PubMed Health⌕ Search

Biomedical subjects

J Funk

Publications and source records attributed to J Funk.

At least 19 recordsLinked to original sources
PubMed2000

[Intraocular pressure reduction by endoscopically controlled erbium:YAG goniotomy].

BACKGROUND: Microperforations of the trabecular meshwork can be made using an endoscope guided Er:YAG laser. As shown in enucleated human melanoma eyes, these microperforations are not accompanied by thermal damage of the surrounding tissue. We now report our first clinical results using a commercially available endoscope/laser system for performing this particular kind of goniotomy. PATIENTS AND METHOD: A combined cataract extraction and Er:YAG goniotomy was performed in 24 eyes of 20 patients. Seventeen eyes were reexamined after a minimum follow-up of 4 months (mean 6.5 months, max. 12 months). The results were compared to a control group having only the cataract operation (14 eyes). RESULTS: After combined cataract operation and Er:YAG goniotomy, mean intraocular pressure dropped from 21.8 to 15.5 mmHg. Intraocular pressure regulation was successful in 88% of these cases. In contrast to this, the intraocular pressure reduction in eyes having only the cataract operation was much less pronounced (mean intraocular pressure preoperative 20.0, postoperative 17.4, success rate 35%). CONCLUSION: The first results with our particular endoscope/laser system are encouraging. Other groups using comparable devices have reported similar success rates. We hope that the endoscopic Er:YAG goniotomy may become a minimally invasive type of glaucoma surgery in the near future.

Aged↗
PubMed1999

Children and electronic games: a comparison of parents' and children's perceptions of children's habits and preferences in a United States sample.

Despite the popularity of violent electronic games, anecdotal evidence suggests that many parents lack even basic information about children's game-playing habits. The goal of the present study was to examine parental knowledge of children's electronic game-playing habits by assessing the congruence between children's and parents' perceptions of child's playing time, parental supervision, game preference, and reaction to actual game-playing. 35 children in Grades 3 to 5 and one parent of each child completed a background questionnaire and played either a violent or nonviolent electronic game. In paired comparisons, parents reported significantly higher estimates of supervision time than children. Most parents either named an incorrect game or were not able to guess their child's favorite game. In 70% of these incorrect matches, children described their favorite game as violent. Parents may underestimate their child's exposure to violence in electronic games. After playing the same electronic game as part of the study, parents reported significantly higher frustration than children. Higher frustration with game-playing could contribute to deficits in parental knowledge of children's playing habits.

Adult↗
PubMed1998

[Endoscopically controlled erbium YAG laser goniotomy. Initial preclinical trials].

INTRODUCTION: Endoscopic erbium-YAG laser treatment is a new approach in glaucoma surgery. In contrast to conventional laser systems, the photoablative erbium-YAG laser allows microperforations of the trabecular meshwork without thermal side effects. We report our first preclinical trials using this new system. METHOD: We used the Endognost system (Schwind Co.). The device combines an endoscope and illumination fiber (0.5 mm diameter), laser fiber (0.5 mm) and a irrigation tube in one probe with a 1.1 mm external diameter. The Endognost system was tested in porcine and enucleated human eyes. All eyes were examined histologically. RESULTS: The endoscopic view into the anterior chamber allows for precise allocation of the laser pulses. Using a single pulse mode with 10 mJ a micropuncture of the trabecular meshwork can be achieved without damaging the adjacent tissue. Using multiple pulses or higher energy levels leads to damage of the posterior wall of Schlemm's canal and to thermal side effects. CONCLUSIONS: Endoscope guided erbium-YAG laser effects on trabecular tissue are comparable to those produced by a 308 nm excimer laser. Therefore, a similar reduction in intraocular pressure can be expected.

Animals↗
PubMed1998

Imaging of the optic disc in glaucoma: which way to go?

Less than 10 years ago, fundus photography was believed to be the only method to document optic disc changes in glaucoma. Since then, many sophisticated electronic devices have been developed to supersede conventional photography. At the moment, confocal laser scanning tomography, nerve fiber layer polarimetry, and optical coherence tomography are the most popular techniques. The current status of optic disc imaging in glaucoma can (in our very subjective opinion) be summarized as follows. Confocal laser scanning tomography is the most comprehensively tested electronic modality. It is perhaps the method of choice in major glaucoma centers. Nerve fiber layer polarimetry has forged ahead during the past 2 years and may become an alternative to confocal laser scanning tomography in the future. Optical coherence tomography is a fascinating technique, which may also become important in the future. Right now, however, it is still in the experimental stage. Conventional disc photography--despite all those new techniques--still has its place. Perhaps it is the method of choice in routine glaucoma practice, except those clinics that can afford one of the "high tech" machines.

