A Hassenstein

University Medical Center Hamburg - Eppendorf, Hamburg, Hamburg, Germany

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Publications (50)46.17 Total impact

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    ABSTRACT: PurposeThe study was performed to analyse the retina of patients with Parkinson's disease (PD) for morphological changes compared to healthy controls (HC) using spectral-domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy.Methods We enrolled 108 patients with idiopathic PD and 165 HC. All study participants underwent an ophthalmological examination to exclude ophthalmological disorder potentially interfering with the retinal analyses. Peripapillary retinal nerve fibre layer (RNFL) thickness and macular thickness and volume were measured by a SD-OCT device (Heidelberg Spectralis®). Stereometric parameters of the optic disc were acquired by Heidelberg Retina Tomograph (HRT III).ResultsThe RNFL thickness did not significantly differ between patients with PD and HC. The thickness of the central minimum and the centre of the macular area were significantly reduced in patients with PD, while the total macular volume did not significantly differ between the groups. Furthermore, we noted an inverse correlation between the central minimum thickness and the disease severity (assessed by the Hoehn and Yahr scale). HRT data showed no significant differences.Conclusion The HRT device and the RNFL measurements of the SD-OCT did not prove to be a clinically valid diagnostic tool to distinguish eyes of patients with PD and HC. However, the macular region and especially the foveola (central minimum) with the highest density of photoreceptor cells seem to be more sensitive and might be potential biomarkers.
    Acta ophthalmologica 06/2015; 93(7). DOI:10.1111/aos.12757 · 2.51 Impact Factor
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    ABSTRACT: Whether retinal degeneration is part of the degenerative processes in patients with Parkinson's disease (PD) is still unclear. This cross-sectional study was undertaken to compare the retinal morphology of patients with PD and healthy controls using spectral domain optical coherence tomography (SD-OCT) and scanning laser polarimetry (SLP). Both eyes of patients with PD (n = 108) and healthy controls (n = 165) were examined using SD-OCT and SLP on the same day. Data on the thickness of the retinal nerve fibre layer (RNFL) of all quadrants and the macular area were acquired by OCT (Cirrus, Zeiss). The SLP device (Glaucoma diagnostics (GDx), Zeiss) measured the RNFL and calculated the nerve fibre index (NFI). All patients and probands were checked for concomitant ocular disorders by an ophthalmologist. Visual acuity, intraocular pressure (IOP), objective refraction and the anterior and posterior segment were assessed. Patients with PD showed a reduced macular volume and a reduced central subfield thickness in OCT examinations. The RNFL in the different quadrants did not differ significantly from that of controls. SLP data showed a reduced average RNFL thickness, a decreased thickness of the inferior quadrant and an increase of the NFI in patients with PD. PD may be associated with reduced thickness and volume of the macula and a reduced thickness of the RNFL in the inferior quadrant of the retina. Investigations using SD-OCT and SLP revealed distinct but significant differences between patients with PD and healthy controls. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
    Acta ophthalmologica 06/2015; DOI:10.1111/aos.12764 · 2.84 Impact Factor
  • C Gesser · T Küper · G Richard · A Hassenstein ·
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    ABSTRACT: Purpose: The aim of this study was to evaluate an intraoperative measurement of objective refraction with a hand-held retinomax instrument. Methods: At the end of cataract surgery objective refraction in a lying position was measured with a retinomax instrument. On the first postoperative day the same measurement was performed with a retinomax and a standard autorefractometer. To evaluate the differences between measurements, the spherical equivalent (SE) and Jackson's cross cylinder at 0° (J0) and 45° (J45) was used. Results: 103 eyes were included. 95 of them had normal cataract surgery. Differences between retinomax at the operative day and the standard autorefractometer were 0.68 ± 2.58 D in SE, 0.05 ± 1.4D in J0 and 0.05 ± 1.4D in J45. There were no statistically significant differences between the groups. Conclusion: Intraoperative measurement of the refraction with a retinomax can predict the postoperative refraction. Nevertheless, in a few patients great differences may occur. Georg Thieme Verlag KG Stuttgart · New York.
