Showing papers by "Gottfried O. H. Naumann published in 1993"

Decreased choroidal thickness in eyes with secondary angle closure glaucoma. An aetiological factor for deep retinal changes in glaucoma

Abstract: A decreased count of retinal photoreceptors all over the fundus and a loss of retinal pigment epithelium cells mainly in the parapapillary region have been reported to be associated with glaucoma. This study addressed the question whether this cell loss in the deep retinal layers may be connected with a change of the choroidal thickness in glaucomatous eyes. Histological sections of 12 eyes with secondary angle closure glaucoma due to a malignant melanoma of the ciliary body and 20 eyes with a malignant choroidal melanoma and normal intraocular pressure were histomorphometrically evaluated. Before enucleation the intraocular pressure was significantly higher in the glaucoma group compared with the control group. Thickness of the choroid was measured at 12 locations from the posterior pole to the fundus periphery. The choroid was significantly thinner in the glaucoma group than in the control group. The decreased choroidal thickness was mainly due to a diminished choroidal vessel diameter. The differences were more marked at the optic disc border than in the fundus periphery. The decreased choroidal thickness in the glaucomatous eyes suggests a reduced choroidal perfusion. It fits with the reported lack of autoregulation of the choroidal blood circulation. Considering the diminished choroidal thickness especially in the parapapillary region, it may be one among other factors explaining the changes of the deep retinal layers in eyes with glaucoma. It indicates that thinning of the choroid, besides the chorioretinal atrophy in the parapapillary region, should be added to the panoply of histological changes in glaucoma.

Corneal endothelial involvement in pseudoexfoliation syndrome.

Abstract: • Information on corneal manifestation in pseudoexfoliation syndrome is restricted to specular microscopic studies. We investigated morphologic changes of the posterior cornea of two corneal buttons with Fuchs' endothelial dystrophy obtained at penetrating keratoplasty and of one enucleated glaucomatous eye from three patients with ocular pseudoexfoliation syndrome. By transmission electron microscopy, large clumps of typical pseudoexfoliation material were found adhering to the corneal endothelium and masses of pseudoexfoliation material were incorporated into the posterior Descemet's membrane. In the affected areas, the endothelial layer appeared irregular and discontinuous, with loosely adherent, degenerating cells producing pseudoexfoliation fibers and fibroblastic cells spreading to cover denuded Descemet's membrane. The present findings indicate that the pseudoexfoliation material is initially formed by degenerative endothelial cells and that it becomes subsequently buried by overgrowing cells. The corneal endothelial involvement may potentiate complications of cataract surgery and open angle glaucoma in patients with pseudoexfoliation syndrome.

Direct clinico-histological correlation of parapapillary chorioretinal atrophy.

Abstract: Parapapillary chorioretinal atrophy is a morphological feature of glaucomatous optic nerve damage since it occurs more often and is larger in glaucomatous eyes than in normal eyes. This study was undertaken to find the histological correlation. Optic disc photographs and histological sections through the optic disc of 21 human eyes enucleated because of malignant uveal melanoma were morphometrically evaluated. Seventeen eyes had normal intraocular pressure and four eyes showed elevated intraocular pressure and glaucomatous optic disc cupping. Ophthalmoscopically, the parapillary chorioretinal atrophy was divided into zone 'alpha', located peripherally and characterised by irregular hypopigmentation and hyperpigmentation, and zone 'beta' located close to the optic disc border and showing visible sclera and visible large choroidal vessels. Histologically, zones 'A' and 'B' were differentiated. Zone 'A' peripheral to zone 'B' showed irregularities in the retinal pigment epithelium. It consisted of an unequal distribution of melanin granules and partial atrophy of cells. In zone 'B' adjacent to the optic disc, Bruch's membrane was bared of retinal pigment epithelium cells and the photoreceptors were markedly reduced in density or were completely missing. In a direct clinical histological comparison, zone 'A' correlated significantly with zone 'alpha' (r = 0.66; p < 0.01), and zone 'B' correlated with zone 'beta' (r = 0.99; p < 0.0001). Zone 'A', 'B', 'alpha' and 'beta' were larger in the four glaucomatous eyes than in the normal ones. The findings indicate that zone 'beta' represents histologically a complete loss of retinal pigment epithelium cells and an incomplete loss of adjacent photoreceptors. Zone 'alpha' may be the histological correlate of irregularities in the retinal pigment epithelium.

