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L M Holbach

Publications and source records attributed to L M Holbach.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Differential diagnosis and prognosis of 112 excised epibulbar epithelial tumors].

BACKGROUND: Epithelial tumors of the epibulbar conjunctiva are rare in northern Europe. There are no reliable clinical criteria to predict the histological nature of the lesion. Even histologically proven malignant tumors typically do not show ocular invasion or metastasis. PATIENTS AND METHODS: From 1980 to 1993, 112 epithelial epibulbar tumors were classified in our ophthalmopathological laboratory. Surgical management of 50 papillomas (mean age 46 +/- 18 years, 58% males), 49 conjunctival/corneal intraepithelial neoplasias (CIN) (28 mild, 21 severe) and 12 squamous cell carcinomas (mean age 63 +/- 13 years, 69% males) included excisional biopsy (61%), with additional lamellar keratectomy (14%), epithelial abrasion (10%), cauterisation (3%), cryotherapy (2%), excimer laser ablation (2%). Other management regimes were lamellar keratoplasty (2%), penetrating keratoplasty (2%), epithelial abrasion (2%). One eye with intraocular invasion of a mucoepidermoid carcinoma was enucleated. RESULTS: Fifty five per cent of the papillomas were located at the caruncle or semilunar fold. Seventy eight percent of the papillomas had a pedunculated appearance. Two lesions involved the epibulbar conjunctiva as well as the opposite tarsal conjunctiva ("kissing papilloma"). Eighty eight percent of CIN/carcinoma were located at the limbus. The clinical differential diagnoses of CIN/carcinoma were squamous cell carcinoma (26%), papilloma (18%), leukoplakia (10%), pinguecula/pterygium (10%), dysplasia (8%), malignant melanoma (5%), trachoma (3%), chronic keratoconjunctivitis with corneal pannus (2%), "granuloma" (2%), non-pigmented naevus (2%). After a mean follow-up of 6.3 +/- 3.5 years, 13% of the papillomas showed a local recurrence. After a mean follow-up of 4.8 +/- 3.7 years, there were 30% local recurrences of CIN/carcinoma (50% each in severe CIN and carcinoma, 9% in mild CIN). But there was no recurrence of CIN/carcinoma in patients who had received a complete tumor resection initially. If the surgical margins were involved, there was a 64% recurrence rate (80% each in severe CIN and carcinoma). Thirteen per cent of the patients with CIN/carcinoma showed an additional malignant tumor elsewhere in the body. CONCLUSIONS: Local recurrences after excision of CIN/carcinoma did occur only if the surgical margins where involved, and most often within the first year following surgery. Dedifferentiation of epithelial tumors in recurrences was not observed. The diagnosis of CIN/carcinoma of the conjunctiva requires the exclusion of an additional extraocular neoplasia. Histopathological classification and assessment of resection margins of epibulbar tumors is indispensable, especially in view of the more aggressive treatment necessary in mucoepidermoid carcinomas.

Adult↗
PubMed1995

Diseases of the eyelid-conjunctival complex and corneal complications of lid disease.

The vascular anatomy of the eyelids has been studied in more detail with regard to possible applications in eyelid surgery. The recognition of different subtypes of eyelid laxity, eg, floppy eyelid, lax eyelid, and eyelid imbrication syndromes, as underlying causes of conjunctival and corneal irritation will contribute to their successful management. Involvement of eyelid, conjunctiva, or cornea has been reported in association with systemic diseases such as Wegener's granulomatosis, xeroderma pigmentosum, scleromyxedema, sarcoidosis, and abnormalities of mitochondrial DNA. The ocular manifestations may be the presenting feature of the underlying disease. Results in two series of patients with ocular surface diseases such as chemical and thermal eye burns suggest that the use of autologous nasal mucosa transplantation is promising for the management of this disorder. Clinical features and results of cryotherapy are reviewed in two series of patients with congenital distichiasis and trichiasis due to ocular cicatricial pemphigoid.

Conjunctiva↗
PubMed1995

[Conjunctival myxoma. Apropos of an anatomo-clinical case].

In the ocular area, myxoma is a benign and uncommon tumor located essentially in the lids, more rarely in the conjunctiva. We report the case of a 31-year-old male suffering from the recent growth of an epibulbar painless tumefaction located in the temporal conjunctiva. This gelatinous mass was excised and has revealed a conjunctival myxoma. Surgical excision and histopathologic examination of such epibulabar lesions are necessary because they are few malignant tumors, like botryoid rhabdomyosarcoma or fibrosarcoma, which may have a similar clinical aspect.

