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Abstract
Non-arteritic ischemic optic neuropathy (NAION) is virtually unknown outside ophthalmology. It is characterised by acute unilateral visual loss, no pain on eye movements and virtually always optic disc swelling. Optic disc oedema resolves within 1 to 2 months, leaving behind optic atrophy. Vision hardly improves. NAION is the product of local abnormalities of the vascular supply to the optic nerve and general vascular risk factors. Of these, diabetes, hypertension and especially sleep apnoea syndrome are the most important. Recurrences in the involved eye are rare; contralateral recurrence occurs in approximately 15 % of patients. There is no clear scientific evidence for any specific therapy. However, there is general agreement that it is reasonable to control risk factors.
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Affiliation(s)
- H Wilhelm
- Augenheilkunde, Universitätskliniken Tübingen
| | - F Beisse
- Augenheilkunde, Universitätskliniken Heidelberg
| | - K Rüther
- Augenarztpraxis, Dorotheenstraße 56, Berlin
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2
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Beisse F, Beisse C, Lagrèze WA, Rüther K, Schiefer U, Wilhelm H. [Current recommendations on optic neuritis]. Ophthalmologe 2014; 111:722-6. [PMID: 25113867 DOI: 10.1007/s00347-013-2983-y] [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: 11/24/2022]
Abstract
BACKGROUND The diagnostics and therapy of optic neuritis are complex and require interdisciplinary cooperation. AIM Compact, up-to-date recommendations for the clinician appear to be desirable. MATERIAL AND METHODS A selective literature search including the authors' professional experience was carried out. An algorithm for the practical approach to optic neuritis was derived from the best available evidence. RESULTS Our recommendation distinguishes between compulsory and optional investigations. Differential diagnostic cues with regard to atypical optic neuritis and other optic neuropathies are shown. Standard therapy patterns and means of escalation are suggested. Indications for referral are presented. CONCLUSION The algorithm suggested in this article provides ophthalmologists with an effective orientation aid for the complete treatment procedure of optic neuritis.
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Affiliation(s)
- F Beisse
- Universitäts-Augenklinik, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland,
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3
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Abstract
Pseudotumor cerebri is a non-tumor related idiopathic or secondary intracranial hypertension. It is typically associated with papilledema and headache and patients are typically female, young and obese. Diagnosis is established by neuroimaging by magnetic resonance imaging (MRI), cerebral MR venography (MRV) and lumbar puncture. Papilledema is assessed by ophthalmoscopy, ultrasound and optical coherence tomography. Ophthalmologists monitor visual function by measuring visual acuity and visual field testing. Therapy of patients not facing immediate visual loss encompasses weight reduction and administration of carbonic anhydrase inhibitors. In vision-threatening situations invasive procedures are necessary, such as repeated lumbar puncture, liquor drainage, optic nerve sheath fenestration and endovascular venous stenting.
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Affiliation(s)
- K Rüther
- -, Dorotheenstr. 56, 10117, Berlin, Deutschland,
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4
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Rüther K, Kellner S. Prinzipien der Diagnostik retinaler Erkrankungen. Klin Monbl Augenheilkd 2013; 230:e20. [DOI: 10.1055/s-0033-1350891] [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: 10/26/2022]
Affiliation(s)
- K. Rüther
- Sankt Gertrauden-Krankenhaus, Augenklinik, Berlin
| | - S. Kellner
- Zentrum für seltene Netzhauterkrankungen, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH
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5
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Rüther K, Kellner S. Prinzipien der Diagnostik retinaler Erkrankungen. Augenheilkunde up2date 2013. [DOI: 10.1055/s-0033-1350895] [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: 10/26/2022]
Affiliation(s)
- K. Rüther
- Sankt Gertrauden-Krankenhaus, Augenklinik, Berlin
| | - S. Kellner
- Zentrum für seltene Netzhauterkrankungen, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH
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6
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Affiliation(s)
- K. Rüther
- Sankt Gertrauden-Krankenhaus, Augenklinik, Berlin
| | - S. Kellner
- Zentrum für seltene Netzhauterkrankungen, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH
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7
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Kellner S, Rüther K. Prinzipien der Diagnostik retinaler Erkrankungen. Klin Monbl Augenheilkd 2013; 230:e35-55. [DOI: 10.1055/s-0032-1325095] [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: 10/26/2022]
Affiliation(s)
- S. Kellner
- Zentrum für seltene Netzhauterkrankungen, AugenZentrum Siegburg, MVZ ADTV Siegburg GmbH
| | - K. Rüther
- Sankt Gertrauden-Krankenhaus, Augenklinik, Berlin
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8
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Rüther K, Kellner S. Prinzipien der Diagnostik retinaler Erkrankungen. Klin Monbl Augenheilkd 2013; 230:943-59. [DOI: 10.1055/s-0032-1325093] [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: 10/26/2022]
Affiliation(s)
- K. Rüther
- Sankt Gertrauden-Krankenhaus, Augenklinik, Berlin
| | - S. Kellner
- Zentrum für seltene Netzhauterkrankungen, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH
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9
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Bergholz R, Rüther K, Tillack H, Joussen AM, Schroeter J. [Ophthalmologic screening history and vision-targeted health status of patients suffering from chloroquine maculopathy]. Ophthalmologe 2012; 110:654-62. [PMID: 22972175 DOI: 10.1007/s00347-012-2657-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maculopathy or retinopathy can develop as a side effect of chloroquine intake. Despite recommendations for ophthalmologic screening by the American Academy of Ophthalmology (AAO) severe toxic retinal damage still occurs. This study aims to clarify how maculopathy affects patient quality of life and whether it arises only due to non-compliance with screening guidelines. METHODS Patients suffering from chloroquine maculopathy were questioned about the ophthalmologic examinations that took place under therapy and completed a German version of the 25 item visual function questionnaire (VFQ-25). RESULTS A total of ten female patients were included in the analysis. Weighted visual acuity ranged from 0.09 to 0.8. Median composite score of the VFQ-25 was 33.9. All patients were periodically screened for ocular toxicity with a median trimestrial screening frequency but five patients did not receive all recommended methods of examination. There was suspicion of retinal damage in only one patient even without the patient reporting complaints. Median time span between onset of visual complaints and the cessation of the drug was 12 months. All patients with complaints reported a continuing deterioration of vision even after cessation. CONCLUSIONS Chloroquine maculopathy has a major impact on the vision-related health status of affected patients, emphasizing the need for its anticipation. Although patients were screened even more frequently than recommended by the AAO only half were examined properly and nine out of ten patients had a delay in diagnosis and in drug cessation. The continuing deterioration of vision even after termination of intake further contributes to the severity of the disease.
