Showing papers by "Gottfried O. H. Naumann published in 2000"

Long term results after autologous nasal mucosal transplantation in severe mucus deficiency syndromes.

Abstract: AIM—Severe mucus deficiency syndromes may require substitution of mucous membrane for re-establishment of the ocular surfaces. The long term results after autologous nasal mucosal transplantation were investigated. METHODS—55 eyes of 50 patients with severe mucus deficiency syndromes were followed retrospectively after free autologous nasal mucosal transplantation—group A: patients after severe lye, acid, heat burns, or radiation (n=38 eyes), group B: patients with systemic mucosal disease (n=17 eyes). The results of routine clinical examination were recorded and patients were followed for a median of 37 months. 17 biopsies of transplanted nasal mucosa were studied by light microscopy and 22 patients by impression cytology before and at several intervals after mucosal transplantation. RESULTS—All nasal mucosal grafts healed well and no intraoperative complications occurred. During follow up 107 additional surgical procedures were performed including 16 lamellar and 21 penetrating keratoplasties. Subjective complaints improved in 44/47 patients with preoperative symptoms. Best corrected visual acuity at the end of follow up was increased in 23 eyes, 10 eyes (18.2%) reached a final visual acuity equal to or greater than 20/200. Histopathologically, all (n=17) biopsies showed vital intraepithelial mucin producing goblet cells in the nasal mucosal graft (median 25 cells/field (400× magnification)). The mean density of goblet cells before transplantation was 48/mm2 and after nasal mucosal grafting 432/mm2 measured by impression cytology (p<0.0001). CONCLUSIONS—Functional goblet cells persist in autologous nasal mucosa for up to 10 years after transplantation. In patients with severe mucus deficiency syndromes of different origin nasal mucosal transplantation can re-establish the ocular surface, substitute the mucus components of the tear film, improve symptoms of the patients, and facilitate a moderate increase in visual acuity.

Chronic inflammation in dermoid cysts: a clinicopathologic study of 115 patients.

Abstract: PURPOSE. To analyze the frequency, pattern, and extent of chronic inflammation in orbital and periorbital dermoid cysts and to correlate these findings with clinical data. PATIENTS AND METHODS. We reviewed the clinical and histopathologic data of 115 consecutive patients with histopathologically confirmed orbital or periorbital dermoid cysts between 1980 and 1998. RESULTS. Sixty-one patients were male and 54 female. Their mean age at the time of surgery was 13 years. The lesion was located superotemporally in 71% of the patients. Patients presented most commonly with a palpable mass without clinical signs of inflammation. The mean cyst volume was 1276 mm(3) (range: 72 to 9900 mm(3)). Histopathologically, 50 lesions (43%) showed chronic granulomatous inflammation of the cyst wall. In 16% of them, the inflammatory response completely replaced the epidermal elements and the normal architecture of the cyst wall. Nine lesions showed spread of granulomatous cell infiltration to the surrounding tissue. Granulomatous inflammation was detected more frequently (p 1000 mm(3)) should be removed early.

Merkel cell carcinoma: clinicopathologic correlation, management, and follow-up in five patients

Abstract: Purpose To review the clinicopathologic features, management and follow-up in five patients with periocular Merkel cell carcinoma (MCC) Methods In this case series study we reviewed the clinical records and histopathologic findings of five consecutive patients with MCC, treated and followed between May 1991 and November 1998 Results Four patients were female and one was male Their mean age at the time of surgery was 80 years (range: 69-86 years) Patients presented with a painless, nonulcerated, rapidly growing, solitary reddish or violaceous nodule, ranging in size from 11 to 21 mm, located in the upper eyelid in 4 patients and in the left eyebrow in one patient Management included excision with frozen section control in three patients, and excision with wide surgical margins in two patients Histopathologically, all tumors exhibited round cells of intermediate size and scanty cytoplasm, and large, round to oval vesicular nuclei with finely dispersed chromatin and one to three inconspicuous nucleoli Mitotic figures were numerous No patient had regional or extraregional metastases at diagnosis Local recurrence or distant metastases were not detectable during a mean follow-up period of 45 months (range: 32-61 months) This outcome contrasts with the high incidence of local recurrence and early nodal metastasis reported in previous publications Conclusions Early diagnosis and aggressive, histologically controlled surgical treatment of this rare, highly malignant tumor may provide a longer disease-free period Further investigation is necessary to determine the prognostic factors for recurrence and survival