    Klinische Monatsblätter für Augenheilkunde 04/2015; 232(7). DOI:10.1055/s-0035-1545733 · 0.46 Impact Factor
  • Konstantinos Giannakakis · Andrea Hassenstein · Gisbert Richard ·

    112. Deutsche Ophthalmologische Gesellschaft (DOG)-Kongress, Leipzig; 09/2014
  • A Hassenstein ·
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    ABSTRACT: A possible manifestation site for multiple sclerosis (MS) is the optic nerve which clinically presents as optic neuritis. In recent years studies have shown that MS patients have a reduced retinal nerve fiber layer (RNFL) thickness. The literature and own investigations could show that MS patients have a thinning of the RNFL (especially in temporal quadrants) with reduction of the total macular volume and this alteration is also correlated with the severity of the disease. Neuromyelitis optica (monophasic) shows an extreme thinning of the RNFL with severe reduction in vision. In neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease, a thinning of the RNFL is also present mostly in all quadrants. Amyotrophic lateral sclerosis and schizophrenia do not show alterations of the retinal layers with optical coherence tomography.
    Der Ophthalmologe 07/2014; 111(7):676-80. DOI:10.1007/s00347-014-3090-4 · 0.50 Impact Factor
  • Konstantinos Giannakakis · Andrea Hassenstein · Gisbert Richard ·

    27. Internationaler Kongress der Deutschen Ophthalmochirurgen (DOC), Nürnberg; 05/2014
  • Andrea Hassenstein · Konstantinos Giannakakis · Rüdiger Schwartz ·

    111. Deutsche Ophthalmologische Gesellschaft (DOG)- Kongress, Berlin; 09/2013
  • A Hassenstein · F Scholz · G Richard ·
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    ABSTRACT: Until now depiction of the choroid using time domain optical coherence tomography (OCT) (Stratus III) was barely possible. Visualization of choroidal perfusion was carried out using indocyanine green angiography (ICGA). The spectral-domain OCT, such as Cirrus OCT (C-OCT) is able to image the choroid better because it offers higher resolution, increased penetration depth of the scan beam and faster acquisition of A-scan data. The aim of the study was to evaluate the potential of choroidal imaging in patients suffering from macular disease. The advanced visualization tool of C-OCT was primarily used and converted to a z-axis topography. Because of a special algorithm developed by our team, targeted imaging of the choroidal vessels was possible through the scanned two dimensional retinal areas. This image offers an extended image of choroidal vessels (large and small vessels) in several levels. In total 20 patients eyes (n = 15 with various macular diseases and n = 5 normal conditions) who underwent C-OCT and ICG angiography (HRA 2) were chosen to participate in this special algorithm. A precise correlation of ICG and choroid OCT in a semitransparent manner was carried out. The first prototype of the recognition software prototype produced clear imaging of the choroid in 100% of cases but only in 55% in the macular region depending on the extent of macular disease. Limitations were low signal intensity and penetration depth as well as a poorly defined retinal pigment epithelium (RPE) and choriocapillaris especially in macular diseases of the RPE layer. After a black and white conversion in OCT using the software it was possible in all cases to integrate the choroidal OCT with the ICG angiogram in a semitransparent manner. This confirms that the choroidal vessels in C-OCT correlated identically with the ICG angiography. In contrast to the ICG where the contrast agent in the vessel emits a signal, the choroidal vessels are visible due to different reflectivity in the merging tissue. These investigations showed that non-invasive topographic imaging of the choroid using spectral domain OCT, such as Cirrus OCT is now possible. Distinguishability of smaller vessels was excellent. The ICG (perfusion) and C-OCT (morphology) methods are two very different vessel imaging techniques. The integration of both methods is possible. The clinical relevance of the new image information still has to be researched.
