[Unilateral hemiarcus lipoides corneae following filtration surgery].
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Adult↗
Biomedical subjects
T S Dietlein
Publications and source records attributed to T S Dietlein.
[Glaucoma in the aged--barriers to understanding and compliance].
Glaucoma is a relatively common ocular disease among adults aged >65 years. However, knowledge about glaucoma, the physical capacity to perform self-application of antiglaucomatous drops, and general compliance may be massively restricted in the older population owing to significantly increasing comorbidity and other factors (e.g. their social and financial situation). Additional efforts by ophthalmologists, the pharmaceutical industry and health politics are required to improve knowledge and compliance among elderly glaucoma patients.
Aged↗
[Early postoperative spikes of the intraocular pressure (IOP) following phacoemulsification in late-stage glaucoma].
BACKGROUND: Modern cataract surgery with use of viscoelastics can induce remarkable early spikes of the intraocular pressure (IOP) in patients with glaucoma. PATIENTS AND METHODS: The purpose of this prospective study was to investigate risk factors for an early increase of the IOP following cataract surgery in eyes with end-stage glaucoma. Clear cornea phacoemulsification with implantation of a foldable acrylic lens was performed in 25 eyes with end-stage glaucoma (primary open-angle glaucoma including normal tension glaucoma or exfoliative glaucoma) either under topical anesthesia or under general anesthesia. In eyes with exfoliative glaucoma, trabecular aspiration was performed additionally. IOP measurements were conducted at the day before surgery, 4 hours following surgery and on the first morning following surgery. RESULTS: Cataract surgery was performed without complications. The mean IOP was 18.5 +/- 4.2 mm Hg with 2.1 +/- 1.0 topical medications. 4 hours postoperatively, mean IOP was 31.3 +/- 11.9 mm Hg. In eyes with exfoliative glaucoma (n = 12) the early postoperative IOP was 28.5 +/- 12.0 mm Hg, but without significant difference compared to eyes with POAG (n = 13). The early postoperative IOP showed significant correlation with the maximum IOP in patient's history (p = 0.014). CONCLUSIONS: Patients with late-stage glaucoma can experience considerable early IOP spikes following uneventful cataract surgery, although preoperatively IOP is controlled by topical medications. Postoperative IOP monitoring is recommended at the day of surgery, especially if high IOP values are reported in patient's history.
Aged↗
[Patient characteristics in a tertiary glaucoma center. Circumstances of treatment and attitudes of patients].
BACKGROUND: In order to look for conceptual improvements in the practical management of patients sent to our glaucoma department, we analyzed the structures, behaviour, and knowledge about the disease in this patient group. METHODS: Glaucoma patients who were sent for the first time to our department were included prospectively. Before being examined 129 patients were asked to answer a questionnaire concerning their individual characteristics, their behaviour, and patterns of treatment. RESULTS: Of the patients 74% had open-angle glaucoma (including normal tension, exfoliative, and pigment glaucoma), 22% had secondary glaucoma (including neovascular, congenital, and chronic closed-angle glaucoma), and 4% had suspected glaucoma. Written documentation of previously performed intraocular pressure measurements was not available for 84% of the patients. Younger patients had significantly more knowledge about glaucoma and used more possibilities to get information about the disease than elder patients. CONCLUSION: Education about glaucoma disease should be optimized especially for elder glaucoma patients. Documentation of intraocular pressure measurements is insufficient in our patient group.
Adult↗
[Lessons from 10 years of the Advanced Glaucoma Intervention Study (AGIS)].
The 10-year results of the AGIS have revealed different outcomes of therapeutic strategies depending on ethnic factors, but also different success rates of trabeculectomy depending on age, preoperative intraocular pressure, and presence of diabetes or postoperative complications. Conclusions from the study may be limited by the fact that medical options and surgical strategies in glaucoma treatment have obviously changed during the last decade.
