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Jens Martin Rohrbach

Publications and source records attributed to Jens Martin Rohrbach.

18 recordsLinked to original sources
PubMed2006

A case of cutaneous melanoma metastatic to the vitreous cavity: possible pathomechanism and review of the literature.

BACKGROUND: Isolated vitreous metastases are extremely rare and the pathogenesis of metastasis is still unclear. Here we present the detailed description of the disease progression in a 68-year-old patient with vitreous seeding of a metastatic cutaneous melanoma beginning at a very early stage. METHODS: Interventional case report and review of the literature. RESULTS: The initial retrohyaloidal metastatic lesion was identified adjacent to a small epiretinal hemorrhage. As the disease progressed golden brown spherules appeared in the posterior vitreous emanating from the area of the lesion. Further progression led to a dense metastatic infiltration of the entire vitreous cavity and a decline of the visual acuity to 20/1200. Diagnostic and therapeutic pars plana vitrectomy was performed to confirm the diagnosis and preserve the eye and useful vision. CONCLUSIONS: For the first time the formation of vitreous metastases derived from cutaneous melanoma was carefully studied beginning at a very early stage. This made it possible to analyze the rare mechanism of vitreous metastasis, which has not been conclusively known till now. The features of metastatic cutaneous melanoma to the vitreous are discussed in context of a review of the literature that resulted from the study of 17 patients with 22 affected eyes.

Aged↗
PubMed2006

Muscarinic cholinoceptor-stimulated phosphatidyl inositol pathway in corneal epithelial and endothelial cells.

BACKGROUND: Muscarinic cholinoceptors are distributed widely in both the central and peripheral nervous system. The presence of muscarinic cholinoceptors in corneal tissue is well established. Previous reports have shown that corneal muscarinic cholinoceptors are of the m2 or m4 subtype. However, recent studies have indicated the presence of the m5 muscarinic cholinoceptor subtype in human corneal epithelium and endothelium. The aim of the study was to confirm the presence of the m5 cholinoceptor subtype in bovine corneal epithelium and endothelium and the activation of phosphatidyl inositol pathway by its stimulation. METHODS: Muscarinic m5 cholinoceptor sites, phosphatidyl inositol 4,5-biphosphate, inositol 1,4,5-triphosphate and protein kinase C, were studied using immunocytochemistry and immunofluorescence. Activation of protein kinase C after stimulation of the m5 muscarinic cholinoceptor subtype was measured using the HTS protein kinase C assay kit. RESULTS: Immunocytochemistry/immunofluorescence revealed the presence of the m5 muscarinic cholinoceptor subtype, phosphatidyl inositol 4,5-biphosphate and protein kinase C in bovine corneal epithelial and endothelial cells. In bovine corneal epithelium and endothelium, protein kinase C activity was stimulated by acetylcholine in a dose-dependent manner (P<0.0001). CONCLUSIONS: Our findings indicate that acetylcholine-induced stimulation of muscarinic m5 cholinoceptors activates the phosphatidyl inositol pathway in corneal epithelial and endothelial cells, resulting in increased protein kinase C activity. Further work will be needed to clear the physiologic role of this signaling pathway in corneal epithelium and endothelium.

Acetylcholine↗
PubMed2006

Expression of endostatin in human choroidal neovascular membranes secondary to age-related macular degeneration.

