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M Küchle

Publications and source records attributed to M Küchle.

At least 145 records · Page 8Linked to original sources
PubMed1992

Late histopathological findings of neodymium:YAG laser iridotomies in humans.

We studied three sector iridectomy specimens from three patients who had undergone neodymium:YAG (Nd:YAG) laser iridotomies 3 to 5 years earlier for treatment of imminent angle closure glaucoma. The specimens were obtained during cataract extraction and were examined by light and transmission electron microscopy. In all iris specimens, the edges of the iridotomy sites consisted of loosely arranged melanocytes, fibrocytes, and vessels. In the iris stroma, there were numerous pigment-laden cells. The iris vessels appeared to be intact; there were no fibrinous aggregates, no inflammatory response or scarring, nor any signs of proliferation of the iris pigment epithelium. Our findings suggest that in humans, iris wound healing after Nd:YAG laser iridotomy occurs without induction of fibrous scars or proliferation of the iris pigment epithelium. This indicates that there is no tendency toward late closure of the iridotomy sites.

Aged↗
PubMed1992

Precapsular layer of the anterior lens capsule in early pseudoexfoliation syndrome.

We examined a possible correlation between clinical signs of early pseudoexfoliation (PSX) syndrome related to pigment dispersion and iris stroma atrophy and morphological alterations of the lens capsule. 63 anterior lens capsules (30 PSX suspects, 3 pre-PSX, 10 PSX, 20 controls) were studied by transmission and immuno-electron microscopy (TEM). In 20 PSX suspect and 3 pre-PSX capsulotomy specimens, TEM revealed a precapsular layer (0.1-11 microns in thickness) composed of microfibrils, amorphous material, and granular inclusions. The incidence of this fibrillar layer was significantly higher (p = 0.001) in PSX suspect and pre-PSX eyes than in controls (5 positive). Ultrastructural and immunohistochemical similarities of the fibrillar surface network in PSX suspect and typical PSX specimens indicate that the precapsular layer may represent a precursor of PSX. The beginning PSX process in the eye is obviously indicated by certain clinical signs.

Aged↗
PubMed1992

[Penetrating keratoplasty for keratoconus in trisomy 21].

Between 1982 and 1990, penetrating keratoplasties for keratoconus were performed in 9 eyes of 7 patients (age 17-41 years) with Down's syndrome. All eyes showed dense scarring of the central cornea. Follow-up was 10-49 months (mean 28 months). Preoperative corrected visual acuity was hand movements to 20/400. Complications were suture loosening in one eye and leukocytic infiltration of a suture track in one eye, both responded well to therapy. Graft rejection, intraocular infection, wound dehiscence and secondary glaucomas were not observed. The postoperative visual acuity improved in all eyes, ranging from 20/200 to 20/100. If indication to surgery is made carefully and if adequate postoperative care and frequent follow-up examinations are provided, the prognosis of penetrating keratoplasty in patients with Down's syndrome seems to be good and keratoplasty should be considered in patients with dense corneal scars.

Adolescent↗
PubMed1992

[Varix node of the iris with spontaneous regression].

We report the findings in a 76-year-old woman who presented with a varix of the left iris that had manifested with hyphema. Slit lamp examination disclosed a circumscribed prominent round blood-filled lesion of the iris with smooth surface and surrounding hemorrhage. Examination with the laser flare-cell meter disclosed slightly increased flare of the left eye (10.2 photon counts/ms). Iris fluorescein angiography revealed a focal early circular hyperfluorescent area without leakage and a surrounding hypofluorescent area. Additionally, there was bilateral pseudoexfoliation. The iris varix showed complete regression during follow-up of two months. Possible etiological factors, including congenital or acquired changes of the iris vessels and alterations of the iris vessel walls in pseudoexfoliation syndrome, are discussed. Although varices of the iris are rare, they should be included in the differential diagnosis of prominent iris lesions.

Aged↗
PubMed1992

Quantitative assessment of aqueous flare and aqueous 'cells' in pseudoexfoliation syndrome.

