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Maier AKB, Mandrossa D, Reitemeyer E, Winterhalter S, Rübsam A, Pleyer U. Viral Anterior Uveitis: Differences in Retinal Vessel Area Density between the Affected and Non-Affected Eye Using Optical Coherence Tomography Angiography. Ocul Immunol Inflamm 2024:1-9. [PMID: 38517389 DOI: 10.1080/09273948.2024.2329318] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To investigate differences in the retinal vessel area density (VAD) on optical coherence tomography angiography (OCTA) between eyes with unilateral herpetic viral anterior uveitis (VAU) (herpes-simplex virus (HSV) and varicella-zoster virus (VZV)) and the non-affected fellow eye. METHODS In this monocentric, observational, prospective case series we analyzed the VAD of the macula, optic disc, and peripapillary region in affected and non-affected eyes of 22 patients with HSV-positive and 22 patients with VZV-positive VAU using OCTA. We analyzed also the visual field mean deviation (MD), the retinal nerve fiber layer (RNFL) thickness, Bruch's Membrane Opening-Minimum Rim Width (BMO-MRW), and ganglion cell layer (GCL) thickness on OCT and correlated the results with the different VADs. RESULTS The macular VAD in the superficial vascular plexus (SVC) was significant lower in the affected compared to the non-affected eye for both viruses (HSV: 33.0% ± 3.3% vs. 34.7% ± 2.6%, p = 0.011; adjusted p = 0.040; VZV: 33.1% ± 3.2% vs. 34.3% ± 2.8%, p = 0.012; adjusted p = 0.050). Additionally, the VAD of the peripapillary SVC differed between the affected and non-affected eye for VZV-positive VAU (47.1% ± 6.2% vs. 50.5% ± 6.3%, p = 0.048, adjusted p = 0.100). For both HSV-positive and VZV-positive VAU, there were correlations between macular or peripapillary SVC VAD and BMO-MRW, GCL thickness, RNFL thickness or MD of the affected eye. CONCLUSION We observed vascular dysfunction characterized by decreased macular and peripapillary VAD in the superficial plexus on OCTA in eyes with HSV- and VZV-positive VAU compared to non-affected fellow eyes. These changes might be an early sign of glaucomatous damage or may be a direct consequence of the herpes viruses themselves.
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Affiliation(s)
- Anna-Karina B Maier
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Mandrossa
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anne Rübsam
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Hofmann W, Kötter I, Winterhalter S, Krupp S. [Polymyalgia rheumatica-A challenge in geriatrics : Interdisciplinary presentation of diagnostics and treatment]. Z Rheumatol 2024; 83:112-121. [PMID: 38285216 DOI: 10.1007/s00393-024-01484-0] [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] [Indexed: 01/30/2024]
Abstract
Polymyalgia rheumatica is the second most frequent inflammatory rheumatic disease in people aged over 50 years, after rheumatoid arthritis. It is characterized by pain and morning stiffness in the region of the shoulders, hip girdle and neck. It can be associated with giant cell arteritis (CGA). Treatment with glucocorticoids is indispensable. The duration of treatment varies and often exceeds 1 year. The additive administration of methotrexate is an option for saving glucocorticoids. The biologicals tocilizumab or secukinumab are very promising alternatives. The course of treatment should be closely monitored for inflammation parameters, glucocorticoid side effects, pain, visual acuity, depression, activities of daily living and especially related to functions of the upper extremities. The geriatric assessment plays an important role in the management of this condition.
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Affiliation(s)
- W Hofmann
- , An den Uferwiesen 6, 17248, Rechlin/Müritz, Deutschland.
- ehem. Geriatrisches Zentrum, Neumünster und Bad Bramstedt, Deutschland.
| | - I Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Sektion Rheumatologie und entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Winterhalter
- Klinik für Augenheilkunde, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - S Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck - Geriatriezentrum, Lübeck, Deutschland
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Hofmann W, Kötter I, Winterhalter S, Krupp S. [Polymyalgia rheumatica-A challenge in geriatrics : Interdisciplinary presentation of diagnostics and treatment]. Z Gerontol Geriatr 2023:10.1007/s00391-023-02211-1. [PMID: 37522895 DOI: 10.1007/s00391-023-02211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/03/2023] [Indexed: 08/01/2023]
Abstract
Polymyalgia rheumatica is the second most frequent inflammatory rheumatic disease in people aged over 50 years, after rheumatoid arthritis. It is characterized by pain and morning stiffness in the region of the shoulders, hip girdle and neck. It can be associated with giant cell arteritis (CGA). Treatment with glucocorticoids is indispensable. The duration of treatment varies and often exceeds 1 year. The additive administration of methotrexate is an option for saving glucocorticoids. The biologicals tocilizumab or secukinumab are very promising alternatives. The course of treatment should be closely monitored for inflammation parameters, glucocorticoid side effects, pain, visual acuity, depression, activities of daily living and especially related to functions of the upper extremities. The geriatric assessment plays an important role in the management of this condition.
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Affiliation(s)
- W Hofmann
- , An den Uferwiesen 6, 17248, Rechlin/Müritz, Deutschland.
- ehem. Geriatrisches Zentrum, Neumünster und Bad Bramstedt, Deutschland.
| | - I Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Sektion Rheumatologie und entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Winterhalter
- Klinik für Augenheilkunde, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - S Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck - Geriatriezentrum, Lübeck, Deutschland
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Dieke S, Wurche S, Ruebsam A, Wirbelauer C, Joussen AM, Winterhalter S. Impact of intravitreal injection therapy on contrast sensitivity in patients with nAMD and DME. Graefes Arch Clin Exp Ophthalmol 2023; 261:1823-1833. [PMID: 36622409 PMCID: PMC10272247 DOI: 10.1007/s00417-022-05944-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The study aims to evaluate changes in contrast sensitivity (CS) during therapy with intravitreal vascular endothelial growth factor (VEGF) inhibitors in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). METHODS Prospective, uncontrolled, multicenter study on patients with neovascular AMD or DME who underwent intravitreal injection therapy with Ranibizumab, Aflibercept, or Bevacizumab was conducted. Best corrected visual acuity (BCVA) and CS measured by Mars Letter Contrast Sensitivity Test (MLCS) and Freiburg Visual Acuity and Contrast Test (FrACT) in logCS were evaluated before 3 consecutive VEGF inhibitor injections, which followed the pro renata regimen in treatment-naïve and pretreated eyes with a maximum of 9 injections. Correlation of MLCS and FrACT was calculated by the Spearman's rank correlation coefficient. RESULTS Eighty eyes of 74 patients (mean age 72.7; SD ± 9.96) were included. BCVA improved significantly from 0.44 (SD ± 0.21) logMAR to 0.38 (SD ± 0.23) logMAR by 0.06 (SD ± 0.14) logMAR values (p < 0.001). CS measured by MLCS increased significantly from 1.27 (SD ± 0.25) logCS to 1.39 (SD ± 0.22) logCS (p < 0.001). CS measured by FrACT also improved significantly from 1.22 (SD ± 0.32) logCS to 1.30 (SD ± 0.29) logCS (p = 0.035). A positive correlation between MLCS and FrACT was found (r = 0.389; p < 0.001). Despite statistical significance, results for BCVA, MLCS, and FrACT failed clinical significance. Overall best test results were achieved with MLCS. CONCLUSIONS Intravitreal injection therapy with VEGF inhibitors led to an improvement of BCVA and CS measured by MLCS and FrACT. MLCS was superior and more sensitive compared to FrACT and even BCVA to evaluate CS in elderly patients with macular pathology.
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Affiliation(s)
- Sebastian Dieke
- Beuth Hochschule for Technology Berlin, University of Applied Sciences, Berlin, Germany
| | - Stefanie Wurche
- Beuth Hochschule for Technology Berlin, University of Applied Sciences, Berlin, Germany
| | - Anne Ruebsam
- Department of Ophthalmology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Antonia M Joussen
- Department of Ophthalmology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Pohlmann D, Berlin M, Reidl F, Künzel SE, Pleyer U, Joussen AM, Winterhalter S. Longitudinal Comparison of Constant Artifacts in Optical Coherence Tomography Angiography in Patients with Posterior Uveitis Compared to Healthy Subjects. J Clin Med 2022; 11:jcm11185376. [PMID: 36143023 PMCID: PMC9502304 DOI: 10.3390/jcm11185376] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/27/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Knowledge about artifacts in optical coherence tomography angiography (OCTA) is important to avoid misinterpretations. An overview of possible artifacts in posterior uveitis provides important information for interpretations. Methods: In this monocentric prospective study, OCTA images from a total of 102 eyes of 54 patients with posterior uveitis, and an age-matched control group including 34 healthy subjects (67 eyes), were evaluated (day 0, month 3, month 6). We assigned different artifacts to distinct layers. Various types of artifacts were examined in different retinal layers. The χ2 test for the comparison between the control and uveitis group and Cochran’s Q test for the longitudinal comparison within the uveitis group were used. Results: A total of 2238 images were evaluated; 1836 from uveitis patients and 402 from healthy subjects. A total of 2193 artifacts were revealed. Projection (812 [36.3%]), segmentation (579 [25.9%]), shadowing (404 [18.1%]), and blink artifacts (297 [13.3%]) were the most common artifact types. The uveitis group displayed significantly more segmentation artifacts and projection artifacts (p < 0.001). No segmentation artifacts were documented in healthy subjects. The consecutive examinations within the uveitis group revealed the same artifact types without significance (p > 0.1). Conclusions: The uveitis patients showed more segmentation and projection artifacts than the control group. Within the uveitis group, artifacts remained longitudinally constant in terms of artifact type and pattern. The artifacts therefore appear to be reproducible on an individual level.
