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M Küchle

Publications and source records attributed to M Küchle.

157 records · Page 9Linked to original sources
PubMed1990

[Direct cyclopexy in cyclodialysis with persistent hypotony syndrome].

We report the results of direct cyclopexy performed on all 16 eyes of 16 patients between 1980 and 1988. The follow-up was 7 months to 95 months (mean 51.4 months). All eyes had developed persistent ocular hypotony following traumatic (15 eyes) or surgical (1 eye) cyclodialysis. The cyclodialyses extended from 45 degrees-255 degrees (mean 120 degrees). Preoperative intraocular pressure was 0 to 8 mm Hg (mean 2.9 mm Hg); preoperative visual acuity ranged from light perception to 20/50. Direct cyclopexy by suture of the insertion of the ciliary muscle to the scleral spur with 10/0 nylon was performed in 16 eyes according to the technique described earlier. In addition, 7 eyes simultaneously underwent the following operative procedures: tectonic keratoplasty (2 eyes), intracapsular cataract extraction and anterior vitrectomy (3 eyes), extracapsular cataract extraction and implantation of a posterior chamber lens (1 eye), and encircling procedure (1 eye). During and after cyclopexy no severe complications were observed. During the immediate postoperative course four eyes developed temporary increased intraocular pressure (26 to 50 mm Hg), which was controlled by medication and was fully reversible. After cyclopexy the cyclodialysis cleft was closed in 15 of 16 eyes with a small persisting cleft (30 degrees) without ocular hypotony persisting in one eye. No new anterior synechiae developed. Visual acuity improved in 14 of 16 eyes (20/80 to 20/20) being 20/40 or better in 10 eyes. In only two eyes was there no improvement in visual acuity as a result of severe traumatic posterior changes. During further postoperative follow-up, the intraocular pressure was below 20 mm Hg in all eyes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

["Early" immunologic transplant reactions following perforating keratoplasty. A prospective clinical study].

Between September 1986 and June 1988 310 penetrating keratoplasties were performed and prospectively analyzed. The purpose of this prospective study was the evaluation of graft rejections and the underlying corneal diseases. The mean follow-up time was 6.9 months. We found early graft rejections in 5.8% of the eyes. The increased rate of graft rejection in eyes with herpetic corneal ulcers was remarkable.

Cornea↗
PubMed1989

[Risk factors for capsular rupture and vitreous loss in extracapsular cataract extraction. The Erlangen Ophthalmology Group].

A prospective study of preoperative risk factors in extracapsular cataract surgery was undertaken. The study included 2042 planned extracapsular cataract extractions in 1772 patients performed by 12 surgeons between February, 1986 and June, 1988. The possible risk factors to be analysed included sex, age, right or left eye, axial length, pseudoexfoliation syndrome, preceding blunt ocular trauma, diabetes mellitus and systemic hypertension. Capsular breaks occurred in 2.9% and vitreous loss in 1.9% of our patients. A significant increase in the frequency of capsular breaks was observed for patients under the age of 41 and for patients with diabetes mellitus, vitreous loss being observed significantly more frequently in eyes with pseudoexfoliation syndrome. A slight but insignificant increase in capsular breaks was observed for male patients, left eyes, eyes smaller than 22 mm, pseudoexfoliation syndrome and systemic hypertension. Advanced age, myopia and previous blunt trauma were not found to be significant risk factors for capsular breaks or vitreous loss. We recommend careful preoperative patient examination to identify preoperative risk factors and possibly avoid intraoperative complications.

Adolescent↗
PubMed1989

[Pseudo-exfoliation syndrome as a risk factor for vitreous loss in extra-capsular cataract extraction. The Erlangen Eye Information Group].

