Helmut Buettner

Mayo Clinic - Rochester, Rochester, MN, United States

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Publications (17)60.33 Total impact

  • Harrup Kaur · Helmut Buettner · Diva R Salomao · Randolph S Marks
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    ABSTRACT: To report transcleral orbital invasion by a radiation- and chemotherapy-resistant choroidal metastasis of a pulmonary adenocarcinoma. Interventional case report. A 51-year-old female was found to have choroidal metastasis from a previously unknown primary pulmonary adenocarcinoma. She underwent external beam radiation treatment with a total dose of 40 Gray (Gy), delivered in 20 fractions over 28 days, followed by adjuvant chemotherapy with gemcitabine and carboplatin. After completing two of the three scheduled chemotherapy cycles, the choroidal lesion was observed to have increased in size. A transvitreal aspiration biopsy of the choroidal lesion confirmed the diagnosis of metastatic pulmonary adenocarcinoma. Enucleation was performed for intractable pain. Histopathology revealed invasion through scleral emissary channels to the retrobulbar tissue and through the optic nerve substance itself. Despite appropriate external beam radiation therapy (EBRT) and chemotherapy, pulmonary adenocarcinoma metastases to the choroid can continue to grow and may invade the orbit transclerally.
    American Journal of Ophthalmology 03/2007; 143(2):369-70. DOI:10.1016/j.ajo.2006.09.031 · 4.02 Impact Factor
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    H B Harold Lee · Jose S Pulido · Colin A McCannel · Helmut Buettner
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    ABSTRACT: Inflammation measured by using highly sensitive C-reactive protein (hs-CRP) may be a separate risk factor in retinal vein occlusion (RVO). In a small consecutive pilot case series, hs-CRP was measured in 11 patients with RVO. Levels ranged from 1.0 to 18.0 mg/L (mean 6.5 [SD 6.1] mg/L), with >3.0 mg/L being considered high risk for developing vascular disease. The new role of hs-CRP is important for ophthalmologists because of its part in vascular disease.
    Canadian Journal of Ophthalmology 02/2007; 42(1):131-3. DOI:10.1139/i06-101 · 1.30 Impact Factor
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    ABSTRACT: Purpose: To present the clinical findings in a patient with hemochromatosis, secondary porphyria cutanea tarda and angioid-like streaks. Methods: Retrospective clinical report. Results: This patient presented with angioid like streaks and choroidal neovascularization. Hemochromatosis is a common genetic disease in the general population and presents at variable ages. The iron deposition may predispose to angioid streaks. In addition, secondary porphyria cutanea tarda (PCT) is associated with hemochromatosis and care should be taken during intraocular surgery since PCT may predispose to phototoxcity. Conclusion: In patients with angioid-like streaks, there should be consideration of hemochromatosis as a possible cause.
    Retinal Cases & Brief Reports 12/2006; 1(4):254-256. DOI:10.1097/01.iae.0000231365.48293.a2
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Retinal Cases & Brief Reports 12/2006; 1(1):30-32. DOI:10.1097/01.ICB.0000256942.27082.1b
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    ABSTRACT: To investigate whether intravitreal methotrexate could be safely administered and improve vision in patients with ocular disease other than primary central nervous system lymphoma (PCNSL). A retrospective, small-case series. Patients with various clinical conditions were treated with intravitreal methotrexate (cumulative dose < or =400 microg). Visual acuity and clinical examination were recorded to assess the safety and efficacy of the injection. Of 16 study eyes, final visual acuity was improved in seven, remained stable in five, and decreased in four. There was no observed toxicity attributable to methotrexate in any case. Preservation of visual acuity in 12 of 16 study eyes suggests that a 400-microg intravitreal injection is safe in ocular disease other than PCNSL. The loss of acuity in four eyes with advanced preexisting pathology may be just as likely attributable to the natural history of the disease as to intraocular methotrexate.
    American Journal of Ophthalmology 12/2006; 142(5):883-5. DOI:10.1016/j.ajo.2006.06.002 · 4.02 Impact Factor
