Elke Altpeter

Full macular translocation (FMT) versus photodynamic therapy (PDT) with verteporfin in the treatment of neovascular age-related macular degeneration: 2-year results of a prospective, controlled, randomised pilot trial (FMT-PDT)

BackgroundThe purpose of this study was to compare full macular translocation (FMT) with photodynamic therapy (PDT) in the treatment of neovascular age-related macular degeneration (AMD).MethodsIn a prospective, randomised, non-masked, monocenter, pilot-trial, 50 eyes of 50 patients were assigned to either FMT or PDT. Baseline and control examinations in 3-monthly intervals over a 12-month period included standardized protocol refraction, visual acuity testing and fluorescein angiography. Primary outcome measurements were made to establish the change in distant visual acuity from the baseline to the 12-month examination. The statistical analyses were carried out on the intent-to-treat principle.ResultsThe improvement of one or more ETDRS lines was 56% (14/25) of the eyes in the FMT and 16% (4/25) of the eyes in the PDT arm (P=0.007). Twenty eyes (80%) in the FMT and 16 eyes (64%) in the PDT group had less than three ETDRS lines of vision loss (P=0.35). Retinal detachment (six eyes) and diplopia (five patients) were recorded in the FMT group. None of the eyes treated in the FMT group had phtysis.ConclusionThis pilot study showed that no statistically significant difference existed between the FMT and PDT in terms of the vision loss of less than three ETDRS lines in eyes with neovascular AMD. The chance of vision improvement was significantly higher for the patients in the FMT group. However, in the era of promising therapy with anti-vascular endothelial growth factor for neovascular AMD, FMT should not be offered as a standard primary procedure for neovascular AMD.

Sulcus anatomy and diameter in pseudophakic eyes and correlation with biometric data: evaluation with a 50 MHz ultrasound biomicroscope.

PURPOSE: To evaluate the sulcus anatomy and possible correlations between sulcus diameter and white‐to‐white (WTW) diameter in pseudophakic eyes, data that may be important in the stability of add‐on intraocular lenses (IOLs). SETTING: University Eye Hospital, Tuebingen, Germany. DESIGN: Case series. METHODS: In pseudophakic eyes, the axial length (AL) and horizontal WTW were measured by the IOLMaster device. Cross‐sectional images were obtained with a 50 MHz ultrasound biomicroscope on the 4 meridians: vertical, horizontal (180 degrees), temporal oblique, and nasal oblique. Sulcus‐to‐sulcus (STS), angle‐to‐angle (ATA), and sclera‐to‐sclera (ScTSc) diameters were measured. The IOL optic diameter (6.0 mm) served as a control. To test reliability, optic measurements were repeated 5 times in a subset of eyes. RESULTS: The vertical ATA and STS diameters were statistically significantly larger than the horizontal diameter (P=.0328 and P=.0216, respectively). There was no statistically significant difference in ScTSc diameters. A weak correlation was found between WTW and horizontal ATA (r = 0.5766, P<.0001) and between WTW and horizontal STS (r = 0.5040, P=.0002). No correlation was found between WTW and horizontal ScTSc (r = 0.2217, P=.1217). CONCLUSIONS: The sulcus anatomy had a vertical oval shape with the vertical meridian being the largest, but it also had variation in the direction of the largest meridian. The WTW measurements showed a weak correlation with STS. In pseudophakic eyes, Soemmerring ring or a bulky haptic may affect the ciliary sulcus anatomy. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of fixation pattern and reading ability in patients with Leber hereditary optic neuropathy.

Background: Leber hereditary optic neuropathy (LHON) is characterized by progressive loss of central vision leading to impaired reading ability. The aim of this study was to evaluate sensory adaptation and reading ability in LHON patients. Methods: This prospective pilot study included 12 male patients with a clinical diagnosis and a positive genetic analysis of LHON, who matched the inclusion criteria of a central scotoma on visual field testing and the use of magnifying aids to read. Examination included best-corrected visual acuity, magnification need, reading speed, and evaluation of fixation by corneal reflexes and by Rodenstock scanning laser ophthalmoscope (SLO). Central scotoma was assessed by conventional perimetry (Tübingen Automated Perimeter) and microperimetry (NIDEK MP1). Results: Mean magnification need was 13.2 ± 7.3-fold (range: 2- to 25-fold). Mean reading speed was 53 ± 18 words per minute (WPM) (range: 24–85 WPM). With automated perimetry, all patients showed central scotomas with a mean radius of 13° ± 7° (range: 1°–30°) in the better eye. Microperimetry in all patients showed fenestrated central scotomas. Eccentric fixation with a preferred retinal locus (PRL) was detected with SLO examination and microperimetry correlated well in 11 of 12 patients. The SLO results showed no systematic pattern in the placement of the PRL; however, 7 of 12 patients (58%) placed their PRL in an unfavorable location left or below the fovea. In 8 of 12 patients, fixation was unstable. Between reading speed and central scotoma size, there was a statistically significant negative correlation (P = 0.021, r = −0.65). Conclusions: The percentage of unfavorable PRL locations was extremely high compared with other disorders with central scotomas. Unstable fixation and fenestrated central scotomas led to difficulties in reading. Early rehabilitation and, if necessary, eccentric viewing training should be considered in LHON patients.

