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M Küchle

Publications and source records attributed to M Küchle.

At least 37 records · Page 2Linked to original sources
PubMed2001

Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation.

BACKGROUND: The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare it with the alterations following PK only. METHODS: This study included 72 eyes after triple procedure and 227 eyes after PK only. The diagnosis for PK was Fuchs dystrophy in 39%, keratokonus in 44%, stromal corneal dystrophy in 3% and avascular corneal scars in 6% of cases. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) at defined postoperative intervals (10 days, 6 weeks, then every 3 months until 1 year postoperatively). Patients with conditions associated with impairment of the BAB were excluded from the study. RESULTS: In the early postoperative course, aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 +/- 11.0) than in patients with PK only (9.8 +/- 3.2; P = 0.001). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2 +/- 2.3), whereas patients with triple procedure still showed significantly increased flare values (10.8 +/- 5.6; P = 0.01). At 6 months postoperatively, aqueous flare values of patients with triple had returned to normal levels (6.8 +/- 3.8) and did not differ significantly from those after PK only (5.2 +/- 1.9; P = 0.09). CONCLUSION: Our results indicate that triple procedure causes a more extensive and longer-lasting breakdown of the blood-aqueous barrier than PK only. Quantification of aqueous flare with the laser flare-cell meter is useful in the postoperative follow-up after triple procedure. Further studies are required to investigate the clinical relevance of BAB breakdown on endothelial cell count and the incidence of subsequent immunological graft rejection.

Aqueous Humor↗
PubMed2001

Effect of neodymium:YAG laser iridotomy on number of aqueous melanin granules in primary pigment dispersion syndrome.

PURPOSE: Increased numbers of aqueous melanin granules have been reproducibly demonstrated in eyes with pigment dispersion syndrome using the cell count mode of the laser flare-cell meter. It was the aim of this study to measure the exact number of aqueous melanin granules in eyes with pigment dispersion syndrome and pigmentary glaucoma before and after Nd:YAG laser iridotomy. METHODS: Nine eyes of seven patients with a clinical diagnosis of primary pigment dispersion syndrome and secondary open-angle glaucoma (mean age 41.1 +/- 10.8 years) were included in this study. Aqueous cells were quantified using the cell count mode of the laser flare-cell meter (Kowa FC-1000) before and 30 min after medical pupillary dilation. Measurements were performed before and 15 +/- 7 weeks after Nd:YAG laser iridotomy. The main outcome measure was the number of aqueous melanin granules before and after Nd:YAG laser iridotomy. RESULTS: The number (mean and quartiles) of aqueous melanin granules/0.075 microl aqueous humor (normal/dilated pupil) before antiglaucoma treatment was 4.5 (4.0, 7.25)/ 9.0 (5.0, 13.0) and was significantly reduced after iridotomy [1.5 (0.75, 3.25)/4.0 (1.6, 6.25), P=0.016]. CONCLUSION: Nd:YAG laser iridotomy results in significant (65%) decrease of aqueous melanin granules in eyes with primary pigment dispersion syndrome. This finding appears to confirm the concept of reverse pupillary block in primary pigment dispersion syndrome and may indicate that laser iridotomy is a useful treatment option in this condition.

Adult↗
PubMed2001

Impact of short-term versus long-term topical steroids on corneal neovascularization after non-high-risk keratoplasty.

