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Gabel-Pfisterer A, Kischio S, Keen M, Bartz-Schmidt KU, Bartz-Schmidt A, Gekeler F, Neß T, Böhringer D, Weig M, Storch M, Feltgen N. [Surgical therapy and pathogen detection in endogenous endophthalmitis : Analysis of data from five German eye hospitals]. Ophthalmologie 2024; 121:282-290. [PMID: 38459269 DOI: 10.1007/s00347-024-02018-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Endogenous endophthalmitis results from hematogenous spread of bacterial or fungal infection in severely diseased patients. Specific systemic and intraocular therapy is required. The basis for this treatment is causal pathogen detection in blood culture or vitreous sample. However, functional results are limited. OBJECTIVE The current article provides practical hints for surgical therapy and pathogen detection in patients with endogenous endophthalmitis. METHODS A retrospective analysis of anonymous data of 68 male and female patients from 2018-2023 from five ophthalmology clinics in Germany was performed. RESULTS Mean age of affected patients was 71.4 years (31-96 years). Surgical therapy included pars plana vitrectomy (ppV) and intravitreal injection (IVOM). In 44 of 68 patients (65%), 1-3 surgeries were performed, 4-6 surgeries were required in 14/68 (21%) of patients, and 10 or more surgeries were required in 4/68 patients (6%). Pathogen detection was possible in 34% of vitreous specimens and in 11% of anterior chamber samples. Mean initial visual acuity was logMAR 1.5. After treatment and a mean follow-up of 2.5 months, mean visual acuity was logMAR 1.3. Preanalytical methods for specimen collection like the Freiburg endophthalmitis set to optimize pathogen detection are presented. CONCLUSION Severe inflammatory intraocular reactions in endogenous endophthalmitis necessitate a combination of ppV and repeated IVOM. In addition to providing a vitreous sample, ppV also serves to remove inflammatory fibrin membranes. Early pars plana vitrectomy with specific antibiotic or antifungal therapy should be sought in addition to the focus search and systemic therapy.
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Affiliation(s)
- Ameli Gabel-Pfisterer
- Augenklinik Klinikum Ernst-von-Bergmann Potsdam, Potsdam, Deutschland, Charlottenstr 72, 14467.
- Augenklinik, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland.
| | - Stephanie Kischio
- Augenklinik Klinikum Ernst-von-Bergmann Potsdam, Potsdam, Deutschland, Charlottenstr 72, 14467
| | - Mandana Keen
- Augenklinik Klinikum Ernst-von-Bergmann Potsdam, Potsdam, Deutschland, Charlottenstr 72, 14467
| | | | | | - Florian Gekeler
- Universitätsaugenklinik Tübingen, Tübingen, Deutschland
- Augenklinik am Katharinenhospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland
| | - Daniel Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland
| | - Michael Weig
- Institut für Medizinische Mikrobiologie und Virologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Marcus Storch
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland, 37075, Robert-Koch-Strasse 40
| | - Nicolas Feltgen
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland, 37075, Robert-Koch-Strasse 40
- Augenklinik, Universitätsspital, Basel, Schweiz, Mittlere Strasse 91, 4031
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Bonzheim I, Salmerón-Villalobos J, Süsskind D, Szurman P, Gekeler F, Spitzer MS, Salaverria I, Campo E, Coupland SE, Quintanilla-Martinez L, Fend F. [Molecular diagnostics for vitreoretinal lymphoma]. Pathologie (Heidelb) 2023; 44:150-154. [PMID: 37947807 DOI: 10.1007/s00292-023-01251-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Primary vitreoretinal lymphoma (PVRL) represents a subtype of intraocular lymphomas, which are a subgroup of malignant lymphomas of the eye. PVRL is considered a special form of primary diffuse large cell lymphoma (DLBCL) of the CNS (central nervous system) (PCNSL) and arises primary or secondary to PCNSL. According to the cell of origin (COO) classification of DLBCL, PVRL largely belongs to the activated B‑cell (ABC) type of DLBCL. Based on a recently established genetic-biological classification of DLBCL, PCNSL and thus also PVRL belong to a group of DLBCL of the MYD88/CD79B-mutated (MCD) or cluster 5 subtype, which often shows extranodal manifestations and MYD88 and CD79A mutations as well as CDKN2A deletions.PVRL diagnostics is often complicated as it represents a classic masquerade syndrome. Due to the usually limited material with often large numbers of reactive lymphocytes and/or degenerative changes in the cells, the results of diagnostic tests are difficult to interpret. Classic diagnostic tests include cytology on vitreous aspirates, immunocytochemistry, and clonality analysis.New insights into the spectrum of genetic alterations of vitreoretinal lymphomas (VRL) confirm the close relationship to PCNSL and could significantly improve pathological diagnosis. Next-generation sequencing panel-based diagnostics allow VRL diagnosis confirmation with little DNA in almost 100% of patients in cases with insufficient cytological evidence or lack of clonality detection. PVRL, as well as secondary vitreoretinal lymphomas after PCNSL or extracerebral DLBCL, have high mutation frequencies in characteristically mutated genes in PCNSL or MCD/cluster 5 type DLBCL. Supporting diagnostics, mutation detection can also be performed on cell-free DNA from the vitreous supernatant.
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Affiliation(s)
- Irina Bonzheim
- Institut für Pathologie und Neuropathologie, Abt. Allgemeine und Molekulare Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland.
| | - Julia Salmerón-Villalobos
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spanien
| | - Daniela Süsskind
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | | | - Florian Gekeler
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Augenklinik, Klinikum Stuttgart, Stuttgart, Deutschland
| | - Martin S Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Itziar Salaverria
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spanien
| | - Elias Campo
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spanien
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, Großbritannien
| | - Leticia Quintanilla-Martinez
- Institut für Pathologie und Neuropathologie, Abt. Allgemeine und Molekulare Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
| | - Falko Fend
- Institut für Pathologie und Neuropathologie, Abt. Allgemeine und Molekulare Pathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
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Garg SJ, Gekeler F. SUBRETINAL AIR USED AS A BALL VALVE TO STABILIZE A RETINAL BLEB. Retin Cases Brief Rep 2023; 17:189-190. [PMID: 33731602 DOI: 10.1097/icb.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a technique of using subretinal air to create and stabilize a neurosensory detachment performed during placement of a subretinal implant. METHODS A case report of an experiment in a live porcine model. RESULTS Creation of a neurosensory detachment may be facilitated by instillation of subretinal air. We use a small-gauge cannula to infuse approximately 0.1 mL of subretinal air to create a neurosensory detachment. We then expand the bleb using an additional 0.1 cc to 0.2 cc of subretinal air followed by balanced salt solution and stabilize it further with installation of viscoelastic. The small-gauge retinotomy should be created on the anterior and superior aspect of the bleb so that the air can tamponade the retinotomy both during surgery and postoperatively. CONCLUSION This technique may be useful for some newer procedures, such as subretinal implants and perhaps administration of subretinal gene therapy or cell therapy, that require access to the subretinal space.
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Affiliation(s)
- Sunir J Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Florian Gekeler
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
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Stett A, Schatz A, Gekeler F, Franklin J. Transcorneal Electrical Stimulation Dose-Dependently Slows the Visual Field Loss in Retinitis Pigmentosa. Transl Vis Sci Technol 2023; 12:29. [PMID: 36809335 PMCID: PMC9946045 DOI: 10.1167/tvst.12.2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Purpose To assess whether transcorneal electrical stimulation (TcES) current-dependently slows progressive loss of visual field area (VFA) in retinitis pigmentosa (RP). Methods Data from 51 patients with RP who received monocular TcES treatment once weekly over 1 year in an interventional, randomized study have been analyzed a posteriori. Current amplitudes were 0.1 to 1.0 mA in the TcES-treated group (n = 31) and 0.0 mA in the sham group (n = 20). VFA was assessed in both eyes (semiautomatic kinetic perimetry, Goldmann targets V4e, III4e). Annual decline rate (ADR) of exponential loss and model-independent percentage reduction of VFA at treatment cessation were correlated to current amplitude. Results For V4e, mean ADR was -4.1% in TcES-treated eyes, -6.4% in untreated fellow eyes, and -7.2% in placebo-treated eyes; mean VFA reduction in TcES-treated eyes was 64% less than in untreated fellow eyes (P = 0.013) and 72% less than in placebo-treated eyes (P = 0.103). Individual VFA reductions correlated with current amplitude (P = 0.043) and tended toward zero in patients who received 0.8 to 1.0 mA. For III4e, there was a marginally significant current-dependency of interocular difference in reduction (P = 0.11). ADR and VFA reduction did not significantly correlate with baseline VFA. Conclusions Loss of VFA (V4e) in patients with RP was significantly reduced in treated eyes compared to untreated eyes by regular use of TcES in a dose-dependent manner. No dependence of effects on the initial extent of VFA loss was found. Translational Relevance TcES provides potential for preservation of visual field in patients with RP.
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Affiliation(s)
| | - Andreas Schatz
- Centre for Ophthalmology, University Eye Hospital, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Florian Gekeler
- Centre for Ophthalmology, University Eye Hospital, Eberhard-Karls University Tübingen, Tübingen, Germany,Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
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Stett A, Schatz A, Franklin J, Gekeler F. Transcorneal electrical stimulation reduces the annual rate of visual field decline in retinitis pigmentosa. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andreas Schatz
- Centre for Ophthalmology University Eye Hospital Tuebingen Tuebingen Germany
| | - Jeremy Franklin
- Institute of Medical Statistics and Computational Biology Koeln Germany
| | - Florian Gekeler
- Department of Ophthalmology Klinikum Stuttgart Stuttgart Germany
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William A, Dias Blak M, Eshref A, Gekeler F, Schatz A, Gekeler K. Chromatic Full-Field Stimulus Thresholds in Patients with Treatment-Naive Age-Related Macular Degeneration. Clin Ophthalmol 2022; 16:223-229. [PMID: 35125864 PMCID: PMC8809673 DOI: 10.2147/opth.s346291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate retinal sensitivity using chromatic full-field stimulus thresholds (FST) in patients with treatment naive exudative age-related macular degeneration (e-ARMD) before and during the first intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment. Patients and Methods After general ophthalmological examinations to diagnose patients with e-ARMD the FST, the central foveal thickness (FCt) and the visual acuity were assessed in 20 eyes of 20 patients during this prospective study. Examinations were performed before and during the first treatment series with three intravitreal anti-VEGF injections. Normal values for FST were assessed in 19 eyes of 19 healthy subjects. Results were analyzed using Student’s two-tailed t-test and Pearson’s correlation coefficients between all functional parameters. Results At baseline and before the 1st intravitreal anti-VEGF treatment, a moderately significant negative correlation between VA and FCt was found in the e-ARMD group (p = 0.02, r = −0.45 and p = 0.03, r = −0.45), respectively. After the 2nd intravitreal anti-VEGF injection, no significant correlation between VA and FCt was found (p = 0.12). However, a significant correlation between FCt and blue FST was evident (p = 0.04, r = 0.4). After the 3rd intravitreal anti-VEGF treatment, there was no correlation evident between VA and FCt (p = 0.31) but a high significant correlation between FCt and FST using red (p = 0.01, r = 0.53), green (p = 0.002, r = 0.6) and blue light (p = 0.007, r = 0.66). Conclusion During anti-VEGF treatment in patients with e-ARMD, the FST test showed higher significant correlations with the morphology measured by FCt, as it is the case for VA. These findings support that the FST test might serve as a valuable diagnostic tool for monitoring patients with e-ARMD and enhance functional assessment of retinal function under treatment with anti-VEGF.
