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ABSTRACT: Pterygium excision with postoperative instillation of mitoymcin C (MMC, 0.4 mg/ml) is encouraging because of the technical simplicity and low recurrence rates, but serious postoperative complications have been described (scleral necrosis, corneal perforation, glaucoma, cataract). The authors studied the efficacy and safety of pterygium excisions with a single intraoperative application of low-dose MMC (0.2 mg/ml). Pterygium excision (bare sclera technique) was performed in 18 patients with primary or recurrent pterygia. MMC (0.2 mg/ml) was applied intraoperatively (5 min) to the exposed sclera. Patients were followed up for signs of recurrence and complications. There were four recurrences (mean follow-up 13.8 months). Postoperative complications consisted of granuloma formation (n = 2). Delayed conjunctival healing was observed in all cases. Scleral necrosis, corneal complications, cataract, or glaucoma were not seen. Intraoperative application of MMC apparently reduces the recurrence rate after pterygium excision. The use of a 0.2 mg/ml concentration of MMC appears to be safe.
Der Ophthalmologe 09/1995; 92(4):458-62. · 0.62 Impact Factor
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ABSTRACT: Artificial tears often fail in dry eye patients. Our goal was to establish a diagnostic approach that involves alternatives that are more effective for the treatment. We examined 110 patients with dry eyes not stabilized by artificial tears: medical history, visual acuity, slit lamp examination, rose bengal stains and fluorescein stains, Schirmer test, break-up time (BUT), dye tests, impression cytology, and lid transillumination. This allowed disturbances of the three layers of the tear film (lipid, aqueous, mucin) to be differentiated. Cellular damage of the ocular surface was evaluated and scored by slit lamp examination, rose bengal staining, and impression cytology. Only 8% of the patients with "sicca syndrome" had exclusive aqueous deficiencies amenable to artificial tears. In contrast, lipid deficiencies (chronic blepharitis) were determined most frequently (78%). Twenty-six percent had disturbances in two or more layers of the tear film. The diagnostic strategy of differentiating disturbances of the layers of the tear film offers a more specific approach to the treatment of dry eyes.
Der Ophthalmologe 03/1995; 92(1):6-11. · 0.62 Impact Factor
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ABSTRACT: The treatment of dry eyes with artificial tears often fails. We differentiated the disturbances of the three layers of the tear film in 90 such patients. This showed that only 11.1% had aqueous deficiency, while 42.3% had combined disturbances of different layers of the tear film, and 76.7% had lipid deficiencies.
We now studied the efficacy of a therapeutic approach, which intended to stabilize each individual deficiency of the three layers of the tear film (follow-up > or = 6 months). The medical history, visual acuity, slit lamp examination, rose bengal stains and fluorescein stains, Schirmer test, break-up time (BUT), dye tests, impression cytology, and lid transillumination were analyzed.
Therapy was beneficial in all patients (n = 90) with regard to the symptoms and the objective parameters. Artificial tears applied strictly were without preservatives. Patients with toxic conjunctivitis induced by high dosages of eye drops were often stabilized through withdrawing the medication. The frequency of applying artificial tears was significantly tapered by punctum plugs and -coagulation. Tarsorrhapies were helpful in the most severe cases. Topical retinoids significantly reduced the symptoms and increased the goblet cell density. Treating chronic blepharitis was very sufficient, when initiated by topical steroids and Tetracycline, and systemical Doxycycline.
Differentiating the disturbances of the three tear film layers in "sicca syndrome", and stabilizing each component is more effective than artificial tears alone.
Klinische Monatsblätter für Augenheilkunde 03/1994; 204(3):162-8. · 0.51 Impact Factor
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ABSTRACT: Survival time after bone marrow transplantation is getting increasingly longer and secondary ocular complications need to be identified and deserve more attention as so far.
We evaluated the ocular complications of 21 not selected, long-term survivors after bone marrow transplantation in a prospective study. The ophthalmological examination consisted of visual acuity, slit lamp examination, tonometry and ophthalmoscopy. It included also determination of tears break-up-time, Jones-test, rose bengal staining and impression cytology of the conjunctiva.
The major ocular complication was the development of a keratoconjunctivitis sicca syndrome in 14 of the 21 patients. This complication is probably due to the total-body irradiation in the preparative before and to the development of a chronic Graft-versus-Host-Disease after transplantation. 13 of the 21 patients developed a cataract. This might be a result of the total-body irradiation and a prolonged high steroid intake.
The frequency and severity of ocular complications suggest that detailed ocular examinations should be performed routinely in patients after bone marrow transplantation.
Klinische Monatsblätter für Augenheilkunde 03/1993; 202(2):110-5. · 0.51 Impact Factor
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ABSTRACT: Based on a new concept of the limbus as a junctional zone for separating the vascularized conjunctiva from the avascular cornea, this study presents conjunctival/limbal autograft transplantation for 22 cases of pterygium. The pterygia were primary in 17 eyes, cicatricial in 1 and recurrent in 4. In all cases a free transplant of the superotemperal limbus with an adjacent piece of thin conjunctiva was placed in the excision area. Postoperative follow-up ranged from 1 1/2 to 17 months, with a mean of 8.7 months. Only two pterygia recurred. In all other cases ideal anatomic reconstruction was achieved without any side effects. The authors believe that conjunctival/limbal transplantation is an encouraging technique for treating a pterygium surgically.
