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Biomedical subjects

J Stürmer

Publications and source records attributed to J Stürmer.

18 recordsLinked to original sources
PubMed1995

[Normal pressure glaucoma: a diagnostic challenge].

PURPOSE: Normal-tension glaucoma (NTG) is a frequently discussed optic neuropathy. The purpose of this retrospective study was to evaluate the final diagnosis of patients with presumed NTG and to select the best distinguishing examination methods. PATIENTS: All patients with presumed NTG hospitalized for diurnal IOP curves from 1987-1992 were studied. We evaluated retrospectively which diagnostic tests contributed most to the final diagnosis. RESULTS: In 26 out of 50 patients with presumed NTG the final diagnosis had to be changed, mainly because the diurnal IOP curve showed a dysregulation; often only the early-morning IOP in supine position was elevated. CONCLUSIONS: We suggest that early-morning IOP spikes are one of the important pathogenetic factors in patients with glaucomatous changes without other pathology. Early morning IOP measurement in supine position before rising should therefore be a mandatory part of diurnal IOP curves in patients with presumed NTG.

Blood Pressure↗
PubMed1995

[Follow-up of a pilot study of trabeculectomy with low dosage mitomycin C (0.2 mg/ml for 1 minute). Independent evaluation of a retrospective nonrandomized study].

BACKGROUND: The application of anti fibroses agents during glaucoma surgery leads to more satisfactory results with lower i.o. pressure, yet eliciting complications in wound healing, avascular filtering blebs and frequent chronic hypotonias. In patients with lower risk for failure a reduction of concentration and application time of Mitomycin C should minimise side effects while maintaining the beneficial effect of lower intraocular pressure. PATIENTS AND METHODS: 34 eyes of 32 patients (age 72 +/- 8) underwent trabeculectomy (14 combined with phacoemulsification and implantation of a foldable posterior chamber lens). During filtering surgery, Mitomycin C (0.2 mg/ml for 1 min) was applied after preparation of the scleral flap. An 11.5 +/- 5.0 (3-21), month followup, 30 (34) eyes (88.2%) had an i.o. pressure of < or = 21 mm Hg (14.0 +/- 4.3 mm Hg at the last control) without additional glaucoma medications. RESULTS: The majority of filtering blebs (30/34; 88.2%) were well vascularised, often showing polycystic degenerations near the limbus. Only 3 eyes developed an avascular filtering bleb. No persisting leaks were observed and only 2 of 34 eyes (5.9%) developed short transient hypotonia (IOP < 6 mm Hg). CONCLUSIONS: Adjunctive treatment with low concentration of Mitomycin C during filtering surgery results in good i.o. pressure with little risk of avascular bleb development. A prospective, randomised trial is required to assess the safety and efficacy of adjuvantive Mitomycin C treatment in low risk filtering surgery.

Aged↗
PubMed1992

Intra- and inter-observer variation of optic nerve head measurements in glaucoma suspects using disc-data.

The aim of this study was to determine the intra- and inter-observer variation in the use of a system designed for exact measurements from standard optic nerve head photographs. The commercially available system consisted of a colour CCD Videocamera, a dedicated frame grabber and customized software run on a IBM AT compatible computer. Masked measurements were made 3 times by 2 observers, from stereophotographs of the optic nerve head of 56 eyes from 30 glaucoma suspects. The cup was defined on the basis of contour, not pallor and the disc area was defined as the area inside Elschnig's ring. Intra-observer variances were 0.001 +/- 0.001 mm2 for cup area (mean +/- SD), 0.002 +/- 0.002 mm2 for disc area and 0.002 +/- 0.003 mm2 for rim area. These values for intra-observer variance were comparable with the results obtained using manual planimetric techniques. Intra-observer variance for disc area was significantly larger for the less trained of the two experienced observers. Inter-observer variances were 0.004 +/- 0.009 mm2 for cup area, 0.008 +/- 0.013 mm2 for disc area and 0.009 +/- 0.014 mm2 for rim area. These inter-observer variances were significantly larger than those previously reported for manual planimetry. The absolute differences between the two observers ranged from -0.35 to +0.20 mm2 (-0.08 +/- 0.11 mm2) for cup area, from -0.38 to +0.15 mm2 (-0.08 +/- 0.11 mm2) for disc area and from -0.29 to +0.34 mm2 (-0.06 +/- 0.12 mm2) for rim area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Natural versus haploscopic stereopsis.

