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Biomedical subjects

M Reim

Publications and source records attributed to M Reim.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Follow-up of arteriosclerosis-induced anterior ischemic optic neuropathy].

In 22 patients with acute arteriosclerotic anterior ischemic optic neuropathy (AION), examinations were conducted before the start of therapy and between 1 and 3 years later. In the acute stage of the disease the patients were treated with hemodilution for 10 days. The visual acuity improved from 0.2 to 0.4 (median). Compared with the visual acuity before therapy, at the follow-up 1-3 years later visual acuity had improved by 3 lines or more in 11 patients, remained stationary in 9 patients (+/- 1 line), and worsened in 2 patients by 3 lines or more. The visual fields (Goldmann) improved in 8 patients, did not change in 10 patients and worsened in 4 patients. After 1-3 years, 14 patients (64%) showed a sectorial pallor and 8 patients (36%) a diffuse pallor of the optic disc. Videofluorescein angiography revealed hypofluorescent discs in all patients. No difference in arm-retina time (ART) was found between the acute phase (13.0 +/- 3.3 s) and the examination 1-3 years later (13.1 +/- 2.2 s). ART was within normal limits in all patients. The arteriovenous passage time (AVP) dropped significantly, from 2.36 (+/- 0.81) s in the acute phase to 1.91 (+/- 0.56) s 1-3 years later. However, the AVP still did not fall to normal levels (1.45 +/- 0.40 s). Slowed retinal hemodynamics (AVP) with normal ART at the same time suggests a disturbance in microcirculation still present 1-3 years after the acute phase of AION. The rheological parameters (hematocrit, plasma viscosity, erythrocyte aggregation index) did not show any change between examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Retinal hemodynamics after pars plana vitrectomy with silicone oil tamponade.

Pars plana vitrectomy with silicone-oil tamponade is frequently performed in cases of complicated retinal detachment. Because of the lower specific gravity and the lower surface tension of silicone oil in comparison with the aqueous phase of the vitreous, an influence on the blood flow in the retinal vessels would be expected. However, not only the silicone oil but also the operative trauma and a buckling procedure may have an influence on the retinal blood flow. To examine this question we measured the arteriovenous passage time in the silicone-oil-filled eye and in the contralateral eye in 14 cases using a laser scan ophthalmoscope at 3-5 days after surgery. The arteriovenous passage time is a parameter for the retinal microicirculation. In all cases we found a prolonged arteriovenous passage time in the silicone-oil-filled eye in comparison with the contralateral eye (mean value +/- SD, 2.5 +/- 0.8 vs 1.25 +/- 0.25 s; P < 0.01). The prolongation of arteriovenous passage times observed in silicone-oil-filled eyes indicates that the microcirculation is worsened at least during the early postoperative period.

Adult↗
PubMed1993

Immunological reactions against PMMA lens material?

We investigated the kind of reactions that occur after injection of a PMMA lens powder into the back skin of rabbit. The lens powder was suspended in NaCl and incomplete Freund's adjuvant to reinforce the immunological reaction. The ELISA test was carried out to detect antibodies against the lens material as a whole and against the UV absorber Tinuvin in particular. We also performed histological and immunohistochemical examinations of the back skin. We did not detect antibodies against either the lens material or against Tinuvin. Histological examination showed a foreign-body or delayed allergic reaction against the lens material. Lymphocytes surrounding the PMMA were found to be mainly of the T-type, which supports the results of the ELISA test.

Animals↗
PubMed1993

Investigation of enzyme activities in severe burns of the anterior eye segment.

In severe burns of the anterior eye segment, including the cornea, limbus and adjacent conjunctiva, ischemia resulted from the necroses. While necrotic conjunctival and subconjunctival tissues may be removed to eliminate the toxic influence, the opaque cornea and ischemic sclera could not be removed. In the surrounding healthy tissues an inflammatory reaction developed, which brought about an infiltration of the damaged tissues by leukocytes and the release of lysosomal marker enzymes. N-Acetylglucosaminidase and cathepsin-D represent a number of other destructive enzymes involved with corneal and corneoscleral ulceration. Initially, their activities were low in the turbid, acellular cornea and increased 3 weeks after the burn. In the surrounding conjunctiva, these enzyme activities were normally higher than in the cornea and increased significantly after the burn. The elevated activities of N-acetylglucosaminidase and cathepsin-D in the conjunctiva and cornea were related clinically to corneal and corneoscleral ulceration.

