共查询到20条相似文献,搜索用时 31 毫秒
1.
Berthold Seitz Achim Langenbucher M. Murat Kus Michael Küchle Gottfried O. H. Naumann 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(9):607-618
Background: Nonmechanical trephination has been established as the standard procedure in penetrating keratoplasty (PK) for avascular
corneal diseases at our institution. The purpose of this study was to analyze the incidence and reversibility of immunologic
graft reactions after nonmechanical trephination and to detect potentially causative factors.
Patients and methods: Out of a total series of 400 nonmechanical PKs, 286 consecutive procedures with sufficient follow-up performed between 07/1989
and 09/1997 were included in the study (104 × keratoconus, 78 × Fuchs' dystrophies, 31 ×bullous keratopathies, 28 × ulcers,
25 × avascular scars, 12 × stromal dystrophies, 4 × buphthalmos, 4 × others; 202 × PK only, 84 × combined procedures; 276
first PK). The age of the 138 females and 148 males at the time of surgery ranged from 16 to 89 (mean 55 ± 19) years. The
recipient and donor trephinations were performed from the epithelial side using an 193-mm excimer laser (MEL50 or MEL60, Aesculap-Meditec,
1.5 ×1.5 mm spot mode, 16–24 mJ/pulse, repetition rate 30 or 25/s; metal masks). The shape of the recipient trephination was
either circular with four or eight “orientation teeth” (n = 251; 5.0–8.0 mm diameter) or elliptical (n = 35, 6.0 × 7.0 to 7.5 × 8.5 mm diameter). In 62 % of procedures fresh or short-term-preserved donor tissue was used, and
in 38 % of procedures the donor tissue was organ-culture-preserved.
Results: During a mean follow-up of 22 ± 18 months (maximum 7.7 years), 10 acute diffuse (3 irreversible; 1.0 %) and 3 chronic focal
endothelial graft reactions occurred (4.5 %) not earlier than 4 months and not later than 35 months after PK. Elective procedures
(3.5 %) resulted in significantly (P = 0.01) less reactions than acute corneal ulcers (14.3 %). After 1, 2 and 3 years, the cumulative reaction rates (Kaplan-Meier
values) were 1.3 %, 6.3 % and 13.9 % in elective procedures, none of which, however, occurred after 26 elliptical trephinations.
With fresh or short-term-preserved donor tissue (4.2 %), graft reactions did not happen more frequently but earlier (12 ±
6 months) than with organ-culture-preserved donor tissue (2.2 %, 30 ± 6 months). In patients with keratoconus (4.9 %), reactions
occurred more frequently (P = 0.05, LogRank) and earlier than in patients with Fuchs' dystrophy (1.3 %).
Conclusions: In addition to well-established optical advantages, nonmechanical trephination seems to have no immunologic drawbacks.
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2.
Thomas Eusterholz Martin Wenzel 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1997,94(10):745-750
Summary
In the past 3 years, 85 basal cell carcinomas were treated in our clinic using eyelid reconstruction. During the same period,
54 lids were reconstructed after other diseases, mostly after chemical burns. In one of the 54 patients, the upper lid was
reconstructed using a tarso-marginal graft after congenital coloboma.
Method: In 31 of the 85 patients with basal-well carcinoma (36 %), so much tarsus was lost that a transplantation of tarsus was necessary.
Fifteen of the 31 patients were treated with a Hughes-plasty and 16 using a tarsomarginal graft, two in the upper lid.
Results: In eight of the remaining 16 cases, the defect was less than one half of length, so that the graft was taken from the second
lower lid. In the remaining eight patients, the defect was two thirds of length or longer. In six cases, a 7 mm-graft was
taken from the upper lid. As the tarsus from the upper lid measures 10 mm and is thus twice as big as the lower lid tarsus,
it was divided into two grafts, resulting in two grafts measuring 7 × 5 mm. They were placed in the lower lid (“double tarsomarginal
graft”). The former lower part with lashes was placed in the middle of the lower lid, the former upper part peripherally.
In two patients, the defect was healed with three tarsomarginal grafts. A pedicle skin flap was transposed to cover the posterior
grafts. Remaining defects were closed with free skin transplants.
