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Mohabati D, Boon CJF, Hoyng CB, Purtskhvanidze K, Roider J, van Dijk EHC. Fundus autofluorescence abnormalities can predict fluorescein angiography abnormalities in patients with chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:2489-2495. [PMID: 37036511 PMCID: PMC10432322 DOI: 10.1007/s00417-023-06042-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 04/11/2023] Open
Abstract
PURPOSE This study is to assess the possible correlation between findings on fundus autofluorescence (FAF) and fluorescein angiography (FA) in patients with chronic central serous chorioretinopathy (cCSC). METHODS This multicentre retrospective cohort study included 71 cCSC patients (92 eyes) with at least 6 months of follow-up, who had a FAF-FA imaging discrepancy larger than 0.5 optic disc diameters in size in the corresponding areas of hyperfluorescent abnormalities. A comparison was performed between progression in size of areas of hyperautofluorescent retinal pigment epithelium (RPE) abnormalities on FAF (HF-FAF) and the hyperfluorescent areas on FA (HF-FA) at first visit and last visit. The possible correlations were estimated between FAF-FA discrepancy and disease characteristics. RESULTS The median area of HF-FAF at first visit was 7.48 mm2 (1.41-27.9). The median area of HF-FA at first visit and last visit was 2.40 mm2 (0.02-17.27) and 5.22 mm2 (0.53-25.62), respectively. FAF-FA discrepancy was associated with follow-up duration and the area of HF-FAF at first visit. A mathematical algorithm for grading FAF-FA discrepancy in time was suggested, which predicted the enlargement of hyperfluorescent RPE abnormalities on FA in 82.6% of cases. CONCLUSION There is a statistically significant relationship between the areas of HF-FAF and HF-FA in cCSC patients with FAF-FA imaging discrepancy at first presentation. Long-term changes in RPE alterations in cCSC on FA can be predicted based on baseline HF-FAF and follow-up duration.
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Affiliation(s)
- Danial Mohabati
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Johann Roider
- Department of Ophthalmology, University Medical Center, University of Kiel, Kiel, Germany
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
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Fleger JE, Roider JB, Purtskhvanidze K. [Asymptomatic optic disc edema as ophthalmological incidental finding]. Ophthalmologie 2022; 119:855-859. [PMID: 34426849 DOI: 10.1007/s00347-021-01479-1] [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] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Jan-Erik Fleger
- Klinik für Ophthalmologie, UKSH Campus Kiel, Arnold-Heller-Str. 3, Haus B2, 24105, Kiel, Deutschland.
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von der Burchard C, Sudkamp H, Tode J, Ehlken C, Purtskhvanidze K, Moltmann M, Heimes B, Koch P, Münst M, Vom Endt M, Kepp T, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) for neovascular age-related macular degeneration: a cross-sectional diagnostic accuracy study. BMJ Open 2022; 12:e055082. [PMID: 35760534 PMCID: PMC9237881 DOI: 10.1136/bmjopen-2021-055082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) is a novel OCT technology that was specifically designed for home monitoring of neovascular age-related macular degeneration (AMD). First clinical findings have been reported before. This trial investigates an improved prototype for patients with AMD and focusses on device operability and diagnostic accuracy compared with established spectral-domain OCT (SD-OCT). DESIGN Prospective single-arm diagnostic accuracy study. SETTING Tertiary care centre (University Eye Clinic). PARTICIPANTS 46 patients with age-related macular degeneration. INTERVENTIONS Patients received short training in device handling and then performed multiple self-scans with the SELFF-OCT according to a predefined protocol. Additionally, all eyes were examined with standard SD-OCT, performed by medical personnel. All images were graded by at least 2 masked investigators in a reading centre. PRIMARY OUTCOME MEASURE Rate of successful self-measurements. SECONDARY OUTCOME MEASURES Sensitivity and specificity of SELFF-OCT versus SD-OCT for different biomarkers and necessity for antivascular endothelial growth factor (anti-VEGF) treatment. RESULTS In 86% of all examined eyes, OCT self-acquisition resulted in interpretable retinal OCT volume scans. In these patients, the sensitivity for detection of anti-VEGF treatment necessity was 0.94 (95% CI 0.79 to 0.99) and specificity 0.95 (95% CI 0.82 to 0.99). CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination in most patients, and it could become a valuable tool for retinal home monitoring in the future. Improvements are in progress to reduce device size and to improve handling, image quality and success rates. TRIAL REGISTRATION NUMBER DRKS00013755, CIV-17-12-022384.