A prospective study for evaluation of the pseudoexfoliation syndrome (PES) as a risk factor in extracapsular surgery was undertaken from February 1986 to June 1988. The study included 2042 planned extracapsular cataract extractions performed by 12 surgeons. Seventy-two eyes revealed PES (3.5%). Frequency of PES increased with age (p less than 0.005). The male-female ratio of PES was 1:1.6, and eyes of average axial length showed PES more frequently than myopic or hyperopic eyes, although these differences were not significant statistically. The incidence of vitreous loss was 11.1% in eyes with PES and 1.6% in eyes without PES, a sevenfold increase that was statistically significant (p less than 0.0001). Rupture of the posterior lens capsule was observed in 4.2% of PES eyes compared to 2.8% of eyes without PES (no significance). The pseudoexfoliation syndrome is not a harmless anomaly, but a potentially disastrous disease of the anterior segment of the eye. As precautionary measures we recommend thorough biomicroscopic examination preoperatively for signs of PES, iridotomy or sector iridectomy in cases with poorly dilating pupils, very gentle manipulation intraoperatively, and posterior chamber lens sulcus implantation in eyes with zonular defects or phacodonesis.

Adolescent↗
PubMed1988

[Perforating keratoplasty in pseudophakia].

Between July 1980 and March 1987 the authors performed pseudophakic penetrating keratoplasty in 56 eyes with bullous keratopathy following implantation of an intraocular lens. The postoperative results in 50 eyes (47 patients) are reported in this retrospective study. Average duration of follow-up after keratoplasty was 8.1 months. The intraocular lenses were either iris-supported (31), anterior chamber lenses (12), or posterior chamber lenses (7). The interval between implantation of the lens and performance of the keratoplasty ranged from three to 451 months (average 69.9 months). It varied considerably, depending on the type of lens used. Vision after penetrating keratoplasty improved in 44 of the 50 eyes and was unchanged in three. In ten eyes, improvement in vision was limited by persistent cystoid maculopathy (CMP). Postoperative complications occurred in five eyes and traumatic wound dehiscence in two. However, none of the transplants showed any signs of rejection during the follow-up period. The prognosis for penetrating keratoplasty following intraocular lens implantation is generally good; impaired vision is due to extracorneal factors, in particular CMP.

Adult↗
PubMed1988

[Hypotonia bulbi and gonadotropins in myotonic dystrophy].

Patients with myotonic dystrophy show ocular hypotony associated with primary hypogonadism and a secondary increase in the gonadotropins FSH and LH. By examining ten patients (nine men, one woman) with myotonic dystrophy and determining serum FSH and LH concentrations by radioimmunoassay, the authors tried to evaluate whether the decrease in intraocular pressure (IOP) seen in myotonic dystrophy might be related to increase levels of gonadotropins. The IOP of the patients with myotonic dystrophy (mean 10.6 mm Hg, SD 3.9 mm Hg) was significantly lower (P less than 0.0005) than that of a randomly selected control group. In all nine male patients serum FSH concentrations (mean 41.7 mIU/ml, SD 18.9 mIU/ml, normal range 0.9-9.8 mIU/ml) and serum LH concentrations (mean 18.6 mIU/ml. SD 6.8 mIU/ml, normal range 2.2-12.0 mIU/ml) were significantly higher (FSH: P less than 0.0005, LH: P less than 0.05) than those of a control group of four normal men. The female patient's FSH was elevated (11.5 mIU/ml, normal range 1.7-8.5 mIU/ml), her LH concentration was slightly elevated (15.5 mIU/ml, normal range 2.5-15.4 mIU/ml). A statistically significant correlation was found between elevated LH concentrations and decreased IOP (P less than 0.05) but no such correlation between FSH and IOP (P less than = 0.17). Endogenous circulating gonadotropins may play an important role in regulating aqueous inflow via cyclic AMP which is produced by ciliary epithelia and causes a decrease in the rate of aqueous humor production. This theory is corroborated by humor production. This theory is corroborated by the authors' data and by experimental studies by Sears and co-workers.

Adult↗
PubMedDate not supplied

[A clinical comparative study of tyndallometry using 2 laser flare meters].

