Michael Partsch

Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization

PURPOSE To report a case of retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. METHODS Case report. A 74-year-old woman with exudative age-related macular degeneration and classic subfoveal choroidal neovascularization RE underwent photodynamic therapy with verteporfin. RESULTS Ophthalmoscopy and fluorescein angiography RE disclosed a retinal pigment epithelial tear in the area of photodynamic therapy. CONCLUSION This case presents the first report of a retinal pigment epithelial tear after photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration.

Effects of bevacizumab on retinal function in isolated vertebrate retina.

Background: Bevacizumab (Avastin) is a recombinant protein that targets vascular endothelial growth factor (VEGF). In vitro, bevacizumab inhibits VEGF induced cell proliferation and tissue factor production. Abnormal angiogenesis involving VEGF is a central event during the development of choroidal neovascularisation (CNV). The present study was designed to evaluate the short term toxic effects of bevacizumab on retinal function for a therapeutic intraocular application. Methods: Isolated bovine retinas were perfused with an oxygen pre-incubated nutrient solution. The electroretinogram (ERG) was recorded as a transretinal potential using silver/silver chloride electrodes. Bevacizumab was added in different concentrations to the nutrient solution for 45 minutes. Thereafter the retina was reperfused for 60 minutes with normal nutrient solution. The percentage of a-wave and b-wave reduction during the application of bevacizumab was calculated and compared to control recordings. Results: During the application of three different concentrations of bevacizumab (0.08 mg/ml, 0.25 mg/ml, 0.8 mg/ml) no significant reduction of the a-wave and b-wave amplitude was observed. During the washout, the ERG amplitudes were unchanged. Conclusion: The present study suggests that an intraocular application of 0.25 mg/ml bevacizumab for the treatment of CNV is reasonable. No significant short term effects of bevacizumab on retinal function were detected, but long term effects cannot be excluded.

Subfoveal hemorrhage after verteporfin photodynamic therapy in treatment of choroidal neovascularization

BackgroundTo identify the frequency of new subfoveal hemorrhage and its impact on visual acuity 2 weeks following verteporfin photodynamic therapy (PDT) in the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).MethodsRetrospective, noncomparative, consecutive, interventional case series. At a tertiary retinal referral center, 104 eyes of 97 consecutive patients with predominantly classic subfoveal CNV were treated by PDT. Morphological outcomes include new subfoveal hemorrhage assessed on the photo review (pretreatment, 2 and 12 weeks after PDT). Visual acuity outcomes include moderate (3–5 ETDRS lines) and severe (6 and more ETDRS lines) loss of visual acuity at 2 weeks after PDT.ResultsIn this study, 104 eyes of 97 patients were analyzed. CNV in all eyes was secondary to AMD. New subfoveal hemorrhage was found in 22% (23/104) of the eyes 2 weeks following PDT. 17.4% (4/23) of the eyes with new subfoveal hemorrhage had moderate or severe loss of visual acuity. In such eyes the 12-week examination revealed considerable resorption of the new subfoveal hemorrhage with some improvement of visual acuity.ConclusionsIn 3.8% of the eyes that underwent PDT for predominantly classic subfoveal CNV secondary to AMD, new subfoveal hemorrhage may result in moderate or severe loss of visual acuity within 2 weeks. In all eyes with new subfoveal hemorrhage, considerable resorption of the hemorrhage and some improvement of the visual acuity were seen at 12 weeks. Candidates for PDT should be informed about the low risk of this complication.