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Affiliation(s)
| | | | - Jan Tode
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Cristoph Ehlken
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | - Britta Heimes
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Peter Koch
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | | | - Timo Kepp
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lubeck, Germany
| | - Johann Roider
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Schaub F, Schiller P, Hoerster R, Kraus D, Holz FG, Guthoff R, Agostini H, Spitzer MS, Wiedemann P, Lommatzsch A, Boden KT, Dimopoulos S, Bemme S, Tamm S, Maier M, Roider J, Enders P, Altay L, Fauser S, Kirchhof B, Agostini H, Bartz-Schmidt KU, Bemme S, Boden K, Callizo J, Dahlke C, Eberwein P, Ehlken C, Feltgen N, Gamulescu A, Gelisken F, Gutfleisch M, Guthoff R, Haus A, Helbig H, Hermann M, Holz FG, Januschowski K, Jochmann C, Kirchhof B, Krohne T, Lagrèze W, Lange C, Lohmann C, Lommatzsch A, Macek MA, Maier M, Märker D, Mayer C, Meier P, Müther P, Prahs P, Purtskhvanidze K, Rehak M, Schaub F, Schick T, Schmitz-Valckenberg S, Schultheiß M, Skevas C, Spitzer MS, Stahl A, Szurman P, Unterlauft JD. Intravitreal 5-Fluorouracil and Heparin to Prevent Proliferative Vitreoretinopathy: results from a randomized clinical trial. Ophthalmology 2022; 129:1129-1141. [DOI: 10.1016/j.ophtha.2022.05.024] [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] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022] Open
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Stahl A, Bründer M, Lagrèze WA, Molnár FE, Barth T, Eter N, Guthoff R, Krohne TU, Pfeil JM, Bühler A, Daniel M, Felzmann S, Gross N, Horn S, Müller C, Reichl S, Reiff C, Richter O, Stech M, Hentschel R, Stavropoulou D, Tautz J, Bartsch K, Braunstein J, Brinken R, Brinkmann CK, Czauderna J, Dralle W, Gliem M, Goebel A, Heymer P, Hofmann M, Holz FG, Kupitz D, Müller P, Petrak M, Schmitz EJ, Schmitz‐Valckenberg S, Schröder M, Steinberg J, Supé J, Kant E, Kunze D, Müller A, Adorf A, Alex A, Alten F, Clemens CR, Falkenau S, Friedhoff C, Loos DS, Mihailovic N, Termühlen J, Uhlig C, Hörnig‐Franz I, Rieger‐Fackeldey E, Tekaat M, Werner C, Altmann M, Blecha C, Brandl S, Helbig H, Hufendiek K, Jägle H, Konrad J, Kopetzky E, Lehmann F, Oberacher‐Velten I, Keller‐Wackerbauer A, Kittel J, Segerer H, Ackermann P, Benga J, Guthoff T, Kleinert E, Mayatepek E, Schrader S, Völker M, Höhn T, Lohmeier K, Sabir H, Mayatepek E, Brevis F, Mönig T, Schwarz S, Ehmer A, Meltendorf S, Schuart C, Avenarius S, Böttger R, Apel C, Bergmann A, Herrmann K, Ockert‐Schön F, Wegener S, Ehrt O, Nentwich M, Pressler A, Rudolph G, Genzel‐Boroviczeny O, Schmidt S, Münch H, Thilmany C, Aisenbrey S, Bruckmann A, Dimopoulos S, Hagemann U, Inhoffen W, Partsch M, Schrader M, Süsskind D, Völker M, Bialkowski A, Müller‐Hansen I, Gerberth A, Hasselbach HC, Lindemann S, Purtskhvanidze K, Raffel Y, Roider J, Gerding H, Jandeck C, Smith L. Ranibizumab in retinopathy of prematurity - one-year follow-up of ophthalmic outcomes and two-year follow-up of neurodevelopmental outcomes from the CARE-ROP study. Acta Ophthalmol 2022; 100:e91-e99. [PMID: 33742551 PMCID: PMC9460412 DOI: 10.1111/aos.14852] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/05/2020] [Accepted: 02/27/2021] [Indexed: 12/01/2022]
Abstract
Purpose: The primary endpoint results from the comparing alternative ranibizumab dosages for safety and effcacy in retinopathy of prematurity (CARE-ROP) core study identified ranibizumab as an effective treatment to control acute retinopathy of prematurity (ROP). This study reports the 1- and 2-year follow-up data focusing on long-term functional outcomes and safety. Methods: The CARE-ROP trial compared 0.12 mg versus 0.20 mg ranibizumab in 20 infants with ROP in a multicentric, prospective, randomized, double-blind, controlled study design. Sixteen patients entered the follow-up period. An ophthalmologic assessment at one year postbaseline was acquired from all 16 patients and