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M Küchle

Publications and source records attributed to M Küchle.

At least 55 records · Page 3Linked to original sources
PubMed2000

Thermal load of laser aperture masks in nonmechanical trephination for penetrating keratoplasty with the Er:YAG laser: comparison between stainless steel and ceramic masks.

PURPOSE: Thermal effects on the laser aperture mask may play a major role in the thermal loading of the cornea during nonmechanical trephination in penetrating keratoplasty. The purpose of this study was to assess the temperature increase on the laser mask using the 2.94-microm Er:YAG laser in order to find suitable parameters for avoidance of thermal damage to the cornea. METHODS: Thermal load measurements were performed on donor (7.5 mm trephination diameter, 0.7 mm thickness, central hole 3.0 mm) and recipient (7.5 mm trephination diameter, 0.7 mm thickness, outer diameter 13.0 mm) aperture masks. The masks were either mounted on a thermal isolator or fixed directly on porcine corneal samples. Temperature increase was measured either under static conditions in the ablation area (setup 1) and at the opposite side of the mask (setup 2) or in the ablation area under dynamic conditions, rotating the whole globe to simulate a constant trephination speed with the mask positioned directly on a porcine cornea (setup 3). We used the NWL Er:YAG solid-state laser in a 1.3-mm free-running spot mode focused on the trephination margin (half of the beam on the mask and half of it on the cornea) with a pulse energy of 200 or 400 mJ and 18CrNi10 stainless steel versus three different types of ceramic masks (silicium carbide, silicium nitrite, aluminum oxide). Temperature was assessed using an infrared pyrometer with automatic data acquisition software for a personal computer. RESULTS: Overall, the temperature rise ranged between 43.6 K (metal donor mask at the trephination area with 400 mJ pulse energy) and 3.3 K (silicium carbide recipient mask at the opposite side of the mask with 200 mJ pulse energy). With all setups and both energy levels, the heating of the metal mask was significantly higher (P<0.02) than the heating of the three types of ceramic masks. The silicium carbide masks revealed the lowest temperature rise. Comparing the three setups, the temperature rise was maximal under static conditions in the ablation area and minimal at the opposite side, with the dynamic setup ranging in between. Temperature rise was significantly greater (P<0.04) in donor masks than in recipient masks for each mask material and both energy levels. CONCLUSION: The physical characteristics of silicium carbide masks seem superior to those of metal masks with regard to minimizing the thermal load of the epithelium or superficial stroma during Er:YAG laser trephination of the cornea for penetrating keratoplasty.

Animals↗
PubMed2000

Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome.

PURPOSE: To look for associations of preoperative A-scan ultrasound ocular dimensions with complications during phacoemulsification in eyes with pseudoexfoliation. METHODS: A total of 174 eyes with pseudoexfoliation of 135 patients undergoing planned cataract surgery were included in a prognostic study based on the review of a clinical database. Preoperatively, A-scan ultrasound examination with measurement of anterior chamber depth, lens thickness, and total axial length was performed. Phacoemulsification with implantation of a posterior chamber intraocular lens was performed by a total of five surgeons. Intraoperative complications (zonular dialysis and/or vitreous loss) were correlated with preoperative findings including ultrasound dimensions. Multivariate logistic regression analysis with a generalized estimating equations method was used for statistical analysis. RESULTS: Intraoperative complications occurred in 12 eyes (6.9%) of 11 patients. The anterior chamber was significantly shallower in eyes with than in eyes without complications (mean, 2.36 +/- 0.44 mm vs 2.74 +/- 0.52 mm; P =.013). The differences in lens thickness (4.93 +/- 0.55 mm vs 4.72 +/- 0.54 mm; P =.30) and the differences in axial length (22.92 +/- 1.09 mm vs 23.66 +/- 1.36 mm; P =.07) between the two groups did not reach statistical significance. In eyes with pseudoexfoliation, an anterior chamber depth of less than 2.5 mm was associated with a risk of 13.4% for intraoperative complications compared with an overall incidence of intraoperative complications of 6.9% and an incidence of 2.8% for an anterior chamber depth of 2.5 mm or more. CONCLUSIONS: A small anterior chamber depth may indicate zonular instability in eyes with pseudoexfoliation syndrome and should alert the cataract surgeon to the possibility of intraoperative complications.

