Peter Kroll

Acute retinal pigment epithelial tear following intravitreal bevacizumab (Avastin) injection for occult choroidal neovascularisation secondary to age related macular degeneration

Retinal pigment epithelium (RPE) tears are well recognised complications of pigment epithelial detachments (PED) in age related macular degeneration (AMD) and may arise spontaneously after trauma, photocoagulation, or photodynamic therapy (PDT).1 Rosenfeld et al recently reported favourable results after intravitreal (IV) bevacizumab (Avastin) injection in neovascular AMD.2 We present two patients, who developed an RPE tear after an intravitreal Avastin injection.nnThe first case was a 64 year old man with an occult CNV with a PED in the right eye ( fig 1A–C). His visual acuity (VA) gradually declined from 20/30 to 20/60. Four days after an uneventful IV injection of 0.05 ml Avastin, the patient noted a sudden drop in VA. His VA was 20/80 while fluorescein angiography (FA) and optical coherence tomography revealed a large RPE tear (fig 2A–C). The second case was a 84 year old woman with an occult CNV with a PED. Her VA was 20/60 when she required an IV Avastin injection. When …

Optical Sectioning of the Cornea with a New Confocal In Vivo Slit-scanning Videomicroscope

PURPOSEnThe purpose of this article is to introduce a newly developed confocal in vivo slit-scanning microscope for continuous recording and real-time imaging of the various corneal subsegments of the patients eye with high microscopical resolution and adequate contrast.nnnMETHODSnOne-dimensional confocal slit-scanning videomicroscopy of the human cornea was performed with an instrument mainly consisting of a scanning module, an image-intensifier video camera, a video monitor, and a synchronization unit for matching optical scan and video cycle with respect to frequency and phase. Light intensity or fluorescence intensity profiles through the cornea could be obtained by microphotometric recording of part of the imaging light. An immersion contact technique using an isotonic tear replacement liquid with thixotropic properties avoids any mechanical contact between the front lens of the microscope objective and the corneal surface.nnnRESULTSnIn normal human eyes, the corneal micromorphology could be made visible with satisfactory lateral and axial resolution and with good contrast. The separately focussed sections of the cornea showed the endothelial cells, the superficial, intermediary, and basal cells of the epithelium, as well as stromal keratocytes and nerves. Even in eyes with significant corneal opacities resulting from corneal edema, the endothelial pathology could be imaged with sufficient contrast.nnnCONCLUSIONnThe in vivo slit-scanning videomicroscopy offers real-time noninvasive and noncontact serial imaging of corneal subsegments with resolution and imaging contrast. Thus, an important step toward using confocal scanning microscopy for corneal diagnosis seems to be done.

Vitreopapillary traction in proliferative diabetic vitreoretinopathy

AIM To present the clinical profile of a new entity in advanced proliferative diabetic vitreoretinopathy (PDVR). Mechanisms of vision loss due to vitreopapillary traction on the nasal optic disc are described, followed by an introduction of methods for prevention and treatment in such cases. METHODS 17 patients with PDVR and traction on the nasal side of the optic disc, pallor of the optic nerve head, and reduced visual acuity were included in the study. Six patients were observed retrospectively and 11 patients prospectively before and after pars plana vitrectomy. Pre- and postoperative examinations included visual acuity, Goldmann’s visual field, fluorescein angiography, and measurements of visual evoked potentials (VEP). RESULTS During a postoperative follow up period of 3 to 24.5 months (mean 14.5 months) an improvement in optic disc appearance combined with an increased visual acuity (mean increase in VA = 0.171) was observed in 15/17 (88.3%) patients. In addition, 8/17 (47%) of these patients showed higher VEP amplitudes (mean 3.83 μV), and eight (6/8 of the same patients as VEP amplitudes) patients showed a reduction of latency (mean reduction 22.25 ms) during VEP assessment. CONCLUSION These results suggest that vitreopapillary traction may damage the anterior optic nerve, via decreased axoplasmatic flow in the optic nerve fibres and/or mechanical reduction of perfusion in the posterior ciliary arteries. The effects of each mechanism appear to be reversible, but in the long term might lead to irreversible optic nerve atrophy. Therefore, in patients with vitreopapillary traction, early vitrectomy should be considered as a method to prevent optic neuropathy.

Primary vitrectomy in complicated rhegmatogenous retinal detachment--a survey of 205 eyes.

Introduction: In a few types of rhegmatogenous retinal detachment (RRD), scleral buckling (SB) has a lower success, and, here, pars plana vitrectomy (PPV) is a good alternative option. This survey reviews the indications and the surgical outcome of primary PPV with internal tamponade. Patients and Methods: We reviewed 205 eyes operated by primary PPV for RRD at the Department of Ophthalmology of the Philipps University Marburg between the years 1990 and 1997. The indications of PPV were: holes greater than 90°; holes posterior to the equator; proliferative vitreoretinopathy grade C; pseudophakic status. Results: A complete reattachment of the retina after absorption of the gas or after silicone oil removal was achieved by 1 operation in 146 eyes (71.2%) and in 195 eyes (95.2%) by a second intervention. Conclusion: Although SB is the standard procedure for the treatment of RRD, complicated cases can be treated successfully with primary PPV.

