Primary corneal graft failure.
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Corneal Diseases↗
Biomedical subjects
M Küchle
Publications and source records attributed to M Küchle.
Blood-aqueous barrier in pseudoexfoliation syndrome: evaluation by immunohistochemical staining of endogenous albumin.
BACKGROUND: Alterations of the integrity of the blood-aqueous barrier (BAB) are frequent findings in eyes with pseudoexfoliation syndrome (PSX). METHODS: Immunohistochemical staining for the demonstration of albumin was used to analyze the BAB in 10 eyes with PSX without previous intraocular surgery and in 10 age-matched normal control eyes. RESULTS: In eyes with PSX, small amounts of albumin were detected along the anterior surface of the iris in 7, in the anterior chamber in 1, along the ciliary epithelium in 4, and in the trabecular meshwork in 9 of 10 eyes. PSX material was also immunoreactive. In the 10 normal control eyes, albumin was detected anterior to the iris stroma in 1 eye, in the anterior chamber in 2 eyes, in the trabecular meshwork in 1 eye, but not internal to the ciliary epithelium. CONCLUSIONS: Our findings indicate that impairment of the BAB in PSX can be localized at the level of the iris and, less frequently or to a lesser extent, at the level of the ciliary body.
Aged↗
[Combined true exfoliation and pseudoexfoliation of the anterior lens capsule].
BACKGROUND: True exfoliation of the lens capsule is rare, and its occurrence with pseudoexfoliation in the same eye is very unusual. CASE REPORT: An 81-year-old female presented with bilateral cataracts and a history of working with ceramics in her home kiln. Slit-lamp examination revealed pseudoexfoliation. She underwent intracapsular cataract extraction and sector iridectomy in both eyes. Light and electron microscopy of the lenses revealed a central area of splitting of the anterior lens capsule into a thin anterior and a thicker posterior layer, and deposits pseudoexfoliation material on the anterior lens capsule, on the iris pigment epithelium, and in the iris stroma. CONCLUSIONS: We interpret our findings as representing a combination of true exfoliation and pseudoexfoliation, but we did not observe any signs that might indicate a correlation or a common pathogenesis of the two conditions. Although they may occur in one eye, true exfoliation of the lens capsule and pseudoexfoliation are two unrelated distinct entities.
Aged↗
[Tyndallometry for follow-up of iodine-125 brachytherapy of uveal malignant melanomas. Report of 2 patients].
BACKGROUND: Previous studies that used the noninvasive laser flare-cell meter (LFCM) have demonstrated impairment of the blood-aqueous barriers in eyes with uveal melanoma. Herein we report the use of the LFCM in the follow-up of brachytherapy in 2 patients after radiation therapy with iodine 125 for choroidal melanoma. CASE REPORT: Two women (59-and 57-years-old) with choroidal melanoma who were treated with iodine 125-plaque, were followed-up for 24 and 36 months, respectively. Complete ophthalmological examination including tyndallometry and echography were performed regularly. Following radiation, patient 1 showed decreasing flare values, that returned to normal level one year after radiation (5.9 photon counts/ms). The decrease in flare values correlated with fundoscopic and ultrasonographic signs of tumor regression. After 14 months, flare values suddenly increased up to 15 photon counts/ms, and fluorescein angiography revealed signs of radiation retinopathy. In patient 2, flare values (18.0 photon counts/ms) did not decrease after radiation but showed further increase one year after radiation (39.0 photon counts/ms). Slitlamp biomicroscopy revealed segmental iris neovascularization from 6 to 9 hours, corresponding to the site of the previous plaque application. CONCLUSIONS: Measurement of aqueous flare with the LFCM appears to be a useful ancillary diagnostic method in following patients after radiation therapy for uveal melanoma. In eyes that show an increase of aqueous flare months or years after radiation therapy, recurrence of the tumor, radiation retinopathy and iris neovascularization should be excluded.
Blood-Aqueous Barrier↗
Epithelial ingrowth: a study of 207 histopathologically proven cases.