Endostatin is an endogenous angiogenesis inhibitor which requires E-selectin for its antiangiogenic activity. The aim of this study was to investigate the expression of endostatin in human choroidal neovascular membranes (CNV) secondary to age-related macular degeneration (AMD) with regard to vascularization and proliferative activity. An interventional case series of 36 patients who underwent removal of CNV were retrospectively investigated. Thirty-six CNV were analyzed by light microscopic immunohistochemistry for the expression of CD34 (endothelial cells, EC), CD105 (activated EC), Ki-67 (cell proliferation), Cytokeratin 18 (epithelial cells), VEGF (vascular endothelial growth factor), E-selectin and endostatin. Donor eyes (n=7) including one with AMD were used as controls. Endostatin immunoreactivity was present in choroidal vessels of five as well as in the retinal pigment epithelium (RPE)-Bruch's membrane complex of two donor eyes without AMD. In one eye with AMD, endostatin was detected in RPE, Bruch's membrane and choroidal vessels. Ninety-two percent (33/36) of CNV disclosed endostatin staining. RPE-Bruch's membrane complex, choroidal vessels and stroma were positive in 50% (18/36), 72% (26/36), and 78% (28/36) of the membranes, respectively. Both control eyes and CNV expressed all the investigated markers except E-selectin being positive only in membranes. Endostatin, an endogenous angiogenesis inhibitor, is expressed in CNV and its therapeutic up-regulation may be a new strategy in the treatment of neovascular AMD.

Adult↗
PubMed2006

Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma. Long-term clinical outcomes.

BACKGROUND: Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. METHODS: In a retrospective chart review we analyzed 90 eyes (48 OD/42 OS) in 90 patients (mean age 75 years, range 60-92 years; 51 men/39 woman) with primary open-angle glaucoma (n=66) and pseudoexfoliative glaucoma (n=24) who consecutively underwent TDLC with a minimum follow-up of 24 months. In 24 eyes (26.7%) TDLC was the primary surgical treatment. Mean energy was 80 J (60-92 J). Success was defined as a final intraocular pressure (IOP) between 4 and 18 mmHg, a minimum IOP reduction of 20% and the absence of major complications. RESULTS: The overall success rate was 36.7% after 24 months. A mean of 1.3 procedures was performed per patient. No correlation between age and success rate (p=0.887) or gender and success rate (p=0.895) was seen. There was no significant reduction in antiglaucomatous medication (p=0.208), no significant loss of visual acuity (p=0.324) nor a significant relationship between loss of visual acuity and failure of treatment (p=0.201). In patients with primary open-angle glaucoma the success rate was 40.9% after 24 months; in patients with pseudoexfoliative glaucoma it was 25.0% after 24 months. There was no significant difference between primary open-angle glaucoma and pseudoexfoliative glaucoma (p=0.684). Previous ocular surgery decreased the success probability from 45.8 to 33.3% (p=0.001). Prolonged hypotonia occurred in 1 patient. No phthisis bulbi developed. CONCLUSIONS: Transscleral diode laser cyclophotocoagulation is an effective and safe method not only in the treatment of refractive glaucoma, but also as a primary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. TDLC may be used more widely in glaucoma therapy, although further long-term studies have to confirm these findings.

Aged↗
PubMed2006

Muscarinic acetylcholine receptor subtypes in human corneal epithelium and endothelium.

BACKGROUND: Muscarinic acetylcholine receptors are located throughout the body. The demonstration of muscarinic receptors in corneal tissue has been inconsistent. Using freshly fixed human corneal tissue, we show a complete profile of muscarinic receptor subtypes in human corneal epithelium and endothelium. METHODS: Muscarinic receptor sites were studied using immunocytochemistry, immunofluorescence and immunoblotting. RESULTS: Antibodies to M2, M4 and M5 muscarinic receptor subtypes bound in human corneal epithelium and endothelium. No binding was found for antibodies to M1 and M3 muscarinic receptor subtypes. CONCLUSIONS: Our studies indicate the presence of M2, M4 and M5 muscarinic acetylcholine receptor subtypes in human corneal epithelium and endothelium. These receptors may play a role in the regulation of corneal homeostasis, other functions, like wound healing, or the pathogenesis of corneal diseases.

Adult↗
PubMed2006

Amphotericin B in the therapy of Candida glabrata endophthalmitis after penetrating keratoplasty.

