H Helbig

University Hospital Regensburg, Ratisbon, Bavaria, Germany

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Publications (136)174.29 Total impact

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    ABSTRACT: Pseudotumor cerebri is an idiopathic increase in intracranial pressure, which commonly affects obese women of fertile age. The diagnostic criteria according to the guidelines of the German Society for Neurology are increased cerebrospinal fluid (CSF) pressure, symptoms of increased CSF pressure, normal results of CSF examination, no relevant medication and a lack of structural and vascular lesions in magnetic resonance imaging (MRI). This article presents the case of a 39-year-old male patient who presented at hospital with visual obscuration and recently occurred double vision. Except for a recently diagnosed thrombosis of the left jugular vein of unknown origin, there was nothing else of note in the medical history. Biomicroscopic examination showed papilledema with hemorrhages and cotton wool spots. The CSF opening pressure was initially > 50 cmH2O. During therapy by lumbar puncture (three times), oral carbonic anhydrase inhibitors and loop diuretics, the abducens nerve palsy and papilledema receded. Anticoagulation therapy (initially with coumarin derivatives, then with low molecular weight heparins) was unsuccessful in eliminating the thrombosis of the jugular vein. Surgical intervention was not recommended by the vascular surgeons. This case report demonstrates the unusual combination of (idiopathic) intracranial hypertension and thrombosis of the jugular vein, which occurred spontaneously and without any detectable coagulation disorders.
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    ABSTRACT: A prematurely born male infant (24+5 gestational weeks, birth weight 485 g) was diagnosed with bilateral aggressive posterior retinopathy of prematurity (AP-ROP) in zone I. After obtaining informed written consent from the parents, one eye was treated with diode laser photocoagulation and the other eye with 0.25 mg intravitreal ranibizumab. Laser photocoagulation was found to be an effective tool for fast regression of AP-ROP; however, medium-term evaluation showed poor macular formation and peripheral retinal detachment. The intravitreal injection led to a slower but better control of the AP-ROP and central foveal reflexes showed better anatomical outcome.
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    ABSTRACT: To describe clinical characteristics of Muller cell sheen dystrophy (MCSD) in two unrelated patients followed for 10 years. Best-corrected visual acuity (BCVA), kinetic perimetry, biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, fundus autofluorescence, near-infrared reflectance, optical coherence tomography (OCT), and electroretinography (ERG). Case 1: A 61-year-old woman showed internal limiting membrane (ILM) folds at the posterior pole (OU), and cystoid macular edema (CME) in OD. During follow-up, BCVA decreased from 0.2 to 0.06 (OD) and from 0.7 to hand movements (OS). Fundus presented fluctuant CME and subretinal fluid, and an increase in ILM folds and intraretinal schisis cavities. ERG was negative in OD and initially normal in OS. Case 2: A 60-year-old man was first diagnosed with epiretinal membrane before MCSD with ILM folds was detected. OCT showed schisis cavities in all retinal layers. After vitrectomy with ILM peeling in OD because of visual loss and massive CME, BCVA recovered from 0.05 to 0.4. BCVA in OS remained at 0.6. OD developed negative ERG. MCSD presents with late onset, ILM folds, intraretinal schisis cavities, and negative ERG. Visual loss is accompanied by CME and subretinal fluid. Vitrectomy with ILM peeling led to BCVA increase and anatomic improvement.
    Documenta Ophthalmologica 10/2014; 129(3). DOI:10.1007/s10633-014-9463-9 · 1.11 Impact Factor
  • Journal of neuroimaging: official journal of the American Society of Neuroimaging 09/2014; DOI:10.1111/jon.12161 · 1.82 Impact Factor
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    ABSTRACT: Age-related macular degeneration (AMD) is the leading cause of severe vision impairment in Western populations over 55 years. A growing number of gene variants have been identified which are strongly associated with an altered risk to develop AMD. Nevertheless, gene-based biomarkers which could be dysregulated at defined stages of AMD may point toward key processes in disease mechanism and thus may support efforts to design novel treatment regimens for this blinding disorder. Circulating microRNAs (cmiRNAs) which are carried by nanosized exosomes or microvesicles in blood plasma or serum, have been recognized as valuable indicators for various age-related diseases. We therefore aimed to elucidate the role of cmiRNAs in AMD by genome-wide miRNA expression profiling and replication analyses in 147 controls and 129 neovascular AMD patients. We identified three microRNAs differentially secreted in neovascular (NV) AMD (hsa-mir-301-3p, pcorrected = 5.6*10-5, hsa-mir-361-5p, pcorrected = 8.0*10-4 and hsa-mir-424-5p, pcorrected = 9.6*10-3). A