ischemic in 53.1% of the patients. The mean visual acuity in the non ischemic type was 20/50 and significantly better (p = 0.008) than in the ischemic type with a mean visual acuity of 20/60 (Mann-Whitney test). Preretinal neovascularisation was found in 14.7% and iris neovascularisation in 0.9%. One main branch was occluded in 82.9% and two main branches in 17.1%. The temporal superior quadrant was affected in 51.7%, the temporal inferior in 28%, the nasal inferior in 2.8% and the nasal superior in 0.5%. Hemisperical inferior BRVO were found in 8.1% and hemisperical superior in 5.7% of the patients. A BRVO in the fellow eye occurred in 8.5% and a CRVO in the other eye in 3.8%. Cystoid macular edema was present in 46.4%, a combination of cystoid and ischemic maculopathy in 23.7%, and ischemic maculopathy was found in 10%. Density of intraretinal hemorrhages was significantly (p = 0.046) and type of maculopathy highly significant (p < 0.0001) related to the ischemia type (Chi-square method).
Adult↗
[Clinical and fluorescein angiography changes in patients with central retinal vein occlusion. A unicenter study of 125 patients].
Between January 1986 and December 1989 we prospectively studied 125 patients with central retinal vein occlusion (CRVO). Documented by fundus photography and fluorescein angiography clinical and angiographic findings were analysed. The age of the patients was between 22 and 89 years with a mean of 60 years. 74 (59%) were male and 51 (41%) female. 63 (50.4%) right and 62 (49.6%) left eyes were affected. Arterial hypertension was found in 34 (37.2%) and diabetes mellitus in 18 (14.4%) of the patients. Glaucoma was present in 14 (11.2%). 11 (8.8%) patients had bilateral CRVO. Preretinal neovascularisation was found in 5 (4%), vitreous hemorrhage in 6 (4.8%) and a retinal detachment in 2 (1.6%) patients. Iris neovascularisation at time of first presentation was found in 8 (6.4%) of all patients, related to the number of ischemic type of CRVO in 17.7%. Cystoid macular edema was found in 77 (61.6%), ischemic maculopathy in 24 (19.2%) patients, and a combination of cystoid and ischemic maculopathy in 11 (8.8%). Mean visual acuity was 20/100. A non ischemic type was present in 80 (64%) an ischemic in 45 (36%) of patients. Mean visual acuity in the non ischemic type was 20/60 and highly significant better (p < 0.0001) than in the ischemic type with a mean visual acuity of 20/400 (Mann-Whitney test). The density of intraretinal hemorrhages (p = 0.0005) and type of maculopathy (p < 0.0001) were highly significant related to the ischemia type (chi-square method).
Adult↗
Retinal vasculitis with proliferative retinopathy in a patient with evidence of Borrelia burgdorferi infection.
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Adult↗
[Bilateral Leber's neuroretinitis stellata in Borrelia burgdorferi seroconversion].
We report on a 22-year-old white female with bilateral Leber's stellate neuroretinitis occurring 5 weeks after a viral-like illness. Serological tests revealed a seroconversion for Borrelia burgdorferi indicating an etiological connection. During therapy with 200 mg doxycycline daily for 2 weeks on systemically steroids the optic disc swelling and macular star figure resolved. Visual acuity improved from 0.4 to 1.0 in this time period. It is important that the ophthalmologist should consider Lyme-Borreliosis in isolated neuroretinitis, because the prognosis depends on the time when treatment is initiated.
Adult↗
[Autosome dominant vitreoretinal dystrophy with skeletal dysplasia in one generation].
We report on ten patients of four generations with autosomal dominant vitreoretinal dystrophy with different manifestation. The ophthalmological findings are retinal detachment, retinal holes, retinoschisis, lattice and snowflake degeneration, vitreoretinal adhesions, chorioretinal atrophy and peripheral pigment epithelial changes. Two sisters show growth retardation with skeletal anomalies most likely brachyolmia.
Amblyopia↗
[Acanthamoeba keratitis in hard contact lens wearers. Case report and review of the literature of 108 cases].
We report on a 49 year old woman with Acanthamoeba keratitis. She was wearing hard contact lenses and had a history of a minor trauma when removing her lens after a visit of a hot tub. She had the typical corneal ring infiltrate and complained about severe pain. The medical treatment was uneffective. Because of progressive deterioration penetrating keratoplasty was necessary. After a rekeratoplasty because of a recurrent infection on the transplant the patient has done well now for 3 years. The diagnosis was made on histological grounds. We report on 108 patients of the literature: 8 (7%) patients were wearing hard contact lenses; 19 (17%) remembered a trauma; 4 (3.7%) had visited a hot tub; 61 (56%) needed penetrating keratoplasty, 11 (10%) rekeratoplasty; 5 (4.6%) eyes were enucleated; in 21 (19%) patients the diagnosis was made on histological grounds.
Acanthamoeba↗
[Keratoconus in Alagille syndrome].
We report on a 20 year old white male with growth retardation, secondary hypothyroidism, typical facies, skin lichenification and brachydactylia due to arteriohepatic dysplasia. We found a bilateral keratoconus with corneal scaring but none of the other known ophthalmological findings. A keratoplasty was performed in the right eye. The pathogenesis of the keratoconus is unknown.
Abnormalities, Multiple↗