K Schmid

Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Wien, Vienna, Austria

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Publications (12)35.22 Total impact

  • B. Neumaier-Ammerer · K. E. Schmid · S. Binder
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    ABSTRACT: BACKGROUND: To examine macular thickness changes after uncomplicated cataract surgery in healthy patients and patients with diabetes mellitus and/or arterial hypertension without ocular manifestation. SETTING: Department of Ophthalmology, Rudolf Foundation Clinic, Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Vienna, Austria. METHODS: Prospective study with uneventful cataract surgery. Patients were subdevided into two groups. In group one, we included 10 patients without any general internal disease, in group two 15 patients with diabetes and/or arterial hypertension without ocular pathologies. Patients were examined preoperatively, one day, 1, 4 and 12 weeks postoperatively. At each visit a complete ophthalmic evaluation, best corrected Snellen visual acuity and optical coherence tomography of the macula were performed. RESULTS: Twenty-five eyes of 25 patients were recruited. The mean age was 70 ± 10 years. The average preoperative foveal thickness in both groups was 164 µm ± 12. The foveal thickness four weeks after surgery was 167 ± 14 (p = 0.64) in group 1 and 173 µm ± 14 (p = 0.08) in group 2. One eye in each group had decreased visual results 1 week postoperatively with subclinical thickening of the central macula in OCT measurement. CONCLUSION: We found no significant increase of foveal thickness after uneventful cataract surgery in both groups and there was no significant difference between these groups. However the percentage of eyes with foveal thickening was higher in group 2 than in group 1 (60% to 20% after 4 weeks and 47% to 30% 12 weeks after surgery).
    Spektrum der Augenheilkunde 10/2008; 22(5):301-304. DOI:10.1007/s00717-008-0281-x · 0.18 Impact Factor
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    ABSTRACT: Glycosylated haemoglobin (HbA1c) correlates with the amount of hyperglycemia in diabetic patients. High HbA1c levels often predict clinically significant macular edema (CSME), which then needs to be treated with grid laser photocoagulation. The question asked in this study was whether there is a correlation between the effect grid laser photocoagulation in diffuse diabetic macular edema and HbA1c, using an optical coherence tomography (OCT) for the evaluation of the retinal thickness. A prospective, non-comparative case series was performed to find a correlation between the effect of grid laser photocoagulation in diffuse diabetic macular edema and HbA1c. Thirty eyes with CSME of diabetic patients were included in the study. Complete ophthalmic examinations and OCT were performed at baseline, 1 month, 3, and 6 months after grid laser photocoagulation therapy. HbA1c was measured at the end of study. Significance level was set at P<0.05. A significant difference in the foveal (P=0.02) and superior (P=0.021) retinal thickness 6 months after laser therapy, no correlation between HbA1c and retinal thickness after photocoagulation, and an insignificant decrease in visual acuity (P=0.9) were found. The correlation between foveal retinal thickness and visual acuity was P=0.24 6 months after treatment. There was no significant correlation between HbA1c and the effect of grid laser photocoagulation therapy in diffuse diabetic macular edema. The retinal thickness decreased significantly in the foveal and superior area 6 months after therapy. No correlation between the foveal retinal thickness and the visual acuity was found. The visual acuity did not increase after treatment. There are many factors influencing the retinal thickness, such as the blood pressure and the attached posterior hyaloid.
    Albrecht von Graæes Archiv für Ophthalmologie 12/2006; 244(11):1446-52. DOI:10.1007/s00417-006-0322-6 · 2.33 Impact Factor
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    ABSTRACT: The constantly growing list of cytotoxic chemotherapeutics requires a new survey of ophthalmic complications, which are often underestimated. Based on the review by Imperia et al (1989), an update on ophthalmic complications of currently used cytotoxic chemotherapeutics in oncology was written. Vision is a quality of life issue, which must be nurtured, especially if loss of vision can be prevented. The broad spectrum of ophthalmic complications induced by cytotoxic chemotherapy includes reversible and irreversible acute and chronic disorders. Mild to moderate ophthalmic complications are very common and reversible after cessation of anti-cancer therapy. Some major ocular toxicities may require a dose reduction or the discontinuation of cytotoxic chemotherapy in order to prevent visual loss. Ocular toxicities can be treated or even prevented, if detected early enough. That is why an ophthalmic baseline examination for patients receiving cytosine arabinoside, 5-fluorourocil, methotrexate, or docetaxel should be taken into consideration, and a consultation with an ophthalmologist has to be done as soon as symptoms are recognized. Oncologists and ophthalmologists must be aware of potential ophthalmic complications during cytotoxic chemotherapy, and should work together.
