Adalbert Lakits

Orbital helical computed tomography in the diagnosis and management of eye trauma

OBJECTIVE To prospectively determine the accuracy of helical computed tomography (CT) and multiplanar reconstruction and its value in surgical planning for the management of ocular trauma with suspected intraocular and orbital foreign bodies using surgical and clinical follow-up findings as the gold standard. DESIGN Prospective, observational case series. PARTICIPANTS Thirty-six patients with ocular trauma and suspected foreign bodies were studied. INTERVENTION All patients were examined using a standardized scanning protocol with helical CT direct scanning in the axial plane and multiplanar reconstruction of coronal and sagittal planes. MAIN OUTCOME MEASURES The images were analyzed for the presence and number of intraocular and orbital foreign bodies, anatomic location, and foreign body size. The surgical and clinical follow-up findings (contact lens examination, gonioscopy, indirect ophthalmoscopy and scleral depression, perimetry, color testing, measurement of size) were used as the gold standard to which the image results were compared. RESULTS Helical CT showed a single intraocular foreign body in 14 patients, a single orbital foreign body in 9 patients, and multiple orbital foreign bodies in 2 patients. Intraocular or orbital foreign bodies were excluded in 11 patients. Twenty foreign bodies were correlated with surgical results. Surgical and clinical follow-up findings were in agreement with helical CT results regarding the detection and determination of the number of presumed foreign bodies. Localization to intraocular versus orbital compartment and proximity to the optic nerve was accurate in all patients. Determination of size of the foreign bodies on the helical CT images was reliable and repeatable. CONCLUSIONS Helical CT axial scanning with multiplanar reconstruction is accurate at detecting and localizing intraocular and orbital metallic, glass, and stone foreign bodies. This imaging method aids the surgeon in choosing the surgical approach to retained intraocular and orbital foreign bodies.

Evaluation of intraocular foreign bodies by spiral computed tomography and multiplanar reconstruction

OBJECTIVE This study aimed to evaluate the ability of spiral computed tomography (CT) and multiplanar reconstruction in the assessment of intraocular foreign bodies. DESIGN The study design was experimental. MATERIAL Three foreign bodies (metal, glass, and plastic) implanted into the globe of a cadaveric head were studied. INTERVENTION Spiral CT in the axial plane was used. Beam collimation and table increment were both 3 mm, whereby overlapping axial slices were reconstructed at 1-mm intervals. The data were transferred to a workstation, and reconstructions in the coronal and sagittal plane were performed. MAIN OUTCOME MEASURES The ability to detect and evaluate localization, shape, and size of the foreign bodies in all three imaging planes was assessed. RESULTS All foreign bodies were detected in the axial and in both reconstructed planes. The metal foreign body caused imaging artifacts in the axial plane. In the reconstructed planes. imaging artifacts were less severe, and evaluation of localization and shape was improved. Glass and plastic foreign bodies were well seen in all planes, and shape and localization were well demonstrated. Appropriate window settings improved determination of size of the different foreign bodies. CONCLUSIONS Spiral CT of the orbit and multiplanar reconstruction offers a promising tool for evaluation of intraocular foreign bodies. Advantages of spiral CT compared to conventional CT are data acquisition in only one axial plane; shortened examination time; reduced radiation exposure; reduced imaging artifacts from metallic foreign bodies in the reconstructed planes; and demonstration of localization, shape, and size of the foreign body in three imaging planes.

Multiplanar imaging in the preoperative assessment of metallic intraocular foreign bodies: Helical computed tomography versus conventional computed tomography

OBJECTIVE This study aimed to compare the effectiveness of helical computed tomography (CT) versus conventional CT in the preoperative assessment of metallic intraocular foreign bodies on axial, coronal, and multiplanar reconstruction images in clinical routine. DESIGN Prospective comparative trial, alternate assignment of consecutive patients. PARTICIPANTS Eighteen patients with penetrating eye injuries and suspected metallic intraocular foreign bodies were studied. INTERVENTION Alternate patients were assigned to undergo either helical CT or conventional CT in the axial plane. Both the helical and the conventional data were transferred to a workstation, and reconstructions in the coronal and sagittal planes were performed. Additional direct coronal scanning was performed only when necessary for preoperative assessment. MAIN OUTCOME MEASURES The quality of the directly obtained axial and coronal, as well as the reconstructed coronal and sagittal images, was assessed for each, imaging method based on the ability to detect and accurately localize foreign bodies. The size of the foreign bodies was measured and compared to the actual diameter. Total examination time and radiation dose delivered to the lens were measured for each imaging method. RESULTS All foreign bodies were detected by each scanning method on the axial, the coronal, and on the reconstructed planes. The quality of the axial images was similar for helical and conventional CT. The helical technique provided high-quality reconstructed images comparable in quality to the directly obtained coronal planes in conventional CT. Reconstructions by conventional technique were not useful for preoperative assessment. The examination time for the total orbital volume was 18 seconds for helical CT examinations and 52 seconds for conventional CT examinations. Radiation dose delivered to the lens for the complete examination was 35 mGy for helical CT axial scanning, 56 mGy for conventional CT axial scanning, and 63 mGy for conventional CT coronal scanning. CONCLUSIONS Helical CT multiplanar imaging offers several significant advantages for the preoperative assessment of metallic intraocular foreign bodies compared to the conventional CT technique in clinical practice, including short examination time, reduced motion artifacts, reduced radiation exposure, and the ability to obtain diagnostically useful coronal and sagittal reconstruction images without the need for additional scanning.