Aged↗
PubMed2000

Quantification of aqueous melanin granules, intraocular pressure and glaucomatous damage in primary pigment dispersion syndrome.

OBJECTIVE: Aqueous melanin granules may be accurately quantified with the laser flare-cell meter and have been demonstrated to be increased in primary pigment dispersion syndrome (PDS). It was the aim of this study to correlate intraocular pressure, glaucomatous damage of the optic nerve head, and visual field defects with the number of aqueous melanin granules in PDS. DESIGN: Cross-sectional study. PARTICIPANTS: Thirty-nine eyes of 21 patients with PDS and either ocular hypertension or pigmentary glaucoma. MAIN OUTCOME MEASURES: A 24-hour intraocular pressure (IOP) profile, automated perimetry (Octopus G1), and analysis of photostereographs and HRT (Heidelberg Retina Tomograph) images of the optic disc were performed. Aqueous melanin granules were quantified using the cell count mode of the laser flare-cell meter (KOWA FC-1000) with undilated and dilated pupils. Granule counts were correlated with maximum and mean IOP, maximum range (amplitude) of IOP, mean defect of automated perimetry (G1-program), and damage to the optic disc was measured with the HRT. RESULTS: The number of aqueous melanin granules showed a strong correlation with maximum IOP in both undilated (r = 0.72, P < 0.001) and dilated eyes (r = 0.5, P = 0.02). A marginal correlation was found with the IOP range (r = 0.43, P = 0.04) and the mean defect of automated perimetry (r = 0.41, P = 0.06) in undilated eyes. The mean IOP and HRT measurements of the optic disc (area, volume of the neuroretinal rim, third moment in contour) showed no statistically significant correlation with the number of aqueous melanin granules (r < 0.4, P > 0.2). CONCLUSIONS: A larger number of aqueous melanin granules is strongly associated with high IOP and also with visual field loss, providing additional evidence of the relation between aqueous melanin dispersion and development of pigmentary glaucoma. Quantification of aqueous melanin granules with the laser flare-cell meter might be useful for evaluation of treatment effects, including laser iridotomy, in patients with PDS.

Adult↗
PubMed2000

Lens opacities after nonmechanical versus mechanical corneal trephination for keratoplasty in keratoconus.

PURPOSE: To compare the lens opacity formation after penetrating keratoplasty (PKP) using nonmechanical excimer laser corneal trephination and mechanical motor trephination. SETTTING: University Eye Clinic, University of Erlangen-Nürnberg, Erlangen, Germany. METHODS: Ninety-six patients with keratoconus (96 eyes) and clear crystalline lenses were randomly assigned to the nonmechanical trephination (NMT) group (n = 46; 35 men; mean age 38.2 years +/- 10.8 [SD]) or the mechanical trephination (MT) group (n = 50; 35 men; mean age 34.4 +/- 9.0 years). Suturing and postoperative treatment were identical. Dilated pupil biomicroscopy and slitlamp lens photography were performed preoperatively and postoperatively at 3 month intervals. Opacities were identified as cortical, nuclear, and posterior subcapsular and graded from 1 (mild) to 3 (severe). RESULTS: Mean follow-up in the NMT/MT group was 3.2 +/- 1.3 years/3.4 +/- 1.1 years. Overall, incident opacities appeared in 23.9%/32.0% of eyes (4.3%/6.0% cortical; 19. 6%/26.0% posterior subcapsular; 0%/0% nuclear) (P =.833). All cortical opacities in both groups were grade 1; posterior subcapsular opacities were grade 1 in 66.6%/61.5% of eyes and grade 2 in 22.2%/30.8% of eyes. One patient in each group presented grade 3 posterior subcapsular opacities. No differences between trephination methods were seen in a 5 year Kaplan-Meier cumulative risk of lens opacity formation (P =.763 cortical, P =.530 posterior subcapsular). CONCLUSIONS: In addition to its optical advantages, nonmechanical corneal trephination appears to have no adverse impact on cataract formation after PKP for keratoconus.

Adolescent↗
PubMed2000

[Analysis of the blood aqueous barrier by measurement of aqueous flare in 31 eyes with Fuchs' heterochromic uveitis with and without secondary open-angle glaucoma].

