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Biomedical subjects

R J de Keizer

Publications and source records attributed to R J de Keizer.

At least 19 recordsLinked to original sources
PubMed1992

Iris nevi and melanomas: a clinical follow-up study.

A follow-up study of 113 patients with suspicious iris nevi who were referred to our clinic between 1973 and 1991 was carried out by: reviewing their clinical records, fluorescein angiography, obtaining recent data with cooperation of their own or the referring ophthalmologist and contacting patients for reexamination. After examination the diagnoses were: 64 suspicious nevi, 23 melanomas, 15 ciliary body tumors with iris involvement and 11 other pseudomelanomas. In the group of suspicious nevi 86% was localized in the inferior part and 66% in the temporal part of the iris; for the melanoma group these figures were 78% and 75% respectively. The chamber angle was more often involved in the melanoma group, 40% against 17% in the suspicious nevi group. In this group 11 cases (21.6%) showed growth during the follow-up (mean 10.6 years). In three cases the tumor was surgically removed, with as histopathologic diagnosis: 1 xanthogranuloma, 1 neurolemmoma and 1 possible melanoma. In the melanoma group 16 lesions (76%) showed growth during the follow-up (mean 7.2 years), in most cases within 5 years of the initial diagnosis. The lesion was surgically removed in 11 cases. The histopathologic diagnoses were: 8 melanomas, 1 xanthogranuloma, 1 possible melanoma and 1 metastasis of a skin melanoma. Our study shows that periodic ophthalmic check-ups are of great importance in the management of iris lesions suspect for melanoma.

Adult↗
PubMed1992

Toxicity of 1-(beta-D-arabinofuranosyl)cytosine after intravitreal injection in the rabbit eye.

The retinal toxicity of intravitreally injected 1-(beta-D-arabinofuranosyl)cytosine (cytarabine) was examined in 7 chinchilla rabbits to determine if cytarabine can be used as local therapy for vitreoretinal non-Hodgkin's lymphoma. Fractionated dose of 600 micrograms, 1500 micrograms, and 2700 micrograms cytarabine in stabilized saline were given intravitreally in one eye (2 x 300 micrograms, 5 x 300 micrograms, and 3 x 900 micrograms, respectively, with an interval time of 24 h) and stabilized saline in the other eye as control. Toxic effects were evaluated with biomicroscopy, direct ophthalmoscopy, fluorophotometry, electroretinography, light, and electron microscopy. Toxic effects were found with the 1500 micrograms and 2700 micrograms doses only. They consisted of a temporary impairment of the blood retina barrier function for fluorescein as measured by fluorophotometry and an irreversible change of the b-wave in the electroretinograms. No histopathologic changes were seen under the light microscope. Electron microscopic examination showed aberrations in the synaptic pedicles of the photoreceptor cells at a dose of 1500 micrograms cytarabine. The results suggest that the cytarabine dose that is expected to be therapeutic for vitreoretinal non-Hodgkin's lymphoma (about 90 micrograms given in three doses of 30 micrograms) is non-toxic for ocular structures.

Animals↗
PubMed1992

Basal tear turnover and topical timolol in glaucoma patients and healthy controls by fluorophotometry.

To assess the effect of glaucoma and timolol on tear secretion, basal tear turnover was measured with fluorophotometry in 13 open-angle glaucoma patients not using any ophthalmic medication, 24 patients using timolol medication daily, and 41 healthy control subjects. Basal tear turnover is defined as the tear turnover at the lowest level of reflex lacrimation possible under physiologic conditions. Tear turnover was calculated from the decay of the tear fluorescence after instillation of fluorescein. Minimal influence of reflex lacrimation was obtained by instilling 1 microliter of 2% fluorescein without touching the eye and by discarding measurements performed in the first 5 min. Minimization was confirmed by a monophasic decay of tear fluorescence. The values of patients who used timolol and those who did not use timolol were significantly lower than those of healthy control subjects (mean values in percent/minute +/- standard deviation: 10.1 +/- 3.2, 12.3 +/- 4.1, and 15.6 +/- 5.4, respectively; Student's t-test: P < 0.02). The values of patients who used timolol were significantly lower compared to those of patients who did not use timolol (P = 0.03). The tear film break up time values of patients who used timolol were significantly shorter than those of patients who did not use timolol and healthy control subjects (Fisher exact test: P < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1992

Complications of secondary surgical capsulotomy in pseudophakic and aphakic eyes.

A retrospective study was conducted to analyze the complications of surgical capsulotomy in 587 eyes--51 aphakic and 536 pseudophakic. Transient or permanent complications occurred in 20 (3.4%). One eye was seriously damaged by perforation during retrobulbar anesthesia, and another eye was lost due to endophthalmitis. Endophthalmitis developed in two other eyes, but it readily resolved with medication. Two eyes had markedly elevated intraocular pressure (IOP) (greater than 35 mm Hg), which was associated with the presence viscoelastic material in one eye; in the other eye, elevated IOP was the result of vitreous blocking of the pupillary aperture. Retinal detachments developed in nine patients (eight of whom, a significant number [P = .006], were males). Apart from the eyes in which endophthalmitis developed, all were markedly quiet after the procedure, and pressure elevation was not significant.

