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S Grob,
J Luo,
G Hughes,
C Lee,
X Zhou,
J Lee,
H Du,
H Ferreyra, W R Freeman,
I Kozak,
K Zhang
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ABSTRACT: To investigate clinical presentation and genotypes in patients with simultaneous geographic atrophy (GA) and choroidal neovascularization (CNV) and to compare with patients with GA or CNV only.
Twenty patients with combined CNV-GA and 154 CNV only and 154 GA only were chosen based on clinical exam and imaging. Six single-nucleotide polymorphisms (SNPs)-rs2274700 and rs1061170 (complement factor H), rs10490924 and rs11200638 (HTRA1/LOC387715), rs2230199 (C3), rs9332739 (C2)-were genotyped using the SNaPshot method. Chi-squared tests were used for genetic analysis.
In patients with CNV-GA, GA progressed slowly and often preceded CNV. CNV presented as subretinal haemorrhage or fluid, with a sudden drop in visual acuity (VA). Comparing combined CNV-GA to GA and CNV only, patients with both had a higher frequency of at-risk alleles at both SNPs within the HTRA1 gene-rs10490924 (52.5%), rs11200638 (52.6%). Statistical significance was not achieved. CNV-GA patients had no protective alleles at SNP rs9332739 (C2), compared with GA (27%) and CNV only (10%).
There is a paucity of reports describing simultaneous CNV-GA. Clinical and genetic results may support the fact that GA and CNV fit on an age-related macular degeneration (AMD)-disease continuum and may clarify the disease processes in AMD.
Eye (London, England) 06/2012; 26(8):1106-13. · 1.97 Impact Factor
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ABSTRACT: •
Diagnostic vitreoretinal surgery should be considered when other noninvasive methods of diagnosis have failed to establish
a pathoetiologic mechanism.
•
The goals of ocular biopsy should be to acquire microbiological, cytologic, histologic, immunologic and genetic information,
with minimum surgical trauma, for modifying and directing medical and surgical treatments.
•
The development of a 25-gauge operating system introduces a new concept in vitreous, retinal and choroidal biopsy.
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Vitreous, retinal or choroidal biopsy are relatively safe procedures, and the results often change clinical management.
•
25-gauge procedures induce minimal ocular trauma, decrease the inflammatory response, and may allow faster overall patient
recovery.
11/2008: pages 147-156;
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ABSTRACT: To compare the non-decanted (standard) 4 mg versus the decanted 20 mg intravitreal triamcinolone acetonide (IVTA) injections and to assess their effect on intraocular pressure (IOP).
We retrospectively reviewed the records of 92 consecutive eyes, which received an intravitreal injection of either dose of triamcinolone acetonide, at a single retina centre. The change in IOP (elevation of at least 5 mm Hg from baseline or above 21 mm Hg) was analysed with a multivariate logistic analysis. The mean follow-up period in both groups was 27 weeks. A subgroup analysis comparing vitrectomised to non-vitrectomised eyes in both groups was also performed.
Of the 92 eyes, 46% (23 of 51) in the 4 mg group versus 30% (12 of 41) in the 20 mg group had an IOP >21 mm of Hg (p = 0.14) after a mean follow-up period of 27 weeks. The vitrectomised eyes (3 of 24) in the 20 mg group had a significantly lower rate of IVTA induced IOP elevation than the non-vitrectomised eyes (9 of 17) (p = 0.013). The IOP elevation occurred significantly earlier in the 4 mg group (vitrectomised eyes 27 (SD 43) days and non-vitrectomised eyes 61 (52) days) than in the 20 mg group (vitrectomised eyes 104 (56) days and non-vitrectomised eyes 119 (82) days), independent of the vitreous status (vitrectomised p = 0.05 and non-vitrectomised p = 0.04). The mean value of initial high IOP in the non-vitrectomised eyes was higher in the 4 mg group than in the corresponding 20 mg group (p = 0.048).
Decanted 20 mg IVTA may not pose a significantly greater risk of IOP elevation than the 4 mg non-decanted IVTA.
The British journal of ophthalmology 06/2008; 92(6):810-3. · 2.92 Impact Factor
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ABSTRACT: To compare two wavefront-sensing devices based on different principles.
