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Biomedical subjects

R Sundmacher

Publications and source records attributed to R Sundmacher.

At least 19 recordsLinked to original sources
PubMed1995

[Treatment of toxoplasmosis retinochoroiditis with atovaquone in an AIDS patient].

BACKGROUND: Treatment of ocular toxoplasmosis in HIV-infected patients with standard drug regimens (Pyrimethamine, Clindamycine, Sulfonamides) is very often complicated by side-effects and adverse reactions. On the other hand, maintenance therapy must be continued life long, because of the high recurrence rates. Atovaquone (Hydroxynaphthoquinon) is tolerated excellently and is very effective against tachyzoits of toxoplasma gondii and its cysts. PATIENT HISTORY AND CLINICAL FINDINGS: A 49-year-old homosexual man with AIDS developed an allergic rash after being treated with a course of Pyrimethamine and Clindamycine for unilateral, bifocal ocular toxoplasmosis for 13 days. Therapy with Atovaquone 3 x 750 mg/d was instituted and within 8 days the infiltrates healed leaving retinochorioidal scars. THERAPY AND CLINICAL COURSE: During maintenance therapy with Atovaquone (3 x 750 mg/d) two relapses occurred, the first after 2 months and the second after 8 months. The recurrences were successfully treated by increasing the dosage of Atovaquone to 4 x 750 mg/d and the addition of Trimethoprime/Sulfamethoxazol and Clindamycine/Pyrimethamine respectively. Reexposition was tolerated without an allergic reaction. Under maintenance therapy with Pyrimethamine the patient was free of recurrences for another 4 months until he died. CONCLUSIONS: Atovaquone is an effective and well tolerated substance for the treatment of ocular toxoplasmosis. In contrast to earlier reports, two recurrences occurred under maintenance therapy. It cannot be excluded that the patient was incomplient and did not take the tablets according to our prescription. Future clinical investigations have to control the efficacy of Atovaquone in the therapy of ocular toxoplasmosis.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Iris black diaphragm intraocular lenses in traumatic Aniridia].

PURPOSE: In this study we wanted to gain experiences with a new black diaphragm IOL concerning surgical postoperative difficulties in traumatic aniridia. PATIENTS: Since June 1991 we have implanted the IOL prototype and the modifications into 13 eyes with traumatic aniridia. The IOL was transsclerally sutured in 11 eyes without capsular support and it was positioned in front of capsular remnants in two eyes. In eight eyes penetrating keratoplasty was necessary. The mean follow-up period was 17 (1-34) months. RESULTS: The seventh IOL modification can be implanted safely now. Persistent intraocular inflammation (Tyndall +) has been observed in all eyes postoperatively but it seems to disappear slowly. Its effect upon the corneal endothelium and the development of cystoid macula edema is still under investigation. Secondary glaucoma has been the greatest postoperative problem: It could be controlled medically in five eyes, surgically in two eyes, but remained uncontrolled in one eye. Implantation of the IOL improved visual acuity in 11/13 eyes. CONCLUSION: Rehabilitation of eyes with traumatic aniridia by implanting the new black diaphragm IOL still presents some unsolved problems, especially uncontrolled secondary glaucoma and prolonged intraocular inflammation. In spite of many encouraging aspects we advise to be rather cautious and self-restrictive in this group of patients.

Adolescent↗
PubMed1994

[Lamellar horseshoe sclerokeratoplasty and thermoplasty in keratoconus with peripheral ectasia of the cornea].

PURPOSE: Peripheral ectasia of the cornea is a rare, but rather complicated form of keratoconus, which in its severest form cannot be corrected by glasses or contact lenses. Penetrating corneal grafts must be positioned directly at the limbus. Such transplants mostly fail because of a high risk of immune reactions which can only be circumvented by systemic Ciclosporin A. To avoid the potential risks of such a systemic immunomodulation we performed instead of a penetrating keratoplasty a special lamellar procedure which restored the normal configuration of the cornea. PATIENT: The 35-year-old man presented with best corrected visual acuity of 0.1 in both eyes. Contact lenses were not tolerated any longer. RESULT: After lamellar dissection, thermoplasty and lamellar horse-shoe sclerokeratoplasty the patient now wears well-fitting contact lenses and has a visual acuity of 0.8 with his right and 0.5 with his left eye after a follow-up period of 25 and 14 months respectively. There were no postoperative complications. CONCLUSION: Lamellar horse-shoe sclerokeratoplasty preceded by lamellar corneal dissection and thermoplasty is a technically difficult, but efficient surgical measure to restore the normal corneal curvature in patients with advanced peripheral ectasia of the cornea.