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Affiliation(s)
- Antony William
- Department of Ophthalmology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Altan Eshref
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Florian Gekeler
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Andreas Schatz
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
- Correspondence: Andreas Schatz, Department of Ophthalmology, University Hospital Tuebingen, Tuebingen, Elfriede –Alhorn-Straße 7, Tuebingen, 72076, Germany, Tel +4970712988088, Email
| | - Katrin Gekeler
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
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Faber H, Ernemann U, Sachs H, Gekeler F, Danz S, Koitschev A, Besch D, Bartz-Schmidt KU, Zrenner E, Stingl K, Kernstock C. CT Assessment of Intraorbital Cable Movement of Electronic Subretinal Prosthesis in Three Different Surgical Approaches. Transl Vis Sci Technol 2021; 10:16. [PMID: 34264295 PMCID: PMC8299430 DOI: 10.1167/tvst.10.8.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose Electronic retinal implants restore some visual perception in patients blind from retinitis pigmentosa. Eye movements cause mechanical stress in intraorbital power supply cables leading to cable breaks. By using computer tomography (CT) scans at the extreme positions of the four cardinal gaze directions, this study determined in vivo, which of three surgical routing techniques results in minimal bending radius variation and favors durability. Methods Nine patients received the first-generation subretinal implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) in one eye. Three techniques for intraorbital cable routing were used (straight cable route (A), parabulbar loop (B), and encircling band (C)), each in three patients. All patients underwent computer tomography of the orbital region. The bending radius of the intraorbital cable was measured with the DICOM viewer Osirix v4.1.2 (Pixmeo SARL, Bernex, Switzerland) and served as indicator for mechanical stress. Results Average bending radius variation was 87% for method A, 11% for method B, and 16% for method C. Methods A and B (P = 0.005) and methods A and C (P = 0.007) differed significantly, while method B and C showed no statistical difference (P = 0.07). Conclusions Compared to straight routes, arcuated cable routes significantly reduce cable movement and bending. Due to an easier surgical procedure, a parabulbar loop is the preferred method to minimize bending radius variation and prolong survival time of electronic subretinal implants. Translational Relevance CT analysis of cable bending of implanted medical devices allows to determine which surgical routing technique favors durability in vivo.
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Affiliation(s)
- Hanna Faber
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Radiological Clinic, University of Tuebingen, Tuebingen, Germany
| | - Helmut Sachs
- Ophthalmology Clinic, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany
| | - Florian Gekeler
- Ophthalmology Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - Søren Danz
- Radiologische Praxis Hofbauer Danz Fischer, Sindelfingen, Germany
| | - Assen Koitschev
- Clinic for Ear, Nose and Throat Disorders, Plastic Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Dorothea Besch
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | | | - Eberhart Zrenner
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Institute for Ophthalmic Research, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Werner Reichardt Centre for Integrative Neuroscience, University of Tuebingen, Tuebingen, Germany
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Center of Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Christoph Kernstock
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
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Kahle N, Peters T, Braun A, Franklin J, Michalik C, Gekeler F, Wilhelm B. [Transcorneal electrostimulation in retinitis pigmentosa : Protocol of a multicentric prospective, randomized, controlled and double-masked trial on behalf of the Joint Federal Committee (G-BA pilot regulation)]. Ophthalmologe 2021; 118:512-516. [PMID: 33740090 PMCID: PMC8105205 DOI: 10.1007/s00347-021-01360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/10/2022]
Abstract
The focus of this large multicenter trial commissioned by the Joint Federal Committee (Gemeinsamer Bundesausschuss, G‑BA) is to determine a benefit of transcorneal electrical stimulation for retinitis pigmentosa (RP) patients. The main criterion for benefit is the kinetic visual field and whether the deterioration progresses more slowly in the study eyes compared to the sham-stimulated fellow eyes over a treatment period of 3 years.
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Affiliation(s)
- Nadine Kahle
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 7, 72076, Tübingen, Deutschland
| | - Tobias Peters
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 7, 72076, Tübingen, Deutschland.
| | - Angelika Braun
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 7, 72076, Tübingen, Deutschland
| | - Jeremy Franklin
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - Claudia Michalik
- Zentrum für Klinische Studien, Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - Florian Gekeler
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 7, 72076, Tübingen, Deutschland
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Stuttgart, Deutschland
| | - Barbara Wilhelm
- Steinbeis Transfer Zentrum (STZ) eyetrial am Department für Augenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Faber H, Besch D, Bartz‐Schmidt K, Eisenstein H, Roider J, Sachs H, Gekeler F, Zrenner E, Stingl K. Restriction of eye motility in patients with RETINA IMPLANT Alpha AMS. Acta Ophthalmol 2020; 98:e998-e1003. [PMID: 32304165 DOI: 10.1111/aos.14435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/16/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the motility of the eye in patients with the RETINA IMPLANT Alpha AMS. METHODS Eye motility was determined in eight gaze directions in ten blind retinitis pigmentosa patients, who had received the RETINA IMPLANT Alpha AMS, before implantation of the subretinal implant and at six time-points up to one year after. RESULTS The analysis of eye motility showed a restriction in the upgaze and gaze to the temporal side directly after surgery in eight of the nine patients included. The degree of motility restriction decreased continuously with recovery during the observation time. One year after surgery, eye motility was still restricted in the majority of patients, especially in the upgaze to the temporal side at 20° (five of seven patients). CONCLUSION Retinal implants with intraorbital parts (e.g. connecting cables) caused restriction in the temporal and superior viewing directions in the majority of patients. Although this restriction might be cosmetically visible, this limitation in eye motility has no effects on the monocular vision and the implant's efficacy for daily use.
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Affiliation(s)
- Hanna Faber
- University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | - Dorothea Besch
- University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | | | - Hanna Eisenstein
- University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | - Johann Roider
- Department of Ophthalmology Christian‐Albrechts‐University of Kiel University Medical Center Kiel Germany
| | - Helmut Sachs
- Städtisches Klinikum Dresden Friedrichstadt Dresden Germany
| | - Florian Gekeler
- Department of Ophthalmology Klinikum Stuttgart Stuttgart Germany
| | - Eberhart Zrenner
- Institute for Ophthalmic Research Center for Ophthalmology Eberhard Karls University Tuebingen Germany
- Werner Reichardt Centre for Integrative Neuroscience Eberhard Karls University Tuebingen Tuebingen Germany
| | - Katarina Stingl
- University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
- Center for Rare Eye Diseases Eberhard Karls University Tuebingen Germany
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Jolly J, Wagner S, Martus P, MacLaren R, Wilhelm B, Webster A, Downes S, Charbel Issa P, Kellner U, Jägle H, Rüther K, Bertelsen M, Bragadóttir R, Prener Holtan J, van den Born L, Sodi A, Virgili G, Gosheva M, Pach J, Zündorf I, Zrenner E, Gekeler F. Transcorneal Electrical Stimulation for the Treatment of Retinitis Pigmentosa: A Multicenter Safety Study of the OkuStim® System (TESOLA-Study). Ophthalmic Res 2019; 63:234-243. [DOI: 10.1159/000505001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
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11
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Kuehlewein L, Troelenberg N, Stingl K, Schleehauf S, Kusnyerik A, Jackson TL, MacLaren RE, Chee C, Roider J, Wilhelm B, Gekeler F, Bartz‐Schmidt KU, Zrenner E, Stingl K. Changes in microchip position after implantation of a subretinal vision prosthesis in humans. Acta Ophthalmol 2019; 97:e871-e876. [PMID: 30816625 DOI: 10.1111/aos.14077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/02/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Retinal prosthetic devices have been developed to partially restore very low vision in legally blind patients with end-stage hereditary retinal dystrophies. Subretinal implants, unlike epiretinal implants, are not fixated by a tack. The aim of this study was to assess and analyse possible changes over time in the subretinal position of the RETINA IMPLANT Alpha IMS and Alpha AMS (ClinicalTrials.gov NCT01024803). METHODS Imaging studies were performed on fundus photographs using GIMP (Version 2.8.14). Postoperative photographs of the implanted eye were scaled and aligned. Landmarks were chosen and distances between landmarks were measured to then calculate the displacement of the microchip using a transformation matrix for rotational and translational movements. Analyses were performed using MATLAB 8.6 (The MathWorks Inc., Natick, MA). RESULTS Of the 27 datasets with the Alpha IMS device, 12 (44%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 15 (56%), displacement occurred. The mean ± SD displacement in those 15 eyes was 0.66 ± 0.35 mm (range, 0.24-1.67 mm). Of the eight datasets with the Alpha AMS device, 1 (13%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 7 (87%), displacement occurred. The mean ± SD displacement in those seven eyes was 0.66 ± 0.26 mm (range, 0.32-0.97 mm). Calculated from all eyes (including those in which no displacement occurred), the mean displacement was 0.36 mm in the IMS cohort, and 0.58 mm in the AMS cohort, however, the difference was not statistically significant (p = 0.17). CONCLUSIONS We have shown that the position of the subretinal implant changes in the majority of the cases after implantation. While the overall mean displacement of the chip was not significantly different in either of the cohorts, the maximum displacement was smaller in the Alpha AMS cohort.