Conclusion: The tarsomarginal graft permits a short operation time and early rehabilitation of the patients. The disadvantage of the
double tarsomarginal graft is that the more valuable upper lid tarsus is used to reconstruct the less valuable lower lid tarsus.
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3.
Schimidbauer JM Höh H Franke G Petsch E Siegmund W 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(3):182-186
Background: Dapiprazole hydrochloride is an alpha-1-adrenergic inhibitor that anticipates the mydriatic effect of phenylephrine in dilator
muscle receptors in a competitive way. The aim of this study was to determine for which indications for mydriasis pupil dilation
by phenylephrine alone is sufficient and if the reversal by dapiprazole is convenient and the practical.
Material and method: In 286 eyes of 147 outpatients, the pupil was dilated for fluorescein angiography – FLA (100 eyes of 50 patients), examination
of the fundus – Fd (99 eyes of 52 patients), central argon laser coagulation – cALC (64 eyes of 32 patients), peripheral argon
laser coagulation – pALC (16 eyes of 9 patients) and Nd:YAG capsulotomy (7 eyes of 4 patients) with phenylephrine 10 % eye
drops, followed by reversal by dapiprazole 0.5 %. The width and mobility of the pupil were tested at intervals of 10 min.
When mydriasis by phenylephrine was insufficient, tropicamide was applied additionally.
Results: In 98 % of FLA with scanning laser ophthalmoscope, 75 % of cALC, 76 % of Fd, 62 % FLA with fundus camera and 38 % of pALC,
mydriasis could be reached that was sufficient for the indication. Diabetics showed significantly more sluggish pupil mobility
(t1/2: P < 0.05 mydriasis, P < 0.005 reversal). The mean duration after using dapiprazole until reaching the starting value ( ± 1 mm) of the pupil was
44.3 ± 26.3 min. In 86 % of the examined eyes, the pupil reached its starting value within 1 h. The subjective degree of satisfaction
with the application of dapiprazole was “satisfied” to “very satisfied” (5.4 ± 1.4 points on a scale from 1 to 7 points).
Discussion and conclusion: In fundus examination, fluorescein angiography by a laser scanner, diagnostic retinal examination and central laser coagulation,
the combination phenylephrine/dapiprazole was most suitable. In our opinion, the combination is less suitable for peripheral
argon laser coagulation and fluorescein angiography using a fundus camera.
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4.
Alexander A. Bialasiewicz Volker Knospe Hansjörg Schäfer Andrea Hassenstein Gisbert Richard 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(4):229-232
Summary
Background: Intraocular pseudotumors are a rare event in Aids patients and often pose diagnostic problems.
Case report: A 37-year-old patient who had had HIV seroconversion for 7 years was seen to developed progressively growing, multiple, disseminated,
subretinal lesions OD > OS, accompanied by exudative retinal detachment and iritis. Since all etiological laboratory diagnostic
efforts to detect an infectious, noninfectious and neoplastic systemic lesion failed, a diagnostic and curative therapeutic
chorioretinal excisional biopsy specimen of the largest of the tumors (3 × 3 × 2 mm) was taken. The histological work-up demonstrated
granulation tissue similar to an intracular pseudotumor without signs of infection, malignancy or reactive lymphoid hyperplasia.
This finding resulted in systemic corticosteroid treatment with complete resolution of the lesions in both eyes and no recurrences.
Conclusions: An invasive diagnostic procedure in patients suffering from lesions of unknown cause resulting in the institution of an appropriate
medical treatment may be beneficial for the integrity and vision of the respective eye.
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5.
Rainer W. Schalnus Christian Ohrloff 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(1):3-7
Summary
Recent studies have sought to quantify aqueous flare by laser flare measurement. An increase in aqueous flare caused by a
rise of protein concentration was frequently found both in anterior and posterior segment disease. This has been interpreted
as a breakdown of the blood – aqueous barrier (BAB). By measuring the diffusion coefficient of the BAB compared to the aqueous
flare value in patients with anterior and posterior uveitis, the extent to which the increase in flare value was related to
a possible break down of the BAB was examined.