    Survey of Ophthalmology 01/2006; 51(1):19-40. DOI:10.1016/j.survophthal.2005.11.001 · 3.51 Impact Factor
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    ABSTRACT: To evaluate the results of a retreatment modality of photodynamic therapy (PDT) based on optical coherence tomography (OCT) and fluorescein angiography (FA). To quantify the effect of PDT with the help of measurement of the retinal thickness. Eyes with predominantly classic subfoveal choroidal neovascularisation (CNV) due to age related macular degeneration were included. PDT was performed every three months, when needed. OCT, FA, and measures of distance acuity were performed at baseline, after 6 weeks, 3 months, and from then on every 3 months. A control group of a consecutive series of eyes that had been retreated based only on FA results was installed. Forty eyes of 38 patients were included. The average age was 73 years. The maximum retinal thickness decreased from 404 mum at baseline to 281.6 mum at month 12. Furthermore there was a significant decrease of retinal thickness in both subgroups. The number of retreatments was reduced, when activity was diagnosed using OCT and FA. (2.4 v 4.0). The distance acuity correlated significantly with the maximum retinal thickness (p=0.0042). Information about the activity of a neovascular lesion can be obtained with the help of OCT. The retreatment modalities can be optimised by using OCT and FA and the number of retreatments can be reduced.
    British Journal of Ophthalmology 10/2005; 89(9):1184-7. DOI:10.1136/bjo.2005.067389 · 2.81 Impact Factor
  • K. E. Schmid · S. Binder
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    ABSTRACT: ProblemstellungDie ständig wachsende Liste an Chemotherapeutika veranlasste uns eine aktuelle Übersichtsarbeit, welche die Nebenwirkungen im Augenbereich darstellt, zu verfassen. Da das Sehvermögen eine Lebensqualität ist, die im Rahmen von Voruntersuchungen und eventuellen regelmäßigen Kontrollen erhalten werden kann, ist es für den Onkologen als auch für den Ophthalmologen wichtig, dass beide über die Augennebenwirkungen der geläufigen Chemotherapeutika Bescheid wissen. Eine Früherkennung und rechtzeitige Behandlung der Nebenwirkungen im Augenbereich kann oftmals den Sehverlust oder bleibende Folgeschäden verhindern. Methoden und/oder PatientenEs wurde eine Übersichtsarbeit verfasst, die alle Augennebenwirkungen der heute verwendeten Chemotherapeutika zusammenfasst. Die Literatursuche wurde im MEDLINE durchgeführt und die Übersichtsarbeit beinhaltet alle beschriebenen Augennebenwirkungen von 1966 bis August 2003. Die Chemotherapeutika wurden nach ihren verschiedenen Wirkungsmechanismen in folgende Gruppen eingeteilt: Alkylantien, Antimetabolite, Mitose Inhibitoren, Antibiotika und hormonelle Antagonisten. Bei jeder Substanz wird kurz die Verwendung und der Wirkmechanismus beschrieben, bevor auf die Augennebenwirkungen eingegangen wird. ErgebnisseGeringgradige Nebenwirkungen im Augenbereich kommen häufig bei niedrig dosierten Chemotherapien vor. Diese sind aber meist reversibel und verschwinden auch schnell wieder nach Beendigung der Therapie. Hochdosierte Chemotherapien, starke Kombinationstherapien und intraarterielle Verabreichung mancher Substanzen kann hingegen irreversible Schäden zur Folge haben. Bei der rechtzeitigen Erkennung solcher Nebenwirkungen muss eine Dosisreduzierung oder sogar Therapieunterbrechung in Betracht gezogen werden, um den Sehverlust zu verhindern. SchlussfolgerungenOnkologen und Ophthalmologen sollten sich über die Augennebenwirkungen von Chemotherapien bewusst sein. Durch eine