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Featured researches published by Christoph Mayer.


PLOS ONE | 2015

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

Laura Pertl; Gernot Steinwender; Christoph Mayer; Silke Hausberger; Eva-Maria Pöschl; Werner Wackernagel; Andreas Wedrich; Yosuf El-Shabrawi; Anton Haas

Introduction Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors. Methods The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library. Results This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents. Discussion VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.


Acta Ophthalmologica | 2014

Ozurdex® reduces the retinal thickness in radiation maculopathy refractory to bevacizumab

Lisa Tarmann; Gerald Langmann; Christoph Mayer; Martin Weger; Anton Haas; Werner Wackernagel

pathognomonic for classic WD. He was diagnosed with kidney sarcoidosis before the WD diagnosis and was pharmacologically immunosuppressed. After the patient had his first cataract surgery performed, a severe mostly posterior uveitis was diagnosed. It did not respond to neither topical nor systemic immunosuppressive treatment. Case reports have described uveitis after intraocular operations in patients unknown to have WD, only diagnosed later on by vitreous samples. It is uncertain whether it is the operation in itself or the use of post-operative topical steroids that provokes the development of uveitis in these WD patients (Drancourt et al. 2009). In parallel with the eye problems, the patient developed significant neurological symptoms indicating involvement of the brain. WD is a fascinating disease entity with a wide range of clinical manifestations and has been considered to be an extremely rare disease (Raoult et al. 2000). This makes it difficult for clinicians to identify cases, especially the non-classic cases, with more atypical symptoms and findings. New data indicate that Tropheryma whipplei is ubiquitous in the environment (Maiwald et al. 1998). Clinicians treating patients with diffuse symptoms involving the brain and the eyes should not forget about this very rare disease which can be treated effectively with antibiotics.


British Journal of Ophthalmology | 2014

Local tumour control and eye preservation after gamma-knife radiosurgery of choroidal melanomas

Werner Wackernagel; Etienne Holl; Lisa Tarmann; Christoph Mayer; Alexander Avian; Mona Regina Schneider; Karin S. Kapp; Gerald Langmann

Background/aims To report on local tumour control and eye preservation after gamma knife radiosurgery (GK-RS) to treat choroidal melanomas. Methods A total of 189 patients with choroidal melanoma were treated with GK-RS, with treatment doses between 25 and 80 Grays. The main outcome measures of our retrospective analysis were local tumour control, time to recurrence, eye retention rate and the reason for and time to secondary enucleation. Patient-associated, tumour-associated and treatment-associated parameters were evaluated as potential risk factors. Results Local tumour control was achieved in 94.4% of patients. The estimated tumour control rates were 97.6% at 1u2005year, 94.2% at 5u2005years and 92.4% at 10u2005years after treatment. Recurrence was observed between 3.1u2005months and 60.7u2005months post-treatment (median: 13.5u2005months). Advanced tumour stage (Tumour, Node, Metastasis (TNM) 3–4) was the most important risk factor for recurrence (Fine-Gray model; subhazard ratio, SHR: 3.3; p=0.079). The treatment dose was not related to tumour recurrence. The eye preservation rate was 81.6% at 5u2005years after treatment, remaining stable thereafter. Twenty-five eyes (14.1%) had to be enucleated at between 17u2005days and 68.0u2005months (median: 13.9u2005months) after GK-RS, and advanced tumour stage (Cox model; p=0.005), treatment dose (p=0.048), pretreatment visual acuity (p=0.016), and retinal detachment (p=0.027) were risk factors for requiring enucleation. Conclusions GK-RS achieved a high tumour control rate, comparable to linear accelerator-based radiotherapy. Advanced TNM stage was a predictive risk factor for tumour recurrence and for secondary enucleation after GK-RS. Lower treatment doses were unrelated to tumour recurrence, although they were associated with an improved eye retention rate.