Patients: Thirty-nine normal eyes (23–78 years; 41.6 ± 18.6), 18 eyes with anterior uveitis (iritis, iridocyclitis; 18–57 years; 35.2
± 12.4) and 29 eyes with posterior uveitis (chorioretinitis or retinochorioiditis; 18–51 years; 31.7 ± 10.5). The diffusion
coefficient P(a) of the BAB was measured fluorophotometrically, while the flare value was quantified by laser flare measurement.
Results: Flare values (1/ms) were found to be significantly increased (p < 0.001) compared to normal eyes (4.6 ± 1.7) both in anterior uveitis (20.9 ± 8.5) and in posterior uveitis (17.4 ± 8.3)
but did not significantly differ between them (p = 0.43). The diffusion coefficient P(a) (10–3/min) of the BAB was not significantly different (p > 0.05) between normal eyes (0.5 ± 0.2) and eyes with posterior uveitis (0.9 ± 0.7), whereas it was significantly increased
(p < 0.001) in anterior uveitis (6.5 ± 5.4) compared to the other groups.
Conclusions: (1) In posterior uveitis, an increased flare value is not necessarily correlated with a breakdown of the BAB; proteins may
enter the aqueous from posterior. (2) Assessing the function of the BAB in posterior segment disease using laser measurement
should be carried out with caution; if possible, permeability measurements of the BAB should be undertaken seperately.
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6.
Kirk Nordwald Norbert Anders Tony Walkow Duy Thoai Pham 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(7):453-458
Introduction: The correction of low to moderate astigmatism is possible today by means of photoablation (PRK), while the treatment of moderate
and higher astigmatism still involves refractive keratotomy. Experience has shown that cataract surgery, using modern tunnel
techniques with self-healing incisions, results in earlier stability in both the refractive outcome and wound healing. In
this study, we attempted to combine the advantages of lamellar keratotomy with those of a pair-wise T-incision as arcuate
lamellar keratotomy (ALK).
Patients and methods: The clinical outcome of 41 patients who underwent ALK was investigate in a prospective study over a period of 3 years. The
pre- and postoperative investigations undertaken included the measurement of astigmatism using a Zeiss keratometer, uncorrected
visual acuity, and corrected glare vision using a Humphrey autorefractor. All patients had astigmatism between 2.0 and 7.0
D. Together with a uniform arcuate incision, we used 7 mm (n = 26) and 8 mm (n = 15) mm zones for correction.
Results: The average preoperative astigmatism was 4.01 ± 1.90 (median, 3.50) D. After a 3-year follow-up the average postoperative
astigmatism was 1.59 ± 1.29 (median, 1.38) D. The astigmatic change induced (Jaffé) after 3 years was about 3.23 ± 2.23 (median,
3.16) D. The average uncorrected visual acuity (log MAR) before ALK was 0.20 ± 0.12 (median, 0.22) and after follow-up, 0.41
± 0.14 (median, 0.39). Corrected glare vision before surgery was 0.23 ± 0.19 (median, 0.10) and afterwards, 0.25 ± 0.22 (median,
0.14).
Conclusions: Arcuate lamellar keratomy (ALK) stood the test as a routine clinical procedure for correction of moderate astigmatism with
stable postoperative functional outcomes. We did not find impairment of glare vision following this procedure.
相似文献
7.
Philipp Hugger Thomas Kohnen Douglas D. Koch 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1997,94(10):699-702
Summary
The purpose of this study was to determine which corneal curvature values most closely correlated to change in subjective
manifest refraction following excimer laser photorefractive keratectomy (PRK).
Methods: Excimer laser PRK was performed on ten eyes of ten patients (mean age: 37.3 years). Preoperative refractive errors ranged
from –2.25 to –8.75 diopters. Preoperatively and 1 month postoperatively, we determined the spherical equivalent of the manifest
refraction (corrected for a 12 mm vertex distance) and measured corneal power using standard keratometry (Bausch and Lomb
keratometer) and computerized videokeratography (EyeSys Corneal Analysis System). We collected five corneal values: standard
keratometry, videokeratography-derived simulated keratometric readings calculated using the axial, instantaneous and refractive
formulas, and corneal refractive power over the central 3-mm zone (effective refractive power); apart from the traditional
refractive index of the cornea (n = 1.3375), we used the refractive value of the anterior corneal stroma (n = 1.376). For each of the five corneal values, we subtracted the change in corneal power from the change in manifest refraction
and calculated the means and standard deviations.
