Biomedical subjects

T Gracner

Publications and source records attributed to T Gracner.

13 recordsLinked to original sources

PubMed2006

[Repair of an extensive corneoscleral perforation in a case of ocular rosacea with a keratoplasty].

BACKGROUND: A 58-year-old female patient with rosacea and a 7year history of eye trouble presented with a spontaneous corneoscleral perforation of the left eye. METHODS: The persisting ocular hypotonia with retinal folds made a closure of the leakage area necessary. Covering with a corneal transplant was chosen from among several possibilities available for the repair of eye-surface defects. The involved parts of the sclera and cornea were removed in a diameter of 7 mm. RESULTS AND CONCLUSIONS: The almost 6-year postoperative course with virtually no problems confirmed the keratoplasty as being effective therapy also in the case of perforation in rosacea scleroperikeratitis.

Corneal Transplantation↗

PubMed2006

[Long-term follow-up of selective laser trabeculoplasty in primary open-angle glaucoma].

BACKGROUND: Our aim was to investigate the outcomes of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study. PATIENTS AND METHODS: In 90 eyes suffering from POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66 and 72 months after. A failure was defined as an IOP reduction of less than 20 % of the pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged. RESULTS: The mean follow-up time was 41.2 months (SD 20.0). The mean pretreatment IOP was 22.4 mmHg (SD 2.3). At one month of follow-up, the mean IOP reduction was 5.0 mmHg (SD 2.3) or 22.3 % and at 6 months 5.2 mmHg (SD 2.4) or 23.2 %. At 12 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.4) or 24.0 % and at 24 months 5.8 mmHg (SD 2.3) or 25.5 %. At 36 months of follow-up, the mean IOP reduction was 5.7 mmHg (SD 2.1) or 25.1 % and at 48 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 1.9) or 23.1 %. At 60 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 2.0) or 22.6 % and at the end of 72 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.3) or 22.8 %. The success rate after 12 months determined by Kaplan-Meier survival analysis was 94 %, after 24 months 85 %, after 36 months 74 %, after 48 months 68 % and after 72 months 59 %. CONCLUSION: SLT is an effective procedure offering an additional therapy option for the treatment of POAG, but the effect diminishes over time.

Female↗

PubMed2006

[Pseudomonas-keratoconjunctivitis in a contact lens wearer, the therapy and keratoplasty á chaud].

BACKGROUND: Eye infections in contact lens wearers can cause severe complications. Especially dangerous is Pseudomonas aeruginosa. PATIENT: A 18-year-old patient who received her first soft contact lens from a optician two years ago without an ophthalmological examination, will be presented. At the time of an excursion to Paris in August 2004 she suffered from a purulent secretion on her right eye. In a pharmacy she bought medicinal herbal eye drops first. Then after three days a physician prescribed her Tobramycin eye drops 4 times per day and Chloramphenicol ointment at bedtime. At that time the visual acuity (VA) of the infected eye was already very bad. Two days later we performed the first ophthalmological examination at our Ophthalmological Department. RESULTS: The clinical finding was typical for a Pseudomonas infection: mucopurulent secretion, corneal ring abscess with stromal necrosis and hypopyon. The VA was only light perception. Immediately, a topical and systemic antibiotic therapy was prescribed (grade III by W. Behrens-Baumann). A conjunctival smear was sterile. For the microbiological examination the corneal scraping, the contact lens and storing solution were also taken and Pseudomonas aeruginosa and Klebsiella spp. were isolated. One month after the first presentation of the patient at our Department we performed a keratoplasty á chaud (diameter 8.0 mm). 1 year later the corneal graft is clear and the VA is 0.6 - 0.7 cc. CONCLUSIONS: The contact lens fitting lies worldwide in different hands and could be done by an ophthalmologist, an optometrist or an optician. The changes of the cornea and conjunctiva made by contact lenses can have different causes. Especially dangerous are metabolic-hypoxic corneal changes and infections. Therefore, an ophthalmological check-up, particularly after contact lens fitting done by an non-physician, is very important and necessary.