We used the laser flare-cell meter to measure aqueous flare and aqueous 'cells' in 38 eyes of 38 patients with pseudoexfoliation, in 36 normal control eyes of 36 subjects, and in 19 eyes of 19 patients with chronic open-angle glaucoma unrelated to pseudoexfoliation. In pseudoexfoliation eyes, both aqueous flare (0.61 +/- 0.55 mg/ml human albumin equivalent) and aqueous 'cells' (mean 10.70, range 0-50.6 cells/0.075 mm3) were significantly higher than in the normal control group (flare 0.15 +/- 0.06 mg/ml, 'cells' 0.43, range 0-2, P less than 0.0001) and in the glaucoma group without pseudoexfoliation (flare 0.19 +/- 0.08 mg/ml, 'cells' 0.80, range 0-2.4, P less than 0.0001 and P less than 0.005). No significant difference could be found between the flare and cell counts of normal eyes and glaucoma eyes without pseudoexfoliation (P greater than 0.09, P greater than 0.05) and between PSX eyes with (18 eyes) and without (20 eyes) open-angle glaucoma (P greater than 0.99, P greater than 0.4). Our findings indicate that the blood-aqueous barrier is impaired in eyes with pseudoexfoliation, and that the laser flare-cell meter may be a useful tool to quantify these changes. These alterations of the blood-aqueous barrier need to be considered in medical therapy and intraocular surgery.

Aged↗
PubMed1992

Occurrence of pseudoexfoliation following penetrating keratoplasty for keratoconus.

The occurrence of pseudoexfoliation (PSX) following penetrating keratoplasty for keratoconus is reported in three eyes of two patients. The patients' ages at keratoplasty were 37, 40, and 31 years, and PSX was first observed 5, 4, and 6 years following keratoplasty. The donor age was 76, 81, and 81 years. Possible explanations for the occurrence of PSX after keratoplasty include mere coincidence, some sort of non-specific reaction to surgery or to postoperative medication, an immunogenic reaction to transplanted foreign corneal tissue, and the hypothetical speculation that PSX might be a transmissible disease.

Adult↗
PubMed1992

Quantitative measurement of aqueous flare and aqueous "cells" in eyes with diabetic retinopathy.

In order to evaluate the applicability of the laser flare-cell meter to diabetic oculopathy, we measured aqueous flare and aqueous "cells" in 84 diabetic eyes of 84 patients and 50 normal control eyes of 50 age-matched subjects. Using fluorescein angiography, diabetic retinopathy was divided into background retinopathy (11 eyes), preproliferative retinopathy (38 eyes), and proliferative retinopathy (35 eyes). In diabetic eyes, the occurrence of both aqueous flare (0.73 +/- 0.39 mg/ml human albumin equivalent) and aqueous cells (mean 2.96, range 0-35.7 cells/0.075 mm3) was significantly greater than in the normal control group (flare 0.14 +/- 0.06 mg/ml, cells 0.39, range 0-2 cells/0.075 mm3, P < 0.0001 and P < 0.0002, respectively). The flare values also showed differences between the diabetic subgroups, with flare values being higher in more advanced stages of diabetic retinopathy. No significant correlation could be found between the flare values and the kind of diabetic therapy, the duration of the diabetes, and the number of or the time interval since previous retinal laser coagulations. A flare value of more than 0.5 mg/ml was found to represent probably a "critical value" indicating a tendency towards preproliferative and or proliferative changes. The laser flare-cell meter is a valuable instrument for noninvasive, quantitative assessment of alterations of the blood-aqueous barrier in diabetes. The increase of flare values seems to parallel the progression of diabetic retinopathy.

Adult↗
PubMed1991

Mucogenic secondary open-angle glaucoma in diffuse epithelial ingrowth treated by block-excision.

