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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. · 0.62 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Kolobome des vorderen Augenabschnittes können isoliert oder in Kombination mit Veränderungen des hinteren Augenabschnitts
vorkommen. Kolobome der Zonulafasern führen meist zu einer deutlichen Myopisierung und zum Astigmatismus, da sich die Linsenform
verändert. Dadurch besteht die Gefahr der Amblyopie. Auch eine Kataraktentwicklung ist möglich. Wir beschreiben 2 unterschiedlich
ausgeprägte Fälle eines Zonulakoloboms und diskutieren die häufigsten Differenzialdiagnosen.
Anterior segment colobomas can be found isolated or in combination with changes in the posterior segment. A coloboma of the
ciliary zonule leads to alteration of the lens profile with myopia and astigmatism. Amblyopia and cataract development may
also occur. We present two cases with a coloboma of the zonule with different degrees of expression and the most important
differential diagnoses are discussed.
SchlüsselwörterZonulafaserdefekt–Zonulakolobom–Linsenkolobom–Astigmatismus–Kolobom
KeywordsCiliary zonule defect–Coloboma of the zonule–Coloboma of the lens–Astigmatism–Coloboma
Der Ophthalmologe 05/2012; 108(7):672-675. · 0.62 Impact Factor
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ABSTRACT: Über viele Jahrzehnte war die skleraeindellende externe Buckelchirurgie der „goldstandard“ in der Therapie der rhegmatogenen
Netzhautablösung. Die Operationstechnik hat sich in diesem Zeitraum nur wenig verändert. Die 3 Standardtechniken, welche auch
heute breite Anwendung finden, sind die radiäre Plombe, die limbusparallele Plombe und die Cerclage. Mit diesen Techniken
lässt sich bei einfacher Ausgangssituation eine Wiederanlage in etwa 90% der Fälle erreichen. Bei pseudophaken Patienten liegt
die primäre Erfolgsrate mit skleraeindellenden Verfahren niedriger. Die pneumatische Retinopexie konnte sich bei uns wegen
der niedrigeren primären Erfolgsrate nicht durchsetzen und bleibt Sonderindikationen vorbehalten. Für viele überraschend hat
die Buckelchirurgie in der SPR-Studie gut abgeschnitten und selbst bei komplexeren mittelschweren Netzhautablösungen in der
Subgruppe der phaken Patienten bezüglich der Wiederanlagerate gleichwertige und bezüglich des Visus sogar bessere Ergebnisse
erzielt. Dies ist Anlass, den heutigen Trend zur primären Vitrektomie selbst bei einfacheren Ausgangssituationen kritisch
zu hinterfragen und für eine Neubewertung skleraeindellender Verfahren. Die längere Lernkurve neu auszubildender Netzhautchirurgen
sollte in Kauf genommen werden und eine gründliche binokulare Spiegeltechnik unbedingt weiterhin essenzieller Bestandteil
der Ausbildung bleiben.
For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment.
The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are
the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90%
can be achieved in “simple” forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after
buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in
Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised
that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional
results even in this group of patients with complex hole configuration. This gives physicians reason to critically question
the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling
surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful
preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential
part of the surgeon’s education.
Der Ophthalmologe 04/2012; 105(1):7-18. · 0.62 Impact Factor
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Der Ophthalmologe 04/2012; 104(9):806-809. · 0.62 Impact Factor
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ABSTRACT: Die Chorioretinopathia centralis serosa (CCS) ist im akuten Stadium durch eine seröse Abhebung der neurosensorischen Netzhaut
und/oder des retinalen Pigmentepithels (RPE) am hinteren Augenpol gekennzeichnet. Sie geht mit mono- oder multifokalen RPE-Veränderungen
einher und führt häufig zu einer einseitigen Sehverschlechterung. Die Ursache ist noch immer unklar, Kortison und Stress scheinen
sich aber ungünstig auf den Verlauf auszuwirken. Der Spontanverlauf ist günstig. Unterstützend kann eine Entspannungstherapie
wirken, Kortison sollte abgesetzt oder zumindest reduziert werden. Als weitere therapeutische Elemente kommen die Gabe von
Karboanhydrasehemmern, eine vorsichtige Laserkoagulation des Quellpunktes, die selektive Retinatherapie, die photodynamische
Therapie und die intravitreale Injektion von Bevacizumab in Frage. Die Autoren präsentieren ein therapeutisches Eskalationsschema
auf Basis der verfügbaren Daten.