British Journal of Ophthalmology | 2015

New insights into oculodermal nevogenesis and proposal for a new iris nevus classification

Christoph Schwab; Iris Zalaudek; Christoph Mayer; Regina Riedl; Werner Wackernagel; Herbert Juch; Birgit Aigner; Alexandra Maria Giovanna Brunasso; Gerald Langmann; Erika Richtig

Background/aims To gain more knowledge about presence and dermatological associations of iris nevi as well as possible pathways involved in the formation of iris nevi. Methods We conducted a prospective, interdisciplinary observational study. Presence, morphology, topography of iris and cutaneous nevi as well as factors indicating sun-exposure were noted. Results A total of 632 participants including 360 (57%) women were examined. Of those, 26 subjects revealed 27 iris nevi. According to the current classification, all iris nevi were judged as solitary with the majority of them (n=20; 74%) located in the lower quadrants. In six (22.2%) cases we noted a peculiar incomplete sectoral pattern; these nevi were located close to the pupil, were larger and had a more elongated, triangular shape compared with those located distant from the pupil, which appeared smaller and more roundish. Notably, five of these six peculiar (incomplete sectoral) iris nevi were located on the upper half of the iris. Conclusions Based on our findings we propose classifying iris nevi into sectoral, incomplete sectoral and solitary subtypes. Additionally, we set up a hypothetic concept of oculodermal nevogenesis suggesting a time-dependent embryogenic alteration affecting the normal melanocyte location, migration and maturation along peripheral nerve sheets. Our new concept explains well the morphology and extension of benign melanocytic proliferations in the ocular region as well as their relation to uveal melanoma.


British Journal of Ophthalmology | 2015

Ruthenium-106 plaque brachytherapy for uveal melanoma

Lisa Tarmann; Werner Wackernagel; Alexander Avian; Christoph Mayer; Mona Regina Schneider; Peter Winkler; Gerald Langmann

Background To report on local tumour control, eye preservation and visual outcome after ruthenium-106 brachytherapy for uveal melanoma. Methods Medical records of 143 eyes with uveal melanoma, treated by ruthenium-106 brachytherapy between 1997 and 2012 at one single centre, were included. Primary outcome measures were local tumour control, eye preservation and visual outcome. The influence of patient, tumour and treatment parameters on outcome was analysed by time to event analysis and competing risk regression. Results The median overall follow-up was 37.9u2005months. Tumour control: recurrent tumour growth was observed in 17 patients. The estimated local tumour recurrence rate at 12, 24 and 48u2005months after irradiation was 3%, 8.4% and 14.7%, respectively. The only significant risk factors for tumour recurrence were age (p=0.046) and reduced initial visual acuity (VA, p=0.045). No significant difference could be shown for tumour size or tumour category (T1–T2 vs T3–T4), and for any other tumour or treatment parameters (including combined transpupillary thermo-therapy (TTT)). Eye preservation: The likelihood of keeping the eye 12, 24 and 48u2005months after irradiation was 97.7%, 94.7% and 91.8%, respectively. Most significant risk factors for secondary enucleation were initial VA (p<0.001), tumour height (p=0.002) and tumour category (p=0.015). Vision The chances of keeping VA of 20/200 or better at 1, 2 and 5u2005years after treatment were 86.4%, 80.8% and 61.7%, respectively. Patients receiving sandwich-TTT showed significantly worse visual outcomes. Conclusions Ruthenium-106 brachytherapy appears to be a useful treatment regarding tumour control, eye preservation and visual function. Adjunct sandwich therapy resulted in worse visual outcome.


Acta Ophthalmologica | 2010

von Hippel–Lindau disease: treatment of retinal haemangioblastomas by targeted therapy with systemic bevacizumab

Werner Wackernagel; Eva-Maria Lackner; Stefan Pilz; Christoph Mayer; Vinzenz Stepan

