M H Foerster

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (320)510.49 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Relapsing ocular involvement is one of the major manifestations in Adamantiades-Behçet's disease (ABD). Combining systemic corticosteroids with cyclosporin A is currently the treatment of choice. Interferon-alpha (IFN-alpha) has proven to be effective in mucocutaneous ABD and has been reported to improve ocular lesions. We examined the longterm effects of IFN-alpha-2a in a case series of 45 patients with ocular involvement. Since 1988, 45 patients (79 eyes of 90 eyes) with ocular involvement in ABD have been treated with IFN-alpha (3 x 6-9 Mio IU per wk). In the initial acute phase of the disease, patients additionally received short-term corticosteroids (oral prednisolone 100 mg/day), tapered to a maintenance dose of 10 mg/day within 2 weeks. IFN-alpha-2a was administered as longterm therapy with a mean duration of 30 months (range 1.1-101 mo). IFN-alpha-2a/prednisolone treatment was effective against vasculitis, optic nerve neuropathy, and iritis. Sixty-four eyes had no recurrence under therapy. To date, recurrences have been seen in 26 eyes under IFN-alpha treatment. Flu-like symptoms were recorded in nearly all patients (n = 43). Further side effects were dose-dependent reversible thrombocytopenia (n = 1), psychosis (n = 3), depression (n = 13), thyroiditis (n = 1), and reversible diffuse alopecia (n = 7). In our series, 92% of all eyes showed stable or improved visual acuity in longterm followup. Longterm remission of ocular inflammation can be achieved with the combination of IFN-alpha and low-dose corticosteroids.
    The Journal of Rheumatology 06/2008; 35(5):896-903. · 3.19 Impact Factor
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    ABSTRACT: The implantation of scleral fixated sutured posterior chamber lenses enables lens implantation in the absence of adequate lens capsule support. Anterior chamber lenses and their side effects can also be avoided, particularly in cases of unilateral aphakia and contact lens incompatibility. This study is a retrospective analysis of 119 scleral fixated sutured posterior chamber lenses implanted in 115 patients. Seventy-nine cases of damaged zonula or damaged lens capsule and 17 cases of corneal decompensation secondary to anterior chamber lenses were the main indications for the suture fixation. The mean follow-up was 23 months (6-83 months). In 50% of all cases, improved visual acuity was achieved. Twenty-four percent of patients showed unchanged visual acuity, while 26% had poorer vision postoperatively, mainly because of corneal decompensation following anterior chamber lens explantation. The main postoperative complication was transient rise of intraocular pressure, occurring in 44% of the cases. In most cases improved or comparable postoperative visual acuity was achieved. The main complication observed was postoperative glaucoma, especially in patients with pre-existing glaucoma.
    International Ophthalmology 05/2008; 29(4):207-12. DOI:10.1007/s10792-008-9217-3 · 0.55 Impact Factor
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    ABSTRACT: X-linked congenital retinoschisis (RS) is a relatively frequent retinal dystrophy associated with RS1 gene mutations. A negative electroretinogram (ERG), i.e., a b/a wave ratio <1.0 in the standard combined response, is considered a key diagnostic feature of RS. Only a few cases without a negative ERG have been reported. This study includes 24 RS patients with RS1 mutations. ERGs (according to ISCEV standards, n = 23), ON-OFF-responses (n = 9), fundus autofluorescence (FAF, n = 8), and optical coherence tomography (OCT, n = 6) were performed. The mean age at examination was 22.6 years (0.5-53.2 years), and median visual acuity was 0.3 (no light perception to 0.6). A negative ERG was found in 13 of 23 patients (56.5%), of whom one patient presented a negative ERG at the 2-year follow-up, with an initial b/a wave ratio >1.0. Another patient had a b/a wave ratio of 0.96 in one eye and 1.02 in the fellow eye. In 10 of 23 patients, the b/a wave ratio ranged from 1.03 to 1.34. Single-flash cone and 30 Hz flicker responses were always reduced. FAF and OCT were pathologic in all patients tested. FAF was increased in the fovea. OCT revealed foveal schisis to various degrees and thinning of the retina in an older patient. Although ERG abnormalities were detected in all patients tested, more than 40% of patients with RS1 mutations did not have a negative ERG. In clinically suspected RS a combination of ERG, FAF, OCT, and molecular-genetic testing is advised to verify the diagnosis.
