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Der Ophthalmologe 05/2013; · 0.62 Impact Factor
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ABSTRACT: Die Transplantation von Iris-Pigmentepithel (IPE) in den subretinalen Raum wird als therapeutischer Ansatz in der Behandlung
der altersabhängigen Makuladegeneration nach chirurgischer Membranextraktion untersucht. Der Erfolg einer IPE-Transplantation
hängt von verschiedenen Faktoren ab, wie einer ausreichenden Anzahl transplantierter Zellen, der Fähigkeit der transplantierten
Zellen einen Zellverband mit den Photorezeptoraußensegmenten zu bilden, sowie die Übernahme der RPE-Zellfunktionen durch die
transplantierten IPE-Zellen.
In der Kölner Universitätsklinik wurden bei 20 Patienten mit altersabhängiger Makuladegeneration nach Membranextraktion autologe
IPE-Zellen als Zellsuspension in den Subretinalraum transplantiert. Während der Nachbeobachtung von mindestens einem Jahr
zeigte sich ein Überleben der Zellen sowie kein Hinweis für eine Beeinträchtigung der Photorezeptorfunktion. Eine Stabilisierung
der Funktion konnte in der Mehrheit der Patienten erzielt werden und fluoreszenzangiographisch zeigt sich bei keinem der 20
Patienten ein Anhalt für ein Rezidiv der subretinalen Neovaskularisierung. Die transplantierten Zellen scheinen funduskopisch
am Ort der Transplantation verblieben zu sein, jedoch ist es klinisch nicht möglich sicherzustellen ob die Zellen sich ausgebreitet
oder geteilt hatten. Die vorläufige Auswertung der 3-Jahres-Nachbeobachtung bestätigte diese Ergebnisse. Da die sichere Ausbildung
eines einschichtigen Zellverbandes wichtig für einen funktioneilen Erfolg der IPE-Transplantation ist, wurden an unserer Klinik
Studien begonnen, die eine Transplantation von Zellverbänden im Tierexperiment untersuchen.
Spektrum der Augenheilkunde 04/2012; 18(1):44-47. · 0.26 Impact Factor
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ABSTRACT: The presented Z-suture is a simple, rapid and safe knotless technique that facilitates transscleral suture fixation of various intraocular implants in the ciliary sulcus, such as sutured intraocular lenses, artificial iris prostheses and iris diaphragms. As the knotless approach reliably avoids suture erosion, external fixation can be performed without any protecting scleral flaps or lamellar grooves. The needle is simply passed through the sulcus and the emerging polypropylene suture is secured in the sclera using a zigzag-shaped intrascleral suture (Z-suture). Each pass starts directly adjacent to the exiting site. Five passes are sufficient to reliably fix the suture so that it resists even maximum tractive forces. Once this procedure is done, the suture can be cut without any knot. By avoiding suture knots, and hence the need for intrascleral flaps, this knotless approach may help to reduce suture-related complications such as scleral atrophy, suture erosion and infections.
The British journal of ophthalmology 02/2010; 94(2):167-9. · 2.92 Impact Factor
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Klinische Monatsblätter für Augenheilkunde 02/2009; 226(1):70-2. · 0.51 Impact Factor
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Der Ophthalmologe 02/2008; 105(1):74-7. · 0.62 Impact Factor
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ABSTRACT: To report the functional and morphological outcome of surgical treatment of peripapillary choroidal neovascularisation due to age-related macular degeneration.
Consecutive interventional case series of eight patients with extensive peripapillary choroidal neovascularisation and accompanying haemorrhage who underwent subretinal surgery including extraction of the neovascular complex. Ophthalmic examination, including visual acuity testing, colour photography and fluorescein angiography, was performed at baseline and at 3, 6, 9 and 12 months, and then yearly.
Mean follow-up was 26 months (12-60 months). Preoperative best corrected visual acuity (BCVA) ranged from logMAR (logarithm of minimum angle of acuity) 1.0 (20/200) to logMAR 0.0 (20/20), with a mean of logMAR 0.5 (20/63). Mean postoperative BCVA was logMAR 0.3 (20/40). BCVA improved in six patients, was stable in one patient and deteriorated in one patient. Two years after surgery, one patient developed recurrence of the CNV that was removed surgically. One patient showed retinal detachment 5 years after subretinal surgery.