a neurodevelopmental assessment at two years postbaseline was acquired from 15 patients. Results: Fifteen of 16 infants were able to fixate and follow moving objects at one year postbaseline treatment. One child progressed to stage 5 ROP bilaterally between the end of the core study and the 1-year follow-up (first seen at PMA 75 weeks). Mean spherical equivalents were −1.9 diopters (D) and −0.75 D in the 0.12 mg and the 0.20 mg treatment arms. Strabismus was present in seven and nystagmus in five out of 16 infants. Mental development scores were within normal limits in six out of ten patients with available data. No statistically significant difference was observed between the two treatment arms. Conclusion: Neurodevelopmental and functional ocular outcomes 1 and 2 years after treatment with ranibizumab are reassuring regarding long-term safety. Late reactivation of ROP, however, represents a challenge during the follow-up phase and it is of utmost importance that regular follow-ups are maintained.
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Affiliation(s)
- Andreas Stahl
- Department of Ophthalmology University Medicine Greifswald Greifswald Germany
| | | | - Wolf A. Lagrèze
- Eye Center Medical Center Faculty of Medicine University of Freiburg Freiburg Germany
| | - Fanni E. Molnár
- Eye Center Medical Center Faculty of Medicine University of Freiburg Freiburg Germany
| | - Teresa Barth
- Department of Ophthalmology University of Regensburg Regensburg Germany
| | - Nicole Eter
- Department of Ophthalmology University of Muenster Medical Center Muenster Germany
| | - Rainer Guthoff
- Department of Ophthalmology Faculty of Medicine University of Dusseldorf Dusseldorf Germany
| | - Tim U. Krohne
- Department of Ophthalmology Faculty of Medicine University Hospital Cologne University of Cologne Cologne Germany
| | - Johanna M. Pfeil
- Department of Ophthalmology University Medicine Greifswald Greifswald Germany
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Jiang P, Purtskhvanidze K, Kandzia G, Neumann D, Luetzen U, Siebert FA, Roider J, Dunst J. 106Ruthenium eye plaque brachytherapy in the management of medium sized uveal melanoma. Radiat Oncol 2020; 15:183. [PMID: 32727533 PMCID: PMC7392724 DOI: 10.1186/s13014-020-01621-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/15/2020] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate 106Ruthenium Brachytherapy in management of medium sized uveal melanoma, with emphasis on 5-year outcome and toxicity. Methods From April 2007 to October 2015, 39 patients with medium sized uveal melanoma were treated with 106 Ru eye plaques brachytherapy. At the time of diagnosis, the mean tumor depth was 3.7 mm (±SD:1.6 mm). The mean dose at the tumor apex was 141.4 Gy (± SD: 12.1 Gy) and 557.7 Gy (± SD: 257.3 Gy) to the sclera. Results Mean follow-up was 69.5 months (± SD: 53.8 months). Thirty-four patients (87.1%) remained free of recurrence. Twenty-six patients (66.7%) demonstrated a complete tumor regression after a median period of 12 months (3–60 mon.). By the final examination, the visual acuity of 26 patients (66.7%) was better than 20/200, and 12 patients (30.7%) had a visual acuity better than 20/40. Retinopathy was detected in 11 patients (28.2%). After treatments only one patient (5.1%) had active vascular changes by the last examination. Moderate optic neuropathy was observed in 4 patients (10.3%). Cataract development was diagnosed in 21 patients (53.8%), and 16 patients (41%) had bilateral cataract development. Special emphasis was made on patients with larger tumors. Twelve out of the 39 patients had a tumor with a depth of 5 mm or more. There was no significant difference in local control or in side effects between both groups observed. Conclusions Our study proved 106Ru -brachytherapy to be an excellent treatment option with regard to tumor control and preservation of the visual acuity in well-selected patients. Our data suggested that this treatment is also suitable for tumors with a depth of more than 5 mm.