    Documenta Ophthalmologica 03/2008; 116(2):97-109. DOI:10.1007/s10633-007-9094-5 · 1.63 Impact Factor
  • H Heimann · K-U Bartz-Schmidt · N Bornfeld · C Weiss · R-D Hilgers · M H Foerster ·
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    ABSTRACT: The choice of primary vitrectomy as the first treatment method for rhegmatogenous retinal detachment has grown in popularity over recent years. The main reason behind this trend is the improved control of more complicated situations of retinal detachment. However, clinical trials comparing primary vitrectomy with scleral buckling had failed to demonstrate an advantage of this method regarding anatomical and functional results. The Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study (SPR study) is a prospective, randomised, multicentre study comparing primary vitrectomy with or without additional scleral buckling to scleral buckling alone. Overall, 681 patients with more complicated retinal detachments were recruited in 25 centres. In the phakic subgroup of patients, an advantage regarding the main endpoint (change in visual acuity) was found in the scleral buckling group. In the pseudophakic subgroup, no difference in functional outcome could be seen; however, better anatomical results with a lower rate of retina-affecting reoperations was observed in the vitrectomy group, with particularly good results in the subgroup of patients receiving vitrectomy and additional scleral buckling. Based on the available data, primary vitrectomy combined with a scleral buckle is the method of choice in more complicated types of retinal detachment in pseudophakic patients. In contrast, primary vitrectomy does not seem to offer an advantage over scleral buckling in phakic patients.
    Der Ophthalmologe 02/2008; 105(1):19-26. DOI:10.1007/s00347-007-1672-0 · 0.50 Impact Factor
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    ABSTRACT: Adamantiades-Behçet's disease (ABD) is a multi-system disorder with recurrent oral and/or genital ulcerations, skin lesions and ocular involvement. Eye involvement is a common manifestation that affects the patients' quality of life more than any other. Left untreated, it leads to blindness and often to loss of the eye through secondary complications like phthisis or painful glaucoma. In some cases, such as tractional retinal detachment, secondary glaucoma or secondary cataract formation, intraocular surgery is required. A prospective study of patients with ocular ABD who underwent intraocular surgery under systemic treatment with interferon-alpha was conducted. From 1999 to 2005, we treated eight eyes from five patients with pars plana vitrectomy (n = 1), phacoemulsification (n = 6) and trabeculectomy (n = 1). The mean follow-up was 49 months (range 5-94 months). Seven out of eight eyes had better visual acuity following surgery. One eye did not benefit from cataract surgery because of optic nerve atrophy. Only one eye showed prolonged inflammation following phacoemulsification. None of the patients showed a recurrence during follow-up. The failure of conservative glaucoma treatment necessitated trabeculectomy in one eye; the patient has had no further recurrence for 6 years under monotherapy with interferon-alpha. Interferon-alpha is a potent therapy for Adamantiades-Behçet's disease with ocular involvement. It also provides a basis for safe and reliable surgical interventions. In seven of eight eyes, there was no intra- or peri-operative recurrence of inflammation, which is a common complication after these procedures. Only one eye showed acute and prolonged inflammation following cataract surgery.