PURPOSE: To analyze incidence and extent of corneal neovascularization (CN) after non-high-risk keratoplasty and to find out whether duration of postoperative topical steroid therapy (6 vs 12 months) affects CN, corneal endothelial cell count, pachymetry, aqueous flare values, and best-corrected visual acuity at 1 year after keratoplasty. METHODS: Patients of the prospective Erlangen non-high-risk keratoplasty study with available high-quality corneal photographs taken preoperatively and 1 year later were analyzed (n=136). Corneal photographs were evaluated by two independent observers in a standardized semiquantitative fashion. Slides were projected with 100x magnification and corneal vessels classified into five grades with regard to the limbus, sutures and host-graft junction in each of 12 corneal sectors. Incidence and extent of CN after keratoplasty and relation to short-term (0-6 months) versus long-term (0-12 months) postoperative topical steroid therapy were analyzed. The effect of duration of topical steroid therapy on corneal endothelial cell count, pachymetry, aqueous flare values, and best corrected visual acuity was also analyzed. Of the 136 patients, 69 (51%) were randomly assigned to short-term and 67 to long-term topical prednisolone acetate 1%. RESULTS: Fifty-eight percent of patients (n=79) developed a CN within 1 year after keratoplasty in at least one corneal sector (mean 3.1 +/- 2.2, range 1-10). At 1 year after keratoplasty, only in 12% of these patients did at least one vessel reach the host-graft junction or grow into the donor cornea, whereas in 51% vessels were seen beyond the outer suture ends of the double running suture without reaching the host-graft junction. In 37%, capillaries were located between limbus and outer suture ends. New vessels usually pointed directly or indirectly to the outer suture ends and usually were located around the 12 o'clock and 6 o'clock positions. There was no significant difference regarding incidence and extent of CN 1 year after keratoplasty between the long-term and the short-term group. Duration of topical steroid therapy had no significant effect on corneal endothelial cell count and thickness, aqueous flare values and best-corrected visual acuity at 6 and 12 months postoperatively (only at 12 months, corneas in the long-term treatment group were slightly thicker; P=0.03). Interobserver correlation of vessel assessment was 0.77 (Kendall's tau B). CONCLUSIONS: CN is a common phenomenon after non-high-risk keratoplasty. New vessels rarely reach the host-graft junction, most commonly develop from the 6 o'clock and 12 o'clock positions and are usually located between epithelium and Bowman's layer (i.e., at the level of the superficial suture). The direction of vessel growth from the limbus towards the outer suture ends suggests release of angiogenic factors in this area. Prolongation of topical steroid therapy after non-high-risk keratoplasty beyond 6 months in this study did not significantly influence incidence and extent of CN, corneal endothelial cell count, aqueous flare values and best-corrected visual acuity observed 1 year after keratoplasty.

Administration, Topical↗
PubMed2001

Histopathologic findings in a transsclerally sutured posterior chamber intraocular lens.

A 77-year-old woman had penetrating keratoplasty (PKP), removal of an anterior chamber intraocular lens (IOL), and implantation of a transsclerally sutured posterior chamber IOL for painful pseudophakic bullous keratopathy. Postoperatively, preexisting anterior synechias led to painful secondary angle-closure glaucoma and the eye was enucleated 8 months after the PKP. Light microscopy of the eye revealed that the haptics of the IOL were surrounded by a variably dense fibrous membrane consisting of connective tissue and fibroblasts. In some areas, the haptics had eroded into the superficial stroma of the ciliary body. Except for rare foreign-body giant cells, no inflammatory cells were present near the haptics. This case illustrates that haptics of transsclerally sutured posterior chamber IOLs may be stabilized by fibrous membranes and/or by erosion into the ciliary body relatively soon after implantation. This should be considered if surgical centration, removal, or exchange of such a lens is planned.

Aged↗
PubMed2001

Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion. A histopathologic and electron microscopic study.

PURPOSE: To determine histopathologically the prevalence of pseudoexfoliation (PEX) material in eyes enucleated secondary to ischemic central retinal vein occlusion (CRVO) and to evaluate eyes with PEX material in the anterior segment and CRVO ultrastructurally for PEX deposits in the vicinity of central retinal vessels. These deposits could explain an association of CRVO and PEX. METHODS: All surgically enucleated eyes with secondary angle closure glaucoma due to rubeotic iris secondary to ischemic CRVO (1981-1998) available were re-analyzed light microscopically for the presence of PEX in the anterior segment (n=120; 76.9+/-8.5 years [range: 51-91]). Eyes with PEX in the anterior segment and available optic nerve cross sections were examined by electron microscopy for PEX material in the retrolaminar (n=7) and intralaminar central retinal vessels (n=3). All eyes surgically enucleated because of malignant melanoma of the choroid aged 70 years and older (1981-1998) with sections available served as age-matched controls (n=107; 76.4+/-5 years [range: 70-91]). RESULTS: PEX material was present light microscopically in the anterior segment in 12 of 120 eyes with CRVO (10%) compared to 2 of 107 age-matched eyes with choroidal malignant melanoma (1.9%; p<0.05). Electron microscopically, neither structural alterations of the vessel wall nor PEX deposits were found in association with central retinal vessels both in the intra- and retrolaminar areas in any of the 7 eyes with PEX in the anterior segment and CRVO analyzed. CONCLUSIONS: Histopathologically, PEX is significantly more common in eyes enucleated secondary to CRVO compared to eyes enucleated because of an intraocular tumor. This most likely is due to the secondary open angle glaucoma in eyes with PEX as a known risk factor for CRVO. According to the small number of optic nerves analyzed here, there seems to be no morphologically evident PEX vasculopathy in the central retinal vessels both within and immediately behind the lamina cribrosa in eyes with PEX in the anterior segment and CRVO potentially causing retinal venous thrombosis.