Thirty-eight healthy eyes of 19 patients were measured five times in the reproducibility study. Twenty eyes of 10 patients were measured in the comparison study. The Tracey Visual Function Analyzer (VFA), based on the ray-tracing principle and the Nidek optical pathway difference (OPD)-Scan, based on the dynamic skiascopy principle were compared. Standard deviation (SD) of root mean square (RMS) errors was compared to verify the reproducibility. We evaluated RMS errors, Zernike terms and conventional refractive indexes (Sph, Cyl, Ax, and spherical equivalent).
In RMS errors reading, both devices showed similar ratios of SD to the mean measurement value (VFA: 57.5+/-11.7%, OPD-Scan: 53.9+/-10.9%). Comparison on the same eye showed that almost all terms were significantly greater using the VFA than using the OPD-Scan. However, certain high spatial frequency aberrations (tetrafoil, pentafoil, and hexafoil) were consistently measured near zero with the OPD-Scan.
Both devices showed similar level of reproducibility; however, there was considerable difference in the wavefront reading between machines when measuring the same eye. Differences in the number of sample points, centration, and measurement algorithms between the two instruments may explain our results.
Eye (London, England) 07/2007; 22(11):1384-90. · 1.97 Impact Factor
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ABSTRACT: To investigate the safety and effectiveness of extrafoveal photodynamic therapy (PDT) occlusion of feeder vessels (FVs) in patients with subfoveal choroidal neovascularisation (CNV) as a result of age related macular degeneration.
FVs were identified using dynamic fluorescein and indocyanine green angiography with scanning laser ophthalmoscope. The standard doses of verteporfin and laser wavelength were used. The light dose was escalated by increasing the duration of the light dose so the light regimen was 50 J/cm2 for patients 1 and 2; 100 J/cm2 for patients 3, 4, 5; 125 J/cm2 for patients 6 and 7; and 150 J/cm2 for patients 8 and 9. Patients were examined at weeks 1, 4, and 12.
The mean improvement on EDTRS chart 3 months after treatment was an increase of 2.1 lines (p = 0.07). Closure of the FV was achieved angiographically in three eyes at various light doses, in three eyes the FV was hypoperfused, and in three eyes the vessels were were neither closed nor hypoperfused. At the last follow up all FVs were reperfused. There was no evidence of retinal damage.
Verteporfin enhanced FV therapy does not cause subfoveal retinal damage and may have potential to improve central vision in subfoveal CNV caused by exudative macular degeneration. It is not recommended as a monotherapy for CNV.
British Journal of Ophthalmology 10/2006; 90(9):1152-6. · 2.90 Impact Factor
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ABSTRACT: To determine the duration of residence of triamcinolone in the vitrectomised eye.
23 eyes of 23 patients underwent intravitreal injection of high dose (20 mg) decanted triamcinolone acetonide (Kenalog) at the conclusion of vitrectomy surgery or in previously vitrectomised eyes with macular oedema from diabetes, uveitis, cataract surgery, or other surgery.
The median time to disappearance of triamcinolone in the vitrectomised eye was 113 days (95% confidence interval (CI) 85 to 191). In the phakic eyes the median time to disappearance was 191 days (95% CI 148 to 191). In the pseudophakic eyes the median time to disappearance was 102 days (95% CI 85 to 113). This difference was not significant (p = 0.12). There were no cases of endophthalmitis or severe inflammatory reaction. Five eyes (22%) experienced intraocular pressure rise >/=10 mm Hg.
High dose decanted intravitreal triamcinolone has a median residence time of 113 days in the vitrectomised eye. Although this appears to be shorter than in the non-vitrectomised eye, this study suggests that a sufficient duration of action will be present to be clinically useful.
British Journal of Ophthalmology 07/2006; 90(6):705-8. · 2.90 Impact Factor
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ABSTRACT: To investigate the subretinal toxicity profile of the ribozyme to the proliferating cell nuclear antigen (PCNA-Rz) and 5-fluorouracil (5-FU), as well as the highest nontoxic subretinal dose of the mixture of the two agents in rat eyes.