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Affiliation(s)
- R Bergholz
- Klinik für Augenheilkunde, Augenklinik Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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10
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Bertelmann E, Rüther K. [Two-wall decompression without resection of the medial wall. Effect on squint angle]. Ophthalmologe 2011; 108:1032-4, 1037-8. [PMID: 22037836 DOI: 10.1007/s00347-011-2405-y] [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: 10/15/2022]
Abstract
BACKGROUND Postoperative new onset diplopia can be a disadvantage for surgical orbital decompression in patients with exophthalmos in thyroid eye disease. The various modifications of decompression (number and combination of walls) differ in their influence on the postoperative squint angle. We report on postoperative diplopia in a modified 2 wall decompression strategy (lateral wall and floor). METHODS This study was a retrospective analysis of 36 consecutive 2-wall decompressions performed between 2006-2010 in 24 patients with 6 months of stable exophthalmos in thyroid eye disease after medical therapy and radiotherapy. The preoperative and postoperative squint angle in prism cover test (PCT), motility, induction of diplopia, reduction of exophthalmos, visual acuity and complications were evaluated. RESULTS In all 36 decompressions the postoperative squint angle was equal to or less than before surgery. In 8 eyes additional squint surgery was performed. The mean reduction in exopthalmos was 4.3 mm. CONCLUSIONS An adverse effect of decompression on the postoperative squint angle was not evident in this study. New induction of diplopia was not observed at all. One possible explanation is the preservation of the medial wall.
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Affiliation(s)
- E Bertelmann
- Augenklinik, Charité Campus Virchow-Klinikum, Berlin, Deutschland.
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11
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Krohne TU, Herrmann P, Kopitz J, Rüther K, Holz FG. [Juvenile neuronal ceroid lipofuscinosis. Ophthalmologic findings and differential diagnosis]. Ophthalmologe 2010; 107:606-11. [PMID: 20454901 DOI: 10.1007/s00347-009-2106-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/26/2022]
Abstract
Neuronal ceroid lipofuscinoses (NCL) are a heterogeneous group of neurodegenerative diseases with mostly autosomal recessive inheritance whose common feature is the intralysosomal accumulation of ceroid lipofuscin. With varying manifestation ages the diseases result in cognitive and motor deterioration, epilepsy, diffuse retinal degeneration, and eventually death. Juvenile ceroid lipofuscinosis (JNCL, CLN3, Batten disease) has the distinctive feature that the ophthalmologic symptoms precede the neurologic symptoms by several years, and thus the ophthalmologist plays a central role in early diagnosis. Important clinical signs of JNCL include bull's eye maculopathy, severely reduced Ganzfeld ERG already at initial presentation, and unusually rapid progression of the functional decline. If JNCL is clinically suspected the diagnosis can be made by means of a standard blood smear and confirmed by genetic detection of the mutation. Although causal therapeutic options are currently only in the developmental stage, early diagnosis by the ophthalmologist is of utmost importance to allow for medical and educational support of the affected child and for adequate counseling of the parents.
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Affiliation(s)
- T U Krohne
- Department of Cell Biology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
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12
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Affiliation(s)
- R Bergholz
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
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13
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Pluta J, Rüther K. Netzhautschädigung bei (Hydroxy-)Chloroquin-Einnahme: Evidenzlage als Basis für eine rationale augenärztliche Untersuchungsstrategie. Klin Monbl Augenheilkd 2009; 226:891-6. [PMID: 19916149 DOI: 10.1055/s-0028-1109881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Strathmann S, Burmester GR, Rüther K, Olze H. Cogan-I-Syndrom Eine seltene Differenzialdiagnose bei progredienter Innenohrschwerhörigkeit. Laryngorhinootologie 2009; 88:477-8. [DOI: 10.1055/s-0029-1216372] [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: 10/20/2022]
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15
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Sarpong A, Schottmann G, Rüther K, Stoltenburg G, Kohlschütter A, Hübner C, Schuelke M. Protracted course of juvenile ceroid lipofuscinosis associated with a novel CLN3 mutation (p.Y199X). Clin Genet 2009; 76:38-45. [PMID: 19489875 DOI: 10.1111/j.1399-0004.2009.01179.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The juvenile neuronal ceroid lipofuscinosis (JNCL, Batten disease, MIM 204200), is an autosomal recessive lysosomal storage disease, which is characterized by ubiquitous accumulation of the lipopigment material ceroid-lipofuscin. It manifests with loss of vision in childhood due to retinal degeneration, followed by seizures and parkinsonism leading to premature death at around 30 years. Eighty-five percent of JNCL patients carry a disease-causing 1.02 kb deletion in the CLN3 gene on chromosome 16. Here we report on a large consanguineous Lebanese family with five affected siblings. Electron microscopy of lymphocytes revealed the presence of fingerprint profiles suggesting JNCL. However, disease progression, especially of mental and motor function was slower as expected for 'classic' JNCL. We thus confirmed the diagnosis by genetic testing and found a new c.597C>A transversion in exon 8, homozygous in all affected family members and not present in 200 alleles of normal controls. The mutation generates a premature termination codon (p.Y199X) truncating the CLN3 protein by 55%. In heterozygous state mutant mRNA transcripts are expressed at the same levels as the wild-type ones, suggesting the absence of nonsense mediated messenger decay. We discuss a potential residual catalytic function of the truncated protein as a cause for the mild phenotype.