Corneal Transplantation↗
PubMed1994

Anterior capsular shrinkage and intraocular pressure reduction after capsulorhexis.

A significantly lower intraocular pressure level was found 2 months after in-the-bag implantation of 4 different posterior-chamber lenses in a consecutive series of operations involving 401 eyes. The anterior capsular opening was achieved with either an intact continuous circular capsulorhexis (349) or a capsulorhexis with one radial tear (52). The typical shrinkage of the anterior capsule following a continuous capsulorhexis was hypothesized to be an essential part of the pressure-lowering mechanism by traction on the ciliary body via the zonula. However, a direct correlation between the degree of anterior capsular shrinkage and the degree of pressure reduction in glaucomatous and non-glaucomatous eyes could not be established. The reduction was equal in all shrinkage subgroups. Thus, the most likely explanation for intraocular pressure reduction after intracapsular implantation should be sought not in mechanical but in non-mechanical (i.e. biochemical) alterations and influences.

Adolescent↗
PubMed1992

[Risk factors for fibrinoid reaction after posterior chamber lens implantation--a retrospective study].

Previous ocular diseases (e.g. herpetic keratouveitis), glaucoma, previous ocular surgery and surgery longer than normal turned out to be the main risk factors for a fibrinoid reaction after an extracapsular cataract extraction with posterior chamber lens implantation in patients of the Universitäts-Augenklinik Düsseldorf between June 1989 and March 1990. This result was obtained from a retrospective study of the medical records. No special risks could be concluded neither from the presence of general diseases (e.g. diabetes mellitus, consumptive basic diseases), immuno-suppressive treatment, constitutional factors, nor from age, sex, operative method nor from the surgeon. Preoperative antiexsudative prophylactic treatment is suggested for patients with one or more risk factor.

Adult↗
PubMed1992

[Perforating keratoplasty in endogenous eczema. An indication for systemic cyclosporin A--a retrospective study of 18 patients].

Endogenous eczema represents a considerable risk for perforating keratoplasty because of the associated chronic surface disorders and complex immunological disturbances. Between December 1986 through October 1991 we performed 24 perforating keratoplasties in 20 eyes of 18 patients with endogenous eczema suffering from keratokonus, atopic keratokonjunctivitis and bullous keratopathy after intracapsular cataract extraction. During the follow-up period of 16 (3-48) months 6 transplants failed mostly due to surface problems as well as immune reactions and bacterial transplant infections. Systemically administered ciclosporin A was found to eliminate many of the previously unsolved problems. In summary, 18 out of 20 eyes achieved an improved visual acuity with clear transplants.

Adult↗
PubMed1992

Transscleral suture fixation of posterior chamber intraocular lenses through the ciliary sulcus: endoscopic comparison of different suture techniques.

Two technical difficulties exist in transscleral suture fixation of posterior chamber intraocular lenses (PCL) in the ciliary sulcus: first, exact needle penetration of the sulcus and second, exact positioning of the PCL haptics in the sulcus. We used, for the first time, intraocular endoscopy to visualize the site of needle penetration and the final location of the haptics in patients. It turned out that with our previously described standard techniques, precision was far less than anticipated. Thus, new technical ways had to be sought to improve the precision of positioning. In secondary implantation, we achieved best results when the needle was passed from the outside before opening the eyeball, taking advantage of a precisely prepared blue-white line. Passing the needle in an already hypotonic eyeball gives much less precise results. In combination with perforating keratoplasty, passing the needle from the inside by feeling one's way into the sulcus with the needle tip gives the best results. Correct positioning of the PCL haptics is at least as difficult as is needle penetration, a fact which up to now has mostly been ignored. More suitable lens designs may offer a solution for this problem. Their clinical value has to be established by intraocular endoscopy.