Chemical stability of silicone oil in the human eye after prolonged clinical use

OBJECTIVE To investigate the assumption that silicone oil is chemically stable in the human eye after prolonged clinical use as a vitreous substitute. DESIGN Experimental study. MATERIAL Samples of silicone oil recovered from the vitreous cavities of 25 consecutive patients up to 26 months (mean, 9.2 months) after implantation and 4 different batches of original highly purified silicone oil with a kinematic viscosity of 5000 mPa.s were analyzed. Visible silicone oil emulsification was present in 18 of the 25 eyes. INTERVENTION Gas chromatography/mass spectroscopy (GC/MS) was used to detect and characterize low-molecular weight components (LMWC). Gel permeation chromatography (GPC) was used to determine the molecular weight distribution of the silicone oils. Functional groups of the silicone oils were quantified and characterized by infrared (IR) spectroscopy and 1H nuclear magnetic resonance (1H NMR) spectroscopy. MAIN OUTCOME MEASURES The sample oils explanted from the eyes were compared to the original oils with regard to LMWC, molecular weight distribution, and type and amount of functional groups. RESULTS The GC/MS chromatograms showed no peaks indicative of LMWC in any of the 25 sample oils explanted from the eyes or any of the original oils. In the GPC chromatograms, the peak position occurred at the same retention times with identical signal shape in all original and sample oils, indicating that the molecular weight and the molecular weight distribution did not change after prolonged implantation. The IR spectroscopy and 1H NMR spectroscopy showed characteristic absorption bands at 1260 cm(-1) related to symmetric deformation vibration of the Si-CH3 group and at 800 cm(-1) related to the Si-(CH3)2 group. This was identical for all sample and original oils. CONCLUSIONS Highly purified 5000-mPa.s silicone oils, used as prolonged retinal tamponades in patients with proliferative vitreoretinopathy, proliferative diabetic retinopathy, and tractional retinal detachment after central retinal vein occlusion, are chemically stable in the human eye and do not undergo chemical modification. The LMWC do not play a substantial role in the variations of oil emulsification.

Beeinflussen andere Faktoren als der histologische Typ die Uberlebensdauer nach Enukleation wegen eines malignen Aderhautmelanoms

