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Biomedical subjects

G I Duncker

Publications and source records attributed to G I Duncker.

At least 19 recordsLinked to original sources
PubMed2006

[Idiopathic orbital inflammatory syndrome (orbital pseudotumors): diagnosis and therapy].

BACKGROUND: Pseudotumors of the orbit comprise a group of idiopathic inflammatory processes and are, except for endocrine orbitopathy, the most common reason for exophthalmos in adults. Orbital pseudotumors, also called idiopathic orbital inflammatory syndrome (IOIS), can be determined from orbital involvement in systemic fibrosing diseases. Finding the correct diagnosis can be challenging. Due to the topographic relations of the orbit to neighbouring structures, a multidisciplinary cooperation is highly recommended. CASE REPORT: We report a case of a 42-year-old woman with unilateral exophthalmos. Additionally we found impaired motility of the affected bulbus, ptosis and reduction of visual acuity. Orbital MR imaging demonstrated dense fibrotic masses filling the whole orbita including the extraocular muscles as well as the optic nerve. Tissue specimens were extracted while performing orbital decompression via a lateral orbitotomy. Histological examination revealed a lymphatic infiltration and fibrotically destroyed tissue containing the lacrimal gland. After surgical decompression, oral steroid therapy and immunotherapy, a recovery of the visual loss could be seen. CONCLUSIONS: Intraorbital fibrosclerosing pseudotumors often require a difficult long-term treatment. Therapeutic options are steroid therapy, immunotherapy, radiotherapy and surgery. The diagnostic steps include blood tests, ultrasound, CT and/or MRI as well as histological differentiation. Solid tumors and orbital involvement in diseases of the hematopoetic system have to be excluded. Since intraorbital fibrosis can be accompanied by manifestations in various other organs, a complete investigation of the body and thorough follow up are crucial.

Adult↗
PubMed2006

[Correction and induction of high-order aberrations after standard and wavefront-guided LASIK and their influence on the postoperative contrast sensitivity].

BACKGROUND: Wavefront-guided LASIK-treatments should reduce high-order aberrations (HOA). However, both the microkeratome cut as well as the ablation itself induce HOA. The purpose of this study was to investigate the amount of corrected preoperative measured HOA and induction of new HOA. METHODS: In this retrospective study 67 eyes of 45 myopic patients (- 2 to - 8.1 D SE; spherical equivalent) were treated by standard and wavefront-guided LASIK (Keracor 217z). Pre- and postoperative measurements of total aberrations and contrast sensitivity were performed. The follow-up time was 5.7 +/- 0.9 months. RESULTS: Patients with preoperative increased aberrations of 3rd and 4th order and myopia up to 5 D showed a slightly reduction of wavefront deformation. Cases of higher myopic corrections and lower preoperative spherical aberrations developed an increase of spherical aberrations after LASIK. The changes of other HOA showed no correlation with the amount of corrected myopia. Up to - 5 D patients showed the trend to better postoperative contrast sensitivity under 3 and 85 cd/m (2) after wavefront-guided LASIK than after standard LASIK. A significant advantage of wavefront-guided LASIK can be detected under a spatial frequency of 3 CPD (cycles per degree) and 85 cd/m (2). No advantages of any treatment procedure were shown after higher myopic corrections. CONCLUSION: If preoperative aberrations of 3rd and 4th order were increased and the myopia is < 5 D (SE) -- wavefront-guided LASIK can reduce total ocular HOA. Aberrometric findings after wavefront-guided LASIK in patients with lower preoperative HOA and myopia > 5 D (SE) are comparable with the results after standard treatment.

Contrast Sensitivity↗
PubMed2006

[Keratoconus: epidemiology, risk factors and diagnosis].

Keratoconus is a bilateral, non-inflammatory and progredient corneal ectasia with an incidence of approximately 1 per 2,000 in the general population. Within the second decade of life the cornea develops a conical shape, due to thinning of the corneal stroma with subsequent irregular astigmatism and myopia leading to marked impairment of vision. The most common presentation of the keratoconus is as a sporadic disorder, but it has long been recognized that a significant minority of patients exhibit a family history as an autosomal dominant mode of inheritance. Most investigators suggest complete penetrance of predisposing factors with variable phenotypic expression. In some patients heterozygous mutations in the VSX1 gene are described as the underlying gene defect. An association with Down syndrome, monosomia X (Turner syndrome), Leber's congenital amaurosis, mitral valve prolaps, collagenosis, retinitis pigmentosa and Marfan syndrome is described. The role of corneal cells in the pathogenesis of keratoconus is supported by the published reports of recurrence of keratoconus in eyes after penetrating keratoplasty due to graft repopulation by the recipient cells. Placido-based computeed videokeratographic corneal curvature mapping systems, linked with pachymetry, are useful for identifying overt and subclinical cases of keratoconus. Different indices may quantify the clinical features of keratoconus and may improve the classification. We compared videokeratometric data (Fourier series harmonic analysis and wavefront analysis) in eyes with keratoconus to answer the question of which parameters are useful for early diagnosis of keratoconus.