Acetylglucosaminidase↗
PubMed1993

Retinal hemodynamics using scanning laser ophthalmoscopy and hemorheology in chronic open-angle glaucoma.

PURPOSE: Recent studies suggest that elevated intraocular pressure is not the only causative factor for the development of visual field loss and optic nerve damage in glaucomatous eyes. The authors determine whether retinal hemodynamics or blood fluidity are alternated in eyes of patients with open-angle glaucoma compared with those of age- and sex-matched healthy subjects. METHOD: High-quality video fluorescein angiograms were obtained from single eyes of 51 patients with chronic open-angle glaucoma. From these angiograms, the arm-retina time, mean dye velocity, and arteriovenous passage time were quantified. The data from patients were compared with those of an age- and sex-matched group of healthy subjects. RESULTS: In patients with chronic open-angle glaucoma, an 11% reduction of the mean dye velocity (P < 0.05) and a 41% prolongation of the arteriovenous passage time (P < 0.01) was observed relative to the values obtained among the control subjects. Among hematocrit values, plasma viscosity, and erythrocyte aggregation, only plasma viscosity showed a significant increase (4%; P < 0.01) in patients with chronic open-angle glaucoma. CONCLUSION: These results indicate that a pronounced circulatory deficit exists within the retinal vasculature of glaucomatous eyes, which may coexist with, but cannot be fully attributed to, an increase in plasma viscosity.

Adult↗
PubMed1993

[Tarsoconjunctival advancement--a surgical procedure in cicatricial entropion with marginal tarsus deformation].

BACKGROUND: After severe chemical and thermal burns, and in chronic inflammatory conditions of the conjunctiva frequently scarring of the tarsal plate with distortion of the eyelid margin and keratinization of the tarsal conjunctiva could be found. This condition is accompanied with chronic inflammation and malposition of the eyelids resulting in entropion and trichiasis. PATIENTS AND METHODS: A surgical procedure is introduced separating the scarred and shortened tarsal plate from the cutis-muscle sheet. After excision of tarsal scar tissue and of the marginal metaplastic tarsus a new eyelid margin is formed by tarso-conjunctival advancement, correcting trichiasis and cicatricial entropion. During the time from August 1984 to December 1991 this surgical procedure was conducted on 16 patients, correcting 18 upper and 4 lower eyelids. 11 patients suffered from severe chemical and thermal burns, 2 patients from Stevens-Johnson-syndrome, 2 patients from ocular pemphigoid and 1 patient from herpes zoster infection. RESULTS: All patients were examined at least once in the first 6 postoperative months, 11 patients are still under continuing outpatient review. The mean follow-up time is 27 months, the minimum follow-up period is 7 months. In 7 patients the surgical procedure prepared conditions for a successful keratoplasty and in 5 other cases the keratopathy healed. In 4 cases a recurrence of the entropion occurred (18% recurrence rate). CONCLUSIONS: The presented surgical procedure is a promising alternative to more complicated procedures for correcting cicatricial entropion with keratinization of the marginal tarsus.

Adult↗
PubMed1993

[Clinical experiences with adhesive hard contact lenses].

BACKGROUND: Persistent epithelial defects of the cornea are difficult to treat and can lead to severe complications such as melting processes. Therefore the application of a glued-on hard contact lens as an artificial epithelium has been recommended for many years, to protect the denuded corneal stroma. MATERIALS AND METHODS: This paper presents a 7-year retrospective study on the application of a hard contact lens as an artificial epithelium. 46 patients with 50 eyes were treated with this method from january 1985 to march 1992. The majority of the patients suffered from most severe burns of the whole anterior eye segment (group I: n = 29 eyes) or of the cornea alone (group II: n = 13 eyes). A smaller number of patients (group III: n = 8 eyes) presented corneal melting processes associated with other diseases. RESULTS: The patients of group II and III showed the best outcome concerning spontaneous epithelialization and prognosis for a penetrating keratoplasty. The treatment with a glued-on hard contact lens was limited by the high rate of complications (92%) in group I and II. In one third of the cases of group I these complications led to further surgical interventions (e.g. conjunctivoplasty of the globe). The results also show, that the application of a glued-on hard contact lens in patients with most severe eye burns is a long-term treatment (> one year). CONCLUSION: The poor prognosis of corneas with severe healing problems of the epithelium can be improved by the application of a glued-on hard contact lens as an artificial epithelium. In severe burns of the whole anterior eye segment however, the treatment with an early keratoplasty should be considered.