PURPOSE: Candida glabrata is a rare cause of endophthalmitis after penetrating keratoplasty. Adequate therapy is still under discussion. With respect to severe complications and side effects of antifungal therapy, a substantial knowledge of sensitivity and resistance of the organism is necessary. METHODS: We report on a 26-year-old man with a hyperacute onset of the infection only 10 hours after surgery. A combined therapy for fluconazole and steroids administered over 3 months had shown no effect on intraocular infection. RESULTS: After topical and intracameral application of amphotericin B in combination with topical prednisolone 3 months after the onset of the endophthalmitis, the infection disappeared within 14 days, and the graft remained clear for 2 months. No toxic effects were noticed. CONCLUSION: In the case presented here, topical and intracameral application of amphotericin B was sufficient and safe in the therapy for C. glabrata endophthalmitis after penetrating keratoplasty. Although typically the intraocular infection is first noticed within the first 2 weeks, a hyperacute onset has to be considered.

Adult↗
PubMed2006

Monoamine receptors in human corneal epithelium and endothelium.

PURPOSE: Monoamine receptors are found throughout the body. Reports about the presence of monoamine receptors in the human cornea are inconsistent. METHODS: Immunohistochemistry, immunofluorescence and immunoblotting were used to localize monoamine receptor sites on human corneal epithelium and endothelium. RESULTS: Antibodies to alpha-1, beta-1 and beta-2 adrenergic receptors and to D1-like and 5HT-7 receptors were bound in corneal epithelium. Antibodies to alpha-1, alpha-2A, beta-1 and beta-2 adrenergic receptors and to 5HT-7 receptors were bound in corneal endothelium. CONCLUSIONS: Our data demonstrate the presence of several monoamine receptors in the human cornea. These receptors may play a role in the regulation of fluid transport or corneal homeostasis.

Adult↗
PubMed2004

Massive retinal gliosis: a late complication of retinal detachment surgery.

PURPOSE: Massive retinal gliosis is a rare, benign, intraocular tumor. It develops mostly in long-standing ocular disease such as chronic inflammation, vascular disorders, glaucoma, trauma, or congenital abnormalities. We report on a case of massive retinal gliosis, which developed 17 years following retinal detachment surgery. METHODS: Case report. RESULTS: A 64-year-old woman developed a peripheral fundus tumor 17 years after successful retinal detachment surgery. Follow-up examination demonstrated growth of the mass. The tumor was treated by pars plana vitrectomy and local endoresection. Histopathological study revealed massive reactive gliosis of the retina. CONCLUSIONS: To our knowledge, this is the first histopathologically proven case of a massive retinal gliosis, which developed after a non-drainage retinal detachment surgery. Endoresection is a therapeutic option in suspected massive retinal gliosis. It provides material for histological diagnosis which obviates unnecessary intervention in a functioning eye.

Catheterization↗
PubMed2004

[Ophthalmopathology between yesterday and tomorrow].

As financial resources run short there are considerations to integrate the ophthalmopathological laboratories of the eye hospitals into the institutes for pathology. The term "return" which is used sometimes in the discussion is historically incorrect as the pathology of the eye--similar to dermatopathology in the clinics for dermatology--was developed quite independently from general pathology in the eye hospitals over the last 150 years. Due to the work of outstanding ophthalmologists like Otto Becker, Theodor Leber, Julius Michel, and Ernst Fuchs ophthalmopathology augmented the ophthalmological knowledge much more than any other subdiscipline in the late 19th and the early 20th century. At any time, the very close link of the clinical picture and the morphology proved to be very advantageous for the understanding of the diseases. As a consequence of new diagnostic tools and progress in therapy the pathology of the eye is always changing and it is a still very important motor of modern ophthalmology. Whether in the clinical or in the experimental field: classical ophthalmopathology serves to characterise the phenotype, and nothing indicates that genomics or proteomics will make it unnecessary within the foreseeable future. Pure diagnostic pathology of the eye does not cover the costs. However, there are enough good reasons to keep the ophthalmopathological laboratories as parts of the eye hospitals.

Delivery of Health Care, Integrated↗
PubMed2003

EBV-induced polymorphic lymphoproliferative disorder of the iris after heart transplantation.