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Affiliation(s)
- Dominika Pohlmann
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-554202; Fax: +49-30-450-554900
| | - Martin Berlin
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Felix Reidl
- Birkbeck College, University of London, Malet St., Bloomsbury, London WC1E 7HX, UK
| | - Steffen Emil Künzel
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Antonia M. Joussen
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany
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Neß T, Winterhalter S, Stübiger N. Infectious Posterior Uveitis - Toxoplasmosis, Treponema, Tuberculosis (TTT). Klin Monbl Augenheilkd 2022; 239:666-675. [PMID: 35320874 DOI: 10.1055/a-1727-1951] [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: 10/18/2022]
Abstract
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
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Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | | | - Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Cornelius A, Pilger D, Riechardt A, Reitemeyer E, Rübsam A, Winterhalter S, Maier AKB. Macular, papillary and peripapillary perfusion densities measured with optical coherence tomography angiography in primary open angle glaucoma and pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 260:957-965. [PMID: 34499247 PMCID: PMC8850224 DOI: 10.1007/s00417-021-05321-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/28/2023] Open
Abstract
Purpose To compare the blood flow situation in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) using optical coherence tomography angiography (OCTA). Methods In this prospective study a total of 26 POAG and 23 PXG eyes were included. All patients underwent a complete ophthalmological examination including standard automated perimetry, stereoscopic photographs of the optic disc, peripapillary retinal nerve fibre layer analysis and examination of vascular parameters of the optic nerve head (ONH), the peripapillary region and macula using OCTA. In addition to the vascular parameters recorded by the device, the vascular images were graphically evaluated using Image J. All recorded vascular parameters were compared between both groups and correlated to structural and functional parameters. Results The mean superficial perifoveal plexus perfusion density (PD) was significantly lower in PXG eyes than compared to POAG eyes using OCTA (32.57% ± 3.57% vs. 34.92% ± 2.11%, p = 0.007). The mean PD parameters for the superficial peripapillary plexus (40.98% ± 3.04% vs. 42.09% ± 2.29%, p = 0.152) as well as the size of the foveal avascular zone (FAZ) (0.23 mm2 ± 0.1 mm2 vs. 0.23 mm2 ± 0.09 mm2) did not differ between both groups. Additional graphic evaluation using Image J showed no significant difference for superficial perifoveal plexus PD (32.97% ± 1.11% vs. 33.35% ± 0.95%, p = 0.194) and peripapillary plexus PD (46.65% ± 0.83% vs. 46.95% ± 0.5%, p = 0.127) between the groups. Retinal nerve fibre layer (RNFL) thickness correlated significantly with peripapillary plexus PD for both OCTA data and Image J data (p < 0.001, p = 0.032). Conclusion The severity of the glaucoma seems to be crucial for peripapillary and macular perfusion densities, and not the form of glaucoma. An additional graphic evaluation is a possible step that could be implemented to improve the comparability of OCTA scans and to optimize the possibility of quantitative perfusion analysis in the case of deviating quality criteria.
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Affiliation(s)
- Anna Cornelius
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aline Riechardt
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne Rübsam
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna-Karina B Maier
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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Pahlitzsch M, Fritsche-Guenther R, Pompös I, Pohlmann D, Maier AKB, Winterhalter S, Erb C, Rübsam A. Correlation of NUCB2/Nesfatin-1 with Cytokine Levels in Primary Open-Angle Glaucoma. Clin Ophthalmol 2021; 15:2505-2517. [PMID: 34163135 PMCID: PMC8216077 DOI: 10.2147/opth.s307379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/19/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Nesfatin-1 is produced in various tissues of the body including the hypothalamus. Neuroprotective properties of the neuropeptide hormone Nesfatin-1 were recently described. The aim of the study was to analyze the molecule Nesfatin-1 as a possible biomarker in POAG with neuroprotective properties pointing out the retinal-hypothalamic axis as target site in POAG and to obtain a molecular signature of cytokines in POAG as neuroinflammatory processes are a key factor of glaucoma development. Methods In this study, n=35 patients with moderate and advanced POAG (mean age 65.0y, IOP 13.9±3.0mmHg) and n=35 healthy controls (mean age 51.6y, IOP 14.3±2.7mmHg) were included. Clinical parameters including IOP, cup to disc ratio (CDR), glaucoma medication and retinal nerve fiber layer thickness (RNFL) were recorded. Plasma was collected for NUCB2/nesfatin-1 measurement using a Nesfatin-1 ELISA and for detection of 13 inflammatory cytokines using a multiplex bead-based immunoassay (MagPix). Multiple linear regression analysis was performed to adjust for confounding factors. Results Sex-independent or sex-dependent variables showed no significant differences in the Nesfatin-1 level (p>0.05). As a trend, an increase in NUCB2/nesfatin-1 in male glaucoma patients was found. Increased concentrations of 11 cytokines (GM-CSF, Interferon-γ, Interleukin-1β, IL-2, 4, 5, 6, 7, 10, 12 and TNF-α) were detected in POAG. The female glaucoma patients demonstrated elevated cytokine concentrations compared to male patients. NUCB2/nesfatin-1 showed a significant correlation to IL-2 and IL-13 levels in POAG. Stepwise multiple regression analysis showed no difference in NUCB2/nesfatin-1 level between POAG and healthy controls after adjusting for sex and age (all p>0.05). Conclusion As a trend, male POAG patients showed increased plasma NUCB2/nesfatin-1 levels. We further found inflammation as contributing factor to the pathogenesis of glaucoma, with a greater inflammatory response in women.
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Affiliation(s)
- Milena Pahlitzsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Raphaela Fritsche-Guenther
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Metabolomics Platform, Berlin, Germany
| | - Inga Pompös
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dominika Pohlmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna-Karina B Maier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carl Erb
- Eye clinic Wittenbergplatz, Berlin, Germany
| | - Anne Rübsam
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Pahlitzsch M, Davids AM, Winterhalter S, Zorn M, Reitemeyer E, Klamann MKJ, Torun N, Bertelmann E, Maier AK. Selective Laser Trabeculoplasty Versus MIGS: Forgotten Art or First-Step Procedure in Selected Patients with Open-Angle Glaucoma. Ophthalmol Ther 2021; 10:509-524. [PMID: 33963524 PMCID: PMC8319229 DOI: 10.1007/s40123-021-00347-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/17/2021] [Accepted: 04/24/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction To evaluate the long-term effect on intraocular pressure (IOP) and glaucoma medication of selective laser trabeculoplasty (SLT) compared to minimally invasive glaucoma surgery (MIGS) in primary open-angle glaucoma (POAG) and its potential in clinical practice. Methods A total of 342 consecutive patients (stand-alone procedures) were included. One hundred and five patients underwent SLT treatment (360° SLT, 95–105 spots, Trabeculas SLT ARCLaser, Nürnberg, DE), 107 patients had an ab interno-derived trabeculotomy (Trabectome®, NeoMedix, Tustin, USA), and 130 patients received iStent inject® implantation (2 implants-Glaukos, CA, USA). IOP and glaucoma therapy were evaluated preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1, 2, and 3 years postoperatively. Statistical analysis was performed using a regression model and propensity matching score (reduced cohort number) using SPSS v20.0. Kaplan–Meier analysis was included using the following six criteria: criterion A (IOP ≤ 21 mmHg with or without medication, qualified success), criterion B (IOP ≤ 18 mmHg with or without medication, qualified success), criterion C (IOP ≤ 21 mmHg without medication, complete success), criterion D (IOP ≤ 18 mmHg without medication, complete success), criterion E (IOP ≤ 21 mmHg and IOP reduction > 20% after therapy), and criterion F (IOP ≤ 18 mmHg and IOP reduction > 20% after therapy). Results In the matched cohort, the SLT cohort showed an IOP reduction of 31.2% from 19.9 ± 2.3 to 13.7 ± 2.7 mmHg (p < 0.001) 3 years postoperatively; in Trabectome® IOP decreased by 31.4% from 20.5 ± 1.3 to 13.8 ± 2.0 mmHg (p < 0.001) and in iStent inject® by 29.9% from 19.5 ± 2.0 to 13.8 ± 2.7 mmHg (p < 0.001). Trabectome® and iStent inject® could not demonstrate a significant reduction in glaucoma therapy (Trabectome®p = 0.138, iStent inject®p = 0.612); a significant drop was noted in SLT (2.2 ± 1.2 to 1.7 ± 1.2, p = 0.046). SLT and MIGS achieved good to moderate survival rates using criterion A (93.3% SLT, 79.7% Trabectome®, 77.6% iStent inject®) and criterion B (74.5% SLT, 48.0% Trabectome®, 56.2% iStent inject®). As expected, low survival rates were obtained with non-filtering procedures: criterion C 11.1% in SLT, 6.5% in Trabectome®, 7.0% in iStent inject® and criterion D 3.0% in SLT, 4.3% in Trabectome®, 3.7% in iStent inject® in 3-year follow-up. Conclusion The SLT is a low-complication and effective method for reducing pressure in mild to moderate POAG. SLT is suitable as an initial procedure when setting up a step scheme; MIGS is the treatment of choice as a follow-up for mild to moderate forms of glaucoma and accepted topical therapy. Ethic approval had been given by the Ethikkommission Charité – Universitätsmedizin Berlin, EA4/047/20—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00347-0.