Editor, W e read with interest the report by von Buelow and colleagues in this journal on the systemic treatment of a sporadic juxtapapillary retinal haemangioma with systemic bevacizumab (von Buelow et al. 2007). We present a similar case of a patient who underwent treatment with systemic bevacizumab for recurrent retinal haemangiomas associated with von Hippel–Lindau (VHL) disease. To our knowledge, this is the first report on the use of bevacizumab for this indication. VHL disease is an autosomaldominant inherited phacomatosis. Affected individuals develop retinal capillary haemangiomas (RCHs) and haemangioblastomas of the central nervous system, renal cell carcinomas, pheochromocytomas and other tumours (Singh et al. 2001). The underlying mechanism of VHL disease is a mutation of the VHL tumour suppressor gene, resulting in increased levels of the hypoxia inducible factor (HIF) and subsequently the over-expression of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), transforming growth factor-a (TGF-a) and erythropoietin. A 22-year-old woman was diagnosed with VHL disease in 1996 after she had noticed reduced visual acuity in her left eye caused by multiple RCHs in both eyes, which were treated with photocoagulation at another hospital. On her left eye she developed retinal detachment and finally, at the age of 29, after multiple surgeries (encircling band and vitrectomy), the left eye became blind and painful and finally had to be enucleated. Genetic testing confirmed VHL disease. She was first seen at our clinic in Graz at the age of 30, with best-corrected visual acuity (BCVA) in the right eye of 20 ⁄ 20. She continued to develop new RCHs, which were treated with lasercoagulation but showed only incomplete regression (Fig. 1A). Vision remained stable until 2007, when BCVA dropped to 20 ⁄ 30 because of a posterior vitreous detachment and vitreous bleeding. Ultrasonography (Cine-Scan S; Quantel Medical, Clermont-Ferrand France) showed circumscribed tractional retinal detachment and confirmed vitreous traction to the apex of the haemangiomas (Fig. 1B). The vitreous bleeding resolved spontaneously. However, BCVA did not improve and cystoid macular oedema (CMO) was diagnosed on optical coherence tomography (OCT) (Carl Zeiss Ophthalmic Systems Inc., Humphrey Division, Dublin, California, USA) (Fig. 1C) and flourescein angiography (FA) (Fig. 1D). CMO did not improve over the following 6 months and peripheral retinal haemangiomas progressed. The patient refused any surgery or invasive treatment, including intravitreal injections. Finally we decided to treat the patient with bevacizumab intravenously at a dose of 5 mg ⁄kg over 90 min every second week after informed consent was given. Treatment was tolerated well except for paraesthesia and petechial bleeding of nail beds, which presented after the first cycle. Before each therapy with bevacizumab the patient’s blood pressure and renal parameters were evaluated. After 2 months, BCVA improved to 20 ⁄25


Spektrum Der Augenheilkunde | 2013

Genetic analysis of uveal melanoma by array comparative genomic hybridization before and after radiotherapy

Werner Wackernagel; Lisa Tarmann; Christoph Mayer; Gerald Langmann; Andreas Wedrich

SummaryBackgroundGenetic analysis of choroidal melanoma is frequently used to estimate the risk of metastatic spread of the tumor. Obtaining a biopsy for genetic analysis, however, can be difficult and sometimes unsuccessful. We evaluated the feasibility and accuracy of genetic testing using array comparative genomic hybridization (CGH) after radiotherapy, from tumor samples obtained by endoresection or after secondary enucleation.Material and methodsFifteen choroidal melanoma samples obtained after radiotherapy (Ruthenium-106 plaque brachytherapy or Gamma-Knife radiosurgery) were analyzed by array CGH to detect chromosomal aberrations (monosomy 3 and trisomy 8q), and the results were compared with pre-irradiation findings in five cases.ResultsArray CGH was successfully performed in all 15 cases. Time from radiotherapy to obtaining the sample for cytogenetic testing was between 14 and 879 days. Results of post-radiotherapy genetic analysis did not differ from pre-radiotherapy findings.ConclusionPost-radiation CGH appears to be a promising option for prognostic testing if a first biopsy before radiotherapy failed or was not performed. It could be useful to avoid an additional surgical procedure before radiotherapy if vitrectomy or endoresection is planned after radiotherapy.ZusammenfassungHintergrundDie genetische Untersuchung von Aderhautmelanomen ist eine zunehmend häufiger eingesetzte Methode, um das Risiko der Metastasenentwicklung bei PatientInnen mit Aderhautmelanomen einzuschätzen. Die Gewinnung einer Gewebeprobe zur Durchführung der Untersuchung ist jedoch manchmal schwierig und nicht in allen Fällen erfolgreich. Wir untersuchten die Durchführbarkeit und Genauigkeit der genetischen Untersuchung von Aderhautmelanomen mittels array comparative genomic hybridization (CGH) nach Strahlentherapie, an mittels Endoresektion oder nach Enukleation gewonnenem Tumormaterial.Material und MethodeFünfzehn Gewebeproben von strahlentherapeutisch behandelten Aderhautmelanomen wurden mittels array-CGH auf Veränderungen an den Chromosomen 3 und 8 untersucht (Monosomie 3, Trisomie 8q). Die Ergebnisse wurden mit den in fünf Fällen vorliegenden Resultaten der genetischen Untersuchung vor Bestrahlung verglichen.ResultateDie array CGH konnte in allen 15 Fällen nach Bestrahlung erfolgreich durchgeführt werden. Die Zeitspanne von der Bestrahlung bis zur genetischen Untersuchung lag zwischen 14 und 879 Tagen. Die Resultate der genetischen Untersuchung nach Bestrahlung unterschieden sich nicht von den Ergebnissen der in 5 Fällen vorliegenden Ergebnissen vor der Bestrahlung.SchlußfolgerungDie array CGH von Aderhautmelanomen nach Strahlentherapie erscheint eine vielversprechende Option zur prognostischen Unteruchung in den Fällen zu sein, in denen eine Biopsie vor Bestrahlung nicht durchgeführt wurde oder nicht erfolgreich war. Im Falle einer geplanten Endoresektion nach Bestrahlung, könnte auf einen zusätzlichen Eingiff zu Biopsie vor der Bestrahlung verzichtet werden.