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Affiliation(s)
- A Sarpong
- Department of Neuropediatrics, University Medical School Berlin, Berlin, Germany
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16
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Rüther K, Hinz B, Zappe H, Schwarz E. Operative Behandlung des Strabismus sursoadductorius und der N. trochlearis-Parese. Klin Monbl Augenheilkd 2008. [DOI: 10.1055/s-0028-1110067] [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: 10/21/2022]
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17
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Rieger R, Ruokonen P, Velhagen KH, Rüther K, Pleyer U. Birdshot-Retinochoroidopathie: Verlauf, Komplikationen und Behandlungsoptionen. Klin Monbl Augenheilkd 2008. [DOI: 10.1055/s-0028-1110050] [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: 10/21/2022]
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18
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Seifert C, Valet M, von Kalckreuth A, Pfaffenrath V, Boecker H, Rüther K, Tölle T, Sprenger T. Neurometabolische Korrelate von Schmerz, Depression und Lebensqualität bei Patienten mit episodischem Cluster-Kopfschmerz. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086592] [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: 10/21/2022]
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19
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Rüther K, Leo-Kottler B. Diagnostik und Management erblicher Optikusatrophien und Netzhautdegenerationen. Klin Monbl Augenheilkd 2008; 225:R143-59; quiz R160-1. [DOI: 10.1055/s-2008-1038769] [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: 10/21/2022]
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20
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Abstract
OBJECTIVE The critical dose of chloroquine/hydroxychloroquine leading to a maculopathy or generalised retinopathy remains undetermined. In the literature, 100 g is considered the dose at which regular vision checks should be performed. Generally, chloroquine is said to be more toxic than hydroxychloroquine. A young patient presenting with toxic maculopathy after 57 g of hydroxychloroquine and a daily dosage of 2 mg/kg body weight prompted us to retrospectively look at our patients examined in this respect over about 1 year. METHODS The data of patients who were examined because of chloroquine/hydroxychloroquine intake or a respective maculopathy/retinopathy were retrospectively analysed. The time period was January 2005 until March 2006. Retinal damage was defined by fundus changes and alteration of the multifocal electroretinogram (ERG). RESULTS Twenty-one patients--18 women and three men--were examined. The mean age was 51 years (range 6-71). Five of the nine chloroquine-treated patients developed a maculopathy, and one of them developed an additional generalised retinopathy. Of the patients treated by hydroxychloroquine, three of 12 suffered from a maculopathy and one from an additional generalised retinopathy. The cumulative doses leading to retinal damage ranged from 170 g to 1650 g for chloroquine and from 57 g to 1190 g for hydroxychloroquine. The highest cumulative doses without leading to signs of retinopathy were 790 g for chloroquine and 1200 g for hydroxychloroquine. CONCLUSIONS There is a high variability of cumulative doses of chloroquine/hydroxychloroquine that lead to a toxic retinopathy. Therefore, early and regular ophthalmologic examinations are recommended. Electrophysiological testing should be performed once a year, corresponding to about 60 g of base with one tablet a day. For electrophysiology, the multifocal ERG has turned out to be the most important test in this regard. However, visual acuity and funduscopy should be performed more frequently.
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Affiliation(s)
- K Rüther
- Charitè-Augenklinik Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin.
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21
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Brunsmann F, von Gizycki R, Rybalko A, Hildebrandt AG, Rüther K. Patientenselbsthilfe und seltene Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1494-501. [DOI: 10.1007/s00103-007-0383-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bergholz R, Lehmann TN, Fritz G, Rüther K. Fourier transformed steady-state flash evoked potentials for continuous monitoring of visual pathway function. Doc Ophthalmol 2007; 116:217-29. [PMID: 17922154 DOI: 10.1007/s10633-007-9085-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 09/17/2007] [Indexed: 11/30/2022]
Affiliation(s)
- R Bergholz
- Charité-Augenklinik Campus Virchow-Klinikum, Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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23
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Abstract
BACKGROUND Neuronal ceroid lipofuscinoses (NCL) are storage diseases leading to severe somatic and mental deterioration with blindness and death. To date, there are no therapeutic options. Juvenile NCL (JNCL), also known as Batten's disease, is one of the most prevalent forms of NCL. MATERIALS AND METHODS A 6-year-old boy with the primary diagnosis of retinitis pigmentosa was examined. The parents reported a rapid deterioration of vision during the past months. In view of this history, additional, non-ophthalmological diagnostic procedures have been performed (peripheral blood smear, molecular genetics). RESULTS The eye examination showed a considerable reduction of visual acuity, a concentric visual field constriction, an extinguished electroretinogram and a bull's eye maculopathy. The peripheral blood smear revealed vacuolated lymphocytes. Molecular genetic investigation confirmed the diagnosis of juvenile NCL by detecting a homozygous (1-kb deletion of the CLN3-gene). CONCLUSIONS The ophthalmologist plays a key role for an early diagnosis of juvenile NCL. An early diagnosis is important for the affected families because only then they can handle this stroke of fate.
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Affiliation(s)
- K Rüther
- Charité-Augenklinik Campus Virchow-Klinikum, Berlin.
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24
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Abstract
Adult Refsum disease is one of the few forms of tapetoretinal degenerations accessible for therapy. The disease is characterized by an elevated plasma phytanic acid level and high concentrations of phytanic acid in a variety tissues. Beside tapetoretinal degeneration, additional symptoms are chronic polyneuropathy, cerebellar ataxia, sensorineural hearing loss, anosmia, ichthyosis, skeletal malformations, and cardiac abnormalities. A diet low in phytanic acid leads to an amelioration of polyneuropathy and ataxia and slows or even stops the other manifestations. This beneficial effect of dietary precautions requires the need to get hold of as much patients as possible but better all of them. The ophthalmologist plays a crucial role to this end because of the early manifestation of the tapetoretinal degeneration. A delay of 11 years between the appearance of first symptoms and the diagnosis of Refsum disease, as reported in the literature, is not acceptable.
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Affiliation(s)
- K Rüther
- Augenklinik Campus Virchow-Klinikum, Charité, Berlin.
