D Pauleikhoff

St. Franziskus-Hospital Münster, Muenster, North Rhine-Westphalia, Germany

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Publications (193)270.56 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund Selbst unter konsequenter Anti-VEGF („vascular endothelial growth factor“)-Therapie zeigen sich bei neovaskulärer altersabhängiger Makuladegeneration (AMD) oft Reaktivierungen der Läsion. Die vorliegende Fallserie untersucht, ob ein Wechsel des Präparates von Ranibizumab zu Aflibercept sicher ist und Unterschiede hinsichtlich der Wirksamkeit beobachtet werden können. Patienten und Methoden Bei 56 konsekutiven Patienten mit erneuter Aktivität der AMD, gemäß morphologischen Kriterien der Spectral-Domain-optischen Kohärenztomographie (SD-OCT)-Untersuchung, wurde nach 6 bis maximal 41 Injektionen (im Mittel 18,9, SD 6,3) ein Wechsel von Ranibizumab zu Aflibercept vorgenommen. Bei allen Kontrollen und vor jeder Injektion wurde neben der klinischen Untersuchung der Visus (LogMAR) erhoben und eine SD-OCT (Volumenscan) durchgeführt. Ergebnisse Der mittlere Visusverlauf war unter beiden Therapien stabil. Morphologisch zeigte sich eine stärkere Reduktion der Netzhautdicke nach dem Therapiewechsel (innerhalb von 1000 μm und foveolär) gegenüber der initialen Behandlung. Sowohl die Änderung der subretinalen Flüssigkeit als auch die Höhe einer assoziierten Pigmentblattanhebung (PED) wiesen keinen signifikanten Unterschied auf. Die Analyse der morphologischen Veränderungen auf der Ebene der Photorezeptoren zeigte eine Abnahme der Diskontinuität sowohl in der ellipsoiden Bande als auch im Bereich der Membrana limitans externa (ELM). Zusammenfassung Bei Patienten mit erneuter und/oder hoher Läsionsaktivität kann durch einen Wechsel des Präparates eine erneute funktionelle Stabilisierung trotz mehrfacher Vorbehandlung erreicht werden. Morphologisch fanden sich zudem Hinweise auf eine Regression des intraretinalen Ödems und Verbesserungen auf der Ebene der Photorezeptoren. Im Rahmen einer klar definierten Behandlungsstrategie ist der Wechsel von einem Anti-VEGF-Präparat auf einen ähnlichen Wirkstoff sicher. Vor einer definitiven Bewertung sind prospektiv kontrollierte Studienbedingungen erforderlich, bevor der klinische Nutzen eines Wechsels verifiziert werden kann.
    Der Ophthalmologe 12/2014; · 0.53 Impact Factor
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    ABSTRACT: Even during consistent anti-vascular endothelial growth factor (VEGF) therapy a reactivation of exudative age-related macular degeneration (AMD) lesions can be observed in many patients. The present case series examined whether a switch from ranibizumab to aflibercept is safe and whether differences in potency can be observed. In 56 consecutive patients with recurrent activity of AMD according to the morphological criteria of the spectral domain optical coherence tomography (SD-OCT) examination, a change to aflibercept was made after 6-41 (mean 18.9, SD 6.3) injections with ranibizumab. In all controls and before each injection logMAR visual acuity was measured and a SD-OCT (volume scan) was performed in addition to the clinical examination. The mean visual acuity was stable under both therapies. The analysis of the morphological parameters showed a greater reduction of the retinal thickness after the change in therapy (mean retinal thickness within 1000 μm and central foveal thickness) compared to the initial treatment. The changes in the subretinal fluid as well as the height of an associated pigment epithelial detachment (PED) did not show any significant differences. The analysis of the morphological parameters at the level of the photoreceptors showed a decrease in discontinuity in the ellipsoid layer and also in the external limiting membrane (ELM). In patients with recurrent or high SD-OCT-based activity of exudative AMD lesions, a switch of the treatment strategy from ranibizumab to aflibercept can achieve a new functional stability in spite of multiple pretreatment. We found morphological indications of a regression of intraretinal edema and improvement in the photoreceptor area. In the context of a well-defined treatment strategy, a switch from anti-VEGF therapy to a similar active substance is safe. Before a definitive evaluation can be made, prospective controlled conditions are required to verify the clinical benefits of the switch.