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Affiliation(s)
- Ping Jiang
- University Clinic for Medical Radiation Physics, Medical Campus Pius-Hospital, Carl von Ossietzky University, Georgstrasse 12, Oldenburg, Germany.
| | | | - Gerit Kandzia
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Germany
| | - Dirk Neumann
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Germany
| | - Ulf Luetzen
- Department of Nuclear Medicine, University Clinic Schleswig-Holstein, Campus Kiel, Germany
| | - Frank-André Siebert
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Clinic Schleswig-Holstein, Campus Kiel, Germany
| | - Juergen Dunst
- University Clinic for Medical Radiation Physics, Medical Campus Pius-Hospital, Carl von Ossietzky University, Georgstrasse 12, Oldenburg, Germany.,Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Germany
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Purtskhvanidze K, Saeger M, Treumer F, Nölle B, Roider J. Open globe and penetrating eyelid injuries from fish hooks. BMC Ophthalmol 2019; 19:26. [PMID: 30665380 PMCID: PMC6341560 DOI: 10.1186/s12886-019-1040-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/03/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background A few case reports have described accidental eye injuries caused by fish hooks. The severity of ocular injuries is dependent on the involved ocular structures. Severe ocular injuries due to fish hooks are rare. We describe open globe and penetrating eyelid injuries from fish hooks at the Baltic Sea. Methods Nine patients with traumatic ocular injuries caused by fish hooks were included. The following parameters were evaluated: severity of injury, best corrected visual acuity at admission and last follow-up, and surgical treatment. Results All nine patients were male. Age ranged between 7 and 51 years with a median of 13 years. Sixty-seven percent of the patients were children. Four of the nine patients were 9 years or younger. In 5 eyes (55%) the injury was limited to the eyelid. An open globe injury was found in 4 patients (45%). The mean follow-up was 16.7 ± 32.8 months. All patients required surgical treatment. The number of operations ranged from 1 to 3, with a mean of 1.4. At admission and last follow-up, patients with eyelid injuries showed a median best corrected visual acuity (BCVA) of logMAR 0.0. Patients with open globe injuries showed a median best corrected visual acuity of logMAR 1.5 at admission, and of logMAR 0.6 at last follow-up. Conclusions Nearly half of the patients suffered severe penetrating injuries. Especially children misjudge the risk potential of fishing due to their lack of experience. Fishing glasses should be worn not only for UV protection, but also as injury prevention strategy.
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Affiliation(s)
- Konstantine Purtskhvanidze
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, 24105, Kiel, Germany.
| | - Mark Saeger
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, 24105, Kiel, Germany
| | - Felix Treumer
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, 24105, Kiel, Germany
| | - Bernhard Nölle
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, 24105, Kiel, Germany
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Purtskhvanidze K, Saeger M, Treumer F, Roider J, Nölle B. Long-term results of glaucoma drainage device surgery. BMC Ophthalmol 2019; 19:14. [PMID: 30630462 PMCID: PMC6327392 DOI: 10.1186/s12886-019-1027-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/10/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate long-term results of eyes with glaucoma drainage device (GDD). Methods We retrospectively reviewed medical records of all patients who underwent GDD placement at our institution between 2001 and 2014. A total of 110 eyes of 90 patients were studied. Glaucoma outcome was assessed by postoperative intraocular pressure (IOP), number of medications, and need for further glaucoma surgery. Surgical procedures before and during the study period, and their complications were evaluated. Results The mean follow-up was 78.3 ± 44.0 months. The mean preoperative intraocular pressure was 30.8 ± 6.9 mmHg with 3.5 ± 1.1 glaucoma medications. At last postoperative follow-up, the mean IOP decreased to 14.3 ± 5.4 mmHg with 1.6 ± 1.5 glaucoma medications. GDD implantation successfully controlled glaucoma in 86, 85, 81, 78, 79, 76 and 73% of eyes at 1, 2, 3, 4, 5, 7 and 10 years, respectively. At last follow-up IOP was successfully controlled in 67% of eyes. Clinical complications occurred in 56.4% of eyes during the follow-up period. Conclusions A glaucoma drainage device can successfully control intractable glaucoma even after a very long period of time.
