Christopher G. Kiss

Central visual field impairment during and following cystoid macular oedema

Aim: To determine differential light threshold values obtained with the Micro Perimeter 1 (MP1) in uveitis patients suffering from cystoid macular oedema (CMO) and to compare these measures to retinal thickness. Methods: Static threshold perimetry was performed with the MP1 Microperimeter in 27 eyes of 21 patients with a history of chronically recurring CMO. Active CMO was confirmed in 19 eyes. Eight eyes with a history of recurrent CMO were found to have normal foveal contours in optical coherence tomography (OCT). Differential light threshold values (MP1) were compared with the corresponding retinal thickness measures (OCT). Results: Mean differential threshold values within the central two degrees of the stimulation pattern were reduced compared with normal values and ranged from 5.8 to 9.5 dB in CMO eyes and from 9.3 to 12.9 dB in eyes with a normal foveal contour but a history of previous CMO. The corresponding mean retinal thickness ranged from 390 (SD 90) to 389 (88) μm (at 0° and 1°, respectively) for active CMO and from 199 (36) to 211 (33) μm in eyes with normal fovea following CMO resolution. Statistical correlations between mean differential sensitivity threshold and retinal thickness were only weak and showed no association. Conclusions: Active CMO causes a marked reduction in central retinal sensitivity. In addition, following the resolution of the CMO, a substantial impairment of central retinal sensitivity remains. Morphology in terms of retinal thickness in OCT does not correlate with visual function in terms of retinal sensitivity in these patients.

Intravitreal triamcinolone for persistent cystoid macular oedema in eyes with quiescent uveitis

Background:u2002 To determine the outcome following injections of triamcinolone acetate (IVTA) in the treatment of persistent cystoid macular oedema (CMO) in quiescent, non‐infectious uveitis.

Morphologic and functional evaluations during development, resolution, and relapse of uveitis-associated cystoid macular edema.

Objectives: To describe progression and resolution of uveitis-associated cystoid macular edema (uvCME) using spectral-domain optical coherence tomography and find predictive factors for successful intravitreal triamcinolone acetonide (IVTA) therapy. Methods: Twenty-nine eyes with treatment-naive uvCME were examined before and at 5 scheduled visits within 3 months after intravitreal triamcinolone acetonide administration. Distribution, resolution, relapse, and development of uvCME were evaluated using spectral-domain optical coherence tomography to describe morphology, progression, and relapse according to a standardized reading protocol. Applying repeated measures analysis of variance, morphologic findings were evaluated as predictive factors of the treatment outcome. Results: At baseline, 89.3% presented with focal CME; 65.6% had outer nuclear/Henley’s layer and inner nuclear layer cysts. Following intravitreal triamcinolone acetonide administration, cysts of outer nuclear/Henley’s layer diminished before those of inner nuclear layer (P = 0.0004). Small-pointed subretinal detachment (SRD) resolution synchronized with inner nuclear layer cyst extinction, whereas dome-shaped SRD resolution lagged behind (P = 0.014). Relapses of CME appeared in 71.4% of eyes with parafoveal inner nuclear layer cysts. Cysts of outer nuclear/Henley’s layer were present in an additional 28.6%. None of the eyes developed SRD during CME relapse. The main effect variables “SRD” and “absence of epiretinal membrane” were associated with greater best-corrected visual acuity improvement (P = 0.05 and P = 0.047), whereas the side effect variables “CME duration”, “age,” and “uveitis location” had no additional effect on best-corrected visual acuity. Baseline SRD predicted a relapse-free clinical course within the observational period (P = 0.025). Conclusion: Different morphologic patterns in uvCME may represent different stages in uvCME progression, and initial morphologic appearance can be linked to the clinical prognosis after the treatment.

