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J Gerling

Publications and source records attributed to J Gerling.

33 records · Page 2Linked to original sources

Retinal and cortical activity in human subjects during color flicker fusion.

Pattern electroretinograms (PERG) and cortical visually evoked potentials (VEP) were simultaneously recorded from 7 visually normal and 1 protanopic subjects. Stimuli were color checkerboards (0.5 degrees check size), phase-reversing at 17 Hz (i.e. 34 reversals/sec). Using a stepwise sweep procedure, the luminance of the red (lambda peak = 550 nm) and green (lambda peak = 630 nm) checks varied in 11 steps in opposite directions from 0 to 30 cd/m2, embracing the subjective equiluminance point. For normal subjects at subjective equiluminance, the VEP amplitude dropped sharply down to 13 +/- 2% of the value at pure luminance contrast. The PERG, however, was only reduced to 56 +/- 10% at this point, an attenuation 4 times less than that of the VEP. In contrast to normal subjects, in the protanopic subject the PERG was sharply reduced at equiluminance, parallel to the VEP. This would be expected when L-cones are missing. Assuming that the PERG reflects the activity of the retinal ganglion cells, our findings suggest that human retinal ganglion cells respond well under the condition of equiluminant flicker fusion, which is in agreement with recent single-cell studies in the monkey. Consequently, the temporal low-pass filter, which mediates color-flicker fusion, would seem to lie central to the retinal ganglion cells.

Adult↗

Sezolamide: additivity to timolol twice daily.

Sezolamide, a potent topical carbonic anhydrase inhibitor previously known as MK-417, was studied to determine its ocular hypotensive activity in patients with elevated intraocular pressure while on continuing therapy with topical timolol. This was a three-centre, double-masked, randomised, placebo-controlled, parallel study in 36 patients with bilateral primary open angle glaucoma or ocular hypertension on therapy receiving 0.5% timolol twice daily, with a morning intraocular pressure greater than or equal to 22 mmHg in both eyes 2-4 hours following an 8 a.m. dose of timolol. Sezolamide 1.8% or placebo twice daily was added to treatment with timolol on the evening of day 1 and continued for 2 weeks. Twelve-hour diurnal curves were performed before the study on day 1 (timolol alone) and on day 15. Intraocular pressure measurements were also taken on days 2 and 8 at 8 a.m. and 9 a.m. Patients who received timolol and sezolamide showed additional intraocular pressure reductions from day 1 (timolol alone) of 8.0 to 15.5%, which were significant at all times. At hours 1, 2, 4 and 8 the reductions in intraocular pressure observed in the group receiving sezolamide and timolol were significantly greater than those in the group receiving timolol and placebo.

Aged↗

[Short-term effect of megadose steroid therapy in optic neuritis].

15 patients with unilateral optic neuritis and 2 patients with bilateral optic neuritis were treated with 1000 mg methylprednisolone i.v. per day for 5 days. In the cases of unilateral optic neuritis, visual acuity was reduced to < or = 0.1, in those with bilateral optic neuritis to < or = 0.6 in the better eye. The treatment was started one to 70 days after the onset of the neuritis. We examined whether vision recovered rapidly during the treatment. As a rapid recovery we defined a fourfold improvement on a logarithmic scale during the 5 days of methylprednisolone medication. Such a rapid recovery was found in 11 of the 15 patients with unilateral and in 1 of the 2 patients with bilateral optic neuritis. A similar recovery was not found before and after the treatment interval. Although we did not have a control group, the correlation in time between the therapy and the rapid recovery suggests that the megadose steroids were effective in our patients. This interpretation is compatible with the results of the randomized controlled multicenter trial of Beck et al. (New Engl. J. Med. 326:81, 1992): However, the beneficial effect was seen up to 6 months only; one year after treatment, visual functions did no longer differ between the megadose and the placebo groups. Low-dose oral steroids did not improve visual function at any time and carried a higher risk for new episodes of neuritis, compared to placebo. Therefore, the "traditional" low-dose steroid therapy for optic neuritis has become obsolete.

Adolescent↗

Diagnosis and management of the acute retinal necrosis syndrome.

