Showing papers by "Gottfried O. H. Naumann published in 1992"
TL;DR: Findings provide evidence for the systemic nature of the pseudoexfoliation syndrome, which apparently involves an aberrant connective-tissue metabolism throughout the body.
Abstract: The pseudoexfoliation syndrome has recently been suggested to represent the local manifestation of a more widespread disorder. In this study, a case of classic bilateral pseudoexfoliation syndrome with systemic distribution of pseudoexfoliation material involving a variety of organ systems is described. Using transmission electron microscopy, typical pseudoexfoliation fibers were identified in autopsy tissue specimens of skin, heart, lungs, liver, kidney, and cerebral meninges in addition to the classic intraocular locations. The pseudoexfoliation material was mainly localized to connective-tissue portions or septa traversing the various organs. The pseudoexfoliation fibers were consistently associated with connective-tissue components, particularly fibroblasts and collagen and elastic fibers; myocardial tissue specimens; and heart-muscle cells. These findings provide evidence for the systemic nature of the pseudoexfoliation syndrome, which apparently involves an aberrant connective-tissue metabolism throughout the body.
400 citations
TL;DR: This investigation was directed at determining the count and regional distribution of photoreceptors in the eyes of 21 human cornea donors aged between 2 and 90 years, and cone concentration was significantly highest in the nasal region.
Abstract: This investigation was directed at determining the count and regional distribution of photoreceptors in the eyes of 21 human cornea donors aged between 2 and 90 years. Mean count of rods was 60 123 000 ±12907000, and mean cone count was 3173000 ± 555000. Determined 40 μm away from the foveola, cone density measured 125 500 cones/mm2. Extrapolating the distribution curve, cone concentration in the foveal center can be assumed to be about 150 000 cells/mm2 to 180 000 cones/mm2. Towards the retinal periphery, cone density decreased from 6000 cones/mm2 at a distance of 1.5 mm from the fovea to 2500 cells/mm2 close to the ora serrata. Comparing different fundus regions, cone concentration was significantly highest in the nasal region. Cone diameter increased from the center towards the periphery. At a distance of 40 μm away from the foveola, it measured about 3.3 μm, and in the outer retinal regions about 10 μm Rod density was highest in a ring-like area at a distance of about 3–5 mm from the foveola with a mean of 72 246 ± 17 295 cells/mm2. Rod density peaked at 150 000 rods/mm2. It decreased towards the retinal periphery to 30 000–40 000 rods/mm2. Rod diameter increased from 3 μm at the area with the highest rod density to 5.5 μm in the periphery. The hexagonal rod and cone inner segments were regularly arranged in a honey-comb fashion.
248 citations
TL;DR: Parapapillary chorioretinal atrophy was associated with shallow glaucomatous cupping, diffuse nerve fiber loss, a marked tessellated fundus, and only moderately elevated intraocular pressure and showed a spatial correlation to neuroretinal rim loss inside the optic disc.
Abstract: Glaucomatous optic nerve damage is typically associated with intrapapillary changes, such as neuroretinal rim loss. In this study, parapapillary chorioretinal atrophy was evaluated in 691 normal eyes, 1081 glaucomatous eyes, and 31 eyes with ocular hypertension. It was significantly larger and occurred more often in the glaucomatous eyes (parapapillary atrophy area, 1.07 +/- 0.83 mm2) (mean +/- SD) than in the normal eyes (0.55 +/- 0.64 mm2) or in the eyes with ocular hypertension (0.55 +/- 0.37 mm2). These differences were significant also for eyes with moderate glaucomatous damage (0.86 +/- 0.62 mm2). Parapapillary chorioretinal atrophy was associated with shallow glaucomatous cupping, diffuse nerve fiber loss, a marked tessellated fundus, and only moderately elevated intraocular pressure. It increased with a decreasing neuroretinal rim area. It showed a spatial correlation to neuroretinal rim loss inside the optic disc. In unilateral glaucoma, it was larger in the affected eye than in the unaffected eye. Parapapillary chorioretinal atrophy is associated with glaucoma.