Adult↗
[New aspects of corneal pachymetry in congenital glaucoma and pediatric aphakic glaucoma].
BACKGROUND: Knowledge of individual corneal thickness in individual eyes is proving to be more and more crucial for correcting Goldmann applanation tonometry, as well as to assess its predictive value regarding the possible progression of glaucomatous damage. It has become an important factor in determining appropriate glaucoma therapy. Only few pachymetric data exist about eyes with congenital or secondary pediatric aphakic glaucoma. METHODS: 12 eyes with congenital glaucoma (6 patients, mean age 3.3 years, mean 3.9 previous operations) and 7 eyes with secondary pediatric aphakic glaucoma (4 patients, mean age 14.8 years, mean 3 previous operations) without clinical signs of corneal decompensation were investigated by ultrasound pachymetry. RESULTS: Eyes with glaucoma due to aphakia had a mean corneal thickness of 708 +/- 77.3 microm. Mean corneal thickness of the eyes with congenital glaucoma was 688.1 +/- 115.9 microm, which is far above the values known from the literature. Two eyes, which had a central corneal thickness of 646 microm and 640 microm, presented with a localised paracentral corneal thickness of only 402 microm and 405 microm, respectively, correlating with microscopic descemet scars. CONCLUSIONS: Congenital glaucoma and the pediatric aphakic glaucoma present with very heterogeneous clinical pictures. Especially for congenital glaucoma, this is confirmed by the high interindividual, but also intraindividual, variability of corneal pachymetry.
Adolescent↗
Retinal tolerance to dyes.
BACKGROUND: Dye solutions for intraoperative staining of epiretinal membranes and the internal limiting membrane improve the visualisation of these thin structures and facilitate their removal. In the present study the authors investigated the effects of indocyanine green 0.05%, trypan blue 0.15%, and patent blue 0.48% on bovine retinal function. METHODS: Bovine retina preparations were perfused with a standard solution and the electroretinogram (ERG) was recorded repeatedly. After recording of stable ERG amplitudes the nutrient solution was substituted by one of the dye solutions. The duration of retinal exposure to a dye solution was varied between 10 seconds and 2 minutes. Thereupon, the preparation was reperfused with standard solution for at least 115 minutes. The percentage of b-wave reduction after exposition was calculated. RESULTS: Reductions of the b-wave amplitude were found for each dye solution tested. The effects after application of patent blue and indocyanine green were completely reversible within the recovery time for an exposure period of 60 and 30 seconds, respectively. The application of trypan blue lead to a loss of the b-wave when the retina was exposed for 15 seconds or longer. This effect was only partly reversible within the recovery time. CONCLUSION: The ERG showed toxic effects of trypan blue after a short period of retinal exposure. The intraocular application of trypan blue should be limited to selected cases. However, intraocular application of indocyanine green and patent blue in a sufficient concentration and taking account of a short period of retinal exposure seems possible.
Animals↗
[Measurement of corneal thickness in cases where tonometry is contraindicated].
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Antihypertensive Agents↗
[Implant exposure after viscocanalostomy with reticulated hyaluronic acid (SK-GEL)].
BACKGROUND: Lately, the application of intrascleral implants has been increasingly discussed to improve success rates of nonpenetrating surgery for the treatment of open-angle glaucoma. PATIENTS AND METHODS: A 36-year-old male patient with medically uncontrolled pigmentary glaucoma underwent viscocanalostomy with intrascleral implantation of reticulated hyaluronic acid (SK-GEL) in his right eye. RESULTS: The immediate postoperative course was unremarkable with control of intraocular pressure without additional glaucoma medications. At first follow-up, 2 weeks post surgery, conjunctival dehiscence with partial extrusion and exposure of the reticulated hyaluronic acid implant was observed. Under topical tobramycin ointment a gradual limbal readaptation of the conjunctiva over the surface of the exposed parts of the implant with formation of a filtration bleb was noted. Therefore, surgical revision remained unnecessary. CONCLUSIONS: Implant exposure following nonpenetrating antiglaucomatous surgery is a specific complication, which can appear whenever intrascleral implants are used. Depending on the local situation nonsurgical treatment may be successful.
