Showing papers by "Ursula Schmidt-Erfurth published in 2006"

Human macula investigated in vivo with polarization-sensitive optical coherence tomography

Abstract: PURPOSE. To investigate a depolarizing layer that is visible in polarization-sensitive optical coherence tomography (PS-OCT) images of the retina. To identify this layer and characterize its depolarizing effect quantitatively. METHODS. Ten healthy human subjects (mean age, 31 8 years) and two patients with RPE diseases participated in the study. The macular region of one eye of each subject was investigated with a phase-resolved PS-OCT system. The instrument measured backscattered intensity (standard OCT), phase retardation, and (cumulative) birefringent axis orientation, simultaneously. For a quantification of the depolarizing layer, plots of the distributions of retardation and axis orientation within and above this layer were analyzed. RESULTS. A polarization-scrambling layer (PSL) was observed at the posterior boundary of the retina in PS-OCT images of all volunteers. It was identified in PS-OCT images by determining random retardation and axis orientation in a transverse direction. Measurements in patients with neurosensory retinal detachment, retinal pigment epithelium (RPE) detachment, and RPE atrophy suggest that the PSL is the RPE. The statistical analysis provided objective discrimination of the RPE from the other retinal structures. CONCLUSIONS. PS-OCT represents a powerful tool for increasing image contrast in ocular tissues. The observed polarizationscrambling nature of the RPE may be used in diseased eyes to locate the RPE or remains of the RPE definitively in OCT images. (Invest Ophthalmol Vis Sci. 2006;47:5487‐5494) DOI:

Influence of treatment parameters on selectivity of verteporfin therapy.

Abstract: PURPOSE. To improve selectivity of verteporfin therapy (PDT) in neovascular age-related macular degeneration (AMD) using modified treatment parameters. METHODS. Nineteen consecutive patients with predominantly classic choroidal neovascularization (CNV) in AMD were treated with 6 mg/m 2 verteporfin given as bolus infusion. Patients received PDT with a fluence of either 25 or 50 J/cm 2 . Choroidal perfusion changes were evaluated by indocyanine green angiography (ICGA) at baseline, day 1, week 1, week 4, and month 3. Secondary outcomes were CNV closure rate and therapy-induced leakage documented by fluorescein angiography (FA). The safety of the treatment was assessed with ETDRS visual acuity. RESULTS. Complete CNV closure was achieved in all patients at day 1. Choroidal hypoperfusion was minimal in eyes treated with a reduced fluence of 25 J/cm 2 . Most patients treated with 50 J/cm 2 showed significant choriocapillary nonperfusion at week 1, lasting as long as 3 months. A transient PDT-induced increase in leakage area in FA at day 1 was found to be more extensive in the 50-J/cm 2 group. CONCLUSIONS. Bolus administration of verteporfin combined with a reduced light dose achieved improved selectivity of photodynamic effects, avoiding collateral alteration of the physiologic choroid while obtaining complete CNV closure. An increased selectivity with decreased effect on the surrounding choroid should be of advantage in verteporfin monotherapy as well as in combination strategies.

Promising new treatments for neovascular age-related macular degeneration

Abstract: Angiogenesis, the growth of new blood vessels from existing blood vessels, is responsible for vision loss in a variety of ophthalmic diseases. In neovascular age-related macular degeneration (AMD), the leading cause for legal blindness in many industrialised countries, abnormal blood vessels grow in the macula and cause blindness. There are a number of factors important in the angiogenic cascade but VEGF-A has been implicated in recent years as the major factor responsible for neovascular and exudative diseases of the eye. Numerous antiangiogenic drugs are in development but anti-VEGF drugs have shown great promise in treating neovascular AMD and other ocular diseases, and many of these drugs have been adopted from oncology where antiangiogenic therapy is gaining wide acceptance. For the first time in neovascular AMD, anti-VEGF drugs have brought the hope of vision improvement to a significant proportion of patients. This review provides an overview on angiogenic mechanisms, potential antiangiogenic treatment strategies and different antiangiogenic drugs with special focus on neovascular AMD.