Diagnostic Imaging↗
PubMed1998

Long-term results after filtering surgery with limbal-based and fornix-based conjunctival flaps.

BACKGROUND AND OBJECTIVE: To compare the long-term results of filtering surgery using either a limbal-based or fornix-based flap. PATIENTS AND METHODS: From 1985 to 1988, 90 eyes of 81 glaucoma patients undergoing filtering surgery were included in a prospective randomized clinical trial. They were alternately operated on with either a limbal-based or fornix-based conjunctival flap. The authors evaluated the functional and morphologic long-term results of 34 eyes (18 fornix based, 16 limbal based) after a minimum follow-up of 6 years. Intraocular pressure (IOP), visual acuity, visual field, intensity of symptoms due to dry eyes, and corneal overlap of the filtering bleb using planimetry were reexamined. RESULTS: No statistically significant difference of IOP reduction, deterioration of visual acuity, deterioration of visual field, sicca score, or corneal overlap of the filtering bleb was found between the limbal-based and fornix-based groups. There was no correlation between corneal overlap of the filtering bleb and the sicca score. CONCLUSION: The long-term results of fornix-based and limbal-based filtering surgery did not show a statistically significant difference.

Aged↗
PubMed1997

[Success and complications of rTPA treatment of the anterior eye segment].

Recombinant tissue plasminogen activator (rTPA) is commonly used in patients with myocardial infarction. Recently, it has also been applied intraocularly to dissolve postoperative fibrin with no serious complications being reported so far. In this study we describe our own experience with rTPA in 25 patients with persisting fibrinous membranes in the anterior segment. rTPA (Actilyse, Dr. Karl Thomae GmbH) was given in a single dose of 25 micrograms and injected into the anterior chamber via a paracentesis. We did not encounter any complications during the injection of rTPA. In 21 eyes fibrin could be reduced significantly, albeit sometimes only slowly. In 13 patients, the membrane had dissolved almost completely by the following day. In contrast, no success was observed after glaucoma surgery (2 eyes) and in chronic iritis (1 eye), or when fibrin mixed with blood was treated (1 eye). There were two (controllable) post-operative hemorrhages (rTPA after vitrectomy, and for fibrin/blood after cataract surgery). In addition, we noted 2 cases of irreversible superficial corneal clouding (rTPA after cataract surgery). We conclude that injection of rTPA can be a useful addition to steroid treatment in selective cases of persisting fibrin in the anterior segment. Long-standing membranes, however, are unlikely to be dissolved. Care should also be taken and rTPA be avoided when there is evidence of recent bleeding. Most worrying to us were the corneal complications that we cannot explain to date. With regard to the definite time correlation we feel that rTPA or one of the solution components might be the cause of this unusual feature.

Anterior Eye Segment↗
PubMed1997

[Does the fundus perimetry determined edge of the blind spot depend on the superficial form of the papilla?].

BACKGROUND: We wanted to find out whether the borders of the blind spot depend on the surface topography of the optic disc and its surrounding area. PATIENTS AND METHODS: We therefore examined ten eyes with parapapillary atrophy adjacent to the temporal side of the disc. Fundus perimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. We examined the horizontal meridian of the optic discs in 0.5 degree steps using Goldmann IV-stimuli with 10 different degrees of brightness and the Goldmann stimulus 1, 0 dB (greatest luminance). Six eyes with symmetric, "normal" excavation served as controls. Optic disc topography was measured with the Heidelberg Retina Tomograph (HRT). RESULTS: Stimuli with a large luminance power (Goldmann IV, 4 dB) were seen up to 0.8 degree centrally (i.e., towards the optic disc center) from the temporal edge of the parapapillary atrophy, but up to 1.9 degrees centrally from the nasal optic disc border (P < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. In all six subjects with a normally shaped disc there was no such "nasotemporal asymmetry." CONCLUSIONS: The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less "blind" than the shallow temporal part, probably due to more intensive light scattering by the prominent nasal part of the disc.