Excimer-Laser-193 nm-Trepanation bei der perforierenden Keratoplastik - Bericht über die ersten 70 Patienten

Abstract: BACKGROUND In penetrating keratoplasty, trephination with the 193 nm excimer laser may help avoid the differences in the deformation of the donor and recipient wound margins which occur with the conventional procedure. By varying the shape of the "open metal mask", other cut configurations can be achieved besides circular. Thus, "vertical tilt" and "horizontal torsion", both potential reasons for persistent long-term astigmatism after PK, may be minimized. Following experimental studies, the authors present the results obtained in their first 70 consecutive patients. PATIENTS AND METHODS 38 women and 32 men were treated (mean age 60.6 years, range 17 to 89 years). Indications were corneal processes without vascularization: Fuchs' dystrophy (n = 32), other stromal dystrophies (n = 5), secondary corneal endothelial decompensation (n = 6), keratoconus (n = 15), nonvascularized corneal scars (n = 4) and miscellaneous (n = 8 ). We used elliptical metal masks with/without orientation teeth and circular masks with four and eight orientation teeth, respectively. The HeNe aiming beam was manually controlled by a micromanipulator ("joystick"). The technical data of the laser were as follows: spot mode, 1.5 x 1.5 mm; repetition rate 30/sec and 25/sec, respectively; pulse energy 15-25 mJ; mean number of pulses 6407 (recipient) and 9150 (donor). With an elliptical outline, wound closure was usually achieved with single sutures. With a circular outline with orientation teeth, wound closure was most commonly achieved with a double running suture. Patients were prospectively documented using modified Erlangen record sheets. Follow-up ranged from 3 months to 3.4 years (mean 11.4 months). RESULTS With two exceptions, penetration of the anterior chamber with the 193 nm excimer laser was accomplished without deformation of the cut edges. The elliptical outline facilitated fitting of the graft into the recipient wound bed, and the orientation teeth made fitting even easier. Initial intraoperative complications due to excessive laser energy densities included minor thermally induced corneal alterations caused by the heat of the metal mask and in a few cases minimal iris bleeding during corneal penetration. The median duration of re-epithelialization was two days. Wound healing was without complications. In particular, no primary graft insufficiency and no unexpected effects in donor or recipient corneas, iris, lens or posterior segments were observed. Postoperative complications were one corneal ulcer caused by premature fitting of an extended-wear contact lens and two immunologic graft reactions (3%). Mean astigmatism after suture removal was 4.6 D with an elliptical outline, and 3.9 D after trephination with orientation teeth and with the sutures in situ. CONCLUSION Non-mechanical, "non-thermal" trephination with elliptical and circular metal masks with orientation teeth represents a viable alternative to knife trephination in penetrating keratoplasty. No unexpected complications such as disturbances of wound healing were seen. Further studies are needed to determine the effect on residual long-term astigmatism after suture removal.

Diffuse unilateral subacute neuroretinitis syndrome in a German most likely caused by the raccoon roundworm, Baylisascaris procyonis.

Abstract: In 1978, Gass and Scelfo [7] described a peculiar clinical syndrome which they called diffuse unilateral subacute neuroretinitis (DUSN). This syndrome is characterized by progressive unilateral visual loss, vitritis, papillitis, recurrent gray-white retinal lesions, and later diffuse retinalpigment epithelial degeneration. Subretinal nematodes that were subsequently observed by Gass et al. [8] in this syndrome were believed to cause DUSN and to represent larvae of Toxocara canis. Later, Kazacos et al. [13-15] provided evidence that at least some cases of DUSN might be caused by larvae of the raccoon roundworm, Baylisascaris procyonis. We describe a patient with DUSN and with a motile intraretinal larva which most likely represented Baylisascaris procyonis. A 48-year-old female German presented in March 1991 with unilateral painless progressive visual loss in her right eye that had started 1 month earlier. She lived in north-eastern Bavaria and had never been abroad. She had bred dogs since her youth and kept two dogs, one cat, one cockatoo, and a racoon in her house; the raccoon had been purchased at a small local zoo about 1 year earlier. Her medical history included salpingitis 3 years earlier and a tick bite in June, 1990. Her past ophthalmological history was unremarkable. Her corrected visual acuity was 1/35 in the right eye and 20/20 in the left. Intraocular pressure was 17 mmHg in both eyes. The right eye showed an extensive afferent pupillary defect, anterior chamber cells, marked vitreous inflammation with numerous vitreal cells, advanced optic atrophy, attenuated retinal vessels, cystoid macular edema, multiple, disseminated intraretinal and subretihal gray-white lesions, and focal hypertrophies of the retinal pigment epithelium. During ophthalmoscopy, a white, S-shaped, subor intraretinal, threadlike\" worm\" was seen in the parafoveal area (Fig. 1). The \"worm\" was observed on several occasions in different locations moving and disappearing on direct illumination. Photographs of the intraretinal parasite were taken, and its absolute length was evaluated planimetrically using Litt-