BACKGROUND: Posttransplantation lymphoproliferative disorder (PTLD) of the iris is a rare entity with only ten cases having been published as yet. Its clinical aspect is typical. Therapy is multimodal and affords an interdisciplinary approach. METHODS: A 7-year-old boy developed a lymphoproliferative mass of the iris with uveitis 4 years after heart transplantation and immunosuppression. A progressive, flesh-colored thickening of the iris with secondary angle closure glaucoma necessitated a diagnostic and therapeutic iridectomy. Morphological investigation of the iris specimen disclosed a polymorphic posttransplantation lymphoproliferative disorder (PTLD) and the presence of Epstein-Barr virus (EBV) within the tissue. The EBV load in peripheral blood monocytes was massively elevated, thus indicating a chronic EBV infection. After conservative treatment and radiation therapy, the iris mass quickly resolved. There was no evidence of systemic PTLD. CONCLUSIONS: PTLD is a well-known, EBV-induced entity that rarely affects the eye. EBV is principally detectable in specimens of iris PTLD. If conservative, antiviral treatment fails, the iris lesions can be treated by local radiation therapy with very good success. In the near future, patients with PTLD of the eye may benefit from immunologic treatment with ex vivo generation of virus-specific T-lymphocytes.

Antiviral Agents↗
PubMed2003

[Plastic reconstructive correction of persistent orofacial swelling and swelling of the eyelids in Melkersson-Rosenthal syndrome].

BACKGROUND: The Melkersson-Rosenthal syndrome complex is characterised by asymmetric orofacial oedema, facial palsy, furrowed tongue (lingua plicata) and additional neurological symptoms. PATIENT: A 21-year old man presented with a bilateral asymmetric oedema of the eyelids which increased during the follow-up period of 12 years. Intermittent swelling of the auditory channel occurred and resulted in hearing loss. Furthermore, the patient complained unspecific neurological symptoms as headache, tinnitus and subjective visual defects. The lid oedema did not only result in cosmetic problems but seriously restricted visual fields. RESULTS: Our patient showed the typical symptoms of the Melkersson-Rosenthal complex, lacking however facial palsy which is often caused by mechanical compression along the course of the facial nerve. The differential diagnosis of recurrent swelling of the lids was discussed on an interdisciplinary plane. The inflammatory activity could be reduced and the frequency of swelling episodes could be diminished by a treatment with hydroxychloroquine. The initially relapsing, then persistent swelling had led to severe restriction of the visual field and resulted in a severe social stigmatisation and psychic stress for the patient. The surgical resection of the granulomatous tissue was carried out under steroid treatment to prevent recurrence. Histochemical analysis showed inflammation of the lymphoid plasmacellular type with mucipolysaccharidoid deposition typical of Melkersson-Rosenthal syndrome. Blepharoplasty resulted in an improved cosmetic appearance. The patient remained symptom-free with an excellent functional result. CONCLUSIONS: After persistence and constancy of the findings of a granulomatous blepharitis, surgical correction is a good opportunity to minimise the subjective complaints and neurological symptoms.

Adult↗
PubMed2003

[Current State of Corneal Pathology in Germany: Results of a Survey Conducted Among Members of the Cornea Section of the German Ophthalmological Society (DOG)].