Brown-Norway rats received subretinal injections of 1 microg, 10 microg, and 100 microg/microl PCNA-Rz and 0.06 microg/microl, 0.3 microg/microl, and 1.5 microg/microl 5-FU in the right eyes, and the left eyes were injected with H-BSS as control. Each dose was tested on 5 eyes in a 5 microl volume. In a second study, a combination of 5-FU (1.5 microg/microL) with varying 10-30-50 microg/microl doses of PCNA-Rz was tested in a regimen of four sequential subretinal injections. Toxicity was monitored by biomicroscopy, indirect ophthalmoscopy, electroretinography (ERG), and histology.
The highest nontoxic dose for subretinal PCNA-Rz was 10 microg/microl, whereas 100 microg/microl showed disturbance of pigmentation with corresponding histological changes of retinal photoreceptor loss and retinal pigment epithelium proliferation or irregularities. Subretinal injection of all three doses of 5-FU did not show any toxicity. Serial injections of a mixture of 1.5 microg/microl 5-FU with 10 microg/microl of PCNA-Rz was found to be safe in rat eyes.
Subretinal injections of the combination of PCNA-Rz (10 microg/microl) and 5-FU (1.5 microg/microl) demonstrated to be safe in rat eyes during the course of this study, even with a multiple administration of four injections.
Current Eye Research 06/2006; 31(5):435-40. · 1.28 Impact Factor
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ABSTRACT: To determine the sensitivity and specificity of entoptic perimetry for diagnosing diabetic retinopathy at all levels of severity.
A prospective clinical study at the Shiley Eye Center, University of California, and San Diego. 30 patients with photographically documented diabetic retinopathy and 24 controls with a similar age distribution. Sensitivity and specificity of entoptic perimetry were computed for detecting clinically significant macular oedema within the central 120 degree radius of the fovea compared to fundus photographs.
Entoptic perimetry can detect clinically significant diabetic retinopathy with a sensitivity of 0.88 and specificity of 1.00. Entoptic perimetry can detect the earliest stages of diabetic retinopathy with a sensitivity of 0.86.
Scanning laser entoptic perimetry is an effective tool for detecting visual function loss caused by diabetic retinopathy.
British Journal of Ophthalmology 02/2006; 90(1):17-9. · 2.90 Impact Factor
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ABSTRACT: To improve visualisation of angiographic features in patients with age related macular degeneration associated with choroidal neovascularisation (CNV) and related complications. To evaluate if image averaging can achieve this goal.
27 eyes of 20 sequential patients with age related macular degeneration over a 3 month period were studied. Indocyanine green angiograms (ICGA), fluorescein angiograms (FA), and oral fluorescein angiograms were recorded with a confocal scanning laser ophthalmoscope. Software was used to average multiple images from a 10-20 image series (over 0.5-1.0 seconds). Image quality was assessed by two masked observers and graded on a scale of 0-3. A more quantifiable grading method was devised by adding a variable amount of Gaussian noise to the improved image until the original and image averaged image appeared equal.
Masked review showed mild to strong improvement of visualisation of structures including borders of CNV. Improvement varied depending on the type and phase of the angiogram. Improvement was highest in late phase FA, mid and late phase ICGA, and all phases of oral FA.
Image averaging using software based algorithms improves the quality of angiographic images, particularly late ICGA images and oral FAs. This method may assist in the visualisation of choroidal neovascularisation in age related macular degeneration.
British Journal of Ophthalmology 09/2005; 89(8):1026-30. · 2.90 Impact Factor
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ABSTRACT: We previously reported a long-lasting crystalline lipid pro-drug of cyclic cidofovir, hexadecyloxypropyl-cyclic-cidofovir (HDP-cCDV), to treat experimental retinitis in rabbit eyes. With HDP-cCDV there was a longer intraocular therapeutic effect than with cidofovir (CDV) and no toxicity with 100 microg/eye. It has been known that CDV and related analogues lower intraocular pressure (IOP) after local use, and it is also accepted that the guinea pig is a better model to study this toxicity before human clinical trials.
