[Show abstract][Hide abstract] ABSTRACT: The Watzke-Allen test (WAT) is a simple diagnostic tool designed for the diagnosis of full thickness macular holes (FTMH) but due to the rapid progress of imaging diagnostics it was replaced by spectral domain optical coherence tomography (SD-OCT) of macular pathologies. The aim of this study was to examine if the WAT is able to distinguish between the different FTMH stages.
In 57 eyes of 57 patients with clinical evidance of FTMH, the WAT was first performed followed by SD-OCT examination and a distinction was made between a negative (slit beam normal) and a positive sign (slit beam modified as groove and hourglass configuration or completely broken).
In 49 out of 57 patients the WAT was positive (hourglass 46 patients and broken 3 patients). Based on the SD-OCT results the following diagnoses were made: lamellar macular holes (LMH, 3 patients), vitreomacular traction (VMT, 4 patients), small macular hole (≤ 250 µm, 5 patients), medium sized macular hole (250-400 µm, 11 patients) and large macular hole (≥ 400 µm, 34 patients). In 91 % of the patients with medium and large FTMH, the WAT was positive, whereas the WAT was positive in only 67 % of patients with small FTMH, VMT and LMH. The sensitivity for large and medium FTMH was 93 % but the specificity was only 33 %.
The WAT was positive in a high percentage of patients with large and medium sized macular holes as well as patients with small macular holes and LMH. The sensitivity of certain indications for treatment was 93 % but the specificity was only 33 %; therefore, the WAT alone is not suitable for a certain preoperative differentiation of macular alterations.
Der Ophthalmologe 07/2015; DOI:10.1007/s00347-015-0102-y · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article presents the spontaneous development of ocular complications in a case of dengue fever in a young tourist returning from Thailand. Despite severe inital clinical symptoms, a clear remission occurred after several months without any therapy; however, a partial atrophy of the optic nerve remained.
Der Ophthalmologe 07/2015; DOI:10.1007/s00347-015-0093-8 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute annular outer retinopathy (AAOR) is a very rare variant of acute zonal occult outer retinopathy (AZOOR). Both variants are characterized by the perception of a progressive visual field defect and can be accompanied by photopsia. In contrast to AZOOR, a progressive whitish and annular demarcation of the involved retina is observed in AAOR using ophthalmoscopy. Optical coherence tomography (OCT) reveals morphological changes predominantly in the outer retinal layers. Although there is no proof of an effective therapy, in the case presented here further progression could be stopped by a combination of antiviral and immunosuppressive therapy.
Der Ophthalmologe 05/2015; DOI:10.1007/s00347-015-0012-z · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Universitäre Lehre in der Augenheilkunde konzentriert sich bisher auf die Vermittlung und Prüfung von Wissen. Die praktische Ausbildung spielt dabei eine untergeordnete Rolle. In Göttingen ergab sich durch die Einrichtung eines Skillslabs die Gelegenheit, Lehren und Prüfen praktischer Fertigkeiten als festen Bestandteil in die studentische Ausbildung zu integrieren. Als Lernziele wurden Techniken gewählt, die als ,,ophthalmologische Basisfertigkeiten“ ohne größeren apparativen Aufwand von jedem Arzt beherrscht werden sollten.Wir beschreiben Entwicklung und Ergebnisse aus 4 Semestern praktischer Prüfung (OSCE) und vorbereitender Lehrangebote (,,Peer-Teaching“), sowie die Ergebnisse einer studentischen Befragung zur Akzeptanz der neuen Prüfungsform.Die neuen Lehr- und Prüfungsformen zeigen, dass die definierten praktischen Fertigkeiten auch in kurzer Zeit ausreichend vermittelt werden konnten. An den verschiedenen Prüfungsstationen erreichten jeweils 68–100 % der Studierenden die maximale Punktzahl.Praktische Prüfungen und ,,Peer-Teaching“ sind im Fach Augenheilkunde machbar und stoßen auf große Akzeptanz bei den Studierenden.