Adolescent↗
PubMed1991

Determination of basal tear turnover in insulin-dependent diabetes mellitus patients by fluorophotometry.

The tear turnover was determined by fluorophotometry in 25 insulin-dependent diabetes mellitus (IDDM) patients without retinopathy and 29 IDDM patients with (pre-)proliferative retinopathy. The results were compared with those in 34 healthy controls, to investigate the lacrimal gland function in diabetic patients. The tear turnover was calculated from the decay of the relative tear fluorescein concentration values measured after instillation of one microliters of fluorescein. The tear turnover values in both patient groups did not correlate significantly with age or diabetes duration (linear correlation coefficients: r less than 0.3). The tear turnover values in patients both without retinoplathy and with (pre-)proliferative retinopathy did not differ significantly from those in healthy controls (mean +/- SD in %/min: 13.7 +/- 4.5, 14.7 +/- 5.8 and 15.5 +/- 5.1, respectively; P greater than 0.16). The tear turnover was significantly decreased in eyes having a BUT shorter than 10 seconds compared with eyes having a BUT longer than 10 seconds (P less than 0.05). The tear turnover values correlated significantly with the HbA1c and Schirmer-test values in patients with (pre-)proliferative retinopathy (r = 0.7 and r = 0.4, respectively; P less than 0.02) and with the blood glucose values in patients without retinopathy (r = 0.41, P = 0.04). Since the tear turnover was not significantly decreased in IDDM patients in comparison with healthy controls the corneal disorders which are more frequently seen in these patients than in a healthy population may not be attributed to a decrease in tear production.

Adult↗
PubMed1991

Conjunctival xerosis, arcus lipoides and Rieger's disease.

Three generations of a family with conjunctival xerosis, Rieger's anomaly (complete or incomplete) and arcus lipoides are described. The xerosis was found always to be accompanied by a Rieger anomaly, which had sometimes, but not always, been detected before. Independent heredity was not observed. In a number of cases the xerosis was bilateral and localised both temporally and nasally. The combination appears to be a stigma malformationis oculi. Correlation with a temporary vitamin A deficiency in early youth appears possible. At this age in such families caution is advisable in the administration of vitamin A inhibiting medicines such as steroids and neomycine.

Abnormalities, Multiple↗
PubMed1991

Granulocytic sarcoma (chloroma). Presentation of an unusual case.

An unusual case of granulocytic sarcoma with a large retro-orbital tumor mass is described. The tumor had an uncommon cytomorphology and ultrastructure that mimicked a signet ring cell lymphoma. It was negative by chloroacetate esterase (CAE) stain. The patient was treated successfully with CHOP-regimen polychemotherapy and irradiation. Seventeen months after the initial diagnosis of malignant lymphoma, acute myeloid leukemia developed. Additional immunohistochemistry, including an immunoperoxidase staining for lysozyme, clearly demonstrated the early myeloid nature of the original tumor. This case emphasizes the importance of staining for lysozyme and other myeloid markers in addition to CAE staining in cases that demonstrate unusual morphological features.

Carboxylic Ester Hydrolases↗
PubMed1990

Clinical course and pathologic features of conjunctival non-Hodgkin's lymphoma. A report of six cases.

Six patients with conjunctival non-Hodgkin's lymphoma (NHL) were evaluated. In all six cases the conjunctiva was the primary site of clinical presentation; four cases involved low-grade malignancy and two, intermediate-grade malignancy, according to the International Working Formulation. The disease developed within a short period of time to stage IV. The poor response to therapy revealed a worse prognosis than would be expected according to the histopathologic classification. Four of the six patients died of NHL, three of them within 15 months. Comparison of these 6 cases with a group of 15 patients with orbital NHL revealed a much better prognosis in the latter patients. In spite of the fact that 4 of the 15 orbital cases showed NHL of high-grade malignancy, only 2 of them died of the lymphoma. Therefore, conjunctival NHL requires a fast and adequate diagnostic and therapeutic approach.

Adrenal Cortex Hormones↗
PubMed1990

Cyclosporin in the treatment of severe chronic idiopathic uveitis.

In a randomised double-masked study of 27 patients with a severe chronic idiopathic uveitis we evaluated the efficacy, safety, and tolerability of cyclosporin. All received prednisone in a low dose (0.3 mg/kg/day). In 14 patients this was combined with cyclosporin in a single daily dose of 10 mg/kg/day, while 13 patients received a placebo. The dosages were tapered off in accordance with a protocol, and we compared the number of months of successful therapy before the uveitis relapsed. The efficacy results, as expressed in a Kaplan-Meier curve, were in favour of cyclosporin. Owing to the small sample size, however, this difference did not reach statistical significance. The immunosuppressive effect of cyclosporin was not permanent, and in all but one patient the intraocular inflammation relapsed on reduction of dosage. Rather small cumulative doses of cyclosporin proved to be nephrotoxic, but subjective tolerability for cyclosporin was good.