Adult↗
PubMed1994

Clinicopathological review of 1146 enucleations (1980-90).

The clinicopathological data of 1146 enucleated eyes obtained from 1146 patients (485 females and 661 males; mean age 57.4 (SD 21.6) years) between 1980 and 1990 were reviewed. The most common underlying diseases included trauma (37.4%), malignant tumours (19.6%), systemic diseases (diabetes, vascular diseases) (17.1%), surgical diseases (retinal detachment, glaucoma, cataract, corneal dystrophy) (14.1%), infection and inflammation (7%). The most frequent indications for enucleation were secondary angle closure glaucoma (34.9%), ocular malignant tumours (21.7%), atrophia or phthisis bulbi (18.7%), ocular infectious or inflammatory disease (14.7%), and recent trauma (enucleation was performed within the first month after trauma) (11.2%). Histopathologically, diagnoses included secondary angle closure (691 eyes or 60.3%), rubeosis iridis (550 or 48%), endothelialisation of the iridocorneal angle (198 or 17.3%), and retrocorneal membrane (143 or 12.5%). These data indicate that rubeosis iridis, often followed by irreversible secondary angle closure, represents the most common pathogenetic reason for enucleating eyes. Management procedures must be directed towards the prevention or consequent therapy of rubeosis iridis.

Adolescent↗
PubMed1993

Corpora amylacea in glaucomatous and non-glaucomatous optic nerve and retina.

We studied the occurrence, location, and size of corpora amylacea (CA) in periodic acid-Schiff (PAS)-stained histological sections of the retina and optic nerve. The glaucoma group included 48 blind eyes obtained from 48 patients (mean age: 64 +/- 13.9 years; range 26-83 years) with advanced secondary angle-closure glaucoma. The non-glaucomatous group consisted of 45 non-glaucomatous eyes from 45 patients (mean age: 62.1 +/- 12.2 years, range 34-78 years) suffering from malignant melanoma of the choroid, and six autopsy eyes obtained from young individuals (age range 2.5-29 years). The mean diameter of CA at the level of the retinal ganglion cells (retrolaminar: 10.92 +/- 5.15 microns, intralaminar: 10.97 +/- 5.04 microns, prelaminar: 9.17 +/- 4.53 microns, nerve fiber layer: 8.56 +/- 4.27 microns) was significantly larger (P < 0.0001; Wilcoxon-Mann-Whitney test) than their size at the level of the bipolar cells (inner plexiform layer: 3.79 +/- 1.30 microns). The count of CA in sections from non-glaucomatous subjects aged 2.5 to 78 years (45 eyes with malignant melanoma and 6 autopsy eyes) increased significantly (P < 0.01) with advancing age. CA occurred significantly more often (P < 0.0001) in eyes with melanoma (45.7 +/- 29.4 per section) than in eyes with glaucoma (4.7 +/- 6.9 per section). These results suggest that CA represent intraneuronal aging products that are diminished in eyes with end-stage glaucoma due to neuronal loss.

Adolescent↗
PubMed1993

[Medial canthus pilomatrixoma in an 80-year-old patient].

An 80-year-old lady noticed a painless "swelling" in the medial canthal region 3 months. The tumor showed a reddish color due to a recurrent superficial bleeding for 2 weeks. Clinically the tumor was supposed to be a super-infected keratoacanthoma. The differential diagnosis included an ulcerative basal cell carcinoma. Excisional biopsy and reconstruction using a free graft from the ipsilateral upper lid were performed. Histopathologically the lesion proved to be a "benign calcifying epithelioma Malherbe" (pilomatrixoma). Today, 8 years after surgery, there was no recurrence of the tumor. A circumscribed, subepidermal, movable reddish or livid tumor of the upper lid, eye brow or of the canthal region should be suggestive of pilomatrixoma, not only in young females.

Aged↗
PubMed1993

Epithelial transformation of the corneal endothelium in forceps birth-injury-associated keratopathy.