Cells Tissues Organs | 2016

A Unifying Concept of Uveal Pigment Cell Distribution and Dissemination Based on an Animal Model: Insights into Ocular Melanogenesis.

Christoph Schwab; Werner Wackernagel; Petra Grinninger; Christoph Mayer; Katharina Schwab; Gerald Langmann; Erika Richtig; Andreas Wedrich; Rainer Hofmann-Wellenhof; Iris Zalaudek

Pigmented cells are derived from neural crest cells, which migrate along the peripheral nerve sheets into their specific final region. During their migration, cells progressively acquire pigment-producing capabilities, maturation, and the shape of melanocytes. These insights, along with specific clinical characteristics of melanocytic nevi, have led to new concepts of cutaneous, periocular, and iris nevogenesis. To further elucidate the specific ocular embryogenic melanoblast distribution and dissemination - that could explain the distinct distribution of uveal melanocytic neoplasms - we investigated the ocular pigmentation of dogs affected by a specific mutation called Merle, which results in either pigment- (wild type) or non-pigment- (mutated type) producing cells. Based on our observations, we propose a unifying concept of uveal pigment cell distribution and dissemination, which postulates melanoblast migration and maturation following the trigeminal V1 branch and, later, their entrance into the eye along the ciliary nerves and their finest iris branches. Our concept provides an explanation not only for the specific distribution of ocular melanocytic lesions, including uveal and iris nevi, but also for the different locations depending on the metastatic potential of the ocular melanoma. Though speculative, the higher metastatic potential of posterior uveal melanomas compared to iris melanomas may be related to a less differentiated stage in the maturation of migrating melanocytes in the posterior segment compared to the anterior segment of the eye. However, there is a need of further studies focusing on cell differentiation markers of melanocytes at different locations in the eye.


Investigative Ophthalmology & Visual Science | 2017

Iris Freckles a Potential Biomarker for Chronic Sun Damage.

Christoph Schwab; Christoph Mayer; Iris Zalaudek; Regina Riedl; Markus Richtig; Werner Wackernagel; Rainer Hofmann-Wellenhof; Georg Richtig; Gerald Langmann; Lisa Tarmann; Andreas Wedrich; Erika Richtig

PurposenTo investigate the role of sunlight exposure in iris freckles formation.nnnMethodsnWe prospectively examined volunteers attending a skin cancer screening program conducted by ophthalmologists and dermatologists. Frequency and topographical variability of iris freckles were noted and associated with behavioral and dermatologic characteristics indicating high sun exposure.nnnResultsnSix hundred thirty-two participants (n = 360; 57% female) were examined. Mean age of all participants was 38.4 ± 18.4 years (range, 4-84 years). Of all individuals, 76.1% (n = 481) exhibited at least one iris freckle. Most freckles were observed in the inferior temporal quadrant. The presence of iris freckles was associated with higher age (participants with iris freckles: 41.8 ± 16.8 years versus participants without iris freckles: 27.6 ± 19.2 years), a high number of sunburns during lifetime (>10: 31% vs. 19%), sunlight-damaged skin (26% vs. 11%), presence of actinic lentigines (72% vs. 45%), and a high total nevus body count (>10; 78% vs. 67%).nnnConclusionsnThe association of iris freckles, behavioral factors, and dermatologic findings, as well as the topographical distribution, indicate that sunlight exposure may trigger the formation of iris freckles. The evaluation of iris freckles offers an easily accessible potential biomarker, which might be helpful in indicating sun damage on the skin associated with cutaneous malignancies. Furthermore, the evaluation of iris freckles could also be helpful in understanding the role of sunlight in several ophthalmologic diseases.