Natural stereopsis is better with a large interpupillary distance (IPD). With haploscopic devices, depth perception is better with a small IPD. This apparently unknown fact has been trigonometrically calculated and experimentally shown by enlarging and diminishing the IPD in 20 subjects.

Adolescent↗
PubMed1990

[Measuring the optic papilla with planimetry and the optic nerve head analyzer in glaucoma and suspected glaucoma. II. Correlations of the results of both methods with changes in the visual field, studied with the Octopus automatic perimeter].

Sixty-seven optic nerve heads of 40 patients with proven or suspected glaucoma were measured by planimetry and with the Rodenstock Optic Nerve Head Analyser (ONHA). The results were compared to visual field indices obtained with the Octopus program G-1. Good correlation of the results obtained by the two measurement procedures has been shown (Stürmer et al. 1989), between values for the disk area, the excavation area, and the cup/disk ratio. However, there is only weak correlation of values for the neuroretinal rim. The planimetrically measured neuroretinal rim area in the total population examined proved to be significantly correlated only with the visual field index for mean retinal sensitivity (MS; r2 = 0.106; P = 0.007) and short-term fluctuations (SF; r2 = 0.066; P = 0.036). After division of the population examined into different diagnostic groups, further statistically significant correlations between optic nerve head parameters and the various visual field indices were shown; here, the cup/disk ratio of both measurement procedures in two subgroups showed the best correlation with the visual field indices MS and mean defect (MD). Neither in the total population nor in any of the subgroups was a statistically significant correlation found between the volume of the excavation and one of the visual field indices. Comparing only the data for the temporal quadrant of the optic nerve head with the visual field did not improve the correlations. The best, i.e. highly significant, correlations were between optic nerve head parameters and the age of the patient. The correlation factors are much lower than other published data. A variety of factors could be responsible for these weak correlations: different optic nerve head configurations on the one hand, and localized or diffuse visual field defects on the other. In unselected cases it appears impossible to predict the visual field of a given optic nerve head. Both methods are suitable for follow-up, but not all anatomical configuration of the optic nerve head permit this.

Adolescent↗
PubMed1990

[Comparison of tonometry with the Keeler air puff non-contact tonometer "Pulsair" and the Goldmann applanation tonometer].

Intraocular pressure (IOP) readings were performed with the Keeler Air-Puff Non-Contact Tonometer "Pulsair" in 126 patients before (NCT1) and after (NCT2) applanation-tonometry with the Goldmann device (GAT). For the whole population of 126 patients, in each of whom only one eye was selected, there was a significant difference of the mean IOP measurement, but the difference between the two measurement methods was only slightly significant when the NCT was applied before the GAT, and highly significant vice versa. Also the variation of the NCT-measurements was significantly larger than that for the GAT, while the before- and after GAT measurements had equal variations. If only the measurements under 18 mmHg mean GAT are taken into account (n = 101), the difference between GAT and NCT1 was not significant (p = 0.437), as opposed to the GAT-measurements above 18 mmHg, where a highly significant difference between the means was found (p = 0.0033). In most cases, the IOP-readings were underestimated using NCT. The Non Contact Tonometer "Pulsair" could be used for IOP-readings in patients with increased risk of infection, as well as in those with known allergic reactions to topical anesthetic agents, with poor or absent fixation ability, with corneal edema, and postoperative after anterior-segment surgery. The possibility of IOP-measurement in a reclined position is a true advantage of the Non-Contact Tonometer presented here. A measuring strategy for the above-mentioned applications is presented.