Visual performance 3 years after successful macular hole surgery

Background/aims: To evaluate the visual performance of patients with successful macular hole surgery with a minimum follow-up of 3 years. Results were compared with the performance of the healthy fellow eyes. Methods: 15 patients were studied. The healthy fellow eyes of the patients (13 eyes) served as a control group. Age, gender and best-corrected logMAR visual acuity were recorded. Reading acuity (in log reading acuity determination (RAD), reading equivalent of logMAR) and speed were tested monocularly. Scotoma size was measured with SLO perimetry, and hole closure was confirmed with an OCT scan. Results: The mean distance visual acuity of the operated eyes (logMAR 0.32 (SD 0.21)) was significantly lower than that of the healthy fellow eyes (logMAR 0.05 (0.17)), but significantly higher than preoperatively (logMAR 0.71 (0.32)). The mean reading acuity was logRAD 0.47 (0.25) for the operated eyes (u200a=u200a77.9% of logMAR), and statistically significantly higher (logRAD 0.16 (0.16)) for the fellow eyes (u200a=u200a89.4% of logMAR). The mean maximum reading speeds were comparable for the operated eyes (168.3 (23.1) words per minute (wpm)) and the fellow eyes (178.7 (26.1) wpm) (pu200a=u200a0.3). Within logRAD 1.3 and 0.5, the mean reading speeds of the two groups were comparable, but critical print size (CPS) for the operated group (logRAD 0.7 (0.2)) was significantly worse than those for the fellow eyes (logRAD 0.4 (0.2)). The SLO analysis showed absence of absolute scotoma in 12 eyes. Conclusion: Distance and reading acuity showed remaining deficits compared with the healthy fellow eyes; however, mean maximum reading speeds of the operated eyes achieved results comparable with healthy eyes. The results show a long-term benefit in the visual function of eyes with closed macular holes.

Proliferative vitreoretinopathy — At what risk is the fellow eye?

ZusammenfassungFragestellungWir untersuchten, ob und wann bei Patienten mit proliferativer Vitreoretinopathie (PVR) nach komplizierter Netzhautabhebung ein Risiko für die Entstehung derselben Erkrankung oder einer einfachen Netzhautabhebung bzw. eines Netzhautdefektes am Partnerauge besteht. Weiters wurden der Zeitpunkt des Auftretens sowie das Bestehen Spezifischer Risken für verschiedene Patientengruppen untersucht.Methoden100 PVR-Patienten wurden in einer retrospektiven Studie untersucht. 21 Patienten mit einer PVR Grad C2 oder kleiner, traumatischer PVR, diabetischer Retinopathie oder kongenitalen vitreoretinalen Erkrankungen wurden ausgeschlossen. Alter, Geschlecht, bestkorrigierter Visus bei der ersten wie letzten Untersuchung, Refraktion, Art der Augenerkrankung in beiden Augen und der Beobachtungszeitraum wurden aufgezeichnet.Ergebnisse42 von 79 Patienten (53, 4%) zeigten nach einem durchschnittlichen Follow-up von 8,5 Jahren