    Der Ophthalmologe 03/2013; 110(3):239-46. · 0.50 Impact Factor
  • M.-T. Eddy · J. Steinberg · G. Richard · A. Hassenstein ·
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    ABSTRACT: Ein 23-jähriger Patient stellte sich mit schwerer, anbehandelter kontaktlinsenassoziierten Keratitis und Descemetozele vor. Nach 1 Woche intensiver antibiotischer Therapie wurde der Erreger Aspergillus fumigatus nachgewiesen. Trotz angepasster antimykotischer Therapie kam es zur kornealen Perforation. Um bei peripheren Randinfiltrationen auf eine Sklero-Keratoplastik (KP) mit schlechter Prognose zu verzichten, wurde der Befund primär mit einer doppelschichtigen Amnionmembran gedeckt. Zwei Wochen später klarte die periphere Hornhaut auf, sodass eine reine KP à chaud durchgeführt werden konnte. Postoperativ kam es trotz angepasster Therapie zu keiner Befundbesserung. In erneuten Abstrichen zeigte sich eine Besiedlung mit Candida albicans, weswegen eine Therapieumstellung erfolgte. Dieses führte im Verlauf zu einer Stabilisierung des Befundes. Nach 5 Jahren und Re-KP zeigte sich ein reizarmer Befund mit einem korrigierten Visus von 0,8 p.
    Der Ophthalmologe 11/2012; 109(11). DOI:10.1007/s00347-012-2570-7 · 0.50 Impact Factor
  • M-T Eddy · J Steinberg · G Richard · A Hassenstein ·
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    ABSTRACT: A 23-year-old man presented with severe contact lens-associated keratitis and descemetocele with pre-existing drug therapy. After 1 week of intensive antibiotic treatment Aspergillus fumigatus was identified. Despite adjusted antimycotic treatment a corneal perforation occurred. Due to peripheral scleral infiltration the cornea was primarily closed with a double layer amniotic membrane in order to avoid a sclerokeratoplasty with a bad prognosis. After 2 weeks the peripheral corneal situation stabilized and a simple keratoplasty á chaud could be performed. After surgery and adjusted drug therapy, no adequate signs of recovery occured. In repeated microbiological testing an additional Candida albicans infection was diagnosed and therapy was readjusted. This resulted in a cure of the corneal infection. After 5 years and a re-keratoplasty the patient presented with a clear corneal transplant and a corrected visual acuity of 20/25.
    Der Ophthalmologe 09/2012; · 0.50 Impact Factor
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    ABSTRACT: Purpose: To evaluate donor demographics, trends in donor tissue procurement and tissue storage over a long period. Methods: A retrospective, longitudinal, descriptive analysis was undertaken of data from the Hamburg Eye Bank Data Base (HEB-DB) that had been collected between 1981 and 2010. Data on 54 parameters of cornea donors [including clinical history, age, death cause, gender and death-to-explantation interval (DEI)] and of cultivated corneas (endothelial quality and development in culture, cultivation period, microbiological contamination) were retrieved. These data were analysed statistically, focusing on the historical development of the eye bank. Results: At the time of retrieval (June 2010), the HEB-DB contained data on 10 943 corneas (5503 donors). Most donors were men (65%) and had died from cardiopulmonary (n = 801)/cerebral (n = 261) failure or as the result of a polytraumatic accident/suicide (n = 602). Within these years, donor age, DEI and storage time increased. The percentage of stored corneas suitable for transplantation displayed a variable but increasing trend; in 2007, almost 75% of the stored corneas were transplanted. Between 1995 and June 2010, the median microbiological contamination rate was 5.3%. A change in the procurement procedure from enucleation to corneoscleral explantation in 2008 led to a briefly increased contamination rate. Conclusion: Donor demographic data run parallel to the general demographic development. Our analysis indicates a dynamic development of the eye bank over the last 30 years and emphasizes the need for an active quality management in coping with the challenges of modern eye banking.