Adolescent↗

PubMed2006

[Changes of retinal light sensitivity after YAG-laser capsulotomy].

BACKGROUND: The aim of this prospective study was firstly to investigate the changes of retinal light sensitivity of the central visual field in patients with posterior capsule opacification (PCO) after YAG-laser capsulotomy and secondly to determine the correlation between changes in retinal light sensitivity and patient's age and the diameter of posterior laser capsulotomy. PATIENTS AND METHODS: Our study includes 25 eyes (25 patients) with PCO after phacoemulsification and intraocular lens implantation. In all patients YAG-laser capsulotomy was performed. In all patients, a threshold visual field analysis was carried out with the C 30 - 2 programme of the automated Humphrey Field Analyzer before and one month after the procedure. RESULTS: In all patients a significant improvement of visual acuity was observed one month after capsulotomy (p = 0,00003). One month after YAG-laser treatment, a significant improvement of retinal light sensitivity in the central visual field was also observed. The average MD (mean deviation) before the procedure was - 6.05 db (+/- 3.2, max. - 11.7, min. + 2.17) and after the procedure - 3.61 db (+/- 3.7, max. - 10.87, min. + 0.71). Before laser capsulotomy obvious areas of reduced retinal sensitivity in 19 of 25 eyes (76 %) were found with MD p values of less than 5 %. One month after the procedure the MD p values were less than 5 % only in 8 eyes (32 %). The improvement in MD was statistically significant (p = 0,0002). No correlation was established between the improvement of retinal light sensitivity and patient's age or the size of the capsulotomy. CONCLUSIONS: Our study shows that the improvement of retinal light sensitivity is significant after YAG-laser capsulotomy and not depends on patient age or capsulotomy size.

Adaptation, Physiological↗

PubMed2005

[Cause and repair of a corneoscleral fistula in two patients].

BACKGROUND: A slowly progressing bulbar hypotension with maculopathy in a male patient as well as an endophthalmitis in a female patient both required surgical repair of posttraumatic leaks. PATIENTS AND METHODS: In a 32-year-old male patient, a filtration bleb leak occurred 4 months after a penetrating stab wound in the corneoscleral region. Persistent bulbar hypotension demanded microsurgical revision, revealing a 1 x 1 mm scleral defect. The leakage area was close to the limbus. In a 75-year-old female patient, signs of endophthalmitis occurred 4 years after extracapsular cataract extraction with posterior intraocular lens implantation. The place of entry of the inflammation was a 1 x 3 mm subconjunctival fistula in the corneoscleral scar. In both cases the leakage areas were repaired by an autologous 4 x 4 mm scleral graft obtained from the pars plana region in the same eye. RESULTS: The postoperative course was without complications, the intraocular pressure was back to normal within a few days in both cases. Two weeks after surgical repair in the first patient, normal ocular fundus and normal visual acuity were observed. In both cases complete and permanent leakage closure was achieved. CONCLUSIONS: There are various surgical possibilities for the repair of scleral defects. Patching the defects with autologous scleral grafts has several advantages. Dissection of the graft in the pars plana region is relatively simple. The graft comprising 30% of the scleral thickness is sufficiently firm and supple and there is no danger of infection transmission or of rejection.

Adult↗

PubMed2005

[The surprising finding and removal of a large plastic foreign body through the corneal wound from the vitreous cavity with good outcome].

BACKGROUND: Presented is a patient whose history showed that during a hammer-blow on a piece of iron something had flown into his left eye. Clinical investigation revealed a 9-mm long, horizontal, paracentrally located, penetrating corneal wound. Temporally in the same region the iris was torn in its entire width. The lens appeared opaque and seemed to be cut in two parts. Radiological investigation revealed no foreign body. METHODS: The operative treatment presented a surprise: the white piece, which had been considered to be a part of the traumatic cataract, was actually the edge of a large plastic foreign body lying in the vitreous cavity. The exciting and complicated procedure of removing this 12 x 9 x 2 mm large foreign body through the corneal wound as well as the reconstruction of the anterior segment of the eye are demonstrated. RESULTS: Seven months after the injury the corneal wound is very tender, the corneal sutures have not been removed, and the retina of the aphakic eye is undamaged. Visual acuity with a contact lens is 0.6 - 0.7. CONCLUSIONS: Operative treatment of patients with a penetrating eye injury is always demanding and difficult and requires a lot of experience. Particularly in apparently hopeless cases, an optimum primary care is of greatest importance.