Epithelial ingrowth is a major complication of penetrating trauma or intraocular surgery. The present study was undertaken to analyze the clinical and histopathologic findings in a large series of consecutive patients. All cases of epithelial ingrowth on file in the Eye Pathology Laboratory of the Wilmer Ophthalmological Institute, Johns Hopkins Hospital, were included. Histopathologic slides of 207 consecutive cases of epithelial ingrowth were reviewed and, where necessary, additional sectioning and staining was performed. Transmission electron microscopy was performed in 15 cases and immunohistochemistry, in 28 cases. The histopathologic specimens included globes (46), corneal buttons (64), iris tissue (87), and block excisions (7). The causes of epithelial ingrowth were penetrating trauma (48), cataract surgery (123), keratoplasty (21), and others (15). There was a wide spectrum of presenting signs and symptoms, most frequently glaucoma (35), fistula (34), retrocorneal membrane (31), "uveitis" (29), iris cyst formation (28), pain (25), bullous keratopathy (20), and corneal graft failure (19). Glaucoma was present in 43.1% of eyes and fistula and/or wound dehiscence was present in 29 eyes. Epithelial ingrowth was cystic in 40 cases and diffuse in 167 and was not suspected prior to histopathologic examination in 36% of cases. Histologically a multilayer of surface epithelium was present on intraocular surfaces such as the cornea, iris, chamber angle, ciliary body, lens capsule, and Bruch's membrane. Epithelial ingrowth may present with a wide variety of often uncharacteristic signs and symptoms and should always be included in the differential diagnosis of unusual posttraumatic or postoperative findings.
Adolescent↗
Spontaneous dislocation of the lens in pseudoexfoliation syndrome.
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Aged↗
Immunohistochemical evaluation of the integrity of the blood-aqueous barrier in normal and rubeotic human eyes.
BACKGROUND: The integrity of the blood-aqueous barrier (BAB) was analyzed using an immunohistochemical technique for the demonstration of albumin. METHODS: Paraffin sections of 36 normal eyes obtained from eye banks or at autopsy (mean age 62.8 +/- 15.2 years) and 46 eyes with marked iris neovascularization (mean age 54.6 +/- 25.3 years) were formalin-fixed and examined using rabbit anti-human albumin. RESULTS: In normal eyes, albumin staining was found in the iris stroma inside and outside the iris vessels but was not detected across the anterior iris border; albumin was present in the anterior chamber in one eye, but not internal to the nonpigmented ciliary epithelium. In rubeotic eyes, albumin staining extended along the anterior iris in all 46 cases; albumin was demonstrated in the anterior chamber in 31 eyes and along to the nonpigmented ciliary epithelium in 13 eyes. Differences between normal and rubeotic eyes were significant for intensity of albumin staining in the iris stroma and for presence of albumin along the anterior iris, within the anterior chamber, and along the ciliary epithelium (P < 0.001, chi 2 test). CONCLUSION: Our findings indicate that the BAB may be less resistant to leakage in the iris stroma than at the ciliary epithelium. BAB breakdown in rubeotic eyes occurred mainly in the iris; the ciliary epithelium was much less involved. Immunohistochemical staining for albumin appears to be useful for evaluating the integrity of the BAB in human pathologic specimens.
Adolescent↗
Studies of the blood-aqueous barrier in diabetes mellitus.
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Aqueous Humor↗
Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients.
BACKGROUND: Traumatic or postoperative cyclodialysis frequently is associated with persisting ocular hypotony, causing morphologic changes and visual loss. METHODS: The authors retrospectively analyzed the data of 29 eyes of 29 patients who underwent consecutive direct surgical cyclopexy for hypotonus cyclodialysis between 1980 and 1993 at the authors' institution. Cyclopexy was performed by directly suturing the ciliary body to the scleral spur under a scleral flap. RESULTS: The cyclodialysis clefts were posttraumatic (26 eyes) or postsurgical (3 eyes), extended for 3.6 +/- 1.7 clock hours (range, 1.5-9.5 clock hours), and were most frequently located superiorly. In eight eyes, argon laser photocoagulation of the cyclodialysis cleft (1-11 sessions) was performed before surgical cyclopexy but failed to permanently close the clefts. Preoperatively, all eyes showed persisting ocular hypotony with intraocular pressure of 3.1 +/- 2.3 mmHg (range, 0-8 mm Hg), macular edema, and disc swelling. Postoperatively, intraocular pressure was 14.0 +/- 3.7 mmHg (range, 6-20 mmHg), and visual acuity improved in 25 eyes (86%) and remained unchanged in 4 (14%) because of posttraumatic posterior segment problems. In 14 eyes, painful reversible pressure spikes of up to 58 mmHg developed during the first postoperative days, but no persisting secondary glaucoma was observed during further follow-up of 37.7 +/- 35.9 months (range, 2-134 months). All ten phakic eyes that were refracted preoperatively and postoperatively showed hyperopic shifts of more than 1 diopter after cyclopexy. CONCLUSIONS: Direct surgical cyclopexy is a successful treatment for large hypotonus cyclodialysis clefts that are unresponsive to or too large for laser photocoagulation. Painful early postoperative pressure spikes are frequent, but the development of glaucoma seems to be very uncommon. Postoperative visual acuity may be compromised due to posterior segment sequelae of preceding ocular trauma.