Results: The mean differences between the refraction and the corneal values for a refractive index of 1.3375/1.376 were: 0.89 ± 0.54*/1.26 ± 0.59* for standard keratometry; 1.64 ± 0.75*/1.37 ± 0.7*, 4.03 ± 1.86*/3.86 ± 1.87*, and 1.16 ± 0.76*/0.91 ± 0.74* for the axial, instantaneous, and refractive videokeratography values, respectively; and 0.83 ± 1.03*/0.39 ± 1.08 for the effective refractive power (*, p < 0.05).
Conclusions: In our series, only the values for the effective refractive power, calculated with the refractive index of the anterior stroma
of the cornea, were not statistically different from the change in manifest refraction.
相似文献
8.
Michael C. Knorz Bettina Jendritza Philipp Hugger Andreas Liermann 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(8):503-508
Background: The incidence and course of intraoperative and postoperative complications of LASIK were investigated.
Patients and methods: We consecutively treated 598 eyes (316 patients) using the Automatic Corneal Shaper and the Keracor 117 C excimer laser.
One hundred and sixty-three eyes were also available at 12 months. The preoperative spherical equivalent was − 5.31 ± 5.49
D (+ 9 to − 23 D). We evaluated intra- and postoperative complications.
Results: Intraoperative complications of keratotomy were observed in 1.3 % (irregular cut, n = 5; free cap, n = 2; incomplete cap, n = 1), and other intraoperative complications in 1.7 % (epithelial defects, n = 7; flap dislocation, n = 1; lateral kanthotomy required, n = 2). None of these complications caused any long-term effects or loss of two or more lines of visual acuity. Postoperative
complications were observed in 0.9 % (peripheral epithelial ingrowth, n = 4; keratectasia, n = 1; subretinal neovascularisation, n = 1).
Conclusions: The rate of complications in LASIK is low, and intraoperative complications did not cause any significant loss of vision.
We observed keratectasia in one eye, which suggests that deep ablations should be avoided, which limits the amount of correction
possible.
相似文献
9.
Arend O Remky A Redbrake C Arend S Wenzel M Harris A 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(1):24-29
Summary
Chronic ischemia of the retina and the optic nerve head seems of importance especially in patients with normal-tension glaucoma
(NTG). The purpose of this study was to examine the retinal hemodynamics in patients with NTG.
Patients: Twenty-five patients with NTG were examined (3 weeks washout period) in this study (age 58 ± 16 years). The arteriovenous
passage (AVP) time and arterial and venous diameters from scanning laser fluorescein angiograms were evaluated by means of
digital image analysis.
Results: The AVP time in patients with NTG (2.78 ± 1.1 s) was significantly prolonged (P < 0.0001) compared with healthy subjects (1.58 ± 0.4 s). No significant correlation was found between arterial and venous
diameters, intraocular pressure, blood pressure or calculated perfusion pressure and retinal arteriovenous passage time.
Conclusion: Patients with NTG showed prolonged retinal passage, which could cause chronic hypoxia. This prolongation of circulation is
not correlated with any of the clinical parameters. Thus, a circulatory defect might be a primary factor in the pathogenesis
of NTG.
相似文献
10.
Nahel Alkara Uwe Genth Theo Seiler 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(10):677-683
Background: In contrast to the correction of simple myopia there is no widely accepted technique for the correction of myopic astigmatism.
Currently two techniques are available: the photoastigmatic refractive keratectomy (PARK) and the combination of arcuate keratotomies
with standard PRK (PRK-T).
Methods: In two groups, 67 patients underwent a correction of myopic astigmatism in a total of 87 eyes (19 by PRK-T and 68 by PARK),
and were followed for 1 year. The spherical equivalent was − 6.7 D in both groups and the refractive astigmatism ranged from
− 1.0 to − 6.5 D. The PARK procedure was performed by means of an elliptic ablation (Kertom I, Schwind) with a 5.8 × 8.1 mm
zone. The PRK-T technique consisted of two arcuate keratotomies with a free optical zone of 7 mm and a standard myopic PRK
at least 6 weeks later.