    Acta ophthalmologica 08/2012; 91(6). DOI:10.1111/j.1755-3768.2012.02471.x · 2.84 Impact Factor
  • A Hassenstein ·
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    ABSTRACT: Pathological myopia is synonymous with high myopia and generally refers to a condition in which individuals have greater than 6 to 8 diopters of myopia or an axial length greater than 26 to 27 mm Pathological myopia is a major cause of legal blindness in many developed countries (2–4), affecting 27 to 33% of all myopic eyes, which corresponds to a prevalence of 0.2 to 0.4% in the general population of the United States (4). High myopia is especially common in Asia and the Middle East. In Japan, the number of cases of myopia is unknown, but pathological or high myopia affects 6 to 18% of the myopic population and approx 1% of the general population (5).
    Der Ophthalmologe 08/2012; 109(8):737. · 0.50 Impact Factor
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    ABSTRACT: Based on findings in animal models of autoimmune optic nerve inflammation, we have assessed the safety and efficacy of erythropoietin in patients presenting with a first episode of optic neuritis. Patients with optic neuritis who attended the University Hospitals of Homburg/Saar, Göttingen, or Hamburg (Germany) were included in this double-blind, placebo-controlled, phase 2 study (ClinicalTrials.gov, NCT00355095). They were randomly assigned to groups receiving either 33,000IU recombinant human erythropoietin intravenously daily for 3 days or placebo as an add-on therapy to methylprednisolone. The primary outcome parameter was change in retinal nerve fiber layer (RNFL) thickness after 16 weeks. Secondary outcome parameters included optic nerve atrophy as assessed by magnetic resonance imaging, and changes in visual acuity, visual field, and visual evoked potentials (VEPs). Forty patients were assigned to the treatment groups (21/19 erythropoietin/placebo). Safety monitoring revealed no relevant issues. Thirty-seven patients (20/17 erythropoietin/placebo) were analyzed for the primary endpoint according to the intention-to-treat protocol. RNFL thinning was less apparent after erythropoietin treatment. Thickness of the RNFL decreased by a median of 7.5μm by week 16 (mean ± standard deviation, 10.55 ± 17.54μm) compared to a median of 16.0μm (22.65 ± 29.18μm) in the placebo group (p = 0.0357). Decrease in retrobulbar diameter of the optic nerve was smaller in the erythropoietin group (p = 0.0112). VEP latencies at week 16 were shorter in erythropoietin-treated patients than in the placebo group (p = 0.0011). Testing of visual functions revealed trends toward an improved outcome after erythropoietin treatment. These results give the first indications that erythropoietin might be neuroprotective in optic neuritis.
    Annals of Neurology 08/2012; 72(2):199-210. DOI:10.1002/ana.23573 · 9.98 Impact Factor
  • A. Hassenstein · R. Rühl · G. Richard ·
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    ABSTRACT: EinleitungZu den Frühstadien der altersbedingten Makuladegeneration zählen miliare und seröse Drusen und Pigmentepithel Veränderungen. Die optische Kohärenztomographie (OCT) stellt ein bildgebendes Verfahren mit hoher Auflösung der retinalen Strukturen der Makula dar. Ziel der Studie ist es, OCT- und fluoreszenzangiographische Befunde bei Patienten mit Drusenmakulopathie bezüglich der prognostischen Aussagekraft zu vergleichen. Patienten/MethodeEs wurden 26 Patienten (= 36 Augen) mit Drusenmakulopathie untersucht und die Befunde der Biomikroskopie, Fluoreszenzangiographie (FAG), OCT und histologische Erkenntnisse verglichen. Bei 12 Augen fanden sich miliare Drusen und bei 24 Augen serös konfluierende Drusen. ErgebnisseIm OCT können aufgrund ihrer geringen Größe miliare Drusen nicht dargestellt werden. Serös konfluierende Drusen stellen sich als fokale, solide oder seröse Pigmentepithelabhebungen dar. Die lipoiden serösen Drusen sind nicht reflektiv. Sie weisen unterhalb des hochreflektiven Pigmentepithels (PE) ein schmales niedrigreflektives Band auf. Bei großen konfluierenden serösen Drusen mit ausgeprägter Hyperfluoresenz im FAG kann das OCT konfluierende Drusen von okkulten subretinalen Neovaskularisationen (SNV) unterscheiden, da letzere sich als hochreflektive spindelförmige konvexe Pigmentepithelauftreibung darstellen. DiskussionGroße konfluierende Drusen können im OCT als