A Hassenstein

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

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Publications (40)41.47 Total impact

  • 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 : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 07/2014; 111(7):676-80.
  • 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. · 0.53 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; · 0.53 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; · 2.44 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. · 0.53 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. · 11.19 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. · 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. · 0.70 Impact Factor
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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. · 0.53 Impact Factor
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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 01/2011; 108(3):252-259. · 0.53 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. · 3.02 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. · 0.70 Impact Factor
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    ABSTRACT: Optical coherence tomography (OCT) has gained increasing relevance for follow-up after the treatment of macular diseases especially after anti-VEGF therapy. Therefore it seemed reasonable to develop standardized evaluation strategies and OCT examination guidelines for Stratus OCT III. Basic guidelines for the Stratus OCT III examination of macular diseases were developed. The first part contains basic advice for the OCT examination with respect to the examiner, patients, image quality, movement artefacts, algorithms, archiving and interpretation of OCT images. The second part consists of the relevance and indications for OCT examination especially in age-related macular degeneration (AMD), subgroups of AMD and follow-up after treatment. The third part demonstrates a brief outlook on future developments, such as the digital integration method (DIM), which provides identical scan localization in follow-up and eliminates any movement artefacts. The application of standardized routine scanning and analysis protocols in Stratus OCT III for macular diseases and follow-up examinations provides an optimized, time-saving and comparable use of OCT. Therefore, the relevance and quality of OCT is increased for routine use in outpatient departments, hospitals and also for clinical studies.
    Der Ophthalmologe 02/2009; 106(2):116-26. · 0.53 Impact Factor
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    Andrea Hassenstein, Carsten H Meyer
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    ABSTRACT: Fluorescein angiography (FA) was discovered by Nowotny and Alvis in the 1960s of the 20th century and has evolved to become the 'Gold standard' for macular diagnostics. Scanning laser imaging technology achieved enhancement of contrast and resolution. The combined Heidelberg retina angiograph (HRA2) adds novel innovative features to established fundus cameras. The principle of confocal scanning laser imaging provides a high resolution of retinal and choroidal vasculature with low light exposure providing comfort and safety for the patient. Enhanced contrast, details and image sharpness image are generated using confocality. For the visualization of the choroid an indocyanine green angiography (ICGA) is the most suitable application. The main indications for ICGA are age-related macular degeneration, choroidal polypoidal vasculopathy and choroidal haemangiomas. Simultaneous digital FA and ICGA images with three-dimensional resolution offer improved diagnosis of retinal and choroidal pathologies. High-speed ICGA dynamic imaging can identify feeder vessels and retinal choroidal anastomoses, ensuring safer treatment of choroidal neovascularization. Autofluorescence imaging and fundus reflectance imaging with blue and infrared light offer new follow-up parameters for retinal diseases. Finally, the real-time optical coherence tomography provides a new level of accuracy for assessment of the angiographic and morphological correlation. The combination of various macular diagnostic tools, such as infrared, blue reflectance, fundus autofluorescence, FA, ICGA and also spectral domain optical coherence tomography, lead to a better understanding and improved knowledge of macular diseases.