Results: The 1 year follow-up was completed in 57 out of 87 eyes included in the study. At 1 year post-operation, 83 % of the PRK-T
group and 80 % of the PARK group had an uncorrected visual acuity of 20/40 or better. The refractive astigmatism was reduced
by 76 % in the PRK-T group and by 67 % in the PARK group. The spherical equivalent was − 0.59 ± 1.1 D at 1 year after PRK-T
and − 0.28 ± 1.04 D after PARK. In three eyes of the PARK group (6.7 %) a visual loss of more than one Snellen line occured.
Two of these eyes had a preoperative myopia of more than − 6 diopters.
Conclusion: Both techniques have the potential to reduce myopic astigmatism, however, the success rate is not as high compared to spherical
PRK. Also, the complication rate of 2.5 % in corrections to − 6 D is significantly higher than that with spherical myopic
PRK.
相似文献
11.
Welzl-Hinterkörner E Thölen H Stürmer J Opravil M Bernauer W 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(2):87-91
Background: Cystoid macular edema (CME) in AIDS patients with inactive cytomegalovirus (CMV) retinitis is an uncommon but potentially
sight-threatening complication. The pathogenesis of CME in these patients is unclear. This study tries to identify possible
risk factors by analyzing the charts of five patients.
Methods: Ten eyes of 5 patients that finally developed CME were followed for an average of 18 months. The initial retinal lesions,
their response to antiviral treatment, the development of CME, and the patients' immune status were prospectively monitored.
Results: CMV retinitis was diagnosed at a median CD4+ count of 3 cells/mm3 (range 0–11). All eyes responded to the initial systemic anti-viral treatment. At the onset of CME, CMV retinitis was controlled
by antiviral maintenance therapy in all patients [ganciclovir (n = 2), cidofovir (n = 2), foscarnet (n = 1)]. The median time between diagnosis of CMV retinitis and onset of CME was 11.5 months (range 5–24). Development of CME
was associated with significant visual loss: acuity ranged from 0.05 to 0.7 when CME was first noticed, compared to 0.8–1.25
at diagnosis of CMV retinitis. Duration of inflammation, size or zone of retinal necrosis did not favor the development of
CME, neither did the antiviral therapy. A weak correlation of CME development and immune status (expressed as increase of
CD4+ cells) was found. Due to systemic corticosteroids CME resolved.
Conclusions: CME is a new visual threat to AIDS-patients with CMV retinitis whose immune status improved under the latest combined antiretroviral
therapy. Therapy with oral corticosteroids may positively influence this condition.
相似文献
12.
Norbert Anders Holger Stahl Tony Walkow Norbert Hosten Peter Wust Christian Hartmann Josef Wollensak Alexander Dorn 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(11):760-764
Summary
Despite the successful therapy of subretinal neovascular membranes by laserphotocoagulation there are many problems to be
overcome. In the case of subfoveolar neovascularization, photocoagulation leads to a sudden decrease in visual acuity.Recently
radiotherapy is considered as an alternative. Complications and effectivity were evaluated in this prospective and randomized
trial. The initial results are presented.
Patients and methods: There are 76 patients (51 women, 25 men, average age 77.7 ± 8.6 years) included in the prospective randomized study. All
of them show subfoveolar neovascular membranes in FLA and a decrease in visual acuity between 0.05 and 0.5. They were randomly
assigned to either the radiotherapy or the control group. Radiotherapy was done within 6 days by 6 × 2 Gy (6 MV photons).
The follow-up was at 4 weeks, after 3 months, after 6 months and then every 6 months after the end of radiotherapy. On average
the follow-up is at 15.1 months.
Results: Concerning age and visual acuity before therapy, the control group and the radiotherapy group were not significantly different.
At 4 weeks after radiotherapy, visual acuity was 0.13 ± 0.46 (LogMAR). After 12 months, visual acuity at a distance was 0.11
± 0.30 in the therapy group and 0.09 ± 0.13 (P = 0.838) in the control group. Patients with a preoperative visual acuity better than 0.2 improved more after radiotherapy.