Comorbidity↗
PubMed2005

[Usability of self-tonometry under ambulatory conditions to obtain daily profiles of intraocular pressure at home].

BACKGROUND: Diurnal profiles of intraocular pressure at opening times in the doctor's office do not deliver enough information, especially nightly and early morning measurements are lacking. Self-tonometry using the automatic self-tonometer "Ocuton S" might be suitable to achieve valid 24-hour IOP profiles without the need to stay in a hospital. MATERIALS AND METHODS: 96 people were taught to use the automatic self-tonometer once. Those who had learnt self-tonometry after this training underwent a diurnal IOP profile for 24 hours in the hospital using Goldmann tonometry and self-tonometry every 4 hours at the same times of day. One to three days later, they created a third IOP profile at home using self-tonometry at the same intervals as at the hospital. The IOP profiles were then tested for equality. RESULTS: 50 people out of 96 were able to perform self-tonometry after one training session. The IOP measurements of all three IOP profiles did not differ by more than 2 mmHg and thus may be considered comparable. There was no significant difference between daily curves, either. CONCLUSIONS: Self-tonometry using the automatic self-tonometer "Ocuton S" appears to be suitable to record diurnal profiles of intraocular pressure at home.

Adult↗
PubMed2005

[Quantitative assessment of topographical parameters to differentiate keratoconus from pellucid marginal corneal degeneration and ].

INTRODUCTION: The purpose is to compare videokeratometric data (Fourier series harmonic analysis and wave-front analysis) in eyes with ectatic corneal disease (keratoconus; pellucid marginal corneal degeneration [PMCD]) and to determine parameters for early diagnosis and distinction of keratoconus and PMCD. PATIENTS AND METHODS: 13 eyes with PMCD, 32 eyes with keratoconus and 18 healthy eyes were included. Computerized videokeratographic methods were assessed, using Fourier series harmonic analysis, Zernike coefficients and eccentricity. RESULTS: Irregular astigmatism (Fourier series harmonic analysis: decentration and/or irregularity) and the aberration coefficient were out of the normal range in all pathologic eyes. Both the nasal and the temporal eccentricities were greater than 0.63 in all PMCD patients, whereas either the superior or the inferior eccentricity was negative in all patients. In keraotoconic eyes, all quadrant eccentricities were positive and greater than 0.4. CONCLUSIONS: Irregular astigmatism and the aberration coefficient are useful parameters in detecting ectatic corneal disease using a computerized videokeratoscope. The calculation of the spherical equivalent (Fourier series harmonic analysis: no decrease of spherical equivalent in PMCD subjects) and of quadrant eccentricities are useful tools in distinguishing PMCD and keratoconus.

Child, Preschool↗
PubMed2004

[Contact lens fitting as a possibility for visual rehabilitation in patients after open globe injuries].

INTRODUCTION: Visual rehabilitation after open globe injury may be a challenging process because of ametropia following aphakia, corneal scarring with high or irregular corneal astigmatism or loss of contrast sensitivity due to traumatic aniridia. We report on contact lens fitting for visual rehabilitation in patients after open globe injury. PATIENTS: From 2000 to 2003, contact lenses were fitted unilaterally for the visual rehabilitation in 13 patients after open globe injury. In three patients we found unilateral aphakia, in 8 patients a high or irregular astigmatism after penetrating or autorotation keratoplasty and in two patients a traumatic aniridia, in one case combined with aphakia. RESULTS: 11 rigid contact lenses were fitted with different designs of the front and back surface as well as two iris-print lenses. In 11 patients (86 %) a good visual rehabilitation was achieved with an increase of visual acuity up to 9 lines while obtaining a good contact lens tolerance. One patient wearing an iris-print contact lens was unable to tolerate the contact lens due to its thickness and its weight. In another patient fitting of a contact lens was not possible because of the complicated corneal condition. We did not observed severe contact lens complications at any time. CONCLUSIONS: In addition to operative procedures for visual rehabilitation after open globe injuries, the use of contact lenses is another possible procedure for refractive correction. Different problems such as ametropia following aphakia, irregular or high astigmatism or aniridia can be solved with good visual results, good tolerance and less complications.

Adolescent↗
PubMed2004

[Prognosis of corneal transplantation after penetrating eye injury].