Burns, Chemical↗
PubMed1993

[Chemical and thermal eye burns in the residential area of RWTH Aachen. Analysis of accidents in 1 year using a new automated documentation of findings].

BACKGROUND: Until now there were no statistical data on the incidence and the prevalence of eye burns. Therefore we studied all patients coming to our hospital from the area of Aachen with eye burns during the time from September 1990 until August 1991. PATIENTS AND METHODS: All patients underwent a standardized examination including special history of the burning agent, industrial medical aspects and the employers liability insurance association. The documentation of the anterior eye segment pathology was scored separately for each eye encoded by location and special items. This documentation was worked up by the aid of a database (Filemaker II). 171 patients with eye burns were documented during one year. 65 patients had both eyes burned resulting in 236 documented records. RESULTS: The 171 accidents can be divided in 104 (61%) industrial accidents and 64 (37%) housework accidents. 3 accidents were of unknown origin. Classification of burns was scored according to Reim 1991. 208 (88%) eyes showed score I burns, 27 (11.5%) score II and only one patient showed a score III eye burn. We saw 121 (70%) male patients, 39 (23%) female patients and 11 children (7%). The main age group ranged from 16-45 years. 28% (n = 30) of all accidents happened in machine factories, which have thereby in our study the highest incidence of industrial accidents. CONCLUSION: By means of a one-year statistic we found that over 60% of all eye burns were industrial accidents, 28 in machine factories and 20% in service industries. 37% houseworks accidents are very difficult to prevent because of a deficit of safety rules.

Accidents, Home↗
PubMed1993

[Retrospective study of severe alkali burns of the eyes].

BACKGROUND: Alkali burns are of special interest because of the rapid and deep penetration of alkali into the ocular tissues. PATIENTS AND METHODS: This report examines the epidemiology, management and outcome of 42 cases of alkali burns of the eye admitted to the eye clinic of the RWTH Aachen from 1985 to 1992. Aspects examined were the nature of accident, type of alkali, treatment and complications. The intention was to use this information for improvement of prevention and treatment of these cases. RESULTS: The age analysis showed the greatest at-risk population were the 20-40 year-old patients. 73.8% were industrial accidents, 30% happened to builders and labourers, 20% in the chemical industry and 20% in machine factories. At home most of the injuries were caused by lime and drain cleaners. Sodium and potassium hydroxide produced more extended and deeper damages than lime due to their rapid penetration through the ocular tissues. A delayed surgical intervention led to a longer time of stay in hospital and to a higher number of operations. All eyes could be prevented from melting, but an optical rehabilitation (visual acuity > 0.3) was achieved only in a few cases (14.5%). CONCLUSION: There is a need to ensure adequate public awareness of the danger of alkali burns to the eye. Beside the primary prevention, adequate first aid with immediate and continuous irrigation is of paramount importance. A uniform concept for the management of these severe cases is necessary including an antiinflammatory medical and surgical treatment.

Accidents, Occupational↗
PubMed1993

N-acetylglucose aminidase activity in corneoscleral ulceration after severe eye burns.

In some patients with severe burns, major problems were delayed regeneration of the surface epithelium, extensive ulceration of the sclera near the limbus, subsequent corneal ulceration, and subconjunctival scarring. Human tissues surrounding ulcerations in severe eye burns were obtained from surgical interventions in 12 such patients. High activities of the lysosomal marker enzyme N-acetyl-glucose aminidase were found. As is known from histological examinations, these tissues do not represent regeneration of conjunctiva, but rather inflammatory proliferation. The tissues adjacent to corneoscleral ulceration release large amounts of lysosomal destructive enzymes. The rather simple assay of the activity of the N-acetylglucose aminidase proved useful in clinical cases to assess the activity of the inflammation of eye burns and to estimate the efficacy of the therapy applied.