    Albrecht von Graæes Archiv für Ophthalmologie 12/2007; 245(11):1617-21. DOI:10.1007/s00417-007-0577-6 · 1.91 Impact Factor
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    ABSTRACT: To compare scleral buckling surgery (SB) and primary pars plana vitrectomy (PPV) in rhegmatogenous retinal detachments of medium complexity. Prospective randomized multicenter clinical trial (the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study), separated into phakic or aphakic/pseudophakic eyes. Patients were enrolled over a 5-year period. There was 1-year follow up in the study, and the primary outcome was assessed at 1 year. Forty-five surgeons (25 centers, 5 European countries) recruited 416 phakic and 265 pseudophakic patients. Completion of follow-up was achieved in 93% of the phakic and 89% of the pseudophakic patients. Scleral buckling surgery with the potential use of multiple sponges, encircling elements, drainage, and intraocular injections. Primary vitrectomy included 3-port vitrectomy with sulfur hexafluoride-air tamponade; additional SB was left to the surgeon's decision. Primary study end point: change in best-corrected visual acuity (BCVA); secondary end points: primary and final anatomical success, proliferative vitreoretinopathy, cataract progression, and number of reoperations. In the phakic trial, the mean BCVA change was significantly (P = 0.0005) greater in the SB group (SB, -0.71 logarithm of the minimum angle of resolution [logMAR], standard deviation [SD] 0.68; PPV, -0.56 logMAR, SD 0.76). In the pseudophakic trial, changes in BCVA showed a nonsignificant difference of 0.09 logMAR. In phakic patients, cataract progression was greater in the PPV group (P<0.00005). In the pseudophakic group, the primary anatomical success rate (defined as retinal reattachment without any secondary retina-affecting surgery; SB, 71/133 [53.4%]; PPV, 95/132 [72.0%]) was significantly better (P = 0.0020), and the mean number of retina-affecting secondary surgeries (SB, 0.77, SD 1.08; PPV, 0.43, SD 0.85) was lower (P = 0.0032) in the PPV group. Redetachment rates were 26.3% (SB; 55/209) and 25.1% (PPV; 52/207) in the phakic trial and 39.8% (SB; 53/133) and 20.4% (PPV; 27/132) in the pseudophakic trial. The study shows a benefit of SB in phakic eyes with respect to BCVA improvement. No difference in BCVA was demonstrated in the pseudophakic trial; based on a better anatomical outcome, we recommend PPV in these patients.
    Ophthalmology 12/2007; 114(12):2142-54. DOI:10.1016/j.ophtha.2007.09.013 · 6.14 Impact Factor
  • Steffen Schmidt · Christoph Bethge · Michael H Förster · Michael Schäfer ·
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    ABSTRACT: This clinical study tested the hypothesis whether intraoperative high versus low dose of intravenous remifentanil resulted in postoperatively increased pain sensitivity to painful cold or pressure stimulation in eye surgery patients without significant postoperative pain. Forty-two minor eye surgery patients were randomized to receive intraoperative high (0.4 microg/kg/min) or low (0.1 microg/kg/min) dose of intravenous remifentanil plus isoflurane over an average period of 70 minutes. Pain assessment at the surgical site, postoperative versus preoperative baseline measurements by the cold as well as the pressor test, sedation score, and withdrawal signs were evaluated 30 and 90 minutes after stop of remifentanil infusion. Patients with pain at the surgical site were excluded. Pressure pain tolerance thresholds at the palmar carpus of the right hand were significantly decreased in these patients after cessation of intraoperative high but not low dose of IV remifentanil. However, withdrawal latencies to cold stimulation were not significantly altered. Isoflurane concentrations were slightly higher in patients receiving the low dose of remifentanil, however, there were no significant differences in length of anesthesia and postoperative sedation. Signs of withdrawal were not observed. After high dose intravenous remifentanil our results show signs of a reduced tolerance to painful pressure but not cold stimuli distant to the surgical field. Although clinically relevant surgical pain was not reported in these patients, the demonstrated induction of hyperalgesia to painful pressure stimuli suggests a general effect in the central nervous system.
    Clinical Journal of Pain 10/2007; 23(7):605-11. DOI:10.1097/AJP.0b013e318122d1e4 · 2.53 Impact Factor
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    ABSTRACT: To determine the clinical incidence and characteristics of symptomatic choroidal metastasis (CM) in breast cancer. Forty-six consecutive patients with CM from breast cancer were retrospectively reviewed in respect of ocular findings, medical history and systemic disease. Clinical incidence of CM was determined and compared with the incidence predicted from prevalence data obtained in ocular screening studies. Choroidal metastasis occurred with a median interval of 42.4 months after diagnosis of breast cancer and was predominantly unilateral (63% patients) and solitary (57% affected eyes). A total of 32% of patients had no history of metastatic tumour disease, but systemic screening with CT and scintigraphy revealed metastatic disease in 100% of patients. A median number of three other organs were affected by metastasis. Median survival from diagnosis of CM was 13.1 months. The mean number of local patients diagnosed with CM was 2.9 per year, which was one order of magnitude less than predicted from clinical screening studies. Choroidal metastasis occurs in advanced metastatic breast cancer, indicating a grave vital prognosis. In a minority of patients (32%) it is the first sign of metastatic disease. The clinical incidence of CM is far smaller than predicted from prevalence data obtained from ocular screening studies.