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25
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Alexander T, Klotz O, Feist E, Rüther K, Burmester GR, Pleyer U. Successful treatment of acute visual loss in Muckle-Wells syndrome with interleukin 1 receptor antagonist. Ann Rheum Dis 2005; 64:1245-6. [PMID: 16014694 PMCID: PMC1755588 DOI: 10.1136/ard.2004.032060] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Rüther K, Bartsch U. Therapeutische Strategien bei erblichen Netzhauterkrankungen. Ophthalmologe 2005; 102:755-6. [PMID: 15999275 DOI: 10.1007/s00347-005-1243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- K Rüther
- Charité-Augenklinik Campus Virchow Klinikum, Humboldt-Universität, Berlin.
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27
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Bartsch U, Rüther K. Therapeutische Strategien bei erblichen Netzhauterkrankungen. Ophthalmologe 2005; 102:659-60. [PMID: 15883845 DOI: 10.1007/s00347-005-1184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- U Bartsch
- Transplantationslabor des Kopf- und Hautzentrums, Klinik und Poliklinik für Augenheilkunde des Universitätsklinikums Hamburg-Eppendorf, Hamburg.
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28
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Schmidt T, Rüther K, Schmitz B. Are vigabatrin-associated visual field constrictions asymptomatic? J Neurol 2004; 251:887-8. [PMID: 15258797 DOI: 10.1007/s00415-004-0443-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Revised: 02/11/2004] [Accepted: 02/16/2004] [Indexed: 11/28/2022]
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29
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Rüther K, Janssen BPM, Kellner U, Janssen JJM, Bohne M, Reimann J, Driessen CAGG. Klinische und molekulargenetische Befunde bei einer Patientin mit Fundus albipunctatus. Ophthalmologe 2004; 101:177-85. [PMID: 14991316 DOI: 10.1007/s00347-003-0895-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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
METHODS The 38-year-old index patient was examined by visual acuity testing, perimetry, dark adaptometry, funduscopy, electroretinogram (ERG), and multifocal ERG. She was screened for mutations in exons 2-5 and exon/intron boundaries of the 11- cis retinol dehydrogenase gene by direct sequencing. RESULTS Visual acuity was 1.0, but perimetry revealed paracentral scotomas associated with reading problems. The optic discs were normal. After 45 min of darkness there was nearly no increase of light sensitivity. After 30 min of dark adaptation, the scotopic ERG showed reduced amplitudes, but after 60 min a nearly normal level was reached. The 30-Hz flicker response of the cone ERG showed borderline implicit times, but no reduction of amplitudes. However, multifocal ERG clearly disclosed a paracentral amplitude reduction as the reason for the visual field defects. The fundus was typical for fundus albipunctatus. The patient is a compound heterozygote carrying a Ile33Asn and a Arg157Trp mutation. CONCLUSIONS The paracentral visual field defects were due to cone dysfunction. So far the patient exhibits no cone dystrophy.
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Affiliation(s)
- K Rüther
- Charité, Universitätsmedizin Berlin, Augenklinik Campus Virchow Klinikum.
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30
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Rüther K, Breidenbach K, Schwartz R, Hassenstein A, Richard G. [Testing central retinal function with multifocal electroretinography before and after photodynamic therapy]. Ophthalmologe 2003; 100:459-64. [PMID: 12820013 DOI: 10.1007/s00347-002-0757-z] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is applied for certain forms of choroidal neovascular membrane (CNV). The aim of this study was to investigate the effect of PDT on central retinal function as assessed by multifocal electroretinography (ERG). METHODS 24 patients (25 eyes) with CNV (>50% classic 12 eyes) or occult (9 eyes) in age related macular degeneration (AMD) and CNV with pathological myopia (4 eyes) were treated by PDT using Verteporfin((R)). Before and a median of 6 weeks after therapy, central retinal function was examined using multifocal ERG (RetiScan, 61 hexagons, first-order response). RESULTS In the area of treatment,we found a tendency of the amplitude of the first positive deflection (P1) to decrease and of the implicit time to increase, but both effects were not statistically significant. These alterations were more pronounced in eyes with occult CNV and in myopia-related CNV. Amplitude reduction and implicit time prolongation could also be found in the areas represented by the multifocal ERG but not treated. There was no significant correlation between change in visual acuity after PDT and amplitude of the multifocal ERG. CONCLUSION The effects of PDT on retinal function seem to be moderate as assessed by multifocal ERG. An inherent problem of this investigation was the recruitment of nontreated patients as controls. Future goals are investigations of patients with repeated PDT and of long-term alterations in multifocal ERG after PDT.
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Affiliation(s)
- K Rüther
- Augenklinik des Universitätsklinikums Eppendorf, Hamburg.
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Schmidt T, Rüther K, Jokiel B, Pfeiffer S, Tiel-Wilck K, Schmitz B. Is visual field constriction in epilepsy patients treated with vigabatrin reversible? J Neurol 2002; 249:1066-71. [PMID: 12195456 DOI: 10.1007/s00415-002-0789-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 10/26/2022]
Abstract
OBJECTIVE To evaluate the reversibility of vigabatrin associated visual field constriction. BACKGROUND Visual field constriction (VFC) occurs in approximately 40 % of epilepsy patients under treatment with vigabatrin (VGB). There is still controversy about whether VGB-associated VFC is reversible. From a cross-sectional study there is evidence that VFC does not reverse three to six months after stopping VGB treatment. So far, there are no long term studies on this subject. METHODS We performed a follow-up study on 15 epilepsy patients (eight women, seven men, median age 45 (21-58) years) with VGB-associated VFC but otherwise normal ophthalmological examination. Kinetic and static perimetry was performed one and two years after VFC was diagnosed (baseline examination). Visual field size at first and at second year-follow-up was compared with the baseline examination. Because discontinuation of VGB-treatment was dependant on clinical needs, patients either stopped VGB treatment before or after VFC was diagnosed. In a small group of patients VGB treatment was continued despite of VFC. RESULTS There was no statistically significant difference in visual field size comparing baseline values with first year and second year follow-up examinations either in patients who stopped VGB treatment (n = 11) or in patients who continued VGB treatment on a reduced dosage (n = 4). CONCLUSION Although our data are based on a relatively small group of patients there is evidence that VFC resulting from VGB treatment is not reversible in epilepsy patients after stopping the drug.