fokale Pigmentepithelabhebungen dargestellt werden. Es ist eine Differenzierung von konfluierenden hyperfluoreszenten Drusenarealen von einer okkulten SNV möglich. Aufgrund der unterschiedlichen Zielsetzung und Darstellungsmöglichkeit (Fluoreszenzangiographie: Perfusionstopographie und OCT: Tomographie) sind beide Verfahren nicht konkurrent, sondern ergänzend. In einzelnen Fällen kann auf die Durchführung einer Fluoreszenzangiographie verzichtet werden. Age-related macular degeneration is the most common cause for legal blindness in old patients. At the beginning of the disease Drusen and proliferations of the retinal pigment epithelium can be observed. Geographic atrophy and choroidal neovascularisation also develop in follow up. Optical coherence tomography is a new imaging modality which shows the macular retinal structures with high resolution. The method is used for the examination of patients in different stages of age-related macular degeneration and in comparison with other biomicroscopy and fluorescein angiography. Patients/Method26 patients with Drusen (n = 36 eyes) were examined and the findings compared with color fundus photographs, fluorescenceangiography, optical coherence tomography and histological knowledge. 12 eyes showed small hard drusen and 24 eyes large soft drusen. ResultsSmall hard drusen are not detectable with optical coherence tomography because of their size. Large soft drusen appear as focal solid or serous detachments of the pigment epithelium. Lipoid drusen are not reflective. They show a low reflective layer beneath the high-reflective pigment epithelium. Large soft drusen with distinct hyperfluorescence are distinguished from occult choroidal neovascularisation, the latter showing highly reflective enlargements of the pigment epithelium in a convex manner. DiscussionLarge soft drusen appear as localized detachments of the pigment epithelium in OCT. Occult choroidal neovascularization can be distuingished from distinctly hyperfluorescent large soft drusen as a result of the highly reflective membrane of choroidal neovascularization. The different character of fluorescein angiography (topographic perfusion), and optical coherence tomography is used in an additive, not concurrent way. Single borderline cases allow diagnosis without fluorescein angiography.
    Spektrum der Augenheilkunde 05/2012; 14(4):209-213. DOI:10.1007/BF03162805 · 0.18 Impact Factor
  • Andrea Hassenstein · F Scholz · G Richard ·
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    ABSTRACT: In the new generation of EYECUBE devices, the angiography image and the OCT are included in a 3D illustration as an integration. Other diagnostic procedures such as autofluorescence and ICG can also be correlated to the OCT. The aim was to precisely classify various two-dimensional findings in relation to each other. The new generation of OCT devices enables imaging with a low incidence of motion artefacts with very good fundus image quality - and with that, permits a largely automatic classification. The feature enabling the integration of the EYECUBE was further developed with new software, so that not only the topographic image (red-free, autofluorescence) can be correlated to the Cirrus OCT, but also all other findings gathered within the same time frame can be correlated to each other. These were brightened and projected onto the cube surface in a defined interval. The imaging procedures can be selected in a menu toolbar. Topographic volumetry OCT images can be overlayed. The practical application of the new method was tested on patients with macular disorders. By lightening up the results from various diagnostic procedures, it is possible of late to directly compare pathologies to each other and to the OCT results. In all patients (n = 45 eyes) with good single-image quality, the automated integration into the EYECUBE was possible (to a great extent). The application is not dependent on a certain type of device used in the procedures performed. The increasing level of precision in imaging procedures and the handling of large data volumes has led to the possibility of examining each macular diagnostics procedure from the comparative perspective: imaging (photo) with perfusion (FLA, ICG) and morphology (OCT). The exclusion of motion artefacts and the reliable scan position in the course of the imaging process increases the informative value of OCT.
