H Helbig

University Hospital Regensburg, Ratisbon, Bavaria, Germany

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Publications (146)167.16 Total impact

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    ABSTRACT: To describe clinical characteristics of Müller cell sheen dystrophy (MCSD) in two unrelated patients followed for 10 years.
    Documenta ophthalmologica. Advances in ophthalmology. 10/2014;
  • Journal of neuroimaging: official journal of the American Society of Neuroimaging 09/2014; · 3.36 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 Monatsblatter fur Augenheilkunde. 09/2014; 231(9):883-889.
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    ABSTRACT: This article reports a case of primary localized conjunctival λ light-chain (AL) amyloidosis.
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 08/2014;
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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 Monatsblatter fur Augenheilkunde. 06/2014;
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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; · 5.00 Impact Factor
  • Bone marrow transplantation 04/2014; · 3.00 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; · 4.12 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; · 3.36 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; · 0.53 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 01/2014; 9(9):e107461. · 3.53 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. · 0.53 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;
  • 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
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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;
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    ABSTRACT: To date, little is known about the morphology of optic discs in premature infants. However, optic disc morphology and optic nerve development are two factors that potentially influence visual function in infants. Thus we analysed the morphology of the optic disc and its correlation with gestational age and birth weight. In a retrospective trial, we assessed the widefield images (RetCam system) of 111 optic discs of 61 premature infants. We evaluated the form of the optic disc, defined by the ratio of the vertical to the horizontal diameter, the presence or absence of visible disc cupping, the cup to disc ratio and the presence or absence of a double ring (a concentric paler zone around the optic disc). 110 of 111 optic discs had a vertical-oval form. We found a significant negative correlation between the form of the optic disc and birth weight (p=0.003) and gestational age (p=0.03); 75% of optic discs showed a double ring and 89% had visible disc cupping. In our study, premature birth was associated with the presence of a double ring. A low birth weight and low gestational age influence the form of the optic disc.
    The British journal of ophthalmology 03/2013; 97(3):314-7. · 2.92 Impact Factor
  • Klinische Monatsblätter für Augenheilkunde 02/2013; 230(2):170-7. · 0.70 Impact Factor
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    ABSTRACT: Retinopathy of prematurity (ROP) is one of the three leading causes of legal blindness in childhood in developed countries. Adequate screening is one of the most important steps towards successful treatment. During the last decades, international and national guidelines for ROP screening have been continually updated. These guidelines correspond to progress in neonatal care and to a better understanding of the relationship between different neonatal parameters and the risk of developing ROP. The present article surveys ROP classification, the current national and international guidelines and new aspects of ROP screening.
    Der Ophthalmologe 12/2012; 109(12):1182-8. · 0.53 Impact Factor
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    ABSTRACT: Purpose: Sudden retinal blindness is a common complication of temporal arteritis (TA). Another common cause is embolic occlusion of the central retinal artery (CRA). The aim of this prospective study was to examine the diagnostic value of hyperechoic material in the CRA for the exclusion of vasculitis as a cause. The authors used orbital color-coded sonography (OCCS) for the detection of hyperechoic material. Materials and Methods: 24 patients with sudden vision loss were included in the study after the exclusion of other causes (e. g. vitreous bleeding, retinal detachment). Parallel to routine diagnostic workup, OCCS was performed in all patients. Results: 7 patients with a diagnosis of TA presented with different degrees of hypoperfusion in the CRA without hyperechoic material (referred to as "spot sign") detected by OCCS. Diagnostic workup in the remaining 17 patients revealed other causes of sudden vision loss, such as central retinal artery occlusion (CRAO) (12), anterior ischemic optic neuropathy (AION) (2), upstream vascular stenosis or occlusion (2) and delayed reperfusion of the CRA (1). The hyperechoic "spot sign" was visible in 10 of 12 patients (83 %) with embolic CRAO. The detection of embolic CRAO using the "spot sign" had a sensitivity of 83 % and a specificity of 100 %. The missing "spot sign" in patients with TA was a highly specific finding (p-value 0.01). Conclusion: The detection of the "spot sign" specifically minimizes the probability of TA as a reason for sudden blindness.
    Ultraschall in der Medizin 09/2012; · 4.12 Impact Factor

Publication Stats

636 Citations
167.16 Total Impact Points

Institutions

  • 2009–2014
    • University Hospital Regensburg
      • Klinik für Augenheilkunde
      Ratisbon, Bavaria, Germany
  • 2007–2014
    • Universität Regensburg
      • Department of Ophthalmology
      Ratisbon, Bavaria, Germany
  • 2011
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2005–2008
    • University of Zurich
      • Ophthalmology Unit
      Zürich, ZH, Switzerland
  • 2006
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      Liverpool, England, United Kingdom
  • 2000–2005
    • Kantonsspital St. Gallen
      San Gallo, Saint Gallen, Switzerland
  • 2002–2003
    • Cantonal Hospital of Schwyz
      Schwyz, Schwyz, Switzerland
  • 1993–2001
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlín, Berlin, Germany