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Affiliation(s)
- Milena Pahlitzsch
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anja-Maria Davids
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Malte Zorn
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias K J Klamann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Necip Torun
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna-Karina Maier
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Kakkassery V, Heindl LM, Rokohl AC, Chronopoulos A, Schutz JS, Ranjbar M, Schargus M, Böker A, Winterhalter S, Stübiger N. Primary Vitreoretinal Lymphoma Therapy Monitoring: Significant Vitreous Haze Reduction After Intravitreal Rituximab. Neurosignals 2021; 29:1-7. [PMID: 33945240 DOI: 10.33594/000000367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/AIMS Intravitreal rituximab is an off-label treatment option for primary vitreoretinal lymphoma (PVRL). The objective of this study was to monitor the therapeutic response and safety profile of intravitreal rituximab in a cohort of PVRL patients. METHODS In this retrospective, uncontrolled, open label, multicentre study, 20 eyes from 15 consecutive patients diagnosed with PRVL received at least one intravitreal injection of 1mg in 0.1ml rituximab. Biodata of the PVRL patients was recorded as well as visual acuity and vitreous haze score immediately before rituximab intravitreal injection and at follow-up examinations. Intravitreal rituximab safety data was also recorded. Additional rituximab injections were made during control visits on a pro re nata (PRN) regime using increased vitreous haze to indicate recurrence. RESULTS There was significant vitreous haze reduction (p=0.0002) followed by significant improvement of visual acuity (mean best visual acuity before therapy 0.57 logMAR, after therapy 0.20 logMAR (p=0.0228) during the follow-up time up to 4 years. Only mild ocular side effects were reported. Median follow-up time was 565 days (range, 7-1253 days). CONCLUSION Intravitreal rituximab therapy shows promising PVRL regression without any severe side effects. Although our clinical data support rituximab as intravitreal therapy in PVRL disease, further study is warranted.
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Affiliation(s)
- Vinodh Kakkassery
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany, .,Department of Ophthalmology, Ruhr-University, Bochum, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Alexander C Rokohl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - James S Schutz
- Department of Ophthalmology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Mahdy Ranjbar
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
| | - Marc Schargus
- Department of Ophthalmology, Ruhr-University, Bochum, Germany.,Department of Ophthalmology, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Ophthalmology, Asklepios Hospital Nord-Heidberg, Hamburg, Germany
| | - Alexander Böker
- Department of Ophthalmology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Nicole Stübiger
- Department of Ophthalmology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Maier AKB, Arani P, Pahlitzsch M, Davids AM, Pilger D, Klamann MKJ, Winterhalter S. Influence of Selective Laser Trabeculoplasty (SLT) on the iStent inject® outcomes. BMC Ophthalmol 2020; 20:457. [PMID: 33213403 PMCID: PMC7678109 DOI: 10.1186/s12886-020-01723-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in open-angle glaucoma (OAG). Methods In this retrospective comparative cohort outcome study, 66 patients who were treated with two iStent inject® devices were included. Patients were divided into two subgroups consisting of patients without SLT treatment prior to surgery and patients who had been treated previously with 360° SLT but without sufficient response. Outcome measures included intraocular pressure (IOP) and number of antiglaucoma medications after 6 weeks with three, six, 12, and 24 month follow-ups. Results Mean preoperative IOP decreased from 20.4 ± 5.3 mmHg to 14.8 ± 3.0 mmHg for patients without SLT treatment prior to surgery (p = 0.001) and from 19.2 ± 4.5 mmHg to 14.0 ± 1.6 mmHg for patients with insufficient response to 360° SLT treatment (p = 0.027) at 12 months after iStent inject® implantation. No significant difference was found between the two groups (p > 0.05). The number of antiglaucoma medications did not change in both groups (p > 0.05) and showed no significant difference between the two groups (p > 0.05). Conclusion Prior SLT treatment seems to have no negative influence on the IOP lowering-effect of iStent inject® implantation in patients with OAG. It is therefore an appropriate incremental procedure with no exclusion criterion for an iStent inject® implantation.
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Affiliation(s)
- Anna-Karina B Maier
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Parisa Arani
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Milena Pahlitzsch
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja-Maria Davids
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias K J Klamann
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Brockmann C, Löwen J, Schönfeld S, Rossel-Zemkouo M, Seibel I, Winterhalter S, Müller B, Joussen AM. Vascular findings in primarily affected and fellow eyes of middle-aged patients with Coats' disease using multimodal imaging. Br J Ophthalmol 2020; 105:1444-1453. [PMID: 33130555 DOI: 10.1136/bjophthalmol-2020-317101] [Citation(s) in RCA: 4] [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: 08/03/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 11/03/2022]
Abstract
AIMS To investigate the retinal vascular structure and capillary anomalies of affected and fellow eyes of patients with unilateral Coats' disease using multimodal imaging. METHODS Clinical investigation of both eyes of each patient with diagnosed Coats' disease using ultra-widefield (UWF) fundus imaging, including UWF fluorescein angiography (UWFFA), spectral domain optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). RESULTS We analysed 38 eyes of 19 patients with unilateral Coats' disease and found that all fellow eyes (19/19; 100%) revealed vascular alterations, detected by UWFFA, predominantly located in the temporal periphery. Thereby, 89% of the fellow eyes (17/19) presented capillary bed abnormalities, that did not exceed the capillary level; 58% (11/19) presented tortuous abnormalities and 26% (5/19) presented microaneurysmatic abnormalities, exceeding the capillary level. If primarily affected eyes presented central Coats' specific vascular abnormalities, fellow eyes revealed tortuous vascular abnormalities twice as often (78% (7/9) vs 40% (4/10); P=0.096). In primarily affected eyes, a tendency towards larger foveal avascular zones was revealed, compared to fellow eyes (0.28±0.16 mm2 vs 0.20±0.10 mm2; P=0.123). CONCLUSION The use of modern multimodal imaging allows the detection of even subtle vascular changes in fellow eyes of patients with Coats' disease. Coats' disease appears to be a bilateral ocular disease with a predominant manifestation in one eye of the affected patients.
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Affiliation(s)
- Claudia Brockmann
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Julia Löwen
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Shideh Schönfeld
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | | | - Ira Seibel
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Bert Müller
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Charité Universitatsmedizin Berlin, Berlin, Germany
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Pohlmann D, Barth A, Macedo S, Pleyer U, Winterhalter S, Albayrak Ö. The impact of impending / onset of vision loss on depression, anxiety, and vision-related quality of life in Birdshot-Retinochoroiditis and Serpiginous Choroiditis. PLoS One 2020; 15:e0239210. [PMID: 33017403 PMCID: PMC7535062 DOI: 10.1371/journal.pone.0239210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022] Open
Abstract
To evaluate the impact of Birdshot-Retinochoroidopathy (BSRC) and Serpiginous Choroiditis (SC) on depression, anxiety, and vision-related quality of life. 72 individuals (BSRC: n = 28, SC: n = 8; healthy control group (HC): n = 36) completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Visual Function Questionnaire (VFQ-25). Multivariate linear regression models were used to analyze different subscales of the PHQ-9, the GAD-7 and the VFQ-25. The results showed that the mean of PHQ-9 was significantly higher while the mean of the VFQ-25 and its´ subscales were consistently lower in the disease group compared to HC. The mean of GAD-7 was not significantly lower in the disease group compared to HC. Stratification for different disease severity stages and duration of disease did not reveal any differences in sum scores of PHQ-9, GAD-7, and VFQ-25, whereas there were significant differences in some subscales of the VFQ-25. We conclude that BSRC and SC patients show higher levels of depression and a reduced visual quality of life due to imminent loss of vision. Because depression and quality of life are adversely affected by lack of social contacts and functioning, psychological treatment should enable patients to maintain their independence and ability to social interaction. Psychosomatic care should be taken in account for the treatment of BSRC and SC.