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Affiliation(s)
- Konstantine Purtskhvanidze
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, D-24105, Kiel, Germany.
| | - Mark Saeger
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, D-24105, Kiel, Germany
| | - Felix Treumer
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, D-24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, D-24105, Kiel, Germany
| | - Bernhard Nölle
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, D-24105, Kiel, Germany
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Sheptulin V, Purtskhvanidze K, Roider J. Half-time photodynamic therapy in treatment of chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2018; 256:2027-2034. [DOI: 10.1007/s00417-018-4086-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022] Open
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von der Burchard CC, Tode J, Koinzer S, Purtskhvanidze K, Roider J. Localized Photoreceptor Damage after Femtosecond Laser Injury. Ophthalmol Retina 2018; 2:751-753. [PMID: 31047387 DOI: 10.1016/j.oret.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, University of Kiel, Kiel, Germany
| | | | - Johann Roider
- Department of Ophthalmology, University of Kiel, Kiel, Germany
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von der Burchard C, Treumer F, Ehlken C, Koinzer S, Purtskhvanidze K, Tode J, Roider J. Retinal volume change is a reliable OCT biomarker for disease activity in neovascular AMD. Graefes Arch Clin Exp Ophthalmol 2018; 256:1623-1629. [PMID: 29915918 DOI: 10.1007/s00417-018-4040-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/29/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Current algorithms for automated computer interpretation of optical coherence tomography (OCT) imaging of patients suffering from neovascular age-related macular degeneration (AMD) mostly rely on fluid detection. However, fluid detection itself and correct interpretation of the fluid currently limits diagnostic accuracy. We therefore performed a detailed analysis of the requirements that would have to be met for fluid detection approaches. We further investigated if monitoring retinal volume would be a viable alternative to detect disease activity. METHODS Retrospective analysis and manual grading of 764 OCT volume scans of 44 patients with exudative AMD treated with intravitreal anti-VEGF injections at a pro-re-nata (PRN) treatment regimen for at least 24 months. RESULTS Detection of subretinal fluid (SRF) or intraretinal fluid (IRF) alone is not sufficient for disease detection. A combination of SRF and IRF can detect disease activity with a sensitivity of 98.6% and a specificity of 82%. With further characterization of IRF into exudative and degenerative cysts, specificity can be increased to 100%. However, correct characterization is currently not achieved by published fluid detection approaches. Change of macular retinal volume (MRV) can depict disease activity with sensitivity of 88.4% and specificity of 89.6%. Combination with the detection of SRF can further improve diagnostic accuracy to a specificity of 93.3% and sensitivity of 93.9% without relying on IRF or IRF characterization. CONCLUSION Fluid detection without further characterization is not sufficient for AMD monitoring. Either further distinction between exudative and degenerative cysts is necessary, or other activity markers have to be taken into account. MRV offers good potential to fill this diagnostic gap and might become an important monitoring marker.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Felix Treumer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Christoph Ehlken
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Purtskhvanidze K, Balken L, Hamann T, Wöster L, von der Burchard C, Roider J, Treumer F. Long-term follow-up of lamellar macular holes and pseudoholes over at least 5 years. Graefes Arch Clin Exp Ophthalmol 2018; 256:1067-1078. [DOI: 10.1007/s00417-018-3972-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/06/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022] Open
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Purtskhvanidze K, Frühsorger B, Bartsch S, Hedderich J, Roider J, Treumer F. Persistent Full-Thickness Idiopathic Macular Hole: Anatomical and Functional Outcome of Revitrectomy with Autologous Platelet Concentrate or Autologous Whole Blood. Ophthalmologica 2017; 239:19-26. [DOI: 10.1159/000481268] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/31/2017] [Indexed: 11/19/2022]