Adult↗
PubMed1997

[Surgical revision for hypotonia after glaucoma operation with mitomycin C].

PURPOSE: Persistent hypotony with maculopathy is a severe complication of mitomycin C when used during filtration surgery. We wanted to know whether this complication can be controlled by a surgical reintervention yielding tight closure of the initial sclerostomy. METHOD: In our clinic, 52 eyes underwent filtering surgery with intraoperative application of mitomycin C. Seven of them required a reoperation owing to persistent hypotony with maculopathy. During this reoperation, the scleral flap was tightly sutured (5x) or, if necessary, was closed with dehydrated human dura mater (2x). RESULTS: In all cases the intraocular pressure increased immediately (i.e., within less than 24 h) after reoperation. This intraocular pressure increase was accompanied by a simultaneous regression of the maculopathy. Further details: mean intraocular pressure (mmHg): before initial operation with mitomycin C: 38.5 +/- 2.9; after initial operation: 3.7 +/- 0.6; before reoperation (= 8 months after initial operation): 3.3 +/- 0.7; 24 h after reoperation: 22.0 +/- 2.9; 9 months after reoperation: 16.7 +/- 1.7. Mean visual acuity: before initial operation with mitomycin C: 0.72 +/- 0.1; after initial operation: 0.34 +/- 0.1; before reoperation (= 8 months after initial operation): 0.17 +/- 0.05; 24 h after reoperation: 0.28 +/- 0.05; 9 months after reoperation: 0.55 +/- 0.1. CONCLUSIONS: (1) Since the interval between reoperation and intraocular pressure increase was very short in all cases, overfiltration is at least one major reason for hypotony, not only ciliary body failure; (2) in cases of persistent hypotony after filtering surgery with mitomycin C, surgical reintervation can be recommended. During this reoperation, the initial sclerostomy should be closed tightly.

Adult↗
PubMed1997

[Peripheral retinal cryocoagulation. Long-term outcome].

UNLABELLED: Peripheral retinal cryotherapy alone, without additional cyclocryotherapy, can for the short term lead to intraocular pressure reduction and regression of neovascularization. As there is little information concerning the long-term results of this treatment we reexamined all patients treated with peripheral retinal cryotherapy at the Department of Ophthalmology at Freiburg University between 1979 and 1990. PATIENTS AND METHODS: Neovascularization was secondary to proliferative diabetic retinopathy in 33 eyes (65%), secondary to retinal vascular occlusion in 13 eyes (25%), and secondary to a combination of both in 5 eyes (10%). Usually, 2 quadrants of each eye were treated with 9 applications per quadrant. RESULTS: Intraocular pressure was adequately reduced in 49% of the eyes and rubeosis iridis regressed in 57%. Visual acuity deteriorated in 53% of all cases. CONCLUSION: Intraocular pressure and rubeosis iridis can in the long term successfully be treated with peripheral retinal cryotherapy. Despite good intraocular pressure control and regression of rubeosis iridis visual acuity does not improve.

Adult↗
PubMed1997

Perforation rosette of the lens after Nd:YAG laser iridotomy.

PURPOSE: To describe an unreported complication of Nd:YAG laser iridotomy. METHODS: We examined a 31-year-old patient with pigment dispersion syndrome and moderately increased intraocular pressure whose left eye had been treated prophylactically with Nd:YAG laser iridotomy and who complained of blurred vision thereafter. RESULTS: Slit-lamp examination of the left eye disclosed a typical perforation rosette of the posterior pole of the crystalline lens with a perforation of the anterior lens capsule under the iridotomy site and pigment within the lens. Opacity regressed spontaneously, and vision returned to normal. CONCLUSIONS: A perforation rosette of the lens can occur after Nd:YAG laser iridotomy and should be considered a possible serious complication of the procedure.

Adult↗
PubMed1997

[How successful is the filtering bleb "needling"?].