BACKGROUND: Fuchs' heterochromic uveitis is characterized by low-grade intraocular inflammation and a relatively benign clinical course. It was the aim of this study to quantitatively determine alterations of the blood-aqueous barrier in this disease by measuring the aqueous flare. METHODS: 31 affected eyes of 31 patients with the characteristic clinical picture of Fuchs' heterochromic uveitis, 31 apparently unaffected contralateral eyes, and 120 age and sex-matched normal control eyes were included in this retrospective study. Five of the eyes with Fuchs' heterochromic uveitis showed signs of secondary open-angle glaucoma. Determination of aqueous flare was performed in all eyes using the laser flare-cell meter FC-1000 (Kowa, Japan) after pupillary dilation. RESULTS: Aqueous flare values were moderately but significantly increased in eyes with Fuchs' heterochromic uveitis (mean 12.1 +/- 3.6 photon counts/ms) in comparison to normal control eyes (4.1 +/- 1.3 photon counts/ms, p < 0.001). Flare values of apparently unaffected contralateral eyes (mean 3.9 +/- 1.1 photon counts/ms) did not differ from normal control eyes (p = 0.5). In the group of eyes with Fuchs' heterochromic uveitis, aqueous flare was comparable in eyes with and without secondary open angle glaucoma (11.9 +/- 2.5 versus 12.1 +/- 3.8 photon counts/ms, p = 0.9). CONCLUSION: The alteration of the blood-aqueous barrier in patients with Fuchs' heterochromic uveitis is unilateral and relatively mild, corresponding to the well-known clinical picture of the disease. Secondary open-angle glaucoma appears not to be associated with additional increase of aqueous flare. The unilaterality and the relatively homogeneous distribution of the degree of increased aqueous flare values support the clinical impression that Fuchs' heterochromic uveitis is a distinct clinical entity that should be differentiated from other variants of chronic anterior uveitis.

Adolescent↗
PubMed2000

[Interim results from the prospective "Erlanger Non-high-risk Penetrating Keratoplasty Study" in 207 patients].

BACKGROUND: Immunologic graft rejection targeted against corneal endothelium is the most frequent cause for graft failure after corneal transplantation. The purpose of this prospective study was to assess the frequency, early symptoms, prophylaxis and therapy monitoring of corneal graft rejection following non-high-risk penetrating keratoplasty (PK). PATIENTS AND METHODS: From February 1997 to May 1999, 237 patients undergoing non-high-risk PK have been enrolled in this prospective study. We evaluated 207 patients (103 female, 113 right eyes, recipient age 54 +/- 20 years, donor age 59 +/- 17 years). In 2 randomized treatment studies we compared the efficacy of postoperative short-term (ST = 6 months) versus long-term (LT = 12 months) topical steroid therapy on the incidence of graft rejection and the effect of high- versus low-dose systemic steroid therapy on the prognosis after a graft rejection. Follow-up examinations included, laser-tyndallometry, corneal topography analysis, endothelial cell count and pachymetry. RESULTS: The main indications for PK were keratoconus (n = 93), endothelial dystrophy Fuchs (n = 52) and bullous keratopathy (n = 35). In 151 (73%) patients, non mechanical trephination with the 193 nm Excimer laser was performed. Up to now, 78 patients were randomized into two groups comparing the postoperative therapy with topical steroids. During follow-up (median: ST: 13.5 months; LT: 12.5 months, maximum 25.3 months) episodes of endothelial graft rejection (3 chronic focal, 8 acute diffuse) showed 11 eyes of 11 patients. Five patients each had short-term and long-term topical steroid treatment. In 1 patient the graft rejection occurred before randomization at 6 months. Six patients with graft rejection episodes underwent a PK only (54% of graft rejections, 4.4% of all patients). In the remaining 5 patients, PK was combined with a lens surgery (46% of graft rejections, 6.9% of all patients). Ten of 11 corneal grafts regained their full function under treatment with systemic and local steroids. CONCLUSION: The frequency of episodes of graft rejection in our study was lower than usually reported in the literature. A good compliance of patients appears to be a major factor for improved prognosis of the graft after PK and in case of graft rejection. Until now no significant differences between short-term or long-term postoperative topical steroid therapy could be detected regarding the incidence of corneal graft rejection.

Administration, Oral↗
PubMed2000

[Blood-aqueous barrier after phacoemulsification with posterior chamber lens implantation; foldable acrylate lens vs PMMA lens-- a clinical study on 46 eyes].