Der Ophthalmologe 01/2014; 111(3). · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: After being exposed to a kindergarten teacher with infectious pulmonary tuberculosis, a 7-year-old girl with a positive tuberculin skin test was treated with isoniazid. 3 days after initiation of the tuberculostatic therapy, the girl was referred to our hospital with an acute onset of blurred vision. Visual acuity (VA) was 20/200 in both eyes. Examination revealed mild anterior chamber inflammation, optic disc swelling, cystoid macular edema and periphlebitis in both eyes. However, although active tuberculosis was ruled out, the interferon-gamma release assay was positive. The anti-tuberculosis therapy was intensified with pyrazinamide, isoniazid, rifampicin and methylprednisolone. Within 10 days we saw a resolution of the macular edema and VA was 20/25. The paradoxical worsening of the patient's condition after initiation of tuberculostatic therapy with isoniazid and the prompt response to systemic steroids are typical for Jarisch-Herxheimer reaction (JHR). Our patient presented no symptoms before the isoniazid therapy was started and the reaction was ocular without any generalized symptoms. This is unique among all other reported cases of ocular JHR.
International Ophthalmology 09/2013; 34(3). DOI:10.1007/s10792-013-9848-x · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose of the Study: To investigate the outcome of brilliant blue G (BBG)-assisted internal limiting membrane peeling in macular hole surgery after a follow-up of 6 months. Procedures: In this retrospective study 20 eyes have been treated with BBG-assisted macular hole surgery. After a follow-up of 6 months, the functional and anatomical outcomes have been analyzed. Results: The mean preoperative best-corrected visual acuity (BCVA) was 0.7 logMAR units (mean ± SD 0.66 ± 0.27). After 3 months, the mean BCVA increased not significantly to 0.4 (0.54 ± 0.30), but a significant improvement to 0.2 logMAR units (0.28 ± 0.23) could be detected after 6 months compared to baseline (p < 0.01). Primary macular hole closure after a single surgery was found in 17 of 20 eyes. Conclusion and Message: BBG exhibits sufficient staining qualities and safety profile leading to a significant functional improvement after successful macular hole surgery.
[Show abstract][Hide abstract] ABSTRACT: Background:
University teaching in ophthalmology has tended to focus on imparting knowledge rather than practical skills. The new skills laboratory at the University Medical Center in Göttingen enables practical skills to be taught. The focus is on basic skills that could help all physicians. The learning goals set are techniques considered basic in ophthalmology that can be mastered without requiring any physician to operate major equipment.
The design and results from four semesters of an ophthalmological objective structured clinical examination (OSCE) following students engaged in peer-teaching, as well as feedback from a student questionnaire are described.
Practical skills can successfully be taught and mastered within 1 week and 68-100 % of all students achieved the maximum scores in the individual tests. The OSCE and peer- eaching were well received by the students.
Practical skills and peer teaching fulfill student educational goals in ophthalmology and are well accepted by undergraduates.
Der Ophthalmologe 05/2013; 111(3). DOI:10.1007/s00347-013-2859-1 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
To evaluate the incidence of posterior vitreous detachment (PVD) induced by intravitreal injection of different intravitreal drugs.
This prospective observational study included 61 patients (61 eyes) with different underlying retinal diseases: exudative age-related macular degeneration (n = 47), cystoid macular edema (CME) after retinal vein occlusion (n = 8), and CME of other origin (n = 6). Bevazicumab (1.25 mg) was injected into 25 eyes, ranibizumab (0.5 mg) into 27 eyes, triamcinolone (4 mg) into six eyes, and a combination of bevacizumab and triamcinolone into three eyes. Patients with initial PVD were excluded. Patients were followed for at least 4–6 weeks after their last injection by Fourier-domain OCT, fundus biomicroscopy and ultrasound B-examination.
Overall, 15 of 61 eyes developed a PVD after intravitreal injection (n = 6 after ranibizumab, n = 7 after bevacizumab and n = 2 after triamcinolon) within a mean follow-up period of 11.1 weeks. PVD occurred in three eyes after the first injection, in three eyes after the second, and in seven eyes after the third injection. Incidence of PVD correlated with increasing age.
Intravitreal injection of commonly-used drugs seems to induce posterior vitreous detachment, which may thus influence the outcome of the underlying disease.
Albrecht von Graæes Archiv für Ophthalmologie 02/2013; 251(7). DOI:10.1007/s00417-013-2266-y · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this prospective observational study was to analyze the efficacy and safety of a minimally invasive approach in patients with subretinal hemorrhage secondary to exsudative age-related macular degeneration (ARMD).
A total of 34 eyes from 33 patients with submacular hemorrhage due to exsudative ARMD were included in the study and 18 of the 33 patients were under anticoagulant medication. Combined subretinal injection of recombinant tissue plasminogen activator (rTPA) and bevacizumab with subsegment core vitrectomy and gas tamponade with 1.8-2.2 ml pure sulphur hexafluoride gas (SF6) was applied using a single pars plana incision. The follow up period was 1-17 months and median 4.5 months.
