M H Foerster

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (316)521.17 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Treatment modalities in iris melanoma include excision, plaque radiotherapy, photon or proton beam therapy and enucleation. In extensive tumours and diffuse seeding, radiotherapy remains as an alternative to enucleation. This study is a retrospective, consecutive, interventional, single-institutional case series. 54 patients with a diffuse and non-resectable iris melanoma diagnosed from September 1998 to June 2012 were included. A 68-megaelectron volt proton beam was used to treat the anterior segment with a total dose of 4×12.5 cobalt grey equivalent. The cases were evaluated for local tumour control, eye retention, functional outcome and local complications after treatment. During a mean follow-up of 62.7 months (median 54.8 months, range 5.5-159.6 months), local tumour control was achieved in 96.3% of the patients. Cataract and glaucoma were the main complications developing after irradiation in 42.6% and 55.6%, respectively. In 34 of 44 patients (77.3%) who underwent cataract removal, a visual acuity of 20/40 or better following surgery was preserved. Enucleation was performed in three patients. The reason was suspected tumour recurrence in one and glaucoma in two. Hepatic metastasis occurred in one patient. As an alternative to enucleation, whole anterior segment fractionated proton beam radiotherapy offered excellent local tumour control in diffuse iris melanoma. Given the limited alternatives, the rate of complications appears acceptable and visual function could be preserved in the majority of the patients during follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
  • Canadian Journal of Ophthalmology 10/2014; 49(5):e123–e127. DOI:10.1016/j.jcjo.2014.07.009 · 1.30 Impact Factor
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    ABSTRACT: To analyze the functional outcome with regard to the development of visual acuity and radiation induced optic neuropathy of patients with parapapillary choroidal melanoma treated with proton beam therapy. Clinical case series, retrospective study METHODS: We evaluated 147 consecutive patients with parapapillary choroidal melanoma who received proton beam therapy as primary tumor treatment at the Helmholtz Center in Berlin from 1998 to 2005. A cumulative dose of 60 Cobalt Gray Equivalents (CGE) was delivered to the tumor and the optic disc received a minimum of 50 CGEs. Kaplan-Meier analysis was used to assess ocular outcome and survival rates. For trend analysis of functional development, Wilcoxon-Mann-Whitney-U test was used to compare the medians of two groups and Kruskal-Wallis test was used in the case of more than two groups. The mean follow-up time was 6.5 years (range 0.3-11.7 years). The most common side-effects were radiation-induced optic neuropathy, retinopathy, and cataract. The median visual acuity before and within the first year after therapy was 0.4 logMAR (20/50), lapsing to 1.3 logMAR (20/400) after three years and 1.4 logMAR (20/500) after five years. During follow-up, no light perception developed in 17 cases (11.6%), mostly attributed to radiation-induced retinopathy, optic neuropathy and secondary glaucoma. Enucleation was carried out in 14 patients (9.5%) due to local recurrence or severe side-effects. Radiation-induced optic neuropathy is an expected issue after proton beam therapy of parapapillary choroidal melanoma, and visual impairment is common during long-term follow-up, but some useful vision can be preserved in a considerable number of patients.
    American Journal of Ophthalmology 02/2014; 157(6). DOI:10.1016/j.ajo.2014.02.032 · 4.02 Impact Factor
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    ABSTRACT: Purpose: To delineate and discuss a not yet described possible ocular complication of selective intra-arterial chemotherapy (SIAC) for treatment of retinoblastoma. Methods: A 23-month-old girl with a large unilateral retinoblastoma was treated with repeated SIAC using 5 mg melphalan between July 2010 and January 2012. Clinical course of tumor and further ocular changes after therapy and histopathologic findings are described. Results: In total, 5 SIAC were performed over a time period of 18 months. After the last SIAC, diffuse dense cataract prevented further funduscopy. In addition, anterior chamber seeding was obvious, leading to the decision to enucleate the eye. Histopathologically, nearly complete regression of the main tumor mass with prominent calcifications, but vital tumor seeding in the vitreous, on the lens surface, on the ciliary body, and in the anterior chamber, was observed. Peculiar vacuolation of the lens epithelial cells, liquefaction of the subepithelial lens fibers, and diffuse small vacuoles within the lens were striking. Conclusions: Repeated SIAC with melphalan may induce cataract formation, possibly as a toxic effect of the chemotherapeutic to the lens, maybe combined with radiation exposure during fluoroscopy. This ocular complication should be taken into consideration as a limitation of the number of feasible repeated treatments.