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14
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Purtskhvanidze K, Hillenkamp J, Tode J, Junge O, Hedderich J, Roider J, Treumer F. Thinning of Inner Retinal Layers after Vitrectomy with Silicone Oil versus Gas Endotamponade in Eyes with Macula-Off Retinal Detachment. Ophthalmologica 2017; 238:124-132. [DOI: 10.1159/000477743] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022]
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Purtskhvanidze K, Rüfer F, Klettner A, Borzikowsky C, Roider J. Ocular Trauma Score as prognostic value in traumatic ocular injuries due to rotating wire brushes. Graefes Arch Clin Exp Ophthalmol 2017; 255:1037-1042. [PMID: 28303330 DOI: 10.1007/s00417-017-3629-6] [Citation(s) in RCA: 7] [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: 09/16/2016] [Revised: 02/19/2017] [Accepted: 03/06/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Rotating wire brushes are used, e.g., for rust removal. Detaching fragments can cause severe eye injuries. The purpose of this study was to investigate mechanism, severity, clinical outcome, validity of Ocular Trauma Score (OTS) and to assess the likelihood of final visual acuity. METHODS Twenty patients with traumatic ocular injuries by rotating wire brushes were included. Location and type of injury, grade of injury according to OTS, surgical procedure, and development of visual acuity were evaluated. RESULTS Eleven accidents (55%) happened at work, nine at home (45%). Eighteen injuries (90%) were penetrating, one (5%) was perforating. In one case (5%), an intraocular foreign body was present. One case each was classified OTS 1 and 2 (5%), six cases OTS 3 (30%), four cases OTS 4 (20%), and eight cases OTS 5 (40%). None of the patients was wearing safety goggles. Fourteen patients (70%) were surgically treated. Of these, five were treated at the anterior segment only, nine additionally underwent pars-plana vitrectomy. Nine patients received phacoemulsification. Mean best corrected visual acuity was logMAR 1.0 (2/20) at admission and 0.3 (10/20) at last follow-up. Our results were similar to those in the OTS study, except for OTS 1 (p = 0.046). Comparing the categorical distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.119) between our results and the OTS study group. CONCLUSIONS OTS may provide prognostic information in traumatic ocular injuries by rotating wire brushes. The injuries could have been avoided by wearing safety goggles.
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Affiliation(s)
- Konstantine Purtskhvanidze
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, Kiel, D-24105, Germany.
| | - Florian Rüfer
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, Kiel, D-24105, Germany
| | - Alexa Klettner
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, Kiel, D-24105, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Arnold-Heller Strasse 3, Haus 25, Kiel, D-24105, Germany
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16
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Treumer F, Wienand S, Purtskhvanidze K, Roider J, Hillenkamp J. The role of pigment epithelial detachment in AMD with submacular hemorrhage treated with vitrectomy and subretinal co-application of rtPA and anti-VEGF. Graefes Arch Clin Exp Ophthalmol 2017; 255:1115-1123. [PMID: 28280989 DOI: 10.1007/s00417-017-3620-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/29/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess the incidence of pigment epithelial detachment (PED) in age-related macular degeneration (AMD) with submacular hemorrhage (SMH) and its response to treatment with pars plana vitrectomy (ppV), subretinal co-application of recombinant tissue plasminogen activator (rtPA) and anti-VEGF, and an intravitreal gas tamponade. METHODS Consecutive interventional case series of 132 eyes of 129 patients with neovascular AMD with SMH. All eyes underwent ppV with subretinal co-application of rtPA and bevacizumab followed by a gas tamponade. Postoperatively, two additional intravitreal anti-VEGF injections were applied monthly, followed