Cataract Extraction↗
PubMed1992

[Surgical correction of astigmatism after perforating keratoplasty].

Microsurgical control of astigmatism after perforating keratoplasty has widely remained an unsolved problem in spite of many sophisticated suggestions and inventions. The frequent irregularity in the recipient cornea and poor predictability with respect to wound healing are the major obstacles. If spectacles or contact lenses cannot provide useful vision, postoperative surgical correction is needed. Ablative or thermal laser techniques have not been sufficiently tried for such cases to be justified, and one may hesitate anyway to apply destructive methods in transplants. We therefore still use T-incisions and wedge resections, which are said to be rather imprecise. Only 3 out of more than 700 keratoplasties performed in our clinic from 1987 through July 1991 required such procedures. Two more cases were referred by surgeons outside the hospital. All five surgical corrections resulted in a good longterm effect with considerable improvement of vision. Thus, as long as alternative methods for surgical correction of postkeratoplasty astigmatism have not proved to be superior, we should continue to practice these "old" methods, which, indeed, are not bad if properly applied.

Adolescent↗
PubMed1992

Six years' experience with systemic cyclosporin A prophylaxis in high-risk perforating keratoplasty patients. A retrospective study.

Starting with single cases in 1985, we have routinely applied systemic cyclosporin A since 1987 in high-risk keratoplasty patients for a period of up to 37 months postoperatively. In all, 69 eyes undergoing 74 perforating keratoplasties have thus far been treated. A considerable percentage of them initially suffered from chemical burns or from endogenous eczema associated with chronic atopic inflammation. All patients were followed closely and their courses were reevaluated retrospectively. Our current conclusions are that (1) immune reactions are efficiently inhibited with constantly effective blood levels of cyclosporin A, which has enormously increased the rate of keratoplasty successful in these patients; (2) if drug blood levels fall too low due to noncompliance of the patient or to metabolic disturbances, immune reactions may occur, especially during the early postoperative months; (3) serious chronic surface problems, which are especially associated with chemical burns, atopic inflammation, and other chronic kerato-conjunctival diseases, are partly ameliorated but not completely eliminated (surface disorders are presently ranked as the number one cause of transplant failure, whereas immune reactions can be effectively suppressed by cyclosporin A); and (4) close medical follow-up has revealed no serious systemic complication of cyclosporin A prophylaxis over periods of up to 37 months. The present study was not conducted in a prospective, double-blind, controlled fashion.

Adolescent↗
PubMed1991

[Kidney function of patients with healthy kidneys during cyclosporin treatment].

Long-term administration of ciclosporin has been complicated by side-effects, the predominant being nephrotoxicity. We performed renal function studies on 20 patients treated with ciclosporin (group 1) and on 12 patients serving as controls (group 2). Only patients with serum creatinine less than 1.3 mg/dl entered the study. The renal function studies consisted of: Inulin clearance, PAH clearance, sodium sulphate loading, sodium bicarbonate loading. Plasma renin activity (PRA), inactive renin (IR) and aldosterone (ALDO) were measured basally and after stimulation with 40 mg furosemide i.v. Serum creatinine was not significantly impaired under ciclosporin with 1.1 +/- 0.1 mg/dl vs 0.9 +/- 0.1 mg/dl in the control group (ns). Glomerular filtration rates as measured by creatinine and inulin clearance were significantly impaired in group 1 as compared to group 2. Inulin clearance was impaired by ciclosporin with 93.5 +/- 4.4 ml/min/1.73 m2 as compared to 121 +/- 6.6 ml/min/1.73 m2 (p less than 0.05) in patients of group 2. The PAH clearance in ciclosporin treated patients was impaired, with 379 +/- 22.1 ml/min/1.73 m2 in group 1 as compared to 605 +/- 39 ml/min/1.73 m2 (p less than 0.001) in group 2. Mean arterial pressure and renovascular resistance were significantly increased in ciclosporin treated patients. We demonstrated, by means of sodium sulphate and bicarbonate loading, incomplete distal tubular acidosis in 3 patients from group 1 but in none of group 2. There was no difference in basal plasma renin activity (PRA), but during volume contraction induced by furosemide there was only blunted response by PRA in patients receiving ciclosporin with 2.7 +/- 0.3 ng/ml/h as compared to 7.7 +/- 0.5 ng/ml/h in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1991

Experience with transscleral fixation of posterior chamber lenses.