Adult↗
PubMed1990

cANCA test and the detection of Wegener's disease in sclerokeratitis and uveitis.

Ocular signs and symptoms may be the initial signs of systemic or limited Wegener's granulomatosis. The diagnosis is difficult to make on ophthalmic manifestations alone, because clinical and histopathological markers are not specific enough. By means of the cANCA serum test it is possible to make the diagnosis in an early stage and to prevent more disastrous complications. The relation of cANCA titre and the clinical and histopathological findings of five patients with an acute or chronic Wegener's granulomatosis are discussed.

Aged↗
PubMed1989

Optic glioma with intraocular tumor and seeding in a child with neurofibromatosis.

We treated a 3-year-old boy with neurofibromatosis who had an optic glioma, intraocular extension with seeding, and iris tumors. On the basis of results of ultrasonography, computed tomography, magnetic resonance imaging, and fine needle aspiration, other intraocular and orbital tumors were excluded. Because of the malignant intraocular aspect, the optic nerve glioma was extirpated. Histologic examination confirmed the diagnosis of an optic nerve glioma with intraocular extension, seeding, and iris nodules. In this juvenile pilocytic astrocytoma with secondary perineural fibrous hyperplasia, several mitoses were found in the orbital and intraocular parts. In the optic canal, three small islands were found that were compatible with the diagnosis of malignant astrocytoma, grade 3. The iris nevi appeared as iris pits and not like the Lisch nodules typical of neurofibromatosis. Café au lait spots were present on the skin. The family history was positive for neurofibromatosis. The results of this study demonstrate that optic gliomas are true astrocytomas and not hamartomas, and have a continuous scale from benign to malignant differentiation.

Child, Preschool↗
PubMed1989

Masquerade of eyelid tumours.

Space-occupying processes in the eyelids can either be due to lesions which are specific for the eyelids, such as a chalazion or a meibomian carcinoma, or to non-specific lesions of the skin or ocular adnexa. An incorrect interpretation on clinical or histological grounds is often made; in other words, some eyelid processes masquerade as others. The correct diagnosis should be made on the basis of case history, localisation, the appearance of the tumour and the histological findings, so that adequate treatment can be given. One must be aware of the danger of mistaking one space-occupying process for another. In the Leiden Ophthalmological Clinic a study was made of the incidence of eyelid tumours in the period 1981-1987, with special attention to the most important masquerade phenomena observed. In a group of 956 eyelid tumours histological examination was necessary in 126 cases. Basal-cell carcinoma was the most frequent diagnosis, but other less common tumours such as a trichilemmoma, an eosinophilic granuloma, a haemangio-endothelioma, a metastasis from a mammary carcinoma and a granuloma annulare were also diagnosed.

Aged↗
PubMed1989

The permeability of the corneal epithelium of Graves' ophthalmopathy as determined by fluorophotometry.

The function of the corneal epithelium was evaluated in 30 patients with Graves' ophthalmopathy in whom no signs of corneal disease were observed. This function was evaluated by determining the permeability values of the corneal epithelium for fluorescein using fluorophotometry. The permeability values of the patients were compared with those of 46 healthy individuals. A significant increase in the permeability values was seen in 11 (37%) patients and in two (4%) controls (p less than 0.05). The difference in the mean permeability values between patients en controls was statistically significant (0.053 nm/sec. +/- 0.043 SD and 0.038 nm/sec. +/- 0.017 SD, respectively, p less than 0.05). No relation was found between the permeability values of the corneal epithelium and the NOSPECS classification or the duration of the disease. There was a tendency for increased permeability values in patients having an exophthalmos larger than 20 mm. (correl. coeff. = + 0.3, p less than 0.05).

Adult↗
PubMed1989

MRI in eye tumors.

Thirty patients with intraocular tumors were examined with MRI. A clear demarcation was seen between the melanomas and other intraocular structures such as sclera, vitreous and ciliary body. Retinal detachment, hemorrhage or choroidal-retinal layer could be seen separated from the tumor. In all our patients investigated with MRI the absence of extraocular melanoma tissue was confirmed by histopathology or by the findings during surgery. The demarcation between tumor and sclera seemed more sensitive in MRI than in ultrasonography in establishing extrascleral extension. Our study showed that MRI can be a valuable addition to ultrasonography in detecting intraocular tumors or tumor simulating lesions.

Evaluation Studies as Topic↗
PubMed1989

Conjunctival keratinisation, an abnormal reaction to an ocular beta-blocker.

Conjunctival leucoplakia was induced by the local beta-blocker metipranolol in one case. Withdrawal of the drug and application of all-trans retinoic acid ointment resulted in resolving of the keratinisation. A striking pharmacological resemblance is discovered between metipranolol and practolol. Metipranolol seems to be a less toxic phenol derivative of practolol. Nevertheless, it seems able to act as antigen.

Chemical Phenomena↗