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    ABSTRACT: Objective: To evaluate the efficacy and safety of low-intensity laser treatment in the prevention of visual acuity (VA) loss among participants with bilateral large drusen. Design: Multicenter randomized clinical trial. One eye of each participant was assigned to treatment, and the contralateral eye was assigned to observation. Participants: A total of 1052 participants who had >= 10 large (> 125 mu m) drusen and VA :20/40 in each eye enrolled through 22 clinical centers. Intervention: The initial laser treatment protocol specified 60 barely visible burns applied in a grid pattern within an annulus between 1500 and 2500 mu m from the foveal center. At 12 months, eyes assigned to treatment that had sufficient drusen remaining were retreated with 30 burns by targeting drusen within an annulus between 1000 and 2000 mu m from the foveal center. Main Outcome Measure: Proportion of eyes at 5 years with loss of >= 3 lines of VA from baseline. Secondary outcome measures included the development of choroidal neovascularization or geographic atrophy (GA), change in contrast threshold, change in critical print size, and incidence of ocular adverse events. Results: At 5 years, 188 (20.5%) treated eyes and 188 (20.5%) observed eyes had VA scores >= 3 lines worse than at the initial visit (P=1.00). Cumulative 5-year incidence rates for treated and observed eyes were 13.3% and 13.3% (P=0.95) for choroidal neovascularization and 7.4% and 7.8% (P=0.64) for GA, respectively. The contrast threshold doubled in 23.9% of treated eyes and in 20.5% of observed eyes (P=0.40). The critical print size doubled in 29.6% of treated eyes and in 28.4% of observed eyes (P=0.70). Seven treated eyes and 14 observed eyes had an adverse event of a >= 6-line loss in VA in the absence of late age-related macular degeneration or cataract. Conclusion: As applied in the Complications of Age-Related Macular Degeneration Prevention Trial, low-intensity laser treatment did not demonstrate a clinically significant benefit for vision in eyes of people with bilateral large drusen. (c) 2006 by the American Academy of Ophthalmology.
    Ophthalmology 11/2006; 113(11):1974-1986. DOI:10.1016/j.ophtha.2006.08.015 · 6.17 Impact Factor
  • Archives of Ophthalmology 10/2006; 124(9):1357-9. DOI:10.1001/archopht.124.9.1357 · 4.49 Impact Factor
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    ABSTRACT: To report our longer-term follow-up observations in patients with small choroidal melanomas primarily treated with transpupillary thermotherapy (TTT). In this noncomparative interventional case series, 40 patients with small melanocytic tumors of the choroid (thickness <3.5 mm) underwent TTT. Follow-up examinations including ophthalmoscopy, ultrasonography, and fundus photography were conducted at 24 to 48 hours, 2 to 6 weeks, and 6-month intervals after treatment. Forty patients (mean age, 58 years) with small melanocytic tumors underwent TTT. Mean follow-up in all patients was 42 months. In most cases TTT resulted in tumor regression. Thirty-one (77.5%) of 40 tumors did not recur after initial treatment with TTT. In 5 (12.5%) of 40 tumors with initial basal diameters ranging from 4 x 2.75 mm to 7.5 x 6 mm and a mean initial thickness of 2.0 mm, edge recurrences developed, which were satisfactorily treated with additional TTT (4 cases) or cryotherapy (1 case). The mean interval between initial TTT and recurrence in this subgroup was 15 months (range, 7-22 months). Of 36 eyes that were successfully treated with TTT or cryotherapy, 26 eyes (72%) had posttreatment visual acuity better than or equal to pretreatment visual acuity. Four (10%) of 40 tumors were not controlled with TTT and eventually required brachytherapy (n = 1), proton radiation (n = 1), or enucleation (n = 2). The initial basal diameters of these tumors ranged from 7.5 x 7.5 mm to 9 x 7.5 mm, with a mean initial thickness of 2.6 mm. The mean interval between treatment and determination of treatment failure was 22 months (range, 7-30 months). Transpupillary thermotherapy resulted in tumor regression of most small melanocytic choroidal tumors. Tumor edge recurrences were successfully treated with additional TTT in most cases. Four tumors required irradiation or enucleation because of treatment failures with TTT. Transpupillary thermotherapy as a stand-alone therapy is insufficient for some small choroidal melanomas.
    Archives of Ophthalmology 04/2006; 124(4):503-6. DOI:10.1001/archopht.124.4.503 · 4.49 Impact Factor
  • Retina 07/2005; 25(4):510-4. · 3.18 Impact Factor
  • P.W. Hardwig · J.C. Erie · H. Buettner
    American Journal of Ophthalmology 06/2005; 139(6):1151. DOI:10.1016/j.ajo.2005.04.004 · 4.02 Impact Factor
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Retina 05/2005; 25(4):510-514. DOI:10.1097/00006982-200506000-00018 · 3.18 Impact Factor
  • Paul W Hardwig · Jay C Erie · Helmut Buettner