    Acta Ophthalmologica Scandinavica 06/2007; 85(3):298-302. DOI:10.1111/j.1600-0420.2006.00828.x · 1.85 Impact Factor
  • K-M Kreusel · N E Bechrakis · H P H Neumann · M H Foerster ·
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    ABSTRACT: A case of juxtapapillary capillary retinal angioma associated with a vascularized epiretinal membrane of the macula in a 6-year-old girl is presented. Von-Hippel-Lindau-Syndrome was revealed by molecular genetic methods, and further family members were identified as gene carriers. The retinal angioma embedded in an epiretinal membrane was removed completely with the membrane by pars plana vitrectomy with a good functional result. Histopathology confirmed the diagnosis of capillary angioma.
    Der Ophthalmologe 05/2007; 104(4):317-20. · 0.50 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate patients with solitary juxtapapillary capillary retinal angioma for the presence of von Hippel-Lindau disease (VHL). A retrospective case series of 11 patients, each presenting with a solitary juxtapapillary capillary retinal angioma, was examined. Patients were evaluated for type of angioma, presence of other VHL lesions, and mutations of the VHL gene. Juxtapapillary angioma was exophytic in 7 patients and endophytic in 4 patients. VHL could be diagnosed in 7 patients (64%). Four patients were affected by VHL-related lesions as distinct from ocular angioma. A mutation of the VHL gene could be detected in 6 patients; in 1 of these patients, this mutation of the VHL gene was the only evidence of VHL. There was no difference in the age at manifestation or the type of juxtapapillary angioma in VHL patients compared with non-VHL patients. A solitary juxtapapillary angioma may indicate the presence of VHL in a majority of patients, irrespective of the growth pattern of the tumour. Molecular genetic diagnostics is the most effective method of detecting VHL. Because of the high risk of the presence of other VHL lesions, thorough screening for VHL is mandatory for patients presenting with a solitary juxtapapillary angioma.
    Canadian Journal of Ophthalmology 05/2007; 42(2):251-5. DOI:10.1139/I07-002 · 1.33 Impact Factor
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    ABSTRACT: This study was undertaken to identify and compare the prognostic value of gene expression, chromosomal, and clinico-pathological data for the prediction of subsequent metastases in patients with primary uveal melanoma. For comparison of different sets of predictor variables diagonal linear discriminant analysis was used. Chromosomal events were assessed by comparative genomic hybridization and gene expression profiling by microarray. Twenty-eight patients with a median follow-up of 68 months were analyzed, of whom 12 had developed subsequent metastases. Diagonal linear discriminant analysis with crossvalidation of gene expression data detected 42 genes as differentially expressed in metastasizing vsnon-metastasizing uveal melanomas in all 28 cases. Comparing quantitative scores of discriminant analysis, grouping precision was significant better with gene expression profiling compared to comparative genomic hybridization (P=0.01) and to clinical data (P=0.001). Two published gene lists associated with monosomy 3 and metastatic tumor growth were used as classifier for discriminant analysis and yielded superior classification in patients with and without subsequent metastases than chromosomal or clinico-pathological data. In our patient cohort gene expression profiling of primary uveal melanoma tissue was superior to clinical-pathological and chromosomal analysis to assess for the risk of subsequent metastases.
    Eye 04/2007; 22(8):997-1007. DOI:10.1038/sj.eye.6702779 · 2.08 Impact Factor
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    K.-M. Kreusel · N. E. Bechrakis · H. P. H. Neumann · M. H. Foerster ·
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    ABSTRACT: Es wird das Auftreten eines juxtapapillren retinalen kapillren Angioms assoziiert mit einer vaskularisierten epiretinalen Membran der Makula bei einem 6-jhrigen Mdchen beschrieben. Mit Hilfe molekulargenetischer Methodik konnte ein der retinalen Vernderung zugrunde liegendes Von-Hippel-Lindau-Syndrom aufgedeckt und weitere betroffene Familienangehrige identifiziert werden. Mittels Pars-plana-Vitrektomie wurde der Tumor einschlielich der Membran vollstndig entfernt und ein gutes funktionelles Ergebnis erzielt. Histopathologisch konnte ein kapillres Angiom besttigt werden.A case of juxtapapillary capillary retinal angioma associated with a vascularized epiretinal membrane of the macula in a 6-year-old girl is presented. Von-Hippel-Lindau-Syndrome was revealed by molecular genetic methods, and further family members were identified as gene carriers. The retinal angioma embedded in an epiretinal membrane was removed completely with the membrane by pars plana vitrectomy with a good functional result. Histopathology confirmed the diagnosis of capillary angioma.