    Clinical and Experimental Ophthalmology 02/2009; 37(1):130-43. · 1.96 Impact Factor
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    ABSTRACT: HintergrundDie zunehmende Bedeutung des OCT (optische Kohärenztomographie) in der Makuladiagnostik bei Verlaufskontrollen nach Makulatherapie und einer hohen Anzahl von Kontrollen nach Anti-VEGF-Therapie lassen standardisierte Auswertungsstrategien und OCT-Untersuchungsrichtlinien sinnvoll erscheinen. Methode und ErgebnisseFür das Status OCT III wurden grundsätzliche Guidelines zur Untersuchung von Makulaerkrankungen erarbeitet. Im ersten Teil des Beitrags geht es um grundsätzliche Tipps für die OCT-Untersuchung bezüglich Untersuchungsdurchführung, Patientencompliance, Bildqualität, Bewegungsartefakte, Algorithmen, Archivierung und Interpretation von OCT-Bildern. Im zweiten Teil werden der Stellenwert und die Einsatzempfehlung des OCT bei der altersbedingen Makuladegeneration (AMD) und deren Therapiekontrollen zusammengefasst sowie entsprechend ihrerer einzelnen Formen unterteilt. Im dritten Teil wird ein kurzer Ausblick auf Weiterentwicklungen wie die digitale Integrationsmethode (DIM) gegeben, die beim Stratus OCT III eine identische Scanlokalisation im Verlauf und Ausschluss von Bewegungsartefakten gewährleistet. SchlussfolgerungDurch den standardisierten Einsatz des Stratus OCT III und geeigneter Auswertungsprogramme zur Makuladiagnostik im Verlauf nach Therapie kann der Einsatz des OCT optimiert, zeitsparend eingesetzt und v.a. vergleichbar gemacht werden. Damit erhöht sich die Aussagequalität sowohl für die Routine in Arztpraxen und Kliniken sowie auch für Studien. BackgroundOptical coherence tomography (OCT) has gained increasing relevance for follow-up after the treatment of macular diseases especially after anti-VEGF therapy. Therefore it seemed reasonable to develop standardized evaluation strategies and OCT examination guidelines for Stratus OCT III. Materials and methodsBasic guidelines for the Stratus OCT III examination of macular diseases were developed. The first part contains basic advice for the OCT examination with respect to the examiner, patients, image quality, movement artefacts, algorithms, archiving and interpretation of OCT images. The second part consists of the relevance and indications for OCT examination especially in age-related macular degeneration (AMD), subgroups of AMD and follow-up after treatment. The third part demonstrates a brief outlook on future developments, such as the digital integration method (DIM), which provides identical scan localization in follow-up and eliminates any movement artefacts. ConclusionThe application of standardized routine scanning and analysis protocols in Stratus OCT III for macular diseases and follow-up examinations provides an optimized, time-saving and comparable use of OCT. Therefore, the relevance and quality of OCT is increased for routine use in outpatient departments, hospitals and also for clinical studies.
    Der Ophthalmologe 01/2009; 106(2):116-126. · 0.53 Impact Factor
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    ABSTRACT: A fundamental weak point in the previous optical coherence tomography (OCT) pictures of Stratus OCT III is counterbalanced through the correction of eye movement artefacts by the new digital integration method (DIM). For the first time, DIM allows the precise anatomical OCT-scan localization in the fundus or fluorescein angiographic (FLA) image and leads to an objective morphological and topographic correlation. Using a newly developed fundus enhancement system (FES), DIM provides fundus images of OCT of high quality in almost every patient. To control and document any possible eye movement artefacts, a retinal tracking system was developed (RTS). The RTS tapes the fundus image in OCT during the scanning procedure. Using the new morphological information a new knowledge is obtained on uncertain angiographic phenomena by detecting serous retinal pigment epithelium (RPE) detachments and may lead to treatment consequences. In FLA images without leakages DIM reveals in OCT undetected serous RPE detachments. In addition, in 100% classic choroidal neovascularization (CNV) with a hypofluorescent halo DIM demonstrates a larger extent of the CNV than expected in FLA. Using DIM the OCT-scan position for the follow-up can be now assessed in a safe and reliable manner, which is mandatory for the evidence of OCT studies.
    Expert Review of Ophthalmology 11/2007; 2(6):911-916.