In the acute stage central serous chorioretinopathy (CSC) is characterized by serous retinal detachment. Monofocal or multifocal
structural changes of the pigment epithelium layer are common. Unilateral blurred vision is the major clinical symptom. The
pathogenesis is unclear but corticosteroids and stress may trigger the disease. Normal vision often returns spontaneously
within a few months. Therapeutic options are at a low evidence level. Carbonic anhydrase, mild laser photocoagulation, selective
retinal therapy, photodynamic therapy and the intravitreal injection of bevacizumab have been reported. The authors suggest
a treatment strategy on the basis of the available data.
SchlüsselwörterChorioretinopathia centralis serosa-Retinopathia centralis serosa-Selektive Retinatherapie-Retinales Pigmentepithel-Therapeutisches Eskalationsschema
KeywordsCentral serous chorioretinopathy-Central serous retinopathy-Selective retinal therapy-Retinal pigment epithelium-Therapeutic escalation scheme
Der Ophthalmologe 04/2012; 107(5):479-493. · 0.62 Impact Factor
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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. · 0.62 Impact Factor
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The British journal of ophthalmology 06/2011; 95(6):888-9, 898. · 2.92 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Anterior segment colobomas can be found isolated or in combination with changes in the posterior segment. A coloboma of the ciliary zonule leads to alteration of the lens profile with myopia and astigmatism. Amblyopia and cataract development may also occur. We present two cases with a coloboma of the zonule with different degrees of expression and the most important differential diagnoses are discussed.
Der Ophthalmologe 04/2011; 108(7):672-5. · 0.62 Impact Factor
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[hide abstract]
ABSTRACT: The novel therapeutic principle of intravitreal drug therapy for retinal vein occlusion has become an integrated constituent of clinical practice over the last years. The two substance classes that have been evaluated in large randomised clinical trials so far are corticosteroids and inhibitors of vascular endothelial growth factor (VEGF). The reported treatment success of these intravitreally administered substances has lead not only to a paradigm shift in clinical care but has also advanced our understanding of the underlying pathophysiological principles of retinal vein occlusions. In this review the different substances are discussed, their mechanisms of action are analysed and the results of the large clinical trials available to date are critically evaluated. Furthermore, an approach to integrate these novel treatment options into the existing treatment regimes for retinal vein occlusions is suggested.
Klinische Monatsblätter für Augenheilkunde 09/2010; 227(9):681-93. · 0.51 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: In the acute stage central serous chorioretinopathy (CSC) is characterized by serous retinal detachment. Monofocal or multifocal structural changes of the pigment epithelium layer are common. Unilateral blurred vision is the major clinical symptom. The pathogenesis is unclear but corticosteroids and stress may trigger the disease. Normal vision often returns spontaneously within a few months. Therapeutic options are at a low evidence level. Carbonic anhydrase, mild laser photocoagulation, selective retinal therapy, photodynamic therapy and the intravitreal injection of bevacizumab have been reported. The authors suggest a treatment strategy on the basis of the available data.
Der Ophthalmologe 05/2010; 107(5):479-92; quiz 493. · 0.62 Impact Factor
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Klinische Monatsblätter für Augenheilkunde 09/2009; 226(8):R123-35; quiz 136-7. · 0.51 Impact Factor
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ABSTRACT: Perfluorocarbon liquids (PFCL) cause retinal damage when used as long-term ocular endotamponades. Whether these changes are related to the mechanical or to the chemical properties of PFCL is unclear. The purpose of this study was to evaluate pressure spikes or shearing forces during endotamponade with PFCL and standardised eye movements.
Part 1: In an eye model the resulting pressure forces of 6 PFCL were measured at four different sites during standardised eye movements. Part 2: Shearing forces were determined in a plexiglass eye model and the resulting tangential forces at the PFCL-retina interface were calculated. Part 3: Rabbit eyes were vitrectomised and filled with light and heavy fluorocarbons for 6 weeks. Subsequently, the retina were examined histologically and by immunohistochemistry.
With increasing filling of the eye model, the maximum of the pressure peaks moved from the inferior wall of the eye model to the lateral eye walls. For perfluorodecalin (PFD) the highest pressure peak was 407 Pa with a 75 % filling of the vitreous cavity. The lowest pressure peak was 314 Pa with a 50 % filling of hexafluoropropene oxide. Shearing forces for standardised accelerations were dependent on viscosity and ranged between 0.87 mN/m(2) (perfluorohexyloctane) and 8055 mN/m(2) (hexafluoropropene oxide). Part 3: Histological and immunohistochemical analyses did not reveal pressure-related damage or any difference between the effects of the different tamponades in vivo.
In comparison with physiological dynamic and static pressure peaks, the measured mechanical forces induced by intraocular PFCL tamponades are low. Specific gravity and mechanical damage by intraocular PFCL as a cause of retinal damage seem unlikely. Animal studies underline these findings.