BACKGROUND: The current situation of corneal pathology is widely unknown. Especially, there are no data available how corneal tissue is processed after penetrating keratoplasty. MATERIAL AND METHODS: In November 2002 a questionnaire with 15 questions was sent to all registered members of the cornea section of the German Ophthalmological Society (DOG) ( www.sektionkornea.org ) via email. Only one answer per eye clinic was allowed. RESULTS: Answers were obtained from 40 eye hospitals in which 3070 penetrating keratoplasties had been performed in 2001. 90 % of the surgeons believe that ophthalmopathological investigations of excised corneal specimens are always or at least in some cases important, and 80 % examine 75 to 100 % of all corneal buttons. However, the corneoscleral rim is investigated only exceptionally. 45 % of all corneal buttons are examined by a pathologist within the hospital while 33 % of the corneal specimens are investigated by an ophthalmopathologist in an ophthalmopathological laboratory. In most cases the hospital itself has to bear the cost. Clinics with a high number of corneal transplantations do not differ from the average regarding the fate of corneal buttons. Morphological investigations and publications concerning the cornea are more frequent when an ophthalmopathological laboratory is available in the hospital. CONCLUSIONS: For most eye hospitals performing keratoplasties, the histopathological examination of excised corneal buttons is very important. It is carried out to a large extent by pathologists, but specialised ophthalmopathological laboratories are consulted when a profound expertise is needed. Thus, this survey is an argument for the preservation of these laboratories too. Based on the obtained data and on several comments by the section members initiatives to intensify histopathological investigations of excised corneal specimens should be undertaken.

Attitude of Health Personnel↗
PubMed2003

[Spontaneous, bifocal rupture of the limbus in secondary angle closure glaucoma after open globe injury].

PURPOSE: To report on a case of bifocal rupture of the limbus that developed in a young male with secondary angle closure glaucoma 7 months after penetrating eye injury. CASE REPORT: A 20-year old male suffered from severe polytrauma due to a car accident. Examination revealed an open globe injury of the left eye due to corneal penetration by a foreign body (glass). After primary wound closure a pars plana vitrectomy with lens extraction and removal of the foreign body was performed. Five months later IOP increased markedly and could neither be controlled by antiglaucomatous medication nor by cyclophotocoagulation. Seven months after the injury a bifocal, closed rupture of the upper nasal and temporal corneoscleral limbus occurred. IOP of the eye was elevated despite the rupture. The limbal dehiscence was readapted and IOP increased again. A new limbal rupture occurred and a tectonic keratoplasty was performed. Because a marked thinning of the transplanted cornea occurred accompanied by strong evidence of advanced epithelial ingrowth the eye was enucleated. Histologic examination of the excised tissue and enucleated eye showed diffuse epithelial ingrowth. CONCLUSION: This is first reported case of delayed, spontaneous, bifocal rupture of the corneoscleral limbus after primary open globe injury. It may be speculated that severe contusion of the eye with structural damage of the corneoscleral limbus preceded the penetrating injury and that the later limbal rupture was caused by a marked elevated IOP due to epithelial ingrowth.

Adult↗
PubMed2002

[Successful topical cyclosporin A in the therapy of progressive vascularising keratitis in keratitis-ichthyosis-deafness (KID) syndrome (Senter syndrome)].

BACKGROUND: The keratitis-ichthyosis-deafness (KID) syndrome (Senter Syndrome) and its major criteria erythrokeratodermia, neuro-sensoric deafness and vascularising keratitis were defined in 1981. Several cases have been described since 1915, but up to now no causal therapy of this disease with sporadic occurrence has been found. Clinical experience using systemic Cyclosporin A (CsA) in the dermatological therapy of the KID syndrome differs. Up to now there has been no report on the use of topical CsA eye drops in the therapy of vascularising keratitis. HISTORY AND SIGNS: We report on a case of keratitis, ichthyosis and deafness (KID syndrome) in a 36-year old male. Both eyes were suffering from recurrent corneal ulcers (ulcus serpens corneae). No improvement had been observed on topical or systemic medication (including lubricants, antibiotics, steroids, etc.) during a history of more than two years. THERAPY AND OUTCOME: Topical CsA 2 % (eye drops, 3 times daily) was administered in addition to lubricants. After 3 months the deep corneal neovascularisations were significantly reduced. The corneal ulcer was closed and visual acuity increased from 20/400 (OU) to 20/100 (OD) and 20/200 (OS), respectively. CONCLUSION: A dose-dependent keratinocyte growth inhibition was found in vitro for cyclosporin A using ichthyosis skin samples. The reduction of activated T-lymphocytes and the resulting reduced HLA-Class-2 expression of conjunctiva and cornea as well as the inhibition of activated T-Cells in the lacrimal gland might be responsible. Nevertheless, the effect of topical CsA on the vascularizing keratitis in the KID syndrome is unknown.