by intravitreal anti-VEGF injections applied PRN thereafter. PEDs and SMHs were evaluated with SD-OCT pre- and postoperatively. RESULTS Preoperatively, 88 of 132 (67%) eyes were examined by OCT, and in 81 of these eyes the RPE could be visualised. A PED was found in 74 (91%) eyes, and no PED was found in five (6%) eyes. Median height of preoperative PED was 503 μm (range 150-1242, n = 65) and reduced to 344 (n = 62) and 306 μm (n = 27) after 3 and 12 months respectively. Two eyes showed a pre-existing rip of the RPE. Postoperatively, a rip was documented in 12 of 128 (9%) eyes. Median height of SMH was 762 μm (range 217-1840), median diameter was 4.3 (1.5-15) disc diameter. A complete displacement of the SMH from the fovea was achieved in 112 of 129 (87%) eyes. Overall, median best-corrected logMAR visual acuity (BCVA) improved significantly from preoperative 1.6 (0.5-2.0, n = 132) to 1.0 (0.2-2.0) 3 (n = 132) and 12 months (n = 74) postoperatively. Excluding eyes with pre-existing macular scars (n = 22), BCVA 3 months postoperatively was 0.8. Height of PED or SMH did not correlate with postoperatively BCVA, while size of SMH showed a mild correlation (rho = 0.25, p = 0.005). CONCLUSION PpV with subretinal co-application of rtPA and bevacizumab and an intravitreal gas tamponade effectively displaces SMH and improves BCVA. Preoperatively, PED is found in the majority of eyes. Height of PED or SMH did not correlate with postoperatively BCVA. Tears of the RPE occur as frequently as in exudative AMD without SMH.
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Affiliation(s)
- F Treumer
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany.
| | - S Wienand
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany
| | - K Purtskhvanidze
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany
| | - J Roider
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany
| | - J Hillenkamp
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany.,Department of Ophthalmology, University Medical Center Würzburg, Josef-Schneider Str. 11, 97080, Würzburg, Germany
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Mulder VC, Tode J, van Dijk EH, Purtskhvanidze K, Roider J, van Meurs JC, Treumer F. Preoperative aqueous humour flare values do not predict proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment. Br J Ophthalmol 2017; 101:1285-1289. [PMID: 28077370 DOI: 10.1136/bjophthalmol-2016-309134] [Citation(s) in RCA: 7] [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: 06/03/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Patients with rhegmatogenous retinal detachment (RRD) who develop postoperative proliferative vitreoretinopathy (PVR) have been found to have higher preoperative laser flare values than patients with RRD who do not develop this complication. Measurement of laser flare has therefore been proposed as an objective, rapid and non-invasive method for identifying high-risk patients. The purpose of our study was to validate the use of preoperative flare values as a predictor of PVR risk in two additional patient cohorts, and to confirm the sensitivity and specificity of this method for identifying high-risk patients. METHODS We combined data from two independent prospective studies: centre 1 (120 patients) and centre 2 (194 patients). Preoperative aqueous humour flare was measured with a Kowa FM-500 Laser Flare Meter. PVR was defined as redetachment due to the formation of traction membranes that required reoperation within 6 months of initial surgery. Logistic regression and receiver operating characteristic analysis determined whether higher preoperative flare values were associated with an increased risk of postoperative PVR. RESULTS PVR redetachment developed in 21/314 patients (6.7%). Median flare values differed significantly between centres, therefore analyses were done separately. Logistic regression showed a small but statistically significant increase in odds with increasing flare only for centre 2 (OR 1.014; p=0.005). Areas under the receiver operating characteristic showed low sensitivity and specificity: centre 1, 0.634 (95% CI 0.440 to 0.829) and centre 2, 0.731 (95% CI 0.598 to 0.865). CONCLUSIONS Preoperative laser flare measurements are inaccurate in discriminating between those patients with RRD at high and low risk of developing PVR.