  • A. Hassenstein, G. Richard, W. Inhoffen, F. Scholz
    Spektrum Der Augenheilkunde - SPEKTRUM AUGENHEILKD. 01/2007; 21(1):43-48.
  • A. Hassenstein, G. Richard, W. Inhoffen, F. Scholz
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    ABSTRACT: Zusammenfassung Die neue digitale Integrationsmethode (DIM) erlaubt erstmals die anatomisch exakte Integration der OCT-Scanlage in das Fluoreszenzangiographiebild (FLA) mit Hilfe von Referenzmarkern an Gefäßgabelungen. Somit ist eine präzise Korrelation von angiographischen und morphologischen Pathologien möglich und führt zu gegenseitigem besseren Verständnis. Am meisten haben die Erkrankungen profitiert, die in der Angiographie unklare Phänomene zeigen und mit deren präziser Korrelation im OCT zusätzliche Information gewonnen werden kann wie z. B. bei den Leckagen unklarer Herkunft, wo das OCT topographisch das Areal einer serösen RPE-Abhebung (RPE) markieren kann. Bisher war nicht wirklich klar, ob die wichtigsten Makulastrukturpathologien von FLA und OCT dieselbe Region tatsächlich erfasst haben. Dies war besonders dann von Relevanz, wenn unterschiedliche Personen die Untersuchung durchführen oder auch beurteilen. Dieses Problem kann nunmehr durch die neue digitale Integrationsmethode (DIM) als weitgehend gelöst gelten. Dies ist zudem die eigentliche Voraussetzung für Verlaufskontrollen mittels OCT. Durch die objektive, zuverlässige und präzise gegenseitige Korrelation der OCT- und FLA-Befunde ist es nun erstmals möglich auch bei Verlaufskontrollen sicher dieselbe Scanlokalisation einzustellen. Für Verlaufskontrollen in Studien mit dem OCT sollte die digitale Integrationsmethode (DIM) auch als qualitätssichern de Maßnahme gefordert werden, um die Aussagekraft der Ergebnisse zu erhöhen.
    Spektrum der Augenheilkunde 01/2007; 21(1):43-48. · 0.18 Impact Factor
  • A Hassenstein, F Scholz, G Richard
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    ABSTRACT: Biomorphometric studies using optical coherence tomography (OCT) in patients with epiretinal membranes reveal a highly reflective membrane, a significant foveal thickening, loss of the foveal depression, and the presence of intraretinal cysts. Epiretinal membranes are more frequently totally adherent than separated with focal points of adherence. Visual acuity correlates with foveal thickness prior to and 6 months after vitrectomy and surgical removal of epiretinal membranes. Foveal thickening regresses postoperatively, but normal values are seldom reached. Marked foveal thickening, nonexistent foveal depression, and extensive cyst formation are supposed to correlate with a rather poor visual outcome. OCT plays a pivotal role in the differential diagnosis of pseudomacular hole in epiretinal membranes and of full-thickness macular hole. In addition to biomicroscopy and fluorescein angiography, OCT images provide valuable information for a structural assessment of the macula, especially in evaluating the postoperative course of macular surgery.
    Der Ophthalmologe 03/2005; 102(2):127-32. · 0.53 Impact Factor
  • A Hassenstein, F Scholz, G Richard
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    ABSTRACT: The traditional Gass classification of macular holes can now be supplemented by additional and more detailed morphologic information obtained with optical coherence tomography (OCT). The perifoveal vitreous detachment and subsequent anterior foveal traction is considered to be the primary pathomechanism of macular hole formation. In cases of persistent traction on the fovea it may lead to foveal dehiscence. A possible explanation for intraretinal cyst formation may be secondary vitreous body fluid accumulation within the retina. A classification of macular holes based on additional information from OCT images is possible. Thus, OCT is a valuable tool for differential diagnosis of a pseudo macular hole versus macular hole, precise stage classification, therapy decision making process, outcome control after macular surgery, and prognosis prediction.
    Der Ophthalmologe 09/2004; 101(8):777-84. · 0.53 Impact Factor

Publication Stats

190 Citations
41.47 Total Impact Points

Institutions

  • 1998–2013
    • University Medical Center Hamburg - Eppendorf
      • Department of Ophthalmology
      Hamburg, Hamburg, Germany
  • 1998–2011
    • University of Hamburg
      • • Department of Ophthalmology
      • • Department of Medical Microbiology, Virology and Hygiene
      Hamburg, Hamburg, Germany