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Affiliation(s)
- Laura Kuehlewein
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | | | - Krunoslav Stingl
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | | | - Akos Kusnyerik
- Department of Ophthalmology Semmelweis University Budapest Hungary
| | - Timothy L. Jackson
- Department of Ophthalmology Faculty of Life Sciences and Medicine King's College London King's College Hospital London UK
| | - Robert E. MacLaren
- Oxford Eye Hospital at the Oxford University Hospitals NHS Foundation Trust and Nuffield Laboratory of Ophthalmology University of Oxford Oxford UK
| | - Caroline Chee
- Department of Ophthalmology National University Hospital Singapore Singapore
| | - Johann Roider
- Department of Ophthalmology University of Kiel Kiel Germany
| | - Barbara Wilhelm
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | - Florian Gekeler
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | - Karl Ulrich Bartz‐Schmidt
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
| | - Eberhart Zrenner
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
- Werner Reichardt Centre for Integrative Neuroscience Eberhard Karls University Tuebingen Tuebingen Germany
| | - Katarina Stingl
- Institute for Ophthalmic Research University Eye Hospital Center for Ophthalmology Eberhard Karls University Tuebingen Germany
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12
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Gekeler K, Schatz A, Fischer MD, Schommer K, Boden K, Bartz-Schmidt KU, Gekeler F, Willmann G. Decreased contrast sensitivity at high altitude. Br J Ophthalmol 2019; 103:1815-1819. [PMID: 30770358 DOI: 10.1136/bjophthalmol-2018-313260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/16/2018] [Accepted: 01/28/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to investigate a change in visual acuity and contrast sensitivity (CS) during high altitude exposure in healthy subjects due to the effects of hypobaric hypoxia. This study is related to the Tübingen High Altitude Ophthalmology study. METHODS Visual acuity and Weber CS were tested monocularly using the Freiburger Visual Acuity and Contrast Test under standardised conditions in 14 healthy subjects at high altitude at the Capanna Margherita (4559 m, Italy) and compared with baseline measurements in Tübingen (341 m, Germany). Intraindividual differences between baseline and follow-up examinations were calculated by multivariate analysis of variance for repeated measures. Clinical parameters of peripheral oxygen saturation (SpO2) and heart rate (HR) as well as scores for acute mountain sickness (AMS) were correlated to psychophysical tests by Pearson's correlation coefficient. RESULTS A significant decrease in CS with a mean effect size of -0.13 logCS was found for Weber CS (day 1=-0.16±0.22, p=0.01; day 2=-0.10±0.2, p=0.049; day 3=-0.12±0.19, p=0.03) at high altitude compared with baseline. Visual acuity remained unchanged. Decreased CS correlated with SpO2 (r=0.53, p=0.046) but not with HR (r=- 0.16, p=0.59) and occurred irrespective of AMS at high altitude. CONCLUSION High altitude exposure leads to decreased CS. Changes occur independent of AMS. This finding is of clinical importance to trekkers and mountaineers exposed to high altitude as visual processing in particular under mesopic conditions at dusk and dawn is altered. Furthermore, it provides novel insight into hypoxia related changes in CS function.
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Affiliation(s)
- Katrin Gekeler
- Department of Ophthalmology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Andreas Schatz
- Department of Ophthalmology, Katharinenhospital Stuttgart, Stuttgart, Germany.,Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Manuel Dominik Fischer
- Department of Ophthalmology, Katharinenhospital Stuttgart, Stuttgart, Germany.,Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Kai Schommer
- Medizinischer Dienst der Krankenversicherungen, MDK Baden-Württemberg, Mannheim, Germany
| | - Katrin Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Saar, Germany
| | | | - Florian Gekeler
- Department of Ophthalmology, Katharinenhospital Stuttgart, Stuttgart, Germany.,Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Gabriel Willmann
- Department of Ophthalmology, Katharinenhospital Stuttgart, Stuttgart, Germany .,Department of Ophthalmology, University of Tübingen, Tübingen, Germany
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13
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William A, Kohl S, Zeitz C, Willmann G, Zrenner E, Bartz-Schmidt KU, Gekeler F, Schatz A. Macular sensitivity in patients with congenital stationary night-blindness. Br J Ophthalmol 2018; 103:1507-1510. [PMID: 30573500 DOI: 10.1136/bjophthalmol-2018-313072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/04/2022]
Abstract
AIM To evaluate and correlate mean light sensitivity thresholds (MLST) in patients with congenital stationary night-blindness (CSNB) in comparison with healthy subjects using microperimetry (MP1). METHODS Eleven patients with CSNB and 13 healthy subjects were compared. In all subjects, static threshold perimetry was performed using MP1 evaluating the central 6 mm of the retina. This central retinal area was divided into three rings through using the ETDRS grid algorithm with an innermost (1 mm), inner (3 mm) and outer ring (6 mm). The MLSTs were acquired in nine sectors of the ETDRS grid. A comparison of MLST was performed between both groups using a t-test (significance level p<0.005). RESULTS A significant reduction of MLST in the fovea (innermost ring, 1 mm) was observed for patients with CSNB (7.2±3.90 dB) in comparison to healthy subjects (19.7±0.75; p<0.0001). Similarly, comparison of MLST in all other sectors (superior/inferior/temporal and nasal) within the inner and outer ring revealed a statistically significant reduction in patients with CSNB compared with healthy subjects (p<0.001). CONCLUSIONS Examination of macular retinal sensitivity intensity using MP1 revealed for the first time a significant reduction of MLST within the central 6 mm of the retina in patients with CSNB compared with healthy subjects. This finding supports MP1 as an additional diagnostic tool when examining patients with retinal dysfunctions such as CSNB.
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Affiliation(s)
- Antony William
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany.,Schwarzwaldaugenklinik, Schramberg, Germany
| | - Susanne Kohl
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Christina Zeitz
- Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Gabriel Willmann
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany.,Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Eberhart Zrenner
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Florian Gekeler
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany.,Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Andreas Schatz
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany .,Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
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14
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Schatz A, Guggenberger V, Fischer MD, Schommer K, Bartz-Schmidt KU, Gekeler F, Willmann G. Optic nerve oedema at high altitude occurs independent of acute mountain sickness. Br J Ophthalmol 2018; 103:bjophthalmol-2018-312224. [PMID: 29973364 DOI: 10.1136/bjophthalmol-2018-312224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS The study aims to investigate changes in the optic nerve sheath diameter (ONSD) at high altitude and to assess correlation to optic disc oedema (ODE) and acute mountain sickness (AMS). This investigation is part of the Tübingen High Altitude Ophthalmology study. METHODS Fourteen volunteers ascended to 4559 m for 4 days before returning to low altitude. Ultrasonography of ONSD, quantification of optic disc parameters using a scanning laser ophthalmoscope and fluorescein angiography were performed at 341 m and at high altitude. Pearson's coefficient was used to correlate changes in ONSD with the optic disc and AMS. Assessment of AMS was performed using the Lake Louise (LL) and AMS-cerebral (AMS-C) scores of the Environmental Symptom Questionnaire-III. All volunteers were clinically monitored for heart rate (HR) and oxygen saturation (SpO2). RESULTS The mean ONSD at high altitude (4.6±0.3 mm, p<0.05) was significantly increased compared with baseline (3.8±0.4 mm) and remained enlarged throughout high-altitude exposure. This change in ONSD did not correlate with AMS (AMS-C, r=0.26, p=0.37; LL, r=0.21, p=0.48) and high-altitude headache (r=0.54, p=0.046), or clinical parameters of SpO2 (r=0.11, p=0.72) and HR (r=0.22, p=0.44). Increased ONSD did not correlate with altered key stereometric parameters of the optic disc describing ODE at high altitude (r<0.1, p>0.5). CONCLUSION High-altitude exposure leads to marked oedema formation of the optic nerve independent of AMS. Increased ONSD and ODE reflect hypoxia-driven oedema formation of the optic nerve at high altitude, providing important pathophysiological insight into high-altitude illness development and for future research.
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Affiliation(s)
- Andreas Schatz
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | | | - M Dominik Fischer
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Kai Schommer
- Medizinischer Dienst der Krankenversicherungen, MDK Baden-Württemberg, Mannheim, Germany
| | | | - Florian Gekeler
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Gabriel Willmann
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
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15
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Kuehlewein L, Kitiratschky V, Gosheva M, Edwards TL, MacLaren RE, Groppe M, Kusnyerik A, Soare C, Jackson TL, Sun CH, Chee C, Sachs H, Stingl K, Wilhelm B, Gekeler F, Bartz-Schmidt KU, Zrenner E, Stingl K. Optical Coherence Tomography in Patients With the Subretinal Implant Retina Implant Alpha IMS. Ophthalmic Surg Lasers Imaging Retina 2018; 48:993-999. [PMID: 29253302 DOI: 10.3928/23258160-20171130-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to assess changes in retinal structure and thickness after subretinal implantation of the Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany). PATIENTS AND METHODS Spectral-domain optical coherence tomography (SD-OCT) imaging was performed to assess the structure and thickness of the retina anterior to the microphotodiode array preoperatively, within 6 weeks and 6 months ± 1 month after implantation. Thickness measurements were performed using the distance tool of the built-in software. Three thickness measurements were performed in each of the four quadrants of the retina on the microchip within 6 weeks and 6 months ± 1 month after implantation. RESULTS The mean ± standard deviation change in retinal thickness from within 6 weeks to 6 months ± 1 month after implantation in all four quadrants combined was 24 μm ± 68 μm. None of the tested variables (location, time, or their interaction) had a statistically significant effect on the mean retinal thickness (P = .961, P = .131, and P = .182, respectively; n = 19). CONCLUSION The authors report on qualitative and quantitative findings in retinal structure in 27 patients after subretinal implantation of the Retina Implant Alpha IMS using OCT technology. No significant changes of retinal thickness could be observed in a period of 6 months after surgery. With more patients receiving subretinal implants and with advanced OCT technology, the data set will be extended to study possible changes in retinal structure in finer detail. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:993-999.].
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16
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Sachs H, Gekeler F, Schwahn H, Jakob W, Köhler M, Schulmeyer F, Marienhagen J, Brunner U, Framme C. Implantation of Stimulation Electrodes in the Subretinal Space to Demonstrate Cortical Responses in Yucatan Minipig in the Course of Visual Prosthesis Development. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210501500413] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose During the course of the development of visual prostheses, subretinal stimulation films were implanted in micropigs in order to prove the feasibility of subretinal electrical stimulation with subsequent cortical response. One aim was to demonstrate that epidural recording of visual evoked potentials is possible in the micropig. Methods Film-bound stimulation electrode arrays were placed in the subretinal space of micropigs. This enabled the retina to be stimulated subretinally. Since conventional visual evoked potential (VEP) measuring is virtually impossible in the pig from the neurosurgical point of view, epidural recording electrode arrays were positioned over the visual cortex as permanent electrodes. Results The feasibility of temporary implantation of film-bound stimulation electrode arrays was successfully demonstrated in the micropig model. On stimulation with monopolar voltage pulses (1000 to 3000 mV), reproducible epidural VEP measurements (5 to 10 μV) were detected. Conclusions The feasibility of subretinal stimulation of the retina was demonstrated in a retinal model that is similar to the human retina. This animal model therefore offers a suitable means of studying the tolerability of stimulation situations in the course of visual prosthesis development.