204 citations
TL;DR: From 1980 to 1990, 32 consecutive patients with progressive cystic or diffuse epithelial ingrowth of the anterior chamber were treated successfully with block excision, indicating that block excison currently may be the treatment of choice for cystic and diffuse sheetlike epithelialIngrowth ofThe anterior chamber.
Abstract: • From 1980 to 1990, 32 consecutive patients with progressive cystic or diffuse epithelial ingrowth of the anterior chamber were treated successfully with block excision. This technique consists of simultaneous removal of adjacent iris, pars plicata of ciliary body, and all layers of sclera and cornea in contact with the lesion acting as a shell. The resulting defect is covered by a tectonic corneoscleral graft. Twelve patients had suffered from perforating ocular injury, 10 patients had previously undergone cataract extraction, and 10 patients had various causes of epithelial ingrowth. Cystic epithelial ingrowth occurred in 27 patients, diffuse sheetlike epithelial ingrowth occurred in four patients, and one lesion was identified as foreign body granuloma. On histopathologic examination, all but two patients revealed epithelial involvement of the surface of the ciliary body. All patients were followed up for an average of 60.1 months (range, 1 to 120 months). Long-term visual acuity was better than 20/60 in 37.5% of the patients. No recurrence of ingrowth was noted and enucleation was not necessary. Our results indicate that block excision currently may be the treatment of choice for cystic and diffuse sheetlike epithelial ingrowth of the anterior chamber.
78 citations
TL;DR: The histomorphometrically serial sections of 21 human eyes enucleated due to secondary angle-closure glaucoma and 28 nonglaucomatous eyes with malignant choroidal melanoma were evaluated in this paper.
Abstract: Parapapillary atrophy has been reported to occur in glaucoma eyes. Seeking the microscopical equivalent, we evaluated histomorphometrically serial sections of 21 human eyes enucleated due to secondary angle-closure glaucoma and 28 nonglaucomatous eyes with malignant choroidal melanoma. In the parapapillary region two zones were differentiated: in zone "B" adjacent to the optic disc, Bruch's membrane was denuded of retinal pigment epithelium cells; zone "A" peripheral to zone "B" showed pigment irregularities in the retinal pigment epithelium. Both zones "B" and "A" were significantly larger and zone B occurred more frequently in glaucomatous eyes than in the control group. Additionally, the outer and inner retinal layers and the parapapillary retina as a whole were significantly thinner in the glaucoma eyes than in the control eyes. Photoreceptors were completely lost or markedly decreased in number in zone "B." The findings may indicate that zones "B" and "A" represent the histological correlate of the glaucomatous parapapillary chorioretinal atrophy.
76 citations
TL;DR: The additional presence of elastin epitopes indicates that the PSX material is a multicomponent expression of a disordered extracellular matrix synthesis including the incorporation of the principal noncollagenous basement membrane components.
Abstract: The pseudoexfoliation (PSX) syndrome has long been speculated to be a disorder of disturbed basement membrane metabolism. To test this concept, we investigated the presence of all principal basement membrane components in precapsular PSX deposits of 30 anterior lens capsules by immunofluorescence and electron microscopic immunogold techniques. We have shown heparan sulfate and chondroitin sulfate proteoglycans, laminin, entactin/nidogen, fibronectin, and amyloid P protein to be an integral constituent of PSX material; type IV collagen was restricted to a microfibrillar layer interposed between capsular surface and typical PSX material. The additional presence of elastin epitopes indicates that the PSX material is a multicomponent expression of a disordered extracellular matrix synthesis including the incorporation of the principal noncollagenous basement membrane components. The extensive labelling of PSX material for chondroitin sulfate suggests an overproduction and abnormal metabolism of glycosaminogly...
76 citations
TL;DR: It is indicated that corneal wounds caused by excimer laser radiation and those caused by mechanical surgery differ as to healing mechanisms.
Abstract: In order to investigate the effects of excimer laser surgery on corneal wound healing, 25 rabbits underwent anterior keratectomy at a depth of 100 or 300 μm with a Meditec MEL 50 excimer laser. After various intervals the animals were killed and the cornea excised and investigated immunohistochemically for the expression of extracellular matrix (ECM) proteins, fibronectin and tenascin. Fibronectin was shown to occur earlier than tenascin, and the two also had different distribution patterns. Wound depth showed no clear effect on the localization and time of ECM protein expression. This study indicates that corneal wounds caused by excimer laser radiation and those caused by mechanical surgery differ as to healing mechanisms.