Adult↗
[Combined deep sclerectomy and trabeculotomy in congenital glaucoma with complications].
BACKGROUND: Lately there has been growing interest in deep sclerectomy as a therapeutic approach for the management of congenital glaucoma.In theory, its pressure-lowering effect is independent of external filtration, which minimizes the risk of failure due to conjunctival or episcleral scarring. In patients who have failed to benefit from previous filtering procedures and have refractory congenital glaucoma,deep sclerectomy could become an alternative. PATIENTS AND METHODS: A 3-year-old girl with refractory congenital glaucoma underwent deep sclerectomy in her left eye. Intraoperatively, percolation through the trabeculodescemetic window was weak, so that the procedure was supplemented by a trabeculotomy. RESULTS: By now, throughout a follow-up period of 20 months, stabilisation of disc cupping and ocular axial length has been achieved without additional glaucoma surgery or medications. CONCLUSIONS: In patients with congenital glaucoma,the combination of deep sclerectomy with trabeculotomy may provide an additional therapeutic approach whenever the prospect of success appears to be limited with deep sclerectomy alone.
Child, Preschool↗
[Glaucoma and uveitis. Causes of and treatment options for increased intraocular pressure in cases of inflammatory ophthalmology].
Uveitic secondary glaucoma poses one of the most difficult problems for differential diagnostics and therapeutics in the field of clinical glaucomatology. The prevalence of glaucoma among uveitis patients ranges between 5 and 20% with great fluctuations depending on the underlying disease, duration of the disease, and the patient's age. Based on slit-lamp examination, uveitis can be classified as granulomatous and non-granulomatous. The effects of uveitic glaucoma on the quality of life and central visual acuity are particularly serious during childhood. Surgical reduction of eye pressure in cases of uveitic secondary glaucoma should only be performed if medical treatment of the underlying disease or ocular inflammation does not lower the eye pressure level and if in the presence of glaucomatous damage to the optic nerve the level of intraocular pressure is so high that a drastic decrease in pressure that cannot be achieved by medication becomes necessary.
Eye Diseases↗
UBM-guided chamber angle surgery for glaucoma management: an experimental study.
PURPOSE: The aim of this experimental study was to investigate the potential of ultrasound bimicroscopy (UBM)-guided chamber angle surgery as an alternative or supplement to gonioscopy and intraocular microendoscopy for intraoperative control. METHODS: In 15 porcine cadaver eyes, mechanical goniopuncture or punctual Er:YAG laser trabecular ablation was performed without operating microscope or gonioscopy, but with real-life ultrasound biomicroscopy monitoring with a 50 MHz transducer. Intraoperative localization of the microsurgical instruments and tissue-instrument contact were qualitatively evaluated. RESULTS: The instruments could be clearly visualized within the chamber angle and disturbing artefacts were only minimal when using mechanically fixed instruments in slow motion. Topographic localization, tissue contact, and penetration depth of the instruments entering the scleral were well illustrated as far as the technical resolution limits of UBM would allow. CONCLUSIONS: UBM can be used intraoperatively to monitor the correct manoeuvring of microsurgical instruments in selected ab interno procedures. Some adaptations and further modifications of the technique presented here will be necessary before UBM-guided surgery can be considered for clinical use in humans.
Animals↗
A prospective randomised trial of viscocanalostomy with and without implantation of a reticulated hyaluronic acid implant (SKGEL) in open angle glaucoma.