    Der Ophthalmologe 03/2007; 104(4):317-320. DOI:10.1007/s00347-006-1442-4 · 0.50 Impact Factor
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    ABSTRACT: The aim of this study was to determine in patients with high-risk primary uveal melanoma whether the detection of circulating tumor cells by quantitative reverse transcription-PCR (RT-PCR) is of prognostic relevance. Blood samples from 110 patients with high-risk nonmetastatic uveal melanoma were collected on the occasion of primary treatment or follow-up visit. mRNA expression of tyrosinase and MelanA/MART1 were analyzed by real-time RT-PCR and compared with clinical data at presentation and follow-up by univariate and multivariate analyses. The RT-PCR assay yielded a positive result in 11 of 110 patients, with five positive findings for tyrosinase and five for MelanA/MART1, and one sample positive for both markers. At a median follow-up of 22 months, 25% of patients had developed metastases and 15% had died. Univariate statistical analysis revealed RT-PCR and the largest tumor diameter as important prognostic factors for the development of metastases and for survival. In a Cox proportional hazard model, RT-PCR result and largest tumor diameter predicted metastases (hazard ratios 7.3 and 2.6, respectively), whereas PCR result, largest tumor diameter, and Karnofsky performance status were significant variables for disease-specific survival (hazard ratios 22.6, 4.7, and 6.0, respectively). Analysis of individual RT-PCR results revealed both tyrosinase and MelanA/MART1 transcripts as independent prognostic factors. The presence of tyrosinase or MelanA/MART1 transcripts is an independent prognostic factor in patients with high-risk primary uveal melanoma for subsequent development of metastases and for survival and can be used to select patients for adjuvant treatment studies.
    Clinical Cancer Research 03/2007; 13(4):1171-8. DOI:10.1158/1078-0432.CCR-06-2329 · 8.72 Impact Factor
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    ABSTRACT: The purpose of this work was to evaluate the characteristic appearance of untreated retinoblastoma on a large sample in comparison to the histological findings after therapeutical enucleation. In a prospective clinical trial 46 children with retinoblastoma in 63 affected untreated eyes were examined under general anesthesia on MRI using a 1.5-T system. The examinations were performed with a special surface coil applying an examination protocol including fast T2- and T1-weighted spin echo sequences and additional fast T1-WI after intravenous injection of Gd-DTPA in different planes. The imaging results were compared to the histopathological findings in 29 patients with 30 affected eyes. Comparing MRI findings and histopathological results, optic nerve infiltration was detected with a sensitivity of 53.8% and a specificity of 82.3% on MRI, infiltration of the choroid with a sensitivity of 75.0% and a specificity of 100.0%, and the degree of tumor calcification with a sensitivity of 91.7% and a specificity of 88.9%. In this study the characteristic MR appearance of untreated retinoblastoma was evaluated. MRI was helpful in relevant aspects of pretherapeutical retinoblastoma staging, deficits remain regarding optic nerve infiltration.