Evaluation of anterior chamber inflammatory activity in eyes treated with intravitreal bevacizumab.

Abstract: Purpose To evaluate the effect of intravitreal bevacizumab on anterior chamber inflammatory activity. Methods Sixty-one consecutive patients with neovascular age-related macular degeneration were examined before, 1 day, and 1 week after intravitreal administration of 1 mg of bevacizumab (0.04 mL) for neovascular age-related macular degeneration. The intravitreal injection was performed under sterile conditions. Twenty-one fellow eyes served as controls. The anterior chamber inflammatory activity was evaluated using biomicroscopy and the laser flare meter (Kowa FM-500, Kowa Company, Ltd., Tokyo, Japan). Results None of the 61 consecutive patients had a significant, clinically detectable inflammatory response within 1 week of follow-up. Anterior chamber inflammatory activity measured by the laser flare meter ranged from 1.9 counts/ms to 70.0 counts/ms (mean +/- SD, 13.2 +/- 16.9 counts/ms; 95% confidence interval [CI], 7.8-18.6) before treatment. One day and 1 week after injection, values were between 3.2 counts/ms and 30.0 counts/ms (mean +/- SD, 9.1 +/- 6.2 counts/ms; 95% CI, 7.2-11.1) and 2.0 counts/ms and 25.1 counts/ms (mean +/- SD, 7.3 +/- 4.6 counts/ms; 95% CI, 5.8-8.8), respectively. There was a significant reduction of anterior chamber flare at 1 week compared with baseline (P = 0.031). The control eyes had constantly low flare measures. Conclusion No inflammatory response was detected clinically and by the laser flare meter after intravitreal bevacizumab administration. The slight reduction in anterior chamber flare could be due to the known antiinflammatory effect of anti-vascular endothelial growth factor therapy.

Ultrahigh resolution optical coherence tomography of macular holes.

Abstract: PURPOSE To evaluate ultrahigh resolution optical coherence tomography (UHR OCT) for visualization of intraretinal layers, especially the photoreceptor inner segment and outer segment layers, in eyes with macular holes and after surgical intervention. METHODS An UHR OCT system based on a titanium:sapphire laser was used, enabling in vivo cross-sectional retinal imaging with 3-micro m axial resolution. Typical, representative tomograms of 5 of 48 eyes from 36 patients demonstrated the potential of UHR OCT to detect morphologic changes in different stages of full-thickness macular holes and changes induced by surgical intervention. RESULTS UHR OCT could detect subtle intraretinal changes in macular hole formation. Unprecedented visualization of photoreceptor impairment was achieved that appeared to be more extensive than the hole itself. Postoperatively, clinically closed holes showed restoration of the photoreceptor inner and outer segment layers of various extents, with residual disease in some eyes. CONCLUSION In macular holes, UHR OCT allows for detection of even small morphologic changes of the retinal layers, especially the photoreceptor inner and outer segment layers. Therefore, it also represents a superior method to monitor the effect of surgical interventions. Preoperative photoreceptor impairment and the degree of postoperative restoration could possibly be associated with visual function. Hence, UHR OCT could lead to better understanding of macular hole pathogenesis and to more accurate disease prognosis.

Three-dimensional imaging of pigment epithelial detachment in age-related macular degeneration using optical coherence tomography, retinal thickness analysis and topographic angiography.