Acetylglucosaminidase↗
PubMed1993

A rare case of bilateral congenital corneal malformations.

We report the case of a now 6-year-old girl who was born with different abnormalities in each eye. The right eye showed a total sclerocornea. At the age of 4 years we performed a perforating keratoplasty. On the left eye a large staphyloma developed. The staphyloma was excised and a cornea with a scleral rim was fixed in. This transplant became cloudy under a conjunctival flap and blepharoplasty. In addition to the clinical follow-up, histological and immun-histochemical examinations of the corneas were carried out.

Child↗
PubMed1993

[Hemodilution therapy in patients with acute anterior ischemic optic neuropathy].

A prospective study was performed in 22 patients with an anterior ischaemic optic neuropathy (AION). All patients underwent iso- (Hct > or = 42%) or hypervolemic (Hct < 42%) haemodilution for 10 days with daily infusion of 250 ml hydroxyethyl starch (MW 200,000/0.5, 10% HAES-sterile) in combination with pentoxifylline (p.o.: 1200 mg/day; i.v.: 300 mg/day; Trental). Only patients with recent AION (less than 2 weeks' duration of symptoms) were considered for the prospective trial. Clinical, haemodynamic (arterio-venous passage time) and rheological (haematocrit, plasma viscosity, erythrocyte aggregation) data of all patients were recorded before therapy and after 10 days. An improvement of central vision by 2 or more lines was seen in 7 patients after 10 days. Initially the arterio-venous passage time was significantly prolonged in patients (2.42 +/- 0.7 s) with AION compared with healthy volunteers (1.45 +/- 0.4 s). After the 10-day trial arterio-venous passage time was significantly shorter than baseline values. In addition, the initially elevated plasma viscosity (1.33 +/- 0.1 mPa) was significantly lowered by haemodilution therapy.

Aged↗
PubMed1993

[Keratoplasty with 11-12 mm diameter for management of severely chemical-burned eyes].

Up to now 73 patients with 101 very severe eye burns have been operated on in our clinic. Thirty-nine patients were treated by a penetrating keratoplasty. More than 1 year after the accident 8 patients were treated with keratoplasties, 11-12 mm in diameter. These large diameters were necessary, because 6 patients developed widespread progressive corneal ulcerations, and in 2 patients the artificial epithelium failed to protect the denuded corneal stroma and sloughed off because of deep stromal defects. The long-term follow-up in these cases is now at least 1 year. Six grafts remained clear with a healthy epithelial layer. The resulting visual acuity in these cases ranged from 0.1 to 0.5. Five patients developed a cataract secondary to the application of steroids. Two grafts were rejected in a very early period 2-3 months after transplantation. In corneal melting processes including the limbal region, treatment with large keratoplasties seems to be a possibility for long-lasting healing and rehabilitation in very severe eye burns. Important for the prognosis of the graft obviously is the restoration of an intact limbal region.

Adolescent↗
PubMed1993

[Surgical therapy of pterygium. Incidence of recurrence after free conjunctival transplant and surgical techniques without transplantation].

A retrospective examination was conducted on 104 patients who had undergone operations for a pterygium over a time period of 2-73 months. Thirty-one patients were operated on with a free autologous conjunctival transplant; in 40 cases a conjunctival suture was performed and in 33 cases the bare sclera technique was used. The pterygium and any recurrences were scored clinically from 0 to 4. Small recurrences with a score less than 3 and a small conjunctival corpus were called "calm" recurrences. A bigger corpus and a head with a score > or = 3 and parallel vessels were called "active" recurrences. The recurrence rates were taken as the total calm and active recurrences. Autologous conjunctival transplant had a recurrence rate of 32.3%, excision with conjunctival suture 58.5%, and the bare sclera technique had a recurrence rate of 66.7%. Excision techniques cause high rates of recurrences, severe conjunctival scarification and irritation for a long time. A free autologous conjunctival transplant from the same or other eye to the place of excision improves the rate of recurrences even when the condition is more severe initially. Even though more complicated operation methods decrease the rate of recurrence, but 20-35% recurrence rates are still not satisfactory.