AIM: To prospectively assess the efficacy and complications of viscocanalostomy with a reticulated hyaluronic acid implant (VSRHAI) versus standard viscocanalostomy in patients with medically uncontrolled open angle glaucoma. METHODS: A consecutive series of 40 patients (40 eyes) with uncontrolled open angle glaucoma underwent non-penetrating antiglaucomatous surgery. After the excision of the deep scleral flap they were randomly assigned to either a standard viscocanalostomy or additional implantation of a reticulated hyaluronic acid implant. Follow up visits were over a period of 12 months after surgery. RESULTS: The mean preoperative intraocular pressure (IOP) was 26.5 (SD 6.1) mm Hg for all patients enrolled. The mean IOP was 8.1 (SD 5.6) mm Hg 1 day after surgery for the viscocanalostomy group (p<0.001) and 12.0 (SD 5.2) mm Hg for the VSRHAI group (p<0.001). The postoperative IOP difference between the two groups was statistically significant (p = 0.03). The success rate, defined as an IOP lower than 22 mm Hg without medication, was 40% in both groups at 12 months postoperatively (p = 0.90). The number of postoperative complications was equally low for both groups. CONCLUSIONS: Both surgical procedures, viscocanalostomy and VSRHAI, provide comparable success rates over a 1 year follow up period. The specific intraoperative and postoperative complications of non-penetrating surgery were seen in our series, although the overall rate of postoperative complications proved equally low for both techniques.
Aged↗
[Perspectives in glaucoma surgery].
Trabeculectomy is still considered to be the gold standard in the surgical treatment of the open-angle glaucomas. The additional application of local antimetabolites has reduced the rate of early filtering bled fibrosis, but increased the rate of essential late-postoperative complications. Growth factor inhibition and photodynamic therapy may be an alternative local treatment to enhance the results in filtering surgery. Non-penetrating glaucoma surgery and ab-interno trabecular surgery have several conceptual advantages, e.g. the lack of overfiltration or the untouched conjunctiva in the ab-interno approach. Clinical studies of these and other new procedures including antiglaucomatous retinectomy and subchoroidal shunt systems are currently performed in order to evaluate their potential and limits in the clinical management of glaucoma.
Filtering Surgery↗
Multifocal intraocular lens implantation in pediatric cataract surgery.
OBJECTIVE: To evaluate implantation of a zonal-progressive multifocal intraocular lens (IOL) in children. STUDY DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-five eyes of 26 pediatric patients aged 2 to 14 years with multifocal IOL implantation at one institution with more than 1 year of follow-up. INTERVENTIONS: Standard surgical procedure comprised an anterior capsulorrhexis, lens material aspiration via two side-port incisions, temporal tunnel incision, and multifocal IOL (SA40-N; Allergan, Irvine, CA) implantation in all eyes. In 24 eyes (68%), a 5-mm posterior capsulorrhexis was created with forceps, followed by an anterior vitrectomy in 19 of those eyes (54%). RESULTS: Twenty-six patients (35 eyes) had an average follow-up of 27.4 +/- 12.7 months (range, 12-58 months). At last follow-up, best-corrected distance visual acuity improved significantly (P = 0.001), 71% of eyes with a visual acuity of 20/40 or better and 31% of eyes with a visual acuity of 20/25 or better. In the 9 bilateral cases, spectacle dependency was moderate, with only 2 children (22%) reporting the permanent use of an additional near correction. The remaining children were either using distance-correction only (4 patients; 44%) or no glasses at all (3 patients; 33%). Stereopsis also improved significantly after multifocal IOL implantation (P = 0.01). Sixteen eyes (46%) experienced obscuration of the entrance pupil that required intervention, with 10 requiring a second intraocular surgery. Four eyes required an anterior membranectomy for persistent fibrinous membrane. Intraocular lens decentration requiring surgical intervention developed in six eyes. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in this age group.
Adolescent↗
Massive anterior capsule shrinkage after plate-haptic silicone lens implantation in uveitis.