combined profile of the three miRNAs revealed an area under the curve (AUC) value of 0.727 and was highly associated with NV AMD (p = 1.2*10-8). To evaluate subtype-specificity, an additional 59 AMD cases with pure unilateral or bilateral geographic atrophy (GA) were analyzed for microRNAs hsa-mir-301-3p, hsa-mir-361-5p, and hsa-mir-424-5p. While we found no significant differences between GA AMD and controls neither individually nor for a combined microRNAs profile, hsa-mir-424-5p levels remained significantly higher in GA AMD when compared to NV (pcorrected<0.005). Pathway enrichment analysis on genes predicted to be regulated by microRNAs hsa-mir-301-3p, hsa-mir-361-5p, and hsa-mir-424-5p, suggests canonical TGFβ, mTOR and related pathways to be involved in NV AMD. In addition, knockdown of hsa-mir-361-5p resulted in increased neovascularization in an in vitro angiogenesis assay.
    PLoS ONE 09/2014; 9(9):e107461. DOI:10.1371/journal.pone.0107461 · 3.53 Impact Factor
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    ABSTRACT: Retinal haemorrhages are one of the three cardinal manifestations of the "shaken baby syndrome" or "non-accidental head injury" in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper.
    Klinische Monatsblätter für Augenheilkunde 09/2014; 231(9):883-889. DOI:10.1055/s-0034-1382955 · 0.67 Impact Factor
  • H Helbig, A Joussen
    Klinische Monatsblätter für Augenheilkunde 09/2014; 231(9):873. DOI:10.1055/s-0034-1382979 · 0.67 Impact Factor
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    ABSTRACT: This article reports a case of primary localized conjunctival λ light-chain (AL) amyloidosis.
    Der Ophthalmologe 08/2014; DOI:10.1007/s00347-014-3091-3 · 0.72 Impact Factor
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    ABSTRACT: Purpose: Trabeculectomy is a frequently used surgical procedure in open-angle glaucomas. The present study analyses the outcome and complications after trabeculectomy or re-trabeculectomy depending on the preoperative intraocular pressure (IOP) < 30 mmHg and ≥ 30 mmHg. Methods: One hundred and eighteen patients were included in this retrospective study. Primary ocular outcomes were the postoperative IOP at discharge and postoperative complications such as choroidal detachment and flattening of the anterior chamber. The necessity of postoperative interventions such as needle revisions, viscoelastic injections or surgical revision was documented. Results: In this survey 118 patients (68 men, 50 women) were included (age [arithmetic mean] 68.3 ± 12.1 years). The postoperative follow-up period was 6-9 months. In 60 patients the preoperative IOP was < 30 mmHg, in 58 patients ≥ 30 mmHg. Postoperative complications were flattening of the anterior chamber (< 2 corneal thickness) in 11 patients (9.3 %) and temporary choroidal detachment in 20 patients (16.9 %). On the day of discharge the mean IOP was 9.8 mmHg. Hence the IOP was on average reduced by 17 mmHg (SD 11.2 mmHg). Postoperative interventions were necessary in 28 patients (23.7 %). Seventeen (14.4 %) developed tenon cysts which were treated by needle revision of the bleb. Nine patients (7.6 %) underwent a viscoelastic injection for persistent hypotony and 10 patients underwent bleb revision (8.5 %). Conclusions: This study does not show statistically significant differences depending on preoperative IOP in temporary choroidal detachment and postoperative interventions. A postoperative flattening of the anterior chamber was found statistically significantly more often in patients with higher preoperative IOP.
    Klinische Monatsblätter für Augenheilkunde 06/2014; 231(8). DOI:10.1055/s-0034-1368403 · 0.67 Impact Factor
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    ABSTRACT: Induced pluripotent stem cell (iPSC)-derived retinal pigment epithelium (RPE) has widely been appreciated as a promising tool to model human ocular disease emanating from primary RPE pathology. Here, we describe the successful reprogramming of adult human dermal fibroblasts to iPSCs and their differentiation to pure expandable RPE cells with structural and functional features characteristic for native RPE. Fibroblast cultures were established from skin biopsy material and subsequently reprogrammed following polycistronic lentiviral transduction with OCT4, SOX2, KLF4 and L-Myc. Fibroblast-derived iPSCs showed typical morphology, chromosomal integrity and a distinctive stem cell marker profile. Subsequent differentiation resulted in expandable pigmented hexagonal RPE cells. The cells revealed stable RNA expression of mature RPE markers RPE65, RLBP and BEST1. Immunolabelling verified localisation of BEST1 at the basolateral plasma membrane, and scanning electron microscopy showed typical microvilli at the apical side of iPSC-derived RPE cells. Transepithelial resistance was maintained at high levels during cell culture indicating functional formation of tight junctions. Secretion capacity was demonstrated for VEGF-A. Feeding of porcine photoreceptor outer segments revealed the proper ability of these cells for phagocytosis. IPSC-derived RPE cells largely maintained these properties after cryopreservation. Together, our study underlines that adult dermal fibroblasts can serve as a valuable resource for iPSC-derived RPE with characteristics highly reminiscent of true RPE cells. This will allow its broad application to establish cellular models for RPE-related human diseases.