    Klinische Monatsblätter für Augenheilkunde 06/2011; 228(11):991-4. DOI:10.1055/s-0031-1273343 · 0.46 Impact Factor
  • I Ryseck · B Wahl · T Lischka · A Hassenstein ·
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    ABSTRACT: A so-called myopic shift after cataract extraction and IOL implantation is known to occur in children. How much is difficult to predict. In this study we report the refractive development in pseudophakic children after primary and secondary IOL implantation. The refractive change in all patients receiving an IOL-implantation between 2000 and 2008 with a follow-up of a minimum of 6 months was reviewed (6 - 107 months). Rigid or foldable lenses were implanted by the same technique. Refraction postoperatively and at last follow-up was measured. 62 eyes of 41 patients were reviewed. Patients were divided into three groups based on age at time of surgery: 3 - 4 years, 5 - 6 years and 7 - 12 years. The mean myopic shift was 2.5 D in both study groups, patients with primary and secondary IOL implantation. In the group with 3 - 4-year-old children mean myopic shift was 1.5 D in primary and 1.0 D in secondary implantations, in the group with 5 - 6-year-old children 2.75 D in primary and 3.25 D in secondary implantations and in the group with 7 - 12-year-old children 2.0 D in both primary and secondary implanted IOLs. We have shown that there are no differences in refractive changes between primary and secondary IOL implantations in our study group. In contrast to other findings we found the lowest myopic shift in the group of 3 - 4-year-old patients. Our results show that a prediction of expected myopic shift in children after IOL implantations remains difficult.
    Klinische Monatsblätter für Augenheilkunde 04/2011; 228(10):905-9. DOI:10.1055/s-0029-1246031 · 0.46 Impact Factor
  • I. Naydis · M. Klemm · A. Hassenstein · G. Richard · T. Katz · S. J. Linke ·
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    ABSTRACT: Zusammenfassung Ziel Retrospektive Analyse des postoperativen Astigmatismus und der bestkorrigierten Sehschärfe nach perforierender Keratoplastik und Vergleich dreier Nahttechniken. Patienten und Methoden In diese retrospektive Analyse wurden 150 Augen nach perforierender Keratoplastik eingeschlossen und 3 Nahttechniken miteinander verglichen: Bei 37 Augen (24,7%) wurde die Keratoplastik in einfach fortlaufender Nahttechnik (EFN), bei 81 Augen (54%) in doppelt fortlaufender Naht (DFN) und bei 32 Augen (21,3%) in Einzelknüpfnahttechnik (EKN) durchgeführt. Die Diagnosen vor Transplantation waren folgende: 46 Augen (30,7%) Fuchs-Endotheldystrophie, 33 Augen (22%) Keratokonus, 12 Augen (8%) stromale Narben nach herpetischer Keratitis und 7 Augen (4,6%) pseudophake Keratopathie. Zur Trepanation wurde das GTS-System in 44%, Rotortrepan in 46,6% und Best-Trepan in 5,3% verwendet. Astigmatismus und bestkorrigierte Sehschärfe wurden 1, 4, 12 und 24 Monate (alle Fäden entfernt) nach Keratoplastik bestimmt. Subjektive und objektive Refraktion sowie Topographie dienten zur Quantifizierung des Astigmatismus. Zur Beurteilung der statistischen Signifikanz des postoperativen Astigmatismus wurde der Kolmogorov-Smirnov-Zweistichproben-Anpassungstest verwendet (Signifikanzniveau 95%). Ergebnisse Der mittlere topographische Astigmatismus 4 Monate (12 Monate/2 Jahre) nach Transplantation betrug 4,9 dpt (5,3/4,1 [n=4]) für EFN, 4,2 dpt (4,0/5,3) für DFN und 9,7 dpt [n=7] (4,9 [n=8]/6,8 [n=2]) für EKN. Der mittlere Astigmatismus (objektive Refraktion) 4 Monate (12 Monate/2 Jahre) nach KP betrug 5,9 dpt (4,1 [n=7]/5,0 [n=3]) für EFN, 3,4 dpt (4,5/4,98) für DFN und 8,0 dpt [n=3] (6,9 [n=4]/ 7,4 [n=2]) für EKN. Der mittlere refraktive Zylinder 4 Monate (12 Monate/2 Jahre) nach Transplantation betrug 4,5 dpt (3,9/4,9) für EFN, 3,2 dpt (3,3/3,6) für DFN und 6,2 dpt (3,7/4,7) für EKN. Die mittlere bestkorrigierte Sehschärfe nach 4 Monaten (12 Monate/2 Jahre) betrug 0,3 (0,3/0,4) für EFN 0,3 (0,4/0,5) für