A total of 83 eyes with transsclerally sutured PCLs were followed for an average of 10.5 months (range 2-23 months). The vast majority of patients benefitted considerably from the procedure; 8% of cases experienced a reduction in visual acuity and 2% suffered monocular visual loss. General vascular risk factors seemed to be important in bringing about long-term complications. Patients presenting such a risk must be better identified in the future. The solution of some remaining surgical problems and questions will also add to the safety of the procedure in the future.

Adult↗
PubMed1991

[Recurrent and persistent nummuli after epidemic keratoconjunctivitis].

Three observations of typical patients with persistent and recurrent nummuli after epidemic keratoconjunctivitis serve--pars pro toto--to demonstrate that longterm therapy with high-dosed topical steroid offers no therapeutic solution. This experience and other disadvantages of steroids in KCE (dry eyes) lead us to recommend not to apply topical steroids in KCE unless an adenovirus specific antiviral agent has become available for basic antiviral therapy.

Acyclovir↗
PubMed1991

[Clinical follow-up, histologic findings and therapeutic problems in a patient with bilateral ulcus rodens Mooren].

A severe, spontaneously acquired, bilateral, sight threatening Ulcus rodens Mooren of a 31 years old type I diabetic will be demonstrated in its clinical course. An improvement was achieved by a systemic immunomodulating therapy with Ciclosporin A that had to be tapered after 3 weeks due to severe side effects. The exclusive local therapy showed no effect at all. Later, the patient underwent a penetrating keratoplasty and extracapsular cataract extraction of both eyes under systemic Ciclosporin A therapy. The graft of the left eye failed due to a foudroyant bacterial infection whereas the keratoplasty of the right eye was successful up to this day despite of various complications.

Adult↗
PubMed1991

[Local prevention with interferon of "epidemic" conjunctivitis caused by a currently unidentifiable virus].

Topical Interferon application did effectively interrupt the further clinical spread of a highly contagious viral keratoconjunctivitis. A total of 130 endangered inpatients, still free from symptoms, were treated with one drop per eye daily for a period of 12 days. 123 patients stood free from any further infection. Only during the first two days after the beginning of the Interferon prophylaxis 7 inpatients showed an acute viral keratoconjunctivitis still. Obviously these patients were infected prior to the prophylactic therapy and were just in the incubation period. We conclude that Interferon eye drops (one drop per eye daily) may offer a reliable protection from exogenous viral infection. Certainly this protection comes too late if the patient's incubation period has already started.

Adenovirus Infections, Human↗
PubMed1991

[Contusion-induced traumatic aniridia].

Total aniridia occurred after a severe blow on the eyeball of a 65 year old man. The entire iris was torn off the ciliary body and escaped out of the eye through a small corneal wound. The zonular fibres were found to be intact and the posterior parts of the eye showed no traumatic changes.

Aged↗
PubMed1991

[Keratoplasty in infancy and early childhood with special reference to the auto-rotation technique].

Between January 1987 and August 1990, a total of 20 keratoplasties were performed in infants and children in the University Eye Hospital, Düsseldorf, accounting for 4% of all keratoplasties during this period. The indications included malformations of the anterior segment and central corneal opacities, mostly of herpetic or microbial etiology. The ages of the patients varied from 2 weeks to 6 years, and the cases were followed up for an average of 2 years. Five (25%) were treated with the autorotation technique. Visual acuity after surgery was satisfactory, although an irregular astigmatism was found in three cases and one child eventually had to have a contact lens fitted. In view of our encouraging results we recommend that ipsilateral rotational autokeratoplasties should be considered more often for suitable forms of central corneal opacyty, particularly for infants and children.

Child, Preschool↗