BACKGROUND: Cataract surgery leads to a more or less pronounced postoperative inflammation due to breakdown of the blood-aqueous barrier. This alteration of the blood-aqueous barrier can be reduced by minimally invasive surgery. The purpose of this study was to quantify the early course of the postoperative alteration of the blood-aqueous barrier following phacoemulsification with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. PATIENTS AND METHODS: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous intraocular surgeries were divided into two groups: group 1 (24 patients): phacoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneoscleral tunnel incision); group 2 (22 patients): phacoemulsification with foldable acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardized. Alteration of the blood-aqueous barrier was quantified by the laser flare-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. RESULTS: Preoperative aqueous flare values (photon counts/ms) were comparable in both groups (6.7 +/- 2.7 versus 5.6 +/- 2.7 respectively, p = 0.1). On day 1, aqueous flare in group 1 (9.7 +/- 2.9) was not statistically significantly higher than in group 2 (9.2 +/- 2.2, p = 0.2) and remained relatively constant on day 2 after surgery (9.3 +/- 3.3), whereas the aqueous flare values in group 2 decreased statistically significant (6.7 +/- 2.3, p = 0.01). Postoperatively, there was no statistically significant difference of aqueous flare values between eyes with corneoscleral tunnel incision and eyes with clear corneal incision (p = 0.7) in group 2. CONCLUSIONS: Our study shows that phacoemulsification with foldable IOL implantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especially with preexisting alteration of the blood-aqueous-barrier.

Acrylates↗
PubMed2000

[Mid- and long-term results after trabeculectomy in patients with juvenile and late-juvenile open-angle glaucoma].

BACKGROUND: To determine success rate of trabeculotomy in patients with juvenile and late-juvenile glaucoma in a retrospective study. PATIENTS AND METHODS: 46 eyes of 41 juvenile glaucoma-patients (24 female, 17 male) were submitted to trabeculotomy during the period of 1980-1997. Patients age at the time of surgery was 30.2 +/- 10.5 years (11-49 years, median 21 years). Follow-up time was 35 +/- 46 months (1-155 months). RESULTS: Median preoperative visual acuity was 1.0 (range 0.002 to 1.25), postoperative visual acuity at the end of the follow up period was 0.8 (median) with a range from 0.002 to 1.2. In all patients preoperative intraocular pressure was elevated and a glaucomatous configuration of the optic disc was noticed. Preoperative intraocular pressure (IOP) ranged from 30.5 +/- 13.2 mm Hg, after surgery IOP was 16.2 +/- 5 mm Hg. Mean decrease of the IOP postoperatively was 54.4%. In 37% of the eyes IOP was lower than 23 mm Hg without additional medication, in 47% of the eyes IOP was lower than 23 mm Hg with additional medication. In 8 eyes additional antiglaucoma-surgery was necessary. After a follow-up time of 60 months 81% of the patients (n = 37 eyes) had an IOP below 23 mm Hg, after 120 months in 80% of the patients (n = 29 eyes) IOP was below 23 mm Hg. CONCLUSION: The success rate of trabeculotomy (defined as the ability to lower intraocular pressure lower than 23 mm Hg with or without antiglaucoma medication) in our patients is 84%. After second operation, success rate is 89%. Trabeculotomy for patients with juvenile open angle glaucoma is a safe procedure and avoids problems and complications of filtering procedures.

Adult↗
PubMed2000

[Frequency and risk factors of intraocular pressure increase after penetrating keratoplasty].