HDP-cCDV was intravitreally injected into 10 guinea pig eyes in doses of 4, 9, and 18 microg in 20 microL/eye. An 18-microg quantity is the dose equivalent to 100 microg/eye in the rabbit. Only one eye of each animal received drug and the fellow eye served as the control. After injection, the eyes were monitored with tonometry, ophthalmoscopy, electroretinography (ERG), and histology.
Intravitreal injections of doses of 18 microg/eye or lower revealed no toxicity and a high therapeutic index (132,000 to 3300 times higher than the 50% effective concentration for human cytomegalovirus) during 10 weeks of observation. The crystalline drug depot was ophthalmoscopically visible in the inferior vitreous cavity for 5-10 weeks. There was no difference in IOP between the drug-injected and control eyes at any time points (P > 0.05) except for day 3 after drug injection (P = 0.0338). All eyes demonstrated a normal ERG waveform with no differences between the treated and the fellow control eyes (P = 0.85). Histology revealed normal morphology and structures of the retina and ciliary body in all eyes (with or without treatment).
Crystalline HDP-cCDV may be a long-lasting and safer alternative to cidofovir to treat CMV retinitis without the retinal or ciliary body toxicity observed with CDV.
Journal of Ocular Pharmacology and Therapeutics 07/2005; 21(3):205-9. · 1.51 Impact Factor
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ABSTRACT: Healed cytomegalovirus (CMV) retinitis in the setting of highly active antiretroviral therapy (HAART) is complicated by inflammatory sequelae and vision loss.
To determine the long term visual outcome of AIDS patients with CMV retinitis who received HAART.
90 eyes of 63 consecutive AIDS patients with extramacular CMV retinitis were studied prospectively.
Immune recovery status was related to time to onset of epiretinal membrane (p=0.05) and cystoid macular oedema (p=0.06) as well as to the incidence of cataract (p=0.001) and moderate vision loss (p<0.0001). Severe vision loss was associated with retinal detachment (p<0.001).
AIDS patients with extramacular CMV retinitis lose vision while on HAART. HAART related immune recovery is associated with increased frequencies of epiretinal membrane, cystoid macular oedema, cataract, and retinal detachment with resultant vision loss in AIDS patients with healed CMV retinitis.
British Journal of Ophthalmology 07/2003; 87(7):853-5. · 2.90 Impact Factor
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ABSTRACT: To report on the intraindividual and interindividual variability of tumour size (height and base diameter) measurements using standardised echography in a masked prospective study.
20 consecutive eyes of 20 patients were examined on four different visits by three experienced examiners using standardised echography. As common in standardised echography, tumour height was evaluated with A-scan technique, while transverse and longitudinal base diameter were calculated with B-scan.
Tumour height measurements using A-scan were more accurate than base diameter measurements using B-scan. The standard deviation for tumour height over all visits/measurements was 0.18 mm (A-scan), 0.79 mm for transverse, and 0.69 mm for longitudinal base diameters (B-scan). The interclass correlation coefficient (ICC) was much higher for tumour height measurements with A-scan (0.7735 for three examiners on one visit) than for transverse (0.6563) or longitudinal (0.4522) base diameter measurements with B-scan techniques.
A-scan techniques for tumour height measurements provide very reproducible results with little intraindividual and interobserver variability. As B-scan techniques for tumour base evaluation are less accurate they should be used for topographic and morphological examinations.
British Journal of Ophthalmology 01/2003; 86(12):1390-4. · 2.90 Impact Factor
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ABSTRACT: The post-irradiation regression rate of uveal melanomas is a prognostically significant factor for the development of metastases. Other predictive factors for metastases are histological networks which are imagable with confocal ICG angiography. The purpose of this study was to evaluate a possible connection of networks in the ICGA and tumor regression rates.
We compared the post-irradiation regression rates (as %) in 20 patients 1 year after brachytherapy with networks identified in pre-treatment indocyanine green angiography (ICGA). The ICG angiography was performed before irradiation, 10 patients were irradiated with Ru-106 and 10 were irradiated with Id-125.