47 citations
TL;DR: The intrapapillary region of the optic disc shows ophthalmoscopical changes in glaucoma as discussed by the authors, and histological correlation was examined histomorphometrically in serial sections of 21 human eyes with SAC and 28 control eyes with malignant melanoma.
Abstract: The intrapapillary region of the optic disc shows ophthalmoscopical changes in glaucoma. In search of a histological correlate, this region was examined histomorphometrically in serial sections of 21 human eyes with secondary angle-closure glaucoma and 28 control eyes with malignant choroidal melanoma. The lamina cribosa was significantly (P<0.05) thinner, the optic cup deeper and wider, the peripapillary scleral ring finer, and the corpora amylacea count was lower in glaucoma eyes than in control eyes with normal optic nerves. There was no significant difference in optic disc diameter. The decrease in lamina cribrosa thickness may be one of several factors leading to glaucomatous optic nerve fiber loss. Due to a decrease in the relative height the inner limiting membrane should not be taken as the reference level for optic-cup-depth measurement. A high corpora amylacea count may point to a normal optic nerve fiber population.
40 citations
TL;DR: In this paper, the authors examined a possible correlation between clinical signs of early pseudo-exfoliation (PSX) syndrome related to pigment dispersion and iris stroma atrophy and morphological alterations of the lens capsule.
Abstract: We examined a possible correlation between clinical signs of early pseudoexfoliation (PSX) syndrome related to pigment dispersion and iris stroma atrophy and morphological alterations of the lens capsule. 63 anterior lens capsules (30 PSX suspects, 3 pre-PSX, 10 PSX, 20 controls) were studied by transmission and immuno-electron microscopy (TEM). In 20 PSX suspect and 3 pre-PSX capsulotomy specimens, TEM revealed a precapsular layer (0.1–11 μm in thickness) composed of microfibrils, amorphous material, and granular inclusions. The incidence of this fibrillar layer was significantly higher (p=0.001) in PSX suspect and pre-PSX eyes than in controls (5 positive). Ultrastructural and immunohistochemical similarities of the fibrillar surface network in PSX suspect and typical PSX specimens indicate that the precapsular layer may represent a precursor of PSX. The beginning PSX process in the eye is obviously indicated by certain clinical signs.
38 citations
TL;DR: In this paper, the authors describe the clinicopathologic and virologic findings in the right, blind eye of an immunocompetent 61-year-old woman who was enucleated 32 months after the clinical onset of bilateral acute retinal necrosis syndrome.
Abstract: • We describe the clinicopathologic and virologic findings in the right, blind eye of an immunocompetent 61-year-old woman. The eye was enucleated 32 months after the clinical onset of a bilateral acute retinal necrosis syndrome. Histopathologic study showed a diffuse, full-thickness, necrotizing retinitis with replacement of sensory retinal structures by glial tissue, occlusive retinal arteritis, granulomatous choroiditis, and optic neuritis with ischemic optic atrophy. Varicella zoster virus could be identified as the causative agent by DNA in situ hybridization and by immunohistochemical stains in mononuclear cells with eosinophilic intracytoplasmic inclusions. Virus was detected only within the choroid and the choriocapillaris. We conclude that these histopathologic and virologic features are consistent with a "burned-out phase" of a varicella zoster virus—induced acute retinal necrosis syndrome.
37 citations
Journal Article•
TL;DR: The laser flare-cell meter is a valuable instrument for noninvasive, quantitative assessment of alterations of the blood-aqueous barrier in diabetes, as the increase of flare values seems to parallel the progression of diabetic retinopathy.
