Björn C. Harder

Intravitreal bevacizumab for retinopathy of prematurity.

BACKGROUND To evaluate the therapeutic effect of a single intravitreal injection of bevacizumab for treatment of threshold retinopathy in retinopathy of prematurity (ROP). METHODS The retrospective study consisted of all infants who developed threshold ROP in fundus zone I or zone II and who consecutively received an intravitreal injection of bevacizumab (0.375 mg, 0.03 mL) in local anesthesia. RESULTS Twelve infants (23 eyes) were included into the study. The mean birth weight was 625±187 g (mean±standard deviation; range: 450-810 g), mean gestational age was 25.1±1.4 weeks (range: 24.0-28.7 weeks), mean age at the time of intervention was 38.1±3.7 gestational weeks (range: 32.1-45.6 weeks), and mean follow-up was 30.4±25.9 weeks. Three children (6 eyes) showed aggressive posterior ROP. After the injection, all eyes showed a regression of plus disease within 2-6 days, a decrease in pupillary rigidity, a resolution of any tunica vasculosa lentis, and a complete regression of the retinal neovascularization within 2-3 weeks. In none of the children a second intravitreal injection of bevacizumab was performed. CONCLUSIONS A single intravitreal bevacizumab injection of 0.375 mg in 0.03 mL appears to be potentially helpful for the therapy of threshold ROP avoiding side effects of conventional retinal laser coagulation such as irreversible retinal scarring. Long-term effects and side effects may be assessed in future prospective randomized trials.

Choroidal thickness in age-related macular degeneration.

Purpose: To examine choroidal thickness in age-related macular degeneration (AMD). Methods: The hospital-based case series study included patients with nonexudative or exudative AMD as study group, and the control group consisted of subjects with a normal fundus. Choroidal thickness was measured by enhanced depth imaging of spectral domain optical coherence tomography. Results: The study group (126 patients; 204 eyes) included a nonexudative subgroup (n = 50 eyes) and an exudative subgroup (n = 154 eyes), differentiated into eyes with mostly retinal pigment epithelium detachment (n = 35), mostly retinal edema (n = 36), and a subretinal fibrotic scar (n = 83). For 29 patients with unilateral AMD, contralateral normal eyes were compared with affected eyes. The control group consisted of 189 patients (228 eyes). Comparing choroidal thickness between the affected eyes and contralateral unaffected eyes in patients with unilateral AMD revealed no statistically significant differences (all P > 0.20). After adjusting for age and refractive error, subfoveal choroidal thickness was not significantly (all P > 0.10) related with AMD neither as a whole nor with the nonexudative or exudative AMD subgroup nor with the single exudative AMD subtypes (except for the subretinal fibrotic scar subgroup; P = 0.03). Correspondingly, choroidal thickness at a horizontal distance of 1000 &mgr;m from the fovea was not significantly (all P ≥ 0.30) associated with any subgroup of AMD. In binary regression analysis, the presence of AMD or of its subtypes (except for subretinal fibrotic scar type) was not significantly (all P ≥ 0.20) associated with subfoveal or parafoveal choroidal thickness after adjustment for age and refractive error. After matching for age, refractive error, and axial length, study group and control group did not differ significantly (all P ≥ 0.25) in foveal or parafoveal choroidal thickness measurements. Conclusion: After adjusting for age and refractive error, AMD, neither in its nonexudative form nor exudative form, was significantly associated with a marked thinning or thickening of the choroid in the foveal and parafoveal region.

Intravitreal low-dosage bevacizumab for retinopathy of prematurity

To report on the therapeutic effect of intravitreal low‐dose bevacizumab for treatment for retinopathy of prematurity (ROP).

Follow-up after intravitreal triamcinolone acetonide for diabetic macular edema.

Purpose To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema. Methods The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 ± 6.2 months. Results Visual acuity improved significantly (p<0.001) from 0.89 ± 0.33 logMAR to a best minimum of 0.65 ± 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, espectively Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p<0.001), 2 months (p<0.001), 3 months (p<0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure >21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected. Conclusions The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.