Two patients, both with bilateral uveitis, had synechiolysis, continuous curvilinear capsulorhexis (CCC), phacoemulsification, and in-the-bag implantation of a foldable single-piece plate-haptic silicone intraocular lens (IOL) in 1 eye. Several weeks postoperatively, massive anterior capsule shrinkage with obstruction of the visual axis occurred in both patients. Surgical revision was performed in both eyes. Both patients had CCC and phacoemulsification and confirmed in-the-bag acrylic IOL implantation in the second eye months after surgery in the first eye. Follow-up examinations showed no significant shrinkage of the anterior capsule opening in any eye. In patients with uveitis, intraoperative lens epithelial cell removal, creation of a large CCC, and careful selection of IOL style and material may prevent occlusion of the anterior capsule opening.
Aged↗
Cataract surgery under topical anesthesia in patients with coexisting glaucoma.
PURPOSE: To evaluate and compare levels of patient discomfort and complications during phacoemulsification with implantation of a foldable intraocular lens (IOL) under topical lidocaine hydrochloride in patients with and without various forms of chronic open-angle and chronic angle-closure glaucoma. SETTING: Two university eye centers in Germany. METHODS: This prospective nonrandomized comparative study comprised 176 eyes of 176 patients with various forms of chronic open-angle glaucoma and chronic angle-closure glaucoma. Eyes with cataract and without a glaucoma diagnosis or history of intraocular surgery served as a control group (n = 212). All patients received a minimum of 5 doses (2 drops per dose) of topical lidocaine hydrochloride 2% before standard temporal clear corneal phacoemulsification and foldable IOL implantation. No intracameral anesthetic injection was given, and no systemic sedatives were used. The main outcome measures were the number of complications and adverse events. RESULTS: The intraoperative complication rate in all patients (n = 388) was capsule tear, 1.3%; zonule tear, 1.8%; vitreous loss, 1.0%; iris prolapse, 0.8%. No statistically significant differences in intraoperative or early postoperative complications were found between the glaucoma and control groups. The mean pain scores of patients were 0.38 +/- 1.1 (SD) in the glaucoma group and 0.36 +/- 0.8 in the control group (P =.21) Patient preference for cataract surgery under topical anesthesia was similar in both groups. CONCLUSIONS: Surgery-related complications and patient discomfort were similar in patients with and without glaucoma who had phacoemulsification and IOL implantation under topical anesthesia. These results indicate that topical anesthesia is safe for routine phacoemulsification with foldable IOL implantation in patients with glaucoma and does not compromise patient comfort.
Adult↗
[Does the dissection depth and thickness of the deep scleral flap affect intraocular pressure after viscocanalostomy? A clinico-pathologic correlation].
BACKGROUND: Non-perforating glaucoma surgery preserves the integrity of the trabecular meshwork in order to avoid postoperative hypotony. The purpose of our study was to investigate whether the morphologic variability of the excised deep scleral flap influences the postoperative intraocular pressure (IOP) after viscocanalostomy. METHODS: Light-microscopy of the deep scleral flap was performed in 17 patients who had undergone viscocanalstomy. Morphologic parameters (thickness and dissection level of the deep scleral flap) were correlated with the postoperative IOP. RESULTS: The mean thickness of the deep scleral flap was 309 +/- 95 microns; the dissection level was too deep in 5 cases (trabecular tissue excised) and too high in 6 cases (no signs of Schlemm's canal). The max. preop. IOP was 36.2 +/- 8.5 mmHg and came down to 10.6 +/- 5.7 mmHg at day 1 postop. and 12.4 +/- 4.9 mmHg at day 3/4 postop. At a median follow-up of 6 months IOP was 21.7 +/- 5.5 mmHg. A significant correlation between postop. IOP and the morphology of the deep scleral flap could not be demonstrated. CONCLUSIONS: Variations of the thickness and depth of the deep scleral flap showed little influence on the initial IOP level following viscocanalostomy. Other factors, f.e. the suturing of the external flap or invisible microruptures of the trabecular meshwork, could be of importance for the early postoperative IOP.
Adult↗