Aged↗
PubMed2001

[Standardized semiquantitative analysis of corneal neovascularization using projected corneal photographs--pilot study after perforating corneal keratoplasty before immune reaction].

BACKGROUND: A semiquantitative scheme for analysis of corneal neovascularization using projected corneal photographs is demonstrated and tested in a pilot study to analyze occurrence of corneal neovascularization in patients after perforating keratoplasty which subsequently developed transplant rejection. METHODS: Corneal photographs on the slit lamp with diffuse frontal illumination were obtained in a standardized technique. Slides were projected with 100 x magnification and analyzed twice with a 2 months interval. Corneal vessels were graded by two independent observers in each of 12 corneal sectors in a standardized fashion (grade 0: no vessels beyond limbus, 1: vessels between limbus and outer end of a double-running diagonal suture; 2: vessels between outer suture end and graft-host junction; 3: vessels reaching graft-host junction; 4: vessels within donor cornea). All patients with endothelial graft rejection of the prospective Erlangen non-high-risk keratoplasty study were included in a pilot study (1/1997-6/2000: 13 of 325; 4%). One patient without photographs available was excluded. Corneal photographs taken prior to surgery (n = 10), at the last 3 monthly-routine control before (10), at rejection episode (12) and one year later (10) were evaluated for corneal neovascularization. RESULTS: Interobserver correlation at the two assessments was 0.79 and 0.86 (Kendall's Tau B). Correlation between the assessments at the two analyses 2 months apart was 0.8. New vessels with diameter up to 6 microns can be detected. 8 of 12 analyzed patients (67%) with immune reaction after keratoplasty developed corneal neovascularization within 1 year after operation prior to transplant rejection in at least one corneal sector (2.1 +/- 1.9 sectors; 1-6). At time of rejection, new vessels reached the graft-host junction in 2 patients, in 1 patient vessels grew into the donor cornea, whereas in 8 the vessels were seen beyond the outer suture end without reaching host-graft junction (grade I: 1 patient). New vessels usually pointed to the outer suture ends of the double-running suture. CONCLUSIONS: Development of corneal neovascularization e.g. after keratoplasty can be assessed reliably using projected slides of corneal photographs at 100 x magnification. This method has the advantage of being more objective, precise and available compared to simple evaluation at the slit lamp. Postkeratoplasty corneal neovascularization seems to be common in non-high-risk eyes later developing transplant rejection. However, new vessels usually do not reach the host-graft junction. Whether neovascularization after keratoplasty demonstrates a risk factor for subsequent transplant rejection remains to be analyzed in a greater study.

Cornea↗
PubMed2001

[Visual rehabilitation and intraocular pressure elevation due to immunological graft rejection following penetrating keratoplasty].