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Affiliation(s)
- T Schmidt
- Charité, Campus-Virchow-Klinikum, Department of Neurology, Augustenburger Platz 1, 13353 Berlin, Germany.
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Schmitz B, Schmidt T, Jokiel B, Pfeiffer S, Tiel-Wilck K, Rüther K. Visual field constriction in epilepsy patients treated with vigabatrin and other antiepileptic drugs: a prospective study. J Neurol 2002; 249:469-75. [PMID: 11967655 DOI: 10.1007/s004150200041] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [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: 11/26/2022]
Abstract
BACKGROUND Visual field constriction (VFC) has been described in about 30 % to 50 % of patients treated with the antiepileptic drug (AED) Vigabatrin (GVG). The exact incidence of VFC related to GVG exposure is unknown. Risk factors other than medication have not been identified as yet, and it is unclear whether the occurrence of VFC is restricted to the use of GVG. METHODS In a longitudinal study, we investigated 60 epilepsy patients who received GVG and other AEDs. Patients underwent full ophthalmological examination including perimetry. RESULTS 16 of 60 patients exposed to different AEDs developed VFC, which was judged as clinically relevant by an experienced neuroophthalmologist. VFC was observed significantly more often in patients treated with GVG as add-on- or monotherapy as compared with patients who had never been exposed to GVG (13/29 versus 3/31). Within the subgroup of 23 patients who received GVG as add-on therapy, those who developed VFC had been exposed to GVG for significantly longer than patients without VFC. The only non-treatment related feature associated with VFC was older age. Type and severity of epilepsy or type and number of concomitant AED were not related to the occurrence of VFC. CONCLUSIONS The findings of an overrepresentation of VFC in patients receiving GVG and of a correlation between duration of GVG treatment and occurrence of VFC support the causal role of GVG treatment in the development of VFC. Old age is a possible risk factor for the development of VFC associated with GVG in epilepsy patients.
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Affiliation(s)
- B Schmitz
- Charité, Campus-Virchow-Klinikum, Department of Neurology, Augustenburger Platz 1, 13353 Berlin, Germany.
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Lechner S, Rüther K, Hartmann C. [Bilateral optic atrophy and slow worsening of vision]. Ophthalmologe 2001; 98:988-9. [PMID: 11699325 DOI: 10.1007/s003470170051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Lechner
- Augenklinik der Charité Campus Virchow-Klinikum, Berlin
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Affiliation(s)
- E Zrenner
- Universitäts-Augenklinik Tübingen, Abt. Pathophysiologie des Sehens und Neuroophthalmologie Schleichstr. 12-16, 72076 Tübingen
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Frederick JM, Krasnoperova NV, Hoffmann K, Church-Kopish J, Rüther K, Howes K, Lem J, Baehr W. Mutant rhodopsin transgene expression on a null background. Invest Ophthalmol Vis Sci 2001; 42:826-33. [PMID: 11222546] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE To study mechanisms leading to photoreceptor degeneration in mouse models for autosomal dominant retinitis pigmentosa (adRP) based on the rhodopsin P23H mutation. METHODS Mice of a transgenic line expressing a rhodopsin triple mutant, V20G, P23H, and P27L (GHL), were mated with rhodopsin (rho) knockout mice. Littermates of various ages and genotypes (GHL+rho+/+, GHL+rho+/-, and GHL+rho-/-) were examined for outer nuclear layer thickness and outer segment formation (histology), fate of mutant rhodopsin (immunocytochemistry), and photoreceptor function (electroretinogram; ERG). RESULTS Mice expressing GHL-rhodopsin in the absence of wild-type rhodopsin had severe retinopathy, which was nearly complete by postnatal day (P)30. GHL-rhodopsin formed homodimers nearly exclusively on sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels, whereas wild-type rhodopsin predominantly formed monomers. Expression level of mutant rhodopsin in predegenerate (P10) GHL+rho-/- retinas was low, approximately 10% to 25% of normal levels. No elaboration of disc membrane or outer segment formation was observed at any time point examined. The mutant rhodopsin was found mostly in perinuclear locales (endoplasmic reticulum; ER) as evidenced by colocalization using the antibodies Rho1D4 and calnexin-NT. CONCLUSIONS GHL-rhodopsin dimerizes, localizes to the ER, and fails to transport and support outer segment formation. Additionally, the mutant protein does not support a scotopic ERG a-wave and accelerates photoreceptor degeneration over that occurring with the rhodopsin knockout alone. These findings indicate a cytotoxic effect of the mutant protein, probably elicited by an unfolded protein response.
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Affiliation(s)
- J M Frederick
- John A. Moran Eye Center, University of Utah Health Science Center, 50 North Medical Drive, Salt Lake City, UT 04132, USA.
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van den Hurk JA, Schwartz M, van Bokhoven H, van de Pol TJ, Bogerd L, Pinckers AJ, Bleeker-Wagemakers EM, Pawlowitzki IH, Rüther K, Ropers HH, Cremers FP. Molecular basis of choroideremia (CHM): mutations involving the Rab escort protein-1 (REP-1) gene. Hum Mutat 2000; 9:110-7. [PMID: 9067750 DOI: 10.1002/(sici)1098-1004(1997)9:2<110::aid-humu2>3.0.co;2-d] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.5] [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: 02/03/2023]
Abstract
Choroideremia (CHM) is an X-linked recessive eye disease that results from mutations involving the Rab escort protein-1 (REP-1) gene. In 18 patients deletions of different sizes have been found. Two females suffering from CHM were reported to have translocations that disrupt the REP-1 gene. In 22 patients, small mutations have been identified. Interestingly, these are all nonsense, frameshift or splice-site mutations; with one possible exception, missense mutations have not been found. This comprises all the known mutations in the disease.