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Affiliation(s)
- Dominika Pohlmann
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Anne Barth
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sergio Macedo
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Özgür Albayrak
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Macedo S, Pohlmann D, Lenglinger M, Pleyer U, Joussen AM, Winterhalter S. Optical coherence tomography angiography (OCTA) findings in Serpiginous Choroiditis. BMC Ophthalmol 2020; 20:258. [PMID: 32605555 PMCID: PMC7325353 DOI: 10.1186/s12886-020-01527-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background To describe changes in the retina/choroid in patients with Serpiginous Choroiditis (SC) by Optical Coherence Tomography Angiography (OCTA) in a multimodal imaging approach. Methods Prospective, monocentric study of 24 eyes of 12 consenting patients diagnosed with SC, who underwent OCTA, which was analyzed and compared to other methods such as enhanced depth imaging-OCT, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence. Results The study group consisted of 9 patients with peripapillary SC, 1 macular SC, and 2 atypical cases. All eyes presented an inactive SC confirmed by standard imaging. OCTA demonstrated the lesions tridimensionally in great detail. There was no difference in the angioarchitecture among the 3 forms of SC. A loss of the choriocapillaris/retinal pigment epithelium left a “window-defect”, where the vessels of larger caliber of the choroid became recognizable and their appearance inverted (“white-on-black”). A relationship between the presence of segmentation errors (SE) in the slabs and low visual acuity was established with a one-way ANOVA. Conclusions OCTA was able to non-invasively assess vascular lesions of the choroid/retina in patients with SC with a high degree of correlation to other diagnostic modalities. Consequent long-term assessments could lead to a better understanding of disease progression.
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Affiliation(s)
- Sergio Macedo
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dominika Pohlmann
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias Lenglinger
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Pohlmann D, Pahlitzsch M, Schlickeiser S, Metzner S, Lenglinger M, Bertelmann E, Maier AKB, Winterhalter S, Pleyer U. Virus-associated anterior uveitis and secondary glaucoma: Diagnostics, clinical characteristics, and surgical options. PLoS One 2020; 15:e0229260. [PMID: 32092116 PMCID: PMC7039515 DOI: 10.1371/journal.pone.0229260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/02/2020] [Indexed: 12/18/2022] Open
Abstract
In this retrospective, single-center, observational study, we compared the clinical characteristics, analyzed the glaucoma development, and the glaucoma surgery requirement mediators in patients with different virus-associated anterior uveitis (VAU). In total, 270 patients (= eyes) with VAU confirmed by positive Goldmann-Witmer coefficients (GWC) for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubella virus (RV), and multiple virus (MV) were included. Clinical records of these patients were analyzed. Demographic constitution, clinical findings, glaucoma development, and surgeries were recorded. The concentrations of 27 immune mediators were measured in 150 samples of aqueous humor. The GWC analysis demonstrated positive results for CMV in 57 (21%), HSV in 77 (29%), VZV in 45 (17%), RV in 77 (29%), and MV in 14 (5%) patients. CMV and RV AU occurred predominantly in younger and male patients, while VZV and HSV AU appeared mainly with the elderly and females (P<0.0001). The clinical features of all viruses revealed many similarities. In total, 52 patients (19%) showed glaucomatous damage and of these, 27 patients (10%) needed a glaucoma surgery. Minimal-invasive glaucoma surgery (MIGS) showed a reliable IOP reduction in the short-term period. In 10 patients (37%), the first surgical intervention failed and a follow-up surgery was required. We conclude that different virus entities in anterior uveitis present specific risks for the development of glaucoma as well as necessary surgery. MIGS can be suggested as first-line-treatment in individual cases, however, the device needs to be carefully chosen by experienced specialists based on the individual needs of the patient. Filtrating glaucoma surgery can be recommended in VAU as an effective therapy to reduce the IOP over a longer period of time.
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Affiliation(s)
- Dominika Pohlmann
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Milena Pahlitzsch
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité–University Medicine, Berlin, Berlin, Germany
| | - Sylvia Metzner
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Lenglinger
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eckart Bertelmann
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna-Karina B. Maier
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sibylle Winterhalter
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Brockmann C, Müller B, Schönfeld S, Winterhalter S, Zeitz O, Joussen AM. Required stage dependent therapy in coats disease. Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claudia Brockmann
- Department of Ophthalmology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Bert Müller
- Department of Ophthalmology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Shideh Schönfeld
- Department of Ophthalmology Charité – Universitätsmedizin Berlin Berlin Germany
| | | | - Oliver Zeitz
- Department of Ophthalmology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Antonia M. Joussen
- Department of Ophthalmology Charité – Universitätsmedizin Berlin Berlin Germany
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Pohlmann D, Pleyer U, Joussen AM, Winterhalter S. Immunosuppressants and/or antivascular endothelial growth factor inhibitors in punctate inner choroidopathy? Follow-up results with optical coherence tomography angiography. Br J Ophthalmol 2018; 103:1152-1157. [DOI: 10.1136/bjophthalmol-2018-312455] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/04/2022]
Abstract
PurposeTo report the effectiveness of treatment with antivascular endothelial growth factor (VEGF)-inhibitor and/or immunosuppressants in punctate inner choroidopathy (PIC) using standard imaging modalities and optical coherence tomography angiography (OCTA) over a time period of 16 months.MethodsIn this prospective, unmasked, single-centre study, 23 individuals with PIC underwent imaging with spectral domain OCT, fluorescein angiography, indocyanine green angiography and OCTA. Two groups were formed based on systemic treatment. In case of choroidal neovascularisation (CNV) activity, intravitreal anti-VEGF injections were carried out in both groups.ResultsGroup I included 12 patients (24 eyes) with 18 affected eyes (75%) who did not receive any systemic therapy at baseline. Group II contained 11 patients (22 eyes) who started systemic immunosuppressive therapy on average 2 years before baseline. All eyes with recurrence of CNV or residual fluid (group I: seven eyes; group II: six eyes) received anti-VEGF agents. Group I showed a significant reduction of CNV size (p=0.0078), as well as a decrease of fluid retention (p=0.0078) on OCTA after anti-VEGF injection. Group II did not demonstrate any significant reduction of CNV size, vessel shape or fluid retention post injection. But overall, fluid accumulation was significantly lower in group II (median=0.03 mm2) than in group I (median=0.32 mm2) (p=0.0028).ConclusionImmunosuppressants in addition to anti-VEGF agents showed a significant reduction of fluid accumulation, that is, reduced disease activity. We conclude that there is a benefit and effectiveness of immunosuppressants to control inflammatory secondary CNV in PIC.
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Joussen AM, Brockmann C, Urban J, Seibel I, Winterhalter S, Zeitz O, Müller B. [Ultra-Wide Field Retinal Imaging and Angiography in the Differential Diagnosis and Therapeutic Decisions in Vascular Diseases of the Peripheral Retina]. Klin Monbl Augenheilkd 2018; 235:980-993. [PMID: 30216952 DOI: 10.1055/a-0667-0493] [Citation(s) in RCA: 1] [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: 10/28/2022]
Abstract
Investigation of vascular diseases of the peripheral retina requires imaging procedures that allow a comprehensive view of the periphery, as well as reproducible pictures. In particular, ultra-wide field fluorescence angiography facilitates diagnosis, therapeutic decisions and follow-up examinations. While vasculopathies such as Coats disease and familiar exudative vitreoretinopathy are diagnosed within the first and second decade of life, patients' compliance during fundus imaging is typically reduced within this age range. Compared to the repeated imaging procedures for composite formation, ultra-wide field imaging has significantly reduced recording time. Nevertheless, current imaging systems are not able to map the entire retina in scaled proportions. Therefore, the imaging frame must be guided by patients' gaze onto the affected retinal area. Moreover, the medical photographer must be aware of the clinical setting and the region of interest. Hence, previous detailed funduscopy by trained ophthalmologists will remain indispensable.