In this small case series of PPCNV, functional improvement was achieved after surgery in the majority of patients. Surgical extraction of the CNV represents an alternative treatment option in eyes with vision-threatening extensive PPCNV. Randomised controlled studies seem to be justified to evaluate further the beneficial effect and long-term functional outcome of this therapy approach.
British Journal of Ophthalmology 09/2007; 91(8):1027-30. · 2.90 Impact Factor
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ABSTRACT: The purpose of the study is to report data on short-term safety of intravitreal bevacizumab treatment and its effect on visual function, central retinal thickness, and angiographical changes of occult choroidal neovascularization due to age-related macular degeneration.
A consecutive interventional case series of 30 patients with active subfoveal occult choroidal neovascularization secondary to age-related macular degeneration was followed after one intravitreal injection of 1.25 mg bevacizumab at baseline and subsequent injections following standardized criteria. At baseline and follow-up visits patients had visual acuity assessment, intraocular pressure measurement, fluorescein angiography, and optical coherence tomography imaging.
No serious ocular or systemic adverse events were identified. A significant increase of intraocular pressure or signs of retinal toxicity or endophthalmitis were not detected in any patient. Optical coherence tomography revealed significant decrease (p < 0.001) in central retinal thickness after 1 week, 4 weeks, and 12 weeks, respectively. Fluorescein leakage decreased within 1 week and improvement was maintained at week 12 in the majority of patients. Visual acuity improved or remained stable in 29 of 30 patients; improvement of 3 or more lines was seen in 14 of 30 patients; one patients showed improvement of 6 lines. No patient had severe vision loss of 6 lines or more; moderate vision loss of 3 lines was seen in one patient. Re-injections of bevacizumab according to standard criteria were performed one to two times during the follow-up period of 12 weeks with a re-injection interval of 4 to 18 weeks (median 8 weeks).
Short-term results suggest that intravitreal injection of bevacizumab is well tolerated and for the majority of patients with occult choroidal neovascularization in AMD results in improvement of visual acuity, decrease in central retina thickness, and reduction of angiographic leakage of the lesion. Bevacizumab as intravitreal treatment may provide a novel therapeutic option for selected patients with exudative AMD. Randomized prospective multicenter trials seem justified to further evaluate long term effects and impact of intravitreal bevacizumab on different subtypes of AMD compared to established therapies.
Albrecht von Graæes Archiv für Ophthalmologie 07/2007; 245(7):941-8. · 2.17 Impact Factor
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ABSTRACT: The aim of the present study was to evaluate potential electrophysiological changes after 360 degrees retinotomy and macular translocation for subfoveal choroidal neovascularisation in patients with age-related macular degeneration.
A consecutive series of 32 patients suffering from subfoveal choroidal neovascularisation secondary to age-related macular degeneration underwent 360 degrees retinotomy and macular translocation. The scotopic triple-flash ERG (TERG) served as the main parameter of the study and was recorded one day prior to the translocation surgery and no earlier than 4 weeks after the silicone oil removal.
The TERG amplitudes were significantly reduced after translocation surgery. Depending on the applied flash luminance the mean amplitude reduction of the first b-wave varied between 67 % (0.2 cds/m (2)) and 74 % (0.03 cds/m (2)). The latency of the second b-wave of the preoperative TERG proved to have predictive power with reference to the postoperative visual acuity. A statistically significant correlation between the latency of the second b-wave for a flash intensity of 0.03 and 0.1 cds/m (2) and the postoperative visual acuity was shown (p = 0,016 and p = 0,049).
In accordance with previous studies the present study indicates that a significant electrophysiological decrease is caused by surgical procedures associated with macular translocation. In future, due to predictive parameters of the TERG the preoperative selection of patients could be improved.
Klinische Monatsblätter für Augenheilkunde 03/2007; 224(2):120-6. · 0.51 Impact Factor
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ABSTRACT: Cutis marmorata telangiectatica congenita is a rare, cutaneous and vascular anomaly characterised by congenital cutis marmorata, telangiectasis, and phlebectasia. Systemic abnormalities are frequently associated with this condition, although they may be highly variable. Ocular abnormalities are quite rare and include retinal detachment and congenital glaucoma. If glaucoma is present it is unilateral in most cases.
A case of bilateral congenital glaucoma associated with cutis marmorata telangiectatica congenita in a 4-month-old girl is presented. Follow-up and treatment over a four-year period are reported.