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Affiliation(s)
- J A van den Hurk
- Department of Human Genetics, University Hospital Nijmegen, The Netherlands
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Buske A, Gewies A, Lehmann R, Rüther K, Algermissen B, Nürnberg P, Tinschert S. Recurrent NF1 gene mutation in a patient with oligosymptomatic neurofibromatosis type 1 (NF1). Am J Med Genet 1999; 86:328-30. [PMID: 10494088 DOI: 10.1002/(sici)1096-8628(19991008)86:4<328::aid-ajmg6>3.0.co;2-o] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a 21-year-old male with symptomatic optic glioma who does not fulfill the diagnosis of neurofibromatosis 1 (NF1) according to standard NIH criteria. Analysis of the NF1 gene revealed a recurrent mutation in exon 37 (C6792A or Y2264X). This nonsense mutation causes skipping of exon 37 during the splicing process and is predicted to result in a protein shortened by 34 amino acid residues. The mutation was detected in all tissues examined (blood lymphocytes, oral mucosa, and dermal fibroblasts). The same mutation was previously found in 3 patients with clinically confirmed NF1. To our knowledge, this is the first report of an adult patient carrying a putative (non-mosaic) NF1 gene mutation in multiple tissues but not fulfilling the NIH criteria for the clinical diagnosis of NF1.
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Affiliation(s)
- A Buske
- Institut für Medizinische Genetik, Universitätsklinikum Charité, Humboldt-Universität zu Berlin, Germany
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Anders N, Heuermann T, Rüther K, Hartmann C. Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study. Ophthalmology 1999; 106:1863-8. [PMID: 10519578 DOI: 10.1016/s0161-6420(99)90394-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. DESIGN A prospective, randomized, controlled study. PARTICIPANTS A total of 200 consecutive cataract patients (200 eyes) participated. INTERVENTION Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. MAIN OUTCOME MEASURES Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. RESULTS After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). CONCLUSION Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.
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Affiliation(s)
- N Anders
- Department of Ophthalmology, Charté, Faculty of Humboldt University, Berlin, Germany.
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Heine S, Rüther K, Isensee J, Zrenner E. [Clinical significance of objective vision assessment using visually evoked cortical potentials induced by rapid pattern sequences of different spatial frequency]. Klin Monbl Augenheilkd 1999; 215:175-81. [PMID: 10528283 DOI: 10.1055/s-2008-1034695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 10/21/2022]
Abstract
BACKGROUND In patients where reliable subjective assessment of visual acuity is impossible, further diagnostics should be enhanced by an objective method. PATIENTS AND METHODS A group of 34 patients was examined by objective assessment of visual acuity using visual evoked potentials (VEP) as described by Hajek and Zrenner in 1988. The presentation of five checkerboards with different spatial frequency in repetitive sequences on a TV-monitor elicits a series of transient visual evoked potentials. Shape and amplitude of each wavelet depends on check size and directly reflect a spatial tuning function with a low- and high-frequency cut-off. This amplitude is described by a polynomial fit (2nd order). The function's intersection with the x-axis at higher spatial frequencies leads to an estimation of the visual acuity. RESULT This result is compared to the subjectively determined visual acuity. In the majority of the presented cases the suspected malingering was confirmed. CONCLUSION Patients with suspected malingering represent the primary indication of the described method.
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Affiliation(s)
- S Heine
- Universitäts-Augenklinik Tübingen, Abteilung für Pathophysiologie des Sehens und Neuroophthalmologie
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Kretschmann U, Stilling R, Rüther K, Zrenner E. Familial macular cone dystrophy: diagnostic value of multifocal ERG and two-color threshold perimetry. Graefes Arch Clin Exp Ophthalmol 1999; 237:429-32. [PMID: 10333111 DOI: 10.1007/s004170050255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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] Open
Abstract
BACKGROUND It is difficult to detect receptor dysfunction in patients with marked bilateral visual loss but only mild morphological alterations of the fundus. METHODS Two patients, father and son, with visual acuity loss to 20/100 were examined. Using the multifocal ERG, 61 local cone ERGs from each eye were derived from the central visual field. The dark-adapted two-color threshold perimetry using stimuli of 500 nm and 656 nm for rod and cone function was investigated along the horizontal meridian of the visual field. RESULTS In the multifocal ERG of both patients a macular response was absent. From eccentricity at and anterior to 5 degrees, good multifocal cone activity was recorded. Cone thresholds were markedly diminished in the macula. The rod thresholds were borderline in the father and normal in the son. CONCLUSIONS Multifocal ERG is a novel technique, very well suited to reveal the topography of cone function. Using two-color threshold perimetry affords an opportunity to differentiate between rod and cone functional defects. Both together helped to establish the diagnosis of macular cone dystrophy in the present family.
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Affiliation(s)
- U Kretschmann
- University Eye Hospital, Department for Pathophysiology of Vision and Neuro-Ophthalmology, Tübingen, Germany
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Strom TM, Nyakatura G, Apfelstedt-Sylla E, Hellebrand H, Lorenz B, Weber BH, Wutz K, Gutwillinger N, Rüther K, Drescher B, Sauer C, Zrenner E, Meitinger T, Rosenthal A, Meindl A. An L-type calcium-channel gene mutated in incomplete X-linked congenital stationary night blindness. Nat Genet 1998; 19:260-3. [PMID: 9662399 DOI: 10.1038/940] [Citation(s) in RCA: 306] [Impact Index Per Article: 11.8] [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: 02/08/2023]
Abstract
The locus for the incomplete form of X-linked congenital stationary night blindness (CSNB2) maps to a 1.1-Mb region in Xp11.23 between markers DXS722 and DXS255. We identified a retina-specific calcium channel alpha1-subunit gene (CACNA1F) in this region, consisting of 48 exons encoding 1966 amino acids and showing high homology to L-type calcium channel alpha1-subunits. Mutation analysis in 13 families with CSNB2 revealed nine different mutations in 10 families, including three nonsense and one frameshift mutation. These data indicate that aberrations in a voltage-gated calcium channel, presumably causing a decrease in neurotransmitter release from photoreceptor presynaptic terminals, are a frequent cause of CSNB2.