visusbedrohende Veränderungen am Partnerauge: Davon hatten 9 Patienten (11, 4%) PVR, 13 (16%) eine einfache Netzhautabhebung und 14 (17,3%) Netzhautrisse. Veränderungen des Partnerauges traten zu keinem bevorzugten Zeitpunkt nach Operation des primären Auges auf: 71,4% zeigten sich innerhalb von 5 Jahren. Aphake und pseudophake Patienten litten signifikant häufiger an Netzhautrissen als phake Patienten (p=0,011). Myopie stellte kein erhöhtes Risiko für eine Veränderung dar. Männer entwickelten eine Netzhautabhebung (p =0,037) und PVR (p=0,025) signifikant häufiger als Frauen.SchlussfolgerungPatienten mit PVR haben ein über 5% iges Risiko, eine visusbedrohende Netzhautveränderung am Partnerauge zu entwickeln. Wegen dieses erhöhten Risikos sollten diese Patienten regelmäßig und länger nachkontrolliert werden.ZusammenfassungPatienten mit PVR haben ein über 50% iges Risiko, eine visusbedrohende Netzhautveränderung am Partnerauge zu entwickeln und ein 37% iges Risiko für eine PVR bei rhegmatogener Netzhautablösung. Mehr als zwei Drittel der visusbedrohenden Netzhautveränderungen entstehen innerhalb von fünf Jahren nach Operation des ersten Auges.SummaryPurposeTo find out if patients with proliferative vitreoretinopathy (PVR) due to complicated retinal detachment are at risk to acquire the same disease or other vision-threatening retinal abnormalities in the fellow eye. To furthermore assess in what time-period they appear and if subgroups of patients have special risksMethods100 consecutive PVR-patients were studied retrospectively. 21 patients with PVR graded lower than C3, traumatic PVR, diabetic retinopathy or congenital vitreoretinal diseases were excluded. Age, gender, best-corrected visual acuity at the first and last visit, refraction, ocular disease in both eyes and observationtime were recordedResultsAfter a mean follow-up of 8.5 years, 42 of 79 patients (53.4%) showed vision-threatening abnormalities in their fellow eyes: among them, 9 patients (11.4%) had PVR, 13 (16%) simple retinal detachments and 14 (17.3%) retinal breaks. Abnormalities in the fellow eye did not develop after a certain time following surgery of the primary eye; 71.4% appeared within 5 years. Aphakic and pseudophakic patients had retinal breaks significantly more often (p=0.011) than phakic patients. Myopia did not increase the risk for any abnormality. Men developed retinal detachment (p=0.037) and PVR (p=0.025) significantly more often than women.ConclusionPatients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye. Because of this increased risk, these patients need regularly-scheduled long-term follow-up.Summary statementPatients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye and a 37% risk to develop PVR from rhegmatogenous retinal detachment. More than two thirds of abnormalities in the fellow eye developed within five years of surgery of the primary eye.