Adult↗
Reevaluation of corneal dystrophies of Bowman's layer and the anterior stroma (Reis-Bücklers and Thiel-Behnke types): a light and electron microscopic study of eight corneas and a review of the literature.
To clarify whether Reis-Bücklers' and Thiel-Behnke's corneal dystrophies are one entity or whether two distinct corneal dystrophies of Bowman's layer and the superficial stroma (CDB) exist, 28 corneal specimens with clinically suspected diagnosis of CDB were examined by light and electron microscopy, and the literature was reviewed. Eight specimens came from patients with a honeycomb-shaped pattern of opacities at the level of Bowman's layer. Study of those eight specimens disclosed destruction of Bowman's layer, a subepithelial fibrocellular tissue with an undulant configuration, absence of the epithelial basement membrane in many areas and the presence of "curly" collagen fibers with a diameter of 9-15 nm. We concluded that two distinct autosomal dominant CDB exist and propose the designations CDB type I (synonyms: geographic or "true" Reis-Bücklers' dystrophy) and CDB type II (synonyms: honeycomb-shaped or Thiel-Behnke's dystrophy). The eight corneas of our series were characterized as CDB type II. CDB I is clinically characterized by confluent geographic opacities at the level of Bowman's layer, histopathologically by bandshaped granular Masson-positive subepithelial deposits, and ultrastructurally by the presence of "rod-shaped bodies" and may be a superficial variant of granular dystrophy. Visual loss is significantly greater in CDB I, and recurrences after keratoplasty or keratectomy seem to be earlier and more extensive in CDB I. Most cases reported thus far in the literature as "Reis-Bücklers' dystrophy" are CDB II (honeycomb-shaped or Thiel-Behnke's dystrophy).
Adult↗
The blood-aqueous barrier in eyes with pseudoexfoliation syndrome.
UNLABELLED: Eyes with pseudoexfoliation syndrome (PEX) frequently show clinical signs of impairment of the blood-aqueous barrier. Herein we give an overview of recent studies that analyzed the blood-aqueous barrier in eyes with PEX. METHODS: The authors review and summarize recent studies including quantification of aqueous flare in eyes with PEX using the laser flare cell meter (LFCM; Kowa FC-1000) in comparison with normal eyes and eyes with primary open-angle glaucoma (POAG), quantification of aqueous flare in eyes with PEX with and without secondary open-angle glaucoma (SOAG), and quantitative biochemical determination of total aqueous protein concentration in PEX eyes. In addition, studies of noninvasive quantification of the blood-aqueous barrier breakdown following trabeculectomy and following phacoemulsification with intraocular lens implantation in eyes with and without PEX are reviewed. RESULTS: In eyes with manifest PEX, both aqueous flare and aqueous protein concentration were significantly increased in comparison with normal control eyes and eyes with POAG. Flare values in PEX eyes with SOAG were not significantly different from flare values in PEX eyes without SOAG. Following trabeculectomy as well as following cataract surgery, breakdown of the blood-aqueous barrier as determined by quantification of aqueous flare was significantly higher in eyes with PEX than in eyes without PEX. CONCLUSIONS: Impairment of the blood-aqueous barrier with increase in aqueous protein concentration is a feature of PEX and may be quantified both by flare measurement and by biochemical protein determination. The extensive blood-aqueous barrier breakdown in eyes with PEX following intraocular surgery is an important risk factor for early or late postoperative complications. The alterations of the blood-aqueous barrier should be considered in the medical and surgical treatment of eyes with PEX.