ophthalmologische Voruntersuchung, vor Beginn der Chemotherapie, können gefährdete Patienten ermittelt und zu Kontrolluntersuchungen wiederbestellt werden. Bei manchen Chemotherapieschemen sind laufende Kontrolluntersuchungen ohnehin zu empfehlen. Bei Auftreten von gravierenden Augennebenwirkungen soll auf jeden Fall an eine Dosisreduzierung, oder sogar an eine Therapieunterbrechung gedacht werden, da es bei der Tumorbekämpfung auch zum Sehverlust kommen kann. BackgroundThe constantly growing list of cytotoxic chemotherapeutics affords a new survey of ophthalmic complications, which are often underestimated. Vision is a quality of life, which needs to be taken care of, especially if loss of vision can be prevented. The broad spectrum of ophthalmic complications, induced by cytotoxic chemotherapy, includes reversible and irreversible, acute and chronic disorders. MethodsA review of the literature reporting ophthalmic complications of currently used cytotoxic chemotherapeutics in oncology was conducted. Literature was searched in Medline from 1995 until August 2003. Further literature was then found in the references of the pre-selected literature. ResultsOphthalmic complications of low-grade, induced by cytotoxic chemotherapy, are very common and reversible after cessation of anticancer therapy. Some major ocular toxicities may even afford a dose reduction or discontinuation of cytotoxic chemotherapy, in order to impede loss of vision. ConclusionOncologists and ophthalmologists must be aware of potential ophthalmic complications during cytotoxic chemotherapy. Ocular toxicities can be treated or even prevented, if detected on time, which is why immediate consultation of an ophthalmologist seems to be necessary, as soon as symptoms are recognized. An ophthalmic baseline examination, prior to anticancer treatment, may also lead to a reduction of ocular side effects.
    Spektrum der Augenheilkunde 08/2005; 19(4):210-220. DOI:10.1007/BF03163400 · 0.18 Impact Factor
  • K. E. Schmid · S. Binder
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    ABSTRACT: Treatment with oxaliplatin plus raltitrexed has demonstrated an encouraging therapeutic index in patients with advanced colorectal cancer and malignant pleural mesothelioma. The aim of this multi-institutional study was to determine the antitumor potential of this combination in patients with metastatic gastric cancer failing prior palliative first-line chemotherapy, and to reconfirm its favorable toxicity profile. 21 patients with metastatic gastric cancer, who progressed while on or within 6 months after discontinuing palliative first-line chemotherapy, participated in this study. They received raltitrexed 3,0 mg/m(2) and oxaliplatin 130 mg/m(2) both given intravenously on day 1 every 3 weeks. One patient achieved a partial response, 6 had stable disease, and 14 patients progressed. Median progression-free and overall survival from the onset of salvage chemotherapy was 2.0 and 4.5 months, respectively. Hematologic adverse reactions, specifically neutropenia and anemia were common, though generally mild to moderate with only 3 patients experiencing grade 3/4 toxicity. The most frequent non-hematologic adverse events included nausea/emesis, asthenia, and transient elevation of liver functional parameters, again with grade 3 symptoms occurring only in a minority of patients. Despite reproducibility of a favorable toxicity profile of oxaliplatin + raltitrexed, our data suggest that this combination regimen has no substantial antitumor activity in patients with progressive, chemotherapeutically pretreated metastatic gastric cancer.