BACKGROUND: The laser flare meter FM-500 (Kowa, diode laser, 670 nm) is a simplified version of the laser flare-cell meter FC-1000 (Kowa, He-Ne laser, 632.8 nm). the aim of this study was to compare flare measurements of the laser flare meter FC-500 with the established laser flare-cell meter FC-1000 and to determine the reproducibility of both instruments in vivo. PATIENTS AND METHODS: Ten eyes of 10 normal subjects (mean age 32.2 +/- 8.0 y) and 21 eyes of 21 patients (mean age 36.7 +/- 17.2 y) with various forms of uveitis were included in the study. Aqueous flare was quantified using the laser flare-cell meter FC-1000 and the laser flare meter FM-500 by one examiner under comparable conditions. The selection of eyes as well as the order of the examinations were done in a randomized fashion. Measurements with both instruments were repeated the following day in normal eyes. Statistical analysis was done using linear regression analysis, intraclass correlation and U-test. RESULTS: Flare values (photon counts/ms) did not differ significantly between the instruments either for normal eyes (3.3 +/- 0.4 vs 3.5 +/- 0.6) or for eyes with uveitis (16.2 +/- 9.0 vs 16.4 +/- 8.7). A high correlation of flare counts between both instruments was observed in normal eyes (r = 0.73, p < 0.001) and a very high correlation in eyes (R = 0.99, p < 0.0001) with mildly to moderately increased counts (< 50 photon counts/ms). Differences between flare values of both instruments were -0.17 +/- 0.4, range -0.8 +/- 0.6 in the normal eyes and -0.23 +/- 1.38, range -3.1 +/- 3.4 in the patients with mildly to moderately increased flare counts. However, flare counts differed for very high aqueous flare in one patient with acute fibrinous iridocyclitis with the FM-500 indicating higher values. The intraclass correlation coefficients were 0.70 for the FC-1000 and 0.76 for the FM-500 in normal eyes and 0.99 for both instruments in eyes with uveitis. CONCLUSIONS: In eyes without or with mild to moderate breakdown of the blood-aqueous barrier, the two instruments give comparable results. However, measurements may differ in eyes with high flare readings.

Adult↗
PubMedDate not supplied

Impact of increased intraocular pressure on long-term corneal endothelial cell density after penetrating keratoplasty.

PURPOSE: Besides immunological graft rejection, persistently increased intraocular pressure (IOP) is among the most important causes for graft failure after penetrating keratoplasty (PK). The purpose of this study was to assess the longitudinal development of IOP after PK and to investigate possible correlations with corneal endothelial cell density. METHODS: This longitudinal prospective study included 209 eyes after PK with a complete follow-up at 3 months, 6 months, before first suture removal (16 +/- 5 months) and after complete suture removal (21 +/- 5 months). At each examination, IOP was measured by Goldmann applanation tonometry. Endothelial cell density was assessed by specular microscopy (EM 1100, Tomey). The indications for PK were 48% keratoconus, 34% Fuchs' dystrophy, 5.4% stromal dystrophies, 8.6% secondary bullous keratopathy and 4% corneal scars. An iridotomy was performed routinely during PK. The postoperative treatment with topical steroids was standardized. RESULTS: Preoperatively, the mean IOP was 13.6 +/- 2.9 mm Hg with increased IOP (>21 mm Hg) in 2.0% of eyes. After 3 months, the incidence of increased IOP (24.5 +/- 4.6 mm Hg) was highest (6.7%) and decreased thereafter to 3.0% after complete suture removal. No patients showed IOP higher than 30 mm Hg. A persistently increased IOP for more than 3 months was seen in 2% of patients. At 3 months postoperatively, the mean endothelial cell density was 1,977 +/- 496/mm(2) and did not decrease significantly (p > 0.05) until 6 months (1,771 +/- 507 cells/mm(2)). At the end of the follow-up period, the mean endothelial cell density was significantly reduced (1,347 +/- 501 cells/mm(2)). There was no significant correlation between IOP and mean endothelial cell density at any postoperative examination stage (p > 0.24). Patients with persistently increased IOP for more than 3 months did not have significantly different endothelial cell densities in comparison with those without increased IOP. CONCLUSION: From 6 months after PK, the incidence of increased IOP was not higher than the preoperative level. Mild to moderate temporary IOP elevations after PK do not seem to affect the endothelial cell density of the graft until complete suture removal. Further long-term studies are necessary to assess the clinical relevance of these observations.