Korrelation zwischen Tyndallometrie mit dem ”Laser Flare-Cell Meter“ in vivo und biochemischer Proteinbestimmung im menschlichen Kammerwasser

Abstract: INTRODUCTION The laser flare-cell meter allows noninvasive measurement of aqueous flare in humans. In vitro studies have shown good correlations between flare values and albumin concentrations. In this study, we compared aqueous flare values and aqueous protein concentrations in living human eyes. PATIENTS AND METHODS We measured aqueous flare and the total aqueous protein concentration in 52 eyes of 52 patients (age 58.4 +/- 18.8 years) that underwent cataract extraction (22 eyes) or trabeculectomy (30 eyes). Before surgery, aqueous flare was determined with the laser flare-cell meter (Kowa FC-1000). During surgery, 50 microliters of primary aqueous humor was aspired, and total aqueous protein concentration was performed using a modified Pierce-BCA assay. Linear regression analysis was calculated. RESULTS There was a high correlation between aqueous flare values and total aqueous protein concentration (y = 0.52x + 0.15, r = 0.98, p < 0.00001). This correlation was observed both in eyes with and without cataract. CONCLUSION Our results indicate that aqueous flare values as determined with the laser flare-cell meter reflect the true aqueous protein concentration quite accurately. Lens opacities appear not to significantly alter the results of aqueous flare measurements. As expected by theoretical assumptions, flare measurements overestimate aqueous protein concentrations in eyes with severely impaired blood-aqueous barriers because, according to Rayleigh's law, larger protein molecules cause more light scattering. However, transformation and expression of flare values as "albumin concentration equivalents" according to in vitro-calibration may still be useful, especially if the results of different instruments are to be compared.(ABSTRACT TRUNCATED AT 250 WORDS)

Pseudoexfoliative material in the eyelid skin of pseudoexfoliation-suspect patients: a clinico-histopathological correlation.

Abstract: The pseudoexfoliation (PSX) syndrome has recently been suggested to represent the intraocular manifestation of a systemic disorder. In the present study, we examined the correlation between the extraocular occurrence of PSX material in eyelid skin and clinical indications of early stages of PSX syndrome using transmission and immunoelectron microscopy. Typical PSX aggregates were demonstrated in 7 of the eyelid-skin biopsy specimens taken from 12 patients who had been categorized as "PSX suspects" on the basis of certain clinical signs related to loss and dispersion of melanin from the iris pigment epithelium and to iris stromal atrophy but showed no clinical evidence of PSX syndrome in either eye. Another 3 lid specimens obtained from PSX suspects exhibited signs of atypical PSX fibrillopathy. The PSX deposits revealed immunolabeling for heparan and chondroitin sulfate proteoglycan, entactin/nidogen, elastin, amyloid P, and vitronectin. These findings suggest that certain clinical signs indicating early PSX syndrome obviously correlate with the extraocular occurrence of PSX material before its clinically visible appearance on the surfaces of the anterior and posterior chambers.