Abstract: New diagnostic tools such as the retinal thickness analyzer (RTA), optical coherence tomography (OCT), and topographic angiography (TAG) were introduced into clinical ophthalmology during the last years giving the examiner new insights into anatomical and functional aspects of macular disease. In this study, advantages and disadvantages of the new imaging methods have been evaluated in patients with serous (sPED) and fibrovascular pigment epithelial detachments (fPED) secondary to age-related macular degeneration (AMD). TAG, using fluorescein angiography (FA), provides a three-dimensional profile of the fluorescein pattern based on the analysis of a set of 32 confocal images over a depth of 4 mm. RTA and OCT provide cross-sectional images of the neurosensory retina and the retinal pigment epithelium–choriocapillary complex as well as retinal thickness data encoded in a false color map. We compared and evaluated these modalities in 15 patients with fPED and 15 patients with sPED secondary to AMD. In patients with classic fPED, TAG detected neovascular structures and delineated their configuration. In sPEDs, pooling of extravascular fluid was detected in a dome-shaped configuration. OCT provided detailed information on the neurosensory retina’s structures but failed to detect the neovascular membrane in fPED. Mapping the retinal thickness, RTA and OCT both failed to detect the PED and showed typical algorithm error-based patterns. TAG OCT and RTA are useful imaging modalities in the evaluation of AMD cases. TAG visualizes the vascular configuration, dynamic perfusion, and leakage changes. OCT and RTA are able to complementarily document intra-, subretinal, and sub-RPE fluid accumulation secondary to CNV. However, OCT seems to be more efficient in imaging AMD-related pathologies than RTA, as this modality is often compromised by intra- or subretinal structural abnormalities. Nevertheless, all modalities may provide further valuable insight into AMD pathogenesis, enhance diagnostic quality, and improve the assessment of therapeutic effects.

Photodynamic therapy for subretinal neovascularization in type 2A idiopathic juxtafoveolar telangiectasis.

Abstract: Background: Photodynamic therapy (PDT) with verteporfin is now the standard of care worldwide for the treatment of choroidal neovascularization, but has been used only rarely in those with subretinal neovascular membranes (SRNVM) due to type 2A idiopathic juxtafoveolar retinal telangiectasis (IJT). We performed a retrospective study to examine the outcome of patients treated with PDT for SRNVM secondary to IJT. Methods: Retrospective interventional case series of 7 eyes of 6 IJT patients with SRNVMs treated with PDT. Ophthalmic examination and fluorescein angiography were performed before treatment, with retreatment every 3 months as needed. The main outcome was the proportion of patients avoiding vision loss (change of ± 4 letters, or better). Results: Baseline Snellen acuity ranged from 20/40 to 20/400 (median 20/80). Mean follow-up was 21 months. Patients received 2.4 treatments on average. Five of 7 patients avoided vision loss; acuity improved in 3 eyes (≥ 1 line improvement), stayed the same in 2 eyes (± 4 letters) and decreased in 2 eyes (≥ 1 line decrease) over time. Median final acuity was 20/80. Five of 7 eyes had final acuities of ≥ 20/200. No leakage was observed in any eyes following cessation of treatment. Interpretation: Previously reported outcomes for SRNVM in type 2A IJT, in both natural history and after laser or surgical treatment, have been uniformly poor. PDT may be considered for these patients due to its excellent safety profile and clinically favorable outcomes in this study.

Frühe Effekte nach systemischer und intravitrealer Bevacizumab (Avastin®)-Therapie bei neovaskulärer altersbedingter Makuladegeneration

Abstract: PURPOSE The purpose of this study was to evaluate the early treatment response following systemic and intravitreal bevacizumab therapy in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS In a prospective cohort study 12 eyes with neovascular AMD were treated with 5 mg/kg systemic bevacizumab, and 13 eyes with 1 mg intravitreal bevacizumab. Systemic therapy was given three times at 2-week intervals, intravitreal therapy up to three times at 4-week intervals. Patients were evaluated according to best corrected visual acuity (VA) and optical coherence tomography (OCT) at baseline as well as at week 1, week 4 and week 12 after therapy. Fluorescein angiography (FA) was performed at baseline and week 12. RESULTS Systemic and intravitreal bevacizumab therapy showed a treatment response within one week. Visual acuity improved at week 1 by 4.9 letters from baseline in the systemic and by 6.9 letters in the intravitreal treatment group. Central retinal thickness (CRT), as measured by OCT decreased by 51.9 microm and 176.4 microm, respectively. At month 3 a persistent treatment effect was detectable. Mean gain in visual acuity was 11 letters in the systemic and 8.3 letters in the intravitreal group, CRT had decreased by 100 microm and 153.8 microm, respectively. Leakage as evaluated by FA was significantly reduced or absent in all patients. CONCLUSION The early treatment responses following systemic and intravitreal bevacizumab appear to be similar. Both groups show improvement in VA and decrease in CRT within 1 week and up to 3 months. Long-term follow-up is required to evaluate the safety and treatment durability of both treatment modalities using bevacizumab.