Congenital glaucoma is a rare ophthalmic condition encountered in patients with cutis marmorata telangiectatica congenita. If glaucoma is present it is most likely unilateral, although cases of bilateral glaucoma in these patients occur. Regular ophthalmological examinations are recommended for children with cutis marmorata telangiectatica congenita--especially if characteristic skin changes are present in the face.
Klinische Monatsblätter für Augenheilkunde 02/2007; 224(1):66-9. · 0.51 Impact Factor
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Der Ophthalmologe 06/2006; 103(5):421-3. · 0.62 Impact Factor
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ABSTRACT: To analyse the effect of trypan blue on the retina in an experimental setting of macular surgery.
Porcine eyes were used within 3 hours after death. The eyes were hemisected and the vitreous removed. Trypan blue (0.15%) was applied over the trephined posterior pole, whereas the rest of the eye cup was filled with a balanced salt solution (BSS). The dye and the BSS were removed after 1 minute and the complete eye cup irrigated and filled with fresh BSS. Both the treated and untreated retinas were illuminated with a standard surgical light pipe and source at maximum power for 10 minutes. Both the trypan blue exposed retina and the non-treated surrounding retina were processed for histology.
Exposure of the retina to trypan blue for 1 minute, followed by illumination caused no histologically detectable damage compared to the controls. No microarchitectural disorganisation, cellular disruption, or affection of the vitreoretinal interface was detected.
These findings indicate that a 1 minute exposure of trypan blue followed by illumination does not cause an acute morphologically detectable toxic effect on the porcine retina.
British Journal of Ophthalmology 10/2004; 88(9):1206-8. · 2.90 Impact Factor
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ABSTRACT: To analyze the histopathology of choroidal neovascularization after external beam radiotherapy in age-related macular degeneration.
A retrospective non-case-matched comparative histopathologic study. The histoarchitecture of nine surgically removed subretinal specimens from nine patients that had undergone external beam radiotherapy for exudative age-related macular degeneration was studied. Seven patients had received 20 Gy in 10 fractions and two 15 Gy in 5 fractions with an average time interval between radiotherapy and surgical extraction of 14 months (range 3-28). A consecutive series of classic, mixed and occult choroidal neovascular membranes served as controls.
Clinical findings. Radiation-associated choroidal neovasculopathy was angiographically suspected in four patients: a coarse net of vessels on fluorescein angiography developing at the border of previously irradiated choroidal neovascularization was observed in three patients; blebs at the margin of a plaque on indocyanine green angiography were observed in two patients. Pathological findings. Diffuse drusen as well as intra-Bruch's fibrovascular tissue was found in all irradiated specimens. In four specimens an edematous vascularized layer was seen between diffuse drusen and normal-appearing intra-Bruch's fibrovascular tissue. This lesion was not found in the control specimens. A particular correlation for the bleb lesion was not recognized.
The appearance of an edematous subretinal pigment epithelial vascularized layer between diffuse drusen and normal-appearing fibrovascular tissue in four of nine irradiated membranes may be secondary to previous irradiation. It may correlate with the unusual exudative manifestations observed after external beam radiotherapy.
Albrecht von Graæes Archiv für Ophthalmologie 05/2003; 241(4):269-76. · 2.17 Impact Factor
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ABSTRACT: To analyze and compare the histopathology of surgically extracted membranes in hemorrhagic age-related macular degeneration (AMD) versus extracted classic, mixed and occult choroidal neovascularization (CNV) in AMD.
Thirty consecutive membranes, surgically removed in hemorrhagic AMD, were analyzed and compared with consecutive series of 50 classic, 20 mixed and 20 occult membrane specimens in exudative AMD. The specimens were serially sectioned and stained in a stepped fashion with hematoxylin-eosin, Masson trichrome and periodic acid-Schiff stain.
Diffuse drusen were observed in all hemorrhagic AMD specimens, fibrovascular tissue was found in 29 of 30 specimens which was located subretinally in 11 specimens and/or in Bruch's membrane in 28 specimens. A hemorrhage was located subretinally in 21 specimens, in the stroma of the fibrovascular tissue in 17 specimens, at the choroidal side of the diffuse drusen adjacent to fibrovascular tissue in 13 specimens and at the choroidal side of the fibrovascular tissue in Bruch's membrane in 8 specimens. Grossly dilated thin-walled vessels were identified in one hemorrhagic AMD case, suggestive of polypoidal choroidal vasculopathy. Scarred tears of the retinal pigment epithelium were identified in two specimens.