DFN und 0,3 (0,4/0,4) für EKN. Bei Trepanation mit dem GTS-System erreichte die bestkorrigierte Sehschärfe nach 4 Monaten (12 Monate/2 Jahre) 0,3 (0,3/0,5) für EFN und 0,3 (0,4/0,6) für DFN. Schlussfolgerungen In dieser retrospektiven Analyse waren topographischer und objektiver Astigmatismus am höchsten in der Gruppe der EKN (geringe Fallzahl) nach KP. Ein Vergleich der fortlaufenden Nahttechniken (DFN vs. EFN) ergab einen statistisch geringeren topographischen Astigmatismus und refraktiven Zylinder 4 und 12 Monate nach KP in der DFN-Gruppe. Nach Fadenentfernung (2 Jahre nach Operation) war der refraktive Zylinder geringer in der DFN-Gruppe (Signifikanzniveau 95%), der topographische und objektive Astigmatismus zwischen EFN und DFN ergab aber keinen statistisch signifikanten Unterschied. Bei der Interpretation der Ergebnisse ist zu berücksichtigen, dass es insbesondere bei den späten Nachkontrollen mit abnehmenden Fallzahlen zu Verzerrungen in den einzelnen Untergruppen durch stark abweichende Einzelwerte kommen kann.
    Der Ophthalmologe 03/2011; 108(3):252-259. DOI:10.1007/s00347-010-2272-y · 0.50 Impact Factor
  • I Naydis · M Klemm · A Hassenstein · G Richard · T Katz · S J Linke ·
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    ABSTRACT: The aim of this study was a retrospective analysis of postkeratoplasty astigmatism and best corrected visual acuity (BCVA) in patients following penetrating keratoplasty (PK) and a comparison of three suturing techniques. In this retrospective analysis penetrating keratoplasty (PK) was carried out on 150 eyes with 3 suturing techniques: single running (SR), double running (DR counterclockwise) and interrupted (IR) sutures. Of the eyes 37 (24.7%) underwent PK with SR sutures, 81 eyes (54%) with DR sutures and 32 eyes (21.3%) had IR. PK for Fuchs' dystrophy was used on 46 eyes (30.7%), on 33 eyes (22%) for keratoconus, on 12 eyes (8%) for herpetic keratitis and on 7 eyes (4.6%) for pseudophakic bullous keratopathy. For trephination a guided trephine system (GTS) was used in 44%, rotortrepan in 46.6% and best trepan in 5.3%. Postkeratoplasty astigmatism and best corrected visual acuity (BCVA) were evaluated 1, 4, 12 and 24 months after surgery (all sutures removed). Subjective and objective refractions and corneal topography were performed to assess astigmatism. The Kolmogorov-Smirnov test (95% significance) was used to evaluate statistical significance. Mean topographic astigmatism 4 months (12 months/2 years) after keratoplasty was 4.9 dpt (5.3/4.1, n=4) for SR, 4.2 dpt (4.0/5.3) for DR and 9.7 dpt (n=7) (4.9, n=8/6.8, n=2) for IR suturing techniques. Mean objective astigmatism 4 months (12 months/2 years) after PK was 5.9 dpt (4.1, n=7/5.0, n=3) for SR, 3.4 dpt (4.5/4.98) for DR and 8.0 dpt (n=3) (6.9, n=4/7.4, n=2) for IR sutures. Mean refractive cylinder 4 months (12 months/2 years) after keratoplasty was 4.5 dpt (3.9/4.9) for SR, 3.2 dpt (3.3/3.6) for DR and 6.2 dpt (3.7/4.7) for IR suturing. Mean BCVA 4 months (12 months/2 years) was 0.3 (0.3/0.4) for SR, 0.3 (0.4/0.5) for DR and 0.3 (0.4/0.4) for IR sutures. BCVA 4 months (12 months/2 years) after PK (GTS only) reached 0.3 (0.3/0.5) for SR and 0.3 (0.4/0.6) for DR suturing. Topographic and objective astigmatisms were highest for the IR suturing technique. Topographic astigmatism and refractive cylinder were less in the DR (compared to SR) group 4 and 12 months after surgery (statistically significant). After suture removal (2 years after PK) refractive cylinder was still lower for DR compared to SR but there was no statistical difference between DR and SR regarding topographic and objective cylinders. For the interpretation of these data it should be emphasized that due to the retrospective character of this analysis the number of patients in the subgroups is decreasing with time and as a consequence single (strongly deviating) measurements can have a more powerful impact on the outcome in the individual subgroups.