The mean preoperative maximum apical height was 5.2 mm [SD: 1.5 mm; Ru106 group: 5.7 mm (SD: 1.0 mm); Id-125 group: 5.0 mm (SD: 1.9 mm)]. In 11 patients (55%) (Ru-106: 5; Id-125: 6) we found networks in the preoperative ICG. The mean regression rate in tumors with networks was 51.3% (SD: 14.7%) and 28.0% (SD: 16.4%) in the group without networks. The difference between both groups was statistically significant (p = 0.003, Mann-Whitney test). No statistically significant difference in the regression rates was found between the two groups of brachytherapy Ru-106 and Id-125 (p = 0.165, Mann-Whitney test).
Highly proliferative tumors are known to be more sensitive to irradiation. This may be one reason why tumors with a rapid post-irradiation regression are the more aggressive ones with regard to later development of metastases. Histopathological networks are also known to be a strong indication of more aggressive, metastasizing tumors. These networks are also imagable in ICG angiography. Our observation emphasizes a connection between networks in ICG angiography and regression rates of uveal melanomas after brachytherapy.
Der Ophthalmologe 08/2002; 99(7):545-8. · 0.62 Impact Factor
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ABSTRACT: Hintergrund. Die Tumorrückbildungsgeschwindigkeit nach Brachytherapie uvealer Melanome ist ein prognostisch signifikanter Faktor für die
Entwicklung von Metastasen. Einen weiteren prognostisch ungünstigen Faktor für eine Metastasierung stellt der histologische
Nachweis von “Networks” (Gefäßnetze) dar, die sich auch in der ICG-Angiographie darstellen lassen. Ziel ist die Untersuchung
eines Zusammenhangs zwischen ICG-angiographisch nachweisbaren “Networks” und der Tumorrückbildungsgeschwindigkeit 1 Jahr nach
Brachytherapie.
Methoden. Bei 20 Patienten wurde die Tumorrückbildung der maximalen apikalen Tumorhöhe (MAH) innerhalb des 1. Jahres nach Brachytherapie
ermittelt und mit dem präoperativen ICG-angiographischen Vorliegen von “Networks” verglichen. Zehn Patienten wurden mit Ru-106
und 10 Patienten mit I-125 bestrahlt.
Ergebnisse. Die präoperative mittlere MAH betrug 5,2 mm [Standardabweichung (SA): 1,5 mm; Gruppe Ru-106: 5,7 mm (SA: 1,0 mm); Gruppe
I-125: 5,0 mm (SA: 1,9 mm)]. Bei 11 Patienten (55%) (Ru-106: 5; I-125: 6) wurden präoperativ “Networks” in der ICGA identifiziert.
Der Mittelwert der Tumorprominenzabnahme 1 Jahr nach Bestrahlung war bei Melanomen mit präoperativ nachweisbaren Networks
51,3% (SA: 14,7%) und bei Melanomen ohne nachweisbare “Networks” 28,0% (SA: 16,4%). Der Unterschied zwischen beiden Gruppen
war statistisch signifikant (p=0,003, Mann-Whitney-Test). Es zeigte sich kein statistisch signifikanter Unterschied der Rückbildungsgeschwindigkeit
zwischen den Melanomen, die mit Ru-106 bzw. I-125 bestrahlt worden waren (p=0,165, Mann-Whitney-Test).
Schlussfolgerung. Rasch proliferierende Tumoren gelten im Allgemeinen als strahlensensitiv. Daraus erklärt sich auch die Beobachtung, dass
Tumoren, die nach Brachytherapie eine schnellere Tumorrückbildung aufweisen, häufiger metastasieren. Auch histologisch nachweisbare
“Networks” gelten als Zeichen eines aggressiven, metastasierenden Tumors. Diese “Networks” sind auch in der ICG-Angiographie
darstellbar. Unsere Beobachtungen weisen auf einen Zusammenhang zwischen Tumorrückbildungsgeschwindigkeit und angiographischem
Nachweis von “Networks” hin.
Introduction. The post-irradiation regression rate of uveal melanomas is a prognostically significant factor for the development of metastases.
Other predictive factors for metastases are histological networks which are imagable with confocal ICG angiography. The purpose
of this study was to evaluate a possible connection of networks in the ICGA and tumor regression rates.
Methods. We compared the post-irradiation regression rates (as %) in 20 patients 1 year after brachytherapy with networks identified
in pre-treatment indocyanine green angiography (ICGA). The ICG angiography was performed before irradiation, 10 patients were
irradiated with Ru-106 and 10 were irradia-ted with Id-125.