ZusammenfassungVorliegende Studie untersucht den Einfluß klinischer Parameter (Patientenalter, histologischer Typ, Tumorhöhe, größter Basisdurchmesser und Tumorlage) auf die Prognose von Patienten, deren Auge wegen eines malignen Aderhautmelanoms enukleiert worden war. Weiters wurde der assoziative Einfluß dieser Faktoren untereinander auf das Überleben mittels Kovariatenanalyse untersucht.Patienten und MethodeEs wurden insgesamt 119 Patienten, die wegen eines malignen Aderhautmelanoms enukleiert worden waren, mittels aktiver und passiver Follow-up-Prozeduren überprüft. 85 Patienten wurden in die Auswertung einbezogen. Folgende Faktoren von möglicher prognostischer Bedeutung wurden registriert: Alter des Patienten zum Zeitpunkt der Enukleation, Zelltyp, Tumorhöhe, Tumorbasisdurchmesser und Tumorlokalisation. Zur Berechnung der Überlebensraten wurde die Methode nach Kaplan-Meier verwendet. Die statistische Prüfung auf Unterschiedlichkeit der Überlebenskurven sowie Assoziation der Überlebenskurven mit Kovariaten erfolgte mittels Wilcoxon-Test.ErgebnisseDie Überlebenskurven, bezogen auf die histologischen Gruppen, unterschieden sich statistisch signifikant, wobei Tumore vom Spindelzelltyp die beste Prognose hatten. Die Assoziation dieser Überlebenskurven mit den Kovariaten Alter, Tumorhöhe und größter Tumorbasisdurchmesser zeigte keine statistische Signifikanz. Die Überlebensdaten, bezogen auf den größten Tumorbasisdurchmesser, unterschieden sich nicht signifikant. Die Berechnung der Überlebenskurven, bezogen auf die Tumorhöhe, ergab keinen statistisch signifikanten Unterschied, ebenso wie die auf die Tumorlage bezogene.SchlußfolgerungDer histologische Typ ist der wichtigste und in dieser Arbeit einzig statistisch signifikante prognostische Faktor nach Enukleation wegen eines malignen Aderhautme1anoms.SummaryPurpose of the study was to determine the influence of different clinical factors (such as: age, cell type, tumor prominence, largest tumor diameter, and location of the tumor) to the prognosis after enucleation for malignant melanoma of the choroid. Covariance analysis was applied to test the association of covariates.Patients and methods119 patients who were enucleated for malignant melanoma of the choroid were studied by active and passive follow-up studies. 85 were included in the study. Factors of possible relation to prognosis were assessed: age of the patient at the time of enucleation, cell type, largest tumor diameter, tumor prominence, and location of the tumor. To calculate survival curves the method of Kaplan-Meier was used. The statistical analysis of survival data and covariates was done by Wilcoxon test.ResultsThe difference of survival ratios in relation to cell type was statistically significant, indicating best prognosis for tumors of the spindelcell type. The difference of survival curves according to cell type was not significantly influenced by the covariates age, prominence and largest tumor diameter. No significant relationship was found between largest tumor diameter and prognosis. No significant relationship was noticed between neither tumor prominence and tumor location and prognosis.ConclusionIn our study we found the cell type to be the only statistically significant factor influencing the prognosis after enucleation for malignant melanoma of the choroid.

Neue Technik zur Züchtung von Pterygium-Zellkulturen — Ein Vergleich von zwei Techniken

ZusammenfassungHintergrundDas Pterygium ist eine degenerative Erkrankung des Auges, dessen Ätiologie und mikrobiologische Hintergründe noch nicht gänzlich geklärt sind. Die äußerst schwierige Züchtung von Pterygium-Zell-kulturen schafft erst die Basis für die Erforschung von zellulären Vorgängen.Ziel der ArbeitDie Etablierung einer neuen Methode zur Züchtung von Pterygium-Zellkulturen.Materialien und MethodenVon 30 Pterygium-Präparaten wurden 15 Pterygium-Zellkulturen nach der „di Girolamo Technik“ gezüchtet und 15 Pterygium-Zellkulturen mit der „neuen Technik“ gezüchtet. Es wurde die Zeit ab dem Dazugeben des Mediums bis zum Auswachsen der Zellen gemessen.Um auszuschließen, dass das Wachstum der Zellen patientenabhängig ist, haben wir eine zweite Versuchsanordnung aufgestellt. Fünf neue Pterygium-Präparate wurden in jeweils zwei Hälften geteilt und mit beiden Techniken gezüchtet.ErgebnisseMit der „di Girolamo Technik“ kam es zu Zellwachstum nach 29 bis 38 Stunden. Im Gegensatz dazu kam es mit der „neuen Technik“ zu Zellwachstum nach 12 bis 20 Stunden. Ein hoch signifikanter Unterschied (p ≤ 0,0001) in der Zeit des Auswachsens konnte zwischen den zwei Techniken ermittelt werden.Bei der zweiten Versuchsanordnung kam es mit der „di Girolamo Technik“ zu Zellwachstum nach 38 bzw. 40 Stunden. Im Vergleich dazu kam es mit der „neuen Technik“ zum Zellwachstum nach 13 bis 18 Stunden. Ein signifikanter Unterschied (p ≤ 0,004) in der Auswachszeit konnte ermittelt werden.SchlussfolgerungMit der Modifizierung der „di Girolamo Technik“ konnte eine Verbesserung der Gewebehaftung am Näpfchen erreicht werden, Auswachszeiten der Zellen konnten verkürzt werden, und es konnte gezeigt werden, dass das Zellwachstum methodenabhängig und nicht gewebeabhängig bzw. patientenabhängig ist.SummaryBackgroundThe Pterygium is a degenerative disease of the eye. While it has been connected with a variety of factors its ethiology is not yet clarified. Although the cultivation of pterygium cell cultures is extremely difficult, it is necessary for clarification of cellular processes which lead to this disease.GoalsEstablishment of a new pterygium cell cultivation method.Materials and methods30 specimen of pterygium tissue were used for cultivation, 15 pterygium cell-cultures were established following the “di Girolamo technique”, and 15 pterygium cell-cultures following the new technique. The cell outgrowth time was measured starting from the addition of the medium to outgrowth of the cells. To assure that cell outgrowth does not depend on origin of the tissue, five new Pterygium specimen were each divided each into two halves and were cultivated with both techniques.ResultsIn the group cultivated with the “di Girolamo technique” cell outgrowth was noted after 29 to 38 hours. In the “new technique” group however cell outgrowth was observed already within 12 to 20 hours. A highly significant outgrowth time difference (p ≤ 0.0001) was determined between the two techniques.When patients tissue was divided cell outgrowth was noted after 38 and 40 hours with the “di the Girolamo technique” in comparison with outgrowth after only 13 to 18 hours with the “new technique” group. A significant time difference (p ≤ 0.004) was determined.ConclusionThe modification of the “di Girolamo N. Technique” results in improvement of tissue adherence to the well surface and time reduction of cell outgrowth. Results from the “divided tissue group” indicate that cell outgrowth depends on the technique used and not on tissue origin.