Using light and electron microscopy, we studied four keratectomy specimens obtained by penetrating keratoplasty from four patients (ages 33-54 years; mean age: 43 years old) who had clinical evidence of Descemet's folds and bullous keratopathy after ruptures in Descemet's membrane after forceps injury at birth. Histopathologically, three patients showed the typical features of forceps birth injury: Descemet's membrane at the margin of the rupture was folded and assumed a scroll-shape configuration. The fourth patient showed clusters of proliferated endothelial cells at the site of two ruptures, and from one site of the ruptures, these cells invaded into Descemet's membrane, forming a new basement membrane. Transmission electron microscopy revealed that these proliferated cells were epithelial-like cells characterized by desmosomal junctions, basal lamina, numerous microvilli, and 8-nm cytoplasmic filaments. The epithelial transformation of the corneal endothelium was identified in cases of posterior polymorphous dystrophy and assumed to be specific for this entity. The findings in our fourth patient represent the first documentation of epithelial-like cells on the posterior corneal surface in forceps birth-injury-associated keratopathy. Our results suggest that epithelial transformation may be a nonspecific reaction of the young cornea to various stimuli.

Adult↗
PubMed1993

[Herpes simplex keratitis. On the long-term prognosis of first transplants after penetrating keratoplasty].

Eighty-six consecutive first grafts performed between 1980 and 1990 (86 patients) for herpes simplex keratitis (HSK) were studied retrospectively (mean follow-up 4.1 years). Indications for penetrating keratoplasty (PKP) included: persistent inflammation, descemetocele or perforation (21/86); stromal opacities with vascularization (43/86), and avascular stromal opacities (22/86). The overall survival rate of clear transplants was 80% after 2 and 68% after 11 years. Corneal inflammation at the time of surgery was found to be a prognostic factor, but not corneal vascularization: The 2-year survival rates for clear grafts were 95% for avascular and 83% for vascularized stromal opacities in clinically inactive eyes, as against 58% for clinically active corneas at the time of surgery. HSV-specific structural proteins were immunohistochemically detectable most often in keratectomy specimens from patients with corneal inflammation before the operation (91%). In the group of clinically inactive stromal opacities, HSV antigens were detectable significantly (P < 0.001, chi-square test) more often in keratectomy specimens from patients with avascular opacities than in those with vascularized opacities. This may explain why corneal vascularization is not a significant risk factor for HSV recurrences. The different frequency of HSV-specific proteins in avascular and vascularized corneas merits attention in the intra- and postoperative management of patients with HSK undergoing corneal transplantation.

Adolescent↗
PubMed1993

[Pilomatrixoma of the eyelids--clinical differential diagnosis and follow-up. Report of 17 patients].

Pilomatrixomas (benign epithelioma of Malherbe) are often located in the eyelid or eyebrow. Clinically the diagnosis is rarely made. Histologically, especially in partial biopsies, they can be confused with a basal cell carcinoma. We evaluated 17 tumors in 17 patients (19 months to 80 years old). The interval between the diagnosis and total excision of the mass ranged from 4 weeks to 2 years. The clinical misdiagnosis appeared to be related to the patient's age: A cystic dermoid (4x) was considered most frequently in children and sebaceous cyst or atheroma (5x) in patients of middle age. Further diagnoses were as follows: Chalazion, basal cell carcinoma or keratoacanthoma, epidermoid cyst, abscess, papilloma. Nine tumors showed calcifications that might be visible by X-ray examination. After a mean follow-up of 7.6 years no recurrence was observed. Pilomatrixoma should be included in the clinical differential diagnosis of subepidermal solid or cystic tumors, especially in the upper eyelid and eyebrow.

Adolescent↗
PubMed1993

[Fungal keratitis with annular infiltration and hypopyon].

Fungal keratitis is a rare disease in Northern Europe. We report the case of a 57-year-old female suffering from a paracentral corneal ulcer, following minor corneal trauma with a branch of a tree. Clinically, the ulcer was associated with a ring infiltrate and a hypopyon. Corneal smears and cultures were negative. As the corneal lesions and the hypopyon progressed despite maximal treatment, penetrating keratoplasty was performed on the assumption of a fungal origin. Histopathologic examination revealed pseudohyphae, morphologically compatible with a candida species. The clinical picture, its differential diagnosis and the diagnostic methods are discussed.

Abscess↗
PubMed1993

[Acute glaucoma: first manifestation of malignant melanoma of the choroid].

Most malignant melanomas of the choroid are discovered during a routine examination of the fundus or following visual symptoms. More rarely, increased intraocular pressure or acute glaucoma represent the first signs of intraocular malignant melanoma. A 66-year-old female presented with an unilateral acute closed angle glaucoma associated with rubeosis iridis and total retinal detachment. Using ultrasonography, a choroidal neoplasm was diagnosed. Histopathologic examination of the enucleated globe confirmed the diagnosis of a necrotic malignant melanoma of the choroid with subretinal hemorrhage. Every blind eye with opaque media requires ultrasonographic and, if enucleated, histopathologic examination.