Results. The mean preoperative maximum apical height was 5.2 mm [SD: 1.5 mm; Ru106 group: 5.7 mm (SD: 1.0 mm); Id-125 group: 5.0 mm
(SD: 1.9 mm)]. In 11 patients (55%) (Ru-106: 5; Id-125: 6) we found networks in the preoperative ICG. The mean regression
rate in tumors with networks was 51.3% (SD: 14.7%) and 28.0% (SD: 16.4%) in the group without networks. The difference between
both groups was statistically significant (p=0.003, Mann-Whitney test). No statistically significant difference in the regression rates was found between the two groups
of brachytherapy Ru-106 and Id-125 (p=0.165, Mann-Whitney test).
Discussion. Highly proliferative tumors are known to be more sensitive to irradiation. This may be one reason why tumors with a rapid
post-irradiation regression are the more aggressive ones with regard to later development of metastases. Histopathological
networks are also known to be a strong indication of more aggressive, metastasizing tumors. These networks are also imagable
in ICG angiography. Our observation emphasizes a connection between networks in ICG angiography and regression rates of uveal
melanomas after brachytherapy.
Der Ophthalmologe 06/2002; 99(7):545-548. · 0.62 Impact Factor
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ABSTRACT: We have previously shown that histologically described microcirculation patterns (MCP) can be visualized with indocyanine green (ICG) angiography. We have designed a prospective study to evaluate the prognostic value of these angiographically imaged MCP in small choroidal melanocytic lesions. In this report we describe the design of the study, characterize the patient collective, and present the first results.
In this prospective nonrandomized observational study, unilateral choroidal melanocytic lesions with 1.5-5.5 mm maximum apical height are observed until growth is determined according to defined criteria. Variables are demographic parameters, subjective symptoms, subretinal fluid, location and dimension of tumor, hemorrhage, color, orange pigment, and MCP determined by ICG angiography: normal, straight, parallel without crosslinking, parallel with crosslinking, arcs without branching, arcs with branching, loop, and network.
Seventy patients (22 males, 48 females; age: 33-88 years, median: 64 years) have been included up to now: 19 tumors showed growth so far (time to growth: 51-946 days, median: 127 days). The following parameters were statistically significantly correlated with time to tumor growth: flashes (p = 0.082), orange pigment (p = 0.012), subretinal fluid (p < 0.001), maximum basal tumor diameter (p = 0.001), maximum apical tumor height (p < 0.001), parallel with crosslinking (p < 0.001), arcs with branching (p = 0.006), loop (p < 0.001), and network (p < 0.001). Of these, complex MCP (parallel with crosslinking, arcs with branching, loop and/or network) showed the strongest correlation with time to tumor growth in a Cox regression model. Based on our data, the positive predictive value of imaging complex MCP (for growth within 12 months) is 78% and the negative predictive value is 98%.
Our patient collective demonstrates comparable prognostic parameters for time to growth as described in the literature. In addition, the ICG angiographic detection of complex MCP is more strongly predictive of the time to growth than other clinically determinable factors. Thus, we recommend this examination for patients with small choroidal melanocytic lesions, if the patient is to be counseled regarding the likely biologic behavior of his tumor.
Der Ophthalmologe 04/2002; 99(3):193-9. · 0.62 Impact Factor
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ABSTRACT: Hintergrund. Beschrieben wird eine prospektive, nicht randomisierte Studie, um den prognostischen Wert der angiographisch dargestellten
Mikrozirkulationsmuster (MZM) bei kleinen chorioidalen melanozytären Tumoren zu ermitteln.
Patienten und Methoden. Einseitige choroidale melanozytäre Tumoren von 1,5–5,5 mm maximaler apikaler Höhe werden regelmäßig untersucht, bis Wachstum
festgestellt wird. Neben demographischen Parametern werden folgende Faktoren erfasst: subjektive Symptome, Begleitablatio,
Tumorlage, -dimension, -blutung, Farbe, oranges Pigment und ICG-angiographisch darstellbare MZM.