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    ABSTRACT: To determine the rate of secondary opacification of the visual pathway following pediatric cataract surgery in children between the ages of 10 months and 7 years. The medical records of children less than 7 years old who underwent lens aspiration, posterior chamber intraocular lens (IOL) implantation, primary pars plana posterior capsulectomy, and anterior vitrectomy were reviewed retrospectively. Twenty-six eyes in 19 children were included in the study. All procedures were performed by an anterior segment surgeon and a vitreoretinal surgeon. Main outcome measures were the prevalence of re-opacification of the visual pathway and of early postoperative complications. The visual pathway remained clear in 25 of 26 eyes (96%) after pediatric cataract surgery combined with primary pars plana posterior capsulectomy and anterior vitrectomy. The mean age at surgery was 46 +/- 23 months (+/-SD). Secondary opacification of the visual pathway occurred in one eye (4%), requiring another surgical procedure. At last follow-up (mean, 26 months; range, 6 to 79 months), the visual pathway was clear in all 26 eyes (100%). No cases of clinically significant IOL displacement or of retinal detachment were noted. For children undergoing pediatric cataract surgery between the ages of 10 months and 7 years, IOL implantation combined with primary pars plana posterior capsulectomy and anterior vitrectomy is effective in preventing re-opacification of the visual pathway.
    Journal of American Association for Pediatric Ophthalmology and Strabismus 01/2005; 8(6):560-5. DOI:10.1016/j.jaapos.2004.08.003 · 1.14 Impact Factor
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    ABSTRACT: Objective: To describe characteristics of participants in the Complications of Age-Related Macular Degeneration Prevention Trial (CAPT) at baseline and to investigate associations among visual function, fundus features, and vision-related quality of life. Design: Cross-sectional study. Participants: The 1052 participants in CAPT, a multicenter, randomized clinical trial. Eligibility criteria for CAPT included 10 large drusen and visual acuity greater than or equal to20/40 in each eye. Methods: At baseline, the visual acuity, contrast sensitivity, and critical print size for each eye were measured, color stereo photographs of the disc and macula of each eye were taken, and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) was self-administered. Graders from a central photograph reading center evaluated the photographs for drusen characteristics and focal hyperpigmentation. All procedures were performed using standardized protocols. Associations among characteristics were assessed by Spearman correlation coefficients and multiple linear regression. Results: Among CAPT participants at baseline, the mean age was 71.0 years, 60.6% were women, and 99.3% were white. The median visual acuity of the better eye was 20/20 and of the worse eye 20/25. In approximately one third of eyes, drusen covered greater than or equal to10% of the retina within 3000 mum of the foveal center, and 67.7% of eyes had focal hyperpigmentation. Drusen area and focal hyperpigmentation were weakly correlated (r = -0.08 to -0.18) with the measures of visual function. The measures of visual function were weakly associated with the NEI-VFQ-25 scores. An association of fundus features with NEI-VFQ-25 scores was not found. Conclusion: At baseline, CAPT participants had good visual function and several risk factors for progression to neovascular age-related macular degeneration. Scores on the NEI-VFQ-25 indicated that participants perceived some problems with their vision. Within this relatively homogeneous group of participants, measures of visual function were only weakly associated with the measures of vision-related quality of life. (C) 2004 by the American Academy of Ophthalmology.
    Annual Meeting of the; 07/2004
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    ABSTRACT: A prospective study was conducted to determine if external ionizing radiation could favorably influence the orbital manifestations of Graves ophthalmopathy. Diabetes and untreated systemic hypertension were exclusion criteria. Radiation was directed to the orbits of 42 affected patients using 0.2 rad (20 Gy) delivered in 10 doses of 0.02 rad (2 Gy). Patients were periodically examined during a 3-year interval. To report retinal microvascular abnormalities observed in our study cohort. Fundus findings documented with ophthalmoscopy, stereoscopic color photography, and stereoscopic fluorescein angiography prior to radiation were compared with similarly documented findings approximately 3 years following radiation. Prior to orbital radiation, retinal microvascular abnormalities were identified in 2 patients. The abnormalities were present bilaterally in one patient and unilaterally in the other. During the course of the study, microvascular abnormalities developed de novo in the unaffected retina of the latter patient while the retinopathy in the fellow eye progressed. Retinal microvascular abnormalities and their sequelae developed de novo in both eyes in 2 more