The acute retinal necrosis (ARN) syndrome is an increasingly occurring entity characterized by the triad of acute confluent peripheral retinitis with papillitis and anterior-chamber uveitis. We present case reports on four patients (age, 12-65 years) with an ARN syndrome caused by herpes simplex or varicella zoster virus and discuss diagnostic and therapeutic modalities. Immediate antiviral therapy in three patients exhibiting the typical clinical features reduced the intraocular inflammation. However, due to proliferative vitreoretinopathy with peripheral retinal necrosis, vitrectomy with encircling band and silicone oil instillation was necessary in all patients. The suspected diagnosis of an ARN syndrome induced by herpes simplex virus (HSV) was confirmed in one case during the early stage of the disease by the detection of increased levels of HSV-IgA in the vitreous and in another case by the measurement of increased titers of HSV-IgG in the vitreous. For the first time, we found intraocular HSV DNA sequences using the polymerase chain reaction (PCR) in one of these patients. In a fourth patient intraocular varicella zoster virus (VZV) infection was confirmed by the detection of elevated VZV-IgA levels and by positive PCR in the intraocular fluids. Two patients who were diagnosed and treated early retained a visual acuity of 0.4 and 0.5, respectively, whereas in the other two patients, whose diagnosis and therapy were delayed (> 6 weeks), visual acuity was reduced to light perception. We conclude that use of the PCR in the intraocular fluids together with detection of autochthonous antibodies in the vitreous seem to be the most important diagnostic laboratory tools.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Comparative tolerability of topical carbonic anhydrase inhibitor MK-927 and its S-enantiomer MK-417.

A single-dose, randomised, double-masked, placebo-controlled, five-period cross-over comparative ocular tolerance study was undertaken with the topical carbonic anhydrase inhibitor (CAI) MK-927 (1% and 2% concentrations) and its S-enantiomer MK-417 (1% and 1.8% concentrations) in 20 healthy, normal volunteers. Subjects received one drop of placebo (common vehicle) or CAI in each eye on five different days that were separated by washout intervals of 1 week. The incidence of burning increased significantly after treatment with 2% MK-927 (P less than 0.01) and 1.8% MK-417 (P less than 0.05) as compared with placebo. The mean duration of burning following placebo was 16.8 s, somewhat less than that following CAI application (23-37.1 s). The duration of tearing following CAI treatment was also significantly prolonged (P less than 0.05). Pupil size was not changed by CAIs. No other side effects were observed. At 3 h after instillation, intraocular pressure (IOP) was found to be decreased following all four CAI treatments, significantly so with 1% and 1.8% MK-417. The reasonable single-dose tolerability of MK-927 and MK-417 in this sensitive normal-volunteer model supports their potential as topical glaucoma medications. This study suggests that MK-417 may possess greater IOP-lowering activity than MK-927 in man.

Administration, Topical↗

Changes of slow cortical negative DC-potentials during the acquisition of a complex finger motor task.

To study whether electrophysiological correlates of increasing motor skill can be demonstrated in man, we recorded cortical negative DC-potentials during the acquisition of a complex finger movement in 21 subjects. The movement consisted in moving a matchstick to and fro between the index finger (II) and the little finger (V). Cortical negative DC-potentials were recorded at Fz, Cz, C1, C2 and Pz. As a control a simple finger movement was performed during the same session by 7 of the Ss. Both tasks were repeated 60-80 times and averages of the first and the last 15 artifact-free single runs were compared. Whereas only a slight, inconstant decrease in surface electronegativity during the simple motor task was observed, a significant reduction in potential size occurred during the complex task at Cz (maximum), C1, C2 and Pz but not at Fz. In addition, a significant difference in the decrease of surface electronegativity between various electrode positions was observed. We suggest that these changes in potential size during the process of motor learning may reflect an altered cortical organisation of movement control during the acquisition of a complex motor task.

Adult↗

[Atrophy of the ganglion cells reduces pattern ERG not only in fine but also in coarse test patterns].

The pattern electroretinogram (PERG) is thought to be generated by the retinal ganglion cells. For coarse patterns, however, it has been suggested that the PERG is due to nonlinear summation of luminance responses. To test this hypothesis, we recorded the PERG in 8 patients with unilateral complete optic atrophy due to trauma or advanced glaucoma. Stimuli were phase-reversing checkerboards (7.8/s) with checks of 0.8 degrees and 15 degrees in size and with flashes. Retinal stimulation subtended 26 degrees x 34 degrees. In all 8 subjects, the PERG was greatly diminished using a check size of 0.8 degrees. With a check size of 15 degrees, the PERG was similarly diminished, while the flash responses were not reduced. Any overall luminance component of the stimulus, e.g., incomplete balance of light and dark areas, evoked strong luminance responses both in normal eyes and in eyes with optic nerve atrophy. Thus, intact ganglion cells seem to be necessary for a normal PERG regardless of the coarseness of the pattern. It is possible that different mechanisms (variable ganglion cell classes) contribute to the PERG response with different check sizes. Earlier reports, contradictory to these findings, are discussed. If the PERG reflects ganglion cell function even for large check sizes, stimulation of the ganglion cells with less optical degradation would be possible, enlarging its range of applications.