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Affiliation(s)
| | - F. Gekeler
- University Eye Hospital Dept II, Neuro-Ophthalmology, Tübingen
| | - H. Schwahn
- University Eye Hospital Dept II, Neuro-Ophthalmology, Tübingen
| | - W. Jakob
- University Anaesthesiology Clinic, Regensburg
| | - M. Köhler
- University Neurosurgery Clinic, Regensburg
| | | | - J. Marienhagen
- University Clinic for Nuclear Medicine, Regensburg - Germany
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17
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Wagner SK, Jolly JK, Pefkianaki M, Gekeler F, Webster AR, Downes SM, Maclaren RE. Transcorneal electrical stimulation for the treatment of retinitis pigmentosa: results from the TESOLAUK trial. BMJ Open Ophthalmol 2017; 2:e000096. [PMID: 29354722 PMCID: PMC5751865 DOI: 10.1136/bmjophth-2017-000096] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 01/24/2023] Open
Abstract
Objective To explore the impact of weekly transcorneal electrical stimulation (TES) over a 6-month period as a treatment for retinitis pigmentosa (RP). Methods and analysis A prospective open-label observational trial was carried out assessing weekly TES in participants with RP for a period of 6 months followed by observation for a further 6 months. Clinical examination and investigations were carried out at 3 monthly intervals for a total of 12 months. The primary outcome measure explored safety through a descriptive analysis of adverse effects with secondary outcome measures evaluating structural and functional efficacy. Results Seven male and seven female participants with RP aged 18–80 years were recruited. TES was well tolerated with no serious adverse events reported. Two participants reported transient foreign body sensation and one participant had discomfort underneath the skin electrode. Following 6 months of TES, best-corrected visual acuity increased by 1.1±1.4 letters in the control arm and 0.93±1.4 letters in the treated arm. Central microperimetry threshold sensitivity rose by 0.02±0.5 decibels (dB) and 0.37±0.4 dB and Goldmann visual field volume by 0.16±0.09 steradians (sr) vs 0.22±0.12 sr for the control and treated eye, respectively. There was no statistical significance seen between eyes following the treatment or observation period. Conclusion This small open-label clinical trial showed that TES was safe and well tolerated in patients with RP. Visual function measurements at 6 months demonstrated no significant difference between the control and treated eyes. The results justify a larger clinical trial over a longer period of time in order to identify any treatment effect.
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Affiliation(s)
- Siegfried K Wagner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.,Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Jasleen K Jolly
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.,Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Maria Pefkianaki
- Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Florian Gekeler
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Andrew R Webster
- Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Susan M Downes
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Robert E Maclaren
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.,Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
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18
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Stingl K, Schippert R, Bartz-Schmidt KU, Besch D, Cottriall CL, Edwards TL, Gekeler F, Greppmaier U, Kiel K, Koitschev A, Kühlewein L, MacLaren RE, Ramsden JD, Roider J, Rothermel A, Sachs H, Schröder GS, Tode J, Troelenberg N, Zrenner E. Interim Results of a Multicenter Trial with the New Electronic Subretinal Implant Alpha AMS in 15 Patients Blind from Inherited Retinal Degenerations. Front Neurosci 2017; 11:445. [PMID: 28878616 PMCID: PMC5572402 DOI: 10.3389/fnins.2017.00445] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/20/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: We assessed the safety and efficacy of a technically advanced subretinal electronic implant, RETINA IMPLANT Alpha AMS, in end stage retinal degeneration in an interim analysis of two ongoing prospective clinical trials. The purpose of this article is to describe the interim functional results (efficacy). Methods: The subretinal visual prosthesis RETINA IMPLANT Alpha AMS (Retina Implant AG, Reutlingen, Germany) was implanted in 15 blind patients with hereditary retinal degenerations at four study sites with a follow-up period of 12 months (www.clinicaltrials.gov NCT01024803 and NCT02720640). Functional outcome measures included (1) screen-based standardized 2- or 4-alternative forced-choice (AFC) tests of light perception, light localization, grating detection (basic grating acuity (BaGA) test), and Landolt C-rings; (2) gray level discrimination; (3) performance during activities of daily living (ADL-table tasks). Results: Implant-mediated light perception was observed in 13/15 patients. During the observation period implant mediated localization of visual targets was possible in 13/15 patients. Correct grating detection was achieved for spatial frequencies of 0.1 cpd (cycles per degree) in 4/15; 0.33 cpd in 3/15; 0.66 cpd in 2/15; 1.0 cpd in 2/15 and 3.3 cpd in 1/15 patients. In two patients visual acuity (VA) assessed with Landolt C- rings was 20/546 and 20/1111. Of 6 possible gray levels on average 4.6 ± 0.8 (mean ± SD, n = 10) were discerned. Improvements (power ON vs. OFF) of ADL table tasks were measured in 13/15 patients. Overall, results were stable during the observation period. Serious adverse events (SAEs) were reported in 4 patients: 2 movements of the implant, readjusted in a second surgery; 4 conjunctival erosion/dehiscence, successfully treated; 1 pain event around the coil, successfully treated; 1 partial reduction of silicone oil tamponade leading to distorted vision (silicon oil successfully refilled). The majority of adverse events (AEs) were transient and mostly of mild to moderate intensity. Conclusions: Psychophysical and subjective data show that RETINA IMPLANT Alpha AMS is reliable, well tolerated and can restore limited visual functions in blind patients with degenerations of the outer retina. Compared with the previous implant Alpha IMS, longevity of the new implant Alpha AMS has been considerably improved. Alpha AMS has meanwhile been certified as a commercially available medical device, reimbursed in Germany by the public health system.
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Affiliation(s)
- Katarina Stingl
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany
| | | | | | - Dorothea Besch
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany
| | - Charles L Cottriall
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - Thomas L Edwards
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - Florian Gekeler
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany.,Department of Ophthalmology, Katharinenhospital, Klinikum StuttgartStuttgart, Germany
| | | | - Katja Kiel
- Städtisches Klinikum Dresden Friedrichstadt, University Teaching HospitalDresden, Germany
| | - Assen Koitschev
- Division Pediatric Otorhinolaryngology and Otology - Olgahospital, Department of Otorhinolaryngology, Klinikum StuttgartStuttgart, Germany
| | - Laura Kühlewein
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - James D Ramsden
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - Johann Roider
- Department of Ophthalmology, University of KielKiel, Germany
| | | | - Helmut Sachs
- Städtisches Klinikum Dresden Friedrichstadt, University Teaching HospitalDresden, Germany
| | | | - Jan Tode
- Department of Ophthalmology, University of KielKiel, Germany
| | | | - Eberhart Zrenner
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany.,Werner Reichardt Centre for Integrative Neuroscience, University of TuebingenTuebingen, Germany
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19
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Schatz A, Pach J, Gosheva M, Naycheva L, Willmann G, Wilhelm B, Peters T, Bartz-Schmidt KU, Zrenner E, Messias A, Gekeler F. Transcorneal Electrical Stimulation for Patients With Retinitis Pigmentosa: A Prospective, Randomized, Sham-Controlled Follow-up Study Over 1 Year. Invest Ophthalmol Vis Sci 2017; 58:257-269. [PMID: 28114587 DOI: 10.1167/iovs.16-19906] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose After promising results of an exploratory study, this study was designed to assess the safety and efficacy of transcorneal electrical stimulation (TES) over 1 year in patients with retinitis pigmentosa (RP). Methods We included 52 RP patients in this prospective, randomized, partially-masked study which was done in accordance with rules of good clinical practice. Transcorneal electrical stimulation by Okustim was applied monocularly for 30 minutes per week for 52 consecutive weeks. Patients were assigned randomly to the groups: sham, 150%, or 200% of individual electrical phosphene threshold (EPT). Visual acuity (retroilluminated Snellen charts), visual field (VF; Octopus 900), electroretinography (ERG), rod and cone full-field stimulus threshold, EPTs and IOP were assessed. Primary outcome measures were VF area; secondary outcome measures were development of ERG parameters. Results The application of TES was tolerated well. Dry eye symptoms (31 of 52 patients) were registered as the main adverse event. Throughout the study period, the VF area showed only a trend for prevention of VF loss in the 200% group (P = 0.24). A significant improvement of light-adapted single flash b-wave was noted for the 200% (P < 0.0001) and 150% (P = 0.006) groups compared to the sham group. Tendencies of improved function were observed for scotopic b-wave amplitude for the 200% group (P = 0.097). Other examination methods did not reach statistical significance. Conclusions The safety and acceptable tolerability of weekly TES self-administered by patients at home was confirmed over the course of 1 year. Objectively measured improvements in retinal function with ERG provide support for the potential benefits of TES for RP patients.
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Affiliation(s)
- Andreas Schatz
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 2Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Johanna Pach
- Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Mariya Gosheva
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Lubka Naycheva
- Department of Ophthalmology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Gabriel Willmann
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 2Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
| | - Barbara Wilhelm
- STZ eyetrial at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Tobias Peters
- STZ eyetrial at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Eberhart Zrenner
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - André Messias
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, University of São Paulo, Ribeirão Preto, Brazil
| | - Florian Gekeler
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 2Department of Ophthalmology, Klinikum Stuttgart, Stuttgart, Germany
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20
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Willmann G, Schommer K, Schultheiss M, Fischer MD, Bartz-Schmidt KU, Gekeler F, Schatz A. Effect of High Altitude Exposure on Intraocular Pressure Using Goldmann Applanation Tonometry. High Alt Med Biol 2017; 18:114-120. [PMID: 28333563 DOI: 10.1089/ham.2016.0115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Willmann, Gabriel, Kai Schommer, Maximilian Schultheiss, M. Dominik Fischer, Karl-Ulrich Bartz-Schmidt, Florian Gekeler, and Andreas Schatz. Effect of high altitude exposure on intraocular pressure using Goldmann applanation tonometry. High Alt Med Biol. 18:114-120, 2017. AIMS The aim of the study was to quantify changes of intraocular pressure (IOP) during exposure to 4559 m using the state-of-the-art method of Goldmann applanation tonometry for IOP measurement and to detect correlations between IOP and acute mountain sickness (AMS) in a prospective manner. METHODS IOP was measured using a Goldmann applanation tonometer AT 900® (Haag-Streit, Switzerland) and central corneal thickness (CCT) with the anterior segment module of a Spectralis™ HRA+OCT® device (Heidelberg Engineering, Germany) at baseline and high altitude. Assessment of AMS was performed using the Lake Louise and AMS-C questionnaires, and Pearson's correlation coefficient was calculated for association between IOP and AMS. RESULTS Raw IOP values at high altitude were not significantly changed compared to baseline. IOP adjusted to the increase in CCT at high altitude, which is known to alter IOP levels, showed a significant reduction for corrected IOP values on day 3 of exposure (morning -2.1 ± 1.2 mmHg; evening -2.3 ± 1.1 mmHg; p < 0.05). No correlation of IOP with AMS or clinical parameters (heart rate and SpO2) at high altitude was noted. CONCLUSIONS IOP showed a significant reduction of IOP levels when corrected for increased CCT values at high altitude. Furthermore, the prospective measurement of IOP is not useful in diagnosing AMS or for the prediction of more severe high altitude related illnesses as the decrease in IOP and symptoms of AMS do not correlate during altitude exposure.