A large spectrum of histo-architectural lesions is recognized in hemorrhagic maculopathy. Hemorrhages do not only characteristically appear in the subretinal space or in the stroma of the neovascular tissue but also at the choroidal side of the diffuse drusen adjacent to the neovascular complex and at the choroidal side of the intra-Bruch's fibrovascular tissue.
Albrecht von Graæes Archiv für Ophthalmologie 05/2002; 240(4):279-85. · 2.17 Impact Factor
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ABSTRACT: During surgical extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD), the defective foveal retinal pigment epithelium (RPE) is removed. Subsequent translocation of the foveal neural retina to adjacent healthy RPE should result in stabilization and possibly improvement of visual acuity.
A prospective case series was carried out using controlled surgery and examination protocols with examinations made at fixed intervals. The surgical procedures combine counterrotation of the globe, phacoemulsification and implantation of a posterior chamber lens, complete vitrectomy, induction of a total retinal detachment, 360 degrees anterior retinotomy, removal of the subfoveal neovascular complex, foveal translocation outside the RPE defect, reattachment of the retina using F6H8, peripheral laser retinopexy and temporary silicone oil tamponade.
Macular translocation surgery was performed on 100 patients between December 1997 and December 1999. All patients had experienced recent visual loss due to exudative AMD and of these, 26 patients had major macular subretinal hemorrhage, 39 patients had occult and 25 patients classic subfoveal choroidal neovascularization. The preoperative findings in the remaining patients included tears in the pigment epithelium (n = 4), polypoidal choroidal vasculopathy (n = 1), recurrent subfoveal CNV following laser therapy (n = 2) and deep retinal vascular anomalous complexes (n = 3).
A total of 97 patients completed the 12-month examination. Visual acuity increased by 15 or more ETDRS chart letters in 24 patients, remained stable in 42 patients and deteriorated by 15 or more EDTRS chart letters in 34 patients 12 months postoperatively. The silicone oil tamponade was removed in 97 patients, in 10 patients, silicone oil had to be reinjected because of severe complications. A secondary procedure was necessary in 25 patients, primary PVR was observed in 9 eyes, secondary PVR developed in 10 eyes, a macular pucker in 5 eyes and a macular hole in 1 patient. Other postoperative complications included persistent hypotonia, macular edema, IOL dislocation, keratopathy and recurrent CNV (n = 3).
Macular translocation is a technically demanding operation, which requires a considerable learning curve. Although the procedure has a high rate of surgical and postoperative complications, the functional and anatomical results appear to be promising for selected patients with subfoveal CNV secondary to AMD.
Der Ophthalmologe 04/2002; 99(3):164-70. · 0.62 Impact Factor
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ABSTRACT: Hintergrund. Mit dem Ziel einer Stabilisierung oder Verbesserung der visuellen Funktion von Patienten mit altersabhängiger Makuladegeneration
(AMD) wurde die Translokation der Makula auf gesundes Pigmentepithel (RPE) nach Extraktion einer chorioidalen Neovaskularisation
(CNV) entwickelt.
Methodik. In einer prospektiven Fallserie nach kontrolliertem Operations- und Untersuchungsprotokoll wurden funktionelle und angiographische
Veränderungen nach Makulatranslokation bei 100 Patienten im Verlauf eines Jahres untersucht. Das operative Vorgehen umfasst
eine Phakoemulsifikation und Implantation einer Hinterkammerlinse, vollständige Vitrektomie, induzierte Netzhautablösung,
360° anteriore Retinotomie, Entfernung des subretinalen Membrankomplexes, Translokation der Fovea aus dem RPE-Defekt, Wiederanlage
der Netzhaut unter Verwendung von Perfluorcarbonen, Endolaserkoagulation und temporäre Silikonöltamponade. Überwiegend erfolgte
eine Zyklorotation des Bulbus in Kombination mit dem Primäreingriff oder der Silikonölablassung.