    Onkologie 07/2003; 26(3):255-8. DOI:10.1159/000071621 · 0.84 Impact Factor
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    ABSTRACT: There is no established second-line treatment for advanced pancreatic cancer after gemcitabine failure. In view of the urgent need for such therapy, and since preclinical and phase I clinical data suggest an encouraging, potentially synergistic activity between raltitrexed and irinotecan, the present randomised phase II study was initiated. A total of 38 patients with metastatic pancreatic adenocarcinoma, who progressed while receiving or within 6 months after discontinuation of palliative first-line chemotherapy with gemcitabine, were enrolled in this study. They were randomised to 3-weekly courses of raltitrexed 3 mg x m(-2) on day 1 (arm A) or irinotecan 200 mg x m(-2) on day 1 plus raltitrexed 3 mg x m(-2) on day 2 (arm B). The primary study end point was objective response, secondary end points included progression-free survival (PFS) and overall survival (OS), as well as clinical benefit response in symptomatic patients (n=28). In the combination arm, the IRC-confirmed objective response rate was 16% (three out of 19 patients had a partial remission; 95% CI, 3-40%), which was clearly superior to that in the comparator/control arm with raltitrexed alone, in which no response was obtained. Therefore, the trial was already stopped at the first stage of accrual. Also, the secondary study end points, median PFS (2.5 vs 4.0 months), OS (4.3 vs 6.5 months), and clinical benefit response (8 vs 29%) were superior in the combination arm. The objective and subjective benefits of raltitrexed+irinotecan were not negated by severe, clinically relevant treatment-related toxicities: gastrointestinal symptoms (42 vs 68%), partial alopecia (0 vs 42%), and cholinergic syndrome (0 vs 21%) were more commonly noted in arm B; however, grade 3 adverse events occurred in only three patients in both treatment groups. Our data indicate that combined raltitrexed+irinotecan seems to be an effective salvage regimen in patients with gemcitabine-pretreated pancreatic cancer. The superior response activity, PFS and OS (when compared to raltitrexed), as well as its tolerability and ease of administration suggest that future trials with this combination are warranted.
    British Journal of Cancer 05/2003; 88(8):1180-4. DOI:10.1038/sj.bjc.6600883 · 4.82 Impact Factor
  • C Gedlicka · G V Kornek · K Schmid · W Scheithauer
    Annals of Oncology 03/2003; 14(2):339-40. DOI:10.1093/annoc/mdg051 · 6.58 Impact Factor
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    ABSTRACT: Gemcitabine is an active antitumor agent in the treatment of advanced pancreatic cancer, and has shown potential synergistic activity with the oral fluoropyrimidine capecitabine in previous phase I/II trials. Based on this background and in order to define the therapeutic potential and tolerance of this combination more precisely, the present randomized multicenter phase II trial was initiated. We prospectively randomized 83 patients to treatment with biweekly gemcitabine 2,200 mg/m(2) given as a 30 min intravenous infusion on day 1, or the same treatment plus oral capecitabine 2,500 mg/m(2) given from days 1 to 7. In both arms, chemotherapy was administered for a duration of 6 months unless there was prior evidence of progressive disease. The efficacy of the two treatment arms was evaluated according to standard criteria, i.e. objective response, progression-free survival (PFS) and overall survival (OS), as well as by analysis of clinical benefit response. The overall objective response rate among the 42 patients treated with gemcitabine alone was 14% compared with 7/41 (17%) among those treated with the combination arm. Similar to response rates, there was no apparent difference between the two groups in terms of median PFS (4.0 versus 5.1 months) and median OS (8.2 versus 9.5 months) in the gemcitabine and combination arm, respectively. Of 61 patients with tumor-related symptoms, who were considered evaluable for clinical benefit response, 10/30 (33%) and 15/31 (48.4%) experienced significant palliation in the gemcitabine and combination arm, respectively. Chemotherapy was well tolerated in both arms with only four versus six patients experiencing WHO grade 3 symptoms. Apart from the occurrence of hand-foot syndrome in 10 patients, no major increase in incidence and/or degree of adverse reactions was noted in the combination arm. Results of this trial suggest a fairly good therapeutic index for the combination of biweekly high-dose gemcitabine and capecitabine for the treatment of advanced pancreatic cancer. Despite a somewhat superior clinical benefit response rate, no advantage over single-agent gemcitabine, however, was noted in terms of objective efficacy parameters.