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Affiliation(s)
- Antonia M Joussen
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin.,Berlin Institute of Health (BIH), Berlin
| | - Claudia Brockmann
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin.,Berlin Institute of Health (BIH), Berlin
| | - Josefine Urban
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin
| | - Ira Seibel
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin.,Berlin Institute of Health (BIH), Berlin
| | - Sibylle Winterhalter
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin
| | - Oliver Zeitz
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin.,Berlin Institute of Health (BIH), Berlin
| | - Bert Müller
- Klinik und Poliklinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin
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Seibel I, Nürnberg D, Löwen J, Winterhalter S, Zeitz O, Joussen AM. [Peripheral Exudative Haemorrhagic Chorioretinopathy: Course of Disease and Diagnosis - Including Wide-field Imaging of Associated Diseases Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy, Therapy]. Klin Monbl Augenheilkd 2018; 235:994-1000. [PMID: 30096725 DOI: 10.1055/a-0656-6867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PEHCR (peripheral exudative haemorrhagic chorioretinopathy) is a disease manifested clinically, particularly by subretinal bleeding, retinal exudates, retinal pigment epithelium detachments (RPE detachments), exudative retinal detachment and sub-RPE bleeding. The PEHCR lesion is often characterized by its polypoidal pattern, which is very similar to PCV (polypoidal choroidal vasculopathy) polyps. Diagnosis is best made with a wide-field ICGA (indocyanine green angiography). In approximately half of patients, macular changes in the form of drusen, up to exudative AMD (age-related macular degeneration), are detected in the affected eye or partner eye. Since there is very little literature directly available on PEHCR, this work also discusses the peripheral changes described in the context of AMD that were investigated with wide-field imaging.
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Affiliation(s)
- Ira Seibel
- Klinik für Augenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin
| | - Daniela Nürnberg
- Klinik für Augenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin
| | - Julia Löwen
- Klinik für Augenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin
| | - Sibylle Winterhalter
- Klinik für Augenheilkunde, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin
| | - Oliver Zeitz
- Klinik für Augenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin
| | - Antonia M Joussen
- Klinik für Augenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin.,Klinik für Augenheilkunde, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin
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Abstract
PURPOSE To describe retinal vascular changes in Birdshot Retinochoroiditis (BSRC) with multimodal imaging techniques and functional values. METHODS In this single-center study, 64 eyes of 32 subjects with BSRC were classified according to disease activity and duration and underwent imaging with spectral domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography angiography (OCTA). RESULTS Mean age of the patients was 60 years (range, 38-74). OCTA revealed capillary loops (58%), telangiectatic vessels (44%), increased intercapillary spaces (52%), altered vascular architecture (53%), and rarefication of C-scans (63%) in retinal layers. Increased rarefications of C-scans (p = 0.0056; p = 0.0046) and altered vascular architecture (p = 0.0120; p = 0.0243) in superficial and deep capillary layers were significantly correlated with disease activity. CONCLUSION OCTA adds new insights in a multimodal imaging approach of retinal vascular layer visualization in BSRC and may contribute to existing methods for diagnosing severity and potentially progression of the disease.
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Affiliation(s)
- Dominika Pohlmann
- a Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sergio Macedo
- a Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nicole Stübiger
- a Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- a Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Antonia M Joussen
- a Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- a Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Pohlmann D, Schlickeiser S, Metzner S, Lenglinger M, Winterhalter S, Pleyer U. Different composition of intraocular immune mediators in Posner-Schlossman-Syndrome and Fuchs' Uveitis. PLoS One 2018; 13:e0199301. [PMID: 29944680 PMCID: PMC6019249 DOI: 10.1371/journal.pone.0199301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022] Open
Abstract
Posner-Schlossman-Syndrome (PSS) is clinically characterized by acute, recurrent, mild, unilateral uveitis anterior accompanied by elevated intraocular pressure (IOP). Fuchs´ Uveitis (FU) is a chronic, low-grade-inflammatory disorder, involving anterior uvea and vitreous. The clinical findings show remarkable similarities as well as differences. In our study, we determine the composition of immune mediators in aqueous humor of patients with PSS and FU and evaluate if immune mediators play a crucial role in specific viral intraocular inflammation and IOP rises. Aqueous humor samples from 81 uveitis patients (= eyes) presenting with either PSS or FU were collected at one time point. Local intraocular antibody synthesis to rubella virus was confirmed in 65 patients, whereas 16 were tested positively for human cytomegalovirus. Thirteen patients with PSS and 10 patients with FU were treated with glaucoma medications. Additionally, 11 cataract patients acted as control group. Immune mediator concentrations were measured by Bio-Plex Pro assay. We observed in both PSS (IFN-γ: 174.9 pg/mL; TNF-α: 25.1 pg/mL) and FU (IFN-γ: 25.4 pg/mL; TNF-α: 27.2 pg/mL) groups a significantly increased level of T-helper 1 immune mediators compared to controls (IFN-γ, TNF-α: 0 pg/mL) [median]. Notably, PSS patients (IL-1RA: 73.4 pg/mL; IL-8: 199.4 pg/mL; IL-10: 33.4 pg/mL; IP-10: 126350 pg/mL) showed a stronger and more active ocular inflammatory response, than FU patients (IL-1RA: 4.3 pg/mL; IL-8: 72.4 pg/mL; IL-10: 1.6 pg/mL; IP-10: 57400 pg/mL). Furthermore, a negative correlation between mediators and IOP was seen in the PSS group, potentially caused by acetazolamide-treatment. Our findings show that immune mediators play a crucial role in specific viral intraocular inflammation and influence IOP levels. Remarkable similarities but also significant differences of immune mediator concentrations are apparent in PSS compared to FU. High concentrations of IL-1RA, IL-8, IL-10, and IP-10 correlate with active inflammation in PSS, while FU may trigger chronic inflammation. Our data also substantiated a very similar composition of cytokines in those patients from the PSS group suffering from ocular hypertension and thus offers a potential explanation model for a negative correlation between mediators and IOP.
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Affiliation(s)
- Dominika Pohlmann
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Metzner
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Lenglinger
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Pohlmann D, Pleyer U, Joussen AM, Winterhalter S. Optical coherence tomography angiography in comparison with other multimodal imaging techniques in punctate inner choroidopathy. Br J Ophthalmol 2018; 103:60-66. [DOI: 10.1136/bjophthalmol-2017-311764] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 11/03/2022]
Abstract
AimsTo characterise punctate lesions and choroidal neovascularisation (CNV) in eyes with punctate inner choroidopathy (PIC) using current standard multimodal imaging techniques and optical coherence tomography angiography (OCTA).MethodsIn our prospective, single-centre study, 20 individuals with PIC underwent imaging with spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), indocyanine green angiography, fundus autofluorescence, fundus colour photography and OCTA.ResultsThirty-two eyes of 20 patients were affected. Eight (20%) eyes revealed typical punctate lesions, while 24 (60%) eyes had confirmed CNV on SD-OCT and FA in addition to punctate lesions. Of these 24 eyes with CNV, a reoccurrence of active CNV was detected in 5 (21%) eyes, a residual fluid in 3 (13%) eyes, while 16 (67%) eyes were defined as being stable. On OCTA, CNV was classified as having ‘lacy wheel’, ‘pruned large-trunk’ and ‘dead tree aspect’ vessel shapes with or without areas of non-perfusion. The disease activity was dependent on several predictors in the regression analysis such as intraretinal fluid (p=0.0014), CNV type (p=0.0199), leakage (p<0.0001) and hypoperfusion/non-perfusion (p<0.0001) on OCTA.ConclusionOCTA offers additional valuable insight into the current standard multimodal imaging techniques used for characterisation of PIC. This imaging technique can be a useful tool for analysis of disease activity.
