Joachim Wachtlin

Tamoxifen-Retinopathie: Eine Fallserie von klinischen und funktionelle Daten

BACKGROUND Tamoxifen is used in the treatment of selected patients with breast carcinoma. Rarely, it has been shown to cause ocular toxic effects including crystalline retinopathy. METHODS Retrospective analysis of clinical and functional (visual acuity, visual field, colour vision) data of a case series of eight female patients under tamoxifen therapy with electrophysiological examination. RESULTS Seven of eight patients complained of visual disturbances. In one case, examination showed crystalline deposits in the cornea and macular area. Three patients revealed changes in full-field and multifocal electroretinogram, and two had a pathological multifocal electroretinogram only. In six cases we applied a desaturated panel D-15 colour vision test; five of these showed some disorders. CONCLUSIONS Most tamoxifen patients who complained of visual disturbances showed electrophysiological changes, particularly in the multifocal electroretinogram and often without a certain morphological correlate. We recommend electrophysiological examination for patients with unclear visual deterioration who are receiving tamoxifen therapy.

[Tamoxifen retinopathy: a case series of clinical and functional data].

BACKGROUND Tamoxifen is used in the treatment of selected patients with breast carcinoma. Rarely, it has been shown to cause ocular toxic effects including crystalline retinopathy. METHODS Retrospective analysis of clinical and functional (visual acuity, visual field, colour vision) data of a case series of eight female patients under tamoxifen therapy with electrophysiological examination. RESULTS Seven of eight patients complained of visual disturbances. In one case, examination showed crystalline deposits in the cornea and macular area. Three patients revealed changes in full-field and multifocal electroretinogram, and two had a pathological multifocal electroretinogram only. In six cases we applied a desaturated panel D-15 colour vision test; five of these showed some disorders. CONCLUSIONS Most tamoxifen patients who complained of visual disturbances showed electrophysiological changes, particularly in the multifocal electroretinogram and often without a certain morphological correlate. We recommend electrophysiological examination for patients with unclear visual deterioration who are receiving tamoxifen therapy.

Gewebetypisierung bei der perforierenden Keratoplastik

ZusammenfassungIn den letzten Jahren ist aufgrund einer veränderten Beurteilung des Stellenwerts der HLA-Typisierung bei der perforierenden Keratoplastik die Nachfrage nach gematchten Spenderhornhäuten stark angestiegen. Neben den HLA- oder Major-Antigenen gibt es weitere immunologisch bedeutsame Gewebeoberflächenmoleküle, zu denen vor allem die Blutgruppen- und die Minor-Antigene zählen. Im Hinblick auf eine effektive Kosten-Nutzen- bzw. Wartezeit-Nutzen-Kalkulation sind differenzierte Matching-Strategien erforderlich, um eine optimale Nutzung und Verteilung der immer noch in ungenügender Zahl vorhandenen Korneatransplantate zu gewährleisten. Mit speziellen Matching-Strategien wie der Berechnung der individuellen Wartezeit, der Berücksichtigung von Split-, Non-MHC- und HLA-Antigenen, zusätzlichen HLA-Loci sowie „permissible“- und „taboo“-Mismatches wird in Zukunft mehr als nur die zahlenmäßige Übereinstimmung von HLA-Antigenen bei der Gewebetypisierung zu berücksichtigen sein. Dies wird es ermöglichen, von einer rein numerischen zu einer funktionellen Match-Strategie überzugehen. In dieser Übersicht wird der Stand der Diskussion zusammengefasst, und es werden verschiedene Strategien, Möglichkeiten und Grenzen sowohl der HLA- als auch der sonstigen Gewebetypisierung bei der perforierenden Keratoplastik erläutert.AbstractThe demand for matched corneal grafts has risen rapidly over the last years. One reason for this is the change in the judgement of the value of tissue and especially HLA typing for prevention of an immune reaction in perforating corneal transplantation. Besides HLA or major antigens, there are other immunologically relevant tissue surface molecules such as the non-MHC antigens of which blood groups and minor antigens are the most important. With regard to effective cost-benefit and waiting time-benefit analyses, differentiated matching strategies are needed to assure optimized utilization and allocation of the still unsatisfactory number of available corneal grafts. With special matching strategies, such as the calculation of the individual waiting time, the consideration of split, non-MHC and HLA antigens, additional HLA loci as well as so-called “permissible” and “taboo” mismatches, much more has to be taken into account in the future than just the numerical correspondence of HLA antigens. This will make it possible to turn from a pure numerical approach to a functional matching strategy. This review summarizes the discussion and different matching strategies, possibilities and limitations of HLA and tissue typing in perforating corneal transplantation.

