C. Klatt

Autologous retinal pigment epithelium–choroid sheet transplantation in age related macular degeneration: morphological and functional results

Objective: To evaluate the outcome of autologous retinal pigment epithelium (RPE)–choroid sheet transplantation after removal of a subfoveal choroidal neovascularisation (CNV) in patients with age related macular degeneration (AMD). Methods: RPE–choroid sheet transplantation was performed in 10 consecutive patients with exudative AMD (n = 9) or geographic atrophy (n = 1). After CNV extraction, an autologous RPE–choroid patch was translocated from the midperiphery under the macula. Follow-up was between 6 and 12 months. Visual acuity testing and microperimetry (Nidek-MP1) as well as autofluorescence, fluorescein and indocyanine green (ICG) angiography were performed and the data were analysed retrospectively. Results: Visual acuity (logarithm of minimum angel of resolution) before operation ranged from 0.7 to 1.8 (mean 1.37) and after operation from 0.4 to 1.6 (mean 1.24). Visual acuity after operation improved in seven patients (by a mean of 0.26), remained stable in one patient and decreased in two patients. Microperimetry showed light sensitivity and fixation on the sheet in five cases. ICG angiography demonstrated perfusion through the RPE–choroid graft in nine patients. Postoperative complications included retinal detachment (n = 1) and epiretinal membrane formation (n = 2). The patient with geographic atrophy developed a CNV after surgery. Conclusions: Autologous RPE–choroid sheet transplantation is feasible and a comparatively safe procedure. Microperimetry showed fixation and light perception over the graft with a moderate increase in mean visual acuity.

Subretinal coapplication of recombinant tissue plasminogen activator and bevacizumab for neovascular age-related macular degeneration with submacular haemorrhage

Aim: To evaluate the efficacy and safety of pars plana vitrectomy (ppV) with subretinal coapplication of recombinant tissue plasminogen activator (rtPA) and bevacizumab, and fluid–gas exchange for neovascular age-related macular degeneration (AMD) with submacular haemorrhage (SMH). Methods: Consecutive interventional case series of 12 patients with neovascular AMD with SMH with a maximum history of 14 days. All patients underwent ppV with subretinal coapplication of rtPA and bevacizumab, and fluid–gas (20% SF6) exchange. Phakic patients underwent concomitant cataract surgery. Additional injections of bevacizumab were applied intravitreally 4 and 8 weeks postop. Results: Complete displacement of SMH from the fovea was achieved in 9 of 12 patients. The mean best-corrected visual acuity (BCVA) improved significantly from preop logMAR 1.9 (range 3.0 to 0.7) to logMAR 1.2 (range 3.0 to 0.3) at 4 weeks postop (p = 0.01) and to logMAR 0.9 (range 1.6 to 0.2) at 12 weeks postop (p = 0.006). The mean improvement of BCVA 4 weeks postop as compared with preop was logMAR 0.7 (range −0.2 to 2.3). The mean improvement of BCVA 12 weeks postop as compared with preop was logMAR 0.96 (range −0.3 to 2.8). Overall, at 12 weeks postop, BCVA had improved in 10 patients, remained unchanged in one patient and worsened in one patient. Conclusion: PpV with subretinal coapplication of rtPA and bevacizumab, and fluid–gas exchange effectively displaces SMH and improves visual acuity in most patients.