Reply to the letter to the editor: “Incorrect use and presentation of Radner reading charts: comment on measurement of reading speed with standardized texts: a comparison of single sentences and paragraphs”

Dear Editor, It was the declared intention of our paper to measure reading speed alone (see title [1]). For this purpose, we could have used any single sentences, but found it appropriate to use sentences that are already introduced and available to many vision professionals. We did not, and still do not, wish to speculate upon the intentions of the authors of the Radner charts. Thus, the question for what purpose the Radner charts were originally designed is and was not important for our study. The fact that the sentences used in the Radner charts were standardized and of equal length was enough for us to choose them over making up our own. We adhered strictly to the instructions that are supplied with the Radner charts [2]. The only difference was that we calculated reading speed including only the correctly read words/min. However, during reading the 90 Radner sentences (a total of 1260 words), only 13 mistakes occured, which is 1 % of all read words and therefore not relevant. With regard to the onset of measurement, we used a formulation in our paper that could be misunderstood: de facto, we also started the stop watch when the subject started to read. In Dr. Radner’s critique, it was hard to understand what was meant by Bsentence optotypes^. Needless to say, we did not change the optotypes used on the original charts. Equally hard to interpret is the sentence BThe sentences optotypes have consistently given correlations of r≈ 0.9 with long paragraphs.^ The following sentence of Dr. Radner et al. clearly indicates that they did not agree with the goal of our study: BAnalyzing different reading parameters (such as reading acuity, mean and maximum reading speed, and critical print size among others has proven advantageous in evaluating specific alterations of reading performance in different eye diseases.^ In our opinion, it is not a prerogative of Dr. Radner and his colleagues to determine the goal of our study. We see no reason why it should be inappropriate to recruit subjects among our friends and relatives, as long as they remain naïve with regard to the goal of the study, which our subjects were. The presentation of the six texts was randomized. Our finding of a higher variability of reading speeds for Radner texts compared to IReST paragraphs is in full agreement with the study of Brussee et al. [3], who compared the Dutch version of Radner and IReST: Bthe overall reliability concerning reading speed for sentences (Radner 0.81) was lower compared with paragraphs (IReST 0.96).^ ... Bthe longer text paragraphs of the IReST have lower mean intrasubject S.D.s in comparison with the short sentences of Radner .̂ We are sure that we have not cast any doubt on the validity and reliability of the Radner charts.

Proton beam radiotherapy of progressive pediatric choroidal osteoma: First experience

coagulation disorders (such as activated protein C resistance or factor V Leiden mutation), immobilization, pregnancy, smoking, medication with corticoids, family disposition, and COCs. Underlying conditions that may cause CVST vary, and the etiology is unknown in such cases. Several studies have indicated that COCs and thrombophilia greatly increased the risk of CVST. Combined estrogen-progestin oral contraceptives have been associated with an increased risk of venous thromboembolic events. This thrombotic risk was attributed to the estrogen content, which prompted the development of oral contraceptives containing less estrogen. Use of formulations containing lower-dose estrogen still confer about 2fold to 4-fold increased risk of venous thromboembolic events compared with non-use. As the most common causes of HH are infarctions, meningiomas, gliomas, and metastatic lesions, these must be kept in mind. However, only a few patients with HH presenting with neurosyphilis, migraine, demyelinating disease, arteriovenous malformation, or neurosarcoidosis have been reported. MRI and MRV are the best tools for both the diagnosis and the follow-up of CVST. In our case, MRI found right acute occipital lobe infarction (see Fig. 2A-D). MRV showed thrombosis of the right transverse sinus and left internal jugular vein (see Fig. 3A, B). Venous thrombosis has traditionally involved the superficial cerebral venous system, as described in our case. To our knowledge, this is the first published case with HH due to CVST associated with COC usage. Available treatment data from the literature offer the use of anticoagulation in patients with CVST. Oral anticoagulation is recommended for 3 months in patients with idiopathic CVST and for 3 to 6 months if it is related to pregnancy or oral contraceptives. In patients with hereditary thrombophilia, it is used for 6 to 12 months or longer. Anticoagulant therapy was started after the diagnosis of CVST in our patient and continued. Her symptoms improved rapidly, and the visual field defect was much improved in 1 week.