Adult↗
PubMed1990

[Local and diffuse changes in the nerve fiber layer in glaucoma and vascular involvement of the optic papilla. Perimetry correlates].

Alterations in the retinal nerve-fiber layer, as seen in red-free illumination, are early signs of glaucomatous damage. First, small localized defects are often overseen in routine static automated perimetry, as the earliest psychophysical correlation is only a slight, localized increase in short-term fluctuation. Larger, absolute nerve-fiber-bundle defects of glaucomatous or vascular origin lead to broad, arcuate visual field defects, known as Bjerrum scotomata. Diffuse atrophy of the retinal nerve-fiber layer can also be seen in glaucomatous eyes, but it is difficult to detect and can therefore easily be missed by the observer. Perimetric correlations in these cases are mostly identical Bjerrum scotomata, as seen in localized nerve-fiber bundle defects. However, it seems possible that a diffuse reduction in sensitivity can only be detected. If stable fixation is attained, a good, but nevertheless indirect correspondence between the visual field defect and nerve-fiber bundle defect can be obtained by simply superimposing the fundus image on the perimetric results. Fundus-controlled perimetry is a direct combination of these two investigative methods. The advantage of fundus-controlled permetry is a precise, point-to-point correspondence between the fundus image and perimetric results, which is impossible to achieve by projection perimetry. The scanning laser ophthalmoscope is the most suitable device for simultaneously imaging the fundus and conducting psychophysical testing. For static fundus-controlled perimetry we adapted the confocal scanning laser ophthalmoscope from Rodenstock by adding an infrared laser for fundus imaging. The HeNe laser is still used for background illumination, generation of stimuli, and fixation by computer-controlled acousto-optic modulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Type VI-A mucopolysaccharidosis (Maroteaux-Lamy disease). Clinico-pathologic case report].

In this clinicopathological case report on a 27-year-old man suffering from mucopolysaccharidosis (MPS) type VI-A (Maroteaux-Lamy), histologic findings in both eyes, and histologic and ultrastructural findings in a keratoplasty button are presented for the first time in the German literature. Type VI-A is a very rare type of MPS, very benign as regards mental development. It results in a typical corneal opacification due to massive accumulation of mucopolysaccharides in all corneal layers. The opacification was treated successfully in one eye by penetrating keratoplasty. Thickening of the sclera and the optic nerve sheaths was demonstrated for the first time by computer-assisted tomography. Additionally, bilateral atrophy of the optic nerve, probably caused by elevated intracranial pressure, was found. The differential diagnostic differences between this and other types of MPS and the reason for the two cardinal symptoms (corneal opacification and optic atrophy) are discussed in extenso, and a review of the literature is given.

Adult↗
PubMed1989

[Measuring the optic papilla with planimetry and the optic nerve head analyzer in glaucoma and suspected glaucoma. I. Comparison of the 2 measuring methods].

Two-dimensional planimetric measurement of the neuroretinal rim using the method described by Betz has proved to be one of the most objective parameters in evaluating the optic nerve head. Using a three-dimensional stereoscopic measuring procedure (ONHA) described by Cornsweet, the volume of the papillary excavation can be quantified. The two methods were compared in a study involving 67 eyes with confirmed and suspected glaucoma. In agreement with published data, the correlation between the two measuring procedures was good as regards the disk surface (r2 = 0.73), the surface of the excavation (r2 = 0.90), and the cup/disk ratio (r2 = 0.63), although the last-mentioned parameter is calculated differently. While the disk surface as measured by planimetry was significantly greater than with ONHA, the cup surface measurements were almost exactly the same. In contrast to the results of other authors, the measurements of the neuroretinal rim surface correlated poorly (r2 = 0.09). The difference between the two methods in measuring the rim surfaces depends to a great extent on their absolute size and on the cup surface. The different procedures for defining the boundary of the excavation (in planimetry horizontal boundary definition, with the ONHA 150 micrometers below the retinal surface) are considered responsible for this. Advantages and drawbacks of these two clinical measuring methods are discussed. Once the currently excessive variability in the measurements has been reduced, measurement of the excavation volume could prove to be an important parameter for assessing the development of the optic nerve head in confirmed or suspected glaucoma cases.