We treated a 40-year-old man with an acute, unilateral, open-angle glaucoma caused by a gelatinous translucent material in the anterior chamber. A clinical diagnosis of mucogenic secondary open-angle glaucoma caused by diffuse epithelial ingrowth after ocular trauma one year earlier was suspected, but a primary or secondary ciliary body or iris neoplasm could not be ruled out. A curative 9-mm block-excision was performed. Six years later, intraocular pressure was normal, and the visual function was unchanged. Light and electron microscopy disclosed an island of diffuse columnar epithelium with numerous goblet cells on the iris surface and copious mucinous material extending into the trabecular mesh-work.

Adult↗
PubMed1991

Electron-microscopic identification of pseudoexfoliation material in extrabulbar tissue.

The structure and distribution of pseudoexfoliation material in extrabulbar tissues from five eyes with typical unilateral intraocular pseudoexfoliation syndrome and two intraocularly unaffected fellow eyes were examined by transmission electron microscopy. In all seven eyes, unevenly distributed pseudoexfoliation aggregates were found in limbal conjunctivae, extraocular rectus and oblique muscles, orbital connective-tissue septa, and the walls of the posterior ciliary arteries, vortex veins, and central retinal vessels passing through the optic nerve sheaths. Typical pseudoexfoliation fibers occurred in close association with connective-tissue components, especially elastic fibers; a moderate predisposition of pseudoexfoliation clumps to accumulate around blood vessels was observed. The findings of pseudoexfoliation material in similar extrabulbar locations in intraocularly uninvolved fellow eyes indicates that pseudoexfoliation fiber formation outside the globe precedes its intraocular manifestation. The intermingling of pseudoexfoliation fibers, microfibrils, and elastic and collagen fibers suggests that pseudoexfoliation fiber formation might result from a disordered synthesis and/or assembly of connective-tissue microfibrils.

Aged↗
PubMed1991

Occurrence of pseudoexfoliative material in parabulbar structures in pseudoexfoliation syndrome.

The blind and painful left eye of a 88-year-old woman was enucleated and examined by light and transmission electron microscopy. Three years earlier, after unilateral pseudoexfoliation syndrome with advanced open angle glaucoma of the left eye had been diagnosed, argon laser trabeculoplasty and pars plicata diathermy were performed. Light microscopy showed deposits of typical pseudoexfoliative material in the anterior segment and endothelialization of the chamber angle. By transmission electron microscopy we demonstrated pseudoexfoliative fibers not only at the typical intraocular locations and in the bulbar conjunctiva but also ultrastructurally identical material in hitherto not described extraocular locations such as extraocular rectus and oblique muscles, vortex veins and the optic nerve sheaths. Ultrastructurally, the fibers showed all the characteristic features of pseudoexfoliative material. Our findings are another strong indication that pseudoexfoliation syndrome is not a purely intraocular disorder but represents a more widespread disease.

Aged↗
PubMed1991

[Sub-epidermal calcinosis of the eyelid].

We report on a 17-year-old male with an asymptomatic yellowish-grayish solitary tumor of the right medial upper lid margin. An excisional biopsy was performed and histopathologic examination revealed subepidermal calcinosis. The other eye showed a granulomatous chrorioretinits of unknown etiology. The relative rare occurrence of subepidermal calcification should be kept in mind when making a differential diagnosis of superficial lid tumors. In our histopathology laboratory this is the first diagnosis of subepidermal calcinosis among 1,400 comparable specimens from 1980 to 1990. A possible relationship between the subepidermal calcification and granulomatous chorioretinitis of the other eye is discussed.

Adolescent↗
PubMed1991

[Results of 102 perforating pseudophakic keratoplasties].