    European journal of ophthalmology 11/2013; 24(3). DOI:10.5301/ejo.5000393 · 1.06 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 10/2013; 229(S 01). DOI:10.1055/s-0033-1357804 · 0.67 Impact Factor
  • Der Ophthalmologe 10/2013; 110(10). DOI:10.1007/s00347-013-2845-7 · 0.72 Impact Factor
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    ABSTRACT: Background: Since 1982, the indirect binocular ophthalmoscope designed by Foerster has been in use in ophthalmology. The option to implement a new illumination technique using a light-emitting diode (LED) and a new power source should be evaluated in terms of technical feasibility and patient safety.Methods: The cooling element was redesigned to accommodate the new LED electronics and their components, including an option for a variable brightness control. A more compact rechargeable battery was utilized with variable fixation at the headband or elsewhere. Photometric measurements of light intensity and the operating time were planned. Furthermore, a review of the new lighting technology in terms of EN ISO 15004-2 and EN ISO 10943 was necessary.Results: Technical adjustments to accommodate the LED inside the cooling element could be realised. The power source was a modern rechargeable lithium-ion battery with variable fixation. The luminous intensity of the LED is superior to that of the halogen lamp and the operating time was increased to 520 minutes. The required limits according to DIN EN ISO 15004-2 for ophthalmic devices were met by our measurements.Conclusion: The optimisation of the indirect binocular ophthalmoscope brings improvements in illumination intensity and operating time. A conversion for models already in use is possible. A certified appraisal for compliance with the appropriate standards is the next step.
    Klinische Monatsblätter für Augenheilkunde 07/2013; 230(8). DOI:10.1055/s-0032-1328772 · 0.70 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 09/2012; 229(S 01). DOI:10.1055/s-0032-1327149 · 0.67 Impact Factor
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    ABSTRACT: External beam proton radiation therapy has been used since 1975 to treat choroidal melanoma. For tumor location determination during proton radiation treatment, surgical tantalum clips are registered with image data. This report introduces the intraoperative application of an opto-electronic navigation system to determine with high precision the position of the tantalum markers and their spatial relationship to the tumor and anatomical landmarks. The application of the technique in the first 4 patients is described. A navigated reference base was attached noninvasively to the eye, and a navigated pointer device was used to record the spatial position of the tantalum markers, the tumor, and anatomical landmarks. Measurement accuracy was assessed on ex vivo porcine eye specimen by repetitive recording of the tantalum marker positions. The method was applied intraoperatively on 4 patients undergoing routine tantalum clip surgery. The spatial position information delivered by the navigation system was compared to the geometric data generated by the EYEPLAN software. In the ex vivo experiments, the maximum repetition error was 0.34 mm. For the intraoperative application, the root mean square error of paired-points matching of the marker positions from the navigation system and from the EYEPLAN software was 0.701-1.25 mm. Navigation systems are a feasible tool for accurate localization of tantalum markers and anatomic landmarks. They can provide additional geometric information, and therefore have the potential to increase the reliability and accuracy of external beam proton radiation therapy for choroidal melanoma.