Adult↗

PubMed2005

[The outcome of phacoemulsification in eyes after filtering glaucoma surgery].

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.

Aged↗

PubMed2003

[Siderosis bulbi. Is it still a problem?].

BACKGROUND: Siderosis bulbi (SB) is caused by un-removed intraocular iron-containing foreign bodies. Our retrospective study was designed to establish the number of patients treated for SB at our ophthalmology department within the past 10 years, and to find out why SB occurred. PATIENTS AND METHODS: Retrospectively, we analyzed the documentation of every patient treated at our department for ocular injury due to an intraocular metal foreign body between 1.1.1992 and 1.1.2002. Particular attention was focussed on the documentation of patients exhibiting symptoms of SB. RESULTS: During this period of time, 48 eyes with an intraocular iron-containing foreign body were treated operatively. In 45 cases, the foreign body was removed within 3 days after injury without any symptoms of SB. Of these, three patients (6.2%) came so late for treatment that various clinical signs of SB were already present. CONCLUSIONS: There are three major reasons for the development of SB: some patients do not come for an examination because there is no discomfort, the second reason is that the medical treatment at the first visit was too superficial and thirdly a small foreign body may also be overlooked due to deficient or inappropriate methods of examination. Therefore, sporadic cases of SB are still to be expected in the future.

Adult↗

PubMed2001

[Primary congenital glaucoma. Long-term success after goniotrepanation with scleral flap].

BACKGROUND: The long-term success of primary goniotrephining with scleral flap was evaluated in the treatment of primary congenital glaucoma. PATIENTS AND METHODS: Retrospective analysis was carried out in 31 eyes of 18 patients with primary congenital glaucoma (mean follow-up 63 months, range 10-161). Surgical success was defined by an intraocular pressure less than 18 mmHg without medication, stabilization, or reduction in horizontal corneal diameter and stabilization or reversal of disc cupping. Surgical complications were also noted. RESULTS: In 25 eyes control of the glaucoma was achieved with a single goniotrephining procedure (80.6% success rate). In 31 eyes control was achieved with two goniotrephinings (100% success rate). No serious surgical complications were noted. CONCLUSIONS: Primary goniotrephining with scleral flap is a successful and safe method of primary congenital glaucoma treatment.

Adolescent↗

PubMed2001

Intraocular pressure reduction after selective laser trabeculoplasty in primary open angle glaucoma.

The aim of this prospective clinical study was to investigate the intraocular pressure (IOP) reduction after selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). SLT represents a new method in the treatment of POAG. Fifty eyes with uncontrolled POAG were treated with a frequency doubled, Q-switched Nd:YAG laser (532 nm). The pattern of treatment was applying approximately 50 burns to 180 degrees of the trabecular meshwork at energy levels ranging from 0.40-0.92 mJ per pulse. After SLT eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was measured before treatment, 1 and 7 days after treatment and 1, 3, 6 and 12 months after treatment. The mean pretreatment IOP was 22.48 (SD 1.84) mm Hg. At the end of 1 month follow-up period the mean reduction of IOP was 4.86 (SD 2.38) mmHg or 21.6%; after 3 months the mean reduction was 5.66 (SD 2.40) mmHg or 25.2%; after 6 months the mean reduction of IOP was 5.06 (SD 2.37) mmHg or 22.5%; at the end of 12 months follow-up period the mean reduction was 4.92 (SD 2.58) mmHg or 21.9%. It can be concluded that SLT presents a new and effective method of IOP reduction in the treatment of POAG.

