T. Bertelmann

Tear in the retinal pigment epithelium by intravitreal injection of aflibercept

Development of tears in the retinal pigment epithelium (RIP) has been described as a possible complication following anti-vascular endothelial growth factor (VEGF) antibody therapy with substances which have been available for years when treating pigment epithelium detachment (PED) in eyes affected by age-related macular degeneration (AMD). Aflibercept has become available for the treatment of exsudative AMD since December 2012. This case report describes a further patient in addition to the only other case published so far who developed RIP after aflibercept treatment for PED. Patients have to be thoroughly informed about this potential side effect before initiation of intravitreal aflibercept injection therapy.ZusammenfassungEin Einriss des retinalen Pigmentepithels (RIP) bei hochbullösen Pigmentepithelabhebungen (PED) im Rahmen einer Anti-VEGF-Behandlung bei exsudativer altersbedingter Makuladegeneration (eAMD) wurde für die bereits länger verfügbaren Anti-VEGF-Substanzen mehrfach als mögliche Komplikation beschrieben. Seit Ende 2012 steht nun auch Aflibercept als neue Wirksubstanz zur Behandlung der eAMD zur Verfügung. Unsere Kasuistik zeigt den zweiten publizierten Fall eines RIPs nach intravitrealer Aflibercept-Injektion bei PED. Patienten müssen vor der Behandlung explizit über dieses Risiko aufgeklärt werden. Weitere Daten sind zur prozentuellen Risikoeinschätzung erforderlich.AbstractDevelopment of tears in the retinal pigment epithelium (RIP) has been described as a possible complication following anti-vascular endothelial growth factor (VEGF) antibody therapy with substances which have been available for years when treating pigment epithelium detachment (PED) in eyes affected by age-related macular degeneration (AMD). Aflibercept has become available for the treatment of exsudative AMD since December 2012. This case report describes a further patient in addition to the only other case published so far who developed RIP after aflibercept treatment for PED. Patients have to be thoroughly informed about this potential side effect before initiation of intravitreal aflibercept injection therapy.

Vitreous body and retinal vein occlusion

PURPOSE The aim of this study was to evaluate whether the adhesion status of the posterior vitreous cortex (PVC) towards the internal limiting membrane (ILM) has an impact on the development of retinal vein occlusion (RVO). MATERIAL AND METHODS In a retrospective analysis the operation protocols of 238 eyes receiving pars plana vitrectomy (ppV) and radial optic neurotomy (RON) for central retinal vein occlusion (CRVO) or ppV in combination with arteriovenous sheathotomy (AVS) for branch retinal vein occlusion (BRVO) were evaluated with respect to the intraoperative status of posterior vitreous body adhesion. The results were compared with age-matched healthy controls. RESULTS In this study 145 eyes (60.9 %) suffering from CRVO and 93 eyes (39.1 %) diagnosed with BRVO were included. In eyes with CRVO and BRVO the posterior vitreous cortex (PVC) was significantly more often attached (126 eyes, 86.9 % and 89 eyes, 95.7 %, respectively) than completely detached (19 eyes, 13.1 % and 4 eyes, 4.3 %, respectively, in each case p < 0.001). In the age groups between 70 and 79 years as well as between 80 and 89 years the PVC was significantly more often attached in both RVO entities in comparison to age-matched healthy controls (CRVO 70-79 years, p = 0.001 and 80-89 years, p = 0.002 and BRVO 70-79 years, p < 0.001, 80-89 years, p = 0.011). In eyes from the age group between 65 and 69 years (of age) the PVC was not significantly more often attached in comparison to healthy controls (CRVO p = 0.334 and BRVO p = 0.114). CONCLUSION According to these findings posterior vitreous adhesion is an independent risk factor for the development of retinal vein occlusion among patients aged 70 years or older.