    International Journal of Radiation OncologyBiologyPhysics 03/2012; 82(4):1361–1366. DOI:10.1016/j.ijrobp.2011.04.049 · 4.18 Impact Factor
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    ABSTRACT: Hypoxia and its down-stream activated pathways are commonly involved in tumor progression. Genes involved in angiogenesis and glycolysis, i.e. vascular endothelial growth factor (VEGF) and lactase dehydrogenase A (LDHA), respectively, are transcriptionally controlled by the hypoxia inducible factors 1α and 2α (HIF1α and HIF2α). A series of 60 uveal melanomas were immunohistochemically assessed for the expression of VEGF and the phosphorylated/activated form of VEGF receptor 2 (pVEGFR2/KDR), after binding to VEGF. The expression of HIF1α, HIF2α and LDH5 was also investigated. Uveal melanomas overexpressing HIF2α (but not that of HIF1α) were significantly associated with high VEGF (P = 0.005), pVEGFR2/KDR (P < 0.0001) and LDH5 (P ≤ 0.0001). High LDH5 was linked with tumor necrosis (P = 0.01) and increased tumor size (P = 0.03). High VEGF was linked with phosphorylated pVEGFR2/KDR receptors. In univariate analysis high pVEGFR2/KDR receptor expression was significantly related with poor prognosis (P = 0.02). It is concluded that HIF2α plays an important role in the progression of uveal melanomas possibly by promoting the autocrine loop VEGF-pVEGFR2/KDR, and by enhancing the expression of LDHA gene, conferring thus a growth advantage. As pVEGFR2/KDR expression was significantly related with poor prognosis, inhibitors of this receptor may improve the clinical outcome of patients with pVEGFR2/KDR overexpressing uveal melanomas.
    Clinical and Experimental Metastasis 01/2012; 29(1):11-7. DOI:10.1007/s10585-011-9424-6 · 3.46 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 12/2011; 228(S 02). DOI:10.1055/s-0031-1297338 · 0.67 Impact Factor
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    ABSTRACT: Uveal melanoma primarily metastasizes hematogenously with metastases often confined to the liver. The aim of this study was to investigate the presence of circulating tumor cells (CTC) in patients with metastatic disease as a marker for systemic disease and to determine their prognostic relevance. Blood samples from 68 patients were collected at the time of initial treatment of metastases. mRNA expression of tyrosinase and MelanA/MART1 as a surrogate marker for the presence of CTC was analyzed by real-time RT-PCR and compared with patient characteristics. CTC were detected in 63% of all patients and in 67% of the 48 patients with only liver metastases. Univariate and multivariate analyses revealed PCR results and serum lactate dehydrogenase as independent prognostic factors for progression-free (hazard ratios 2.2/3.5) and overall survival (hazard ratios 4.0/6.5). Combination of PCR and lactate dehydrogenase divided the patient cohort into 3 groups with distinct prognosis. CTC as evidence for systemic disease can be found in the majority of patients with metastatic uveal melanoma, including patients with visible disease confined to the liver. Detection of CTC-specific mRNA transcripts for tyrosinase and MelanA/MART1 by PCR is a poor prognostic factor for progression-free and overall survival. Characterization of CTC could improve the understanding of their biology.
    Oncology 05/2011; 80(1-2):57-62. DOI:10.1159/000328283 · 2.17 Impact Factor
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    ABSTRACT: Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.