Patienten. Im Zeitraum Dezember 1997 bis Dezember 1999 wurden 100 Patienten am Zentrum für Augenheilkunde der Universität zu Köln nach
dieser Technik operiert. Alle Patienten hatten eine Visusreduktion infolge einer chorioidalen Neovaskularisation bei AMD erlitten.
Bei 26 Patienten lag eine nach rtPA- und Gasinjektion persistierende submakuläre Blutung vor, bei 39 Patienten bestand eine
okkulte CNV, bei 25 Patienten eine klassische CNV, bei 10 Patienten lagen andere Formen (polypoidale Vaskulopathie, Pigmentepitheleinriss,
chorioretinale Anastomosen) vor.
Ergebnisse. Es konnten 97 Patienten über 12 Monate postoperativ kontrolliert werden. Die Sehschärfe stieg 12 Monate postoperativ bei
24 Patienten um mindestens 15 ETDRS-Zeichen an, blieb bei 42 Patienten stabil und fiel um mindestens 15 ETDRS-Zeichen bei
34 Patienten ab. Die Silikonöltamponade war bei 97 Patienten entfernt worden. Ein Revisionseingriff wegen schwerer Komplikationen
wurde bei 25 Patienten notwendig (primäre PVR n=9, sekundäre PVR n=10, Makulapucker n=5, Makulaforamen n=1). Als weitere Komplikationen
traten eine persistierende okuläre Hypotonie, Keratopathie, IOL-Dislokation, Makulaödem, CNV-Rezidiv (n=3) und Zyklodeviation
auf.
Schlussfolgerung. Das Operationsverfahren stellt einen aufwändigen und technisch anspruchsvollen Eingriff mit langer Lernphase sowie einem
hohen intraoperativen und postoperativen Komplikationsprofil dar. Nach unseren Ergebnissen erscheint die Makulatranslokation
dennoch eine aussichtsreiche Therapieform für ausgewählte Patienten mit exsudativer AMD zu sein.
Background. During surgical extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD), the defective
foveal retinal pigment epithelium (RPE) is removed. Subsequent translocation of the foveal neural retina to adjacent healthy
RPE should result in stabilization and possibly improvement of visual acuity.
Methods. A prospective case series was carried out using controlled surgery and examination protocols with examinations made at fixed
intervals. The surgical procedures combine counterrotation of the globe, phacoemulsification and implantation of a posterior
chamber lens, complete vitrectomy, induction of a total retinal detachment, 360° anterior retinotomy, removal of the subfoveal
neovascular complex, foveal translocation outside the RPE defect, reattachment of the retina using F6H8, peripheral laser
retinopexy and temporary silicone oil tamponade.
Patients. Macular translocation surgery was performed on 100 patients between December 1997 and December 1999. All patients had experienced
recent visual loss due to exudative AMD and of these, 26 patients had major macular subretinal hemorrhage, 39 patients had
occult and 25 patients classic subfoveal choroidal neovascularization. The preoperative findings in the remaining patients
included tears in the pigment epithelium (n=4), polypoidal choroidal vasculopathy (n=1), recurrent subfoveal CNV following laser therapy (n=2) and deep retinal vascular anomalous complexes (n=3).
Results. A total of 97 patients completed the 12-month examination. Visual acuity increased by 15 or more ETDRS chart letters in 24
patients, remained stable in 42 patients and deteriorated by 15 or more EDTRS chart letters in 34 patients 12 months postoperatively.
The silicone oil tamponade was removed in 97 patients, in 10 patients, silicone oil had to be reinjected because of severe
complications. A secondary procedure was necessary in 25 patients, primary PVR was observed in 9 eyes, secondary PVR deve-loped
in 10 eyes, a macular pucker in 5 eyes and a macular hole in 1 patient. Other postoperative complications included persistent
hypotonia, macular edema, IOL dislocation, keratopathy and recurrent CNV (n=3).
Conclusions. Macular translocation is a technically demanding operation, which requires a considerable learning curve. Although the procedure
has a high rate of surgical and postoperative complications, the functional and anatomical results appear to be promising
for selected patients with subfoveal CNV secondary to AMD.
Der Ophthalmologe 02/2002; 99(3):164-170. · 0.62 Impact Factor
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ABSTRACT: Macular translocation for treatment of age-related maculopathy often necessitates surgical counter-rotation of the external eye muscles. Excyclorotatory effects can be attained generally by various surgical methods on all extraocular eye muscles. If procedures on different muscles are combined, anterior segment perfusion has to be maintained.
