Retinale angiomat?se Proliferationen mit assoziierter Pigmentepithelabhebung

Background

Vascularized pigment epithelial detachment (PED) in retinal angiomatous proliferation (RAP) represents a special morphological form of exudative age-related macular degeneration (ARMD) in the natural course and in the frequency of complications, such as tears in the pigment epithelium. In this study the results of inhibition of vascular endothelial growth factor (VEGF) for exudative ARMD with associated PED and RAP were examined.

Materials and methods

Functional and morphological data were retrospectively collected for 61 consecutive eyes with RAP in stages 2 and 3 over an average observation period of 108 weeks. Patients were treated with bevacizumab (n=15), ranibizumab (n=29) and pegabtanib (n=17) according to the recommendations of the German Society of Ophthalmology (DOG) and the German Retina Society (RG). After an initial treatment cycle of 3 injections every 4 weeks (6 weeks for pegabtanib), best corrected visual acuity (BCVA), fluorescence angiography (FAG), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT) were evaluated every 12 weeks.

Results

The mean visual acuity was 0.8?logMAR before therapy and 0.77?logMAR after therapy so that the average difference to the original acuity was ?0.03 ?logMAR after 12 weeks and 0.00?logMAR after 48 weeks. The central retinal thickness measured by OCT decreased on average by 81.2???m after the first cycle of injections and by ?68.4???m after 1 year. The maximum depth of PED could be reduced on average by 1 unit and after 1 year by 1.55 units. Better functional and morphological results were obtained by therapy with ranibizumab and avastin compared to pegabtanib (p=0.03). An RIP occurred in 9.8% of the patients (n=6) on average after 16 weeks.

Conclusions

The morphological functional results can be improved in the early months using the therapy strategy presently recommended in Germany. However, in later stages there was a significant worsening of the functional results. Modification of the treatment strategy with respect to close surveillance and possibly early stage repeat treatment would seem advisable.     

Thrombophiliefaktoren als Auslöser retinaler Gefäßverschlüsse

PURPOSE: Thrombophilic abnormalities and defects in the anticoagulant system, such as protein C or protein S deficiency, activated protein C resistance and factor V Leiden mutation, may produce retinal vascular occlusions. PATIENTS: Blood samples from 66 consecutive retinal vascular occlusion patients were obtained and analysed for protein C resistance and fibrinolysis activity. Other thrombophilic and standard laboratory coagulant tests were also carried out. RESULTS: An increased activity of factor VIII was found in 72% of the collective. Furthermore, 24% of all patients and 32% of patients younger than 45 years old were resistant to activated protein C. Nevertheless only one patient showed a homozygous factor V Leiden mutation. CONCLUSION: Thrombophilic activity in cases of protein C resistance or factor V Leiden mutation may result in severe thrombotic manifestations in ocular vessels. Compared to the elderly, younger people showed a higher activated protein C resistance which seems be one of the most common causes for retinal vascular occlusion in this age group.     

Bevacizumab zur Therapie des Makulaödems infolge venöser retinaler Gefäßverschlüsse

BACKGROUND: Retinal vein occlusion often leads to macular edema as a result of an elevated level of intravitreal VEGF. We report on the anatomic and functional results after intravitreal bevacizumab injections in patients with retinal vein occlusion. METHODS: In a prospective study, 18 patients with central, and 22 patients with branch retinal vein occlusion, all of whom had persistent macular edema (>300 microm) received 2.5 mg intravitreal bevacizumab. ETDRS visual acuity, ophthalmic examination and stratus OCT were performed at baseline, 1 week after injection and then monthly. Further injections were given every 6 weeks in patients with persistent or recurring macular edema.RESULTS: The findings did not deteriorate in any of the 40 patients. The injections (mean of 2.6+/-1.4 injections/patient) were very well tolerated in all cases during a mean follow-up of 23+/-13 weeks. On the last visit, 73.3% of patients with central retinal vein occlusion and 76.5% of those with branch retinal vein occlusion were found to have significantly improved visual acuity (by at least 3 lines). Mean central retinal thickness had decreased from 921+/-264 to 239+/-66.2 microm in patients with central retinal vein occlusion, and from 678+/-221 to 236+/-78 microm in patients with branch retinal vein occlusion.CONCLUSIONS: Neither intraocular nor systemic side-effects were observed in this study after repeated intravitreal injections of 2.5 mg bevacizumab. Current results suggest that intravitreal anti-VEGF therapy is a promising option in macular edema secondary to retinal vein occlusion.     