Oculocerebral Non-Hodgkin's Lymphoma With Uveal Involvement: Development of an Epibulbar Tumor After Vitrectomy

Abstract: Primary ocular lymphoma is the ocular manifestation of primary oculocerebral non-Hodgkin's lymphoma. We describe a 79-year-old woman with a 7-year history of bilateral uveitis and subsequent central nervous system lymphomas. Repeated diagnostic vitrectomy during the following 5 years failed to demonstrate intraocular lymphoma cells. Within 9 months after the second vitrectomy, an epibulbar tumor developed in the limbal region of the left eye at the site of the sclerotomy. The eye, blind and painful due to secondary angle-closure glaucoma, was enucleated. Histopathologically, the globe showed a diffuse large B-cell non-Hodgkin's lymphoma extending from the ciliary body outward through the sclerotomy. We conclude that, following vitrectomy, a primary ocular lymphoma may extend through the sclerotomy lesion and present as an epibulbar tumor. Uveal involvement may occur in oculocerebral non-Hodgkin's lymphoma.

Lens opacities after nonmechanical versus mechanical corneal trephination for keratoplasty in keratoconus.

Abstract: Purpose To compare the lens opacity formation after penetrating keratoplasty (PKP) using nonmechanical excimer laser corneal trephination and mechanical motor trephination. Setting University Eye Clinic, University of Erlangen-Nurnberg, Erlangen, Germany. Methods Ninety-six patients with keratoconus (96 eyes) and clear crystalline lenses were randomly assigned to the nonmechanical trephination (NMT) group (n = 46; 35 men; mean age 38.2 years ± 10.8 [SD]) or the mechanical trephination (MT) group (n = 50; 35 men; mean age 34.4 ± 9.0 years). Suturing and postoperative treatment were identical. Dilated pupil biomicroscopy and slitlamp lens photography were performed preoperatively and postoperatively at 3 month intervals. Opacities were identified as cortical, nuclear, and posterior subcapsular and graded from 1 (mild) to 3 (severe). Results Mean follow-up in the NMT/MT group was 3.2 ± 1.3 years/3.4 ± 1.1 years. Overall, incident opacities appeared in 23.9%/32.0% of eyes (4.3%/6.0% cortical; 19.6%/26.0% posterior subcapsular; 0%/0% nuclear) ( P = .833). All cortical opacities in both groups were grade 1; posterior subcapsular opacities were grade 1 in 66.6%/61.5% of eyes and grade 2 in 22.2%/30.8% of eyes. One patient in each group presented grade 3 posterior subcapsular opacities. No differences between trephination methods were seen in a 5 year Kaplan–Meier cumulative risk of lens opacity formation ( P = .763 cortical, P = .530 posterior subcapsular). Conclusion In addition to its optical advantages, nonmechanical corneal trephination appears to have no adverse impact on cataract formation after PKP for keratoconus.

Malignant Melanoma of the Conjunctiva With Intraocular Extension

Abstract: Intraocular extension of a malignant melanoma of the conjunctiva is a rare entity. A 75-year-old woman underwent repeated surgery after receiving the diagnosis of a multilocular recurrent malignant melanoma arising from a primary acquired melanosis. Treatment included 2 lamellar sclerokeratectomies and percutaneous radiotherapy. Five years after initial surgery, intraocular extension of the melanoma was observed, and enucleation was performed. Findings from histopathological examination revealed a malignant melanoma occupying part of the ciliary body, the trabecular meshwork, and the iris. Eyes with recurrent malignant melanoma of the conjunctiva should be carefully monitored for intraocular extension. Deep excision of conjunctival melanoma, including lamellar sclerokeratectomy, may abolish the natural barrier against intraocular extension of malignant melanomas of the conjunctiva.

Conjunctival cyst and conjunctival dermoid of the orbit

Abstract: BACKGROUND. Conjunctival dermoids and conjunctival cysts of the orbit were first reported by Jakobiec et al. in 1978. Communications regarding this type of cysts have been sporadic. PATIENTS AND METHODS. We describe the clinical and histopathologic findings in two patients with histopathologically confirmed conjunctival dermoid and conjunctival cyst of the orbit. A review of the literature was also carried out. RESULTS. A 27-year-old female presented with a slowly growing tumor in her left orbit inferomedially. Histopathologically, the tumor was a conjunctival cyst. A 20-year-old male was seen with a painless, slowly-growing mass in his right orbit nasally. The histopathologic study disclosed a conjunctival dermoid. Echography was useful in both cases in demonstrating the cystic structure of the tumors. Conjunctival dermoids and cysts are usually noticed in adulthood, are located nasally or superonasally, lack an associated osseous defect and are lined by a non-keratinizing epithelium with goblet cells. CONCLUSION. Conjunctival dermoids and cysts of the orbit display clinical, radiologic and histopathologic features that differentiate them from the more common dermoid cysts. Emphasis must be given to these distinctive features, since these lesions have probably been largely misdiagnosed.