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Affiliation(s)
- Gabriel Willmann
- 1 Department of Ophthalmology, Katharinenhospital Stuttgart , Stuttgart, Germany .,2 Centre for Ophthalmology, University of Tübingen , Tübingen, Germany
| | - Kai Schommer
- 3 Medizinischer Dienst der Krankenversicherungen , MDK Baden-Württemberg, Mannheim, Germany
| | - Maximilian Schultheiss
- 2 Centre for Ophthalmology, University of Tübingen , Tübingen, Germany .,4 Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
| | - M Dominik Fischer
- 2 Centre for Ophthalmology, University of Tübingen , Tübingen, Germany
| | | | - Florian Gekeler
- 1 Department of Ophthalmology, Katharinenhospital Stuttgart , Stuttgart, Germany .,2 Centre for Ophthalmology, University of Tübingen , Tübingen, Germany
| | - Andreas Schatz
- 1 Department of Ophthalmology, Katharinenhospital Stuttgart , Stuttgart, Germany .,2 Centre for Ophthalmology, University of Tübingen , Tübingen, Germany
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Willmann G, Gekeler F. [The effect of high altitude on the ocular surface]. Ther Umsch 2017; 74:564-568. [PMID: 29690835 DOI: 10.1024/0040-5930/a000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Viele verschiedene Strukturen des Auges werden in der Höhe nicht nur wegen der dort herrschenden Hypoxie, sondern auch aufgrund weiterer relevanter Umweltfaktoren wie UV Strahlung, Kälte oder niedere Luftfeuchtigkeit beeinträchtigt. Diese Veränderungen zeigen sich sehr häufig an den der Umwelt exponierten, meist avaskulären Strukturen wie der Hornhaut oder dem Tränenfilm. So kommt es in der Höhe zum Beispiel zu einer akuten Photokeratitis, einem Hornhautödem oder zu einem instabilen Tränenfilm. Die Schädigungen dieser Strukturen können bis zu einer relevanten Funktionsbeeinträchtigung des visuellen Systems mit verminderter Sehfähigkeit führen. Insbesondere präventive Massnahmen sind deshalb von entscheidender Bedeutung.
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Affiliation(s)
- Gabriel Willmann
- 1 Katharinenhospital Stuttgart, Augenklinik, Stuttgart, Deutschland
| | - Florian Gekeler
- 1 Katharinenhospital Stuttgart, Augenklinik, Stuttgart, Deutschland
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22
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Jolly JK, Wagner SK, Moules J, Gekeler F, Webster AR, Downes SM, MacLaren RE. A Novel Method for Quantitative Serial Autofluorescence Analysis in Retinitis Pigmentosa Using Image Characteristics. Transl Vis Sci Technol 2016; 5:10. [PMID: 27933220 PMCID: PMC5142716 DOI: 10.1167/tvst.5.6.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/13/2016] [Indexed: 01/13/2023] Open
Abstract
Purpose Identifying potential biomarkers for disease progression in retinitis pigmentosa (RP) is highly relevant now that gene therapy and other treatments are in clinical trial. Here we report a novel technique for analysis of short-wavelength autofluorescence (AF) imaging to quantify defined regions of AF in RP patients. Methods Fifty-five–degree AF images were acquired from 12 participants with RP over a 12-month period. Of these, five were identified as having a hyperfluorescent annulus. A standard Cartesian coordinate system was superimposed on images with the fovea as the origin and eight bisecting lines traversing the center at 45 degrees to each other. Spatial extraction software was programmed to highlight pixels corresponding to varying degrees of percentile fluorescence such that the parafoveal AF ring was mapped. Distance between the fovea and midpoint of the AF ring was measured. Percentage of low luminance areas was utilized as a measure of atrophy. Results The hyperfluorescent ring was most accurately mapped using the 70th percentile of fluorescence. Both the AF ring and peripheral hypofluorescence showed robust repeatability at all time points noted (P = 0.93). Conclusions Both a hypofluorescent ring and retinal pigment epithelium atrophy were present on a significant proportion of RP patients and were consistently mapped over a 12-month period. There is potential extrapolation of this methodology to wide-field imaging as well as other retinal dystrophies. This anatomical change may provide a useful anatomical biomarker for assessing treatment end points in RP. Translational Relevance Spatial extraction software can be a valuable tool in the assessment of ophthalmic imaging data.
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Affiliation(s)
- Jasleen K Jolly
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK ; Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Siegfried K Wagner
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK ; Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | | | | | - Andrew R Webster
- Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Susan M Downes
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Robert E MacLaren
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK ; Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
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Stingl K, Bartz-Schmidt KU, Braun A, Gekeler F, Greppmaier U, Schatz A, Stett A, Strasser T, Kitiratschky V, Zrenner E. Transfer characteristics of subretinal visual implants: corneally recorded implant responses. Doc Ophthalmol 2016; 133:81-90. [PMID: 27510912 PMCID: PMC5052310 DOI: 10.1007/s10633-016-9557-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The subretinal Alpha IMS visual implant is a CE-approved medical device for restoration of visual functions in blind patients with end-stage outer retina degeneration. We present a method to test the function of the implant objectively in vivo using standard electroretinographic equipment and to assess the devices' parameter range for an optimal perception. METHODS Subretinal implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) consists of 1500 photodiode-amplifier-electrode units and is implanted surgically into the subretinal space in blind retinitis pigmentosa patients. The voltages that regulate the amplifiers' sensitivity (V gl) and gain (V bias), related to the perception of contrast and brightness, respectively, are adjusted manually on a handheld power supply device. Corneally recorded implant responses (CRIR) to full-field illumination with long duration flashes in various implant settings for brightness gain (V bias) and amplifiers' sensitivity (V gl) are measured using electroretinographic setup with a Ganzfeld bowl in a protocol of increasing stimulus luminances up to 1000 cd/m2. RESULTS CRIRs are a meaningful tool for assessing the transfer characteristic curves of the electronic implant in vivo monitoring the implants' voltage output as a function of log luminance in a sigmoidal shape. Changing the amplifiers' sensitivity (V gl) shifts the curve left or right along the log luminance axis. Adjustment of the gain (V bias) changes the maximal output. Contrast perception is only possible within the luminance range of the increasing slope of the function. CONCLUSIONS The technical function of subretinal visual implants can be measured objectively using a standard electroretinographic setup. CRIRs help the patient to optimise the perception by adjusting the gain and luminance range of the device and are a useful tool for clinicians to objectively assess the function of subretinal visual implants in vivo.
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Affiliation(s)
- K Stingl
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany
| | - K U Bartz-Schmidt
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany
| | - A Braun
- Retina Implant AG, Gerhard-Kindler-Straße 8, 72770, Reutlingen, Germany
| | - F Gekeler
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany.,Klinikum Stuttgart - Katharinenhospital, Eye Clinic, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - U Greppmaier
- Retina Implant AG, Gerhard-Kindler-Straße 8, 72770, Reutlingen, Germany
| | - A Schatz
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany.,Klinikum Stuttgart - Katharinenhospital, Eye Clinic, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - A Stett
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Markwiesenstr. 55, 72770, Reutlingen, Germany
| | - T Strasser
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany
| | - V Kitiratschky
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany.
| | - E Zrenner
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany.,Werner Reichardt Centre for Integrative Neuroscience (CIN), University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany
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Fischer MD, Schatz A, Gekeler F, Willmann G. Author Response: Subfoveal Choroidal Thickness in High-Altitude Mountaineers. Invest Ophthalmol Vis Sci 2016; 57:1748. [DOI: 10.1167/iovs.16-19439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- M. Dominik Fischer
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany; and the
| | - Andreas Schatz
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany; and the 2Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Florian Gekeler
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany; and the 2Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Gabriel Willmann
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany; and the 2Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
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25
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Gekeler K, Gekeler F. Sekundäre Linsenimplantation. Augenheilkunde up2date 2015. [DOI: 10.1055/s-0041-102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Gekeler K, Gekeler F. [Secondary Intraocular Lens Implantation]. Klin Monbl Augenheilkd 2015; 232:1003-20; quiz 1021-2. [PMID: 26287546 DOI: 10.1055/s-0033-1358165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fischer MD, Schatz A, Seitz IP, Schommer K, Bartz-Schmidt KU, Gekeler F, Willmann G. Reversible Increase of Central Choroidal Thickness During High-Altitude Exposure. Invest Ophthalmol Vis Sci 2015. [PMID: 26200487 DOI: 10.1167/iovs.15-16770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aimed to quantify the impact of high altitude on choroidal thickness and relate changes of altered choroidal blood flow to clinical parameters and acute mountain sickness (AMS). This work is related to the Tübingen High Altitude Ophthalmology (THAO) study. METHODS Enhanced depth imaging spectral-domain optical coherence tomography was used to quantify macular choroidal layer thickness. Peripheral oxygen saturation, heart rate, and AMS scores were assessed in eight healthy subjects at baseline (altitude, 341 m) and at altitude (4559 m) for respective correlations. RESULTS Longitudinal analysis revealed a significant (P = 0.011, ANOVA) increase in central choroidal thickness (CCT) during altitude exposure (CCT baseline = 271 ± 9 μm; CCT altitude = 288 ± 9 μm) due to an increased choroidal blood flow. Incidence of AMS at altitude was 50%, peripheral oxygen saturation decreased by 25%, and heart rate increased by 39%. All changes were completely reversible after descent to low altitudes. CONCLUSIONS A small but significant increase in choroidal thickness was observed upon acute altitude exposure to 4559 m. This increase in choroidal blood flow was not related to AMS and was fully reversible after return to low altitude.
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Affiliation(s)
- M Dominik Fischer
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 2Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
| | - Andreas Schatz
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 3Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Immanuel P Seitz
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Kai Schommer
- University Medical Centre, I. Medical Department, Mannheim, Germany
| | | | - Florian Gekeler
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 3Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Gabriel Willmann
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany 3Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
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Abstract
BACKGROUND The vitreoretinal interface is not merely the space between the vitreous body and the retina but it is also a site for highly complex pathologies with the vitreous body exerting an influence on all the neighbouring structures. METHODS A literature search was performed in Pubmed and current book articles RESULTS This review article highlights the role of the vitreous body in vitreomacular adhesion and traction, in the development of macular holes and epiretinal membranes as well as its role in age-related macular degeneration. In the retinal periphery the vitreous structures play a pivotal role in retinal tears and detachment as well as in diabetic and other proliferative vitreoretinopathies. The role of the vitreous bodyin the emergence of various forms of cataract is often underestimated. DISCUSSION Vitreo-etinal surgeons should thoroughly understand the pathophysiological relationship between the vitreous body and the neighboring structures, especially in the era of medical vitreolysis.
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Affiliation(s)
- K Gekeler
- Augenklinik des Klinikums Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland,
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29
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Hafed ZM, Stingl K, Bartz-Schmidt KU, Gekeler F, Zrenner E. Oculomotor behavior of blind patients seeing with a subretinal visual implant. Vision Res 2015; 118:119-31. [PMID: 25906684 DOI: 10.1016/j.visres.2015.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 11/19/2022]
Abstract
Electronic implants are able to restore some visual function in blind patients with hereditary retinal degenerations. Subretinal visual implants, such as the CE-approved Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany), sense light through the eye's optics and subsequently stimulate retinal bipolar cells via ∼1500 independent pixels to project visual signals to the brain. Because these devices are directly implanted beneath the fovea, they potentially harness the full benefit of eye movements to scan scenes and fixate objects. However, so far, the oculomotor behavior of patients using subretinal implants has not been characterized. Here, we tracked eye movements in two blind patients seeing with a subretinal implant, and we compared them to those of three healthy controls. We presented bright geometric shapes on a dark background, and we asked the patients to report seeing them or not. We found that once the patients visually localized the shapes, they fixated well and exhibited classic oculomotor fixational patterns, including the generation of microsaccades and ocular drifts. Further, we found that a reduced frequency of saccades and microsaccades was correlated with loss of visibility. Last, but not least, gaze location corresponded to the location of the stimulus, and shape and size aspects of the viewed stimulus were reflected by the direction and size of saccades. Our results pave the way for future use of eye tracking in subretinal implant patients, not only to understand their oculomotor behavior, but also to design oculomotor training strategies that can help improve their quality of life.