Adult↗
PubMed2002

[Trabecular aspiration in pseudoexfoliative glaucoma--surgery to primarily reduce intraocular pressure].

BACKGROUND: Trabecular aspiration has been discussed during the past few years as a new surgical method in the treatment of pseudoexfoliative glaucoma. In this procedure PEX-material, pigment and detritus are aspirated from the trabecular meshwork. Trabecular aspiration has been evaluated mainly in combination with cataract extraction. This study reports on our first experiences concerning the IOP-reducing effect of trabecular aspiration as a primary surgical method in the management of pseudoexfoliative glaucoma. MATERIALS: 17 eyes of 14 patients (7 m, 7 f; 12 OD, 5 OS; age 71 +/- 6 years) with pseudoexfoliative glaucoma were included in this study and operated on by standardised trabecular aspiration (vacuum max. 200 mm Hg, 180 - 270 degrees, 5 min). Therapy success was defined as an IOP reduction by more than 20 % and less than 21 mm Hg. RESULTS: Therapy success was 82 % (14 out of 17) on the first postoperative day, 50 % after 30 days (8 out of 16) and 23 % after 180 days (3 out of 13). IOP was 26.8 +/- 8.5 mm Hg before surgical intervention, 18.1 +/- 11.4 mm Hg after 1 day, 19.1 +/- 7.9 mm Hg after 30 days and 19.2 +/- 5.2 mm Hg after 180 days. Mean quantity of antiglaucomatous eye drops application was 3.1 +/- 0.9 preoperatively, 0.9 +/- 1.6 after 1 day, 0.8 +/- 1.2 after 30 days and 1.0 +/- 1.3 after 180 days. CONCLUSIONS: Trabecular aspiration achieves a good short-term effect in the reduction of IOP in patients with pseudoexfoliative glaucoma. However, this effect was limited to a few weeks in most patients. Trabecular aspiration as a primary surgical method in the management of pseudoexfoliative glaucoma does not appear to be suitable for long-term IOP reduction.

Aged↗
PubMedDate not supplied

["Masquerade foreign body" of the conjunctiva].

CASE REPORT: An eight months old child presented with a "red eye" and a corneal erosion since a week. The parents reported on a "hair" which was invisible most of the time but appeared intermittently at the lid margin. The medical history was otherwise unremarkable. In general anaesthesia, a long structure could be easily extracted. The tapering structure disclosed several tiny hair-like filaments sprouting from the thickened end. This end was embedded within a fold of conjunctiva, thus giving the impression of a hair sheath. Clinically, an ectopic "giant hair" was supposed. Histology, however, revealed plants cells and a birefringence too high for a hair so that a diagnosis of a plant foreign body was established. CONCLUSION: Conjunctival foreign bodies may be overlooked especially in young children with no history of foreign body acquisition. They may occur as a "masquerade foreign body".

Conjunctiva↗
PubMedDate not supplied

Age-corrected normal values for perimetry.

PURPOSE: Age-corrected values are indispensable in assessing discrete changes in light difference sensitivity (LDS) when evaluating perimetric results. In order to detect incipient visual field defects, the present study aimed particularly to determine function of normal values depending on age and eccentricity. METHODS: A test group (n = 83) of ophthalmologically and clinically unremarkable subjects 18-74 years of age was examined with the 'Centerfield' perimeter. A brief introductory program was first used to familiarize each test person with the situation. Then values in the central visual field (30 degrees) were determined with a threshold-splitting program. In addition, the peripheral visual field was examined after a short break. RESULTS: Age-related normal values were calculated both as group averages and as lines of regression by statistical analysis of the resulting data. In contrast to other perimetric studies, decreases in LDS at different test points for persons aged 20 years to persons over 60 were not linear. CONCLUSIONS: Age-related normal values should be reviewed for other perimeters.

Adolescent↗