BACKGROUND: The success of penetrating keratoplasty (PKP) after penetrating eye injuries is often worse than in keratoplasty with Fuchs' endothelial dystrophy. However, comparable investigations are rare. Therefore, we have retrospectively analyzed the results and complication rates of PKPs in patients who experienced penetrating eye injuries. PATIENTS AND METHODS: Between 1990 and 1997 forty-four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re-examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, perimetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (median 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs' endothelial dystrophy (K, n = 18 patients, 25 eyes, median follow-up 2.8 years). RESULTS: 38males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the time of eye injury the patients' age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45 %), glass (20 %), wood (16 %) or stone (11 %). In 73 % of the cases the injury was confined to the anterior segment of the eye (S1). The posterior part of the eye was involved in 27 % (S2). BCVA of S before keratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (p = 0.0234), and K better than S (p = 0.0009). In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 93 % of the grafts (41 patients) were clear at the last examination, 8 patients showed rejection episodes, half of them were reversible. 5 patients received a second graft because of an irreversible rejection or endothelial decompensation. BCVA improved by at least one line in 84 % in S (K 92 %). BCVA was unchanged after KP in 6.8 % (K 8 %). In 9.1 % of S BCVA after KP was worse (K 0 %). 32 out of 44 patients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patients presented with a BCVA of 0.5 or better (K40 %). 15 out of 29 patients separately tested showed stereopsis compared to 8 preoperatively in S. In 48 % of the patients studied stereovision could not be restored. 82 % of the patients suffered from topographical irregular astigmatism in S, the superficial geometry of recipient's cornea seems relevant for astigmatism of the graft. Frequent postsurgical complications consisted of secondary glaucoma (S 27 %, K 4 %), immunological rejections (S 18 %, K 0 %), and amblyopia (S 14 %, K 0 %). CONCLUSION: Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.

Adolescent↗
PubMed2004

[Long-term results of penetrating keratoplasty with different trephine systems -- a clinical investigation from the university eye hospital of halle/saale and the eye clinic of the helios hospital aue].

BACKGROUND: The results of penetrating keratoplasty in two centres for cornea transplantation were investigated with regard to the following parameters: the trephine system used, the origin of the donor cornea, the influence on the postoperative astigmatism and other aspects. PATIENTS AND METHODS: The retrospective clinical investigation reports about the results of 186 patients with penetrating keratoplasty from the University Eye Hospital of Halle and 204 patients from the Eye Clinic of the Helios hospital Aue. RESULTS: Three trephine systems have been used: the Hessburg-Barron trephine, the guided trephine system (GTS) and the Asmotom device. There were no significant differences between them concerning visual acuity after 12 months postoperatively. The results were highly significantly better (p = 0.003 Halle; p = 0.001 Aue) when using larger diameters of the trephine (7.5 mm and 8.0 mm). The origin of the donor cornea ("fresh" cornea from a deceased subject or organ cultivated cornea from a cornea bank) had no influence on visual outcome after twelve months (p > 0.8). There were less wound dehiscences using the double running suture in comparison with other techniques (p = 0.05). The removal of suturing material was not effective in reducing postoperative astigmatism (p > 0.11). There was no increase in astigmatism when leaving the sutures in situ (p > 0.25). CONCLUSIONS: Generally, each of the three trephine systems can be recommended for clinical use. The trephination should be done with trephine diameters of 7.5 mm or 8.0 mm. A timely operation guarantees better visual acuity at one year postoperatively.

Adolescent↗
PubMed2001

[Orbital space-occupying lesions. Practical aspects of imaging].

During the period 1992-1998,we diagnosed orbital tumors in 23 cases at the MLU Halle-Wittenberg. In the intraconal compartment we mostly saw cavernous hemangiomas and neurogenic tumors. Lymphomas and a primary meningioma were located in the extraconal space. Beneath the periosteum, bony processes, tumors of the sinuses, dermoid-and epidermoid-cysts normally occur, but we only observed metastases and hematomas. Furthermore,tumors of the lacrimal gland and inflammatory lesions were diagnosed. Orbital tumors are uncommon lesions, whose location in the orbit gives an important hint to differential diagnosis, because a high percentage of various pathologies is located in special compartments of the orbit. According to our results,the MRI-scan is usually sufficient for differentiation and for preoperative planning in order to reduce the X-ray dose of the lens. CT-scans with contrast are sometimes necessary for examining bone destroying processes and for planning the surgical approach to removing the tumor. X-rays of the skull widely lost their importance in the exact diagnostic of orbital tumors. B-scan ultrasonic imaging is reserved for screening and follow-up examination. Despite the use of MRI and CT scanning, the histological examination remains necessary.