    Mycoses 05/2011; 54(6):e704-11. DOI:10.1111/j.1439-0507.2010.02004.x · 1.81 Impact Factor
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    ABSTRACT: Autophagy is a self-degradation mechanism by which cells recycle their own cytoplasmic constituents. It has been claimed that, under certain conditions, such a process may be associated with tumor progression. In this study, the autophagic activity was investigated in a series of 99 uveal melanomas after immunohistochemical staining for the autophagy-associated proteins MAP1LC3A and BECN1, most commonly known as LC3A and Beclin 1, respectively. These were assessed in parallel with the hypoxia-inducible factor 1α (HIF1A) and its downstream protein lactate dehydrogenase 5 (composed by five LDHA subunits). Increased autophagic reactivity, detected by MAP1LC3A or BECN1, was associated with intense pigmentation and tumor hypoxia. Uveal melanomas with extensive overexpression of BECN1 or those with underexpression of this protein were associated with the worst prognosis, but the former manifested metastases much earlier than the latter; only 58% of patients with extensive BECN1 overexpression were alive at 4 years, compared with 80% of patients with underexpressed patterns. It is concluded that autophagy is commonly upregulated in uveal melanomas, and may be associated with hypoxia and intense pigmentation. There is a strong association between extensive BECN1 overexpression and early metastases/poor prognosis, and between underexpression of this protein and late metastases/better prognosis.Keywords: autophagy; BECN1; HIF1A; hypoxia; LDHA; MAP1LC3A; uveal melanoma
    Modern Pathology 04/2011; 24(8):1036-1045. DOI:10.1038/modpathol.2011.63 · 6.36 Impact Factor
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    ABSTRACT: The black iris-lens diaphragm (ILD) can be used in the treatment of traumatic aniridia and aphakia. The aim of our study was to show postoperative functional and anatomic results and complications in a small case series. We retrospectively analyzed the files of 16 patients managed with a black ILD or a sole iris diaphragm in the period 1994-2007. Four of them were female and 12 were male. The mean age of the group was 50±17 years. At the time of the implantation, all of the eyes had already undergone primary surgical repair. The preoperative best-corrected visual acuity in half of the patients was =0.1 and remained stable after the first postoperative year. During the follow-up years, one eye developed a subluxation of the implant and one eye an anterior chamber hemorrhage. At the same time, out of 8 eyes carrying a silicone tamponade in the vitreous cavity, silicone oil entered the anterior chamber in 3 cases. In one case, enucleation was undertaken due to phthisis. In the case of severely traumatized eyes with aniridia and aphakia, the implantation of a black ILD can have a positive effect on functional and anatomic stabilization.
    European journal of ophthalmology 03/2011; 21(6):754-9. DOI:10.5301/EJO.2011.6484 · 1.06 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 12/2010; 227(S 03). DOI:10.1055/s-0030-1270031 · 0.67 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 12/2010; 227(S 03). DOI:10.1055/s-0030-1270027 · 0.67 Impact Factor
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    ABSTRACT: The liver is the predominant site of metastases in the majority of patients with uveal melanoma, suggesting the evaluation of regional treatment approaches. Here we report our experience with transarterial chemoembolization (TACE) in uveal melanoma patients with pretreated liver metastases. Twenty-five patients were treated with fotemustine-based or cisplatin-based TACE after treatment failure of systemic therapy between 2003 and 2008 at our institution. Grade III toxicity consisted of gastric ulcer (n=1), fever (n=3), splenic infarction (n=1), and thrombocytopenia (n=1). No grade IV toxicity or catheter-associated complications were observed. Fourteen of 25 patients (56%) had stable disease for at least 2 months and four had partial remission. The median progression-free survival (PFS) was 3 months (95% confidence interval: 2-4 months) and the median overall survival (OS) was 6 months (95% confidence interval: 5-7 months), with 15% of patients alive at 1 year. Both PFS and OS were significantly longer, when pretreatment lactate dehydrogenase was below the two-fold upper limit of normal (n=11): PFS 5 versus 2 months (P<0.001) and OS 11 versus 5 months (P=0.012). All patients with lactate dehydrogenase less than 2xupper limit of normal had a clinically detectable benefit. TACE is well tolerated and effective in pretreated patients with liver metastases from uveal melanoma. TACE should further be evaluated as first-line therapy in prospective randomized clinical trials.