PURPOSE: Endothelial graft rejection and intraocular pressure elevation are the most common causes of graft failure following penetrating keratoplasty (PK). Aim of this study was to evaluate the visual rehabilitation and the development of intraocular pressure during and after graft rejection. PATIENTS AND METHODS: The study included 20 eyes of 20 patients (age 54.7 +/- 19.8 years) with endothelial graft rejection, that fulfilled the following inclusion criteria 1) graft rejection was diagnosed and treated in our department; 2) at least one year follow-up after graft rejection; 3) avascular corneal pathology. The mean follow-up was 23 +/- 14 months. According to the type of surgical procedure patients were classified in PK only (n = 15, one after cataract extraction), PK combined with extracapsular cataract extraction and intraocular lens (IOL) implantation (n = 1); PK combined with secondary IOL-implantation or IOL-exchange (n = 4). Standardized complete ophthalmological examinations were performed on a regular basis before, during the acute graft rejection und then regularly in a defined examination raster in an out-patient service with cornea specialization. RESULTS: The time interval between first symptom of 18 acute diffuse and 2 chronic focal graft rejection and start of treatment was 9 +/- 13 days. Best-corrected visual acuity (CVA) was 0.6 +/- 0.2 before graft rejection and decreased significantly at the time of diagnosis (0.2 +/- 0.2; p = 0.001). Six weeks after graft rejection CVA was 0.5 +/- 0.2 and remained almost stable until one year after rejection (0.6 +/- 0.3) in 16 patients with reversible graft rejection. Only 4 patients (20%) showed an irreversible graft failure requiring Re-PK. Intraocular pressure (IOP) was not elevated in 75% of the patients (n = 15) and did not need any antiglaucomatous treatment during and after the rejection phase. In 5 eyes (25%) (3 after PK combined with anterior chamber IOL-explantation and secondary posterior chamber IOL-implantation; 1 with secondary pseudoexfoliation glaucoma and 1 steroidal responder) IOP was elevated during graft rejection (26 +/- 7 mmHg), but was controlled by intensive topical antiglaucomatous treatment. CONCLUSION: Typically, the visual rehabilitation after graft rejection was good if the clinical signs were diagnosed just in time and treated adequately. There is no direct correlation between graft rejection and intraocular pressure elevation. However, the development of intraocular pressure elevation seems to be strongly associated with preexisting glaucoma, preexisting anterior synechiae and/or simultaneous anterior chamber lens implant removal. A careful patient management after PK plays an important role to prevent the development of irreversible graft failure due to graft rejection.

Acute Disease↗
PubMed2001

[Conjunctival cyst: subconjunctival luxation of the lens following ocular contusion - a case report].

PATIENT: Presentation of a 75-year-old female with subconjunctival lens luxation, that was initially misdiagnosed as conjunctival cyst. Initial examination had been difficult due to vascularized stromal corneal scars and a large hyphema. The ocular history revealed an ocular contusion 11 months ago. Aphakia with subconjunctival lens luxation, iris incarceration, iridodialysis and covered scleral rupture were diagnosed by inspection, palpation, slit-lamp biomicroscopy, gonioscopy and ultrasound biomicroscopy. The lens and incarcerated iris tissue were removed, the scleral wound was sutured and a penetrating keratoplasty was performed in combination with anterior vitrectomy and implantation of a transclerally sutured posterior chamber lens. The histologic investigation of the subconjunctival tissue showed the complete lens with intact lens capsule and surrounding subconjunctival connective tissue. CONCLUSION: Hyphemas following ocular contusion are frequent findings. A large hyphema may masquerade alterations of other ocular structures. The differential diagnosis of posttraumatic prominent conjunctival "tumors" should include subconjunctival luxation of the lens.

Aged↗
PubMed2001

[First results of implantation of a new, potentially accommodative posterior chamber intraocular lens].

PURPOSE: Conventional posterior chamber intraocular lenses (PCIOL) generally provide excellent visual acuity but do not restore accommodation. A new, potentially accommodative PCIOL has been designed after principles elaborated by K.D. Hanna using finite element models. However, before newly developed PCIOL may be implanted routinely in larger numbers of patients, careful and meticulous evaluation in clinical studies is necessary. Thus, it was the aim of this study to investigate intra- and early 3-month postoperative findings after implantation of the newly designed PCIOL. PATIENTS AND METHODS: In a prospective pilot and safety study that was approved by the ethics committee of our university, six eyes of six patients (2 males, 4 females, age range 54 to 87 years) with senile or presenile cataract underwent phacoemulsification and implantation of the new PCIOL by one surgeon between June and November 2000. The PCIOL (1 CU, HumanOptics AG, Erlangen, Germany) is a one-piece hydrophilic acrylic foldable lens with an optic diameter of 5.5 mm. Modified haptics are intended to allow anterior movement of the lens optic as a function of contraction of the ciliary muscle. Intra- and early postoperative findings obtained after one and two days, one, two and six weeks and 3 months postoperatively were documented prospectively. Postoperative examinations included recording of distance and near visual acuity both obtained with best distance correction, determination of subjective near point and measurement of distance and near refraction by streak retinoscopy. Follow-up was at least three months in all patients. RESULTS: Surgery was uncomplicated in all patients with successful in-the-bag implantation and good centration of the PCIOL. The postoperative course was uncomplicated without inflammation, hemorrhage, synechiae or decentration. Visual acuity improved in all patients according to the status of the macula with values between 20/200 (atrophic maculopathy) and 20/20. After three to six months we observed a difference between retinoscopic near and distance refraction of 0.625 to 1.875 D and subjective near points of 40 to 100 cm. Near visual acuity with distance correction ranged from 0.1 or J 16 (atrophic maculopathy) to 0.4 or J 7. CONCLUSIONS: These early and preliminary results of our small pilot study are encouraging. Our findings may indicate at least some degree of pseudophakic accommodation. However, further studies with additional methods of measurements, with longer follow-up, more patients and controlled studies with control groups are essential to further determine safety and potential accommodative power of this new PCIOL.