Die Entstehung seröser Iriscysten

Ohne Zusammenfassung     

Kombinierter retinaler arterioven?ser Verschluss unter Interferon-β-Therapie

Interferon (IFN) beta is commonly used in the treatment of multiple sclerosis. Thromboembolic complications may be associated with this therapy. We describe a case of branch arterial occlusions combined with central vein occlusion in a female patient who had undergone IFN beta therapy for 10 years. Thromboembolic and cardiovascular risk factors responsible for this event were excluded. The appearance of retinal vein and artery occlusions in our patient indicates an association with the long-term use of IFN beta.     

Behandlung retinaler VenenastverschlüsseVitrektomie mit arteriovenöser Dekompression und Präparation der Membrana limitans interna

BACKGROUND: Our therapeutical armamentarium for functional improvement after branch retinal vein occlusion (BRVO) is still limited and the efficacy is uncertain. Recently, surgical decompression of the vein at the arteriovenous crossing (AV decompression) has again been proposed as a suitable form of treatment. MATERIAL AND METHODS: A total of 40 patients with BRVO were treated in our department from August 1999 to February 2001 with AV decompression and 22 patients with comparable BRVO who refused this surgical intervention served as control. The surgical procedure consisted of a standard pars plana vitrectomy and separation of the overlying artery from the vein using microscissors. In 13 cases dissection of the internal limiting membrane was additionally performed. Assessment of visual acuity, fluorescein angiography and multifocal ERG in 7 patients was performed preoperatively and 6 weeks after surgery. RESULTS: The surgical procedure and postoperative course were uneventful. In most of the treated eyes, visual acuity improved and fluorescein angiography revealed capillary reperfusion. Functional results in patients with AV-decompression were highly significantly better than in the control group. CONCLUSION: Our results with surgical decompression of branch retinal vein occlusions demonstrate the therapeutical effect of surgical AV-decompression in BRVO. Further experience is necessary before some open questions can be answered.     

Bilaterale Panuveitis mit seröser Amotio retinae

History

A 45-year-old patient with cat scratch disease presented with bilateral panuveitis as well as bilateral serous detachment of the retina. The patient had suffered from influenza with swollen lymph nodes 2 weeks previously.

Diagnosis

The diagnosis could be made serologically: IgG and IgM antibodies against Bartonella henselae were highly positive in the immunofluorescence test and the values for inflammation were also strongly increased.

Therapy

A macular star developed during the course, more in the left eye than in the right eye. The patient was treated with a sulfonamide (Bactrim forte) and prednisolonacetate (Urbason), which was changed to doxyzycline (Doxybene) after an allergic reaction developed. Clinical findings were reduced significantly and visual acuity improved.

Conclusions

Bartonella henselae should be excluded when panuveitis occurs with serous retinal detachment. A uveitis anterior could precede this occurrence.     

Therapie der retinalen angiomatösen Proliferation im Stadium III

Retinal angiomatous proliferation (RAP) is a subtype of exudative age-related macular degeneration which is characterized by an intraretinal origin of the lesion and a particularly poor prognosis. In this retrospective case study 33 eyes from 33 patients with stage III RAP lesions were included and initially treated with 3 intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Criteria for extended treatment were visual deterioration, fresh bleeding, residual fluid or increase of the central retinal thickness in optical coherence tomography (OCT) as well as persisting activity in fluorescence angiography (FLA). The follow-up period was 8 months. The mean best corrected visual acuity (BCVA) increased insignificantly from logMAR 0.71 at the start of therapy to logMAR 0.67 after the first 3 intravitreal treatment injections and remained stable up to 8 months. The mean decrease of the central retinal thickness after 4 months (-90 µm) and after 8 months (-70 µm) was significant. Of the patients included in the study 67 % were treated repeatedly and the mean frequency of reinjections was 2.27 injections after 8 months. The intravitreal injection of ranibizumab in patients with stage III RAP lesions resulted in functional and anatomical stabilization. In most cases repeated treatment is necessary which underlines the urgent need for close surveillance in follow-up     