Klinische Monatsblätter für Augenheilkunde 02/2009; 226(1):38-47. · 0.51 Impact Factor
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ABSTRACT: Therapeutic strategies for macular holes have been optimised during the last years. However, little is known about atypical macular holes. This study was conducted to analyse the clinical and anatomic outcome in secondary macular holes of different origins.
In a retropective analysis 60 eyes with atypical macular holes that underwent surgical repair were identified. Demografic data, lens status, macular situation, best corrected visual acuity (BCVA) pre- and postoperative and complications were documented. After exclusion of patients with trauma, vitreomacular traction syndrome and epiretinal gliosis four subgroups were analysed. Group I: after retinal detachment (n = 6), Group II: with retinal vein occlusion (n = 5), Group III: associated with diabetic macular oedema (n = 6), Group IV: during/after internal limiting membrane peeling (n = 3).
I. Four of six eyes showed a macular hole after successful retinal detachment surgery and two eyes in the presence of retinal detachment. Five of six eyes showed postoperative closure of the macular hole. BCVA improved in four eyes, worsened in one eye and remained unchanged in one. II. In five eyes a secondary macular hole occurred after retinal vein occlusion. After vitrectomy and gas tamponade a successful hole repair was observed in all eyes. Improvement of BCVA occurred in four eyes and remained unchanged in one eye. III. In six eyes a secondary macular hole developed after rupture of cysts in diabetic macular oedema. Four of six holes were closed successfully after vitrectomy. Improvement of BCVA was seen in two eyes, impaired BCVA in one eye and in one eye vision remained unchanged. IV. This group consists of two eyes with a macular hole after vitrectomy and membrane peeling and one eye with an iatrogenic intraoperatively created macular hole. After vitrectomy and gas tamponade, anatomic success was achieved in two eyes. Improvement of BCVA was observed in two eyes, in one eye BCVA deteriorated markedly.
In spite of the different underlying diseases and pathomechanisms, secondary macular holes can be treated successfully in the majority of cases. Visual recovery was moderate in patients with diabetic macular oedema but marked in the other subgroups. Therefore, vitrectomy seems reasonable also in non-atypical macular holes of various origins.
Klinische Monatsblätter für Augenheilkunde 05/2008; 225(4):281-5. · 0.51 Impact Factor
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ABSTRACT: In vivo animal experiments have shown that the cytoskeleton plays a crucial role in case of structural changes after an induced retinal detachment. This study attempts to clarify whether a retinal organ culture could serve as an in vitro model for retinal detachment and thus represent an alternative to animal experiments. The main focus of this publication lies on the early cytoskeletal changes after retinal detachment.
Porcine retinas were mounted on special carriers, cultured for one or two weeks and examined by standard immunohistological (vimentin, GFAP, alpha-tubulin), as well as electron microscopical procedures.
The cytoskeletal changes revealed similar spatio-temporal pattern compared with in vivo induced retinal detachments. In addition, it was shown that microtubules might play a crucial role in the early phase of gliosis, i. e., prior to a subretinal invasion by Müller cell extensions.
The presented organ culture model will be used to unravel the largely unknown initial reactions of retinal gliosis, focusing on subcellular changes localised at the outer limiting membrane. The intracellular transport system of microtubules might play a key role in these processes.
Klinische Monatsblätter für Augenheilkunde 05/2008; 225(4):269-75. · 0.51 Impact Factor
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[hide abstract]
ABSTRACT: The latest development in ARMD surgery is the translocation of an autologeous pigment epithelium choroid patch. The method has technical shortcomings: The transplant is excised including the overlaying retina and inserted through a retinotomy near the posterior pole thus causing iatrogenic field defects. For the same reasons the size of the transplant is limited.
The technique was modified as follows: lens surgery using a special PCL with equal power in water and silicone oil, 180 degrees retinotomy just at the temporal ora serrata, subretinal surgery including patch transplantation with the retina folded over nasally and fixed by PFCL, complete silicone oil tamponade without any water remaining.
12 consecutive cases, age 79 (70 - 86) years, 4 RPE detachments and rips, 8 subretinal hemorrhages from wet ARMD, follow-up in 10 eyes over 15.3 (3 - 23) months. Time courses for visual acuity, depth of central scotoma, OCT and FAG.
The mean diameter of the transplants was 16.5 (9 - 33) degrees . Silicone explantation in 7 / 10. Complications in 3 / 10: 1 macula puckering, 1 peripheral detachment, 1 PVR detachment. According to FAG the transplant vascularises in 4 - 6 weeks. 4 / 10 eyes reached visual acuity > 0.2 with limited reading capability. Central scotoma depth remained constant at -11 dB. Function deteriorated again after 6 - 9 months with cystoid degeneration and retinal thickening. 8 / 11 patients estimated the operated eye to be superior to the untreated partner eye.