    European Radiology 02/2007; 17(1):49-60. DOI:10.1007/s00330-006-0197-2 · 4.01 Impact Factor

  • Klinische Monatsblätter für Augenheilkunde 01/2007; 224. DOI:10.1055/s-2007-1004462 · 0.46 Impact Factor
  • J Wachtlin · S Thormann · D Ottenberg · L Krause · NE Bechrakis · MH Foerster ·

    Klinische Monatsblätter für Augenheilkunde 01/2007; 224. DOI:10.1055/s-2007-1004502 · 0.46 Impact Factor
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    ABSTRACT: Without Abstract
    Strahlentherapie und Onkologie 01/2007; 183(1). DOI:10.1007/s00066-007-8222-1 · 2.91 Impact Factor
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    ABSTRACT: Several trials demonstrated efficacy of the gemcitabine/treosulfan (GeT) combination in metastatic uveal melamoma. This randomized phase II trial compared the GeT combination versus treosulfan alone (T) in this rare disease. Chemotherapy-naive patients with proven metastatic uveal melanoma were randomly assigned to receive 1000 mg/m(2) of gemcitabine plus 3500 mg/m(2) of treosulfan (GeT) or 3500 mg/m(2) of T. Chemotherapy was administered on days 1 and 8 in both arms, cycles were repeated on day 29. Primary end point was rate of responses and disease stabilizations. Forty-eight patients were randomized. Seven confirmed stable diseases (SDs) and one partial remission (PR) were observed in 24 patients treated with the GeT regimen, whereas no PR and only three SDs were observed in the T arm (P = 0.08). Median progression-free survival (PFS) was 3 months (95% CI 1.1-4.9) and 2 months (95% CI 1.7-2.3) in the GeT and T arm (P = 0.008, log-rank). Six and 12 months PFS was 34.8% and 17.9% and 16.7% and 0% always favoring the GeT arm. This first randomized trial in metastatic uveal melanoma showed a superior PFS and a trend for a higher response/stabilization rate of the GeT combination over T.
    Annals of Oncology 01/2007; 17(12):1826-9. DOI:10.1093/annonc/mdl309 · 7.04 Impact Factor
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    ABSTRACT: To determine the effectiveness and risk profile of combined ruthenium- (Ru)-106-brachytherapy and transpupillary thermotherapy (TTT) of the tumour apex for the treatment of large choroidal melanoma. A consecutive series of 31 large choroidal melanoma treated by Ru-106-brachytherapy and adjuvant TTT was studied. TTT was performed 1 day prior to plaque removal and up to 3 times (mean: 1.8) during follow-up. Evaluation comprised tumour regression, treatment-related adverse events, necessity of additional treatment and visual results. Mean follow-up was 21.6+/-7.8 (10.8-38.3) months. Mean tumour thickness was 6.8+/-1.0 (5.0-8.9) mm prior to treatment. Mean residual tumour thickness at the end of follow-up was 2.5+/-1.0 mm. Relevant adverse treatment effects were exudative maculopathy or macula oedema (22.6%), vitreous haemorrhage (16.1%), optic neuropathy (16.1%) and retinal detachment (9.7%). One tumour recurrence occurred during follow-up, and was treated by enucleation. The combination of Ru-106-brachytherapy with TTT allows for the treatment of large posterior choroidal melanoma. The rate of treatment-related adverse events appears to be acceptable.
    Albrecht von Graæes Archiv für Ophthalmologie 01/2007; 244(12):1575-80. DOI:10.1007/s00417-006-0357-8 · 1.91 Impact Factor
  • AB Renner · E Cropp · J Wachtlin · MH Foerster ·

    Klinische Monatsblätter für Augenheilkunde 01/2007; 224. DOI:10.1055/s-2007-1004506 · 0.46 Impact Factor

Publication Stats

4k Citations
510.49 Total Impact Points


  • 2013-2014
    • University of Tuebingen
      • Institute for Ophthalmic Research
      Tübingen, Baden-Württemberg, Germany
  • 2006-2014
    • DRK Kliniken Berlin
      Berlín, Berlin, Germany
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany
  • 2004-2012
    • Charité Universitätsmedizin Berlin
      • Department of Ophthalmology
      Berlín, Berlin, Germany
  • 2009
    • Medizinische Universität Innsbruck
      • Univ.-Klinik für Augenheilkunde und Optometrie
      Innsbruck, Tyrol, Austria
    • Städtisches Klinikums Dessau
      Dessau, Saxony-Anhalt, Germany
  • 1993-2004
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlín, Berlin, Germany
  • 1986-2003
    • University Hospital Essen
      Essen, North Rhine-Westphalia, Germany
  • 1987-2002
    • University of Duisburg-Essen
      Essen, North Rhine-Westphalia, Germany