[NADPH-D reactive choroid ganglion cells in the human]

Abstract: Background The demonstration of uveal ganglion cells has been investigated so far by silver impregnation, rather complicated neurohistochemical methods and by electron microscopy. We present the first results of a simple method in flat-preparation of the human choroid. Material and methods Donors' eyes for cornea transplantation, 5 men, 3 women, aged 45 +/- 13 years, with postmortal time of preparation of 12 +/- 9 h (1 h-24 h) were used. After removal of the cornea with scleral ring, flat-preparations of the choroid were treated by the standard Nicotinamide-Adenine-Dinucleotide-Phosphate (NADPH)-diaphorase reaction, mounted on coated slides in Kayser's glycerol-gelatin and observed by light microscope. Results NADPH-diaphorase reaction reveals abundant aggregates of ganglion cells, with nets of dendrites and axons in the otherwise unstained flat-preparation of the human choroidea. They are more abundant in the layer close to the sclera. Conclusion NADPH-diaphorase reaction is a simple method for the detection of ganglion cells in the human choroid. Their unexpectedly high number suggests yet unknown ganglional functions in the uvea.

Detection of varicella zoster virus DNA and viral antigen in human cornea after herpes zoster ophthalmicus.

Abstract: This article describes the histopathology, immunohistochemistry, and varicella zoster virus DNA in situ hybridization of 14 corneal buttons obtained from 14 patients (average age 69.0 years) after perforating keratoplasty (four patients) or surgical enucleation (10 patients) at different times after

Chronic postoperative endophthalmitis following cataract extraction and intraocular lens implantation. Report on nine patients.

Abstract: Between 1987 and 1992, nine patients (three men and six women; mean age, 75 years) presented with chronic postoperative endophthalmitis after cataract extraction and intraocular lens (IOL) implantation. Eight patients were referred from another institution. The interval between IOL implantation and the beginning of intraocular inflammation averaged 5.6 months (range, 1-19 months). The referral diagnosis was "toxic lens" syndrome in seven patients. The main clinical findings were a hypopyon in the anterior chamber (n = 8) and in the capsule bag (n = 2), and "fibrosis" of the lens capsule (n = 7). In eight patients a vitrectomy was performed, combined with removal of the IOL in six cases and with a total posterior capsulectomy in five cases. Pathogenic organisms were identified in vitreous aspirate (6/8), in culture (3/3), and on histopathological examination (4/5) of lens capsule and included coagulase-negative staphylococci (n = 3, Staphylococcus epidermidis), Propionibacterium acnes (n = 1), Streptococcus viridans (n = 1), Rhodococcus erythropodes and R. luteus (n = 1), and one hyphomycete (Alternaria alternata). In chronic recurrent intraocular inflammations following IOL implantation, an infectious agent should be excluded by diagnostic and therapeutic pars plana vitrectomy including removal of the IOL and posterior capsulectomy.

Aufklaren der transplantatnahen Wirtshornhaut nach perforierender Keratoplastik beim Maroteaux-Lamy-Syndrom (Mukopolysaccharidose Typ VI-A)

Abstract: BACKGROUND The results of penetrating keratoplasty in patients with systemic mucopolysaccharidosis (MPS) type VI-A are controversial. Clouding of the transplant was often observed and was thought to be related to storage of glycosaminoglycans also in the donor button. PATIENTS AND METHODS We performed penetrating keratoplasties successfully in three children with MPS VI-A (severe type) at the age of 7-11 years. RESULTS The transplants remained clear during the follow-up of 2.5-5 years and the longterm visual acuity was encouraging. In two patients we could observe a partial, circular clearing of the host's cornea adjacent to the transplant. The related pathomechanism and the clinical, histopathological and ultrastructural findings of the cornea will be discussed. CONCLUSION As the intellectual development is normal, decrease of vision impairs the patient's life extremely. Thus, the indication of penetrating keratoplasty should be made early to improve the patient's quality of living, who have a reduced life-span.

Epithelial Transformation of the Corneal Endothelium in Forceps Birth-injury-associated Keratopathy

Abstract: Using light and electron microscopy, we studied four keratectomy specimens obtained by penetrating keratoplasty from four patients (ages 33-54 years; mean age: 43 years old) who had clinical evidence of Descemet's folds and bullous keratopathy after ruptures in Descemet's membrane after forceps injury at birth. Histopathologically, three patients showed the typical features of forceps birth injury: Descemet's membrane at the margin of the rupture was folded and assumed a scroll-shape configuration. The fourth patient showed clusters of proliferated endothelial cells at the site of two ruptures, and from one site of the ruptures, these cells invaded into Descemet's membrane, forming a new basement membrane. Transmission electron microscopy revealed that these proliferated cells were epithelial-like cells characterized by desmosomal junctions, basal lamina, numerous microvilli, and 8-nm cytoplasmic filaments. The epithelial transformation of the corneal endothelium was identified in cases of posterior polymorphous dystrophy and assumed to be specific for this entity. The findings in our fourth patient represent the first documentation of epithelial- like cells on the posterior corneal surface in forceps birth-injury-associated keratopathy. Our results suggest that epithelial transformation may be a nonspecific reaction of the young cornea to various stimuli.