Acute Disease↗
PubMed1993

[Palpebral nodule with focal madarosis: neoplasm or chalazion? Apropos of a case].

A palpebral tumor associated with focal madarosis and no improvement to medical treatment may suggest a malignant neoplasm. Surgical excision of such a lesion was performed in a 56-year-old male and the histopathologic examination revealed a chalazion. Many similar clinical aspects between palpebral neoplasms and chalazions as well as a high frequency of chalazions secondary to palpebral neoplasms justify surgical excision with an obligatory histopathologic examination.

Chalazion↗
PubMed1991

Recurrent herpes simplex keratitis with concurrent epithelial and stromal involvement. Immunohistochemical and ultrastructural observations.

A 65-year-old man with recurrent herpetic keratitis underwent corneal transplantation for persistent nonimmunologic graft failure. Histopathologic examination of the corneal button revealed an epithelial dendrite containing Cowdry type A inclusion bodies, moderate stromal edema, and a retrocorneal fibrous membrane. Immunohistochemical studies demonstrated herpes simplex virus antigens in epithelial cells bordering the dendritic defect and in stromal keratocytes. The mean width of corneal epithelium displaying herpes simplex virus-positive epithelial cells on either side of the dendritic defect measured 200 +/- 46 microns. By electron microscopy, herpesvirus particles were identified in epithelial cells lining the dendrite as well as in stromal keratocytes. Infected keratocytes were scattered throughout the stroma but were not observed subjacent to the epithelial dendrite. This study demonstrates that a recurrent epithelial dendrite can be associated with subclinical stromal infection of the graft.

Aged↗
PubMed1991

HSV antigens and HSV DNA in avascular and vascularized lesions of human herpes simplex keratitis.

Fifty-one corneal buttons obtained by penetrating keratoplasty from patients with a preoperative clinical diagnosis of nonulcerative herpetic keratitis and/or disciform stromal scarring (44) as well as ulcerative necrotizing stromal keratitis (7) were processed for herpes simplex virus (HSV) antigens using an immunoperoxidase technique and for HSV DNA by the polymerase chain reaction (PCR). HSV antigens were detected significantly more often (p less than 0.025) in specimens with avascular nonulcerative keratitis than in those with vascularization. In contrast to HSV antigens, HSV DNA was identified at equal proportions in avascular and vascularized lesions. Both HSV antigens and HSV DNA were detected in all specimens from patients with ulcerative necrotizing stromal keratitis. The implications of these findings with regard to possible mechanisms underlying herpetic keratitis in man are discussed.

Adolescent↗
PubMed1990

Bilateral keloid-like myofibroblastic proliferations of the cornea in children.

Two 6-month-old white boys developed localized multifocal white nodules of the anterior corneal stroma without evidence of antecedent trauma, inflammatory disease, or familial occurrence. The first patient had bilateral lesions initially; the second patient initially had unilateral involvement followed by a corneal nodule in the second eye at 11 years of age. Light and electron microscopic studies of the lesions in both patients were similar and disclosed stromal nodules composed of proliferating myofibroblasts, activated fibroblasts, and haphazardly arranged fascicles of collagen. Immunohistochemical studies revealed that the spindle cells within the nodules expressed immunoreactivity for vimentin and alpha-smooth muscle actin. Management options for these slowly progressive corneal lesions include lamellar versus penetrating keratoplasty and topical corticosteroids.

Child, Preschool↗
PubMed1990

Herpes simplex stromal and endothelial keratitis. Granulomatous cell reactions at the level of Descemet's membrane, the stroma, and Bowman's layer.

Fifty-three (25%) of 215 keratectomy specimens of patients with herpes simplex stromal keratitis displayed granulomatous reactions at the level of Descemet's membrane (50/53), midstroma (13/53), and Bowman's layer (5/53). Using an immunoperoxidase technique, herpes simplex virus (HSV) antigens were detected in keratocytes, endothelial cells, and foci of epithelioid histiocytes and multinucleated giant cells around Descemet's membrane. Both granulomatous reactions and HSV antigens were identified significantly more often in specimens with ulcerative necrotizing stromal keratitis than in those from patients with stromal scarring or nonulcerative nonnecrotizing keratitis (P less than 0.00001 and P less than 0.005, respectively). Herpes simplex virus antigens also were present in endothelial cells adjacent to foci of granulomatous reactions around Descemet's membrane in association with disciform stromal scarring. To our knowledge, this is the first demonstration of HSV antigens in human corneal endothelial cells and in the granulomatous reactions at the level of Descemet's membrane.

Adolescent↗