Ergebnisse. In die Studie wurden bisher 70 Patienten aufgenommen, Wachstum zeigten 19 Tumoren. Der angiographische Nachweis von komplexen
MZM in der Cox-Regressionsanalyse war am stärksten mit der Zeit bis zum Wachstum korreliert.
Schlussfolgerung. Unser Patientenkollektiv zeigt vergleichbare prognostische Parameter für die Zeit bis zum Tumorwachstum wie in der Literatur
beschrieben. Darüber hinaus ist der ICG-angiographische Nachweis komplexer MZM stärker für die Zeit bis zum Wachstum prädiktiv
als die anderen klinisch erfassbaren Faktoren. Es ist deshalb empfehlenswert, diese Untersuchung routinemäßig bei Patienten
mit kleinen choroidalen melanozytären Tumoren durchzuführen, insbesondere wenn der Patient bezüglich des wahrscheinlichen
biologischen Verhaltens seines Tumors beraten werden soll.
Background. We have previously shown that histologically described microcirculation patterns (MCP) can be visualized with indocyanine
green (ICG) angiography. We have designed a prospective study to evaluate the prognostic value of these angiographically imaged
MCP in small choroidal melanocytic lesions. In this report we describe the design of the study, characterize the patient collective,
and present the first results.
Patients and methods. In this prospective nonrandomized observational study, unilateral choroidal melanocytic lesions with 1.5–5.5 mm maximum apical
height are observed until growth is determined according to defined criteria. Variables are demographic parameters, subjective
symptoms, subretinal fluid, location and dimension of tumor, hemorrhage, color, orange pigment, and MCP determined by ICG
angiography: normal, straight, parallel without crosslinking, parallel with crosslinking, arcs without branching, arcs with
branching, loop, and network.
Results. Seventy patients (22 males, 48 females; age: 33–88 years, median: 64 years) have been included up to now: 19 tumors showed
growth so far (time to growth: 51–946 days, median: 127 days). The following parameters were statistically significantly correlated
with time to tumor growth: flashes (p=0.082), orange pigment (p=0.012), subretinal fluid (p<0.001), maximum basal tumor diameter (p=0.001), maximum apical tumor height (p<0.001), parallel with crosslinking (p<0.001), arcs with branching (p=0.006), loop (p<0.001), and network (p<0.001). Of these, complex MCP (parallel with crosslinking, arcs with branching, loop and/or network) showed the strongest
correlation with time to tumor growth in a Cox regression model. Based on our data, the positive predictive value of imaging
complex MCP (for growth within 12 months) is 78% and the negative predictive value is 98%.
Conclusion. Our patient collective demonstrates comparable prognostic parameters for time to growth as described in the literature. In
addition, the ICG angiographic detection of complex MCP is more strongly predictive of the time to growth than other clinically
determinable factors. Thus, we recommend this examination for patients with small choroidal melanocytic lesions, if the patient
is to be counseled regarding the likely biologic behavior of his tumor.
Der Ophthalmologe 02/2002; 99(3):193-199. · 0.62 Impact Factor
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ABSTRACT: RD is a serious and well-known complication after cataract surgery, developing in 1% to 3% of all patients undergoing cataract extraction. High myopia, disruption of the posterior capsule intraoperatively or postoperatively by Nd: YAG laser, and vitreous loss increases the risk for RD. Retinal evaluation with detailed indirect ophthalmoscopy with scleral indentation and prophylactic treatment to all lesions that contribute to retinal tear and RD is strongly advocated before cataract surgery and Nd: YAG laser capsulotomy. Intraoperative vitreous loss should be managed meticulously, and these patients should be examined more frequently in the postoperative period. During phacoemulsification, no attempts should be made to retrieve the dislocated nuclear fragments without proper vitrectomy. It is best advised that a vitreoretinal surgeon handles the complication. Early recognition and prompt treatment following the detachment can result in good visual recovery.
Ophthalmology Clinics of North America 01/2002; 14(4):695-704.
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ABSTRACT: To report the association between duration of vitrectomy, as well as other risk factors, and the progression of nuclear sclerosis and posterior subcapsular cataract in the Vitrectomy for Macular Hole Study.
A cohort study nested within a randomized controlled clinical trial.