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Affiliation(s)
- Ziad M Hafed
- Werner Reichardt Centre for Integrative Neuroscience, Otfried-Mueller Strasse 25, Tuebingen 72076, Germany.
| | - Katarina Stingl
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tuebingen, Schleichstrasse 12-16, Tuebingen 72076, Germany.
| | - Karl-Ulrich Bartz-Schmidt
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tuebingen, Schleichstrasse 12-16, Tuebingen 72076, Germany
| | - Florian Gekeler
- Augenklinik Katharinenhospital, Klinikum Stuttgart, Kriegsbergstrasse 60, Stuttgart 70174, Germany
| | - Eberhart Zrenner
- Werner Reichardt Centre for Integrative Neuroscience, Otfried-Mueller Strasse 25, Tuebingen 72076, Germany; Center for Ophthalmology, Institute for Ophthalmic Research, University of Tuebingen, Schleichstrasse 12-16, Tuebingen 72076, Germany
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30
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Stingl K, Bartz-Schmidt KU, Besch D, Chee CK, Cottriall CL, Gekeler F, Groppe M, Jackson TL, MacLaren RE, Koitschev A, Kusnyerik A, Neffendorf J, Nemeth J, Naeem MAN, Peters T, Ramsden JD, Sachs H, Simpson A, Singh MS, Wilhelm B, Wong D, Zrenner E. Subretinal Visual Implant Alpha IMS--Clinical trial interim report. Vision Res 2015; 111:149-60. [PMID: 25812924 DOI: 10.1016/j.visres.2015.03.001] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/27/2022]
Abstract
A subretinal visual implant (Alpha IMS, Retina Implant AG, Reutlingen, Germany) was implanted in 29 blind participants with outer retinal degeneration in an international multicenter clinical trial. Primary efficacy endpoints of the study protocol were a significant improvement of activities of daily living and mobility to be assessed by activities of daily living tasks, recognition tasks, mobility, or a combination thereof. Secondary efficacy endpoints were a significant improvement of visual acuity/light perception and/or object recognition (clinicaltrials.gov, NCT01024803). During up to 12 months observation time twenty-one participants (72%) reached the primary endpoints, of which thirteen participants (45%) reported restoration of visual function which they use in daily life. Additionally, detection, localization, and identification of objects were significantly better with the implant power switched on in the first 3 months. Twenty-five participants (86%) reached the secondary endpoints. Measurable grating acuity was up to 3.3 cycles per degree, visual acuities using standardized Landolt C-rings were 20/2000, 20/2000, 20/606 and 20/546. Maximal correct motion perception ranged from 3 to 35 degrees per second. These results show that subretinal implants can restore very-low-vision or low vision in blind (light perception or less) patients with end-stage hereditary retinal degenerations.
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Affiliation(s)
- Katarina Stingl
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany
| | | | - Dorothea Besch
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany
| | - Caroline K Chee
- Department of Ophthalmology, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Charles L Cottriall
- Oxford Eye Hospital and Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Florian Gekeler
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany; Klinikum Stuttgart - Katharinenhospital, Eye Clinic, Kriegsbergstraße 60, 70174 Stuttgart, Germany(1)
| | - Markus Groppe
- Oxford Eye Hospital and Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Timothy L Jackson
- King's College Hospital and King's College London, Denmark Hill, London SE5 9RS, United Kingdom
| | - Robert E MacLaren
- Oxford Eye Hospital and Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Assen Koitschev
- Klinikum Stuttgart - Olgahospital, ORL-Department, Pediatric Otorhinolaryngology and Otology, Kriegsbergstr. 62, 70176 Stuttgart, Germany
| | - Akos Kusnyerik
- Department of Ophthalmology, Semmelweis University, Maria utca 39, H-1085 Budapest, Hungary
| | - James Neffendorf
- King's College Hospital and King's College London, Denmark Hill, London SE5 9RS, United Kingdom
| | - Janos Nemeth
- Department of Ophthalmology, Semmelweis University, Maria utca 39, H-1085 Budapest, Hungary
| | - Mohamed Adheem Naser Naeem
- Department of Ophthalmology, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Tobias Peters
- STZ Eyetrial, Center for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany
| | - James D Ramsden
- Department of Otolaryngology, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, United Kingdom
| | - Helmut Sachs
- Klinikum Dresden Friedrichstadt, Univ. Teaching Hospital, Eye Clinic, Friedrichstr. 41, 01067 Dresden, Germany
| | - Andrew Simpson
- King's College Hospital and King's College London, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mandeep S Singh
- Department of Ophthalmology, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Barbara Wilhelm
- STZ Eyetrial, Center for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany
| | - David Wong
- Li Ka Shing Faculty of Medicine, University of Hong Kong, 301 Block B, Cyberport 4, Hong Kong
| | - Eberhart Zrenner
- Werner Reichardt Centre for Integrative Neuroscience (CIN), University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany; Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany.
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Thaler S, Haritoglou C, Schuettauf F, Choragiewicz T, May CA, Gekeler F, Fischer MD, Langhals H, Schatz A. In vivo biocompatibility of a new cyanine dye for ILM peeling. Eye (Lond) 2014; 29:428-35. [PMID: 25523205 DOI: 10.1038/eye.2014.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/02/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the biocompatibility of the new cyanine dye: 3,3'-Di-(4-sulfobutyl)-1,1,1',1'-tetramethyl-di-1H-benz[e]indocarbocyanine (DSS) as a vital dye for intraocular application in an in vivo rat model and to evaluate the effects of this dye on retinal structure and function. METHODS DSS at a concentration of 0.5% was applied via intravitreal injections to adult Brown Norway rats with BSS serving as a control. Retinal toxicity was assessed 7 days later by means of retinal ganglion cell (RGC) counts, light microscopy, optical coherence tomography (OCT), and electroretinography (ERG). RESULTS No significant decrease in RGC numbers was observed. No structural changes of the central retina were observed either in vivo (OCT) or under light microscopy. ERGs detected a temporary reduction of retinal function 7 days after injection; this was no longer evident 14 days after injection. CONCLUSIONS DSS showed good biocompatibility in a well-established experimental in vivo setting and may be usable for intraocular surgery as an alternative to other cyanine dyes. In contrast to indocyanine green, it additionally offers fluorescence in the visual spectrum. Further studies with other animal models are needed before translation into clinical application.
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Affiliation(s)
- S Thaler
- Eye Clinic and Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - C Haritoglou
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - F Schuettauf
- Eye Clinic and Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - T Choragiewicz
- 1] Eye Clinic and Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany [2] 1st Eye Hospital, Medical University of Lublin, Lublin, Poland
| | - C A May
- Department of Anatomy, Medical Faculty 'Carl Gustav Carus', Technical University of Dresden, Dresden, Germany
| | - F Gekeler
- Eye Clinic and Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - M D Fischer
- Eye Clinic and Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - H Langhals
- Department of Chemistry, Ludwig-Maximilians-University, Munich, Germany
| | - A Schatz
- Eye Clinic and Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
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Gekeler K, Gekeler F. Multifokale und Add-on-Intraokularlinsen. Augenheilkunde up2date 2014. [DOI: 10.1055/s-0033-1358019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K. Gekeler
- Augenklinik Katharinenhospital, Klinikum Stuttgart
| | - F. Gekeler
- Augenklinik Katharinenhospital, Klinikum Stuttgart
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Gekeler K, Gekeler F. [Multifocal and add-on intraocular lenses]. Klin Monbl Augenheilkd 2014; 231:1037, 1039-48; quiz 1049-50. [PMID: 25333242 DOI: 10.1055/s-0033-1358020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K Gekeler
- Augenklinik Katharinenhospital, Klinikum Stuttgart
| | - F Gekeler
- Augenklinik Katharinenhospital, Klinikum Stuttgart
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Kitiratschky VBD, Stingl K, Wilhelm B, Peters T, Besch D, Sachs H, Gekeler F, Bartz-Schmidt KU, Zrenner E. Safety evaluation of "retina implant alpha IMS"--a prospective clinical trial. Graefes Arch Clin Exp Ophthalmol 2014; 253:381-7. [PMID: 25219982 DOI: 10.1007/s00417-014-2797-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To restore vision in patients with retinitis pigmentosa, several types of electronic devices have been developed to stimulate neurons at different levels along the visual pathway. Subretinal stimulation of the retina with the Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) has been demonstrated to provide useful vision in daily life. Here we evaluated the safety of this device. METHODS An interventional, prospective, multi-center, single-arm study was conducted in patients with retinitis pigmentosa with the Retina Implant Alpha IMS. The results from the first nine patients of a single center regarding safety of the device are reported. Any untoward medical occurrence related or unrelated to the tested device was documented and evaluated. RESULTS Nine adult subjects were included in the study at the Tübingen site. Seventy-five adverse events occurred in total, and 53 affected the eye and its adnexa. Thirty-one ocular adverse events had a relationship to the implant that was classified as "certain" while 19 had a probable or possible relationship; three had no relationship to the implant. Thirty-nine ocular adverse events resolved without sequelae, two resolved with sequelae, 11 remained unresolved, and in one the status was unknown. The intensity of ocular adverse events was mild in the majority of cases (n = 45), while six were of moderate and two of severe intensity. There was no non-ocular adverse event with certain relationship to the device. One subject lost light perception (without light localization) in her study eye. CONCLUSIONS In conclusion, this prospective study, "Safety and Efficacy of Subretinal Implants for Partial Restoration of Vision in Blind Patients," shows that the Retina Implant Alpha IMS is an option for restoring vision using a subretinal stimulation device with a clinically acceptable safety profile.