Between July 1980 and February 1990 we performed 102 penetrating keratoplasties in 102 eyes of 98 patients with pseudophakic bullous keratopathy. Patients were followed up prospectively with an average follow-up of 14 months. 53 of the implant were iris-supported lenses (ISL), 32 were anterior chamber lenses (ACL), and 17 were posterior chamber lenses (PCL) following extracapsular cataract extraction (ECCE). In 88 eyes the intraocular lens implantation had been performed elsewhere. The interval between lens implantation and keratoplasty ranged from 3 to 451 months (mean 59 months) and was significantly shorter (p less than 0.03) for PCL. Eight intraocular lenses had been removed before keratoplasty. During penetrating keratoplasty, 25 lenses were left in place, 49 were removed, and 20 were exchanged. Since 1988, PCL have been implanted and sutured to the iris after removal of the ACL or ISL in 17 eyes that had undergone intracapsular cataract extraction (ICCE). After keratoplasty, visual acuity improved in 95 of the 102 eyes. However, visual acuity was frequently limited by persisting cystoid macular edema. In eyes that had undergone keratoplasty following ECCE and PCL implantation, visual acuity was significantly better (p less than 0.03) and cystoid macula edema was rarer (p = 0.07) than in eyes with ISL or ACL. the prognosis of penetrating keratoplasty for pseudophakic bullous keratopathy is generally good, although visual acuity is often limited postoperatively by cystoid macular edema. The technique of secondary PCL implantation sutured to the iris appears promising for allowing better optic rehabilitation of patients with pseudophakic bullous keratopathy.

Adult↗
PubMed1990

[Ocular changes in MELAS syndrome].

The present paper reports on the clinical findings of a 34-year-old male patient with MELAS syndrome. MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and strokelike episodes) belongs to a group of syndromes called mitochondrial encephalomyopathies that are characterized by changes of the mitochondrial respiratory chain and the histological finding of "ragged red fibers" in muscle biopsy. In our case the diagnosis was confirmed by multiple neurologic tests including muscle biopsy and biochemical analysis of the respiratory chain. The ocular findings included reversible, homonymous hemianopic visual field loss documented six years earlier, atypical retinitis pigmentosa with marked attenuation of the scotopic ERG, myopia and nuclear cataract of the right eye. An extracapsular cataract extraction with implantation of a posterior chamber lens was performed on the rigt eye, the course was unremarkable and vision improved. In dealing with patients presenting with ocular or neurologic signs indicating mitochondrial encephalopathy, the ophthalmologist should consider MELAS syndrome or any other of the mitochondrial encephalomyopathy syndromes as a possible etiology and take the necessary steps for further medical and neurologic evaluation of the patient.

Acidosis, Lactic↗
PubMed1990

[Unilateral hemiarcus lipoides corneae inferior].

We document a case of unilateral hemiarcus lipoides, which developed de novo 10 months after trabeculectomy in the left eye of a 54-year-old woman. The involved eye showed heterochromia complicata Fuchs and had undergone intracapsular cataract extraction 11 years and trabeculectomy one year earlier. Except for intermittent hypercholesterolemia, the patient did not present any signs of systemic disease. The possible roles of relative ocular hypotony and modified aqueous circulation after trabeculectomy in the development of unilateral hemiarcus lipoides are discussed.

Arcus Senilis↗
PubMed1990

[Pseudo-exfoliation syndrome with and without glaucoma as a major risk factor in extracapsular cataract extraction. A prospective clinical study].

A prospective study was undertaken to evaluate the risk factors in extracapsular surgery for eyes with pseudoexfoliation syndrome (PES) with and without open angle glaucoma. The study included 3095 planned extracapsular cataract extractions performed by 18 surgeons between September 1986 and June 1989. Of the 3095 eyes 153 (4.9%) showed clinical signs of PES. We examined three groups of eyes: nonglaucomatous eyes (2476 eyes), glaucomatous eyes controlled by local antiglaucomatous therapy (342 eyes) and glaucomatous eyes that had undergone antiglaucomatous surgery (277 eyes). For each group, the incidence of capsular breaks and vitreous loss was evaluated for eyes with and without PES. In the group of nonglaucomatous eyes, vitreous loss occurred significantly more frequently (p less than 0.05) in eyes with PES. For the group of glaucomatous eyes, complications were more frequent but not significant in the presence of PES (p greater than 0.15). We conclude that PES is a significant risk factor in extracapsular surgery even in the absence of glaucoma. After introducing special precautionary measures for eyes showing signs of PES, the incidence of complications in extracapsular surgery has decreased considerably in our hospital for these eyes.

Cataract Extraction↗