Attention↗

[Additive effect of timolol and the local carbonic anhydrase inhibitor MK-417 (sezolamide)].

MK-417 (sezolamide) is a topically active carbonic anhydrase inhibitor. The effect of additional treatment with sezolamide 1.8% twice daily to patient already receiving timolol 0.5% twice daily was investigated. For this purpose, 12-h diurnal curves were used in a double-masked, randomized, placebo-controlled, parallel study in 36 patients with bilateral primary open angle glaucoma or ocular hypertension who during beta blocker therapy had intraocular pressures (IOP) greater than or equal to 22 mmHg. For 15 days patients received sezolamide or placebo 10 min after 0.5% timolol given at 8 a.m. and 8 p.m. On treatment day 15, this addition of sezolamide twice daily induced a further mean decrease in IOP of approximately 4 mm Hg (about 15%) at 1, 2 and 4 h and of approximately 2-3 mm Hg at 0, 6, 8, 10 and 12 h after drug administration, thus demonstrating a partial additive effect of sezolamide and timolol. Thus, sezolamide may be a useful addition to the treatment of glaucoma in patients not adequately controlled by beta blocker therapy.

Aged↗

Patterns of task-related slow brain potentials in dyslexia.

Six dyslexic youths who met the Hughes and Denckla criteria of "dyslexia pure" and 10 normal control subjects were investigated with DC recordings of task-related cortical negativity using 10 leads over the right and left hemispheres. Potentials were recorded during the following tasks: reading, orthographic error detection, letter series, word assembly, word fluency, finding of antonyms, and viewing of Necker cubes. Both groups exhibited greater right hemisphere negativity during the Necker cube task. Whereas controls revealed greater left hemisphere negativity during linguistic tasks, the reverse was found with dyslexics. The right shift was pronounced with the reading, orthographic error detection, and antonym conditions. Differences between the two groups were also found for the pattern of cortical distribution. We conclude that dyslexia is associated with changes in the lateral distribution of cortical activity during certain types of language processing.

Adolescent↗

Spatial-frequency discrimination of drifting gratings.

Spatial-frequency discrimination thresholds were measured for briefly (300 msec) presented sinewave gratings having a contrast one logarithmic unit above detection threshold. The gratings were drifted at rates varying from 1.1 to 40 Hz. In a two-interval forced-choice paradigm thresholds were determined for vertically and obliquely oriented gratings. Three reference spatial frequencies (1, 4, 12 c/deg) were tested. For the 1 c/deg reference spatial frequency, spatial-frequency discrimination thresholds were constant over the wide range of drift rates used. For 4 and 12 c/deg reference gratings, discrimination thresholds were constant for drift frequencies up to 14 Hz. For drift frequencies beyond 14 Hz, spatial-frequency discrimination thresholds increased abruptly, rising from approx. 6% at 14 Hz to 25% at 40 Hz drift rate. Measurements with obliquely oriented gratings yielded comparable results. The increase in the spatial-frequency discrimination threshold for medium-high spatial frequencies and high temporal frequencies might reflect an increase in the spatial frequency bandwidth of the mechanisms sensitive to these stimulus frequencies.

Adult↗

[Local carbonic anhydrase inhibitors MK-927 and Mk-417. Effect and tolerance].

A comparative ocular tolerance study was undertaken with the topical carbonic anhydrase inhibitor (CAI) MK-927 (1% and 2%) and its S-enantiomer MK-417 (1% and 1.8%) in 20 healthy normal volunteers. In this randomized, double-blind cross over study, placebos were used for control over five periods. The subjects received one drop of placebo (common vehicle) or CAI in each eye in successive periods separated by a washout period of 1 week. Three hours after the dose, the IOP was found to be decreased by 5.3% to 9.1%, depending on the dose, with all four CAI treatments and significantly so with MK-417. Pupil-size and central vision were unchanged by CAIs. External and anterior segment examination revealed no changes following any of the treatments. The incidence of burning was significantly increased by 2% MK-927 (p less than 0.01) and 1.8% MK-417 (p less than 0.05) compared to placebo. The mean duration of burning placebo was 16.8 s, but it was significantly longer (23 to 37.1 s) following CAI application. Duration of tearing following CAI application was also significantly prolonged (p less than 0.05).

Adult↗

Duration of visual afterimages on modulated backgrounds: postreceptoral processes.