CRITICAL EVALUATION OF THE USABILITY OF AUGMENTED REALITY OPHTHALMOSCOPY FOR THE TRAINING OF INEXPERIENCED EXAMINERS

Purpose: To measure the value of augmented reality technology usage to teach the medical students performing binocular indirect ophthalmoscopy. Methods: Thirty-seven medical students were randomly assigned to the training of binocular indirect ophthalmoscopy either in the conventional way or with augmented reality ophthalmoscopy (ARO). For testing students skills, they had to examine a real person using a conventional ophthalmoscopy system and draw the optic disk. They also had to fill out a questionnaire. Subjective and objective evaluations were performed. Results: Thirty-seven students were randomly assigned to two groups. Eighteen students were trained with conventional ophthalmoscopy and 19 students with ARO. The questionnaires showed no differences. Performing an objective analysis, the median ophthalmoscopy training score for the conventional ophthalmoscopy group was 1.2 (range, 0.67–2) and showed a significant difference (P < 0.0033) to the ARO group (median 2; range, 0.67–2). Conclusion: The study provides evidence that a single ARO training is efficient to improve ophthalmoscopy skills. As the objective analysis showed, the ARO group had a significantly superior performance. Our study also indicates that subjective evaluation of the fundus drawings without systematic analysis is prone to errors.

Retrospective Evaluation of Patients With Uveal Melanoma Treated by Stereotactic Radiosurgery With and Without Tumor Resection

IMPORTANCE The present study intended to analyze the suitability of single-dose stereotactic radiotherapy in the treatment of uveal melanoma that cannot be handled with ruthenium-brachytherapy and therefore is a challenge for ophthalmologists concerning local tumor control, as well as preservation of the eye and visual function. OBJECTIVES To evaluate local tumor control, eye preservation, visual course, radiation complications, metastases, and death after single-dose stereotactic radiotherapy (SDRT) applied exclusively or combined with tumor resection in uveal melanomas that are neither suitable nor favorably located for ruthenium brachytherapy. DESIGN Retrospective, observational case series. SETTING Primary care center. PARTICIPANTS Seventy-eight patients with uveal melanoma were treated. INTERVENTION Between June 3, 2003, and March 18, 2008, patients with uveal melanoma received SDRT monotherapy (group 1, 60 patients) or SDRT combined with tumor resection (group 2, 18 patients). Radiotherapy was performed with a tumor-surrounding dose of 25 Gy on a linear accelerator. MAIN OUTCOME MEASURES Local tumor control, eye preservation, visual results, and radiation complications. RESULTS Within a median follow-up of 33.7 months (range, 0.13-81.13 months), 6 recurrences occurred in group 1; none recurred in group 2. The Kaplan-Meier estimate for local control was 85% at 3 years in group 1 and 100% in group 2 (P = .22). Eye preservation rate was 77% vs 87% at 3 years (groups 1 and 2, respectively) (P = .82). Visual acuity decreased with a median loss of -18 Snellen lines (group 1) and -22 Snellen lines (group 2). More retinopathies (P = .07), opticopathies (P = .27), and rubeotic glaucomas (P = .10) occurred in group 1. No significant difference was observed in the development of metastases (P = .33). The groups differed in overall survival because of 2 deaths occurring shortly after surgery in group 2 for unexplained reasons (P = .06). CONCLUSIONS AND RELEVANCE Survival analysis suggested that SDRT with combined tumor resection might be associated with increased tumor control and fewer radiation complications than SDRT as monotherapy. Both groups had similar eye retention rates and were comparable concerning the decrease in visual function in most eyes. However, the protocol was stopped after 3 unexplainable deaths after surgery.