Aged↗
Aqueous flare and retinal capillary changes in eyes with diabetic retinopathy.
We examined 112 eyes of 112 adult-onset diabetic patients by fundus fluorescein angiography and with the laser flare cell meter (LFCM) in order to evaluate the possible correlation between retinal capillary changes and aqueous flare. Diabetic eyes were divided into the following groups: minor background diabetic retinopathy (MDR), nonproliferative diabetic retinopathy with predominant capillary occlusion (ONP), nonproliferative diabetic retinopathy with predominant capillary dilation and exudation (ENP) and proliferative diabetic retinopathy (PDR). 108 age-matched eyes of 108 normal subjects were used as control group. Flare values (photon counts/ms) of all diabetic groups (MDR 9.01 +/- 0.79, ONP 13.66 +/- 3.22, ENP 16.43 +/- 5.55, PDR 18.57 +/- 6.99) were significantly higher than in the normal control group (4.28 +/- 1.14, p < 0.0001). Significant differences were found between ONP and ENP (p = 0.008) and between ONP and PDR (p = 0.0001) but not between ENP and PDR (p = 0.4). Our results indicate that there is a correlation between aqueous flare and the type of angiographic retinal capillary changes with higher flare values in eyes with retinal capillary dilatation and exudation. Measurements with LFCM may be useful to quantify the extent and severity of capillary alterations in diabetic eyes.
Adult↗
Blood-ocular barrier breakdown in eyes with ocular melanoma. A potential role for vascular endothelial growth factor/vascular permeability factor.
A series of 130 eyes with ocular melanomas, 19 normal eyes, and 18 eyes affected with other disorders leading to blood-ocular barrier (BOB) breakdown were immunohistochemically stained for albumin to localize sites of BOB failure within the retina, ciliary body, and iris. Thirty-nine of the eyes containing melanomas and all of the other eyes were also immunohistochemically stained for vascular endothelial growth factor (VEGF), to investigate its potential role as a mediator for BOB failure. Eyes with melanomas showed widespread leakage through the retinal pigment epithelium, and 58% demonstrated leakage from retinal vessels in the proximity of the tumor. BOB failure remote from the tumor also occurred in retina (50%), optic nerve head (77%), ciliary body (51%), and iris (51%), suggesting that a soluble mediator may be involved. VEGF was demonstrated intraretinally in the proximity of (46%) and remote from (24%) melanomas and in eyes affected by other disease processes, particularly those involving neoplasia or retinal detachments, usually within particular cell populations (ie, retinal vessel walls, ganglion cells, inner or outer nuclear layers, retinal pigment epithelium). VEGF localization in retina, ciliary body, and iris often coincided with sites of extravasated albumin. Preincubation of albumin or VEGF antibodies with normal serum or VEGF peptide, respectively, eliminated or markedly reduced all immunoreactivity. Only 1 of 14 normal postmortem eyes and 0 of 5 normal surgically removed eyes showed VEGF positivity in the retina, 5 of 19 normal eyes had weak positivity in the ciliary body, and VEGF was not demonstrated in the iris of normal eyes. VEGF cannot account for all of the BOB failure associated with ocular melanomas, but appears likely to play a contributing role in many cases.
Blood-Retinal Barrier↗
Epithelial iron line in juvenile corneal arcus lipoides.
Iron lines of the corneal epithelium are well-described phenomena in both normal and pathologic conditions. We found a bilateral corneal epithelial iron line at the inner edge of a juvenile corneal arcus lipoides in an otherwise normal eye of a 38-year-old white man. Possible mechanisms that may have led to the development of this new iron line are discussed.
Adult↗
Blood-retinal barrier breakdown in retinitis pigmentosa: light and electron microscopic immunolocalization.