Technik der retropupillaren Irisklauenintraokularlinsenimplantation bei Aphakie

BACKGROUND Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA). MATERIAL AND METHODS A literature search and review of implantation techniques, patient selection, potential complications and management strategies. RESULTS This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications. CONCLUSIONS The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.ZusammenfassungHintergrundDargestellt wird eine Übersicht zur Implantation von Irisklauenlinsen (Artisan®, Ophtec BV, Groningen, Niederlande, bzw. VerisyseTM, AMO, Santa Ana, USA) in den retropupillaren Raum.Material und MethodenDer Beitrag bietet eine Literaturrecherche und die Darstellung unterschiedlicher Implantationstechniken, der Patientenauswahl, potenzieller Komplikationen und Strategien zu derer Vermeidung.ErgebnisseDie retropupillare Implantation einer Irisklauenintraokularlinse zeichnet sich durch eine einfache Implantationstechnik, eine komplette Unabhängigkeit von den verbleibenden Kapselsackstrukturen, eine – im Vergleich zur endokapsulärer Implantation – anatomisch analoge Intraokularlinsen (IOL)-Position und eine vergleichbar niedrige Komplikationsrate aus. Als nachteilig erweisen sich die Voraussetzung einer intakten Iris sowie der Ausschluss von Iris-affektierenden Erkrankungen, seien es Uveitis oder ischämische Vitreoretinopathien wie Diabetes oder Gefäßverschlüsse, und eine relativ kleine Optik.SchlussfolgerungDie Implantation von Irisklauenlinsen in den retropupillaren Raum stellt eine interessante und besonders zeiteffektive Methode zur Rehabilitation aphaker Augen dar.AbstractBackgroundOverview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and VerisyseTM,AMO, Santa Ana CA).Material and methodsA literature search and review of implantation techniques, patient selection, potential complications and management strategies.ResultsThis approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications.ConclusionsThe retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.

Implantation von Intraokularlinsen in den Sulcus ciliaris

ZusammenfassungDie Implantation einer Intraokularlinse (IOL) in den Sulcus ist nach der primären Verankerung im Kapselsack die häufigste Positionierung einer IOL. Sie ist in der Regel nicht primär angestrebt, sondern wird entweder im Rahmen einer komplikativen Kataraktoperation oder sekundär bei IOL-Dislokationen oder Aphakie angewendet. Meist ist ein ausreichend stabiler Sitz, vor allem bei der Optic-capture-Verankerung, zu erzielen. Die Implantation einer IOL in den Sulcus kann unterschiedliche Schwierigkeitsgrade aufweisen, die vor allem von den gegebenen anatomischen Verhältnissen sowie vom aktuellen Operationssetting abhängig sind. Die Wahl der Linse wiederum hängt ebenfalls von der gegebenen Anatomie ab. Bei der Berechnung der Stärke der IOL muss der anteriorisierte Sitz einberechnet werden.AbstractImplantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.Implantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.

Implantation of intraocular lenses in the ciliary sulcus

ZusammenfassungDie Implantation einer Intraokularlinse (IOL) in den Sulcus ist nach der primären Verankerung im Kapselsack die häufigste Positionierung einer IOL. Sie ist in der Regel nicht primär angestrebt, sondern wird entweder im Rahmen einer komplikativen Kataraktoperation oder sekundär bei IOL-Dislokationen oder Aphakie angewendet. Meist ist ein ausreichend stabiler Sitz, vor allem bei der Optic-capture-Verankerung, zu erzielen. Die Implantation einer IOL in den Sulcus kann unterschiedliche Schwierigkeitsgrade aufweisen, die vor allem von den gegebenen anatomischen Verhältnissen sowie vom aktuellen Operationssetting abhängig sind. Die Wahl der Linse wiederum hängt ebenfalls von der gegebenen Anatomie ab. Bei der Berechnung der Stärke der IOL muss der anteriorisierte Sitz einberechnet werden.AbstractImplantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.Implantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.