Aged↗

PubMed2001

Indirect traumatic optic neuropathy--two case report.

The aim of the study was to evaluate the treatment of indirect traumatic optic neuropathy (ITON). ITON is defined as traumatic loss of vision that occurs without external or initial ophthalmoscopic evidence of injury to the eye or its nerve. The optimal management of ITON remains controversial. History, clinical findings and treatment of two cases of ITON with high-dose corticosteroids are described. Improvement of visual acuity after treatment with high-dose corticosteroids was achieved in both cases. The treatment is evaluated in comparison to endorsed treatment modalities found in literature. We concluded that was clinically reasonable to decide to treat or not to treat the indirect optic neuropathy on an individual patient basis.

Adult↗

PubMedDate not supplied

Intraocular pressure response to selective laser trabeculoplasty in the treatment of primary open-angle glaucoma.

PURPOSE: To evaluate the intraocular pressure (IOP) response to selective laser trabeculoplasty (SLT) in the treatment of uncontrolled primary open-angle glaucoma (POAG) in a prospective clinical study. SLT is a new laser procedure that selectively targets trabecular meshwork (TM) cells without coagulative damage to the TM. METHODS: 50 eyes with uncontrolled POAG were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). A total of approximately 50 nonoverlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.40 to 0.92 mJ/pulse. After SLT, the eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was estimated before and 1 day, 7 days, 1 month, 3 months and 6 months after treatment. RESULTS: The mean pretreatment IOP was 22.48 mm Hg (SD 1.84). At the end of 1 month of follow-up IOP was reduced with a mean of 4.86 mm Hg (SD 2.38) or 21.6%; after 3 months, IOP was reduced with a mean of 5.66 mm Hg (SD 2.40) or 25.2%; at the end of 6 months of follow-up, IOP was reduced with a mean of 5.06 mm Hg (SD 2.37) or 22.5%. CONCLUSIONS: SLT is an effective method for lowering IOP in the treatment of POAG.

Aged↗

PubMedDate not supplied

Intraocular pressure response of capsular glaucoma and primary open-angle glaucoma to selective Nd:YAG laser trabeculoplasty: a prospective, comparative clinical trial.

PURPOSE: To compare the intraocular pressure (IOP) response of uncontrolled capsular glaucoma (CG) and primary open-angle glaucoma (POAG) to selective laser trabeculoplasty (SLT) in a prospective clinical trial. METHODS: Ten eyes often patients suffering from uncontrolled CG (CG Group) and ten eyes of ten patients with uncontrolled POAG (POAG Group) were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The baseline characteristics were similar in both groups. IOP was measured before and 1 day, 1 week, 1 month and 3, 6, 9, 12, 15 and 18 months after treatment. Success was defined as IOP more than 20% lower than before treatment. Any change of hypotensive medication led to the subjects' exclusion from the study. The two groups were compared using the independent-sample t test for continuous variables and the log-rank test for survival analysis. A value of p<0.05 was considered significant. RESULTS: The mean follow-up was 12.0 months (SD 5.5) for the CG group and 13.5 months (SD 4.3) for POAG (n.s.). No significant difference was found between the two groups for mean pretreatment IOP (23.6 mmHg +/- 5.70 in the CG group and 22.8 mmHg +/- 2.44 in the POAG group) or for mean IOP and mean IOP reductions during the follow-up. At all follow-up visits, IOP was reduced less in the CG group than in the POAG group (24.8% +/- 11.15 vs. 27.7% +/- 9.91 at 6 months, 22.0% +/- 6.66 vs. 30.6% +/- 6.35 at 12 months, and 31.4% +/- 5.55 vs. 35.1% +/- 1.75 at 18 months), but the difference was significant only at 12 months. Kaplan-Meier survival analysis gave an 18-month success rate of 64% in the CG group and 78% in the POAG group, with no significant differences between the groups. CONCLUSIONS: SLTis an effective procedure forlowering IOP in CG and POAG eyes, although the effect seems to last less in CG eyes.

Aged↗