Unterschiede im Lesevermögen bei gleichem Femvisus von Patienten mit Drusenmakulopathie und CNV-Narben

ZusammenfassungHintergrundIn der vorliegenden Studie untersuchten wir die Unterschiede im Lesevermögen von Patienten mit Drusenmakulopathie und CNV-Narben. Berücksichtigt wurden: der Lesevisus, die Lesegeschwindigkeit in Abhängigkeit von der Schriftgröße, die maximale Lesegeschwindigkeit und die Critical Print Size (CPS).Material und Methode60 Patienten wurden untersucht. Die Patienten wurden entsprechend ihres optimalen Log-MAR-Fernvisus (EDTRS-Charts) und Augenerkrankung in 4 Gruppen aufgeteilt: Patienten mit LogMAR 0,2–0,4 in D1 (= Drusen 1) und N1 (= Narben 1), Patienten mit LogMAR > 0,4–0,7 in D2 und N2. Das Lesevermögen wurde monokular mit den standardisierten Radner-Lesetafeln getestet, dabei wurde der Lesevisus in LogRAD festgelegt. Die Patienten lasen mit optimaler Fernkorrektur und einem Nahzusatz von +4 Dioptrien bei 25 cm.ResultateDie Gruppen D1 und N1, sowie D2 und N2, zeigten übereinstimmende Ergebnisse im Fernvisus. Der Lesevisus der D1-Patienten war LogRAD 0,35 ± 0,1 (= 95,6% von LogMAR), signifikant niedriger in der D2-Gruppe mit LogRAD 0,60 ± 0,20 (= 86,9% von LogMAR). Zwischen D1 und N1 [LogRAD 0,37 ± 0,1 (= 95,4 % von LogMAR)] zeigte sich kein signifikanter Unterschied im Lesevisus. N2-Patienten jedoch lasen mit LogRAD 0,70 ± 0,16 (= 66,7% von LogMAR) signifikant schlechter im Vergleich zur D2-Gruppe (p = 0,03). Die mittleren maximalen Lesegeschwindigkeiten betrugen: 165,2±23,6wpm(D1), 139,6±29,5 wpm (D2), 126,3 ± 21,8 wpm (N1) und 114,6 ± 25,3 wpm (N2). Die Gruppen N1 und N2 lasen signifikant langsamer als die vergleichbaren Gruppen D1 und D2 (p < 0,001). Die durchschnittlichen Lesegeschwindigkeiten von N1 und N2 waren in jeder Schriftgröße signifikant schlechter, ebenso die CPS.SchlussfolgerungTrotz vergleichbarem Fernvisus bei Patienten mit Drusenmakulopathie und CNV-Narben zeigten jene mit CNV-Narben eine größere Beeinträchtigung des Lesevermögens in allen Parametern. Dies zeigt deutlich, dass die alleinige Bestimmung des Fernvisus die funktioneilen Probleme von CNV-Patienten deutlich unterschätzt.SummaryPurposeTo evaluate differences in reading performance on patients with drusen maculopathy and CNV-scars (choroidal neovascularisation) with respect to reading acuity, reading speed based on print size, maximal reading speed and Critical Print Size (CPS).Material and methods60 patients (each 30 with drusen (D) and scars (N)) were studied. Patients were classified according to type of maculopathy and best-corrected visual acuity (EDTRS-Charts) into groups D1 and N1 (LogMAR 0.2–0.4), groups D2 and N2 (LogMAR > 0.4–0.7). Reading acuity (in LogRAD) and speed were examined monocularly with the standardized Radner Reading Charts, Patients read with best-corrected distance visual acuity and an addition of +4 dpts. at 25 cm.ResultsThe patients’ distance visual acuity was comparable between the drusen and CNV scar groups (D1 vs. N1 and D2 vs. N2). The reading acuity of the corresponding groups D1 (LogRAD 0.35 ± 0.1 (= 95.6% of LogMAR)), and N1 (LogRAD 0.37 ± 0.1 (= 95.4% of LogMAR)) was also comparable, but N2 patients (LogRAD 0.70 ± 0.16 (= 66.7% of LogMAR) showed a statistically lower reading acuity than D2 patients (LogRAD 0.60 ± 0.20 (= 86.9% of LogMAR) (p = 0.03). The mean maximal reading speeds were: 165.2 ± 23.6 wpm (D1), 139.6 ± 29.5 wpm (D2), 126.3 ± 21.8 wpm (N1) and 114.6 ± 25.3 wpm (N2). Maximal reading speeds of the groups N1 and N2 were significantly worse than those of the corresponding groups D1 and D2 (p < 0.001). Mean reading speed at every print size aswell as the CPS were significantly worse for groups N1 and N2.ConclusionsDespite comparable results in distance visual acuity, CNV scars patients had a greater reduction in reading ability than the patients with drusen. This shows that distance visual acuity measurements alone, underestimate the real-life conditions and impact of AMD.