Choroidal Thickness in Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE To examine choroidal thickness in nonarteritic anterior ischemic optic neuropathy (AION). DESIGN Retrospective case control study. METHODS In the eye clinic of the University Medical Center in Mannheim, Germany, we studied a group that consisted of patients with nonarteritic AION and a control group that consisted of individuals with normal fundus. Choroidal thickness was measured by the enhanced-depth imaging of spectral-domain optical coherence tomography. The main outcome measure was choroidal thickness. RESULTS The study group consisted of 20 patients: 11 patients with acute nonarteritic AION and an unaffected contralateral eye and 9 patients with acute unilateral nonarteritic AION and previously nonarteritic AION in the contralateral eye. The control group consisted of 58 patients (58 eyes). In multivariate analysis, thinner subfoveal choroidal thickness was associated with the diagnosis of nonarteritic AION (P = 0.001; regression coefficient B, -55.1), after adjusting for age (P < 0.001) and refractive error (P = 0.20). Similarly, unaffected eyes contralateral to eyes with acute nonarteritic AION as compared to control eyes showed thinner subfoveal choroidal thickness (P = 0.037) after adjusting for age (P = 0.001) and refractive error (P = 0.06). In a reverse manner, nonarteritic AION was associated with thinner subfoveal choroidal thickness (P = 0.007) after adjusting for age, optic disc diameter, gender, and refractive error. CONCLUSIONS Eyes affected by nonarteritic AION and unaffected contralateral eyes showed significantly thinner macular choroids than eyes of a control group after adjusting ocular and systemic parameters. A thin choroid may be added to the diagnostic features of nonarteritic AION. Future studies may examine the pathophysiologic meaning of the finding.

Choroidal Thickness in Open-angle Glaucoma.

Purpose:To examine choroidal thickness in open-angle glaucoma. Methods:The hospital-based case series study included a study group with patients with open-angle glaucoma and a control group. Choroidal thickness was measured by enhanced depth imaging by spectral domain optical coherence tomography. Results:The study group included 39 patients (71 eyes) and the control group consisted of 189 patients (228 eyes) with no significant difference between both groups in age (P=0.16) and refractive error (P=0.07). Choroidal thickness in the foveal region (P=0.18), at a distance of 1000 &mgr;m from the fovea (P=0.39), 2000 &mgr;m from the fovea (P=0.46), and 2500 &mgr;m from the fovea (P=0.53) did not vary significantly between both groups. In multivariable analysis with adjustment for age and refractive error, choroidal thickness at the fovea [P=0.12; regression coefficient B: minus−8.60; 95% confidence interval (CI): −19.3, 2.1], at a horizontal distance of 1000 &mgr;m from the fovea (P=0.30; regression coefficient B: −4.98; 95% CI: −14.3, 4.4), 2000 &mgr;m from the fovea (P=0.20; regression coefficient B: −20.9; 95% CI: −53.2, 11.3), and 2500 &mgr;m from the fovea (P=0.45; regression coefficient B: −2.70; 95% CI: −9.67, 4.27) was not significantly associated with the diagnosis of glaucoma. In binary regression analysis with adjustment for age and refractive error, presence of glaucoma was significantly associated neither with subfoveal choroidal thickness [P=0.12; odds ratio (OR): 0.997; 95% CI: 0.993, 1.001] nor with choroidal thickness at a horizontal distance of 1000 &mgr;m from the fovea (P=0.47; OR: 0.998; 95% CI: 0.993, 1.002), 2000 &mgr;m from the fovea (P=0.23; OR: 0.997; 95% CI: 0.993, 1.002), or 2500 &mgr;m from the fovea (P=0.46; OR: 0.998; 95% CI: 0.992, 1.004). Conclusions:After adjusting for age and refractive error, open-angle glaucoma was not significantly associated with a marked thinning or a thickening of the choroid in the foveal and parafoveal region.

Bevacizumab for occult subfoveal neovascularization in age-related macular degeneration.

Purpose To report on the treatment of exudative age-related macular degeneration by intravitreal bevacizumab (Avastin). Methods A 78-year-old patient experienced a progressive loss of visual acuity in her right eye due to an occult subfoveal neovascular membrane in age-related macular degeneration. She received an intravitreal injection of 1.5 mg bevacizumab. Results Within 4 weeks after the injection, visual acuity improved from 0.40 to 0.60 with complete resolution of subretinal and intraretinal leakage and edema as shown on optical coherence tomography. Pre-existing metamorphopsias disappeared. Intraocular pressure remained in the normal range. During the follow-up, there were no sings of intraocular inflammation or any other intraocular pathology induced by the intravitreal injection. Conclusions Intravitreal bevacizumab may potentially be helpful in the treatment of exudative age-related macular degeneration and may deserve further evaluation.

Sympathetic ophthalmia in vater association combined with persisting hyperplastic primary vitreous after cyclodestructive procedure.