Abstract: In order to evaluate the applicability of the laser flare-cell meter to diabetic oculopathy, we measured aqueous flare and aqueous "cells" in 84 diabetic eyes of 84 patients and 50 normal control eyes of 50 age-matched subjects. Using fluorescein angiography, diabetic retinopathy was divided into background retinopathy (11 eyes), preproliferative retinopathy (38 eyes), and proliferative retinopathy (35 eyes). In diabetic eyes, the occurrence of both aqueous flare (0.73 +/- 0.39 mg/ml human albumin equivalent) and aqueous cells (mean 2.96, range 0-35.7 cells/0.075 mm3) was significantly greater than in the normal control group (flare 0.14 +/- 0.06 mg/ml, cells 0.39, range 0-2 cells/0.075 mm3, P < 0.0001 and P < 0.0002, respectively). The flare values also showed differences between the diabetic subgroups, with flare values being higher in more advanced stages of diabetic retinopathy. No significant correlation could be found between the flare values and the kind of diabetic therapy, the duration of the diabetes, and the number of or the time interval since previous retinal laser coagulations. A flare value of more than 0.5 mg/ml was found to represent probably a "critical value" indicating a tendency towards preproliferative and or proliferative changes. The laser flare-cell meter is a valuable instrument for noninvasive, quantitative assessment of alterations of the blood-aqueous barrier in diabetes. The increase of flare values seems to parallel the progression of diabetic retinopathy.
TL;DR: The corneal button after perforating keratoplasty of the right eye demonstrated mucopolysaccharides consisting of numerous vacuoles containing fibrillogranular and partly membranebound material in epithelial cells, histiocytes, keratocytes, and extracellular matrix.
Abstract: A 37-year-old man with coarse facies, stiff joints, corneal clouding, and normal intelligence sought medical attention. The diagnosis of a systemic mucopolysaccharidosis (MPS) type I-S (Scheie's syndrome) was confirmed by the presence of lysosomal alpha-L-iduronidase deficiency and excessive urinary dermatan and heparan sulfate excretion. The corneal button after perforating keratoplasty of the right eye demonstrated mucopolysaccharides consisting of numerous vacuoles containing fibrillogranular and partly membranebound material in epithelial cells, histiocytes, keratocytes, and extracellular matrix. Endothelial cells were distinctly free of storage material. The epithelial basement membrane showed frequent breaks, whereas Bowman's layer was only slightly attenuated. Irregular collagen fibrils and fibrous long-spacing collagen were noted near degenerating distended keratocytes. The Descemet's membrane was normal. The literature of six reported histopathological examinations of the cornea in Scheie's syndrome is reviewed. Detection of fibrous long-spacing collagen seems to be a typical abnormality of the cornea in MPS I-S.
TL;DR: Results indicate that excimer laser is useful for reproducible corneal photoablation in lamellar keratoplasty and a good fit of wound margins and stromal interface is shown.
Abstract: We examined the depth of ablation of the recipient bed with different counts of oscillations of excimer laser beam, to determine the correlation between planned and real depth. The ablation rate per oscillation was tested preoperatively by blackened photographic paper of defined thickness and thus was calculated to be 5 μm. Forty pig eyes were used for the first study. Each eight eyes were ablated in the planned depth 100 μm, 200 μm, 300 μm, 400 μm and 500 μm. The corneal thickness was measured with an ultrasonic pachymeter before and after the procedure. The depth measured after the photoablation was 99.4 ± 36.4 μm for 100 μm planned depth, 186.7 ± 55.3 μm for 200 μm, 298.4 ± 68.5 μm for 300 μm, 373.9 ± 65.7 μm for 400 μm and 480.1 ± 59.3 μm for 500 μm. Comparing the depth measured after the photoablation to planned depth, there was a significant correlation (correlation coefficient: R = 0.93; p < 0.0001). Five other corneas trephinated from pig cadaver eyes were ablated from the endothelial side to the desired thickness (100 to 500 μm) of lamellar graft. In a second step a donor mask was placed onto the cornea and a laser light spot was led until perforating on all sides. The lamellar keratoplasty was completed by suturing the corneal graft into the bed. Macroscopic and microscopic examination of sutured eyes after fixation showed a good fit of wound margins and stromal interface. These results indicate that excimer laser is useful for reproducible corneal photoablation in lamellar keratoplasty.
TL;DR: The results indicate, that decontamination of the conjunctiva may be an import factor for the prevention of postoperative endophthalmitis following elective intraocular surgery.