The results of 29 operations were analysed in order to examine the excyclorotatory effects of 4 different combined surgical approaches.
In 23 patients a partial transposition of all 4 m. recti together with a high dose combined operation on both oblique muscles yielded a mean effect of 21.6 degrees excyclorotation. In four patients a vertical transposition of the horizontal m. recti in opposite directions together with a high dose combined operation on both oblique muscles led to a mean excyclorotation of 22 degrees. A full tendon transposition of the superior oblique muscle to the nasal part of the orbit in one case combined with a downward transposition of the medial rectus muscle resulted in an excyclorotation of 37 degrees, in another case combined with an anterior margin advancement of the inferior oblique muscle led to an excyclorotation of 35 degrees.
All approaches yielded mean counter-rotatory effects over 20 degrees. The indications are discussed under the aspects of the possibility of a one-step correction of horizontal or vertical angles, dosage, induction of inconcomitancies and operation time.
Der Ophthalmologe 02/2002; 99(1):10-4. · 0.62 Impact Factor
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ABSTRACT: Fragestellung. In Zusammenhang mit der Makulatranslokation bei altersbedingter Makuladegeneration sind häufig augenmuskelchirurgische Eingriffe
zur Gegenrotation des Bulbus erforderlich. Es stellt sich die Frage nach der Effektivität von Kombinationen einzelner Eingriffe.
Patienten und Methode. Anhand der Auswertung von 29 Operationen wurde der exzyklorotatorische Effekt von 4 unterschiedlichen kombinierten gegenrotatorischen
Maßnahmen untersucht.
Ergebnisse. Bei 23 Patienten mit Teiltransposition aller 4 geraden Muskeln und hochdosierter kombinierter Operation der schrägen Augenmuskeln
betrug der exzyklorotatorische Effekt im Mittel 21,6°; bei 4 Patienten mit gegensinniger Vertikaltransposition der horizontalen
geraden Muskeln kombiniert mit hochdosierter Chirurgie an beiden schrägen Muskeln 22°. Die vollständige Transposition des
M. obliquus superior nach nasal ergab in einem Fall kombiniert mit der Ansatzverlagerung des M. rectus medialis 37° Exzyklorotation,
in einem weiteren Fall in Kombination mit der Vorderrandvorlagerung des M. obliquus inferior 35°.
Schlussfolgerung. Alle Verfahren zeigten einen mittleren gegenrotatorischen Effekt über 20°. Die Indikationen der Verfahren werden im Hinblick
auf Möglichkeit der gleichzeitigen Korrektur von Horizontal- oder Vertikalwinkeln, Dosierbarkeit, Induktion von Inkomitanzen
und Operationszeit diskutiert.
Background. Macular translocation for treatment of age-related maculopathy often necessitates surgical counter-rotation of the external
eye muscles. Excyclorotatory effects can be attained generally by various surgical methods on all extraocular eye muscles.
If procedures on different muscles are combined, anterior segment perfusion has to be maintained.
Patients and methods. The results of 29 operations were analysed in order to examine the excyclorotatory effects of 4 different combined surgical
approaches.
Results. In 23 patients a partial transposition of all 4 m. recti together with a high dose combined operation on both oblique muscles
yielded a mean effect of 21.6° excyclorotation. In four patients a vertical transposition of the horizontal m. recti in opposite
directions together with a high dose combined operation on both oblique muscles led to a mean excyclorotation of 22°. A full
tendon transposition of the superior oblique muscle to the nasal part of the orbit in one case combined with a downward transposition
of the medial rectus muscle resulted in an excyclorotation of 37°, in another case combined with an anterior margin advancement
of the inferior oblique muscle led to an excyclorotation of 35°
Conclusions. All approaches yielded mean counter-rotatory effects over 20°. The indications are discussed under the aspects of the possibility
of a one-step correction of horizontal or vertical angles, dosage, induction of inconcomitancies and operation time.
Der Ophthalmologe 12/2001; 99(1):10-14. · 0.62 Impact Factor
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[show abstract]
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ABSTRACT: To evaluate electrophysiological changes after 360 degrees retinotomy and macular translocation for subfoveal choroidal neovascularisation in patients with age related macular degeneration (AMD).