Metamorphopsy improved in 75 % of the therapy group. The following complications could be observed: In the control group 3
patients suffered subretinal bleeding, in the radiotherapy group 3 patients, respectively.
Conclusions: At present, the follow-up is too short to recommend radiotherapy as a standard procedure in the case of subfoveolar neovascularization.
The results in patients with a better preoperative visual acuity encourage us to continue this study.
相似文献
13.
F. Faude E. Edel M. Dannhauer C. Petzel P. Meier P. Wiedemann 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1997,94(12):877-881
Background: Recent studies have shown the usefulness of pars plana vitrectomy with the use of growth factors in the treatment of macular
holes. Autologous platelet concentrates contain many growth factors to stimulate glial wound healing.
Patients: Nineteen patients with idiopathic macular hole underwent vitrectomy, membrane peeling, air injection and installation of
autologous platelet concentrate (0.1 ml). The platelet concentrate contained a mean of 1.8 × 109 platelets/ml.
Results: The anatomic success rate in stage 2 macular hole was 100 %, in stage 3, 82 % and in stage 4, 50 %. Visual acuity improved
in all patients with stage 2 (two lines) and in 73 % of stage 3 at least (one line).
Conclusion: Platelets are effective in the treatment of macular holes due to the high amount of different growth factors (PDGF, EGF,
bFGF, IGF-1) which have a high affinity binding to Müller cells helping to seal the hole by photoreceptor adaption.
相似文献
14.
Ileana Tomida Peter Martus Michael Küchle 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(9):583-586
Background: In the present study we evaluated the influence of topical miotics on intraocular pressure and the blood-aqueous barrier
after uncomplicated phacoemulsification and PC-IOL implantation.
Patients and methods: Fifty-two eyes were randomized into 2 groups: with miotics (n = 28) and without miotics (n = 24). The IOP was measured before, 6 h, 1 and 2 days after surgery. Measurement of aqueous flare was performed before and
on days 1 and 2 after surgery. Patients with glaucoma, PEX or previous intraocular surgery were excluded.
Results: In the group without miotics the IOP was 17.9 mm Hg (± 3.34) 6 h postoperatively; in the second group it was 15.5 mm Hg (±
3.25); P = 0.04. On the first postoperative day the IOP measured in the group without miotics was 15.3 mm Hg (± 2.70) and with miotics
13.0 mm Hg (± 2.28); P = 0.007. On the second day in the group without miotics the IOP was 13.9 mm Hg (± 3.05) and with miotics 12.60 mm Hg (± 2.19);
P = 0.53. The changes in aqueous flare on the first and second day after surgery showed no significant influence of miotics
on the blood-aqueous barrier (P > 0.05).
Conclusions: Immediate postoperative application of topical miotics led to a small yet significant reduction of the IOP during the first
24 h after surgery. Our data suggest that there is no need for pharmacological reduction of the IOP after uncomplicated cataract
surgery.
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15.
Detlev Spiegel Wolfgang Wetzel Reginald Birngruber 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(8):537-541
Purpose: This study was conducted to compare the efficacy of the Er-YAG laser sclerostomy ab externo versus trabeculectomy in the
treatment of primary open – angle glaucoma.
Methods: Twelve patients with POAG underwent ab externo laser sclerostomy using an Er-YAG laser (Sklerostom 2.9?; λ = 2940 nm, t = 200 μs, 2 Hz, 400 μm, 15 mJ). Only local medication was used, and there were no risk factors for failure. As a control
group 12 patients out of 248 standardized trabeculectomies were matched in terms of age, sex, diagnosis and local medications.
No antimetabolites were used in either group.
Results: After a follow-up of 9 months in the sclerostomy group 53 %; (7/12; P = 0.03) showed a patent fistula in comparison of 100 % in the trabeculectomy group. There was a significantly lower mean
IOP during the first postsurgical week in the group of sclerostomies (3.6 ± 1.5 mmHg versus 7.5 ± 2.7 mmHg; P = 0.0001) with a higher incidence of choroidal detachments (9/12 versus 2/12; P = 0.004). The choroidal detachments lasted longer in the sclerostomy group (3.5 months versus 0.3 months; P = 0.014). Iris incarcerations were found only in sclerostomies (7/12; P = 0.05).