Glaskörperstatus und retinaler Venenverschluss

PURPOSE The aim of this study was to evaluate whether the adhesion status of the posterior vitreous cortex (PVC) towards the internal limiting membrane (ILM) has an impact on the development of retinal vein occlusion (RVO). MATERIAL AND METHODS In a retrospective analysis the operation protocols of 238 eyes receiving pars plana vitrectomy (ppV) and radial optic neurotomy (RON) for central retinal vein occlusion (CRVO) or ppV in combination with arteriovenous sheathotomy (AVS) for branch retinal vein occlusion (BRVO) were evaluated with respect to the intraoperative status of posterior vitreous body adhesion. The results were compared with age-matched healthy controls. RESULTS In this study 145 eyes (60.9 %) suffering from CRVO and 93 eyes (39.1 %) diagnosed with BRVO were included. In eyes with CRVO and BRVO the posterior vitreous cortex (PVC) was significantly more often attached (126 eyes, 86.9 % and 89 eyes, 95.7 %, respectively) than completely detached (19 eyes, 13.1 % and 4 eyes, 4.3 %, respectively, in each case p < 0.001). In the age groups between 70 and 79 years as well as between 80 and 89 years the PVC was significantly more often attached in both RVO entities in comparison to age-matched healthy controls (CRVO 70-79 years, p = 0.001 and 80-89 years, p = 0.002 and BRVO 70-79 years, p < 0.001, 80-89 years, p = 0.011). In eyes from the age group between 65 and 69 years (of age) the PVC was not significantly more often attached in comparison to healthy controls (CRVO p = 0.334 and BRVO p = 0.114). CONCLUSION According to these findings posterior vitreous adhesion is an independent risk factor for the development of retinal vein occlusion among patients aged 70 years or older.

Is Optical Coherence Tomography a Useful Tool to Objectively Detect Actual Posterior Vitreous Adhesion Status

Purpose. To objectively detect true posterior vitreous cortex (PVC) adhesion status using a commercially available swept-source OCT device (DRI OCT-1, Atlantis©). Material and Methods. Case report, review of the literature, and methodical discussion of concepts to improve OCT-guided PVC imaging. Results. Standard OCT imaging misdiagnosed PVC adhesion status as totally detached in this case report when using a horizontal 6 mm scan only. Contrariwise imaging the same eye with a 12 mm horizontal scan, partial posterior vitreous detachment (PVD) and the presence of a bursa premacularis were clearly discernible. Besides a broader scan, specific scan patterns, highest resolution, and contrast sensitivity, an anterior-to-posterior adjusted scan through the entire vitreous as well as the detection of characteristic undulating aftermovements might enhance the capability of OCT imaging to detect true PVC adhesion status. Conclusions. Further developments are needed to address these issues and to establish OCT recordings as the standard and objective method of choice in PVC adhesion status imaging.

Entspannungsmethoden beim Glaukom

ZusammenfassungHintergrundDas Glaukom ist bis heute die zweithäufigste Ursache für eine schwere Visusminderung bzw. Erblindung weltweit. Oftmals können die klassischen medikamentösen und chirurgischen Therapieverfahren die Progression einer glaukomatösen Optikusneuropathie nicht aufhalten.FragestellungKönnen adjuvant eingesetzte Entspannungsverfahren einen signifikanten Einfluss auf den Augeninnendruck, die okuläre Durchblutung sowie auf die psychische Gesamtsituation der betroffenen Patienten nehmen?Material und MethodenEs erfolgten eine Literatursuche und eine zusammenfassende Darstellung bisher publizierter Forschungsergebnisse.ErgebnisseSowohl autogenes Training als auch Hypnose und Musiktherapie sind in der Lage, einen signifikanten Einfluss auf den Augeninnendruck, die okuläre Durchblutung und die psychische Grundstimmung der Patienten zu nehmen.DiskussionDa diese adjuvanten Verfahren kostengünstig sowie fast jederzeit und ohne jedes Risiko an Nebenwirkungen anwendbar sind, können sie einen wichtigen Mehrwert im Gesamtbehandlungskonzept im Sinne einer ganzheitlichen Betreuung der Glaukompatienten darstellen. Regelmäßige ophthalmologische Kontrollen bleiben obligat.AbstractBackgroundGlaucoma is currently the second most common cause of severe visual impairment and blindness worldwide. Standard pharmaceutical and surgical interventions often fail to prevent progression of glaucomatous optic neuropathy.ObjectivesTo evaluate whether adjuvantly applied self-relaxation techniques can significantly impact intraocular pressure, ocular perfusion and the overall mental state of affected patients.Material and methodsA search of the literature was carried out and a comprehensive overview of currently available data is presented.ResultsAutogenic training, hypnosis and music therapy can significantly impact intraocular pressure, ocular perfusion and overall mental state of patients suffering from glaucoma.ConclusionAs all of these adjuvant therapeutic options are cost-effective, available almost everywhere and at anytime as well as without any known side effects, they can be useful additional techniques in the overall concept for treating glaucoma patients. Regular ocular examinations by an ophthalmologist are, however, mandatory.BACKGROUND Glaucoma is currently the second most common cause of severe visual impairment and blindness worldwide. Standard pharmaceutical and surgical interventions often fail to prevent progression of glaucomatous optic neuropathy. OBJECTIVES To evaluate whether adjuvantly applied self-relaxation techniques can significantly impact intraocular pressure, ocular perfusion and the overall mental state of affected patients. MATERIAL AND METHODS A search of the literature was carried out and a comprehensive overview of currently available data is presented. RESULTS Autogenic training, hypnosis and music therapy can significantly impact intraocular pressure, ocular perfusion and overall mental state of patients suffering from glaucoma. CONCLUSION As all of these adjuvant therapeutic options are cost-effective, available almost everywhere and at anytime as well as without any known side effects, they can be useful additional techniques in the overall concept for treating glaucoma patients. Regular ocular examinations by an ophthalmologist are, however, mandatory.