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 12/2014;
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    ABSTRACT: Macular telangiectasia Type 2 is a bilateral, progressive potentially blinding retinal disease characterized by both vascular and neurodegenerative signs that have been documented using different imaging techniques. The correlation between macular telangiectasia Type 2 signs from various imaging modalities is unknown. Our aim was to investigate the relationship of various macular telangiectasia Type 2 signs using fundus fluorescein angiography, optical coherence tomography and dual-wavelength autofluorescence images. Participants were selected from the macular telangiectasia Type 2 Natural History Observation Study, based on a confirmed diagnosis and the availability of images. Signs in fundus fluorescein angiography, dual-wavelength autofluorescence, and optical coherence tomography images were graded according to standardized categories, and agreement among the multimodel imaging was assessed statistically. One hundred and ninety-one eyes of 96 patients were examined. Significant correlations were found between early and late fundus fluorescein angiography (ρ = 0.82, P < 0.0001), luteal pigment loss and early/late fundus fluorescein angiography signs (ρ = 0.52, P < 0.0001 and ρ = 0.62, P < 0.0001, respectively), inner and outer segment break length and pigment loss (Class 1 vs. 2/3, P < 0.0001; Class 2 vs. 3, P = 0.04). Correlation between pigment loss and retinal spaces/atrophic retinal restructuring was fair (κ = 0.25-0.33). Bilateral symmetry was slight to substantial (κ = 0.18-0.62). Our data demonstrate the relative extent of neurodegenerative and vascular signs; it may be useful for designing systems for staging disease severity using multimodal imaging and may also provide clues to the pathogenesis of the disease.
    Retina (Philadelphia, Pa.) 11/2014; · 2.93 Impact Factor
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    ABSTRACT: Macular telangiectasia type 2 is characterized by neurodegenerative as well as vascular and retinal alterations. Previous therapeutic approaches mainly targeted the vascular changes; however, this did not prove to be beneficial except for secondary neovascularization which may be successfully treated with intravitreal vascular endothelial growth factor inhibitors. As the natural history of the disease is primarily characterized by the neurodegenerative processes, new therapeutic strategies, such as neuroprotective agents are already being explored in clinical trials.
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 09/2014; 111(9):834-8.
  • P Charbel Issa, D Pauleikhoff, F G Holz
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 09/2014; 111(9):817-8.
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    ABSTRACT: Macular telangiectasia type 2 is characterized by atrophic alterations of the central retina which is accompanied by a defined vascular phenotype. The disease manifests within an oval central retinal area the size of approximately two disc diameters, with a topographic predisposition temporal to the foveal center. Funduscopy reveals reduced retinal transparency, crystalline deposits, mildly ectatic capillaries, thickened venules and retinal pigment plaques. Secondary neovascularization and macular holes may occur during the disease course. Fluorescein angiography usually shows a diffuse leakage and often ectatic capillaries. On optical coherence tomography (OCT) examination, hyporeflective cavities and focal atrophy of the photoreceptor layer represent a frequent finding. A characteristic sign is an increased (para) central signal on fundus autofluorescence imaging due to a reduced density of macular pigment.
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 09/2014; 111(9):819-28.
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    ABSTRACT: Are there any morphological parameters in pigment epithelial detachment (PED) in eyes with age-related macular degeneration (AMD), which could identify the development of tears (RIP) in the retinal pigment epithelium (RPE) before initiation of anti-vascular endothelial growth factor (VEGF) therapy?
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 07/2014;
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    ABSTRACT: Genetic factors contribute to the development and progression of age-related macular degeneration (AMD). We aimed to assess the association of drusen as phenotypic characteristics of early AMD and their progression with polymorphisms in the CFH, ABCA1, and ARMS2 genes.