A consecutive series of 32 patients suffering from subfoveal choroidal neovascularisation secondary to AMD underwent 360 degrees retinotomy and macular translocation. The ERG served as the main parameter of the study and was recorded 1 day before the translocation surgery and no earlier than 4 weeks after the silicone oil removal.
The scotopic ERG amplitudes were significantly reduced after translocation surgery. Depending on the applied flash luminance the mean b-wave amplitude reduction of the scotopic ERG varied between 67% (0.2 cd.s/m2) and 74% (0.03 cd.s/m2). The a-waves and b-waves of the saturating light response decreased significantly by 46% and 59%, respectively. The photopic a-wave and b-wave amplitudes were significantly lower after the translocation surgery resulting in a mean reduction of 27% and 43%, respectively.
Although macular translocation may provide the potential of preserving and even restoring vision in patients with subfoveal choroidal neovascular membranes secondary to AMD the present study indicates that a significant electrophysiological decrease is caused by surgical procedures associated with this technique. Further research is necessary to clarify if certain modifications of the surgical procedure are able to substantially reduce the neuroretinal trauma.
British Journal of Ophthalmology 09/2001; 85(8):928-32. · 2.90 Impact Factor
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ABSTRACT: Acanthamoeba keratitis is a severe, painful corneal infection found in contact lens wearers. The entity can easily be confused with herpetic or fungal keratitis, especially if no ocular pain is reported.
A 32-year old myopic female presented a unilateral keratitis of unknown etiology since 3 weeks. Administration of topical antiviral substances and corticosteroids led only to temporary improvement of the condition. The patient complained of photophobia but not of ocular pain. The affected eye showed corneal edema, central stromal thickening, descemet's striae as well as fibrin deposits on the corneal endothelium and in the anterior chamber.
An aqueous specimen was negative for a viral infection. A culture for bacteria was negative. Staphylococci were cultured from corneal scrapings and Enterococci from the contact lens solution. Another corneal scraping revealed Acanthamoeba class II (6 weeks after the onset of symptoms).
Under treatment with propamidine, polymyxin b, neomycin, gramicidin and polyhexidine (topical) as well as fluconazole/ketoconazole (systemic) the diameter of the annular infiltrate, which had developed decreased, but the infiltrate persisted. In the further course, the infiltrate persisted while the amount of fibrin in the anterior chamber increased. Penetrating keratoplasty was performed. Histologic examination of the host corneal tissue revealed massive infiltration with Acanthamoeba.
Severe pain and history of wearing contact lenses are features suggestive of Acanthamoeba keratitis. The patient presented here had a history of contact lens wear, but no ocular pain was reported. The characteristic annular infiltrate had a late onset. Bacterial superinfection could not be ruled out. Therapeutic penetrating keratoplasty had to be performed as the condition deteriorated inspite of intensive chemotherapy. With penetrating keratoplasty a good visual acuity could be regained.
Klinische Monatsblätter für Augenheilkunde 09/2001; 218(8):570-3. · 0.51 Impact Factor
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ABSTRACT: To analyse the histopathology of vascularised pigment epithelial detachments and tears of the retinal pigment epithelium (RPE) in age related macular degeneration (AMD).
The light microscopic architecture of 10 surgically removed subretinal specimens-three vascularised pigment epithelial detachments, four recent tears, and three scarred tears as a manifestation of AMD-were studied and correlated with the angiographic findings.
Recent tears: a large fibrovascular membrane was found to be originally situated in Bruch's membrane. About half of the surface of the fibrovascular tissue was denuded of RPE and diffuse drusen. The RPE and diffuse drusen had retracted and rolled up, covering a neighbouring part of the intra-Bruch's fibrovascular membrane. The rolled up RPE and diffuse drusen were not interspersed with fibrovascular tissue but lay superficial to the intra-Bruch's fibrovascular membrane itself. Scarred tears: a collagen capsule surrounded the rolled up diffuse drusen and RPE. Fibrovascular tissue was found inside the rolled up material, predominantly at its choroidal side.
The area of choroidal neovascularisation associated with a vascularised pigment epithelial detachment and a tear of the RPE may be larger than was hitherto thought or indicated by fluorescein angiography. This neovascular tissue may be present within the bed of the RPE tear, as well as at the site of the scrolled up RPE.
British Journal of Ophthalmology 05/2001; 85(4):454-60. · 2.90 Impact Factor