This approach achieved a sufficient SF6 gas filling in all cases without the requirement of strict face-down positioning. Postoperatively all patients had subjective improvement of central visual field. Visual acuity increased in 16 out of 33 patients and 12 out of 33 patients remained unchanged. As complications seven tears of the retinal pigment epithelium (RPE) and one recurrent subfoveal hemorrhage were observed, two cases of retinal detachment occurred and required buckling surgery. In 14 out of 33 patients further application of intravitreal anti-VEGF (vascular endothelial growth factor) was necessary.
This minimally invasive approach seems to be a feasible and effective method to displace subretinal hemorrhages with tenable results.
Der Ophthalmologe 07/2012; 109(7):670-5. · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hintergrund
Ziel dieser prospektiven Pilotstudie war die Bewertung eines minimal-invasiven Vorgehens bei subretinaler Blutung infolge exsudativer altersbedingter Makuladegeneration (AMD) in Bezug auf Effektivität und Sicherheit.
Eingeschlossen wurden 33 Patienten bzw. 34 Augen mit einer submakulären Blutung bei Vorliegen einer exsudativen AMD. Im Rahmen einer Core-Vitrektomie mit nur einem Pars-plana-Zugang wurden rtpa („recombinant tissue plasminogen activator“) und Bevacizumab subretinal injiziert und der Glaskörperraum partiell mit SF6-Gas gefüllt. Die Nachbeobachtungszeit betrug 1–17, im Mittel 4,5 Monate.
Die Methode gewährleistet eine ausreichende intravitreale Gasfüllung und Verschiebung der submakulären Blutung ohne postoperative Lagerungsprobleme für den Patienten. In allen Fällen konnte eine subjektive Gesichtsfeldverbesserung erreicht werden, ein Visusanstieg wurde bei 16/33 Patienten beobachtet, bei 12 Patienten blieb der Visus unverändert; 18 von 33 Patienten standen unter Antikoagulanzientherapie. Als Komplikationen traten eine submakuläre Nachblutung nach 4 Wochen, 6 extrafoveale RPE (retinales Pigmentepithel)-Risse und eine eindeutig iatrogene RPE-Verletzung auf; 2 Patienten erlitten eine umschriebene Ablatio unten mit kleinem Hufeisenforamen. Stärkere Nachblutungen traten nicht auf. Vierzehn Patienten benötigten eine Fortsetzung der intravitrealen Anti-VEGF-Therapie.
Die vorgestellte minimal-invasive Behandlungsmethode einer submakulären Blutung bei exsudativer AMD scheint effektiv und lieferte in dieser Pilotstudie ermutigende Ergebnisse.
Der Ophthalmologe 07/2012; 109(7). DOI:10.1007/s00347-012-2568-1 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Subretinal perfluorocarbon liquid (PFCL) droplets are occassionally seen after vitreoretinal surgery for retinal detachment. Usually they are located peripherally without causing complications and therapeutic consequences. In contrast, centrally located PFCL droplets affect final visual outcomes. In animal experiments subretinal PFCL has caused direct toxic effects on photoreceptor cells and retinal pigment epithelium.
We report about the rare event of a centrally located subretinal PFCL droplet in 2 patients, their surgical removal and functional outcome. In both patients a PFCL droplet remained subretinally after primary vitrectomy for a rhegmatogenous retinal detachment. In patient 1 the PFCL droplet was located subfoveally for 6 weeks, in patient 2 underneath the papillomacular bundle for 8 weeks causing severe visual loss. In both patients the PFCL was removed transretinally through a 32 gauge cannula. Vision and central scotoma improved in both patients markedly. No complications due to the mini-retinotomy could be observed.
Centrally located PFCL droplets are decreasing vision and should be surgically removed. A transretinal removal of subretinal PFCL droplets is possible and the iatrogenic damage seems acceptable.
[Show abstract][Hide abstract] ABSTRACT: Die Ursachen einer Keratokonjunktivitis können sowohl infektiöser als auch nichtinfektiöser Genese sein. Wir stellen eine 79-jährige Patientin mit beidseits massiv purulenter therapieresistenter Keratokonjunktivitis vor, die außerdem an einer durch eine unspezifische Kollagenose verursachten schweren Siccasymptomatik leidet. Über Jahre konnte der Patientin weder mit antibiotischer noch benetzender Lokaltherapie Linderung verschafft werden, sodass bereits Hornhautnarben entstanden. Als Ursache stellten sich nach langer Fokussuche und Keimnachweis (Stenotrophomonas maltophilia) jeweils 2 übereinander liegende, fast völlig zerfallene therapeutische Kontaktlinsen heraus. Nach deren Entfernen und unter Therapie mit Cotrimoxazol kam es schnell zu einer Besserung und schließlich zum Verschwinden der Symptomatik.