    Albrecht von Graæes Archiv für Ophthalmologie 06/2014; 252(8). · 1.93 Impact Factor
  • D Pauleikhoff, B Bertram, D Claessens
    Klinische Monatsblätter für Augenheilkunde 05/2014; 231(5):548-53. · 0.70 Impact Factor
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    ABSTRACT: Background: The introduction and approval of Ocriplasmin as an intravitreally applicable drug in the pharmocological treatment of vitreomacular traction represents a new therapeutic approach possibly avoiding vitreoretinal surgery. With our article we report our first experience wih Ocriplasmin in clinical practice. Methods: The indication for intravitreal therapy with Ocriplasmin was provided for symptomatic VMT or macular hole with VMT in 20 patients since March 2013. Surgery was planned in cases with remaining symptoms. Before IVI we performed SD-OCT. Best visual acuity (BCVA) was evaluated preoperatively, 7 and 28 days after treatment and finally every month in 14 treated eyes. SD-OCT images were analysed before treatment and later on with every follow-up examination. In addition to functional and morphological changes we analysed all side effects. Results: The mean BCVA at the beginning of treatment was 0.3 and 0.4 before injection. The indications for treatment were as follows: symptomatic VMT in 10 patients and 4 patients suffering from full thickness macular hole stage 2. In 3 patients spontaneous regression of VMT could be observed with increasing of vision from 0.3 to 0.5. In one patient his macular hole was closed and BCVA increased from 0.2 to 0.6 within 7 days. Two patients showed significant enlargement of their macular holes after 7 days and finally underwent surgery. A massive cystoid macular oedema occurred in one patient. No change in the SD-OCT image could be observed 28 days after treatment. The mean visual acuity improved to 0.6 during a follow-up period of 90 days. Photopsia and disturbing vitreous opacities up to 28 days post injection could be regarded as minor side effects. Conclusion: Our first clinical experience with intravitreous injection of Ocriplasmin were performed to confirm the presumed therapeutic effect in patients suffering from VMT. Small macular holes could frequently be closed. The possibility of special side effects must be taken in consideration just as the possibility of spanteous improvement before performing IVI with Ocriplasmin. Further prospective studies must be recommended to be right about Ocriplasmin injections.
    Klinische Monatsblätter für Augenheilkunde 04/2014; · 0.70 Impact Factor
  • D Pauleikhoff, B Bertram, D Claessens
    Der Ophthalmologe 03/2014; 111(3):229-34. · 0.53 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 03/2014; 231(3):266-8. · 0.70 Impact Factor
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    ABSTRACT: Introduction: Macular pigment optical density (MPOD) and age-related macular degeneration (AMD) are thought to be associated; however, the details are not yet clearly understood. This study aimed at investigating how retinal anatomical structures relate with the spatial MPOD distribution in single eyes. Study setting and methods: In a subgroup of the third follow-up examination of the Münster Aging and Retina Study (MARS) cohort (mean age 78.4 years), 124 single eyes of 79 participants were examined. MPOD was assessed using 2-wavelength autofluorescence (AF). Retinal thickness (RT) and fovea pit profile slopes were measured using optical coherence tomography (OCT). The results were analyzed for interocular correlation in 58 pairs of eyes, and for the association of MPOD distribution patterns with RT using uni- and multivariate statistical methods. Results: The interocular correlations for several measures of RT and RT layers were high (p < 0.001). RT was inversely and significantly related to MPOD at 1.0° and at 2.0° from the foveal center but not to central MPOD. After controlling for sex, age, smoking and spherical equivalent, RT was significantly thinner (-39.7 micrometers, p < 0.001) in eyes with ring-like as compared to normal MPOD distribution. In particular, a thinner layer between internal and external limiting membrane showed strong associations with ring-like structures. Conclusion: Higher values of MPOD at 1° and 2° as well as a ring-like distribution of MPOD were significantly associated with thinner maculae, due to thinner inner retinal layers. The MPOD distribution was unrelated to the slope of the foveal pit or the choroidal thickness. Our results suggest that the retinal section between the internal and external limiting membrane is involved in the spatial distribution of MPOD.