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Affiliation(s)
- T M Strom
- Abteilung Medizinische Genetik der Ludwig-Maximilians-Universität, München, Germany
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Rüther K, Ehlich P, Philipp A, Eckstein A, Zrenner E. Prognostic value of the pattern electroretinogram in cases of tumors affecting the optic pathway. Graefes Arch Clin Exp Ophthalmol 1998; 236:259-63. [PMID: 9561357 DOI: 10.1007/s004170050074] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 02/07/2023] Open
Abstract
BACKGROUND Tumors compressing the optic pathway may lead to irreversible loss of vision which may be detected by the pattern electroretinogram (PERG) because of its relation to ganglion cell function. METHODS Eyes of 19 patients were tested shortly before and 5-10 days after tumor surgery. Visual acuity, the 30-deg visual field and the transient and steady-state pattern reversal ERG were measured. RESULTS Using patterns of 1.5 x 1.2 deg there was a good correlation between the change of pre- and post-surgical visual performance and most of the pattern ERG amplitudes. For all variables tested--P50, N95- and steady-state amplitude--there was a critical value beyond which the visual outcome could be bad or favorable, whereas patients showing higher amplitudes always remained stable or improved after surgery. CONCLUSION The positive correlation between pattern ERG amplitudes and the post-surgical outcome in the case of tumors affecting the optic pathway may be helpful in predicting the outcome for these patients.
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Affiliation(s)
- K Rüther
- Klinik und Poliklinik für Augenheilkunde, Charité und Virchow Klinikum, Humboldt-Universität, Berlin, Germany.
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Abstract
PURPOSE To investigate the diagnostic potential of multifocal electroretinography for the evaluation of retinal affection by retinitis pigmentosa in a clinical setting. METHODS For this prospective study, multifocal electroretinograms were obtained from 38 patients who matched the inclusion criteria of either a detectable photopic Ganzfeld response or visual fields of 10 degrees or more, and from 30 normal volunteers. Recordings were performed with the visual evoked response imaging system, using a resolution of 61 hexagonal elements within a 30-degree visual field. The results of the left eye of each patient and control subject were used for statistical evaluation by the Mann-Whitney U test. RESULTS The 38 eligible patients included those with Usher syndrome types I and II (one patient and six patients, respectively) and those with autosomal-recessive (18), X-recessive (two), and autosomal-dominant (11) forms of retinitis pigmentosa. In 27 (71%) of these 38 patients, at least a central response of the multifocal electroretinogram was detectable. Loss of multifocal electroretinogram response density in patients with retinitis pigmentosa was significant (P < .00001) in all five eccentricity groups (concentric rings), with a progression from center to periphery. Implicit time was significantly elevated in the third eccentricity group (P < .0038) and increased further toward the periphery (P < .00001). The results did not differ notably between retinitis pigmentosa subgroups. CONCLUSIONS Because the multifocal electroretinogram differentiates between affected and nonaffected retinal areas, eccentricity-dependent changes in both amplitude and implicit time were found. It can therefore add to the diagnostic information of many patients with retinitis pigmentosa.
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Affiliation(s)
- M Seeliger
- Department of Pathophysiology of Vision and Neuroophthalmology, University Eye Hospital, Tübingen, Germany
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Kremmer S, Eckstein A, Gal A, Apfelstedt-Sylla E, Wedemann H, Rüther K, Zrenner E. Ocular findings in patients with autosomal dominant retinitis pigmentosa and Cys110Phe, Arg135Gly, and Gln344stop mutations of rhodopsin. Graefes Arch Clin Exp Ophthalmol 1997; 235:575-83. [PMID: 9342608 DOI: 10.1007/bf00947087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/05/2023] Open
Abstract
This report describes ocular findings obtained in four patients from three families with autosomal dominant retinitis pigmentosa (adRP) due to missense mutations in the rhodopsin gene. Phenotypes were characterized by standard ophthalmologic examinations, visual fields, electroretinography (ERG), dark adaptation, and two-color dark-adapted threshold perimetry. Two patients aged 38 and 45 years, respectively, from a family with the Cys110Phe mutation showed mild fundus changes without bone spicules as well as small arcuate scotomas in the inferior quadrants of their visual fields but displayed severe functional loss of rods and cones in the ERG. Two-color dark-adapted threshold perimetry revealed a regional type of degeneration. A 48-year-old patient with an Arg135Gly mutation had typical RP with concentrically narrowed visual fields and nondetectable ERG responses. Central visual functions were well preserved for a long time. Two-color dark-adapted threshold perimetry indicated a diffuse type of retinal degeneration. An 18-year-old patient with a Gln344stop mutation has been followed for 13 years. His ERG was clearly reduced at the age of 5 years; since that time, disease progression has been very slow. Currently, there are relatively mild alterations in visual acuity, rod sensitivity, and visual fields. Our findings confirm that there is a large phenotypic variety among patients with adRP and different rhodopsin mutations.
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Affiliation(s)
- S Kremmer
- University Eye Hospital, Essen, Germany
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Seeliger M, Rüther K, Apfelstedt-Sylla E, Schlote W, Wohlrab M, Zrenner E. [Juvenile neuronal ceroid lipofuscinosis (Batten-Mayou) disease. Ophthalmologic diagnosis and findings]. Ophthalmologe 1997; 94:557-62. [PMID: 9376693 DOI: 10.1007/s003470050158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
BACKGROUND Juvenile neuronal ceroid lipofuscinosis (JNCL) is important to the ophthalmologist, since eye symptoms are usually the first evidence of the disease and permit establishment of an early diagnosis. The disorder usually begins with a dramatic loss of vision between age 4 and 10 due to bulls-eye maculopathy followed by rapid degeneration of the retina and pigment epithelium. Blindness results within 1 to 3 years after onset of symptoms. The further course of the disease is mainly determined by degradation of the CNS with motor and intellectual deficits. Most patients die before the age of 30. METHODS A case of two sisters is presented to demonstrate eye findings and diagnostic procedures, emphasizing electrophysiologic and morphologic tests (peripheral blood smear, histology). RESULTS Both sisters reported the first decrease in vision at the ages of 8 and 6 respectively; visual acuity at time of visit was light projection (20/400). Both had tapetoretinal degeneration with optic disc atrophy, narrowed vessels, pigment epitheliopathy and bullseye maculopathy. The ERG was almost extinguished in the older sister and greatly reduced in the younger one (scotopic more than photopic). Histologically, vacuolated lymphocytes were found in the peripheral blood smear, as were intracellular inclusions of the fingerprint and curvilinear type in the conjunctival biopsy. CONCLUSION During the course of JNCL, it is very common for the vision to be affected at the age of 6-7. The correct diagnosis, however, is often made years later when massive neurologic symptoms such as seizures appear. When there is sudden loss of vision in a child of this age combined with a tapetoretinal degeneration, a biopsy or at least a peripheral blood smear should be performed.