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Willmann G, Schatz A, Fischer MD, Schommer K, Zrenner E, Bartz-Schmidt KU, Gekeler F, Gekeler K. Exposure to High Altitude Alters Tear Film Osmolarity and Breakup Time. High Alt Med Biol 2014; 15:203-7. [DOI: 10.1089/ham.2013.1103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gabriel Willmann
- Katharinenhospital, Department of Ophthalmology, Stuttgart, Germany
- Centre for Ophthalmology University of Tübingen, Germany
| | - Andreas Schatz
- Katharinenhospital, Department of Ophthalmology, Stuttgart, Germany
- Centre for Ophthalmology University of Tübingen, Germany
| | - M. Dominik Fischer
- Centre for Ophthalmology University of Tübingen, Germany
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
| | - Kai Schommer
- Department of Sports Medicine, Medical Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Florian Gekeler
- Katharinenhospital, Department of Ophthalmology, Stuttgart, Germany
- Centre for Ophthalmology University of Tübingen, Germany
| | - Katrin Gekeler
- Katharinenhospital, Department of Ophthalmology, Stuttgart, Germany
- Centre for Ophthalmology University of Tübingen, Germany
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Schultheiss M, Schommer K, Schatz A, Wilhelm B, Peters T, Fischer MD, Zrenner E, Bartz-Schmidt KU, Gekeler F, Willmann G. Pupillary light reaction during high altitude exposure. PLoS One 2014; 9:e87889. [PMID: 24503770 PMCID: PMC3913681 DOI: 10.1371/journal.pone.0087889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/05/2014] [Indexed: 01/15/2023] Open
Abstract
PURPOSE This study aimed to quantify the pupillary light reaction during high altitude exposure using the state of the art Compact Integrated Pupillograph (CIP) and to investigate a potential correlation of altered pupil reaction with severity of acute mountain sickness (AMS). This work is related to the Tübingen High Altitude Ophthalmology (THAO) study. METHODS Parameters of pupil dynamics (initial diameter, amplitude, relative amplitude, latency, constriction velocity) were quantified in 14 healthy volunteers at baseline (341 m) and high altitude (4559 m) over several days using the CIP. Scores of AMS, peripheral oxygen saturation and heart rate were assessed for respective correlations with pupil dynamics. For statistical analysis JMP was used and data are shown in terms of intra-individual normalized values (value during exposure/value at baseline) and the 95% confidence interval for each time point. RESULTS During high altitude exposure the initial diameter size was significantly reduced (p<0.05). In contrast, the amplitude, the relative amplitude and the contraction velocity of the light reaction were significantly increased (p<0.05) on all days measured at high altitude. The latency did not show any significant differences at high altitude compared to baseline recordings. Changes in pupil parameters did not correlate with scores of AMS. CONCLUSIONS Key parameters of the pupillary light reaction are significantly altered at high altitude. We hypothesize that high altitude hypoxia itself as well as known side effects of high altitude exposure such as fatigue or exhaustion after ascent may account for an altered pupillogram. Interestingly, none of these changes are related to AMS.
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Affiliation(s)
| | - Kai Schommer
- Department of Sports Medicine of Medical Clinic, University of Heidelberg, Heidelberg, Germany
| | - Andreas Schatz
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Barbara Wilhelm
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Tobias Peters
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - M. Dominik Fischer
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
- Nuffield Laboratory of Ophthalmology Oxford, University of Oxford, Oxford, United Kingdom
| | - Eberhart Zrenner
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Florian Gekeler
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Gabriel Willmann
- Center of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
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Stingl K, Bartz-Schmidt KU, Gekeler F, Kusnyerik A, Sachs H, Zrenner E. Functional outcome in subretinal electronic implants depends on foveal eccentricity. Invest Ophthalmol Vis Sci 2013; 54:7658-65. [PMID: 24150759 DOI: 10.1167/iovs.13-12835] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE An active microelectronic subretinal implant, developed to replace the photoreceptive function in hereditary degenerations of the outer retina, has been applied in a pilot and clinical study in patients with end-stage retinal degeneration. METHODS The study population comprised 20 blind patients, all of whom lost vision as result of a hereditary retinal disease. An active visual implant was placed surgically within the subretinal space of each patient: subfoveal placement in eight patients (group 1) and parafoveal placement in 12 (group 2). Standardized low-vision tests, including light perception, light localization, movement detection, grating acuity, and visual acuity by Landolt C-rings, were used under masked, randomized implant-OFF and implant-ON conditions. For the chip-mediated vision functional results of both subject groups were compared. RESULTS Three of 20 patients were excluded from analysis because of surgical or technical implant issues. Among patients with nonfoveal placement of the implant, 80% could perceive light, 10% recognized location, and 10% correctly distinguished stripe patterns up to a resolution of 0.33 cycles/degree. No nonfoveal placement patient passed the motion or Landolt C-ring tests. When the implant was placed subfoveally, 100% of patients could perceive light and determine light localization, 75% could resolve motion up to 35°/s, 88% correctly distinguished stripe patterns up to a resolution of 3.3 cycles/degree, and 38% passed a Landolt C-ring test with a decimal visual acuity of up to 20/546 (logMAR 1.43). CONCLUSIONS Subfoveal placement of active subretinal visual implants allows superior measurable outcomes compared to para- or nonfoveal placement locations. (ClinicalTrials.gov numbers, NCT01024803, NCT00515814.).
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Affiliation(s)
- Katarina Stingl
- Center for Ophthalmology, University of Tübingen, Tübingen, Germany
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Willmann G, Fischer MD, Schommer K, Bärtsch P, Gekeler F, Schatz A. Missing correlation of retinal vessel diameter with high-altitude headache. Ann Clin Transl Neurol 2013; 1:59-63. [PMID: 25356382 PMCID: PMC4207505 DOI: 10.1002/acn3.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 01/20/2023] Open
Abstract
The most common altitude-related symptom, high-altitude headache (HAH), has recently been suggested to originate from restricted cerebral venous drainage in the presence of increased inflow caused by hypoxia. In support of this novel hypothesis, retinal venous distension was shown to correlate with the degree of HAH. We quantified for the first time retinal vessel diameter changes at 4559 m using infrared fundus images obtained from a state of the art Spectralis™ HRA+OCT with a semiautomatic VesselMap 1® software. High-altitude exposure resulted in altered arterial and venous diameter changes at high altitude, however, independent of headache burden.
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Affiliation(s)
- Gabriel Willmann
- Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - M Dominik Fischer
- Centre for Ophthalmology, University of Tübingen Tübingen, Germany ; Nuffield Laboratory of Ophthalmology, University of Oxford Oxford, United Kingdom
| | - Kai Schommer
- Department of Sports Medicine, Medical Clinic, University Hospital Heidelberg Heidelberg, Germany
| | - Peter Bärtsch
- Department of Sports Medicine, Medical Clinic, University Hospital Heidelberg Heidelberg, Germany
| | - Florian Gekeler
- Centre for Ophthalmology, University of Tübingen Tübingen, Germany ; Department of Ophthalmology, Katharinenhospital Stuttgart, Germany
| | - Andreas Schatz
- Centre for Ophthalmology, University of Tübingen Tübingen, Germany
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Schatz A, Breithaupt M, Hudemann J, Niess A, Messias A, Zrenner E, Bartz-Schmidt KU, Gekeler F, Willmann G. Electroretinographic assessment of retinal function during acute exposure to normobaric hypoxia. Graefes Arch Clin Exp Ophthalmol 2013; 252:43-50. [PMID: 24193351 DOI: 10.1007/s00417-013-2504-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 10/06/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The current study aimed to investigate retinal function during exposure to normobaric hypoxia. METHODS Standard Ganzfeld ERG equipment (Diagnosys LLC, Cambridge, UK) using an extended ISCEV protocol was applied to explore intensity-response relationship in dark- and light- adapted conditions in 13 healthy volunteers (mean age 25 ± 3 years). Baseline examinations were performed under atmospheric air conditions at 341 meters above sea level (FIO2 of 21 %), and were compared to hypoxia (FIO2 of 13.2 %) by breathing a nitrogen-enriched gas mixture for 45 min. All subjects were monitored using infrared oximetry and blood gas analysis. RESULTS The levels of PaCO2 changed from 38.4 ± 2.7 mmHg to 36.4 ± 3.0 mmHg, PaO2 from 95.5 ± 1.9 mmHg to 83.7 ± 4.6 mmHg, and SpO2 from 100 ± 0 % to 87 ± 4 %, from baseline to hypoxia respectively. A significant decrease (p < 0.05) was found for saturation amplitude of the dark-adapted b-wave intensity-response function (Vmax), dark-adapted a- and b-wave amplitudes of combined rod and cone responses (3 and 10 cd.s/m(2)), light-adapted b-wave amplitudes of single flash (3 and 10 cd.s/m(2)), and flicker responses (5-45 Hz) during hypoxia compared to baseline, without changes in implicit times. The a-wave slope of combined rod and cone responses (3 and 10 cd.s/m(2)) and the oscillatory potentials were significantly lower during hypoxia (p < 0.05). A isolated light-adapted ON response (250 ms flash) showed a reduction of amplitudes at hypoxia (p < 0.05), but no changes were observed for the OFF response. CONCLUSIONS The results show significant impairment of retinal function during simulated normobaric short-term hypoxia affecting specific retinal cells of rod and cone pathways.
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Affiliation(s)
- Andreas Schatz
- Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, 72076, Tübingen, Germany
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Willmann G, Schatz A, Zhour A, Schommer K, Zrenner E, Bartz-Schmidt KU, Gekeler F, Fischer MD. Impact of Acute Exposure to High Altitude on Anterior Chamber Geometry. ACTA ACUST UNITED AC 2013; 54:4241-8. [DOI: 10.1167/iovs.13-12158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Andreas Schatz
- Centre for Ophthalmology, University of Tübingen, Germany
| | - Ahmad Zhour
- Centre for Ophthalmology, University of Tübingen, Germany
| | - Kai Schommer
- Department of Sports Medicine, Medical Clinic, University Hospital Heidelberg, Heidelberg, Germany
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Pach J, Kohl S, Gekeler F, Zobor D. Identification of a novel mutation in the PRCD gene causing autosomal recessive retinitis pigmentosa in a Turkish family. Mol Vis 2013; 19:1350-5. [PMID: 23805042 PMCID: PMC3692407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 06/11/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Progressive rod-cone degeneration (PRCD) is a canine form of autosomal recessive photoreceptor degeneration and serves as an animal model for human retinitis pigmentosa (RP). To date, only two RP-causing mutations of the PRCD gene have been reported in humans. We found a novel mutation in PRCD (c.52C>T, p.R18X) in three siblings affected by RP and present detailed morphologic and functional parameters. METHODS A complete ophthalmological examination was performed including psychophysical tests (best-corrected visual acuity, Lanthony Panel D-15 color vision test, and visual field) and electrophysiology (ganzfeld and multifocal electroretinogram). Additionally, color and infrared fundus photography, autofluorescence, and spectral domain optical coherence tomography recordings were performed. Genomic DNA of the three affected individuals was analyzed with high-throughput sequencing for all RP-related genes in a diagnostic set-up. RESULTS We identified a novel homozygous mutation in PRCD (c.52C>T, p.R18X) with diagnostic high-throughput panel sequencing. All three patients showed an advanced stage of retinitis pigmentosa with reduced visual acuity (mean: 20/80), small residual visual fields (mean for target III4e: 1134.35 deg²), and non-detectable electrophysiological responses. Myopia, posterior subcapsular cataract, bone spicule-like pigmentation, and attenuated arterioles were typical findings. Interestingly, bull's eye maculopathy due to patchy retinal pigment epithelium atrophy was also present in all patients. The mean central retinal thickness observed in optical coherence tomography was 148 µm. CONCLUSIONS The identification of a third mutation in PRCD confirms its role in the pathogenesis of RP. Clinical findings were in line with the morphological changes observed in previous studies. Bull's eye maculopathy seems to be a hallmark of RP due to mutations in the PRCD gene.