Accommodation, Ocular↗
PubMed2001

[Impact of pterygium size on corneal topography and visual acuity - a prospective clinical cross-sectional study].

PURPOSE: Pterygia may cause topographic changes featuring increase of astigmatism. The purpose of this study was to quantify the impact of the head-limbus-distance (=height) and limbal base length of the pterygium on the anterior corneal curvature and visual acuity before excision. PATIENTS AND METHODS: In 52 eyes (19 female, 33 male) with a mean age of 53 +/- 14 years the pterygium size (height, base length, area) was quantified using projected preoperative clinical slides and was correlated with visual acuity, refractive, keratometric, topographic astigmatism and Surface Regularity Index (SRI), Surface Asymmetry Index (SAI) of the TMS-1 videokeratoscope. RESULTS: The mean height of the pterygium was 3.1 +/- 1.4 (0.8 to 6.7) mm, the mean base length was 5.1 +/- 1.4 (2.9 to 7.8) mm, the estimated mean area was 11.4 +/- 6.9 (2.1 to 29.4) mm(2). The increasing pterygium height and area resulted in a highly significant elevation of the preoperative SRI and SAI values (p </= 0.01). The amount of keratometric (p=0.02) and topographic astigmatism (p=0.001) correlated significantly with height and area of the pterygium. In addition, pterygium size correlated significantly with the differences of zonal corneal power between steepest and flattest hemimeridian in the 3-mm zone or 5-mm zone, respectively (p </= 0.01). Best-corrected visual acuity and height/area of the pterygium correlated significantly inversely (p=0.001). Visual acuity seemed to be mostly unaffected up to a height of 2.5 mm. Overall, the impact of the base length was much less striking. Topographic astigmatism (3.3 +/- 2.8 D) was significantly larger than keratometric astigmatism (2.1 +/- 2.1 D) (p=0.001). The larger the pterygium, the larger was the difference between keratometric astigmatism and subjectively tolerated spectacle cylinder (p </= 0.01). CONCLUSIONS: Increasing distance of the pterygium head from the limbus results in increased amount and irregularity of preoperatively induced corneal astigmatism. This may explain the patient's decrease in visual acuity before the pterygium reaches the optical axis. Our data may help to determine the adequate time point for primary pterygium excision.

Adult↗
PubMed2001

[Postoperative opacification of 12 hydrogel foldable lenses (Hydroview(R))].

BACKGROUND: To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. PATIENTS AND METHODS: 12 patients (9 female; 3 male; mean age 77.5 +/- 3 years) were referred from one ophthalmologic surgeon because of opacification of IOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. RESULTS: IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 microm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). CONCLUSIONS: Postoperative opacification of hydrogel foldable lenses (Hydroview(R)) are apperantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.

Adsorption↗
PubMed2001

[Retrospective analysis of 417 cases of contusion and rupture of the globe with frequent avoidable causes of trauma: the Erlangen Ocular Contusion-Registry (EOCR) 1985 - 1995].