    Neuromolecular medicine 05/2014; 16(3). DOI:10.1007/s12017-014-8308-8 · 3.89 Impact Factor
  • Bone marrow transplantation 04/2014; 49(7). DOI:10.1038/bmt.2014.81 · 3.47 Impact Factor
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    ABSTRACT: Ocular color-coded duplex sonography (OCCS), when performed within the safety limits of diagnostic ultrasonography, is an easy noninvasive technique with high potential for diagnosis and therapy in diseases with raised intracranial pressure and vascular diseases affecting the eye. Despite the capabilities of modern ultrasound systems and its scientific validation, OCCS has not gained widespread use in neurological practice. In this review, the authors describe the technique and main parameter settings of OCCS systems to reduce potential risks as thermal or cavitational effects for sensitive orbital structures. Applications of OCCS are the determination of intracranial pressure in emergency medicine, and follow-up evaluations of idiopathic intracranial hypertension and ventricular shunting by measuring the optic nerve sheath diameter. A diameter of 5.7 - 6.0 mm corresponds well with symptomatically increased intracranial pressure (> 20 cmH2O). OCCS also helps to discriminate between different etiologies of central retinal artery occlusion - by visualization of a "spot sign" and Doppler flow analysis of the central retinal artery - and aids the differential diagnosis of papilledema. At the end perspectives are illustrated that combine established ultrasound methods such as transcranial color-coded sonography with OCCS.
    Ultraschall in der Medizin 03/2014; 35(5). DOI:10.1055/s-0034-1366113 · 4.65 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSECentral retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery (“spot sign”).METHODS In this study we performed a follow-up investigation in 7 patients with CRAO and positive spot sign indicating the embolic cause of the occlusion after a median interval of 17 months (range 11-38 months) using a battery of tests (ocular color-coded sonography, optic coherence tomography [OCT], fundoscopy, amongst others).RESULTSThe spot sign persisted in all patients, none had high-grade internal carotid artery stenosis, stroke or transient ischemic attacks. Four patients were completely blind, 3 patients were able to recognize hand movements. OCT demonstrated retinal atrophy, and fundoscopy revealed only minimal arterial perfusion.CONCLUSIONS The hyperechoic spot sign may be an important predictive prognostic marker for persistent loss of vision. Its persistence may indicate calcified or cholesterol emboli and may explain the low therapeutic success rate to thrombolysis. Further studies on their origin and significance in atherosclerotic disease are warranted.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 03/2014; DOI:10.1111/jon.12112 · 1.82 Impact Factor
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    ABSTRACT: There are some reports showing isolated cases of drusen regression after pars plana vitrectomy (ppV) with peeling of the internal limiting membrane (iLM). Drusen characteristics after iLM peeling was investigated in this study. The data of 527 patients who had received iLM peeling between 2004 and 2012 were retrospectively collected and those patients with retinal drusen were selected for the study. Fundus photographs before and after vitrectomy due to a macular hole or epiretinal gliosis were compared and drusen arrangement in the peeling site was analyzed. The aim of the study was to show whether there was drusen regression 2-5 months after surgery. Out of the 527 patients 11 showed central macular drusen, 4 with confluent large drusen (> 63 µm diameter) and 7 with small hard drusen (≤ 63 µm diameter). One patient showed drusen regression after iLM peeling without any changes in the other eye and all other patients showed no differences in the drusen findings (n = 6) or even some additional drusen (n = 4) without drusen alterations in the other eye. The results of this study could not confirm some reports showing drusen regression after iLM peeling in the peeling site in general and there was only one single case of central drusen regression.
    Der Ophthalmologe 02/2014; DOI:10.1007/s00347-013-3007-7 · 0.72 Impact Factor
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    ABSTRACT: Retinal pigment epithelial detachment (PED) can occur associated with multiple ocular and infrequently also primarily non-ocular pathologies. They can be sub-divided into drusenoid, serous, serous-vascularized and fibrovascular PED. Most commonly PED is found in age-related macular degeneration. The knowledge of possible differential diagnoses is important for the prognosis and helps in the choice of therapy and in the individual counseling of patients.