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Pohlmann D, Vom Brocke GA, Winterhalter S, Steurer T, Thees S, Pleyer U. Dexamethasone Inserts in Noninfectious Uveitis: A Single-Center Experience. Ophthalmology 2018; 125:1088-1099. [PMID: 29459041 DOI: 10.1016/j.ophtha.2017.12.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/22/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To report the effectiveness of repeated intravitreal dexamethasone (DEX) inserts in noninfectious uveitis patients. DESIGN Prospective, single-center, interventional clinical trial between February 2010 and March 2015. PARTICIPANTS Patients with noninfectious uveitis with cystoid macular edema and/or vitreitis. METHODS Patients were treated with a 700-μg intravitreal DEX insert (Ozurdex; Allergan, Inc., Irvine, CA). Follow-up visits were scheduled 1, 3, and 6 months after injection. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze (VH) score, intraocular pressure (IOP), and adverse events were recorded. MAIN OUTCOME MEASURES Primary outcome was the reduction of CRT. Secondary outcome was the improvement in BCVA and reduction of VH. RESULTS In total, 109 eyes of 76 patients received 298 DEX inserts. Fifty-two patients were women (68%). The mean age of all participants was 57 years (range, 24-88 years). More than 3 DEX inserts were injected into 44% of eyes. Mean number of injections were 1.54±0.5 (standard deviation [SD]), 1.98±0.84, and 2.46±1.1 over 12, 18, and 24 months, respectively. Central retinal thickness decreased significantly (P < 0.001) from 465 μm at baseline to 318, 342, and 388 μm after 1, 3, and 6 months, respectively. Similar trends were seen in eyes receiving a second, third, and fourth DEX insert. Patients with idiopathic uveitis and sarcoidosis benefited well from DEX inserts. The greatest overall benefit was achieved in patients with no systemic treatment and patients receiving antimetabolites and cyclosporin A. A significant VH score reduction was documented in 44% of eyes after 1 month. A gain of more than 3 lines in BCVA was recorded in 31% to 37%, 26% to 39%, and 8% to 32% of eyes after 1, 3, and 6 months, respectively. A transient rise in mean IOP after 1 month (P < 0.001) and after 3 months (P = 0.001) was seen. CONCLUSIONS The repeated longer-term administration of DEX inserts in noninfectious uveitis patients, either alone or in combination with other therapies, led to improved CRT, BCVA, and VH. Underlying diseases and concomitant systemic therapy seem to have an impact on overall treatment benefit. Ocular complications were reversible and were managed by local treatment, with exception of cataract formation.
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Affiliation(s)
- Dominika Pohlmann
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerrit A Vom Brocke
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Theresa Steurer
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabrina Thees
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Winterhalter S, Behrens UD, Salchow D, Joussen AM, Pleyer U. Dexamethasone implants in paediatric patients with noninfectious intermediate or posterior uveitis: first prospective exploratory case series. BMC Ophthalmol 2017; 17:252. [PMID: 29246154 PMCID: PMC5732406 DOI: 10.1186/s12886-017-0648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of dexamethasone (DEX) implants in paediatric patients with noninfectious intermediate or posterior uveitis. METHODS Prospective single center exploratory case series. Children and adolescents, 6 to 17 years old, with a vitreous haze score of ≥1.5+ or cystoid macular edema (CME) of >300 μm were enrolled. Vitreous haze score at month 2 was chosen as primary endpoint. Best corrected visual acuity (BCVA), central retinal thickness (CRT) and concomitant medication at month 6 were defined as secondary endpoints. Intraocular pressure (IOP) and cataract formation were determined as safety endpoints. RESULTS Three out of 6 eligible patients participated in the case series. At month 2, vitreous haze was reduced from a score of 1.5+ to 0.5+ and 0 and BCVA improved by ≥3 lines, ≥4 lines and ≥2 lines of Early Treatment of Diabetic Retinopathy (ETDRS)-letters, respectively. Visual acuity gain was accompanied by a CRT reduction of -186 μm and -83 μm in the first and third patient, in whom CME was the indication for DEX implantation. A reduction of concomitant medication was achieved in 1 patient. IOP increase was seen in all 3 patients, but could be treated sufficiently with primarily IOP lowering medications and without need for glaucoma surgery. Cataract progression did not occur. CONCLUSIONS DEX implants led to an improvement in all endpoints, especially BCVA. This study confirms that IOP rises may also occur in the paediatric population and should be monitored and treated appropriately. TRIAL REGISTRATION European Union Drug Regulating Authorities Clinical Trials (EudraCT)- nr: 2013-000541-39.
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Affiliation(s)
- Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Uwe Diedrich Behrens
- Coordination Center for Clinical Studies, Campus Virchow- Klinikum, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Salchow
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Antonia M. Joussen
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Winterhalter S, Eckert A, Vom Brocke GA, Schneider A, Pohlmann D, Pilger D, Joussen AM, Rehak M, Grittner U. Real-life clinical data for dexamethasone and ranibizumab in the treatment of branch or central retinal vein occlusion over a period of six months. Graefes Arch Clin Exp Ophthalmol 2017; 256:267-279. [PMID: 29185099 DOI: 10.1007/s00417-017-3852-1] [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: 07/21/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the therapeutic outcome for dexamethasone implant (DEX) or intravitreal ranibizumab (IVR) injections over 6 months in patients with macular edema due to branch or central retinal vein occlusion (BRVO, CRVO), in a real-life setting. METHODS A total of 107 patients with BRVO or CRVO were included into this retrospective single-center observational study. Patients were treated with monotherapy consisting of DEX or three monthly IVR injections following a pro re nata regimen (PRN). Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP) were compared between the two therapy groups after 1, 3 and 6 months. RESULTS BRVO patients treated with DEX achieved a statistically significant gain in BCVA measured in logMAR after 1 month (mean gain, 95% CI: 0.21, 0.08-0.34, p = 0.001), 3 months (0.16, 0.03-0.28, p = 0.012) and 6 months (0.19, 0.07-0.32, p = 0.002), whereas patients treated with IVR showed a statistically significant BCVA gain in month 3 (mean improvement, 95% CI: 0.13, 0.01-0.26, p = 0.039) and month 6 (0.16, 0.03-0.29, p = 0.018). BCVA in CRVO patients with DEX worsened slightly at month 6 (mean worsening, 95% CI: -0.08, -0.24 to 0.08, p = 0.305), while IVR treated-patients achieved a statistically significant BCVA gain at 3 months (mean improvement, 95% CI: 0.14, 0.02-0.25, p = 0.021). Both therapies were accompanied by statistically significant CRT reductions of 150 to 200 μm (median). Adverse events reported were predictable and limited. CONCLUSIONS In a clinical setting, comparable improvement in BCVA and CRT were observed after DEX and IVR injections for treatment of BRVO. CRVO patients showed greater benefit with IVR.
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Affiliation(s)
- Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Annabelle Eckert
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Ophthalmicus Augentagesklinik, Villingen-Schwenningen, Germany
| | - Gerrit-Alexander Vom Brocke
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alice Schneider
- Department of Biostatistics and Clinical Epidemiology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Dominika Pohlmann
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matus Rehak
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Ophthalmology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical Epidemiology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Kakkassery V, Winterhalter S, Nick AC, Joachim SC, Joussen AM, Kociok N. Vascular-Associated Muc4/Vwf Co-Localization in Human Conjunctival Malignant Melanoma Specimens-Tumor Metastasis by Migration? Curr Eye Res 2017. [PMID: 28622066 DOI: 10.1080/02713683.2017.1324630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate whether vascular differentiation marker von Willebrand factor (vWf) and proliferation marker KI67 expression correlate with MUC4 localization around stromal tumor vascularization in human conjunctival malignant melanoma (CMM). MATERIALS AND METHODS For the purposes of this study, we analyzed samples from human CMMs (n = 4), conjunctival compound nevi (n = 7), and samples from healthy conjunctiva (n = 7) for MUC1, 4, and 16 by immunohistochemistry. To test CMM vessel association of MUC4, we investigated the co-localization of MUC4 with vWf or KI67 in human CMM specimens (n = 10) by immunohistochemistry. Also, we investigated the MUC4 localization around vessels of healthy conjunctiva (n = 10). RESULTS The immunohistochemical analysis demonstrated membrane-associated mucin expression in epithelia of CMM, nevi and healthy conjunctiva, whereas only MUC4 was localized perivascular in CMM tissue in this preliminary analysis. Co-staining analysis with vWf and KI67 demonstrated MUC4 localization around stromal vessels in human CMM specimens. In contrast, no MUC4 localization has been seen around healthy conjunctiva stroma vessels. CONCLUSIONS MUC4 was detected around vWf/KI67-positive CMM stromal vascular tissue, but not around healthy conjunctival stroma vessels. Therefore, we assume that MUC4 might play a role in tumor cell migration toward vessels inducing metastasis.