Conjunctiva↗
PubMed1993

[Reconstructive surgery of extremely severe chemical eye burn with perforation].

A 23-year-old female received a very severe burn in the anterior eye segment of both eyes from hydrochloric acid. During medical treatment over a period of 4 weeks in an outpatient clinic, the left eye perforated because of corneal and scleral ulceration. In the first emergency operation the necrotic tissue was excised in both eyes. Scleral ulceration in the right eye was treated by a tenonplasty. In the left eye a tenonplasty was carried out in all quadrants. Because of the large amount of ulceration in the cornea, a keratoplasty with a scleral rim was performed. On this occasion a fibrinous membrane was pulled off the iris. The cataractous lens released spontaneously. Finally an anterior vitrectomy was carried out. Two weeks later endophthalmitis occurred. Therefore, a vitrectomy was performed. Microbiological examination yielded mold fungus. Seven days after this operation another infiltration of the vitreous could be detected sonographically. During the third operation 10 mm of the first 16-mm transplant was trephined for another keratoplasty. An open-air vitrectomy was carried out as well. Nevertheless, the bulbus became phthisic afterwards. Amazingly the tenonplasty led to complete regeneration of the conjunctiva and healing of the scleral ulceration. It was possible to take an autologous transplant of the conjunctiva from the eye and graft it on the right eye to relieve a nasal superior symblepharon. After successful keratoplasty visual acuity of the right eye is 0.5.

Adult↗
PubMed1993

Comparative study on the effects of chlorite oxygen reaction product TCDO (tetrachlorodecaoxygen) and sodium chlorite solution (NaClO2) with equimolar chlorite content on bone marrow and peripheral blood of BDIX rats.

The effects of the chlorite-oxygen reaction product TCDO (tetrachlorodecaoxygen, active ingredient of the systemic application form of WF 10) were investigated on bone marrow and peripheral blood of BDIX rats in comparison to a sodium chlorite solution with a chlorite content identical to that of WF 10. Despite difficulties in determining the chemical differences between TCDO and a sodium chlorite solution, their differing effects on cells, tissue and organism were striking. The following characteristics have been observed: Stimulation of the bone marrow, evidenced by the pronounced increase in mature granulocytes, pronormo- and normoblasts, or increased cell proliferation rate, determined by means of the BrdUrd method, was achieved only with WF 10 (TCDO). Stimulation of the bone marrow led in turn to increased numbers of leucocytes and monocytes in the peripheral blood. In addition, WF 10 induced the production of large granular lymphocytes (LGLs), referred to as natural killer cells (NK-cells). In contrast, NaClO2 solution suppressed bone marrow function, exhibiting a toxic effect when given on a long-term basis. At the same time the number of mature granulocytes as well as pronormo- and normoblasts decreased, while the presence of LGLs was not observed. The results showed that TCDO is a potent stimulator of the bone marrow function and an effective modulator of the entire immune system. The toxic effect of chlorite, derived from the TCDO matrix, is not noticeable, being completely compensated by the favourable effects of TCDO.

Animals↗
PubMed1993

A simple empirical calibration of energy dispersive X-ray analysis (EDXA) on the cornea.

Monitoring of the corneal electrolyte content is important for the study of chemical eye burns. This paper describes quantitative measurements on gelatin standards, corneas and a cornea homogenate with an energy dispersive X-ray analyzer (EDX) in the scanning electron microscope (SEM). Ten micrometers thick cryosections were freeze-dried and mounted on solid carbon supports. The applied quantification procedure was a local peak background analysis with a specifically designed computer program. Similar chemical and physical properties of gelatin, cornea homogenate, and cornea were proven by EDX-analysis and wet chemical analysis. Gelatin standards with known concentrations of different added salts showed linear correlations with a correlation coefficient higher than 0.95 for all considered elements. The local background generation on carbon supports was the same for gelatin standards and corneal tissue. The results demonstrate that quantitative EDX analysis of semi-thin samples, mounted on neutral carbon supports, can be reliably used for the assessment of the corneal mineral composition.

Animals↗