Using a system similar to the Lens Opacities Classification System II, nuclear sclerosis (NS) and posterior subcapsular cataract (PSC) were scored in the vitrectomy and fellow eye of 74 patients at baseline and at 6, 12, and 24 months postoperatively. Age, baseline blood pressure and refractive power, and duration of surgery were evaluated as risk factors for NS or PSC progression and cataract extraction.
The incidence of NS progression in the surgical group of vitrectomy eyes was 81% at 6 months, 98% at 1 year, and 100% at 2 years of follow-up. In contrast, NS progression in the control group of fellow eyes was only 18% at 6 months, 20% at 1 year, and 8% at 2 years. The incidence of PSC progression in the surgical group remained at approximately 11% throughout follow-up, which was not significantly higher than the 3% to 5% incidence in the control group. Vitrectomy was significantly related to progression of NS cataract (P <.001) and cataract extraction (P <.01). No statistically significant differences were found for NS scores, PSC scores, or progression rates between eyes that had less than median surgical duration (60 min.) or more than the median surgical duration. Additionally, no significant differences were found when eyes that experienced 45 minutes or less surgical duration were compared with eyes that endured more than 75 minutes surgical duration. Age, blood pressure, and refractive power were not found to be predictors for NS and PSC progression.
Although vitrectomy is a risk factor for NS progression, the duration of vitrectomy does not increase the risk.
American Journal of Ophthalmology 12/2001; 132(6):881-7. · 4.22 Impact Factor
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ABSTRACT: To report an eye with a full-thickness macular hole and an associated optic pit and the noteworthy intraoperative findings.
Case report. A 56-year-old woman presented with visual acuity LE: 20/100, a full thickness macular hole, and an optic pit. Optical coherence tomography and ophthalmic examination were performed preoperatively and postoperatively.
Although usually a macular hole associated with an optic pit tends to be a lamellar and characterized by outer layer defects within preexisting macular detachments or schisis-like cavities, this type of macular hole was not presented in this case. Although the macular hole resembled the idiopathic type on clinical examination as well as on optical coherence tomography, it could only be closed in the third surgical attempt after using silicone oil as a long-standing tamponade. Peeling of an epiretinal membrane or the internal limiting membrane was not possible during any of the three surgeries.
Our observations suggest that in cases of macular hole in association with optic pit, instillation of silicone oil should be considered in the first surgical procedure, especially if no epiretinal membrane or internal limiting membrane peeling is possible intraoperatively.
American Journal of Ophthalmology 09/2001; 132(2):263-4. · 4.22 Impact Factor
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L Cheng,
M E Rivero,
C R Garcia,
C D McDermott,
K S Keefe,
C A Wiley,
K A Soules,
G Bergeron-Lynn,
S Vekich,
K Zhang,
K Appelt, W R Freeman
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ABSTRACT: To determine the ocular pharmacokinetics, physiological and histological effects of prinomastat (a matrix metalloprotease inhibitor), a total of seventy-seven eyes of New Zealand White rabbits received intravitreous and subtenon injections of prinomastat or of acidified water vehicle as control, Doses of 0.5 mg in 0.05 mL of prinomastat or acidified water were used for intravitreal injection. For the subtenon injections, doses of 5 mg prinomastat in 0.5 mL of acidified water were administered in the superotemporal quadrant. Intraocular pharmacokinetics were determined by analyzing vitreous samples at different postinjection time points using Liquid Chromatography-Mass Spectroscopy/Mass Spectroscopy (LC-MS/MS). The toxicity was evaluated by biomicroscopy, electroretinography (ERG), pneumatonometry, and histology. No toxicity was found with either administration method. At day 14 after intravitreal injection, levels of prinomastat in the vitreous and choroid were 1.4 ng/mg and 7.8 ng/mg, respectively. The retinal levels of prinomastat were 22 ng/mg at 24 hr and dropped below 1 ng/mg at 48 hr. Prinomastat remained well above minimum effective concentration in the choroid for at least four weeks after a single intravitreal injection, suggesting that local intravitreal injection may have potential in treating choroidal neovascularization.
Journal of Ocular Pharmacology and Therapeutics 07/2001; 17(3):295-304. · 1.51 Impact Factor