BACKGROUND: Ocular trauma is the cause of every third enucleation. Blunt injuries belong to the most frequent causes. We analysed blunt ocular injuries to collect detailed epidemiological data. PATIENTS AND METHODS: Retrospective analysis of 417 inpatients of the university-eye-hospital Erlangen from 1985-1995 with ocular contusion or globe rupture (EOCR - Erlangen Ocular Contusion-Registry). RESULTS: One third of the injuries occurred during work time, more than 40 % during leisure time. 85 % of the patients were male. One half was 10 to 29 years old. Visual impairment of less than 20/200 was more frequently associated with severe damage of intraocular structures: 53 times more ruptures of the globe, 33 times more lens luxation, 17 times more retinal detachment. Visual acuity was lower following traumas due to fall and grinding. Visual impairment was rarely induced by large objects like soccer balls. Morphological findings included: hyphema (73 %), rebleeding (4 %), angle recession (71 %), iris sphincter tears (20 %), iridodialysis (10 %), cyclodialysis (3,4 %), traumatic aniridia (1 %), lens dislocation (15 %), traumatic cataract (10 %), choroidal rupture (7 %), retinal tear or detachment (7 %), Berlin's edema (35,5 %), globe rupture (4,6 %), blow-out-fracture (8,3 %). Vitreal prolapse (7,5 %) was often associated with vitreal hemorrhage (57 %), hyphema (86 %), globe rupture (20 %), iris sphincter tear (44 %), iridodialysis or cyclodialysis (43 %), traumatic cataract (41 %), lens dislocation (93 %) and retinal tear or detachment (29 %). CONCLUSIONS: Blunt ocular injuries frequently induce severe ocular damage. Only consequent attention to industrial safety act, general preference given to rounded edges and the urgent information about safety eyeware for hobbyists may reduce the number of ocular injuries with permanent morphological and functional damage.

Accidental Falls↗
PubMed2001

[Immunological graft reactions after penetrating keratoplasty - A prospective randomized trial comparing corneal excimer laser and motor trephination].

BACKGROUND AND PURPOSE: Nonmechanical trephination has been established as an advantageous procedure in penetrating keratoplasty (PK) for avascular corneal diseases and has been performed successfully in more than 1000 eyes at our institution. The purpose of this study was to compare incidence, type and reversibility of immunological graft reactions after mechanical and nonmechanical trephination for PK. PATIENTS AND METHODS: As part of a prospective randomized clinical trial 179 eyes of 76 females and 103 males were included, that had primary central PK without previous intraocular surgery between 10/1992 and 12/1997 for Fuchs' dystrophy (diameter 7.5 mm, n=73) or keratoconus (8.0 mm, n=106). The recipient and donor trephinations were performed from the epithelial side using either a motor trephine (Microkeratron, Geuder, n=91) or an 193-nm excimer laser (MEL60, Aesculap-Meditec, 1.5 x 1.5 mm spot mode, 16 - 24 mJ/pulse, repetition rate 25/s) along round metal masks with 8 "orientation teeth/notches" (n=88). As a routine, donor oversize was 0.1 mm. 128 patients (72 %) had PK only, 51 patients had simultaneous cataract extraction and PC-IOL implantation (triple procedure). Wound closure was achieved using a 16-bite double running diagonal suture by one surgeon (G.O.H.N.). In 53 % of procedures short-term-preserved donor tissue, in 47 % organ-cultured tissue was used. The mean patient/donor age was 51 +/- 17/57 +/- 19 years with nonmechanical trephination and 50 +/- 19/58 +/- 20 years with mechanical trephination. Incidence, type and reversibility of endothelial immunologic graft reactions were recorded continuously by clinical follow-up in an outpatient service with cornea specialization (after 6 weeks, then every 3 months until after suture removal, then every half year). RESULTS: During a mean follow-up of 40 +/- 15 months, 7.3 % of eyes developed an immunological endothelial graft reaction. Acute diffuse (5.6 %) were more frequent than chronic focal reactions (1.7 %). Only 1.7 % of grafts became irreversibly cloudy. More than 80 % of all graft reactions occurred later than one year (on average 23 +/- 13 months) after PK. Neither incidence (p=0.82, Chi square test) nor cumulative 3-year-rate of immunological graft reactions (p=0.91, LogRank test) differed significantly comparing nonmechanical (6.8 % or 7.3 %) and mechanical (7.7 % or 5.6 %) trephination. In eyes with keratoconus (6.6 %, 16 +/- 8 months) graft reactions did not occur more frequently (p=0.68) but earlier (p=0.02) than in eyes with Fuchs' dystrophy (8.2 %, 31 +/- 11 months). Donor age, post-mortem-time and preservation period did not significantly affect the rate of graft reactions in our study setting. CONCLUSIONS: Besides well-established optical advantages, nonmechanical trephination using the excimer laser seems to have no immunologic drawbacks in contrast to conventional mechanical trephination. Donor parameters appear to have no major impact on the incidence of graft reactions after non-high-risk PK. Rather, an adequate postoperative therapy with topical steroids, an informed patients' compliance, a consequent long-term follow-up in a clinical out-patient service with corneal specialization and a good education of and cooperation with the referring ophthalmologists are of utmost importance for the clear corneal graft in the long run.