Keratoplastik im Kindesalter - Bericht über 71 Keratoplastiken

Abstract: BACKGROUND Keratoplasty is a routine method in adults but there are some additional problems in children. These include difficulties in examining the patients, amblyopia and an increased rate of graft rejection. PATIENTS AND METHODS Between 1980 and 1990 71 keratoplasties in 66 eyes of 61 patients under 16 years of age were performed. The indications and results were studied retrospectively and since 1987 prospectively. The average follow-up was 24 months. Main indications were traumatic scarring (22 eyes), corneal dystrophy (13 eyes), scarring after keratitis (10 eyes), graft failure (7 eyes), and chemical burn (5 eyes). There were 15 lamellar homologous not HLA-matched keratoplasties, 11 autologous penetrating rotating, 42 penetrating homologous not HLA-matched, and 3 penetrating homologous HLA matched. The most frequent complications were loosening or rupture of the suture in 38% and graft rejection in 20% of the homologous penetrating keratoplasties. 10 of 15 eyes after lamellar grafting showed a clear graft at the last control. 40 of 42 eyes after penetrating keratoplasty had also a clear graft, however second keratoplasties were necessary in 4 eyes. 21 of the 42 eyes after penetrating keratoplasty developed a visual acuity of 0.5 or better. CONCLUSION We recommend interrupted single sutures for keratoplasties in children and an earlier suture removal to avoid severe suture problems. Visual outcome depends on the primary diagnosis and on avoiding irreversible amblyopia. In cases of traumatic corneal and lens opacification an early rehabilitation of the optic system is important, therefore in patients under 7 years of age we prefer a posterior chamber lens implantation for a more effective amblyopia therapy.

Corpora amylacea in glaucomatous and non-glaucomatous optic nerve and retina

Abstract: We studied the occurrence, location, and size of corpora amylacea (CA) in periodic acid-Schiff (PAS)-stained histological sections of the retina and optic nerve. The glaucoma group included 48 blind eyes obtained from 48 patients (mean age: 64±13.9 years; range 26–83 years) with advanced secondary angle-closure glaucoma. The non-glaucomatous group consisted of 45 non-glaucomatous eyes from 45 patients (mean age: 62.1±12.2 years, range 34–78 years) suffering from malignant melanoma of the choroid, and six autopsy eyes obtained from young individuals (age range 2.5–29 years). The mean diameter of CA at the level of the retinal ganglion cells (retrolaminar: 10.92±5.15 µm, intralaminar: 10.97±5.04 µm, prelaminar: 9.17±4.53 µm, nerve fiber layer: 8.56±4.27 µm) was significantly larger (P<0.0001; Wilcoxon-Mann-Whitney test) than their size at the level of the bipolar cells (inner plexiform layer: 3.79±1.30 µm). The count of CA in sections from non-glaucomatous subjects aged 2.5 to 78 years (45 eyes with malignant melanoma and 6 autopsy eyes) increased significantly (P<0.01) with advancing age. CA occurred significantly more often (P<0.0001) in eyes with melanoma (45.7±29.4 per section) than in eyes with glaucoma (4.7±6.9 per section). These results suggest that CA represent intraneuronal aging products that are diminished in eyes with end-stage glaucoma due to neuronal loss.