Thermal load of laser aperture masks in nonmechanical trephination for penetrating keratoplasty with the Er:YAG laser: comparison between stainless steel and ceramic masks.

Abstract: Purpose: Thermal effects on the laser aperture mask may play a major role in the thermal loading of the cornea during nonmechanical trephination in penetrating keratoplasty. The purpose of this study was to assess the temperature increase on the laser mask using the 2.94-µm Er:YAG laser in order to find suitable parameters for avoidance of thermal damage to the cornea. Methods: Thermal load measurements were performed on donor (7.5 mm trephination diameter, 0.7 mm thickness, central hole 3.0 mm) and recipient (7.5 mm trephination diameter, 0.7 mm thickness, outer diameter 13.0 mm) aperture masks. The masks were either mounted on a thermal isolator or fixed directly on porcine corneal samples. Temperature increase was measured either under static conditions in the ablation area (setup 1) and at the opposite side of the mask (setup 2) or in the ablation area under dynamic conditions, rotating the whole globe to simulate a constant trephination speed with the mask positioned directly on a porcine cornea (setup 3). We used the NWL Er:YAG solid-state laser in a 1.3-mm free-running spot mode focused on the trephination margin (half of the beam on the mask and half of it on the cornea) with a pulse energy of 200 or 400 mJ and 18CrNi10 stainless steel versus three different types of ceramic masks (silicium carbide, silicium nitrite, aluminum oxide). Temperature was assessed using an infrared pyrometer with automatic data acquisition software for a personal computer. Results: Overall, the temperature rise ranged between 43.6 K (metal donor mask at the trephination area with 400 mJ pulse energy) and 3.3 K (silicium carbide recipient mask at the opposite side of the mask with 200 mJ pulse energy). With all setups and both energy levels, the heating of the metal mask was significantly higher (P<0.02) than the heating of the three types of ceramic masks. The silicium carbide masks revealed the lowest temperature rise. Comparing the three setups, the temperature rise was maximal under static conditions in the ablation area and minimal at the opposite side, with the dynamic setup ranging in between. Temperature rise was significantly greater (P<0.04) in donor masks than in recipient masks for each mask material and both energy levels. Conclusion: The physical characteristics of silicium carbide masks seem superior to those of metal masks with regard to minimizing the thermal load of the epithelium or superficial stroma during Er:YAG laser trephination of the cornea for penetrating keratoplasty.

Entwicklung der Endothelzellzahl der Wirtshornhaut

Abstract: ZusammenfassungHintergrund. Die Blockexzision von Tumoren der vorderen Uvea und zystischer Epithelinvasion stellt eine bulbuserhaltende kurative Maßnahme dar. Das Ziel dieser Studie war, die Entwicklung des Wirtshornhautendothels bei dieser peripheren Korneoskleralplastik zu quantifizieren. Patienten und Methoden. In einer retrospektiven Querschnittstudie (149 Blockexzisionen) wurde die Endothelzellzahl im Zentrum der Wirtshornhaut untersucht. In die Studie gingen 53 Endothelfotografien von 30 Patienten ein. Der Durchmesser der Blockexzision betrug 8,5±1,9 mm. Ergebnisse. Die Hornhautendothelzellzahl nahm signifikant mit der Beobachtungsdauer nach Blockexzision ab. Statistisch ergab sich kein Zusammenhang zwischen Endothelzellzahl und Indikation zur Operation bzw. dem Blockdurchmesser. Der mittlere Visus vor Blockexzision betrug 0,8±0,3. Der letzte Visus im Beobachtungszeitraum wurde mit 0,3±0,3 angegeben. Schlussfolgerung. Der Endothelzellverlust nach Blockexzision könnte neben dem Operationstrauma durch eine chronische immunologische Reaktion gegen das Spenderendothel und eine nachfolgende Migration der Wirtsendothelzellen auf das korneosklerale Transplantat verursacht sein.AbstractPurpose. Block excision of anterior uveal tumors and cystic epithelial ingrowth to the anterior chamber is a curative treatment for morphological rehabilitation of the globe. This study quantified the course of the host corneal endothelium after this peripheral corneoscleral graft. Patients and methods. This retrospective cross-sectional study examined 53 specular microscopic photographs of the central host cornea in 30 patients. The diameter of the block excision was 8.5±1.9 mm (6.0±11.0 mm). Follow-up after surgery averaged 37.9±47.6 months (1–216). Results. The corneal endothelial cell count decreased with the duration of follow-up after block excision. The cell count was not related to indication for surgery or to diameter of block excision. Mean visual acuity was 16/20 before block excision and 6/20 at the end of follow-up. Conclusion. There is a significant loss of endothelial cells of the host after block excision, requiring a second central penetrating keratoplasty in some patients. Loss of endothelial cells may be due to the surgical trauma, chronic immunological reaction against the donor endothelium, or migration of the host endothelial cells onto the corneoscleral graft.