Conclusions: Based on these findings, Er-YAG laser sclerostomy prooved to be less effective than trabeculectomy in the treatment of glaucoma
patients. Er-YAG laser sclerostomies were associated with a higher incidence of postsurgical complications such as hypotony,
choroidal detachments and iris incarcerations. At this point Er-YAG laser sclerostomy is not superior to conventional trabeculectomy.
相似文献
16.
Ulrich C. Schaller Gerlinde Michl Frank-D. Goebel Volker Klauß 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(4):267-269
Background: Hypopyon-uveitis has been identified as a dosage-dependent side effect in patients with acquired immunodeficiency syndrome
who are treated for Mycobacterium avium complex (MAC) infection with systemic rifabutin.
Patients and methods: We report a 38-year-old female AIDS patient with bilateral hypopyon uveitis under therapy with rifabutin in combination with
clarithromycin and indinavir.
Results: At the time of presentation of the bilateral hypopyon uveitis the patient was treated with rifabutin (300 mg/day), clarithromycin
(1000 mg/day) and ethambutol (1000 mg/day) for an M. avium complex infection. Also, the patient received the protease inhibitor indinavir. The rifabutin dose was reduced to 150 mg/day.
Hypopyon and inflammation resolved under therapy with steroids.
Conclusions: The concomitant use of rifabutin, clarithromycin, and protease inhibitors may lead to hypopyon uveitis. Reduction of dosage
of rifabutin (150 mg/day) and treatment with topical steroids are required.
相似文献
17.
Andreas Böhm Michael Kohlhaas R.-C. Lerche Birgit Bischoff Gisbert Richard 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1997,94(11):771-774
Background: Keratoconus is associated with changes in the corneal structure, such as defects of Bowman's layer, a decrease of corneal
thickness etc. They result in alterations of some of the biomechanical parameters of the cornea, namely, rigidity and elasticity.
The present study was performed to examine how impression tonometry and applanation tonometry for determination of intraocular
pressure (IOP) are affected by the changed biomechanical parameters associated with keratoconus.
Patients and methods: We examined 20 normal subjects (40 eyes) and 17 keratoconus patients (25 eyes). The corneal thickness was measured by ultrasound
pachymetry in the corneal center. In the keratoconus patients, an additional measurement was made at the conus peak. The corneal
curvature was determined using the TMS keratoscope. The IOP measurements were made with the Schi?tz tonometer (10 g). For
comparison, additional IOP measurements in the corneal center and, in the keratoconus group, on the conus peak were made with
the applanation tonometer.
Results: The normal subjects had a central corneal thickness of 548 ± 30 μm, compared to 505 ± 42 μm in the corneal center and 425
± 41 μm on the conus peak in keratoconus patients. The average corneal curvature was 43.3 ± 1.8 D in the normal subjects and
47.8 ± 4.1 D in keratoconus patients. Applanation tonometry produced results on 11.33 ± 1.43 mm Hg in the normal group (corneal
center) compared to values of 12.00 ± 2.55 mm Hg (corneal center) and 7.30 ± 1.95 mm Hg (conus peak) in the keratoconus cohort.
The coefficient of rigidity was 0.0236 ± 0.0026 μl−1 in the normal subjects, compared to 0.0173 ± 0.0050 μl−1 in the keratoconus patients.
Conclusion: The morphological changes associated with keratoconus may cause tonometry errors.
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18.
Jörg H. Krumeich Jan Daniel Martin Winter 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(11):748-754
Background: Despite the fact that deep lamellar keratoplasty (DLKP) is less invasive than to penetrating keratoplasty (PKP), this procedure
is rarely performed. We therefore investigated whether or not the DLKP technique we employed can achieve stable improvement
of visual acuity.
Materials and methods: Thirty-three eyes underwent TLKP for treatment of superficial corneal pathology. The donor tissue transplanted was suitable
for PKP. The donor lenticule was obtained on the artificial chamber of the guided trephine system (GTS). The recipient cornea
was trephined with the same trephine to a depth of 680 μm. Manual dissection was performed with a bevel-up blade. The donor
lenticule with the endothelium peeled off was then sutured in with a 10 × 0 nylon double-running antitorque suture. Cortisone-antibiotic
eye drops were administered postoperatively.