    Investigative ophthalmology & visual science 01/2014; · 3.43 Impact Factor
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    ABSTRACT: To quantitatively analyze the distribution of macular pigment (MP) over a period of 5 years and for monitoring progression of macular telangiectasia. Macular pigment concentration (autofluorescence, excitation wavelengths: 488 and 514 nm) was determined at baseline and after 5 years in 43 eyes of 22 subjects (46-80 years; mean, 65.6 years; 10 men) participating in the macular telangiectasia project. Mean MP density at 0.5° declined in the segment (one eighth of a circle) with the highest MP optical density (-0.04 density units; P= 0.015), where density units (DU), and also averaged in the 2 segments that divided segments with detectable MP from those in which MP was no longer detectable (-0.04 density units; P = 0.0005). In the first segment mentioned, 2° values decreased to a lesser extent and not significantly. The diameter of MP loss expanded horizontally from 2.64 mm to 2.74 mm (P = 0.0001) but not vertically. Macular pigment density in the "halo" of peripheral MP at a mean of 5.44° (4.53-6.21°) increased (+0.01 DU; P= 0.01). Five years of follow-up resulted in central (0.5°) reduction and peripheral (4.53-6.21°) accumulation of MP. Longer period of follow-up may disclose significant changes in paracentral locations. The area of central MP loss expands in particular in a horizontal direction and less vertically. Centrifugal movement of MP during disease may explain our findings.
    Retina (Philadelphia, Pa.) 10/2013; · 2.93 Impact Factor
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    ABSTRACT: This article reports the case of a 72-year-old woman with pigment epithelial detachment with occult choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD) which developed under anti-vascular endothelial growth factor (VEGF) therapy of a tear in the retinal pigment epithelium (RPE). In the area of free RPE autofluorescence was completely absent and the microperimetry in this area showed an absolute scotoma. The visual acuity was 0.1. After continuation of anti-VEGF therapy because of persistent subretinal and intraretinal fluid over 3 years an increased autofluorescence was observed and the microperimetry showed an increase in central retinal sensitivity. The central visual acuity improved to 0.5 and in this area a whitish subretinal tissue formed morphologically. In the spectral domain optical coherence tomography (SD-OCT) image this structure was hyperreflective which might suggest a certain regeneration process of the RPE under anti-VEGF-therapy.
    Der Ophthalmologe 09/2013; · 0.53 Impact Factor
  • F SALLO, I LEUNG, K BALASKAS, D PAULEIKHOFF, AC BIRD, T PETO
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    ABSTRACT: Purpose Idiopathic macular telangiectasia type 2 (MacTel) is associated with characteristic vascular signs including leakage/staining on fluorescein angiography (FA) as well as neurodegenerative signs including a progressive loss of luteal pigment. The distribution of luteal pigment can be assessed by dual-wavelength autofluorescence (DWAF) imaging. Our aim was to investigate the relationship of vascular and neurodegenerative signs of type 2 MacTel in FA and DWAF images. Methods FA and DWAF images were acquired using a Heidelberg Spectralis SLO and a HRA Classic SLO device respectively. Thirty eyes of 30 MacTel patients were examined. Images were aligned to attain exact correspondence. Staging of luteal pigment loss in DWAF images was performed according to the system developed by Zeimer et al. The extent of abnormalities in the two imaging modalities was compared. Results According to severity of luteal pigment loss, 6 eyes were at stage 1, 14 at stage 2 and 10 at stage 3. At stages 2 and 3, the area with early FA changes was always smaller and contained within the area of luteal pigment loss. This also held true for stage 1 except in very early cases with minimal pigment loss. In these, FA changes, especially late staining appeared more extensive. Dense pigment plaques appeared as masking dark areas in both FA and DWAF images with hyperfluorescent spots in DWAF. Subretinal neovascularization broke up the pattern in 3 eyes. Conclusion Our results indicate that in non-neovascular type 2 MacTel, luteal pigment loss appears more extensive than vascular change. The relative time sequence of changes may provide clues to the primary underlying cause. Confirmation on a larger sample with follow-up is indicated.