Adolescent↗
PubMed2001

[Fulminant acute retinal necrosis 10 months after ipsilateral herpes simplex virus encephalitis - a case report].

BACKGROUND: Cases of acute retinal necrosis caused by herpes simplex virus are rare. We present here a case with a very fast progression 10 months after a primary herpetic encephalitis in an immunocompetent patient. CASE REPORT: A 36-year-old otherwise healthy man presented in our hospital with an acute painless loss of vision on the left eye. Initial examination of the fundus showed peripheral retinal necrosis with intra- and preretinal haemorrhages and sheathing of retinal venules. Diagnosis was made by detection of viral DNA in vitreous fluid. Although an antiviral therapy with high doses of acyclovir was started, a vitrectomy with silicon oil instillation was necessary to stabilise the necrotic retina. CONCLUSION: Acute retinal necrosis is relatively rare, and fast diagnosis is required. A detailed case history with attention to previous infections with herpes simplex virus as well as clinical signs were the key for the diagnosis.

Adult↗
PubMed2000

Correlation among refractive, keratometric and topographic astigmatism after myopic photorefractive keratectomy.

BACKGROUND: Photorefrative keratectomy can be used to flatten the curvature of the anterior cornea and reduce the myopic refraction of the eye. This leads to unphysiological topographical changes of the cornea and may alter the conditions for examinations of corneal surface topography. The purpose of this study was to check for mutual agreement of three different methods of assessment of astigmatism before and after myopic photorefractive keratectomy (PRK). PATIENTS AND METHODS: Forty-seven eyes of 28 patients (age 32.7+/-6.6 years) following PRK using an 193-nm excimer laser were included in this study. 37 eyes were treated for pure myopia (-4.9+/-2.4 D) and 10 eyes for myopic astigmatism (sphere -2.0 to -7.0 D, cylinder -1.0 to -3.0 D). Preoperatively and at 18 months postoperatively, subjective refractometry, keratometry and topography analysis were performed. The axes of topographic and keratometric cylinder were standardized periodically (180 degrees) with respect to the refractive cylinder axis. RESULTS: Pre- and postoperatively, the absolute astigmatism values correlated highly significantly between all three methods (P< or =0.001). The mean refractive cylinder was 0.65+/-0.61 D preoperatively and 0.46+/-0.41 D postoperatively (P=0.2). The mean keratometric astigmatism was 1.14+/-0.64 D before and 0.94+/-0.50 D after PRK treatment (P=0.2). Among the three methods, the mean topographic astigmatism was the highest (P<0.001) preoperatively (1.31+/-0.56 D) and postoperatively (1.21+/-0.52 D) (P=0.3). In eyes treated for pure myopia, no difference between pre- and postoperative refractive, keratometric and topographic astigmatism was detected (P>0.5). The axes of both topographic and keratometric astigmatism correlated highly significantly with the refractive cylinder axis (R> or =30.9, P<0.0001). CONCLUSION: Up to 2 years after myopic PRK, the difference between refractive and keratometric astigmatism does not differ from the preoperative value, indicating an even corneal surface. The absolute astigmatism values and the cylinder axis correlated well between subjective and objective methods of astigmatism assessment. Thus, objective measurements may be helpful in determining the cylinder component of best spectacle correction after PRK. However, topographic analysis overestimates astigmatism values systematically before and after PRK.

Adult↗