Implantation von Intraokularlinsen in den Sulcus ciliaris@@@Implantation of intraocular lenses in the ciliary sulcus

ZusammenfassungDie Implantation einer Intraokularlinse (IOL) in den Sulcus ist nach der primären Verankerung im Kapselsack die häufigste Positionierung einer IOL. Sie ist in der Regel nicht primär angestrebt, sondern wird entweder im Rahmen einer komplikativen Kataraktoperation oder sekundär bei IOL-Dislokationen oder Aphakie angewendet. Meist ist ein ausreichend stabiler Sitz, vor allem bei der Optic-capture-Verankerung, zu erzielen. Die Implantation einer IOL in den Sulcus kann unterschiedliche Schwierigkeitsgrade aufweisen, die vor allem von den gegebenen anatomischen Verhältnissen sowie vom aktuellen Operationssetting abhängig sind. Die Wahl der Linse wiederum hängt ebenfalls von der gegebenen Anatomie ab. Bei der Berechnung der Stärke der IOL muss der anteriorisierte Sitz einberechnet werden.AbstractImplantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.Implantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.

Retropupillary iris claw intraocular lens implantation technique for aphakia

BACKGROUND Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA). MATERIAL AND METHODS A literature search and review of implantation techniques, patient selection, potential complications and management strategies. RESULTS This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications. CONCLUSIONS The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.ZusammenfassungHintergrundDargestellt wird eine Übersicht zur Implantation von Irisklauenlinsen (Artisan®, Ophtec BV, Groningen, Niederlande, bzw. VerisyseTM, AMO, Santa Ana, USA) in den retropupillaren Raum.Material und MethodenDer Beitrag bietet eine Literaturrecherche und die Darstellung unterschiedlicher Implantationstechniken, der Patientenauswahl, potenzieller Komplikationen und Strategien zu derer Vermeidung.ErgebnisseDie retropupillare Implantation einer Irisklauenintraokularlinse zeichnet sich durch eine einfache Implantationstechnik, eine komplette Unabhängigkeit von den verbleibenden Kapselsackstrukturen, eine – im Vergleich zur endokapsulärer Implantation – anatomisch analoge Intraokularlinsen (IOL)-Position und eine vergleichbar niedrige Komplikationsrate aus. Als nachteilig erweisen sich die Voraussetzung einer intakten Iris sowie der Ausschluss von Iris-affektierenden Erkrankungen, seien es Uveitis oder ischämische Vitreoretinopathien wie Diabetes oder Gefäßverschlüsse, und eine relativ kleine Optik.SchlussfolgerungDie Implantation von Irisklauenlinsen in den retropupillaren Raum stellt eine interessante und besonders zeiteffektive Methode zur Rehabilitation aphaker Augen dar.AbstractBackgroundOverview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and VerisyseTM,AMO, Santa Ana CA).Material and methodsA literature search and review of implantation techniques, patient selection, potential complications and management strategies.ResultsThis approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications.ConclusionsThe retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.