Adolescent↗
PubMed1989

[Granuloma of the pancreas].

1. Granulomas in the pancreas are not equivalent to granulomatous pancreatitis. 2. Apart from foreign body granulomas on the pseudocyst margin (endogenous foreign body), and around the past operation stitch rests (exogenous foreign body), we have found thirty-six cases of granulomas in 1000 cases of chronic pancreatitis. Occasionally one could find granulomas around Ethibloc residues. The frequency could not be exactly determined, because most of Ethibloc reacted parts of the glands were not operated (removed). 3. We could not clarify the etiology in 20 cases (so-called cryptogenous granulomas). There were 7 cases of vessel granulomas, partly with complete obliteration of the arteries: arteriitic granulomas. The granulomas were always found in many arteries of the same caliber, never in solitary vessels. These findings were always preceded by arteriography. 4. Granulomatous pancreatitis was organ manifestation in primary Syphilis (2 cases) and primary M. Boeck (2 cases). We found fungal granulomas in AIDS. 5. Granulomatous pancreatitis plays a subordinate role in the complete picture of the basic disease; but it can cause an obstructive icterus and show a tumoral symptom.

Arteritis↗
PubMed1988

[Pseudophakic bullous keratopathy].

The number of cataract extractions in Switzerland has tripled since 1981. In 1986, a total of 15,500 cataract operations were performed, 95% of which were accompanied by an intraocular lens implantation. In spite of this tremendous increase pseudophakic bullous keratopathy remains a rare indication for keratoplasties: between 1980 and 1986 only 20 grafts were performed at the authors' clinic for irreversible corneal edema following lens implantation. After implantation of posterior chamber lenses, penetrating keratoplasty for corneal decompensation is performed after a significantly shorter period (one year) than with anterior chamber lenses (three years), or in iris-supported lenses (four years). In Switzerland, the incidence of pseudophakic bullous keratopathy among patients with posterior chamber lenses is around 0.1 to 0.3%. A long-term investigation of the endothelial cell density over a period of seven years in 16 patients with a Binkhorst two-loop lens revealed a quite stable and satisfactory cell density of 1600 cells/mm2.

Adult↗
PubMed1987

Granulomatous pancreatitis--granulomas in chronic pancreatitis.

Granulomatous pancreatitis can be described only in infectious granulomas and pancreatic involvement by systemic granulomatosis. The presence of classical chronic tryptic pancreatitis in addition to individual sarcoidosis granulomas in one of our cases of sarcoidosis, shows that pancreatitis in a patient with generalized granulomatosis should not necessarily be considered granulomatous pancreatitis. A variety of foreign-body granulomas found in the pancreas may be explained by previous surgical operations, and other foreign bodies introducted iatrogenically. Occasionally, the pancreas in chronic pancreatitis contains granulomas that must be considered foreign body granulomas, although the causal foreign body cannot be identified. We believe that we can identify inspissated secretion that has passed out of the ductal system into the interstitium as the foreign body responsible. It is not possible to establish whether such iatrogenic measures as manipulations of the duct with back-up of the secretion within the ductal system, has any causative involvement in this secretion oedema. However, the absorption of the individual parenchymal secretions is impaired to such a degree that any extravasated remain "in situ" for a lengthy period. The absorption of the aqueous constituents leads to inspissation, so that it can finally be absorbed only through the formation of foreign body granulomas. The same granulogenic property in highly scarred pancreatic parenchyma is also recognizable in the abnormal degradation mode of normally absorbable Ethibloc, and in the excessive arterial and periarterial reactions following angiography. The presence of granulomas within the parenchyma of the pancreas in chronic pancreatitis, many of which have been induced by endogenous and/or exogenous foreign bodies would not lead us to refer to a granulomatous pancreatitis, since the remaining sections of the parenchyma manifest typical necroses and scar foci of chronic pancreatitis. We would characterize these granulomas by the term "granulomas in chronic pancreatitis", and differentiate this from granulomatous pancreatitis.