Optische Kohärenztomographie bei Grubenpapille und seröser Makulopathie

BACKGROUND: Of patients with an optic pit 30% develop an associated maculopathy of unknown origin. We report on 8 patients with an optic pit and associated maculopathy evaluated by optical coherence tomography (OCT) for detection of structural retinal changes and indications for the pathogenesis. PATIENTS AND METHODS: A total of 8 patients (mean age 25 years) suffering from an optic pit and associated maculopathy were evaluated by biomicroscopy, fluorescein angiography (FLA) and OCT and the results were compared. RESULTS: Visual acuity was on average 0.5 (0.05-0.8). Funduscopy revealed a macular elevation. In clinically suspected 'pseudo' macular hole, OCT revealed foveal schisis. OCT demonstrated a retinal detachment with a typical convex schisis of the outer retinal layer (n=6), and three patients showed a neurosensory detachment with (n=2) and without (n=1) intraretinal cystoid formation. CONCLUSION: The typical macular schisis pattern in OCT in optic pit with serous maculopathy helps to differentiate this condition from other macular elevations.     

Methoden zur Ermittlung persönlicher Krankheitskosten am Beispiel retinaler Erkrankungen

Purpose

Age-related macular degeneration (AMD) and other retinal diseases, such as diabetic retinopathy (DRP) and hereditary retinal dystrophy can not only lead to a loss of visual function but also to a higher psychological and financial burden for the affected persons. Against this background a quantification of personal cost and vision-related quality of life was performed.

Methods

A total of 66 patients (mean age 69 years, SD 13 years) with clinically confirmed diagnoses of AMD, DRP or retinal dystrophy were interviewed regarding costs for medicines, aids and equipment, support in everyday life and social benefits. Vision-related quality of life was recorded using the Impact of Vision Impairment profile (IVI).

Results

The average total annual cost was 751€ per patient, out of which the largest amount was cost of support in everyday life (506€). Costs as well as dependence on other persons or social services increased with decreasing visual acuity (p=0.013). Vision-related quality of life decreased with increasing visual disability especially in the IVI subscales mobility and independence as well as reading and accessing information (p=0.002).

Conclusions

Prevention or delay of visual disability and blindness caused by AMD or other retinal diseases and thus ensuring independence is not only relevant from a medical perspective but also from a health economic perspective. Against the background of a relative shortage of resources, costs should be reduced regardless of whether they are personal or societal costs.     

Weitwinkelfundusautofluoreszenz bei nichtinfektiöser Uveitis posterior

Background

Posterior uveitis comprises a heterogeneous group of diseases with inflammatory alterations of the posterior fundus and is a common cause of visual impairment and blindness. The goal of this study was to evaluate the diagnostic value of wide-field fundus autofluorescence (FAF) in patients with non-infectious posterior uveitis and chorioretinal alterations.

Material and methods

In this study 73 eyes from 51 patients were included. Best-corrected visual acuity, wide-field color and FAF images achieved by a wide-field scanning laser opththalmoscope (SLO, Optomap P200Tx, Optos PLC, Dunfermline UK) and a full ophthalmological examination were obtained from each patient. A systematic analysis of chorioretinal alterations detected with FAF and color images was conducted followed by the evaluation of the diagnostic information of wide-field FAF compared to the clinical finding and wide-field color images.

Results

Of the 73 eyes included in the study 52 showed peripheral alterations. In 32 cases wide-field FAF images revealed a greater number and more extensive chorioretinal alterations than the corresponding wide-field color images of the posterior fundus.

Conclusions

In this study wide-field FAF images showed more chorioretinal alterations than seen in funduscopy or in color SLO images. Therefore, wide-field FAF images offer important additional information for detection and documentation of peripheral and central chorioretinal alterations.     

Fortschreitende Visusminderung bei bullöser Keratopathie

Ohne Zusammenfassung     

Zur Entstehung der serösen Iriscysten

Ohne Zusammenfassung     

Ein Fall von localer variolöser Bindehauterkrankung

Ohne Zusammenfassung     

Pigmentnaevus des Augenlides mit beginnender sarcomatöser Degeneration

Ohne Zusammenfassung