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Affiliation(s)
- Vinodh Kakkassery
- a Department of Ophthalmology , Charité Universitätsmedizin , Berlin , Germany.,b Department of Ophthalmology , University Eye Clinic, Ruhr-University , Bochum , Germany.,c Department of Ophthalmology , University of Rostock , Rostock , Germany
| | | | - Ann-Christin Nick
- b Department of Ophthalmology , University Eye Clinic, Ruhr-University , Bochum , Germany
| | - Stephanie C Joachim
- b Department of Ophthalmology , University Eye Clinic, Ruhr-University , Bochum , Germany
| | - Antonia M Joussen
- a Department of Ophthalmology , Charité Universitätsmedizin , Berlin , Germany
| | - Norbert Kociok
- a Department of Ophthalmology , Charité Universitätsmedizin , Berlin , Germany
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Rübsam A, Thieme CE, Schlomberg J, Winterhalter S, Müller B, Joussen AM, Stübiger N. Therapy Rationale for Mineralocorticoid-Receptor Antagonists, Acetazolamide and a Switch of Therapy in Nonresponders in Central Serous Chorioretinopathy. J Ocul Pharmacol Ther 2017; 33:141-148. [DOI: 10.1089/jop.2016.0068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne Rübsam
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia E. Thieme
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Juliane Schlomberg
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Bert Müller
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Antonia M. Joussen
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Stübiger
- Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Winterhalter S, Vom Brocke GA, Pilger D, Eckert A, Schlomberg J, Rübsam A, Klamann MK, Gundlach E, Dietrich-Ntoukas T, Joussen AM. Retrospective, controlled observational case study of patients with central retinal vein occlusion and initially low visual acuity treated with an intravitreal dexamethasone implant. BMC Ophthalmol 2016; 16:187. [PMID: 27784291 PMCID: PMC5081977 DOI: 10.1186/s12886-016-0363-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 10/13/2016] [Indexed: 12/02/2022] Open
Abstract
Background Patients with initially low visual acuity were excluded from the therapy approval studies for retinal vein occlusion. But up to 28 % of patients presenting with central retinal vein occlusion have a baseline BCVA of less than 34 ETDRS letters (0.1). The purpose of our study was to assess visual acuity and central retinal thickness in patients suffering from central retinal vein occlusion and low visual acuity (<0.1) in comparison to patients with visual acuity (≥0.1) treated with Dexamethasone implant 0.7 mg for macular edema. Methods Retrospective, controlled observational case study of 30 eyes with macular edema secondary to central retinal vein occlusion, which were treated with a dexamethasone implantation. Visual acuity, central retinal thickness and intraocular pressure were measured monthly. Analyses were performed separately for eyes with visual acuity <0.1 and ≥0.1. Results Two months post intervention, visual acuity improved only marginally from 0.05 to 0.07 (1 month; p = 0,065) and to 0.08 (2 months; p = 0,2) in patients with low visual acuity as compared to patients with visual acuity ≥0.1 with an improvement from 0.33 to 0.47 (1 month; p = 0,005) and to 0.49 (2 months; p = 0,003). The central retinal thickness, however, was reduced in both groups, falling from 694 to 344 μm (1 month; p = 0.003,) to 361 μm (2 months; p = 0,002) and to 415 μm (3 months; p = 0,004) in the low visual acuity group and from 634 to 315 μm (1 month; p < 0,001) and to 343 μm (2 months; p = 0,001) in the visual acuity group ≥0.1. Absence of visual acuity improvement was related to macular ischemia. Conclusions In patients with central retinal vein occlusion and initially low visual acuity, a dexamethasone implantation can lead to an important reduction of central retinal thickness but may be of limited use to increase visual acuity. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0363-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sibylle Winterhalter
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Gerrit Alexander Vom Brocke
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annabelle Eckert
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Juliane Schlomberg
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne Rübsam
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias Karl Klamann
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Enken Gundlach
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tina Dietrich-Ntoukas
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Antonia Maria Joussen
- Department of Ophthalmology, Camus Virchow- Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Joussen AM, Strauß O, Winterhalter S, Klamann M, Dietrich-Ntoukas T, Müller B. [Ocular Hypotension: How the Retina Surgeon Sees the Causes and Therapeutic Options]. Klin Monbl Augenheilkd 2016; 233:1024-32. [PMID: 27617647 DOI: 10.1055/s-0042-109708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ocular hypotension is a result of a lack of production or a loss of intraocular fluid. Intraocular inflammation, drugs, or proliferative vitreoretinopathy (PVR) with overgrowth of the ciliary body can result in reduced secretion of intraocular fluid. Loss of intraocular fluid can result from external loss, such as in fistulating surgery or trauma, or internally, e.g. from cyclodialysis clefts or retinal detachment. In this review, we discuss the causal therapy of ocular hypotension: fixation of the ciliary body, removal of ciliary body membranes, surgery for PVR, choice of tamponade, possibilities and limitations of an iris diaphragm, and pharmacological options.
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Affiliation(s)
- A M Joussen
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
| | - O Strauß
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
| | - S Winterhalter
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
| | - M Klamann
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
| | | | - B Müller
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
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Abstract
PURPOSE To assess the efficacy and tolerability of intravitreal dexamethasone 0.7 mg sustained-release insert (Ozurdex®) in patients with sclerouveitis and recurrent cystoid macula edema (CMO) refractory to treatment. METHODS Interventional retrospective case series of five patients receiving 13 intravitreal dexamethasone inserts. RESULTS Three of five patients presented with an associated systemic disorder, whereas two patients had idiopathic sclerouveitis. All patients received immunosuppressive therapy. The CRT mean (SD) decreased in all eyes from 428 μm (137) (baseline) to 327 μm (149) (1 month), 342 μm (155) (3 months), 297 μm (99) (6 months) and reduced scleral inflammation. No morphologic adverse changes were noted, in particular, no scleral melting or necrosis occurred. CONCLUSIONS Intravitreal dexamethasone may be an effective and safe therapeutic option in sclerouveitis with otherwise treatment-resistant CMO. It resolves not only CMO, but also provides a reduction of scleral inflammation and ocular pain. Nonetheless, adequate immunosuppressive treatment of an underlying disease must ensue.
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Affiliation(s)
- Dominika Pohlmann
- a Department of Ophthalmology , University Medicine Charité, Campus Virchow Clinic , Berlin , Germany
| | - Sibylle Winterhalter
- a Department of Ophthalmology , University Medicine Charité, Campus Virchow Clinic , Berlin , Germany
| | - Uwe Pleyer
- a Department of Ophthalmology , University Medicine Charité, Campus Virchow Clinic , Berlin , Germany
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Mueller B, Salchow DJ, Waffenschmidt E, Joussen AM, Schmalisch G, Czernik C, Bührer C, Schunk KU, Girschick HJ, Winterhalter S. Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone. Br J Ophthalmol 2016; 101:365-370. [PMID: 27301450 DOI: 10.1136/bjophthalmol-2016-308375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 01/07/2016] [Revised: 04/22/2016] [Accepted: 05/18/2016] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the outcome of intravitreal bevacizumab (IVB) compared with laser photocoagulation in type I retinopathy of prematurity (ROP). METHODS Case records of 54 consecutive very low birth weight (VLBW) infants with type I ROP (posterior ROP, n=33; peripheral zone II, n=21) who were treated either with IVB (n=37) or laser photocoagulation (n=17) between 2011 and 2015 were retrospectively evaluated. RESULTS Patients with posterior ROP displayed significantly faster regression of active ROP within 12 days (range 9-15 days) if treated with IVB compared with laser photocoagulation, where active ROP regressed within 57 days (range 28-63 days) (p>0.001). No difference was observed in peripheral zone II.Five of seven patients (12%) who developed a recurrence in both eyes after IVB required additional laser photocoagulation within a mean of 12.7 weeks (11.3-15.6 weeks) after the previous treatment. After laser photocoagulation one patient with posterior ROP developed macular dragging and another patient developed a temporary exudative retinal detachment in both eyes. 12 months after treatment the spherical equivalent was not statistically significant different between IVB and laser photocoagulation in posterior ROP patients. However, IVB lead to a significant lower spherical equivalent in infants with posterior ROP (+0.37 dioptres, range -0.5 to +1.88 dioptres) compared with peripheral zone II (+3.0 dioptres range +2.0 to +4.0 dioptres, p<0.001). CONCLUSIONS IVB leads to faster regression of active ROP in infants with posterior ROP compared with laser photocoagulation. Spherical equivalent after 12 months was comparable in those treated with IVB and laser photocoagulation, but it was significantly lower in posterior ROP than in peripheral zone II.
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Affiliation(s)
- B Mueller
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - D J Salchow
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - E Waffenschmidt
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A M Joussen
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - G Schmalisch
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ch Czernik
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ch Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - K U Schunk
- Department of Neonatology, Vivantes, Klinikum Am Friedrichshain, Berlin, Germany
| | - H J Girschick
- Department of Neonatology, Vivantes, Klinikum Am Friedrichshain, Berlin, Germany
| | - S Winterhalter
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Abstract
BACKGROUND Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, mostly a diffuse large B-cell lymphoma. The PVRL, previously called primary intraocular lymphoma (PIOL), is a subset of primary central nervous system lymphoma (PCNSL). DIAGNOSIS The diagnosis of PVRL is often difficult as it often mimics chronic intermediate or posterior uveitis; therefore, PVRL requires various procedures for the diagnostics, e.g. immunohistochemistry, cytology, pathology, molecular pathology and cytokine analysis (interleukin 10) after surgically obtaining ocular specimens. THERAPY Treatment forms that are effective for systemic lymphomas have not been reliably successful for PVRL and PCNSL. Current management of PVRL consists of chemotherapy, such as methotrexate or rituximab, possibly combined with external beam radiation whereby both chemotherapeutic agents are administered systemically as well as intravitreally. Intravitreal treatment alone is recommended solely in the case of monocular PVRL, which is highly controversial. A PVRL usually responds well to initial treatment; however, relapse rates and CNS involvement are high, resulting in a poor prognosis and limited survival.