    Der Ophthalmologe 01/2014; 111(1):79-92. DOI:10.1007/s00347-013-3005-9 · 0.72 Impact Factor
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    ABSTRACT: We assessed the value of preoperative optical coherence tomography (OCT) for predicting the visual outcome for patients undergoing macular surgery for epiretinal membranes (ERMs). In a retrospective trial, we analyzed the medical charts of patients who had received surgery for ERMs between January and August 2011. The best-corrected pre- and postoperative logMAR visual acuity was assessed. We pre- and postoperatively measured the central foveal thickness with high-resolution spectral-domain OCT and analyzed the structure of the outer retinal layers (retinal pigment epithelium, photoreceptors, and external limiting membrane) before and after surgery. The study included 49 patients (23 male, 27 female) with an average age of 69 years (SD 6.7) who had received macular surgery during the above-mentioned period. For phakic eyes (n = 34), treatment had also included phacoemulsification and intraocular lens implantation. Postoperative follow-up examinations and OCT controls had been conducted after an average of 9 weeks (SD 5). The mean improvement in visual acuity was 2.4 lines (SD 2.3; p < 0.001). For patients with phakic eyes, the combination of vitrectomy and cataract surgery resulted in a slightly better, but insignificant increase in visual acuity than for patients with primary pseudophakia (Δ = 0.05, p = 0.46). On average, central foveal thickness regressed by 94 μm (SD 129 μm). Linear regression showed a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity (R (2) = 0.16, B = 0.71, p = 0.004). A decrease in foveal thickness by 100 μm resulted in an increase in visual acuity by 0.71 lines. Visual improvement did not significantly differ between the group of patients with intact outer retinal layers before surgery and the group of patients with preoperative defects of the retina (p = 0.085). We found a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity for patients undergoing surgery for ERM. However, the preoperative OCT status (intact vs. broken) of the outer retinal layers did not correlate with the change in visual acuity.
    International Ophthalmology 10/2013; DOI:10.1007/s10792-013-9870-z · 0.55 Impact Factor
  • Antonia M Joussen, Horst Helbig
    Klinische Monatsblätter für Augenheilkunde 09/2013; 230(9):878. DOI:10.1055/s-0033-1350752 · 0.67 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 06/2013; 230(6):614-28. DOI:10.1055/s-0032-1328663 · 0.67 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 06/2013; 230(6):629-34. DOI:10.1055/s-0032-1328668 · 0.67 Impact Factor
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    ABSTRACT: To determine changes in choroidal thickness in patients with central serous chorioretinopathy (CSCR) during the first 3 months after initial diagnosis and assess variable therapeutic interventions via enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). In this prospective study, choroidal thickness was measured via EDI-OCT both in the affected and fellow eyes of 10 patients with CSCR at the fovea, as well as at 500 and 1,000 μm both temporal and nasal from the centre of the fovea and at the leakage point (if present), visualised via fluorescein angiography. Follow-up measurements were performed after 2-3 weeks, 6-8 weeks and 3 months. Seven of the 10 patients received additional systemic therapy with oral acetazolamide. A control group of eight healthy subjects was recruited to determine normal choroidal thickness in healthy eyes. The mean age of the 10 patients (9 male, 1 female) in the CSCR group was 42.1 (±9.3) years. The choroid in the affected eyes was significantly thickened at baseline compared to fellow eyes and the eyes of healthy subjects. The choroid in the fellow eyes also revealed a slight thickening at baseline compared to normal eyes. During the 3 month follow-up period, the choroidal thickness of the affected eyes showed a highly significant decrease, but did not reach normal levels. Minor changes could also be observed in the fellow eyes but did not reach statistical significance. In patients with CSCR, the average choroidal thickness not only demonstrated a significant thickening at baseline, but also showed a marked decrease after 3 months, yet not reaching normal levels. Our data indicate that after 3 months, normalisation of choroidal thickness is not yet completed.
    International Ophthalmology 04/2013; 34(1). DOI:10.1007/s10792-013-9774-y · 0.55 Impact Factor

Publication Stats

490 Citations
174.29 Total Impact Points

Institutions

  • 2008–2015
    • University Hospital Regensburg
      • Klinik für Augenheilkunde
      Ratisbon, Bavaria, Germany
  • 2008–2014
    • Universität Regensburg
      • Department of Ophthalmology
      Ratisbon, Bavaria, Germany
  • 2011
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2006
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2000–2005
    • Kantonsspital St. Gallen
      San Gallo, Saint Gallen, Switzerland
  • 2002–2003
    • Cantonal Hospital of Schwyz
      Schwyz, Schwyz, Switzerland