Abstract: Between August 1982 and August 1984 3059 intraocular operations were performed with topical prophylactic antibiotics. Results of conjunctival cultures did not influence the surgical schedule. 8179 intraocular operations were performed between September 1984 and August 1988. An intraocular operation was postponed until conjunctival cultures were negative using topical antibiotics administered at hourly intervals. The rate of postoperative intraocular infections decreased significantly (p less than 0.0001) from 21 (0.69%) of 3059 during the first to 9 (0.11%) of 8179 intraocular operations during the second observation period. In the first period 11 vitrectomies and 2 enucleations due to bacterial endophthalmitis had to be performed. In the second period 2 vitrectomies and no enucleations were necessary (p less than 0.0001). Our results indicate, that decontamination of the conjunctiva may be an import factor for the prevention of postoperative endophthalmitis following elective intraocular surgery.
TL;DR: In two patients suffering from congenital oculodermal melanocytosis (nevus of Ota) orbital, osseous, meningeal, and cerebral manifestations are documented.
Abstract: In two patients suffering from congenital oculodermal melanocytosis (nevus of Ota) orbital, osseous, meningeal, and cerebral manifestations are documented In a 38-year-old European with a nevus of Ota on the right side an ipsilateral orbital tumor was diagnosed and surgically removed The histological examination revealed a primary spindle shaped malignant melanoma of the orbit In addition, many benign melanocytes were found in the optic nerve, in the extraocular muscles, in the orbital fat tissue, and in the dura of the sphenoid In a 17-year-old Ethiopian with a nevus of Ota of the right side an increase in size of the pigmented process was observed during puberty in the orbital fat tissue, in the extraocular muscles, in the optic nerve, in the periorbital bones, in the temporal muscle, and in the cortex of the frontal brain lobe A deep excision from the lower eye lid revealed a histologically benign oculo-orbito-dermal melanocytosis An irradiation was performed because of growth again after segmental excision, however without success In the ipsilateral eye a secondary open-angle glaucoma was diagnosed In the nevus of Ota an involvement of the orbit and of the meningo-cerebral tissue must be considered
TL;DR: It is suggested that in humans, iris wound healing after Nd:YAG laser iridotomy occurs without induction of fibrous scars or proliferation of the iris pigment epithelium, indicating that there is no tendency toward late closure of theiridotomy sites.
Abstract: • We studied three sector iridectomy specimens from three patients who had undergone neodymium:YAG (Nd:YAG) laser iridotomies 3 to 5 years earlier for treatment of imminent angle closure glaucoma. The specimens were obtained during cataract extraction and were examined by light and transmission electron microscopy. In all iris specimens, the edges of the iridotomy sites consisted of loosely arranged melanocytes, fibrocytes, and vessels. In the iris stroma, there were numerous pigment-laden cells. The iris vessels appeared to be intact; there were no fibrinous aggregates, no inflammatory response or scarring, nor any signs of proliferation of the iris pigment epithelium. Our findings suggest that in humans, iris wound healing after Nd:YAG laser iridotomy occurs without induction of fibrous scars or proliferation of the iris pigment epithelium. This indicates that there is no tendency toward late closure of the iridotomy sites.
TL;DR: As a persisting microbial colonisation of the conjunctiva may be an important factor for the development of postoperative endophthalmitis, prophylactic conjunctival smears before surgery are recommended to diminish the risk of intraocular infections after surgery.
Abstract: The risk of a postoperative endophthalmitis is influenced by the presence of a significant bacterial colonisation of the conjunctiva before intraocular surgery. Between February and August 1990 we performed conjunctival smears in 481 patients 1) on the eve of the operation and 2) just before planned intraocular surgery, to evaluate a persistent or transient microbial colonisation of the conjunctiva. 352 patients showed insignificant ("negative") and 129 patients a significant ("positive") bacterial growth in the first conjunctival smear. 96% of the patients (n = 336) had a negative result in both smears. 30% of the patients (n = 37) with a positive conjunctival smear showed a persisting bacterial colonisation, whereas 70% of the patients (n = 92) had a transient colonisation of the conjunctiva with a negative second smear. As a persisting microbial colonisation of the conjunctiva may be an important factor for the development of postoperative endophthalmitis, we recommend prophylactic conjunctival smears before surgery to diminish the risk of intraocular infections after surgery.