    Der Ophthalmologe 03/2011; 108(3):252-9. · 0.50 Impact Factor
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    ABSTRACT: We report the exceptional case of a severe intraocular Abiotrophia defectiva infection which developed after cataract surgery. Retinal involvement as a complication of A. defectiva endophthalmitis or the combination of acute-onset endophthalmitis with infiltrative keratitis caused by this pathogen has not been described. Moreover, our report represents the first documented ocular A. defectiva infection in Germany. A. defectiva was identified using biotyping and 16S ribosomal RNA gene sequence analysis. Despite vigorous antimicrobial therapy and repeated ocular surgery, visual outcome was poor.
    European Journal of Clinical Microbiology 06/2010; 29(6):727-31. DOI:10.1007/s10096-010-0901-7 · 2.67 Impact Factor
  • A Hassenstein · F Scholz · W Inhoffen · G Richard ·
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    ABSTRACT: We describe the establishment of a new digital integration method (DIM) for the anatomically precise and objective correlation of OCT and FLA. The aim of the study was to evaluate the clinical impact of DIM and deduce possible new knowledge in unclear angiographic findings. DIM uses a newly developed software for the integration of OCT and FLA images of the same date. Corresponding vascular bifurcations and OCT scan position are marked in OCT and FLA images. Pathological areas in OCT or FLA can be marked and compared. A fundus enhancement system (FES) was developed for a better fundus image quality in OCT. Using a retinal tracking system (RTS) eye movements can be compensated. DIM was evaluated in 225 patients with macular diseases. Using FES, the DIM was successful in 95 % of the patients in contrast to 25 % without FES. Using the video system of RTS eye movement artefacts could be compensated in all patients. Cases with clear angiographic findings showed a high correspondence (66 %) with the OCT findings. A discrepancy between FLA and OCT findings was found in 33 %, especially in leakages of unknown origin. DIM was of high value in age-related macular degeneration (AMD), detecting a heterogeneous morphology of serous, solid RPE detachments, retinal cystoid formation and choroidal neovascularisation (CNV) and differentiating it in a precise topography. The lesion size of classic CNV with a hypofluorescent halo was in OCT always larger than in FLA. Through the correction of the eye movement artefacts by DIM and FES, a fundamental weak point in the previous OCT pictures is counterbalanced. Using DIM the OCT scan position for the follow-up can now be assessed in a safe and reliable manner which is mandatory for the evidence of OCT studies. The detection of precise morphology (serous RPE detachments) in angiographically unclear phenomena can lead to treatment consequences, e. g., avoiding contraindicated areas in photodynamic therapy. Using the new morphological information new knowledge is obtained on uncertain angiographic phenomena by this integration method (DIM).
    Klinische Monatsblätter für Augenheilkunde 03/2009; 226(2):90-6. DOI:10.1055/s-2008-1027872 · 0.46 Impact Factor

Publication Stats

295 Citations
46.17 Total Impact Points


  • 1998-2015
    • University Medical Center Hamburg - Eppendorf
      • • Department of Ophthalmology
      • • Department of Medical Microbiology, Virology and Hygiene
      Hamburg, Hamburg, Germany
  • 2009
    • University of Hamburg
      Hamburg, Hamburg, Germany