Diagnostics of metamorphopsia in retinal diseases of different origins

ZusammenfassungWir untersuchten die Detektionsraten des Preferential-Hyperacuity-Perimeter- (PHP) sowie des Amsler-Tests für Metamorphopsien bei Patienten mit Makulaforamen (MF), Retinopathia centralis serosa (RCS), epiretinalen Membranen (EM), intermediärer altersbedingter Makuladegeneration (iAMD) sowie klassischen und okkulten choroidalen Neovaskularisationen (CNV) und verglichen die Ergebnisse. Wir untersuchten 147 Patienten (n=153 Augen) mit klassischer (35 Augen) und okkulter (38 Augen) CNV, iAMD (13 Augen), MF (23 Augen), RCS (11 Augen) sowie EM (13 Augen); Kontrollgruppe: 20 Augen. Bei allen Patienten wurde ein bestkorrigierter Fernvisus erhoben sowie ein Amsler-Test durchgeführt. Der PHP-Test erfolgte nach Pupillenerweiterung durch einen Untersucher. Bei allen Patienten wurde eine Fundusfotografie sowie OCT-Untersuchung (Humphrey/Zeiss OCT III) durchgeführt. Bei Patienten mit CNV und RCS erfolgte darüber hinaus eine Fluoreszeinangiographie. Die Detektionsraten für Metamorphopsien von PHP- und Amsler-Test wurden verglichen und statistisch ausgewertet. Die Sensitivität des PHP- im Vergleich zum Amsler-Test zur Detektion von Metamorphopsien betrug bei Patienten mit MF 69% vs. 85%, bei RCS 64% vs. 73%, bei EM 77% vs. 100%, bei iAMD 85% vs. 100%, bei klassischer CNV 83% vs. 94% und bei okkulter CNV 81% vs. 71%. Die Ergebnisse für Patienten mit okkulter CNV waren statistisch signifikant unterschiedlich (p=0,046, Chi-Quadrat-Test), alle anderen Ergebnisse waren ohne statistisch signifikanten Unterschied. Lediglich bei okkulten CNV ist die Detektionsrate und die Sensitivität des PHP-Tests dem Amsler-Test leicht überlegen. Bei allen anderen untersuchten Makulaerkrankungen zeigte sich eine höhere Sensitivität des Amsler-Tests gegenüber der PHP-Untersuchung (statistisch nicht signifikant bei niedrigen Fallzahlen).AbstractWe investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the χ2-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.

Diagnostik von Metamorphopsien bei Netzhauterkrankungen unterschiedlicher Genese

ZusammenfassungWir untersuchten die Detektionsraten des Preferential-Hyperacuity-Perimeter- (PHP) sowie des Amsler-Tests für Metamorphopsien bei Patienten mit Makulaforamen (MF), Retinopathia centralis serosa (RCS), epiretinalen Membranen (EM), intermediärer altersbedingter Makuladegeneration (iAMD) sowie klassischen und okkulten choroidalen Neovaskularisationen (CNV) und verglichen die Ergebnisse. Wir untersuchten 147 Patienten (n=153 Augen) mit klassischer (35 Augen) und okkulter (38 Augen) CNV, iAMD (13 Augen), MF (23 Augen), RCS (11 Augen) sowie EM (13 Augen); Kontrollgruppe: 20 Augen. Bei allen Patienten wurde ein bestkorrigierter Fernvisus erhoben sowie ein Amsler-Test durchgeführt. Der PHP-Test erfolgte nach Pupillenerweiterung durch einen Untersucher. Bei allen Patienten wurde eine Fundusfotografie sowie OCT-Untersuchung (Humphrey/Zeiss OCT III) durchgeführt. Bei Patienten mit CNV und RCS erfolgte darüber hinaus eine Fluoreszeinangiographie. Die Detektionsraten für Metamorphopsien von PHP- und Amsler-Test wurden verglichen und statistisch ausgewertet. Die Sensitivität des PHP- im Vergleich zum Amsler-Test zur Detektion von Metamorphopsien betrug bei Patienten mit MF 69% vs. 85%, bei RCS 64% vs. 73%, bei EM 77% vs. 100%, bei iAMD 85% vs. 100%, bei klassischer CNV 83% vs. 94% und bei okkulter CNV 81% vs. 71%. Die Ergebnisse für Patienten mit okkulter CNV waren statistisch signifikant unterschiedlich (p=0,046, Chi-Quadrat-Test), alle anderen Ergebnisse waren ohne statistisch signifikanten Unterschied. Lediglich bei okkulten CNV ist die Detektionsrate und die Sensitivität des PHP-Tests dem Amsler-Test leicht überlegen. Bei allen anderen untersuchten Makulaerkrankungen zeigte sich eine höhere Sensitivität des Amsler-Tests gegenüber der PHP-Untersuchung (statistisch nicht signifikant bei niedrigen Fallzahlen).AbstractWe investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the χ2-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.