Verteporfin photodynamic therapy for extrafoveal choroidal neovascularisation secondary to age-related macular degeneration.

PurposeTo report the results of verteporfin photodynamic therapy (PDT) of extrafoveal predominantly classic choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD).MethodsIn this retrospective study 20 consecutive patients (20 eyes) undergoing verteporfin PDT for extrafoveal predominantly classic CNV in AMD were examined. Colour photography of the fundus, fluorescein angiography and complete ophthalmic examination, including visual acuity assessment with ETDRS charts, were performed before treatment and at 3-month intervals thereafter. The primary outcome criterion was the change in visual acuity. The secondary outcome criterion was the extension of the CNV beneath the centre of the fovea during the follow-up period.ResultsMean follow-up time of the patients was 24.2 months (range 12 to 58 months). Visual acuity at baseline varied from 20/200 to 20/20 (mean 20/50±2.3 lines). Final visual acuity ranged from 20/1000 to 20/20 (mean 20/200±5.1 lines) (P<0.001). In 85% (17/20) of the eyes visual acuity worsened. Visual acuity improved in 15% (3/20) of the eyes. During the course of the follow-up period, subfoveal extension of the CNV was detected in 80% (16/20) of the eyes.ConclusionIn 85% of the eyes with extrafoveal predominantly classic CNV secondary to AMD, visual acuity worsened after verteporfin PDT in an average follow-up time of 24 months. Subfoveal CNV was found in 80% of the eyes during follow-up. Even though verteporfin PDT can preserve visual acuity in selected cases, deterioration was seen in the majority of the patients.

Bevacizumab for ophthalmic diseases

Bevacizumab, a humanized monoclonal antibody that binds to all isoforms of vascular endothelial growth factor, was originally developed to inhibit tumor angiogenesis. Following its approval for the treatment of metastatic colorectal cancer, bevacizumab was initially used systemically in patients with neovascular age-related macular degeneration. Two case reports on intravitreal bevacizumab led to numerous clinical and preclinical studies on bevacizumab. Intravitreal bevacizumab is popular worldwide as an inexpensive off-label treatment for several neovascular ocular diseases. This article reviews the current clinical and preclinical studies using bevacizumab in ophthalmology.

Tamoxifen-Retinopathie: Eine Fallserie von klinischen und funktionelle Daten@@@Tamoxifen retinopathy: a case series of clinical and functional data

BACKGROUND Tamoxifen is used in the treatment of selected patients with breast carcinoma. Rarely, it has been shown to cause ocular toxic effects including crystalline retinopathy. METHODS Retrospective analysis of clinical and functional (visual acuity, visual field, colour vision) data of a case series of eight female patients under tamoxifen therapy with electrophysiological examination. RESULTS Seven of eight patients complained of visual disturbances. In one case, examination showed crystalline deposits in the cornea and macular area. Three patients revealed changes in full-field and multifocal electroretinogram, and two had a pathological multifocal electroretinogram only. In six cases we applied a desaturated panel D-15 colour vision test; five of these showed some disorders. CONCLUSIONS Most tamoxifen patients who complained of visual disturbances showed electrophysiological changes, particularly in the multifocal electroretinogram and often without a certain morphological correlate. We recommend electrophysiological examination for patients with unclear visual deterioration who are receiving tamoxifen therapy.