BACKGROUND: "Needling" may become necessary when filtering blebs fail due to scarring or encapsulation. Our goal was to calculate the medium term success rate of the needling procedure. METHODS: The results of 90 needling procedures performed on 58 eyes were analyzed, 52 eyes required one single needling (group 1) after simple trabeculectomy, whereas 19 eyes had to have double needling (group 2) and 3 eyes had to be needled 3 times (group 3). These figures do not include a 4th group of 16 eyes which had been needled after repeated and complicated surgery. Success rates were calculated at t1 = 0 - 1 day, t2 = 1 - 4 weeks, t3 = 4 - 8 weeks, t4 = 3 - 5 months and t5 = > 6 months after the treatment. RESULTS: The mean IOP (n = 90) was 29 +/- 6 mm Hg preoperatively, 15 +/- 10 mm Hg at t1, 23 +/- 9 mm Hg at t2, 20 +/- 7 mm Hg at t3, 17 +/- 5 at t4 and 17 +/- 3 at t5. The overall success rates were 80% (t1), 45% (t2), 37% (t3), 35% (t4) and 31% (t5). The corresponding success rates were 74%, 36%, 32%, 28% and 26% for group 1.89%, 52%, 37%, 37% and 31% for group 2.67% at all times for group 3 and 100%, 69%, 54%, 54% and 45% for group 4. CONCLUSIONS: In one third of all cases the needling is effective for more than 6 months. A complicated pressure lowering surgery does not necessarily diminish the effectiveness of a needling procedure. Re-needlings are as successful as the first one.

Aged↗
PubMed1997

Blind spot size depends on the optic disc topography: a study using SLO controlled scotometry and the Heidelberg retina tomograph.

AIMS: To find out whether the size of the blind spot area, determined by static perimetry, depends on the surface topography of the optic disc and its surrounding area. METHODS: Ten eyes were examined; all had a parapapillary atrophy adjacent to the temporal side of the disc. Microperimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. The horizontal meridian of the optic discs was examined in 0.5 degree steps using five stimulus sizes (Goldmann I to V), each with 10 different degrees of brightness. Optic disc topography was measured with the Heidelberg retina tomograph (HRT). RESULTS: Stimuli with a high luminance level (Goldmann IV, 4 dB), presented on the horizontal meridian, were seen up to 0.75 degree centrally (that is, towards the optic disc centre) from the temporal edge of the parapapillary atrophy but up to 1.85 degrees centrally from the nasal optic disc border (p < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. CONCLUSIONS: The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less 'blind' than the shallow temporal part, probably because of more intensive light scattering by the prominent nasal part of the disc. These considerations should also apply to other scotomas.

Adult↗
PubMed1996

[How can the success of a glaucoma operation be predicted?].

PURPOSE: The effect of glaucoma surgery can simply be measured in terms of intraocular pressure (IOP) reduction. However, IOP reduction is not the final goal of glaucoma surgery, but rather long-term visual field preservation. Visual field preservation, on the other hand, can only be judged many years after surgery. Therefore, a formula that could be used to define the success of a pressure-lowering operation soon after surgery should take account of IOP reduction, but the correlation between "successful IOP reduction" and "long-term visual field preservation" should be as high as possible. METHODS: In an attempt to find such a formula, we examined the long-term course with reference to both IOP and visual field in 108 patients (mean follow-up 7.9 years). Several criteria were tested for their ability to predict the long-term visual field preservation. RESULT: The best correlation was obtained by a combined criterion specifying both an absolute upper limit and a relative IOP decrease (i.e. IOP postoperatively < 0.8*IOP preoperatively and IOP postoperatively < 21 mmHg). CONCLUSION: We recommend use of this criterion whenever the effect of a pressure-lowering operation has to be estimated shortly after surgery.

Aged↗
PubMed1996

[Band-like keratopathy after treatment of postoperative fibrin reaction with tissue plasminogen activator].

BACKGROUND: In recent years TPA (tissue-plasminogen activator) has been increasingly and successfully used for the treatment of severe, postoperative fibrin reaction in the anterior chamber. So far no serious side effects of this treatment have been reported. PATIENTS AND METHODS: Altogether, 32 patients received 0.2 ml solution with 20 micrograms TPA intracamerally. In 2 cases a dense corneal opacity was observed 12-24 hours after the injection of TPA which was resistant to treatment with local dexamethasone and lubricants. Therefore it was removed by superficial keratectomy. In one case the keratectomy specimen could be examined by light- and electronmicroscopy. RESULTS: In the keratectomy specimen a selective, fine-granular calcification of Bowman's membrane could be demonstrated. CONCLUSIONS: The intracameral TPA treatment for postoperative fibrin reaction can cause a rapid band keratopathy. Therefore the application of TPA should be restricted to severe therapy-resistant cases of intracameral fibrin reaction. In cases with the development of a band keratopathy EDTA-treatment is recommended.

Aged↗