Fortschritte in der PVR-Chirurgie: Ergebnisse der Silikonölentfernung

ZusammenfassungFragestellungTrotz laufender Verbesserungen der Technik in der PVR-Chirurgie (Proliferative Vitreoretinopathie) liegt die Reablatiorate nach Silikonölentfernung noch immer zwischen 9 und 20%. Wir haben daher unsere primäre PVR-Operation standardisiert und in dieser Arbeit die Ergebnisse nach Silikonölentfernung bei Patienten mit rhegmatogener PVR untersucht.MethodeIn einer retrospektiven Studie wurden 59 Patienten untersucht, die zwischen 1998 und 2001 wegen rhegmatogen bedingter PVR operiert wurden, und die nach kompletter Netzhautanlage eine Silikonölentfernung erhielten. Aphaken Patienten wurde bei dieser Operation gleichzeitig eine Linse implantiert. Beobachtungszeitraum war 6 Monate postoperativ.ErgebnisseVon 59 Patienten wurde in 2 Fällen (3,4%) eine Reablatio beobachtet. 21 Patienten erhielten eine Silikonölentfernung kombiniert mit Linsenimplantation. 38 Patienten waren primär pseudophak. 70% der Patienten wiesen am Ende des Beobachtungszeitraumes einen Visus von 6/60 oder besser auf.SchlussfolgerungDas Risiko einer Reablatio nach Silikonölentfernung bei rhegmatogener PVR wird entscheidend von den davor liegenden vitreoretinalen Eingriffen beeinfiusst. Mit der Standardisierung der primären PVR-Chirurgie können die Ergebnisse nach Silikonölentfernung verbessert werden.AbstractSummaryWithin the last decade the technique of PVR (proliferative vitreoretinopathy) surgery improved constantly. Surprisingly the retinal redatchement rate after silicone oil removal still remains the same and ranges from 9–20%. We standardized our primary PVR surgery and want to present in this study the outcome of silicone oil removal in these eyes.MethodsIn a retrospective study we examined the files of 59 patients operated on between 1998 and 2001 suffering of rhegmatogenes PVR. In aphakic patient the silicone oil removal was combined with a posterior chamber lens implantation. The end of the observation period was 6 months postoperatively.Results2 of 59 (2%) patients developed retinal redetachment after silicone oil removal. 21 patients received a combined procedure with lens implantation. 38 patients were pseudophakic. 70% of the eyes regained a vision of 20/200 or better.ConclusionThe rise of retinal detachment after silicone oil removal is highly influenced by previous surgeries. We therefore believe that standardising the primary silicone oil surgery improves the outcome after silicone oil removal.

The effects of rapamycin and cyclosporin a on tolerance induction through bone marrow transplantation with costimulation blockade

Background: To increase the clinical applicability of a recently developed tolerance protocol using BMT with costimulation blockade, we evaluated the effects of the concomitant use of rapamycin and cyclosporin A (CsA). Methods: C57BL/6 mice (I-E-) received total body irradiation (3Gy, d0), 20x10*6 bone marrow cells from Balb/c donors (I-E ; d1), an anti-CD154 mAb (d1) and CTLA4Ig (d3). One group was treated in addition with rapamycin (0.2 mg/kg/d; d1-d29), and one with CsA (20 mg/kg/d; d1-d29). Results: All mice receiving the standard protocol (n 5, control group) and all mice receiving additional rapamycin (n 6) developed substantial multi-lineage chimerism ( 15% at wk 6), which was sustained throughout the observation period (currently 6 mo). Mice receiving additional CsA (n 6) also developed early chimerism ( 15% at wk 6), but 3 mice lost chimerism by 10 weeks post BMT, and only 2 of 5 mice demonstrated chimerism 6 months post BMT (1 mouse with declining chimerism was sacrificed at 5 mo). Rapamycin had no significant effect on early deletion (wk 1) of Vbeta11 CD4 cells (3.40 0.41% vs. 2.59 0.71% for the control group; p 0.05) or Vbeta5 CD4 cells (0.92 0.20% vs. 1.09 0.19%; p 0.1). CsA, in contrast, blocked deletion of Vb11 CD4 cells (4.28 0.42%; p 0.005 vs. control group) and Vb5 CD4 cells (1.62 0.14%; p 0.005 vs. control group) at wk 1. Levels of Vb11 and Vb5 T cells were also significantly higher in CsA mice at wk 8 compared to the controls. Rapamycin had no negative effect on donor skin graft survival ( 120 days in 6 of 6 mice; control group: 120 days in 3 of 5 mice), while 5 of 6 mice receiving CsA lost their donor graft within 21 days. Conclusions: In a model employing BMT plus anti-CD154 and CTLA4Ig without cytotoxic T cell antibodies, CsA blocked early deletion, allowed BM engraftment but led to a late loss of chimerism and may have impaired tolerance induction. Rapamycin did not impair chimerism, peripheral deletion or tolerance induction and is thus a potential candidate to be used clinically in this tolerance protocol. 279