Populationsbezogene Erhebung zur diabetischen Retinopathie in Wolfsburg

ZusammenfassungHintergrund. Seit November 1997 wird im Rahmen eines Modellprojektes die vollständige Dokumentation einer ophthalmologischen Befundung bei Diabetikern durch die BKK-VW für Versicherte in Wolfsburg einmal jährlich vergütet.nMethoden. Ergebnisse der Untersuchung wurden im Befundbogen der Initiativgruppe zur Früherkennung diabetischer Augenerkrankungen dokumentiert. Erfasst wurden Visus, Augeninnendruck, Linsenstatus sowie Fundusbefund.nErgebnisse. Es wurden ophthalmologische Befunde von 2.801 Patienten mit Diabetes mellitus erfasst. Eine Pseudophakie lag bei 357 Augen vor, 1.216 Augen hatten eine visusrelevante Katarakt oder einen Nachstar. Von 263 Patienten unter 40 Jahren hatten 18,8% eine milde oder mäßige und 3,3% eine schwere nicht proliferative diabetische Retinopathie (NPDR). In dieser Gruppe wurde eine proliferative diabetische Retinopathie (PDR) bei 2,2% gefunden. Von 2.228 Patienten älter als 40 Jahre hatten 11,9% eine milde oder mäßige und 2,6% eine schwere NPDR. Eine PDR wurde in dieser Gruppe bei 0,9% diagnostiziert.nSchlussfolgerung. Die Implementierung einer jährlichen Vorsorgeuntersuchung auf der Basis des Befundbogens der Initiativgruppe war erfolgreich. Erstmals wurde Daten zur Prävalenz der diabetischen Retinopathie in einer populationsbezogenen Erhebung in einer deutschen Stadt gewonnen. Die Prävalenzraten liegen deutlich niedriger als in bisher publizierten vergleichbaren Studien benachbarter Länder.AbstractIntroduction. Since November 1997 the complete documentation of an ophthalmological examination of diabetics has been annually subsidised by the Volkswagen Corporation Health Maintenance Organization (VW-HMO).nMethods. The results of an annual ophthalmological examination were recorded in a standardised history sheet developed by the Initiative Group for Early Detection of Diabetic Eye Diseases. These data included visual acuity, intraocular pressure, lens status and a description of fundus abnormalities.nResults. Within 26 months ophthalmological examinations of 2,801 patients were completed which represented 4.5% of all VW-HMO insured patients. On average, patients suffered from diabetes for 9.6 years (SD±8.3), artificial intraocular lenses were present in 357 eyes (6.4%) and 1,216 eyes (12.0%) were diagnosed with cataract or posterior capsule opacification impairing visual acuity. Out of 263 patients younger than 40 years old, 18.8% had a mild or moderate and 3.3% a severe non-proliferative diabetic retinopathy (NPDR). A proliferative diabetic retinopathy (PDR) was found in 2.2% of the younger patients. Of 2,228 patients aged 40 years and older, 11.9% had a mild or moderate and 2.6% a severe NPDR. In 0.9% of this group PDR was diagnosed.nConclusions. An annual ophthalmological screening based on a survey sheet of the Initiative Group was successfully introduced. For the first time a population-based evaluation on the prevalence of diabetic retinopathy was carried out for inhabitants of a German city. The prevalence of PDR was found to be lower than previously published in comparable studies.

Trypan blue stains the epiretinal membrane but not the internal limiting membrane

We read with great interest the paper by Li et al about staining of the internal limiting membrane (ILM) and epiretinal membrane (ERM) with trypan blue (TB).1 We would like to comment on one aspect of this paper, when the authors claimed that a good staining of both the ILM and the ERM was achieved with TB. We disagree that ILM is stained by TB, and propose that …

Appearance of age-related macular degeneration in vitrectomized and nonvitrectomized eyes: an intraindividual case study

Purpose:u2002 This study analyses the consequences of vitreoretinal traction on the macula and in particular the impact of a vitrectomy on the development of the age‐related macular degeneration (ARMD).

Vergleich von Eigenserum und Hyaluronsäure zur Behandlung kornealer Erosiones nach Vitrektomie bei Diabetikern