Purpose To report on the occurrence of histology-proven sympathetic ophthalmia in a patient with VATER association and persisting hyperplastic primary vitreous (PHPV) after a cyclodestructive procedure was performed to treat secondary angle-closure glaucoma. Methods The left eye of a 13-year-old boy with VATER association was microphthalmic from birth and had been diagnosed with PHPV at age 1 year. It developed iris neovascularization and secondary angle-closure glaucoma, which was treated by combined cyclocryocoagulation and cyclophotocoagulation. Six weeks later, a bilateral fibrinous iritis developed. Despite intensive topical and systemic steroid treatment, the iritis persisted so that the left blind eye was enucleated. Results Histology of the enucleated eye showed a marked intraocular inflammation with lymphocytes, epithelioid cells, and multinuclear giant cells grouped around remnants of melanin-bearing cells. Conclusions Sympathetic ophthalmia may occur in patients with VATER association and PHPV after a secondary angle-closure glaucoma is treated by a combined cyclocryocoagulation and cyclophotocoagulation.

Target refraction for best uncorrected distance and near vision in cataract surgery

Purpose To assess the target refractive error after cataract surgery to achieve best uncorrected visual acuity for both distance vision and reading vision. Methods The study included patients consecutively undergoing routine phacoemulsification with clear corneal incisions and implantation of a foldable monofocal intraocular lens (IOL). Uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), uncorrected near visual acuity (UCNVA,) and best-corrected near visual acuity were measured at 93 ± 47 days (minimum 4 weeks) after surgery. Inclusion criteria were a postoperative cylindrical refractive error ≤1.5 D and an unremarkable postoperative status. Results The study included 493 eyes of 493 patients with a mean age of 74.2 ± 8.7 years and mean axial length 23.4 ± 1.1 mm. The UCDVA significantly (p<0.001) increased with decreasing myopic refractive error (spherical equivalent) towards emmetropia and then significantly (p<0.001) decreased with increasing hyperopic refractive error. The UCNVA significantly (p<0.001) decreased with decreasing myopic and increasing hyperopic refractive error. The ascending UCDVA line and the descending UCNVA line intersected in the refractive error range (spherical equivalent) of −1.00 D to −1.50 D. For patients with a BCDVA of ≥20/25, the lines of UCDVA and UCNVA intersected at a UCDVA range between 20/40 (logMAR 0.30; −1.5 D) and 20/32 (logMAR 0.26; −1.0 D) and at a UCNVA range between Jaeger 3 (logMAR 0.26) and Jaeger 4 (logMAR 0.32). Conclusions For routine unilateral cataract surgery with implantation of monofocal IOLs, target refractive error to achieve best uncorrected distance and near vision was in the range of −1.00 D to −1.50 D (spherical equivalent).

Multiple familiäre Trichoepitheliome (Brooke-Syndrom)@@@Multiple familiar trichoepithelioma (Brooke’s syndrome): Eine seltene Genodermatose mit möglicher periokulärer Manifestation@@@A rare autosomal dermatosis with possible periocular manifestation

ZusammenfassungDas autosomal-dominant vererbte Brooke-Syndrom ist durch das Auftreten multipler Trichoepitheliome, die als dichtstehende Knötchen im Gesichtsbereich imponieren, gekennzeichnet. Die Therapie besteht bei größeren Tumoren in der Exzision, bei flächenhaft ausgebreiteten Tumoren in der Dermabrasion oder Laserabtragung. Patienten mit Brooke-Syndrom sollten regelmäßig kontrolliert werden, da maligne Hauttumoren auftreten können. Wir stellen hier einen Patienten mit einem Brooke-Syndrom vor und berichten über den Behandlungsverlauf.AbstractBrooke’s syndrome is a rare autosomal dominant dermatosis characterized by multiple trichoepitheliomas, which preferentially arise in the face. Therapy consists of excisional surgery of larger tumors and for multiple lesions, dermal abrasion or laser therapy may be considered. Patients with Brooke’s syndrome should be closely followed-up due to the possible development of malignant skin tumours. Here, we present a patient with Brooke’s syndrome and report on the course of treatment.Brookes syndrome is a rare autosomal dominant dermatosis characterized by multiple trichoepitheliomas, which preferentially arise in the face. Therapy consists of excisional surgery of larger tumors and for multiple lesions, dermal abrasion or laser therapy may be considered. Patients with Brookes syndrome should be closely followed-up due to the possible development of malignant skin tumours. Here, we present a patient with Brookes syndrome and report on the course of treatment.