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Affiliation(s)
- Johanna Pach
- Centre for Ophthalmology, University of Tübingen
| | - Susanne Kohl
- Institute for Ophthalmic Research, Molecular Genetics Laboratory, University of Tübingen
| | | | - Ditta Zobor
- Institute for Ophthalmic Research, University of Tübingen, Germany
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Affiliation(s)
- Gabriel Willmann
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
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Schatz A, Willmann G, Fischer MD, Schommer K, Messias A, Zrenner E, Bartz-Schmidt KU, Gekeler F. Electroretinographic assessment of retinal function at high altitude. J Appl Physiol (1985) 2013; 115:365-72. [PMID: 23722709 DOI: 10.1152/japplphysiol.00245.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although hypoxia plays a key role in the pathophysiology of many common and well studied retinal diseases, little is known about the effects of high-altitude hypoxia on retinal function. The aim of the present study was to assess retinal function during exposure to high-altitude hypoxia using electroretinography (ERG). This work is related to the Tübingen High Altitude Ophthalmology (THAO) study. Electroretinography was performed in 14 subjects in Tübingen, Germany (341 m) and at high altitude at La Capanna Regina Margherita, Italy (4,559 m) using an extended protocol to assess functional integrity of various retinal layers. To place findings in the context of acute mountain sickness, correlations between ERG measurements and oxygen saturation, heart rate, and scores of acute mountain sickness (AMS) were calculated. At high altitude, the maximum response of the scotopic sensitivity function, the implicit times of the a- and b-wave of the combined rod-cone responses, and the implicit times of the photopic negative responses (PhNR) were significantly altered. A-wave slopes and i-waves were significantly decreased at high altitude. The strongest correlation was found for PhNR and O2 saturation (r = 0.68; P < 0.05). Of all tested correlations, only the photopic b-wave implicit time (10 cd·s/m(2)) was significantly correlated with severity of AMS (r = 0.57; P < 0.05). ERG data show that retinal function of inner, outer, and ganglion cell layer is altered at high-altitude hypoxia. Interestingly, the most affected ERG parameters are related to combined rod-cone responses, which indicate that phototransduction and visual processing, especially under conditions of rod-cone interaction, are primarily affected at high altitude.
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Affiliation(s)
- Andreas Schatz
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
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Pach J, Gekeler F. [Therapeutic approaches for retinitis pigmentosa]. Klin Monbl Augenheilkd 2013; 230:512-8. [PMID: 23695848 DOI: 10.1055/s-0032-1328471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Retinitis pigmentosa (RP) is a clinically and genetically heterogeneous group of hereditary retinal disorders, which lead to progressive loss of vision and finally blindness. Yet there is no approved therapy. Advances in unravelling underlying genetic disorders and pathophysiological mechanisms offer new therapeutic approaches of which some are summarised in this review. METHODS We performed a systematic literature research for defined key words in PubMed. RESULTS New approaches to therapy for RP include: gene therapy, pharmacological treatment, neuroprotection, electrical stimulation, retinal prostheses, retinal transplantation and optogenetic therapy. CONCLUSIONS Recently there have been advances in new approaches for therapy of dystrophic retinal diseases. Advances in the different approaches are being made at different rates. Although there is no approved therapy yet, the future for treating RP at least in some patients looks promising.
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Affiliation(s)
- J Pach
- Department für Augenheilkunde, Universitätsklinikum Tübingen, Schleichstrasse 12, Tübingen.
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Messias K, Castro VMD, Gekeler F, Messias A. Axonal electrovisiogram or inverse photopic skin electroretinogram? Arq Bras Oftalmol 2013; 75:370-1. [PMID: 23471337 DOI: 10.1590/s0004-27492012000500017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Willmann G, Schatz A, Fischer MD, Zrenner E, Bartz-Schmidt KU, Gekeler F, Schommer K. Hypoxia in the Eye—Retinal Changes in Correlation to Acute Mountain Sickness. Wilderness Environ Med 2013. [DOI: 10.1016/j.wem.2012.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stingl K, Bartz-Schmidt KU, Besch D, Braun A, Bruckmann A, Gekeler F, Greppmaier U, Hipp S, Hörtdörfer G, Kernstock C, Koitschev A, Kusnyerik A, Sachs H, Schatz A, Stingl KT, Peters T, Wilhelm B, Zrenner E. Artificial vision with wirelessly powered subretinal electronic implant alpha-IMS. Proc Biol Sci 2013; 280:20130077. [PMID: 23427175 PMCID: PMC3619489 DOI: 10.1098/rspb.2013.0077] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study aims at substituting the essential functions of photoreceptors in patients who are blind owing to untreatable forms of hereditary retinal degenerations. A microelectronic neuroprosthetic device, powered via transdermal inductive transmission, carrying 1500 independent microphotodiode-amplifier-electrode elements on a 9 mm2 chip, was subretinally implanted in nine blind patients. Light perception (8/9), light localization (7/9), motion detection (5/9, angular speed up to 35 deg s−1), grating acuity measurement (6/9, up to 3.3 cycles per degree) and visual acuity measurement with Landolt C-rings (2/9) up to Snellen visual acuity of 20/546 (corresponding to decimal 0.037 or corresponding to 1.43 logMAR (minimum angle of resolution)) were restored via the subretinal implant. Additionally, the identification, localization and discrimination of objects improved significantly (n = 8; p < 0.05 for each subtest) in repeated tests over a nine-month period. Three subjects were able to read letters spontaneously and one subject was able to read letters after training in an alternative-force choice test. Five subjects reported implant-mediated visual perceptions in daily life within a field of 15° of visual angle. Control tests were performed each time with the implant's power source switched off. These data show that subretinal implants can restore visual functions that are useful for daily life.
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Affiliation(s)
- Katarina Stingl
- Centre for Ophthalmology, University of Tübingen, Schleichstraße 12-16, Tübingen, Germany
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Naycheva L, Schatz A, Willmann G, Bartz-Schmidt KU, Zrenner E, Röck T, Gekeler F. Transcorneal electrical stimulation in patients with retinal artery occlusion: a prospective, randomized, sham-controlled pilot study. Ophthalmol Ther 2013; 2:25-39. [PMID: 25135699 PMCID: PMC4108151 DOI: 10.1007/s40123-013-0012-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Indexed: 11/20/2022] Open
Abstract
Introduction The purpose of this study was to investigate the safety and efficacy of transcorneal electrical stimulation (TES) in patients suffering from retinal artery occlusion (RAO). Methods Twelve patients with central and one patient with branch RAO (age 25–84 years, median 74 years) were enrolled in this prospective, randomized, sham-controlled study. RAO was diagnosed 10 days to 17 months prior to study participation. Patients were treated with TES (5 ms positive followed by 5 ms negative biphasic pulses at 20 Hz; applied with DTL electrodes) for 30 min once a week for 6 consecutive weeks. Patients were randomly assigned to TES with 0 mA (sham, n = 3), 66% (n = 5) or 150% (n = 5) of the patient’s individual electrical phosphene threshold (EPT) at 20 Hz. Best corrected visual acuity, ophthalmology examination and EPT (at 3, 6, 9, 20, 40, 60, and 80 Hz) were determined at baseline and at eight follow-up visits over 17 weeks. During four visits (week 1, 5, 9, and 17) kinetic and static visual fields as well as full-field and multifocal electroretinography were measured. The method of restricted maximum likelihood (P < 0.05, Tukey–Kramer) was used to estimate the development of parameters under treatment. Results TES was tolerated well; no ocular or systemic adverse events were observed except for foreign-body sensation after TES (n = 3). During the study period the slopes of the scotopic a-wave increased significantly (high-intensity flash white 10 cd.s/m2; P = 0.03) in the 150% treatment group. All other parameters in all other groups remained statistically unchanged. Conclusions Although TES was tolerated well, statistically significant improvements were found only for specific a-wave slopes. This is in contradiction to previous smaller, uncontrolled reports. Further studies with larger sample sizes and longer duration might, however, show additional significant effects.
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Affiliation(s)
- Lubka Naycheva
- Centre for Ophthalmology, Schleichstr. 12-16, 72076, Tübingen, Germany
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Stingl K, Gekeler F, Bartz-Schmidt KU, Kögel A, Zrenner E, Gelisken F. Fluorescein Angiographic Findings in Eyes of Patients with a Subretinal Electronic Implant. Curr Eye Res 2013; 38:588-96. [DOI: 10.3109/02713683.2013.767349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stingl K, Bach M, Bartz-Schmidt KU, Braun A, Bruckmann A, Gekeler F, Greppmaier U, Hörtdörfer G, Kusnyerik A, Peters T, Wilhelm B, Wilke R, Zrenner E. Safety and efficacy of subretinal visual implants in humans: methodological aspects. Clin Exp Optom 2012; 96:4-13. [PMID: 23173814 DOI: 10.1111/j.1444-0938.2012.00816.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/24/2012] [Accepted: 08/07/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Replacing the function of visual pathway neurons by electronic implants is a novel approach presently explored by various groups in basic research and clinical trials. The novelty raises unexplored methodological aspects of clinical trial design that may require adaptation and validation. METHODS We present procedures of efficacy and safety testing for subretinal visual implants in humans, as developed during our pilot trial 2005 to 2009 and multi-centre clinical trial since 2010. RESULTS Planning such a trial requires appropriate inclusion and exclusion criteria. For subretinal electronic visual implants, patients with photoreceptor degeneration are the target patient group, whereas presence of additional diseases affecting clear optic media or the visual pathway must be excluded. Because sham surgery is not possible, a masked study design with implant power ON versus OFF is necessary. Prior to the efficacy testing by psychophysical tests, the implant's technical characteristics have to be controlled via electroretinography (ERG). Moreover the testing methods require adaptation to the particular technology. We recommend standardised tasks first to determine the light perception thresholds, light localisation and movement detection, followed by grating acuity and vision acuity test via Landolt C rings. A laboratory setup for assessing essential activities of daily living is presented. Subjective visual experiences with the implant in a natural environment, as well as questionnaires and psychological counselling are further important aspects. CONCLUSIONS A clinical trial protocol for artificial vision in humans, which leads a patient from blindness to the state of very low vision is a challenge and cannot be defined completely prior to the study. Available tests of visual function may not be sufficiently suited for efficacy testing of artificial vision devices. A protocol based on experience with subretinal visual implants in 22 patients is presented that has been found adequate to monitor safety and efficacy.
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Affiliation(s)
- Katarina Stingl
- Center for Ophthalmology, University of Tübingen, Tübingen, Germany.
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