patients. In addition to the radiation, other confounding factors known to be associated with microvascular retinopathy (uveitis, inadequately controlled systemic hypertension, and borderline blood glucose levels) were identified among the 3 patients whose eyes developed new retinal microvascular abnormalities. Whether the retinal microvascular abnormalities observed in these patients were caused or aggravated by external beam irradiation cannot be precisely ascertained. However, the observed progression and de novo development of retinal microvascular abnormalities within 3 years of orbital radiation raise concern that 0.2 rad (20 Gy) delivered to the orbit in 10 doses of 0.02 rad (2 Gy) may aggravate existing retinal microvascular abnormalities or cause radiation retinopathy in some patients with Graves disease. These findings and the failure of external beam radiation with 0.2 rad (2000 cGy) to favorably affect Graves ophthalmopathy, as demonstrated in a previous study, have led us to discourage further treatment of Graves ophthalmopathy with radiation.
    Archives of Ophthalmology 06/2003; 121(5):652-7. DOI:10.1001/archopht.121.5.652 · 4.49 Impact Factor
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    ABSTRACT: All surgical eye specimens examined in our pathology laboratory between January 1, 1990, and July 31, 2000 (N = 646), were classified by surgical procedure (enucleation, evisceration, or exenteration) and pathologic diagnosis. Among 523 enucleated globes (81.0%), 252 (48.2%) contained tumors, of which 208 were intraocular malignant melanomas. Nonneoplastic causes for enucleation included glaucoma (67/523 [12.8%]), phthisis bulbi (61/523 [11.7%]), and recent trauma (59/523 [11.3%]). Sixty-seven specimens (10.4%) had been eviscerated. Fifty-six specimens (8.7%) were obtained by exenteration performed to manage malignant tumors originating in or invading the orbit. Between 1990 and 2000, the percentage of procedures performed to remove neoplasms decreased from 65% to 38%, procedures performed to treat glaucoma increased from 4% to 29%, and those to treat phthisis bulbi increased from 8% to 13%. The numbers of procedures remained relatively constant for trauma and for infectious and inflammatory diseases.
    American Journal of Clinical Pathology 05/2003; 119(4):594-601. DOI:10.1309/MLRM-QWAF-V6A1-15UA · 3.01 Impact Factor
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    ABSTRACT: To determine whether long-term improvement could be observed after orbital radiotherapy for Graves' disease; in addition, to evaluate ancillary treatments needed for those who have received radiotherapy, to search for late-emerging adverse consequences of radiotherapy, and to relate orbital changes to serum levels of thyroid-stimulating immunoglobulin (TSI). Three-year follow-up of noncomparative interventional case series. Forty-two patients. All patients had received orbital radiotherapy within 6 months of study entry. Twelve months after study entry, patients were free to select any additional treatment for their ophthalmopathy. Need for surgery, steroid therapy, volume of extraocular muscles and fat, proptosis, area of diplopia fields and range of extraocular muscle motion, volume changes after decompression and correlations of eye findings with serum TSI levels, retinal status. Half of the patients elected to have a surgical procedure on their eyes or orbits. Among patients who were not decompressed, we found only slight improvement in some of the main outcome measures. TSI did not positively correlate with baseline status or with any observed change in major outcome measures. After orbital decompression, the volumes of both muscle and fat increase, but bony orbital volume increases more and proptosis diminishes. Retinal microvascular abnormalities consistent with radiation retinopathy developed de novo in five eyes of three patients within 3 years of radiation therapy. In this 3-year uncontrolled follow-up phase, limited evidence for a clinically significant improvement was observed, which may be the result of treatment or of natural remission. In either case, the changes are of little clinical significance. Because it is neither effective nor innocuous, radiotherapy does not seem to be indicated for treatment of mild to moderate ophthalmopathy.
    Ophthalmology 12/2002; 109(11):2100-7. DOI:10.1016/S0161-6420(02)01293-9 · 6.17 Impact Factor
  • Helmut Buettner
    Archives of Ophthalmology 12/2002; 120(11):1598-9. DOI:10.1001/archopht.120.11.1598 · 4.49 Impact Factor

Publication Stats

157 Citations
60.33 Total Impact Points

Institutions

  • 2002–2007
    • Mayo Clinic - Rochester
      • Department of Ophthalmology
      Rochester, MN, United States
    • Mayo Foundation for Medical Education and Research
      • Department of Ophthalmology
      Jacksonville, FL, United States