Entwicklung der Endothelzellzahl der Wirtshornhaut Situation nach Blockexzision und exzentrischer Korneoskleralplastik

Abstract: Hintergrund. Die Blockexzision von Tumoren der vorderen Uvea und zystischer Epithelinvasion stellt eine bulbuserhaltende kurative Masnahme dar. Das Ziel dieser Studie war, die Entwicklung des Wirtshornhautendothels bei dieser peripheren Korneoskleralplastik zu quantifizieren. Patienten und Methoden. In einer retrospektiven Querschnittstudie (149 Blockexzisionen) wurde die Endothelzellzahl im Zentrum der Wirtshornhaut untersucht. In die Studie gingen 53 Endothelfotografien von 30 Patienten ein. Der Durchmesser der Blockexzision betrug 8,5±1,9 mm. Ergebnisse. Die Hornhautendothelzellzahl nahm signifikant mit der Beobachtungsdauer nach Blockexzision ab. Statistisch ergab sich kein Zusammenhang zwischen Endothelzellzahl und Indikation zur Operation bzw. dem Blockdurchmesser. Der mittlere Visus vor Blockexzision betrug 0,8±0,3. Der letzte Visus im Beobachtungszeitraum wurde mit 0,3±0,3 angegeben. Schlussfolgerung. Der Endothelzellverlust nach Blockexzision konnte neben dem Operationstrauma durch eine chronische immunologische Reaktion gegen das Spenderendothel und eine nachfolgende Migration der Wirtsendothelzellen auf das korneosklerale Transplantat verursacht sein.

Development of endothelial cell number in the host corneal endothelium. Status after block excision and eccentric corneal scleroplasty

Abstract: PURPOSE Block excision of anterior uveal tumors and cystic epithelial ingrowth to the anterior chamber is a curative treatment for morphological rehabilitation of the globe. This study quantified the course of the host corneal endothelium after this peripheral corneoscleral graft. PATIENTS AND METHODS This retrospective cross-sectional study examined 53 specular microscopic photographs of the central host cornea in 30 patients. The diameter of the block excision was 8.5 +/- 1.9 mm (6.0-11.0 mm). Follow-up after surgery averaged 37.9 +/- 47.6 months (1-216). RESULTS The corneal endothelial cell count decreased with the duration of follow-up after block excision. The cell count was not related to indication for surgery or to diameter of block excision. Mean visual acuity was 16/20 before block excision and 6/20 at the end of follow-up. CONCLUSION There is a significant loss of endothelial cells of the host after block excision, requiring a second central penetrating keratoplasty in some patients. Loss of endothelial cells may be due to the surgical trauma, chronic immunological reaction against the donor endothelium, or migration of the host endothelial cells onto the corneoscleral graft.

Unilateral arcus lipoides corneae with contralateral Sturge–Weber syndrome

Abstract: Editor,—Arcus lipoides corneae usually occurs bilaterally and symmetrically1 Pronounced unilateral arcus lipoides corneae occurs in atrophic eyes, less marked with relative ocular hypotension2-4 or contralateral carotid artery stenosis5-7 We report on a patient with unilateral arcus lipoides in the normal eye sparing the other one with Sturge–Weber syndrome ### CASE REPORT A 33 year old patient showed a left sided secondary juvenile open angle glaucoma due to Sturge–Weber syndrome The glaucoma diagnosed at the age of 10 months with a maximum intraocular pressure (IOP) of 40 mm Hg had been treated twice by diathermy of the ciliary body, and once by trabeculectomy during the first 6 years of life Since then, the …