    Melanoma research 03/2010; 20(3):191-6. DOI:10.1097/CMR.0b013e328334c36e · 2.06 Impact Factor
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    ABSTRACT: Die Protonenstrahlentherapie ist eine Hochpräzisionsbestrahlung, die für umschriebene Tumoren geeignet ist, die sich in der Nähe von kritischen Strukturen befinden und von der Bestrahlung geschont werden müssen. Aderhautmelanome des hinteren Augenpols erfüllen durch ihre Nähe zu Makula und Sehnerv diese Kriterien. Durch den sehr steilen distalen und lateralen Dosisabfall des Protonenstrahls, können diese Strukturen optimal aus dem Bestrahlungsfeld herausgehalten werden, so dass optimale funktionelle Ergebnisse erzielt werden können. Zudem fand sich bei den 336 Patienten eine lokale Tumorkontrollrate von 97,3% und ein Augenerhalt von 94,5% in 3 Jahren. Die Strahlenretinopathie und die strahleninduzierte Opticusneuropathie betrugen 53% respektive 54% nach 3 Jahren. Der mittlere Visus fiel von ursprünglich 0,5 auf 0,27 ab. Zusammenfassend bietet die Strahlentherapie mit Protonen bei Aderhautmelanomen des hinteren Augenabschnittes hervorragende lokale Tumorkontrollraten und funktionelle Ergebnisse, so dass der etwas erhöhte medizinische Aufwand allenfalls gerechtfertigt ist. Proton beam irradiation is a high precision irradiation that is suitable for tumours situated at the vicinity of critical structures which need to be preserved. Choroidal melanomas lying close to the optic nerve and macula fulfil these criteria. These structures can be optimally spared from the irradiation, due to the very steep distal and lateral dose fall-off, allowing for optimal functional results. The local tumour control rate was 97.3% and the eye preservation was 94.5% in 3 years in the 336 patients analyzed. Radiation retinopathy and radiation induced optic neuropathy was found in 53% and 54% respectively. Mean visual acuity dropped from 0.5 initially to 0.27 in the follow-up period. In conclusion proton beam irradiation in choroidal melanomas of the posterior pole is highly effective with excellent local tumour control rates, justifying the somewhat increased medical and financial expenditure for these patients. SchlüsselwörterProtonen-Aderhautmelanom-Bestrahlung KeywordsProton beam-Radiotherapy-Uveal melanoma
    Spektrum der Augenheilkunde 02/2010; 24(1):11-16. DOI:10.1007/s00717-010-0379-9 · 0.18 Impact Factor
  • Spektrum der Augenheilkunde 02/2010; 24(1):17-22. · 0.18 Impact Factor

Publication Stats

3k Citations
521.17 Total Impact Points


  • 2014
    • University of Tuebingen
      • Institute for Ophthalmic Research
      Tübingen, Baden-Württemberg, Germany
  • 2006–2014
    • DRK Kliniken Berlin
      Berlín, Berlin, Germany
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2004–2012
    • Charité Universitätsmedizin Berlin
      • • Department of Ophthalmology
      • • Department of Pediatrics, Division of Oncology and Hematology
      Berlín, Berlin, Germany
  • 2009
    • Medizinische Universität Innsbruck
      • Univ.-Klinik für Augenheilkunde und Optometrie
      Innsbruck, Tyrol, Austria
    • University of Innsbruck
      Innsbruck, Tyrol, Austria
    • Sankt Gertrauden-Krankenhaus
      Berlín, Berlin, Germany
    • Städtisches Klinikums Dessau
      Dessau, Saxony-Anhalt, Germany
  • 2008
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 2007
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      Liverpool, England, United Kingdom
  • 1992–2003
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlín, Berlin, Germany
  • 1986–2003
    • University Hospital Essen
      Essen, North Rhine-Westphalia, Germany
  • 1987–2002
    • University of Duisburg-Essen
      • Faculty of Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2001
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany
  • 1996
    • Jordan University of Science and Technology
      Arbēla, Irbid, Jordan
  • 1990
    • Universität zu Lübeck
      • Klinik für Augenheilkunde
      Lübeck, Schleswig-Holstein, Germany