ZusammenfassungHintergrundEs wurde untersucht, ob die Therapie mit Eigenserum der mit Hyaluronsäure hinsichtlich ihrer epitheliotrophen Wirksamkeit bei Patienten mit schlechterer Wundheilung (Diabetikern) überlegen ist.Patienten und MethodeIn die prospektive, randomisierte Studie wurden Diabetiker einbezogen, bei denen im Rahmen einer ppV auch eine Abrasio corneae durchgeführt werden musste. Eine Gruppe wurde neben der üblichen Lokaltherapie mit stündlicher Applikation von Eigenserum, die andere mit einem hyaluronsäurehaltigen Tränenersatzmittel behandelt. Ausgewertet wurden die Zeit bis zum Epithelschluss und Parameter wie Alter, Geschlecht, Diabetesdauer, HbA1C und Operationsdauer.ErgebnisseEs wurden 23xa0Patienten nachbeobachtet. Der Epithelschluss bei den mit Eigenserum behandelten Patienten fand im Mittel um mehr als 2xa0Tage früher statt. Die Studie wurde nach Behandlung von 23xa0Patienten aufgrund des statistisch signifikanten Unterschiedes zugunsten des Eigenserums abgebrochen (p<0,05).SchlussfolgerungenAufgrund der im Vergleich mit hyaluronsäurehaltigen Tränenersatzmitteln beschleunigenden Wirkung auf den Epithelschluss sollte Eigenserum zur Heilung postoperativer Epitheldefekte bei Diabetikern eingesetzt werden.AbstractPurpose The purpose of this study was to evaluate whether treatment with autologous serum exhibits better epitheliotropic properties than hyaluronic acid in patients with reduced wound healing (diabetics).Patients and methodThis prospective randomized study included all diabetic patients undergoing pars plana vitrectomy with abrasion of the corneal epithelium. In addition to the usual topical therapy one group was treated with hourly application of autologous serum, the other group with hyaluronic acid drops. We evaluated the time needed for closure of the corneal epithelium as well as other parameters such as patient’s age, sex, duration of surgery, history of diabetes, and the current HbA1C.ResultsThere were 23 patients enrolled in the study. The epithelium healed a mean of 2xa0days earlier in the autologous serum group. Based on the statistically significant difference in favor of autologous serum, the study was terminated after treatment of 23 patients.ConclusionsAutologous serum eye drops lead to earlier closure of the corneal epithelium after intraoperative abrasion in diabetic patients when compared with artificial tears.

Autologous serum versus hyaluronic acid eye drops for the treatment of corneal erosions after vitrectomy in diabetic patients. A prospective randomized study

ZusammenfassungHintergrundEs wurde untersucht, ob die Therapie mit Eigenserum der mit Hyaluronsäure hinsichtlich ihrer epitheliotrophen Wirksamkeit bei Patienten mit schlechterer Wundheilung (Diabetikern) überlegen ist.Patienten und MethodeIn die prospektive, randomisierte Studie wurden Diabetiker einbezogen, bei denen im Rahmen einer ppV auch eine Abrasio corneae durchgeführt werden musste. Eine Gruppe wurde neben der üblichen Lokaltherapie mit stündlicher Applikation von Eigenserum, die andere mit einem hyaluronsäurehaltigen Tränenersatzmittel behandelt. Ausgewertet wurden die Zeit bis zum Epithelschluss und Parameter wie Alter, Geschlecht, Diabetesdauer, HbA1C und Operationsdauer.ErgebnisseEs wurden 23xa0Patienten nachbeobachtet. Der Epithelschluss bei den mit Eigenserum behandelten Patienten fand im Mittel um mehr als 2xa0Tage früher statt. Die Studie wurde nach Behandlung von 23xa0Patienten aufgrund des statistisch signifikanten Unterschiedes zugunsten des Eigenserums abgebrochen (p<0,05).SchlussfolgerungenAufgrund der im Vergleich mit hyaluronsäurehaltigen Tränenersatzmitteln beschleunigenden Wirkung auf den Epithelschluss sollte Eigenserum zur Heilung postoperativer Epitheldefekte bei Diabetikern eingesetzt werden.AbstractPurpose The purpose of this study was to evaluate whether treatment with autologous serum exhibits better epitheliotropic properties than hyaluronic acid in patients with reduced wound healing (diabetics).Patients and methodThis prospective randomized study included all diabetic patients undergoing pars plana vitrectomy with abrasion of the corneal epithelium. In addition to the usual topical therapy one group was treated with hourly application of autologous serum, the other group with hyaluronic acid drops. We evaluated the time needed for closure of the corneal epithelium as well as other parameters such as patient’s age, sex, duration of surgery, history of diabetes, and the current HbA1C.ResultsThere were 23 patients enrolled in the study. The epithelium healed a mean of 2xa0days earlier in the autologous serum group. Based on the statistically significant difference in favor of autologous serum, the study was terminated after treatment of 23 patients.ConclusionsAutologous serum eye drops lead to earlier closure of the corneal epithelium after intraoperative abrasion in diabetic patients when compared with artificial tears.

Conjunctival malignant melanoma in children.

The first case concerns a 14-year-old girl with a brown conjunctival mass temporally in her right eye which was excised and diagnosed as active conjunctival melanotic lesion. Five years later, a malignant melanoma of the right lacrimal sac and orbit led to general metastatic spread. The second case demonstrates a conjunctival brown mass temporally in the left eye of a 3-year-old boy which enlarged over 4 years. The excision revealed a melanotic lesion which was of uncertain histological dignity. The third case occurred in a 4-year-old boy with a conjunctival glassy tumor temporally in his right eye which after excision led to controversial discussions concerning benign nevus or malignant melanoma.