Der Ophthalmologe 03/2012; 109(3). DOI:10.1007/s00347-011-2469-8 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The cause of keratoconjunctivitis could be either infectious or non-infectious in etiology. The case of a 79-year-old female patient with chronic, purulent bilateral keratoconjunctivitis which was totally resistant to therapy is presented. The patient also suffered from non-specific collagenosis resulting in severe Sicca symptoms. Over the years none of the many antibiotic or lubricant therapies that were administered could alleviate the symptoms and corneal scars resulted. After a long search the focus was localized. On everting the eyelids a pair of nearly fully decomposed therapeutic contact lenses adhering to each other were found and removed from both eyes. The pathogenic agent was identified as Stenotrophomonas maltophilia which was successfully treated by cotrimoxazol eye drops and immediately caused a dramatic improvement and total relief of the symptoms.
Der Ophthalmologe 03/2012; 109(3):283-5. · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: The ‘Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study’ (SPR study) is a randomized multicentre trial comparing primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). This subanalysis was conducted to identify risk factors associated with anatomical outcomes.
Methods: Relating the anatomical success results at the 1-year follow-up visit to pre- and intraoperative findings using multivariate statistical methods.
Results: In the phakic subtrial, anatomical success was negatively associated with the number of breaks (p < 0.0001), break extension > 1 clock hour (p = 0.0005) and intraoperative use of cryotherapy (p = 0.0484). It was positively associated with retinal breaks with irregular edges (p = 0.0353) and subretinal fluid drainage (p = 0.0155). In the pseudophakic/aphakic subtrial, anatomical success was negatively associated with the number of retinal breaks (p = 0.0004) and previous YAG capsulotomy (p = 0.0256), and the combined effect of the surgical procedure and intraoperative use of laser (p = 0.0229).
Conclusion: Primary anatomical success is an important result for patients undergoing RRD surgery. Our data demonstrate that the final anatomical outcome is related to a higher preoperative number of breaks and cryotherapy in phakic eyes. Additional risk factors varied between phakic and pseudophakic subgroups. Our findings may be used to facilitate the prognosis of future patients with RRD.
[Show abstract][Hide abstract] ABSTRACT: Diabetes mellitus, as well as subsequent ocular complications such as cystoid macular edema (CME), are of fundametal socio-economic relevance. Therefore, we evaluated the influence of internal limiting membrane (ILM) removal on longterm morphological and functional outcome in patients with diabetes mellitus (DM) type 2 and chronic CME without evident vitreomacular traction.
Forty eyes with attached posterior hyaloid were included in this prospective trial and randomized intraoperatively. Prior focal (n = 31) or panretinal (n = 25) laser coagulation was permitted. Group I (n = 19 patients) underwent surgical induction of posterior vitreous detachment (PVD), group II (n = 20 patients) PVD and removal of the ILM. Eleven patients with detached posterior hyaloid (group III) were not randomized, and ILM removal was performed. One eye had to be excluded from further analysis. Examinations included ETDRS best-corrected visual acuity (BCVA), fluorescein angiography (FLA) and OCT at baseline, 3 and 6 months postoperatively. Main outcome measure was BCVA at 6 months, secondary was foveal thickness.
Mean BCVA over 6 months remained unchanged in 85% of patients of group II, and decreased in 53% of patients of group I. Results were not statistically significant different [group I: mean decrease log MAR 95% CI (0.06; 0.32), group II: (-0.02; 0.11)]. OCT revealed a significantly greater reduction of foveal thickness following PVD with ILM removal [group I: mean change: 95% CI (-208.95 μm; -78.05 μm), group II: (-80.90 μm: +59.17 μm)].
Vitrectomy, PVD with or without ILM removal does not improve vision in patients with DM type 2 and cystoid diabetic macular edema without evident vitreoretinal traction. ILM delamination shows improved morphological results, and appears to be beneficial in eyes with preexisting PVD.
Albrecht von Graæes Archiv für Ophthalmologie 07/2011; 249(7):997-1008. DOI:10.1007/s00417-010-1610-8 · 1.91 Impact Factor