PURPOSE: The aim of this study was to evaluate the incidence, risk factors and management of glaucoma following penetrating keratoplasty (PK) and to check for possible correlations with the indication for PK. PATIENTS AND METHODS: 534 eyes of 483 patients (age 54.7 +/- 19.8 years), that had undergone PK from 1989 to 1999 were retrospectively analyzed. The mean follow-up was 2.7 +/- 1.8 years. According to the type of surgical procedure patients were classified in 5 groups: group 1) PK only (n = 291); group 2) PK combined with extracapsular cataract extraction and intraocular lens (IOL) implantation (n = 124); group 3) PK combined with secundary IOL-implantation or IOL-change (n = 32); group 4) PK only after previous cataract surgery (n = 55) and group 5) Cataract surgery after PK (n = 32). The trephination was performed from the epithelial side in donor and recipient either by nonmechanical trephination with the 193 nm excimer laser (n = 444) or mechanical trephination (n = 90). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroids was standardized. RESULTS: Preoperatively, glaucoma was diagnosed in 3.2% for all patients with groups 3 und 4 showing a significantly larger number of glaucomatous eyes (15.6% and 18.9%). Most of the mild early intraocular pressure elevations in group 1 (3.4%) and group 2 (3.0%) were controlled after 6 months (0.5% and 1.1%). Groups 3 and 4 showed most frequently increased intraocular pressure and/or antiglaucomatous treatment (21.4% and 18.7%) six weeks postoperatively. Patients in all groups showed no higher prevalence of persistent glaucoma from six months postoperatively than preoperatively throughout the follow-up period. Again groups 3 and 4 presented the largest number of persistent glaucoma. In most eyes the IOP was controlled by topical antiglaucomatous treatment. Serious forms seen in 2 patients with anterior synechiae caused by anterior chamber lens required several filtering surgeries or pars plicata diathermy, respectively. One patient with pseudoexfoliation syndrome required laser trabeculoplasty. The so-called "Urrets-Zavalia syndrome" was seen in none of the patients. CONCLUSION: The development of increased intraocular pressure after PK varied with the indication for keratoplasty. Postkeratoplasty glaucoma seems to be strongly associated with preexisting anterior synechiae and/or simultaneous anterior chamber lens implant removal. Intraoperative iridotomy can prevent the development of acute angle closure glaucoma after keratoplasty.

Adult↗
PubMed2000

[Immunophenotype classification of macular corneal dystrophy: first case report of immunophenotype I A outside of Saudi Arabia. A clinical histopathological correlation with immunohistochemistry and electron microscopy].

BACKGROUND: Macular corneal dystrophy can be classified into three different immunophenotypes according to presence and distribution of sulfated keratan sulfate (SKS) in the cornea and serum levels of SKS. Immunophenotype I A has yet only been reported in patients with macular corneal dystrophy from Saudi Arabia. MATERIAL AND METHODS: Case report of a patient with macular corneal dystrophy type I A from Germany. Indirect immunohistochemistry for sulfated keratan sulfate was performed on the corneal buttons obtained after perforating keratoplasty (monoclonal antibodies 3D12/H7 and 5-D-4). The serum concentration of SKS was determined using the monoclonal antibody 5-D-4 in a serum antigen-inhibition assay. Immunogold labeling with the 5-D-4 antibody was performed to allow ultrastructural localization of SKS in the cornea. RESULTS: The patient demonstrated the typical clinical picture of macular corneal dystrophy. Serum levels of SKS were not detectable. Positive immunohistochemistry for SKS was found only within single keratocytes of both corneae without staining of the stroma (3D12/H7 and 5-D-4). Immunogold labeling localized SKS within stromal keratocytes and proved this patient to suffer from macular corneal dystrophy immunophenotype I A. CONCLUSION: Macular corneal dystrophy immunophenotype I A can be found outside Saudi Arabia in a German patient. All three immunophenotypes of macular corneal dystrophy are present in corneal buttons from German patients.

Adult↗
PubMed2000

[Regression analysis of corneal endothelium after nonmechanical penetrating keratoplasty].