Cell Count↗
PubMedDate not supplied

Gastric adenocarcinoma presenting as an eyelid and conjunctival mass.

A 50-year-old white man complained of "inflammation" of his right eyelid since January 1989. In June 1990, he had undergone a gastrectomy for an adenocarcinoma of the stomach. In August 1990, his right eye showed a painless, firm infiltration of the upper and lower lid, ulceration and loss of eyelashes of the upper lid and a reddish, subepithelial thickening of the medial bulbar conjunctiva. Biopsies of the right upper lid and nasal bulbar conjunctiva disclosed a metastatic, poorly differentiated adenocarcinoma of the stomach (signet ring cell carcinoma) both in the lid and conjunctival biopsies. Carcinoembryonic antigen (CEA) was detected in the tumor cells. Electron microscopic examination revealed tumor cells with signs of secretory activity. Although metastases to the eyelids and conjunctiva are rare, they may precede the clinical manifestation of the primary tumor for months or even years. In patients with chronic, recalcitrant lesions of eyelids or conjunctiva, especially if accompanied by loss of eyelashes, a primary or secondary malignancy should be excluded by early biopsies and histopathological examination.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Evaluation of corneal flap dimensions and cut quality using a manually guided microkeratome.

BACKGROUND: To evaluate reproducibility of corneal flap dimensions and cut quality with repeated blade use with a manually guided microkeratome in pig eyes. METHODS: Corneal flaps were created using a manually guided microkeratome (Model One, Moria) with an intended 130-microns cut depth in 130 enucleated pig eyes. Flap thickness was calculated by pachymetry and diameter was estimated by means of applanation lenses compared to planimetry. Histology and scanning electron microscopy of samples and blades were performed to evaluate the keratectomy surface and blade cutting edge after repeated use of the blades. RESULTS: Mean flap central thickness was 135 microns (SD, 37 microns). The mean diameter of 8.4 mm (SD, 0.4 mm) correlated significantly (P < .001) to the intended diameter (r = .79). Mean difference from the intended diameter was 0.8 mm (SD, 0.3 mm; range, 0.04 to 1.4 mm). Scanning electron microscopy showed even and smooth cuts with chatter lines at the keratectomy edge using new blades. After repeated blade use, increasing cut irregularity, folds, and tissue remnants on the corneal bed surface, and nicks and tissue remnants at the cutting edge of the blades were observed. CONCLUSION: Reproducible flap dimensions were obtained using the Moria One microkeratome on pig eyes. The cut surface was regular and smooth with a new blade, but surface quality deteriorated considerably after repeated use of the same blade.

Animals↗
PubMedDate not supplied

Evaluation of corneal flap dimensions and cut quality using the Automated Corneal Shaper microkeratome.

PURPOSE: To evaluate flap dimensions and cut deterioration with repeated blade use in an automated microkeratome. METHODS: The Automated Corneal Shaper (Chiron-Adatomed, Munich, Germany), 160-microm plate attached, was used to make a corneal flap in 90 pig cadaver eyes, reusing blades up to five times. Flap diameter was measured by planimetry and thickness was calculated by ultrasound pachymetry. Scanning electron microscopy of stromal beds and blade cutting edges was performed to assess cut deterioration after repeated blade use. RESULTS: Mean flap central thickness was 125 +/- 32 microm. Mean vertical flap diameter was 7.6 +/- 0.4 mm. No correlation was found between thickness and diameter (r = 0.15, P = .45). Progressive thinning of the flap was observed in the direction of the flap hinge. Smooth cuts (using new blades) with periodic chatter lines at the keratectomy edge and in the stromal bed were observed with scanning electron microscopy. Increasing tissue remnants on the stromal bed and decreasing cut quality occurred with repeated blade use. Blades showed larger tissue remnants, nicks, and even folds on the cutting edge proportional to the number of times blades were used. CONCLUSION: Satisfactory cut quality and reproducibility were obtained after a single use of stainless steel blades in the Automated Corneal Shaper microkeratome. Cut quality was degraded dramatically by repeated use of blades.

Animals↗