Chronic Disease↗
PubMed1987

[Lipoma of the mammillary body].

A lipoma of the base of the brain, located at the right mammillary body, was unexpectedly discovered during the autopsy of a 73 year old man. Current theories concerning the development of intracranial lipomas are reviewed.

Aged↗
PubMed1985

What do glaucomatous visual fields really look like in fine-grid computerized profile perimetry?

Analysis of the visual fields of 20 glaucoma patients by Octopus automatic perimeter, using 229 F2 programs consisting of 30 degrees long profiles with 1 degree resolution and double measurements of the light sensitivity threshold, revealed that: (1) there is a positive correlation between mean loss and mean short-term fluctuations; (2) short-term fluctuations tend to be larger with increasing loss of sensitivity; (3) however, small short-term fluctuations were also seen in areas of greatly reduced sensitivity; (4) analysis of the F2 programs showed 12 different abnormal patterns; (5) the most frequently found, 'increased scatter with normal sensitivity', appears to be the earliest perimetric sign of glaucoma, and (6) progression of the glaucomatous damage produces a 'grey area of increased scatter', usually accompanied by reduced sensitivity with a poorly defined lower and upper threshold. It is shown that a relative scotoma does not consist of a sharply bordered area with definite loss of sensitivity, but instead of a region of increased scatter with poorly definable borders. It is indicated that these sensitivity disturbances cannot be detected without extensive threshold perimetry. These findings can, furthermore, explain why quite large differences occur from one visual field examination to the next without the involvement of actual pathological changes. For combined display of several F2 programs a new mode of graphical representation is introduced.

Aged↗
PubMed1984

[What new knowledge has automated perimetry with the Octopus brought on glaucomatous visual field changes?].

The results of studying patients with glaucomatous field defects over a 5-year period using the Octopus automated perimeter are summarized. This instrument relies on a retest logic and problem-orientated adaptation of the test points as well as of the software is possible with it. Automated perimetry offers significant advantages over conventional field testing and has increasing our understanding of glaucoma considerably. (1) The probability of detecting glaucomatous field defects is substantially greater than with manual perimetry; (2) the results of a visual field examination can be treated mathematically and statistically, especially when Bebie and Fankhauser 's Delta program is used; (3) the evaluation of progressive field loss is only possible using threshold perimetry, as supra-threshold stimuli are too crude; (4) increased fluctuations around the normal age-corrected threshold represent the earliest detectable changes in glaucoma; (5) loss of sensitivity is reversible in early relative scotomata; (6) the depth of relative scotomata cannot be sharply defined on account of rapid fluctuations in sensitivity; (7) early visual field changes probably represent late changes in the course of chronic simple glaucoma.

Computers↗
PubMed1984

[What do glaucomatous visual fields really look like?].

Analysis of the visual fields of 20 glaucoma patients using 229 F2 programmes consisting of 30 degrees long profiles with 1 degree resolution and double measurements of the light sensitivity threshold, revealed that there is a positive correlation between mean loss and mean short-term fluctuations; short-term fluctuations tend to be larger with increasing loss of sensitivity. However, small short-term fluctuations were also seen in areas of greatly reduced sensitivity. Analysis of the F2 programmes showed 12 different abnormal patterns. The pattern most frequently found, "increased scatter with normal sensitivity", appears to be the earliest perimetric sign of glaucoma. Progression of the glaucomatous damage produces a "gray area of increased scatter", usually accompanied by reduced sensitivity with a poorly defined lower and upper threshold.

Computers↗