Retrospective case analysis of ophthalmological and systemic risk factors in patients with retinal vascular occlusion

OBJECTIVE The aim was to determine systemic risk factors for acute central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) and to evaluate the usefulness of systemic diagnostics in CRAO and CRVO. METHODS The study consisted of a retrospective chart review including 80 patients (CRAO 38, CRVO 42). All patients underwent systemic diagnostics including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, transthoracic echocardiography (TTE), intraocular pressure measurement, glaucoma history and presence of thrombophilic factors. A systemic medical history was obtained. RESULTS Systemic hypertension was found in 76.3% CRAO and 75.6% CRVO patients. Abnormal cardiac findings were detected in 61% (CRAO) and 22% (CRVO). Abnormal carotid findings were detected in 44.1% for CRAO and 9.5% for CRVO. Pathological thrombophilic factors were found in both groups for approximately 15%. CONCLUSIONS TTE and carotid Doppler are important tools in the diagnosis of sources of emboli in patients with CRAO, while for CRVO abnormal findings are revealed by TTE and carotid Doppler less often. Thrombophilia should be ruled out in the absence of common risk factors, especially in younger patients and systemic hypertension should be adequately controlled.

Retrospektive Fallanalyse zum ophthalmologischen und internistischen Risikoprofil von retinalen Gefäßverschlüssen

OBJECTIVE The aim was to determine systemic risk factors for acute central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) and to evaluate the usefulness of systemic diagnostics in CRAO and CRVO. METHODS The study consisted of a retrospective chart review including 80 patients (CRAO 38, CRVO 42). All patients underwent systemic diagnostics including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, transthoracic echocardiography (TTE), intraocular pressure measurement, glaucoma history and presence of thrombophilic factors. A systemic medical history was obtained. RESULTS Systemic hypertension was found in 76.3% CRAO and 75.6% CRVO patients. Abnormal cardiac findings were detected in 61% (CRAO) and 22% (CRVO). Abnormal carotid findings were detected in 44.1% for CRAO and 9.5% for CRVO. Pathological thrombophilic factors were found in both groups for approximately 15%. CONCLUSIONS TTE and carotid Doppler are important tools in the diagnosis of sources of emboli in patients with CRAO, while for CRVO abnormal findings are revealed by TTE and carotid Doppler less often. Thrombophilia should be ruled out in the absence of common risk factors, especially in younger patients and systemic hypertension should be adequately controlled.

Retrospektive Fallanalyse zum ophthalmologischen und internistischen Risikoprofil von retinalen Gefäßverschlüssen@@@Retrospective case analysis of ophthalmological and systemic risk factors in patients with retinal vascular occlusion

OBJECTIVE The aim was to determine systemic risk factors for acute central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) and to evaluate the usefulness of systemic diagnostics in CRAO and CRVO. METHODS The study consisted of a retrospective chart review including 80 patients (CRAO 38, CRVO 42). All patients underwent systemic diagnostics including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, transthoracic echocardiography (TTE), intraocular pressure measurement, glaucoma history and presence of thrombophilic factors. A systemic medical history was obtained. RESULTS Systemic hypertension was found in 76.3% CRAO and 75.6% CRVO patients. Abnormal cardiac findings were detected in 61% (CRAO) and 22% (CRVO). Abnormal carotid findings were detected in 44.1% for CRAO and 9.5% for CRVO. Pathological thrombophilic factors were found in both groups for approximately 15%. CONCLUSIONS TTE and carotid Doppler are important tools in the diagnosis of sources of emboli in patients with CRAO, while for CRVO abnormal findings are revealed by TTE and carotid Doppler less often. Thrombophilia should be ruled out in the absence of common risk factors, especially in younger patients and systemic hypertension should be adequately controlled.