Die Epidemiologie des Pterygiums an der Universitätsklinik für Augenheilkunde und Optometrie, Wien

ZusammenfassungHintergrundDas Pterygium ist eine degenerative Erkrankung des Auges dessen Ätiologie noch nicht geklärt ist. Insbesondere statistische Erfassungen der in Europa behandelten Patienten sind selten, aber für die Erforschung des Pterygiums notwendig.Ziele der ArbeitDie Schaffung und Evaluierung einer Pterygium-Datenbank.Patienten und Methoden189 Krankengeschichten von Pterygium-Patienten wurden retrospektiv begutachtet. Alle Patienten wurden in der Universitätsklinik für Augenheilkunde und Optometrie, Wien, behandelt.Ergebnisse32,7% der Patienten waren weiblich und 68,3% männlich. 68,3% der Fälle wurden mit der „Baresclera“-Technik, 13,8% mit der „Conjunctival-flap“-Technik und 10,1% mit der „Autologes-Transplantat“-Technik operiert. 9,2% der Patienten stammt aus Westeuropa, 28,6% aus Westasien und 16,9% aus Südeuropa.SchlussfolgerungEin umfassendes Bild über die Häufigkeit der Erkrankung, operativen Behandlungen und demographische Verteilung der Pterygium-Patienten in der Universitätsklinik für Augenheilkunde und Optometrie, Wien, konnte gewonnen werden. Aus diesen Daten kann eine Tendenz bezüglich der Häufigkeit des Pterygiums und deren Abhängigkeit von der Herkunft des Patienten erahnt werden.SummaryBackgroundThe Pterygium is a degenerative disease of the eye, its etiology is brought in connection with different factors. There is still a lack of statistical overviews of pterygium patients in Europe.GoalsThe task of this study was to establish and evaluate a pterygium data base.Patients and methods189 records of patients were reviewed retrospectively. All patients were treated in the Department of Ophtalmology, University of Vienna, Medical School.Results32.7% of the patients were female and 68.3% male. The Bare sciera technique was performed in 68.3%, Conjunctival flap in 13.8% and the autologous conjunctival transplantation in 10.1% of the cases. 39.2% of the patients originate from Western Europe, 28.6% from Western Asia and 16.9% from South Europe.ConclusionA comprehensive picture on operational treatment and demographic distribution could be won. Due to these data a tendency can be suspected concerning the origin of the patients and the number of diseases.

Therapeutisches Vorgehen beim Periokulären Molluscum Contagiosum im Kindesalter

ZusammenfassungDie heute übliche Behandlungsweise eines Molluscum Contagiosums am kindlichen Augenlid besteht, wegen möglicher okulärer Komplikationen, in der frühzeitigen chirurgischen Entfernung. Allerdings nimmt man dabei die Risiken einer Vollnarkose in Kauf, ohne gesicherte epidemiologische Daten über einerseits die Häufigkeit okulärer Komplikationen und andererseits die Häufigkeit von Spontanremissionen. Dieser Fall zeigt die rasche und komplikationslose Remission eines Molluscum Contagiosum bei einem 5-jährigen Kind und befürwortet nach kritischem Studium der Literatur eine abwartende Haltung ohne chirurgische Intervention bei diesen jungen Patienten.SummaryBecause of possible ocular complications, POMC on children’s eyelid, is usually treated with early surgical removal. General anaesthisia, which is need in the case of pediatric patients, is however associated with the well known risks of this procedure and furthermore there are no valid epidemiological data regarding the frequency of ocular complications and/or spontaneous remission. We report a spontaneous and rapid remission, without any ocular complications, of a POMC in a five year old child. This case and critical interpretation of the literature regarding this topic, support the observation of such patient without surgical intervention.