Results: Throughout the series no complications occurred. The mean best corrected visual acuity (BSCVA) over glasses was 0.29 ( ±
0.21) preoperatively, 0.1 ( ± 0.11) at 1 week, 0.33 ( ± 0.14) at 1 month, 0.5 ( ± 0.13) at 6 months, 0.61 ( ± 0.16) at 1 year
and 0.63 ( ± 0.15) at 2 years. Clinically, we observed two subpopulations. In the first group of 87 % of the cases, mean BSCVA
was 0.67 ( ± 0.07) at 6 months. The remaining cases (BSCVA ≤ 0.25 at 6 months) achieved a mean BSCVA of only 0.2 ( ± 0.04)
at 1 year. Mean corneal astigmatism measured 2.93 D ( ± 1.62) preoperatively, 2.69 D ( ± 1.18) at 1 month, 2.09 D ( ± 1.07)
at 1 year, and 2.22 D ( ± 1.11) at 2 years. We did not observe any graft rejection.
Conclusion: The technique reported for DLKP provides excellent matching of donor lenticule and recipient bed. Separation of donor and
recipient stroma prevents interface healing. DLKP appears to be a safe procedure for the surgical treatment of superficial
corneal pathology and may offer a clinically applicable alternative to PKP.
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19.
Harald C. Gäckle Gabriele E. Lang Karin A. Freißler Gerhard K. Lang 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(8):529-533
Summary
The purpose of this retrospective study was to analyze the demographic characteristics of central serous chorioretinopathy
(CSC).
Methods: Findings of 100 consecutive subjects with CSC were evaluated. Clinical and fluorescein angiographic findings, demographic
characteristics, and visual acuity were analyzed.
Results: The age of the patients ranged from 28 to 68 years with a mean of 43 years. No significant sex differences were found concerning
age and other parameters. The highest age peak was in the group of women. The male to female ratio was 5 : 1. Patients with
chronic CSC were significantly older (P = 0.015) than patients with the other angiographic findings. Median visual acuity was 0.5. In 40 % bilateral characteristics
of CSC were found. Clinical and fluorescein angiographic findings showed no significant correlation with visual acuity.
Conclusion: The range of age distribution in CSC is wide. In older patients distinguishing CSC from age-related macular degeneration
can be difficult.
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20.
F. Tost A. Hellmann G. Ockert 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1998,95(7):486-489
Summary
Due to the large number of differential diagnostic possibilities, the etiology of endogenous uveitis is still hard to determine.
One reason for uveitis may be the occurrence of parasites. However, too little attention is paid to this underlying disease.
Methods: To identify certain sources of infection, ovoscopic probes of 98 dog feces from the urban area of Halle were taken. The material
was collected from children's playgrounds, parks and swimming pools. A retrospective analysis of patient case data from the
records of the University Eye Hospital for the years 1986–1995 complemented the environmental and parasitological examination
of patients with Toxocara canis and T. cati infections.
Results: From the ovoscopic examinations, 16 % of the fecal samples contained T. canis eggs. Seventeen percent contained coccicidal sporocysts. Eggs of Trichuris vulpis and not clearly identifiable nematodal larvae were found in 1 % of the samples. The reasons for the morphology was, in one
instance, suspected Echinococcus eggs. The fact that 12 or 15 parasitologically positive dog excrement samples were taken from the immediate vicinity of children's
playgrounds and another three directly from these grounds should be regarded as particularly critical. The investigated patient
case data records revealed for the period studied nine uveitic patients with T. canis infection. The diagnosis was based on the larva precipitation test in all cases. After correct diagnosis and appropriate
treatment, the prognosis was favorable. The specific treatment had to be repeated in two patients.
Conclusions: The environmental parasitological study presented proves the relatively high prevalence of pathogenic causal agents in dog
excrement samples from the area of urban recreation and leisure grounds, in particular, children's playgrounds. Parasite infestation
is a mirror of the efficiency of hygienic and social measures. Public health education must be reinforced. Differential diagnosis
of chronic endogenous eye diseases must pay more attention to infections by parasites.
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