Patch transplantation is able to restore limited reading capability in eyes having minor damage of the central retina. The best cases for this type of operation are RPE rips and recent sub-RPE haemorrhages. The functional success lasts 5 to 9 months, then the retina over the transplant begins to degenerate.
Klinische Monatsblätter für Augenheilkunde 04/2008; 225(4):286-91. · 0.51 Impact Factor
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ABSTRACT: The aim of this communication is to report a case of epiretinal membrane removal with intra-operative unexpected subretinal extension of the membrane.
This is an observational case report. An 83-year-old female patient with bilateral pigmented secondary macular pucker after laser coagulation for diabetic retinopathy underwent vitrectomy with membrane peeling and membrane excision. The specimen was studied by means of light and electron microscopy.
The pigmented membrane extended through the retina forming an epiretinal and an intraretinal portion. Electron microscopy revealed connective tissue, capillaries and two different cell types that were retinal pigment epithelium-like and fibroblast-like.
Misinterpreted parafoveal telangiectasis and focal lasercoagulation is the likely cause for our findings.
Klinische Monatsblätter für Augenheilkunde 04/2008; 225(3):240-2. · 0.51 Impact Factor
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ABSTRACT: The number of intravitreal injections has increased steadily over the past few years. The aim of this prospective study was to evaluate the safety of intravitreal injections in patients under concurrent oral anticoagulation or antiplatelet therapy.
57 patients who underwent consecutively 80 intravitreal injections of Ranibizumab, Bevacizumab or triamcinolone were included in the study. The majority of the patients was treated with Ranibizumab and received antiplatelet therapy. Post-injection intra- or extraocular haemorrhages were documented.
Small subconjunctival haemorrhages were noted in 45 % of the eyes. No patient experienced a subtotal subconjunctival or vitreous haemorrhage. There was no difference between patients who received oral anticoagulation and those with antiplatelet therapy.
This study suggests that intravitreal injections can be performed without cessation of oral anticoagulation or antiplatelet therapy.
Klinische Monatsblätter für Augenheilkunde 04/2008; 225(3):217-9. · 0.51 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90% can be achieved in "simple" forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional results even in this group of patients with complex hole configuration. This gives physicians reason to critically question the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential part of the surgeon's education.
Der Ophthalmologe 02/2008; 105(1):7-18. · 0.62 Impact Factor
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Der Ophthalmologe 10/2007; 104(9):806-9. · 0.62 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: To evaluate the potential role of radial optic neurotomy (RON), a new surgical technique has been recently proposed for treating central retinal vein occlusion (CRVO). It is hypothesized that CRVO constitutes a neurovascular compartment syndrome at the site of the lamina cribrosa, which can be alleviated by performing a radial incision at the nasal part of the optic nerve head, relaxing the cribriform plate and the adjacent sclera.
One hundred and seven patients were treated with RON for CRVO at five collaborating ophthalmologic centers. All patients were evaluated by a standardized protocol. For analysis of the angiographic and fundus findings, reference images were used. Intraoperative and postoperative complications were reviewed.
On 55 right and 52 left eyes of 107 patients (55.6% male, 44.4% female) with a median age of 68 years (range 21-91 years), RON was performed. The median follow-up time was 6 months (range 1-24 months). The median preoperative visual acuity (VA) was 0.05 (logMAR 1.3), increasing to a median postoperative VA of 0.08 (logMAR 1.1). Patients with an interval of more than 90 days between RON and onset of CRVO showed no significant change in VA at the 6-month follow-up. Severe peripapillary swelling of the optic nerve head prior to RON resulted in an average increase of 4.2 lines in VA at the 6-month follow-up. Angiographic findings of shunt vessels were seen in 18/30 cases after 12 months and were accompanied by an average improvement of VA of six lines. Visual field tests showed various defects in 86.8% of all cases. In one patient an iatrogenic injury of the central retinal artery occurred (0.9%).
Despite the potential risk of visual field defects, RON seems to be a quite safe procedure. The majority of patients showed rapid normalization of the morphologic fundus findings, with an improvement in VA uncommon for the natural history of CRVO. No significant change in VA was seen in patients with an interval of more than 90 days between the onset of CRVO and RON. A prospective study is warranted for further investigation.
Albrecht von Graæes Archiv für Ophthalmologie 09/2007; 245(8):1145-56. · 2.17 Impact Factor