    Annals of Oncology 02/2003; 14(1):97-104. DOI:10.1093/annonc/mdg029 · 6.58 Impact Factor
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    ABSTRACT: The aim of this phase I study was to determine the maximum-tolerated dose (MTD) and the dose-limiting toxicities (DLTs) of an intermittent weekly capecitabine regimen in combination with oxaliplatin. Furthermore, we intended to explore its safety at the recommended dose, and to assess its principal antitumor activity in patients with advanced colorectal cancer. Thirty patients with measurable metastatic colorectal cancer who previously were unexposed to palliative chemotherapy were enrolled on to this disease-oriented phase I trial. They were treated with a fixed dose of oxaliplatin (85 mg/m(2) administered as a 2-h intravenous infusion on day 1) plus escalating doses of capecitabine (given at two divided daily doses from days 1 to 7), repeated every 2 weeks. The dose of oral fluoropyrimidine was escalated in consecutive cohorts of three to six patients from 2500 to 4000 mg/m(2)/day. After having defined the toxic dose, nine additional patients were entered at the MTD/recommended dose to confirm its safety profile, and assure suitability for future phase II/III studies. In the phase I part of the study, 21 patients were enrolled, and a total of 222 courses were administered through four dose levels of capecitabine combined with oxaliplatin 85 mg/m(2). Gastrointestinal toxicities, predominantly diarrhea, were the principal DLTs. Other severe adverse events included grade 3 asthenia, acute neurological symptoms and skin toxicity. The combination was not myelosuppressive, eliciting only sporadically grade 3/4 neutropenia and/or thrombocytopenia. There was no alopecia, and only a few patients experienced mild symptoms of hand-foot syndrome. Externally reviewed objective responses were noted in 15 of all 30 evaluable patients (overall response rate, 50%; 95% confidence interval 31% to 69%) including three complete remissions and median progression-free survival was 8.8 months (range 7-14+ months). Overall results of this study indicate that the administration of clinically relevant single-agent doses of both capecitabine and oxaliplatin is feasible and seems to result in promising therapeutic activity in patients with advanced colorectal cancer. On the basis of the toxicological profile of the combination regimen shown in the present study, oxaliplatin 85 mg/m(2) as a 2-h intravenous infusion every 2 weeks administered in combination with capecitabine 3500 mg/m(2)/day x7 in two divided doses is recommended for further evaluations.
    Annals of Oncology 11/2002; 13(10):1583-9. DOI:10.1093/annonc/dkf281 · 6.58 Impact Factor
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    ABSTRACT: Both oxaliplatin and irinotecan have demonstrated antitumor activity in pretreated colorectal cancer; experimental and early clinical data suggest that these two drugs may act synergistically. The aim of this study was to document the therapeutic index of a biweekly combination regimen in patients with metastatic colorectal cancer failing prior palliative first-line chemotherapy with raltitrexed. In this study 27 patients with metastatic colorectal cancer were analyzed, who progressed while on or within 6 months after discontinuation of palliative first-line chemotherapy with raltitrexed. They received oxaliplatin 85 mg/m(2) and irinotecan 150 mg/m(2) both given on days 1 and 15 every 4 weeks. The confirmed overall response rate was 37% (95% confidence interval, 19.4-57.7%), including 2 complete and 8 partial remissions. 12 additional patients (44.4%) had stable disease, and in only 5 cases (18.5%) disease progression was not influenced by chemotherapy. The median progression-free survival for all 27 patients was 8 months (range, 1-16+ months), and 16 patients (59%) are still alive after a median follow-up time of 12.5 months. Hematologic adverse reactions, specifically leukocytopenia and neutropenia, were common though generally mild to moderate with grade 4 toxicity occurring in only 2 cases. The most frequent non-hematologic adverse events included gastrointestinal symptoms; severe nausea/emesis and diarrhea, however, were noted in only 2 and 3 patients, respectively. Our data suggest that the described biweekly combination regimen of oxaliplatin and irinotecan has substantial antitumor activity in patients with progressive, raltitrexed-pretreated metastatic colorectal cancer. Because of its favorable toxicity profile, further evaluation of this combination seems warranted.
    Onkologie 09/2002; 25(4):358-62. DOI:10.1159/000066054 · 0.84 Impact Factor

Publication Stats

331 Citations
35.22 Total Impact Points

Institutions

  • 2005–2008
    • Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery
      Wien, Vienna, Austria
  • 2003
    • Municipal Hospital Neunkirchen
      Neunkirchen, Saarland, Germany
    • University of Vienna
      Wien, Vienna, Austria
  • 2002–2003
    • Medizinische Universität Wien
      • • Klinische Abteilung für Onkologie
      • • Institut für Sozialmedizin
      Vienna, Vienna, Austria