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Affiliation(s)
- N Stübiger
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland,
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Winterhalter S, Dietrich-Ntoukas T, Müller B, Joussen AM. Therapie von retinalen arteriellen Makroaneurysmen. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569204] [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: 10/22/2022]
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Klonner J, Schlomberg J, Rübsam A, Dietrich-Ntoukas T, Winterhalter S, Joussen AM, Müller B. Navigierte retinale Laserkoagulation (NaviLas®) als Therapiealternative bei Patienten mit therapierefraktärer Chorioretinopathia centralis serosa. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569203] [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: 10/22/2022]
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Rachwalik D, Winterhalter S, Pleyer U. Intravitreales Dexamethason Implantat zur Behandlung der therapierefraktären Sklerouveitis. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569170] [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: 10/22/2022]
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Pahlitzsch M, Torun N, Gonnermann J, Maier AK, Winterhalter S, Bertelmann E, Klamann MKJ. MIGS und Filtrationschirurgie: Einfluss auf die Quality of Life? Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569177] [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: 10/22/2022]
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Eckert A, Rehak M, vom Brocke GA, Maier AK, Joussen AM, Winterhalter S. Behandlung des Makulaödems im klinischen Alltag: Eine Ranibizumab-Dexamethason-Vergleichsstudie. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569199] [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: 10/22/2022]
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Stübiger N, Zeisberg AS, Winterhalter S. Ist Eplerenon eine Alternative in der Therapie azetazolamidresistenter entzündlicher Makulaödeme? Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569171] [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: 10/22/2022]
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Winterhalter S, Stuebiger N, Maier AK, Pleyer U, Heiligenhaus A, Mackensen F, Zierhut M, Joussen AM, Ness T. Acute Retinal Necrosis: Diagnostic and Treatment Strategies in Germany. Ocul Immunol Inflamm 2015; 24:537-43. [PMID: 26399848 DOI: 10.3109/09273948.2015.1034375] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To analyze the preferred practice respective diagnosis, treatment, and complications in patients with acute retinal necrosis in Germany. METHODS The uveitis-section of the German Ophthalmologic Society developed a questionnaire with 12 questions concerning patients with acute retinal necrosis seen in the 5 years up to August 2009. RESULTS In total, 35 eye hospitals answered the questionnaire and reported 213 patients with acute retinal necrosis. Diagnosis was made clinically in 86%. Anterior chamber tap, vitreous biopsy, diagnostic vitrectomy, and serology were performed for confirmation. Therapy was started with acyclovir in all institutions, and continued with ganciclovir, foscarnet and brivudine in some cases. Intravitreal injections were performed in 46%. Additional oral steroids were given in 80%. A following oral antiviral treatment was performed in 94%. CONCLUSIONS Relevant variations were seen in diagnosis and treatment practices. The survey outlines the need for a unique diagnostic and therapeutic guideline.
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Affiliation(s)
- Sibylle Winterhalter
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Nicole Stuebiger
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Anna-Karina Maier
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Uwe Pleyer
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Arnd Heiligenhaus
- b Department of Ophthalmology , St Franziskus Hospital of Muenster, University of Duisburg Essen , Essen , Germany
| | - Friederike Mackensen
- c Department of Ophthalmology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Manfred Zierhut
- d Department of Ophthalmology , University Hospital of Tuebingen , Tuebingen , Germany , and
| | - Antonia M Joussen
- a Department of Ophthalmology , Campus Virchow-Klinikum, Charité University Medicine Berlin , Berlin , Germany
| | - Thomas Ness
- e University Eye Center, University Hospital of Freiburg , Freiburg , Germany
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Davids AM, Winterhalter S, Brocke GAV, Cordini D, Joussen AM, Rehak M. Die Bedeutung der Mikroperimetrie als diagnostisches Instrument. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396503] [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: 10/24/2022]
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41
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Winterhalter S, Pleyer U. Dexamethasonimplantate zur Behandlung der nicht infektiösen Uveitis intermedia und posterior bei Kindern und Jugendlichen. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396460] [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: 10/24/2022]
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42
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Schönfeld S, Metzner S, Winterhalter S, Thieme C, Pleyer U. Behandlungsergebnisse der Cytomegalievirus-assoziierten anterioren Uveitis. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396463] [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: 10/24/2022]
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43
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Brocke GAV, Steurer T, Jacob S, Thees S, Winterhalter S, Pleyer U. Ergebnisse zur Re-Injektion von Dexamethason im Langzeitverlauf bei nicht-infektiöser Uveitis. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396459] [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: 10/24/2022]
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Pleyer U, Klamann M, Laurent TJ, Mänz M, Hazirolan D, Winterhalter S, Thurau SR. Fast and Successful Management of Intraocular Inflammation with a Single Intravitreal Dexamethasone Implant. Ophthalmologica 2014; 232:000368987. [PMID: 25428335 DOI: 10.1159/000368987] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/02/2014] [Indexed: 02/28/2024]
Abstract
Purpose: To investigate the efficacy and safety of a single dexamethasone intravitreal implant (Ozurdex®, 700 µg). Methods: In this prospective noncomparative case series, 84 patients (54 females) received a dexamethasone intravitreal implant. At weeks 4, 12 and 24 after the injection, vitreous haze, macular thickness and best corrected visual acuity (BCVA) were assessed and adverse events reported. Results: Clearance of vitreous haze could be achieved after 4 weeks in 61% of all eyes (p < 0.001) and remained significant until week 24 (p < 0.001). This was paralleled by a reduction of central retinal thickness after 4 (p < 0.001), 12 (p < 0.001) and 24 weeks (p < 0.006). Significant and fast improvement of BCVA was already achieved after 4 weeks (p < 0.001) but vanished by week 24. Intraocular pressure reached ≥35 mm Hg in 3 eyes and was significantly more frequent in intermediate uveitis compared to posterior uveitis (p < 0.016). Conclusions: The dexamethasone implant is effective in controlling intraocular posterior segment inflammation and reduces central retinal thickness fast and effectively. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Uwe Pleyer
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 2: Die unterschiedlichen Krankheitsbilder. Augenheilkunde up2date 2014. [DOI: 10.1055/s-0033-1357917] [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: 10/25/2022]
Affiliation(s)
- A. Heiligenhaus
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - M. Breitbach
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - G. Spital
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | | | | | | | - M. Becker
- Augenklinik, Stadtspital Triemli, Zürich, Schweiz
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 1: Diagnostik und Grundkonzepte der Therapie. Augenheilkunde up2date 2014. [DOI: 10.1055/s-0033-1357915] [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: 10/25/2022]
Affiliation(s)
- A. Heiligenhaus
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - M. Breitbach
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - G. Spital
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | | | | | | | - M. Becker
- Augenklinik, Stadtspital Triemli, Zürich, Schweiz
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 1: Diagnostik und Grundkonzepte der Therapie. Klin Monbl Augenheilkd 2014; 231:457-69; quiz 470-1. [DOI: 10.1055/s-0033-1357916] [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: 10/25/2022]
Affiliation(s)
- A. Heiligenhaus
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - M. Breitbach
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - G. Spital
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | | | | | | | - M. Becker
- Augenklinik, Stadtspital Triemli, Zürich, Schweiz
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 2: Die unterschiedlichen Krankheitsbilder. Klin Monbl Augenheilkd 2014; 231:555-79. [DOI: 10.1055/s-0033-1357918] [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: 10/25/2022]
Affiliation(s)
- A. Heiligenhaus
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - M. Breitbach
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | - G. Spital
- Augenabteilung am St. Franziskus-Hospital Münster, Universität Duisburg-Essen
| | | | | | | | - M. Becker
- Augenklinik, Stadtspital Triemli, Zürich, Schweiz
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Müller B, Heede S, Winterhalter S, Joussen AM. Intravitreales Avastin und klassische Laserkoagulation bei Frühgeborenenretinopathie. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363416] [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: 10/25/2022]
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Yermalitski A, Metzner S, Ruokonen P, Dobner B, Winterhalter S, Pleyer U. Klinische Befunde bei dem virusassoziierten Fuchs'schen Uveitis-Syndrom. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363363] [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: 10/25/2022]
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