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Affiliation(s)
- M Seeliger
- Abteilung II, Universitäts-Augenklinik, Tübingen
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van den Hurk JA, Hendriks W, van de Pol DJ, Oerlemans F, Jaissle G, Rüther K, Kohler K, Hartmann J, Zrenner E, van Bokhoven H, Wieringa B, Ropers HH, Cremers FP. Mouse choroideremia gene mutation causes photoreceptor cell degeneration and is not transmitted through the female germline. Hum Mol Genet 1997; 6:851-8. [PMID: 9175730 DOI: 10.1093/hmg/6.6.851] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [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: 02/04/2023] Open
Abstract
Choroideremia (CHM) is an X-linked progressive eye disorder which results from defects in the human Rab escort protein-1 (REP-1) gene. A gene targeting approach was used to disrupt the mouse chm/rep-1 gene. Chimeric males transmitted the mutated gene to their carrier daughters but, surprisingly, these heterozygous females had neither affected male nor carrier female offspring. The targeted rep-1 allele was detectable, however, in male as well as female blastocyst stage embryos isolated from a heterozygous mother. Thus, disruption of the rep-1 gene gives rise to lethality in male embryos; in female embryos it is only lethal if the mutation is of maternal origin. This observation can be explained by preferential inactivation of the paternal X chromosome in murine extraembryonic membranes suggesting that expression of the rep-1 gene is essential in these tissues. In both heterozygous females and chimeras the rep-1 mutation causes photoreceptor cell degeneration. Consequently, conditional rescue of the embryonic lethal phenotype of the rep-1 mutation may provide a faithful mouse model for choroideremia.
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Affiliation(s)
- J A van den Hurk
- Department of Human Genetics, University Hospital Nijmegen, The Netherlands.
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van den Hurk JA, Schwartz M, van Bokhoven H, van de Pol TJ, Bogerd L, Pinckers AJ, Bleeker-Wagemakers EM, Pawlowitzki IH, Rüther K, Ropers HH, Cremers FP. Molecular basis of choroideremia (CHM): mutations involving the Rab escort protein-1 (REP-1) gene. Hum Mutat 1997. [PMID: 9067750 DOI: 10.1002/(sici)1098-1004(1997)9:2%3c110::aid-humu2%3e3.0.co;2-d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 05/07/2023]
Abstract
Choroideremia (CHM) is an X-linked recessive eye disease that results from mutations involving the Rab escort protein-1 (REP-1) gene. In 18 patients deletions of different sizes have been found. Two females suffering from CHM were reported to have translocations that disrupt the REP-1 gene. In 22 patients, small mutations have been identified. Interestingly, these are all nonsense, frameshift or splice-site mutations; with one possible exception, missense mutations have not been found. This comprises all the known mutations in the disease.
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Affiliation(s)
- J A van den Hurk
- Department of Human Genetics, University Hospital Nijmegen, The Netherlands
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van den Hurk J, Schwartz M, van Bokhoven H, van de Pol T, Bogerd L, Pinckers A, Bleeker‐Wagemakers E, Pawlowitzki I, Rüther K, Ropers H, Cremers F. Molecular basis of choroideremia (CHM): Mutations involving the rab escort protein‐1 (REP1) gene. Hum Mutat 1997. [DOI: 10.1002/(sici)1098-1004(1997)9:2<110::aid-humu2>3.3.co;2-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kretschmann U, Rüther K, Usui T, Zrenner E. ERG campimetry using a multi-input stimulation technique for mapping of retinal function in the central visual field. Ophthalmic Res 1996; 28:303-11. [PMID: 8979279 DOI: 10.1159/000267919] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/03/2023]
Abstract
The m-sequence stimulation technique that has previously been described allows simultaneous recording of many local electroretinograms (ERGs). For topographical mapping of cone function in the central retina ERG traces from 61 retinal areas were recorded during a 4-min period in 20 normal volunteers and 4 patients with age-related macular degeneration, Stargardt's disease, choroidal atrophy, and polymyalgia associated with visual field loss. The local photopic luminance response was analyzed in each of the 61 areas. In the 2 patients with macular disease central defects were detected, in the remaining patients local defects were found outside the macular region. The method of multifocal ERG recordings provides the possibility of objective testing of visual fields when the outer retinal layers are affected.
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Affiliation(s)
- U Kretschmann
- Department of Pathophysiology of Vision and Neuro-Ophthalmology, University Eye Hospital, Tübingen, Germany
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Rüther K, Banhart F, Kremmer S, Apfelstedt-Sylla E, Zrenner E. [Social ophthalmologic aspects of retinitis pigmentosa]. Ophthalmologe 1995; 92:704-7. [PMID: 8751001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Inherited retinal degenerations cause severe visual handicaps or blindness later in life. In typical rod cone dystrophy (retinitis pigmentosa) there is relevant visual loss in the third decade with implications for the patients' professional life, their mobility and their private life. For this reason, the disease is relevant for the individual patient as well as for society in general. We investigated social issues in 233 retinitis pigmentosa patients: 9.9% are not able to read any more; 40.9% have never had a driver's license and 27.8% quit driving because of a visual handicap. The mean reduction in the capacity for work is 86%; 12.7% are unable to work and therefore receive public financial support; 22.6% are unable to work in their profession; 20.9% are receiving public support because of legal blindness. Against this background it seems to be important that ophthalmologists inform their patients thoroughly about the implications of the disease for their professional and private lives. Doing this, he/she should ask for support from social service professionals.
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Affiliation(s)
- K Rüther
- Abteilung II, Universitäts-Augenklinik Tübingen
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