PURPOSE: The corneal endothelial cell density is a crucial parameter for the pump function and the transparency of grafts after penetrating keratoplasty (PK). The purpose of this study was to assess corneal endothelial cell density with different regression models after nonmechanical penetrating keratoplasty and to check for differences between diagnoses and two different storage methods. PATIENTS AND METHODS: Two-hundred ninety-six eyes (195 keratoconus, 101 Fuchs' dystrophies, 148 each with short-term preserved and organ-cultured donor corneas) of 268 patients were included in this prospective study. Donor and recipient trephination was performed using nonmechanical trephination technique with the excimer laser 193 nm along metal aperture masks from the epithelial side. The time course of the endothelial cell density (specular microscope EM 1100, TOMEY, Erlangen) after PK was assessed. Endothelial cell density was first analyzed in a cross sectional manner at the 3, 6, 12, 18 and 24 months follow-up and, secondly in a longitudinal manner with linear, polynomial and exponential regression models in the sense of minimizing the residuum (distance between observed and predicted endothelial cell count). The mean donor postmortem time was 10.3 +/- 6.8 hours for short-term-preserved and 19.6 +/- 9.5 hours for organ-cultured corneas (p < 0.0001). The storage time was 63 +/- 49 and 19 +/- 7 days (p < 0.0001), respectively. RESULTS: In a cross section, overall mean endothelial cell density decreased from 2145 +/- 599 cells/mm2 at the 3 months to 1751 +/- 605 cells/mm2 at 2 years follow-up (p > 0.05). Cell density did not differ significantly between different diagnoses or storage methods at any postoperative stage. In a longitudinal section, the linear regression model estimated an annual decrease of 214 cells/mm2. In a polynomial model the decrease expressed by a tangent to the regression line at 24 months was 175 cells/mm2. The exponential regression model yielded a relative decrease of 9.5% annually. The so-called residuum as a measure for the validity of the regression model was maximal in the linear and minimal in the exponential estimate. With keratoconus and short-term preserved donor material the endothelial cell loss was less in the regression analysis. CONCLUSION: During the first two years after nonmechanical trephination in PK, a non-significant decrease in endothelial cell density was observed. The exponential regression model seems to be predestinated for analysis of the time course of corneal endothelium in a longitudinal manner. The annual cell loss ranged around 9.5% without significant differences between diagnoses and storage methods.

Adolescent↗
PubMed2000

[Latent TGF-beta 1 binding protein (LTBP-1); a new marker for intra-and extraocular PEX deposits].

BACKGROUND: Pseudoexfoliation (PEX) syndrome is a generalized process of the extracellular matrix characterized by the accumulation of an abnormal pathognomonic material in various intraocular and extraocular tissues. Whereas the intraocular manifestations can be directly diagnosed by biomicroscopic observations, the extraocular manifestations can presently only be diagnosed by electron microscopic methodology. In order to better evaluate the distribution and precise localization of PEX deposits in the various organ systems, we searched for a relatively specific immunohistochemical marker for PEX material on the light microscopic level. MATERIAL AND METHODS: Eyes and tissue specimens of various organ systems (skin, heart, lungs, liver, kidney, abdominal aorta, cerebral artery, plexus choroideus, meninges) obtained from 4 organ donors with ocular PEX syndrome and age-matched control tissues were investigated by electron microscopy and immunohistochemistry using antibodies against various elastic microfibrillar components. RESULTS: Out of a panel of antibodies tested, the immunolabeling of both intra- and extraocular PEX deposits with antibodies against latent TGF-beta 1 binding protein (LTBP-1) was particularly prominent. In addition to the known intraocular sites of PEX material accumulations, focal plaque-like LTBP-1 positive deposits could be observed in the conjunctival stroma, optic nerve meninges, skin, heart muscle, lungs, kidney as well as in the adventitia of the aorta and cerebral artery from donors with PEX syndrome; such plaque-like deposits positive for LTBP-1 were not present in the control tissues. Transmission electron microscopy confirmed the presence of typical fibrillar PEX aggregates in the respective tissues. CONCLUSIONS: Antibodies against LTBP-1 provide a new and relatively specific marker for PEX deposits both in intraocular and extraocular locations. Systematic screening of PEX accumulations in a larger number of extraocular tissue specimens obtained from PEX patients may help to elucidate the functional implications and consequences of the systemic manifestations.

Aged↗
PubMed2000

[Laser tyndallometry and monitoring of treatment in 20 children with juvenile uveitis].

BACKGROUND: Treatment of children with juvenile uveitis requires adequate control of inflammation while minimizing systemic or ocular side effects. The study was performed to evaluate the potential use of the laser flare-cell meter in monitoring and adjustment of therapy in juvenile uveitis. PATIENTS AND METHODS: Retrospectively, we monitored 20 children (11 girls and 9 boys) with an age range from 3 to 15 years presenting with juvenile iridocyclitis (10/20), intermediate (5/20) or posterior (5/20) uveitis. During the follow-up period (median 25.2 months, range: 2 to 83 months) multiple clinical controls were performed. We recorded clinical data, present therapy, and measurements using the laser flare-cell meter (Kowa FC-1000). RESULTS: Laser flare-cell meter measurements were easily obtained and highly reliable even in these young patients. During follow-up, 36 recurrences of intraocular inflammation were detected in 19 eyes. Relapses of inflammation as well as a response to treatment were seen at an early stage. Semiquantitative observations of cells and aqueous flare in the anterior chamber, or visual acuity of patients were less reliable in predicting recurrences. CONCLUSIONS: Laser tyndallometry offers a reliable, examiner-independent method to assess intraocular inflammation in children with juvenile uveitis and to adjust the necessary treatment.