    Acta ophthalmologica 08/2013; 91(s252). · 2.44 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 06/2013; 230(6):614-28. · 0.70 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 06/2013; 230(6):629-34. · 0.70 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 02/2013; 230(2):170-7. · 0.70 Impact Factor
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    ABSTRACT: PURPOSE: TO DOCUMENT THE PROGRESSION OF A BREAK IN THE PHOTORECEPTOR IS/OS JUNCTION LAYER AND ITS FUNCTIONAL CORRELATES OVER TIME IN THE NATURAL HISTORY OF TYPE 2 IDIOPATHIC MACULAR TELANGIECTASIA (TYPE 2 MACTEL). METHODS: Patients with at least one year of follow-up were selected from the MacTel Study. En face images were created by manual segmentation of the IS/OS line in volume scans acquired using a Topcon 3D-OCT1000 unit. Retinal sensitivity thresholds were determined using a Nidek MP1 microperimeter. Aggregate retinal sensitivity loss within IS/OS lesions was calculated. Change over time in area of IS/OS defects and retinal sensitivity were analyzed. RESULTS: Thirty-nine eyes of 23 patients (mean age 62.3±9.2 years) were analyzed. Mean follow-up time was 1.9 years (range 1-3 years). Mean IS/OS break area at baseline was 0.575mm2 (SE=0.092, 95% CI: 0.394-0.756 mm2). The cluster-adjusted mean annual progression rate in area of IS/OS break was 0.140 mm2 (SE=0.040, 95% CI: 0.062-0.218 mm2, p<0.001). Mean aggregate retinal sensitivity loss was at baseline 28.56 dB (SE=5.43, 95% CI: 17.32-39.80dB, n=28), a positive correlation with IS/OS lesion area was present (p<0.001). The mean annual rate of change in aggregate sensitivity loss was 5.14dB (SE=1.51, 95% CI: 2.19 - 8.10dB, p<0.001, n=37), a significant correlation with lesion area increase was found (p=0.006). CONCLUSIONS: Both IS/OS break area and rate of enlargement correlate with aggregate retinal sensitivity loss in type 2 MacTel. En face OCT imaging of the IS/OS layer provides a functionally relevant method for documenting disease progression in type 2 MacTel.
    Investigative ophthalmology & visual science 10/2012; · 3.43 Impact Factor

Publication Stats

3k Citations
270.56 Total Impact Points

Institutions

  • 1995–2014
    • St. Franziskus-Hospital Münster
      Muenster, North Rhine-Westphalia, Germany
  • 1990–2012
    • Moorfields Eye Hospital NHS Foundation Trust
      • Department of Medical Retina
      Londinium, England, United Kingdom
  • 2011
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      Liverpool, England, United Kingdom
  • 2005–2011
    • University of Münster
      • Institute of Epidemiology and Social Medicine
      Münster, North Rhine-Westphalia, Germany
  • 1997–2011
    • St. Franziskus-Hospital
      Köln, North Rhine-Westphalia, Germany
  • 2010
    • University of Oxford
      Oxford, England, United Kingdom
  • 2009
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2008
    • Dalhousie University
      Halifax, Nova Scotia, Canada
  • 2007
    • Centre Hospitalier Intercommunal Creteil
      Créteil, Île-de-France, France
  • 2004
    • Universität Heidelberg
      • Department of Ophthalmology
      Heidelburg, Baden-Württemberg, Germany
  • 2001
    • University of Wuerzburg
      • Institute for Human Genetics
      Würzburg, Bavaria, Germany
  • 1991–1993
    • University Hospital Essen
      Essen, North Rhine-Westphalia, Germany