Telomeraseaktivität in uvealen Melanomen

ZusammenfassungHintergrund: Nach einer für jede Zellpopulation genetisch fixierten Zahl von Teilungen treten Zellen als Ausdruck der Alterung in ein Stadium der Teilungsunfähigkeit (Seneszenz) ein. Die als “Hayflick-Grenze” bezeichnete replikative Lebensspanne ist wahrscheinlich dann erreicht, wenn die Telomeren – hierbei handelt es sich um spezielle DNS-Abschnitte an den 4 Chromosomenenden, die bei jeder Zellteilung verkürzt werden – eine “kritische” Länge unterschreiten. Zellen der meisten, wenngleich nicht aller maligner Tumoren reaktivieren das Enzym Telomerase. Sie können damit die Telomeren neu aufbauen, die “Hayflick-Grenze”überwinden und unbegrenzte Teilungsfähigkeit herstellen. Mit den vorliegenden Untersuchungen sollte überprüft werden, ob Telomerase- Aktivierung auch für das Wachstum uvealer Melanome eine Rolle spielt. Material und Methoden: Von 10 unbehandelten Aderhautmelanomen wurde nach Enukleation Tumorgewebe entnommen. Die Bestimmung der Telomeraseaktivität erfolgte mit einem PCR ELISA nach dem Telomeric Repeat Amplification Protocol (TRAP). Als Kontrolle diente normales Gewebe von Haut und Bindehaut. Ergebnis: Bei 90% der untersuchten Aderhautmelanome war eine deutliche Telomeraseaktivität feststellbar. Alle Kontrollproben erwiesen sich als Telomerase-negativ. Schlussfolgerungen: Telomerase wird von den meisten uvealen Melanomen aktiviert und scheint daher für das Tumorwachstum von Bedeutung zu sein. Die Hemmung der Telomerase stellt daher auch für Aderhautmelanome ein (noch theoretisches) Behandlungsprinzip dar.SummaryBackground: The maximum number of cell divisions of a certain cell population is genetically fixed so that aging cells become non-dividing (senescent) at least. This replicative life span, also known as “hayflick limit”, is probably defined by a “critical” length of the telomeres. Telomeres are special DNA-sequences located at the four ends of the chromosomes which are shortened with each cell cycle. Cells of most, but not all malignant tumours have been shown to reactivate the enzyme telomerase so that telomeres can be reconstructed, “Hayflick limit” can be overcome, and unlimited cell division can be established. This study was undertaken to elucidate whether telomerase reactivation is used by uveal melanoma cells. Materials and Methods: Fresh tumour tissue was removed from 10 untreated uveal melanomas after enucleation. Telomerase activity was determined using a PCR ELISA according to the Telomeric Repeat Amplification Protocol (TRAP). Normal tissue of the skin and the conjunctiva served as control. Result: Telomerase activity was detectable in 90% of the investigated uveal melanomas. All control specimens were telomerase negative. Conclusions: Uveal melanoma growth seems to depend on telomerase reactivation. Thus, telomerase inhibition could offer a new principle for uveal melanoma therapy in the future.

Sudden increase in intraocular pressure as an initial manifestation of myelodysplastic syndrome.

PURPOSE/METHODS We studied a rare initial manifestation of myelodysplastic syndrome in an 82-year-old woman who had acute secondary glaucoma in the right eye and mature cataracts in both eyes. RESULTS/CONCLUSION Therapy with glaucoma control medications and cataract extraction in the right eye resulted in expulsive hemorrhage and subsequent enucleation of the right eye. After cataract extraction, examination of the left eye disclosed a central serous retinal detachment and hemorrhage. Histopathologic analysis of the right eye demonstrated myelocytic and lymphocytic infiltration.

Outcomes of Primary Transconjunctival 23-Gauge Vitrectomy in the Diagnosis and Treatment of Presumed Endogenous Fungal Endophthalmitis

ABSTRACT Purpose: To report the outcomes of primary transconjunctival 23-gauge (23-G) vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis (EFE). Methods: Retrospective analysis of patients with EFE who underwent diagnostic transconjunctival 23-G vitrectomy at a tertiary referral center. Results: Nineteen eyes of 15 patients with EFE were included in the study. Four patients had bilateral and 11 patients unilateral disease. Sixteen eyes of 15 patients underwent 23-G vitrectomy to confirm the diagnosis using vitreous culture, polymerase chain reaction, and histopathologic examinations. All affected eyes were treated with intravitreal amphotericin B 5 µg/0.1 mL. Fourteen patients received additional systemic antifungal therapy. Diagnostic 23-G vitrectomy confirmed the diagnosis of EFE in 75% of the eyes (12/16). Candida was found to be a causative agent in 62.5% and Aspergillus in 12.5% of the eyes. Retinal detachment was the most common complication (42% of eyes). Conclusions: EFE can be easily confirmed using primary 23-G vitrectomy.