Adolescent↗
PubMed2000

Immunohistochemical localization of vascular endothelial growth factor, transforming growth factor alpha, and transforming growth factor beta1 in human corneas with neovascularization.

PURPOSE: To analyze presence and distribution of vascular endothelial growth factor (VEGF), transforming growth factor (TGF)alpha, and TGFbeta1 in human corneas with neovascularization due to different corneal diseases. METHODS: Indirect immunohistochemistry for VEGF, TGFalpha, and TGFbeta1, was performed on paraffin-embedded corneas obtained by keratoplasty. Corneas from each of the four main groups of histopathologic diagnoses associated with corneal neovascularization were analyzed (scarring after keratitis, graft rejection/insufficiency, acute necrotizing keratitis, scarring after mechanical/chemical injury). Subclassification of inflammatory infiltrates was done using immunohistochemistry for CD3 (T-lymphocytes) and CD68 (macrophages). RESULTS: The analyzed angiogenic factors were detectable in corneas from all four histopathologic groups in a similar distribution; capillary endothelial cells, stromal and intravascular inflammatory cells (T-lymphocytes, macrophages), and basal corneal epithelial cells stained positive for the tested angiogenic factors. CONCLUSION: The angiogenic factors VEGF, TGFalpha, and TGFbeta1 are detectable in human corneas with neovascularization. Their distribution is quite uniform in different corneal diseases, resulting in corneal angiogenesis. An antiangiogenic therapy inhibiting corneal neovascularization by antagonizing angiogenic factors would have to counteract several angiogenic factors.

Antigens, CD↗
PubMed1999

Recurrent macular corneal dystrophy type II 49 years after penetrating keratoplasty.

Recurrence of macular corneal dystrophy after keratoplasty is rare. We report light microscopic, immunohistochemical, electron microscopic, and serologic findings in a 78-year-old woman who underwent regrafting 49 years following the first penetrating keratoplasty. Examination of the corneal button revealed deposits of glycosaminoglycans in the graft beneath the Bowman layer, throughout the stroma, and in the endothelium with positive staining for antigenic keratan sulfate. By transmission electron microscopy, intracellular and extracellular deposits of a fibrillogranular material were detected in the stroma, Descemet membrane, and endothelium. The serum level of antigenic keratan sulfate was normal. Our findings indicate that macular corneal dystrophy type II may show late recurrence after penetrating keratoplasty with intense deposition of antigenic keratan sulfate in all corneal layers.

Aged↗
PubMed1999

Quantification of aqueous flare after phacoemulsification with intraocular lens implantation in eyes with pseudoexfoliation syndrome.

BACKGROUND: Impairment of the blood-aqueous barrier is a frequent finding in eyes with pseudoexfoliation syndrome (PEX). OBJECTIVE: To perform noninvasive quantification of aqueous flare using the laser flare-cell meter to analyze blood-aqueous barrier breakdown following phacoemulsification with intraocular lens implantation in eyes with and without PEX. METHODS: After other conditions that might account for impairment of the blood-aqueous barrier were excluded, 11 eyes with PEX and 11 eyes with senile cataract without PEX were included in the study. Aqueous flare was quantitatively determined using a laser flare-cell meter preoperatively as well as 1, 3, and 5 days postoperatively. Phacoemulsification with posterior chamber intraocular lens implantation was performed by one surgeon. RESULTS: On the first postoperative day, flare values (calculated as mean+/-SD photon counts per millisecond) in eyes with PEX were higher (42.2+/-21.3) than in eyes without PEX (30.6+/-15.1) (P>.05). On days 3 and 5, postoperative flare values decreased slowly in eyes with PEX (23.9+/-7.4 and 21.2+/-5.7 photon counts per millisecond, respectively) and were significantly higher than in eyes without PEX (14.8+/-5.4 and 10.5+/-1.4 photon counts per millisecond, respectively) (P<.05). CONCLUSIONS: Breakdown of the blood-aqueous barrier is significantly more extensive in eyes with PEX and may be an important risk factor for early postoperative complications. The altered response to surgery should be considered in eyes with PEX.

Aged↗