Unilateral type III (Hida) lattice stromal corneal dystrophy

Abstract: BACKGROUND All three types of lattice stromal dystrophy of the cornea use to appear bilaterally. We report on two patients with an unilateral manifestation of type III. PATIENTS A 54 and a 87-years-old man presented a strictly unilateral atypical lattice dystrophy of the cornea and suffered from corneal erosion. Strikingly thickened lattice lines were predominantly orientated radially, almost reached to the corneoscleral limbus and were located in the anterior and midstroma. Both patients had no affected family members and there was no indication on general amyloidosis. RESULTS After successful penetrating keratoplasty histological examination showed remarkably large amyloid deposits predominantly located close to Bowman's layer or in the midstroma and a discontinuous band of amorphous material beneath the intact Bowman's layer. Electron microscopy disclosed that the deposits were composed of typical amyloid fibrils. Four years later the younger of the two patients developed a corneal opacification being suggestive of early stage of lattice dystrophy in the other eye. CONCLUSIONS Lattice corneal dystrophy type III, as described by Hida et al. in 1987, is easily diagnosed at the slit lamp. It may manifest itself unilaterally. In contrast to Meretoja's syndrome, there is no systemic involvement.

Reduction in number of corpora amylacea with advancing histological changes of glaucoma

Abstract: Retina and optic nerve of eyes enucleated due to an iris ring melanoma or a malignant melanoma of the ciliary body were studied to investigate the correlation between corpora amylacea count and glaucoma stages. Ten eyes from ten patients [age: 62.3±13.0 (mean±SD); range 43-84 years] were used for the present study. Eight eyes had shown elevated intraocular pressure readings preoperatively. The corpora amylacea count was correlated with histomorphometric changes of the intra- and parapapillary region. The corpora amylacea count of the retinal ganglion cells decreased significantly with increased histological ratio of cup to disc, decreased retinal nerve fiber layer thickness, and increased optic cup depth. There was no significant correlation between the corpora amylacea count of the bipolar cells and each histomorphometric datum. These results suggest that the corpora amylacea of the retinal ganglion cells decrease in number with advancing histological changes of secondary glaucoma.

Congenital zonular cataract. Clinicopathologic correlation with electron microscopy and review of the literature.

Abstract: A whole subluxated lens with a congenital zonular cataract was obtained after intracapsular extraction from an 83-year-old patient for histopathologic examination. The first electron microscopic description of a congenital zonular cataract revealed the presence of many globules ranging in diameter from 0.1 to 2.5 microns, occasionally accompanied by enlarged intercellular spaces and a few multilamellar bodies. Most of the globules were arranged concentrically around the nucleus like a shell, and only a few globules were concentrated in nodular aggregates in the nucleus. Ultrastructural indications of the relationship between globules and lens fiber membranes have substantiated the idea of the transformation from normal lens fibers into cataractous fibers by primary breakdown of the lens fiber membranes and secondary degeneration or liquefaction of the fiber contents.

Bilateral cavernous degeneration of the optic nerve associated with multiple arteriosclerotic ischemic infarctions.

Abstract: The association of cavernous degeneration of the optic nerve with acute glaucoma was first noted by Schnabel [9]. Cavernous degeneration may also occur as a result of ischemia in the nutrient vessels. Ischemic infarction of the optic nerve resulting in cavernous optic nerve atrophy has been observed in various diseases, such as giant-cell arteritis [6], arteriosclerosis [4, 11] and embolism [1, 3]. These entities were reported to be underlying diseases of cavernous degeneration of the optic nerve with deposition of hyaluronic acid. This study demonstrates bilateral non-glaucomatous cavernous optic nerve atrophy in a 84-year old female with marked ischemic infarctions. A 84-year-old woman was found unconscious on January 28, 1991, and transferred to the Department of Neurology, University of Erlangen-Nfirnberg, with a diagnosis of "apoplexy." The clinical diagnosis was left arteriosclerotic cerebral infarction, absolute arrythmia, and cor pulmonale. On August 3, 1988, corrected visual acuity had been 35/50 in the right eye (with + 1.5D+ 1.25D axis 180 °) and light perception in the left eye. Ophthalmologic examination revealed a cataract in both eyes and ischemic optic nerve atrophy in the left eye. The intraocular pressure was within normal limits. The patient's past medical history included cardiac insufficiency and nephrectomy 10 years ago. Neurological examination revealed a weakness of the right corneal reflex, right facial paresis, and global aphasia. Physical examination showed absolute arrythmia, cardiac insufficiency, and pretibial edema. No ultrasonographic evidence of a stenosis in the carotid arteries was present. The patient showed psychomotoric excitation.