Intraokulärer metallischer Fremdkörper — Immer eine Gefahr für das Auge?

ZusammenfassungPenetrierende Verletzungen mit retinierten intraokularen, eisenhältigen Fremdkörpern sind in vielen Fällen schwere, das Auge stark beeinträchtigende Verletzungen. Aufgrund der Gefahr einer Infektion sowie einer Siderose wird der Fremdkörper in den meisten Fällen im Zuge der Versorgung der Verletzung oder auch sekundär entfernt.Es wird über einen Patienten berichtet, der als Beobachter während einer Operation ein solches Trauma erfährt. Durch die speziellen Umstände des sterilen sowie inerten Fremdkörpers als auch dem durch dieses Trauma unbeeinträchtigtem Virus wurde von einer Fremdkörperentfernung Abstand genommen. Über einen Beobachtungszeitraum von 2 Jahren kam es zu keiner Veränderung des Befundes, und ein Monitoring in Bezug auf Siderosis blieb unauffällig.SummaryPenetrating injuries with an intraocular ironcontaining foreign body represent in many instances severe injuries, threatening the integrity of the eye. Removal will be performed in most cases together with wound-closure or lensectomy or as an elective procedure.We present a patient who was inflicted such an injury while observing an operation. As a cause of the special circumstances — a steril and inert foreign body with no change in the patient’s visual acuity — the foreign material was left in place. During a follow-up period of two years there was no change of signs and symptoms and screening for signs of siderosis stayed negative.

Die Erfassung von Orbitafrakturen: Konventionelle versus Spiral-Computertomographie

ZusammenfassungPatienten mit Orbitafrakturen sind häufig schwer verletzt. Eine direkte, konventionelle koronale Computertomographie (CT) ist aufgrund der dafür nötigen Positionierung in Bauchlage mit überstreckten Nacken in der Regel nicht möglich. Die Diagnostik beruht demnach nur auf konventionellen axialen Schichten, da koronal rekonstruierte Bilder eine stark eingeschränkte Bildqualität besitzen.In einer Pilotstudie an sechs Patienten verglichen wir anhand von Orbitafrakturen die konventionelle Computertomographie in axialen und koronalen Schnittrichtungen mit der Spiral-CT in axialer Schnittebene und koronaler, aus dem Datensatz rekonstruierter Schnitte. Bildqualität und Beurteilbarkeit von Orbitafrakturen wurden von zwei Untersuchern anhand eines Scores konsensuell bewertet.Die axialen Schnitte in konventioneller und Spiral-CT-Technik zeigten keine wesentlichen Unterschiede bezüglich Bildqualität. Bei den koronalen Schichten aus Spiral-CT Datensätzen zeigten sich geringe Nachteile in der Beurteilbarkeit des Orbitabodens, jedoch eine deutlich verbesserte Beurteilbarkeit dieser, sowie auch horizontaler Strukturen bezüglich axialer Daten.Bei verletzten Patienten sollte die Untersuchung der Orbita in Spiral-CT-Technik erfolgen, da koronal rekonstruierte Bilder eine deutlich verbesserte Diagnostik gegenüber herkömmlichen axialen Schnitten ermöglichen und fast an die Bildqualität primär koronaler Schichten heranreichen.SummaryPatients with orbital fractures frequently suffer from concomitant severe trauma which makes the positioning needed (prone with hyperextended neck) for direct coronal computed tomography (CT) impossible. In this situation just axial scans are acquired directly with the possibility of reconstruction of coronal images from the axially acquired data. However, these reconstructed images show severe shortcomings of image quality making misdiagnosis more likely. In a pilot study with six patients we compared image quality and the ability to assess orbital bone fractures on axial and coronal scans of conventional- and spiral-CT. Evaluation criterion was a modified score which was used consensually by two reviewers to judge the hardcopies.Scores of image quality between spiral-CT and conventional CT were comparable on axial scans. In addition, spiral-CT generates coronal scans of diagnostic quality through multiplanar reconstruction. We recommend the use of spiral — CT technique for severely traumatized patients since reconstructed coronal images improve diagnostic accuracy significantly compared to axial images alone and come close to image quality of direct coronal scans.