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Affiliation(s)
- Verena C Mulder
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Elon Hc van Dijk
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jan C van Meurs
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University, Rotterdam, The Netherlands
| | - Felix Treumer
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
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Saeger M, Heckmann J, Purtskhvanidze K, Caliebe A, Roider J, Koinzer S. Variability of panretinal photocoagulation lesions across physicians and patients. Quantification of diameter and intensity variation. Graefes Arch Clin Exp Ophthalmol 2016; 255:49-59. [PMID: 27405976 DOI: 10.1007/s00417-016-3416-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/15/2016] [Revised: 06/12/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Photocoagulation lesion intensity relies on the judgement of retinal blanching. Lesions turn out variable due to observer-dependent judgement and time dependency of blanching. We investigated lesion variability per patient and per physician in clinical routine treatments. METHODS In this observational clinical trial, different physicians performed panretinal photocoagulation for diabetic retinopathy. Study eyes received 20-30 study lesions at 20 ms (three physicians, nine eyes) and 200 ms (four physicians, 12 eyes) irradiation time (532 nm continuous wave photocoagulator, 300 μm spot size). Lesions were imaged after 1 hour with photography and optical coherence tomography (OCT). We measured lesion diameters in fundus and OCT images, and graded intensities according to a previously published six-step classifier. RESULTS 200-ms lesions were larger and more severe (568, 474-625 μm [median, IQR], predominantly class 6) than 20-ms lesions (397, 347-459 μm, predominantly classes 3-4). The impact of laser power was small compared to other factors. Lesion intensities and diameters in fundus and OCT images varied significantly between patients and between physicians. Median photographic lesion diameters varied by up to a factor of 1.61 (20 ms) or 1.5 (200 ms) respectively. CONCLUSIONS In this study, the treated area of retina varied by up to a factor of 1.612 = 2.59 for a given spot number. As clinical efficacy depends on the treated area, which is a function of lesion number by area per lesion, our results implicate poor control of the overall treatment effect if treatments are administered according to lesion number or spacing alone. Better ways of laser effect control should be sought.
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Affiliation(s)
- Mark Saeger
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan Heckmann
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel, House 31, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, House 25, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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Tode J, Purtskhvanidze K, Oppermann T, Hillenkamp J, Treumer F, Roider J. Vision loss under silicone oil tamponade. Graefes Arch Clin Exp Ophthalmol 2016; 254:1465-1471. [PMID: 27278374 DOI: 10.1007/s00417-016-3405-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/22/2015] [Revised: 04/04/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to investigate frequency, time course and pathophysiology of vision loss in eyes with macula-on rhegmatogenous retinal detachment operated with vitrectomy and silicone oil tamponade. PATIENTS AND METHODS Fifteen eyes of 15 patients who had been operated with 5,000 centistoke silicone oil between 2006 and 2014 were included in a retrospective case series. Examinations included logMAR best corrected visual acuity (BCVA), visual field testing (VF), spectral domain optical coherence tomography (OCT), electrophysiology, and fluorescein angiography. RESULTS Vision loss was seen in eight (53 %) eyes of 15 patients with symptomatic central scotoma, which was confirmed by VF (5/6). Preoperative median BCVA of these patients was 0.15 (0.5 to 0), prior to oil removal 0.7 (1.0 to 0.5), and 6 weeks post oil removal 1.0 (1.5 to 0.2). BCVA recovered in five patients to a median of 0.15 (0.5 to 0.1), and it remained 1.0 in three (20 %) out of 15 eyes. OCT revealed significant thinning of the foveal and parafoveal combined nerve fiber, ganglion cell and inner plexiform layers in affected eyes (mean 58.3 μm +/-13, horizontal scan through fovea, 500 μm radius) compared to their healthy fellow eyes (mean 84.5 μm +/-12.3; p < 0.01, n = 6 patients, 12 eyes) and compared to eyes with no vision loss under silicone oil. CONCLUSIONS We find persisting vision loss in three out of 15 patients treated for macula-on rhegmatogenous retinal detachment with silicone oil tamponade. Thinning of inner retinal layers possibly evoked by silicone oil tamponade might be a pathophysiological explanation for vision loss in these patients.
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Affiliation(s)
- Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Till Oppermann
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Felix Treumer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Affiliation(s)
- Konstantine Purtskhvanidze
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
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Purtskhvanidze K, Treumer F, Junge O, Hedderich J, Roider J, Hillenkamp J. The Long-Term Course of Functional and Anatomical Recovery After Macular Hole Surgery. ACTA ACUST UNITED AC 2013; 54:4882-91. [DOI: 10.1167/iovs.13-11699] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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)
| | - Felix Treumer
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Olaf Junge
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jürgen Hedderich
- Institute of Medical Informatics and Statistics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Kiel, Germany
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