Der Ophthalmologe 05/1992; 89(2):143-6. · 0.62 Impact Factor
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ABSTRACT: We report the clinical and Doppler sonographic findings on the internal carotid artery in 230 patients with various purely ocular vascular symptoms. For evaluation, the patients were subdivided into four groups: group I (107): central retinal artery obstruction (CRAO) (13), branch retinal artery obstruction (BRAO) (31), amaurosis fugax (AF) (13), anterior ischemic optic neuropathy (AION) (50); group II: retinal vein occlusion (25); group III: "low-tension glaucoma" (55); group IV: chronic open-angle glaucoma with a possible vascular co-factor (43). In group I with signs of arterial ocular mal-perfusion; 29.5% of cases with CRAO and BRAO revealed significant stenosis or complete obstruction of the ipsilateral internal carotid artery. Only 4 of 50 cases (8.0%) with AION showed positive findings. A remarkable result of this evaluation is the coincidence that nearly all high-grade obliterations and obstructions of the internal carotid arteries diagnosed in this study were exclusively confined to eyes with very severe ischemic changes in both anterior and posterior segments. In no other case was localization or extent of the obstructive process in the internal carotid artery predictive. Venous retinal obstructions with only 16% positive findings did not show any correlation with arterial occlusive disease of extracranial vessels based on demographic aspects and clinicopathological studies. Also no etiological correlation could be detected in either of the glaucoma groups (III and IV).
Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1991; 88(6):694-7.
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ABSTRACT: The present paper reports on the technique and results of conjunctiva/limbus transplantation in 13 eyes with primary or cicatricial pterygium (12 cases and 1 case, respectively). In all cases the pterygia were located nasally. The operation was performed by bare sclera excision, covered with a free graft from the superotemporal conjunctiva and limbus. After a mean follow-up time of 5 months there was only one recurrence. On the basis of a new understanding of limbal diseases the authors believe that conjunctiva/limbus transplantation is an encouraging and appropriate technique for ideal anatomic reconstruction and low recurrence rates in pterygia.
Klinische Monatsblätter für Augenheilkunde 09/1990; 197(2):106-9. · 0.51 Impact Factor
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ABSTRACT: In 69 of 107 patients with primary angle-closure glaucoma, it was possible to control intraocular pressure and visual fields by means of peripheral surgical iridectomy; in 17 of these patients topical glaucoma medication was required in addition. In 11 cases a second surgical operation other than iridectomy was necessary: 6 lensectomies for malignant glaucoma in 2 cases and lens subluxation or phacomorphic glaucoma in 4 and 5 filtering procedures. Among the 85 treated fellow eyes 68 were controlled by iridectomy alone and 17 eyes needed additional topical glaucoma medication. One case of persisting wound leakage from the corneo/scleral wound was the only complication observed in this study. The advantages and disadvantages of peripheral surgical iridectomy are compared with those of argon and neodymium: YAG iridotomies. Owing to the low rate of complications the authors apply the surgical approach as the routine technique for primary angleclosure glaucoma.
Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1990; 87(5):449-52.
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ABSTRACT: To test the efficacy of topically applied tretinoin eyedrops (0.01%, twice daily, in a solution of peanut oil) in the treatment of squamous metaplasia of the conjunctival epithelium associated with dry-eye, the authors evaluated the impression cytology (IPC) of a total of 31 patients. The cytological findings were classified into four different stages with an overall range from 0 to 9 points. The average period of treatment was 12 weeks. The patients were classified into three groups: (1) Those with mucin deficiency (Mucin less than - greater than; n = 19), (2) those with Keratoconjunctivitis sicca (KSC; n = 6), and (3) a control group in whom pure peanut oil was used (n = 6). The IPC showed a considerable improvement of squamous metaplasia in the mucin less than - greater than group, by an average of 4.3 points (from 6.2 points before treatment to 1.9 points). No changes were seen in the IPC of the KCS patients or the control group. The results of this study show a good effect of tretinoin eyedrops in patients with a significant decrease in or loss of goblet cells seen in the IPC, a decreased break-up time and with no severe aqueous deficiency of tear film. These patients seem to have a "primary" mucin deficiency induced by the decrease in or loss of goblet cells. There is no indication for tretinoin treatment in patients with aqueous deficiency involving major or accessory lacrimal glands. The results of other previous and recent studies on tretinoin treatment are discussed.
Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1989; 86(5):530-4.
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1988; 85(6):642-5.
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ABSTRACT: A case of bilateral complete cryptophthalmos combined with other malformations is described. The clinical appearance, histology, and the results of computed tomography and electro-ophthalmological investigations are communicated.
Klinische Monatsblätter für Augenheilkunde 03/1987; 190(2):121-4. · 0.51 Impact Factor
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1987; 84(5):446-9.
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ABSTRACT: The incidence of acute keratoconus has increased in recent years. A defect of the endothelium and Descemet's membrane allows the aqueous to flow into the stroma. The therapy of choice is penetrating keratoplasty. The discussion concerning the best time for the operation is still going on. The present authors have performed penetrating keratoplasties on 9 patients at the acute stage during the last 2 years. The results show that early surgery can prevent progression of the symptoms, with corneal edema and pannus, and subsequent complications.
Klinische Monatsblätter für Augenheilkunde 05/1986; 188(4):266-8. · 0.51 Impact Factor
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ABSTRACT: Experimental keratomileusis operations were performed on 13 rabbit eyes. The corneas of the rabbits, in particular the stroma, were investigated up to 24 months after the operation by light and electron microscopy. The most striking features of the corneal ultrastructure following experimental keratomileusis were the presence of abnormal collagen fibrils and electron-translucent vacuoles in the interface.
Archives of Ophthalmology 03/1986; 104(2):253-8. · 3.71 Impact Factor
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1986; 83(4):417-9.
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1986; 83(2):206-7.
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1985; 82(1):37-8.
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1984; 81(4):331.
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1984; 81(5):426-8.
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Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 02/1983; 80(3):265-6.