Spektrum Der Augenheilkunde | 2016

Ärzteausbildung neu 2015: Facharztausbildung neu im Sonderfach Augenheilkunde und Optometrie an der Universitäts-Augenklinik Graz

Andrea Langmann; Gerald Langmann; D. F. Rabensteiner; Harald Zenz; Ingrid Boldin; Silke Hausberger; Beate Langner-Wegscheider; Christoph Mayer; Eva-Maria Pöschl; Christina Wohlfart; Stefan Palkovits; Andreas Wedrich

ZusammenfassungHintergrundAm 29.5.2015 wurde vom österreichischen Bundesministerium für Gesundheit eine neue Ärzteausbildungsordnung erlassen, deren Ausbildungsinhalte und neuen Rasterzeugnisse am 19.6.2015 in der Generalversammlung der Österreichischen Ärztekammer beschlossen wurden. Für alle ab 1.6.2015 neu in die österreichische Ärzteliste eingetragenen KollegInnen ist die Umsetzung der Ärztenovelle somit gesetzlich gültig, was bedeutet, dass mit frühestens 1.3.2016 die erste Sonderfach-Grundausbildung und mit 1.6.2017 die erste Sonderfach-Schwerpunkt Ausbildung angeboten werden muss.Material und MethodeUm auf diese Änderungen vorbereitet zu sein, arbeitete eine Arbeitsgruppe „AssistentInnen Ausbildung neu“ in 12 Sitzungen und 2 Workshops ein Konzept aus, das die Struktur, die Inhalte, nationale und internationale Voraussetzungen (ÖOG Rasterzeugnis, International Council of Ophthalmology, und European Board of Ophthalmology) und eine elektronische Dokumentation der neuen Ausbildung umfasste. Die Projektplanung erfolgte nach der RADAR Logik des EFQM Models (European Foundation for Quality Management).ErgebnisseDie in der neuen Ausbildungsordnung 36-monatige Facharzt-Grundausbildung wird in Graz in einen basics und einen intermediate level unterteilt. An diesen schließt sich die 27-monatige (3 mal 9 Monate) Facharzt–Schwerpunktausbildung als advanced level. Die Lernziele sind in allen Ebenen modular gegliedert und elektronisch abrufbar, sodass der Lernerfolg jederzeit vom Lehrenden und vom Auszubildenden einsehbar ist. Das parallel dazu laufende elektronisch dokumentierte Rotationssystem ermöglicht zudem eine optimierte, dem jeweiligen Ausbildungsstand des Auszubildenden angepasste Einteilung.SchlussfolgerungenDie in der neuen Ärzteausbildungsordnung 2015 geforderte Ausbildungsreform macht strukturelle Veränderungen im Sinne einer modularen Gestaltung der Facharztausbildung notwendig. Diese Anpassung wurde zum Anlass genommen, die Lerninhalte den nationalen und internationalen Empfehlungen anzupassen, die Rotationszeiten elektronisch zu dokumentieren und den Lernerfolg mit einem elektronischen Evaluierungsprozess zu begleiten.SummaryOn 29/05/2015 a new medical training order was issued by the Austrian Federal Ministry of Health, whose curricula were resolved on 19/6/2015 in the General Assembly of the Austrian Medical Association. For all new medical doctors registered no later than 01/06/2015 on the implementation of doctors amendment is thus legally valid, which means that with the earliest 01/03/2016 the first special technical basic training and with 01/06/2017 the first special technical emphasis training has to be offered. To be prepared for these changes, a group of colleagues worked on a concept including the structure, learning targets, national and international requirements and an electronic documentation of the new training programm. The project planning was carried out according to the RADAR logic of the EFQM model (European Foundation for Quality Management).

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Christoph Schwab

Medical University of Graz

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Alexander Avian

Medical University of Graz

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Anton Haas

Medical University of Graz

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Erika Richtig

Medical University of Graz

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Iris Zalaudek

Medical University of Graz

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