Combined Modality Therapy↗
PubMed2001

[Recurrent corneal erosion after mechanical trauma. Results of transepithelial phototherapeutic keratectomy].

BACKGROUND: Recurrent corneal erosion is a common clinical disorder characterised by repeated spontaneous breakdown of the corneal epithelium. The pathomechanism is due to abnormalities of the adhesion complex between the corneal epithelium and the stroma. In addition to local medical treatment, bandage lenses, debridement and anterior stromal puncture, patients can also be treated by excimer laser phototherapeutic keratectomy. METHODS: We present a series of 45 eyes where a transepithelial therapeutic excimer photoablation (t-PTK) was carried out after recurrent erosions caused by mechanical trauma. We used the flying spot excimer laser Technolas 217-C (Bausch & Lomb Surgical) and the scanning spot laser MEL70 (Aesculap Meditec). Treatment was performed in the relapse-free period. The zone of ablation measured 6-9 mm and the ablation depth 10-30 microns. The mean follow-up period was 7 months (range 3-22). RESULTS: After the first t-PTK treatment, 41 eyes remained without a relapse, but 8 patients had persistent symptoms, 4 of which had a new epithelial breakdown and in 2 patients a second t-PTK had to be carried out. CONCLUSIONS: T-PTK appears to be a safe and effective procedure for treatment of recurrent corneal erosion. However, relative contraindications, such as a previous chemical burn, must be taken into account.

Anti-Bacterial Agents↗
PubMed2001

[Incidence of potential transmitters of Creutzfeldt-Jakob disease. A study of a collective of potential cornea donors].

BACKGROUND: The prevalence of Creutzfeldt-Jakob disease (CJD) is 1.5 cases per million persons. In addition to familial and sporadic forms, fewer than 5% of cases are due to iatrogenic transmission. Corneal transplantation has clearly been implicated as the origin of CJD in four cases. MATERIALS AND METHODS: We examined possible risks factors for corneal transplantation in material from 2545 deceased patients at the University Hospital of Halle. RESULTS: Two patients had died of CJD or slow virus disease. Also in the 109 identified as being at higher risk of CJD no organs or tissues were harvested. CONCLUSION: We strongly recommend that patients at higher risk group of CJD, patients dying of CNS diseases of unknown origin and cause, and patients dying in psychiatric clinics be excluded from donating organ and tissue.

Adult↗
PubMed2001

Short-term visual rehabilitation after LASIK.

PURPOSE: To determine the early course of visual recovery after LASIK for myopia. METHODS: In eight eyes visual acuity, both uncorrected and corrected, objective refraction, topography and contrast sensitivity were measured six times during the first day, twice daily for two days and after 1 week. RESULTS: Patients experienced considerable variability in achieving best corrected visual acuity. 80% of patients already had uncorrected visual acuity of 0.5 or better 1 day after surgery. By the 16th hour 97% of preoperative best spectacle-corrected visual acuity was achieved. The mean radius of anterior corneal curvature was already relatively constant after 3 h. After that the corneal topography was fairly stable. CONCLUSIONS: Vision recovers rapidly after LASIK. Visual rehabilitation was reached after 16 h in most cases. Mesopic vision, however, was reduced after LASIK.

Adult↗
PubMed2001

[Investigations on the cornea donation at the Martin-Luther-University Halle-Wittenberg].

AIM: We analysed the number of the potential cornea donors of the Martin-Luther-University, Halle-Wittenberg over a four-years period, 1995 to 1998 in relationships to the number of the actual donors. PATIENTS AND METHODS: We retrospectively reviewed the data of 2545 patients who died at the hospitals of the Martin-Luther-University, Halle-Wittenberg over a four-years period, from January 1995 to December 1998. The medical records of the patients were inspected and contraindications for cornea donation examined. The patients who were younger than 12 months were omitted in our analysis. The patients with at least one contraindication were excluded as potential cornea donors. Additionally we registered the actual cornea donors of the hospitals of the Martin-Luther-University, Halle-Wittenberg between 1995 to 1998. RESULTS: The mean age of the died patients was 60 years. Because of contraindications 597 patients (23.5 %) were excluded from the cornea donation. An acute sepsis with 25.1 % as well as leukemias and lymphomas with 24.8 % matched about half of the exclusion criteria. In the period of investigation we counted 1948 potential cornea donors. In the hospitals of the Martin-Luther-University, Halle-Wittenberg only 57 (2.9 % of potential donors) actual cornea donors have been registered. CONCLUSIONS: The possible leading causes for the large discrepancy between the number of the potential and actual donors are: (1) the imperfect identification of potential donors, (2) the donor family have not been asked and (3) the denial of consent by the potential donors family.

Adolescent↗