Macular edema can contribute to visual loss in the retinitis pigmentosa (RP), but the sites and mechanism of blood-retinal barrier (BRB) breakdown leading to macular edema are not known. An understanding of the mechanisms involved could lead to the design of effective pharmacologic therapy to prevent or minimize macular edema in RP. To investigate this problem, immunohistochemical staining for albumin was performed on paraffin sections of 22 normal and 29 RP-affected eyes. Specimens were graded for extent of albumin extravasation in different regions of the retina, optic nerve head, ciliary body, and iris. Electron microscopic immunocytochemical staining for albumin was performed on an additional 6 normal and 9 RP-affected eyes. Two-thirds of the eyes from patients with RP and no other ocular disorders demonstrated extravascular albumin in the inner portion of the posterior retina. This was evident even in the absence of cystoid macular edema (CME), but eyes that had CME showed extensive BRB failure. In some cases, passage of albumin from the choroid to the retina was prevented even in the absence of the retinal pigment epithelium (RPE). Electron microscopic immunocytochemistry revealed that albumin permeated retinal vascular endothelial cells and RPE cells that showed degenerative changes in RP.
Adolescent↗
Quantitative assessment of the blood-aqueous barrier in human eyes with malignant or benign uveal tumors.
We assessed alterations of the blood-aqueous barrier in 43 eyes with malignant melanoma (31 choroidal and 12 ciliary body), 40 eyes with benign uveal tumors, and 199-age matched normal control eyes. Aqueous flare was quantified with the laser flare-cell meter and correlated with clinical and histopathologic findings. Aqueous flare (photon counts/ms) was significantly higher in melanoma eyes (20.91 +/- 12.40) than in eyes with benign tumors (4.26 +/- 1.55) (P < .0001) and normal control eyes (3.99 +/- 1.14) (P < .0001). In melanoma eyes, clinical and histologic findings associated with significantly increased aqueous flare values were as follows: tumor height, serous retinal detachment, tumor necrosis, lymphocytic tumor infiltration, and tumor hemorrhage. Development and growth of uveal melanomas are accompanied by marked alterations of the blood-aqueous barrier. The noninvasive laser flare-cell meter may give useful additional information about malignant and benign uveal tumors.
Aqueous Humor↗
Aqueous flare following penetrating keratoplasty and in corneal graft rejection.
OBJECTIVE: Corneal allograft rejection is a major complication of penetrating keratoplasty (PK). We used the laser flare-cell meter that allows, for the first time, non-invasive quantification of aqueous flare in vivo to analyze alterations of the blood-aqueous barrier following uncomplicated PK and in acute corneal graft rejection. PATIENTS AND METHODS: Examination with the laser flare-cell meter was performed in 67 eyes of 62 patients (mean +/- SD age, 46.2 +/- 15.1 years) 12.8 +/- 13.2 months (range, 5 days to 60 months) after uncomplicated PK, in 82 normal control eyes of 82 age-and gender-matched patients (mean age, 49.0 +/- 17.1 years) and in 10 eyes of 10 patients (mean age, 51.6 +/- 15.1 years) with acute diffuse endothelial corneal graft rejection in nonherpetic eyes 15.1 +/- 12.9 months after PK. RESULTS: Compared with the normal unoperated control group (4.43 +/- 1.13 photon counts/ms), aqueous flare was significantly increased during the first 2 weeks following uncomplicated PK (14.73 +/- 8.30 photon counts/ms; P < .0001) but returned to normal levels more than 6 weeks after surgery (4.48 +/- 1.55 photon counts/ms; P > .1). In acute corneal graft rejection, aqueous flare values (17.10 +/- 6.05 photon counts/ms) increased to significantly higher levels than in eyes following uncomplicated PK and in the normal control group (P < .0001), but decreased significantly 9.5 +/- 3.3 days after treatment with systemic and topical corticosteroids (5.78 +/- 2.16; P < .0005). CONCLUSIONS: Application of the laser flare-cell meter appears promising for following up patients after PK and for detecting early corneal allograft rejection.
Acute Disease↗
Raymond's syndrome following petrosal sinus sampling.
Inferior petrosal sinus sampling (IPSS) is used to evaluate the pituitary-dependency of Cushing's disease, and to predict the laterality of a microadenoma prior to transsphenoidal operation. A serious complication occurred in a 14-year-old boy: he suffered brain stem ischaemia with abducens nerve palsy and hemiparesis (Raymond's syndrome). The case prompted us to reconsider the indication for this investigation.
Abducens Nerve↗