Unklarer parapapillärer Tumor im Kindesalter@@@Unclear parapapillary tumor in childhood

Bei einem choroidalen Osteom handelt es sich um einen benignen, zunehmend kalzifizierenden Tumor, der in der uberwiegenden Mehrzahl bei jungen Frauen in der zweiten oder dritten Lebensdekade diagnostiziert wird [1, 2]. Im fruhen Kindesalter kommen Osteome nur sehr selten vor. Klinisch imponiert ein choroidales Osteom meist als gut abgrenzbarer, gelb-orangener subretinaler Tumor mit geringer Prominenz [3], der typischerweise peripapillar liegt, in 25 % besteht eine bilaterale Manifestation. In der Literatur gibt es nur wenige Beschreibungen von Osteomen im Kindesalter (eine Falldarstellung eines 6-jahrigen [4] und eines 7-jahrigen Madchens [5]). Die Atiologie des choroidalen Osteoms ist unklar, es gibt hierzu 2 Theorien: Entweder ist das Auftreten eines Osteoms kongenital als ortsfremde Verknocherung – als sog. ossares Choristom – zu verstehen. Hierfur sprechen die belegten familiaren Haufungen. Einer zweiten Hypothese nach entwickelt sich das Osteom sekundar als Folge von Traumata oder Entzundungen, die Veranderungen im retinalen Pigmentepithel verursachen konnen und mit einer Latenz von Jahren zu einer Verknocherung fuhren [6]. In dem hier prasentierten Fall wurden wir eher von einer intraokularen ossaren Metaplasie sprechen.

Unklarer parapapillärer Tumor im Kindesalter

Bei einem choroidalen Osteom handelt es sich um einen benignen, zunehmend kalzifizierenden Tumor, der in der uberwiegenden Mehrzahl bei jungen Frauen in der zweiten oder dritten Lebensdekade diagnostiziert wird [1, 2]. Im fruhen Kindesalter kommen Osteome nur sehr selten vor. Klinisch imponiert ein choroidales Osteom meist als gut abgrenzbarer, gelb-orangener subretinaler Tumor mit geringer Prominenz [3], der typischerweise peripapillar liegt, in 25 % besteht eine bilaterale Manifestation. In der Literatur gibt es nur wenige Beschreibungen von Osteomen im Kindesalter (eine Falldarstellung eines 6-jahrigen [4] und eines 7-jahrigen Madchens [5]). Die Atiologie des choroidalen Osteoms ist unklar, es gibt hierzu 2 Theorien: Entweder ist das Auftreten eines Osteoms kongenital als ortsfremde Verknocherung – als sog. ossares Choristom – zu verstehen. Hierfur sprechen die belegten familiaren Haufungen. Einer zweiten Hypothese nach entwickelt sich das Osteom sekundar als Folge von Traumata oder Entzundungen, die Veranderungen im retinalen Pigmentepithel verursachen konnen und mit einer Latenz von Jahren zu einer Verknocherung fuhren [6]. In dem hier prasentierten Fall wurden wir eher von einer intraokularen ossaren Metaplasie sprechen.

Unclear parapapillary tumor in childhood

Bei einem choroidalen Osteom handelt es sich um einen benignen, zunehmend kalzifizierenden Tumor, der in der uberwiegenden Mehrzahl bei jungen Frauen in der zweiten oder dritten Lebensdekade diagnostiziert wird [1, 2]. Im fruhen Kindesalter kommen Osteome nur sehr selten vor. Klinisch imponiert ein choroidales Osteom meist als gut abgrenzbarer, gelb-orangener subretinaler Tumor mit geringer Prominenz [3], der typischerweise peripapillar liegt, in 25 % besteht eine bilaterale Manifestation. In der Literatur gibt es nur wenige Beschreibungen von Osteomen im Kindesalter (eine Falldarstellung eines 6-jahrigen [4] und eines 7-jahrigen Madchens [5]). Die Atiologie des choroidalen Osteoms ist unklar, es gibt hierzu 2 Theorien: Entweder ist das Auftreten eines Osteoms kongenital als ortsfremde Verknocherung – als sog. ossares Choristom – zu verstehen. Hierfur sprechen die belegten familiaren Haufungen. Einer zweiten Hypothese nach entwickelt sich das Osteom sekundar als Folge von Traumata oder Entzundungen, die Veranderungen im retinalen Pigmentepithel verursachen konnen und mit einer Latenz von Jahren zu einer Verknocherung fuhren [6]. In dem hier prasentierten Fall wurden wir eher von einer intraokularen ossaren Metaplasie sprechen.