A foveal afterimage produced by a small photoflash increases in duration when the luminance of a 5.8 degrees diameter background on which it is seen is temporally modulated. At a modulation frequency of 1 Hz and a depth of modulation of 52%, the duration of the afterimage is prolonged by 335% compared to the duration obtained on a steady background. This increase has been attributed to the functional border resulting from the difference in excitability between bleached and unbleached photoreceptors. Afterimage duration is also prolonged, although only by 20%, when the luminance of the background is kept constant, while the luminance of an annular surround is modulated. This finding suggests a weak effect of neural lateral interaction (via area contrast). If the background luminance is modulated only in the contralateral eye (dichoptic presentation), afterimage duration increases by as much as 54% compared to the unmodulated state. This result indicates that afterimages, in part, are sustained by processes mediated by the visual cortex.

Adult↗

Little correlation of the pattern electroretinogram (PERG) and visual field measures in early glaucoma.

Pattern-electroretinograms (PERG) to checkerboard reversal at 16/s. 0.8 degrees and 15 degrees check size and visual fields (Octopus G1) were retrospectively analyzed in 40 eyes of 30 patients with early glaucoma. The mean visual field defect was calculated separately for the central 26 degrees x 34 degrees covered by the PERG stimulus (MDc) and the more peripheral area (MDp) surrounding the stimulus. Deeper field loss was correlated with a reduced pattern electroretinogram amplitude (p < 0.01 for both MDp and MDc), indicating that the pattern electroretinogram deteriorates as glaucoma advances. If the analysis was confined to those 18 eyes (16 patients) that had no field defect within the area covered by the PERG stimulus (normal MDc but abnormal MDp), 13 of these had an abnormal PERG amplitude (p < 0.001). The results suggest that the PERG can reveal impairment of ganglion cell function that is not detected by conventional perimetry.

Adult↗

Duction ranges in normal probands and patients with Graves' ophthalmopathy, determined using the Goldmann perimeter.

BACKGROUND: We examined whether the Goldmann perimeter is suitable for measuring the range of monocular ductions, especially in the follow-up of patients with Graves' ophthalmopathy. METHODS: Using the Goldmann perimeter, the range of monocular ductions was determined in one eye of 100 normal probands (aged between 21 and 70 years) and of 36 patients (aged between 29 and 66 years) with a motility disturbance due to Graves' ophthalmopathy. Subjects were asked to follow target I/4e which was slowly moved by the examiner in the vertical and the horizontal meridian. The end-point of the pursuit movement observed by the examiner was taken as the duction limit. Subjects were measured twice, in half of the cases by the same, in the other half by two different examiners. RESULTS: In the 100 normal probands, the mean ranges of ductions were: elevation 37.6 degrees, depression 58.0 degrees, adduction 51.6 degrees, abduction 48.7 degrees. There was a slight age-related decline. The intraobserver and interobserver mean coefficients of variation ranged between 1.5% and 3.8%. In the 36 patients with Graves' ophthalmopathy the coefficients were between 0.7% and 2.3%. In both the normal probands and the Graves' ophthalmopathy patients, the coefficients were smaller for the total vertical and horizontal duction ranges than for adduction, abduction, elevation and depression alone. CONCLUSIONS: Measurements of the range of monocular ductions with the Goldmann perimeter are highly reproducible and appear to be suitable for follow-up studies in patients with Graves' ophthalmopathy.

Adult↗

MRI of lymphomas of the orbits and the paranasal sinuses.

PURPOSE: The purpose of this study was to point out MR characteristics of non-Hodgkin lymphomas of the orbits and the paranasal sinuses and the benefit of fat-suppressed contrast-enhanced sequences. METHOD: The MR images of 16 patients with lymphoma of the orbits and the paranasal sinuses were retrospectively analyzed for signal intensity, contrast enhancement, bone destruction, and mass effect. The findings were confirmed by means of biopsy (Stage IE disease) or follow-up imaging after chemotherapy (Stage IV disease). RESULTS: MRI clearly delineated the extension of the lymphomas. On the T1-weighted images, the signal intensity of the lymphoma was hypointense compared with the gray matter of the brain in 12 cases and intermediate in 4 cases. The T2-weighted fast SE images showed a hyperintense signal in 12 cases, intermediate in 3 cases, and even hypointensity in 1 case. All lesions enhanced after intravenous Gd-DTPA administration, reliably visible in the T1-weighted fat-suppressed sequences but not visible in three cases in the T1-weighted SE sequences. Bony wall destruction was evident in cases with paranasal but never in isolated orbital lymphoma. CONCLUSION: While extension of lymphoma can be accurately described by MRI, a specific diagnosis is not achievable on the basis of signal intensities and enhancement patterns alone. Therefore, at least in cases of suspected Stages IE and IIE, biopsy proof is needed. Fat-suppressed contrast-enhanced sequences possess the highest detection rate and should therefore always be applied.

Adolescent↗