Perspectives on verteporfin therapy combined with intravitreal corticosteroids.

Abstract: S INCE ITS APPROVAL IN 1999, photodynamic therapy (PDT) using verteporfin has become the most important strategy in the treatment of neovascular age-related macular degeneration (AMD). Verteporfin therapy has a proven benefit seen in many subtypes of choroidal neovascularization (CNV). In predominantly classic lesions, 59% of verteporfin-treated patients lost fewer than 3 lines as compared with 31% of sham-treated eyes. In patients with occult CNV with smaller lesions or lower levels of visual acuity, stable vision is seen in 51% of eyes in the verteporfin group while only 25% of sham-treated eyes maintained stable vision. Subgroup analysis suggests that verteporfin may also reduce the risk of vision loss in lesions with minimally classic features smaller than 4 Macular Photocoagulation Study disc areas. Most importantly, vision stabilization and absence of leakage activity was maintained during an extended follow-up of as long as 5 years with no relevant need for retreatment beyond 18 months. Although limited to specific subtypes of lesions, such a solid benefit has not been demonstrated so far by any other modality in the field. Clearly, the monotherapy approach is compromised by several concerns. A reduction in mean visual acuity despite treatment was observed in all treated subgroups, and this was particularly true for lesions with better visual acuity at baseline. A real improvement in visual acuity was a rare event with 9% of treated patients improving by 3 or more lines after 24 months. In occult only and minimally classic subtypes, lesions larger than 4 Macular Photocoagulation Study disc areas appeared not to benefit at all. Finally, the high number of patients requiring retreatment results in significant costs and effort for patients, treating ophthalmologists, and health care institutions. A major cause of the limitations of the monotherapy procedure may be related to the underlying photodynamic tissue effects. The vasoocclusive mechanism, triggered by selective damage to vascular endothelial cells, is not completely selective for neovascular endothelia but also affects normal choroidal vasculature. Resulting choroidal hypoxia and oxidative stress of the retinal pigment epithelium lead to increased expression of vascular endothelial growth factor as documented following verteporfin therapy in human eyes. Experimentally, PDT induced a rapid inflammatory tissue response, including infiltration with leucocytes and increased expression of cytokines, eg, intracellular adhesion molecule 1 and interleukin 6. Hence, some photodynamic mechanisms seem to enhance effects primarily associated with the pathogenesis of neovascular AMD. The pharmacologic profile of corticosteroids has the potential to simultaneously counteract AMDand PDT-related mechanisms. Steroids inhibit angiogenesis, fibrotic proliferation, and inflammatory activity by reducing the migration and activation of inflammatory cells. Upregulation of extracellular matrix protein plasminogen activator inhibitor-1 leads to a direct angiostatic effect. Steroids downregulate expression of intracellular adhesion molecules, an important stimulus in the development of CNV and an inflammatory mediator released by PDT. Moreover, intravitreal administration of triamcinolone acetate (IVTA) was efficient in treating macular edema in multiple conditions, such as diabetic maculopathy, vein occlusion, IrvineGass syndrome, and uveitis. Intravitreal administration of triamcinolone acetate given solely in neovascular AMD has a limited anatomic effect but no relevant clinical benefit. Intravitreal administration of triamcinolone acetate inhibited neovascular growth in an experimental model of laser-induced CNV. A single IVTA resulted in 55% stabilization of visual acuity but could not prevent vision decrease in 30% of patients over an 18-month follow-up. In predominantly occult lesions, CNV enlargement was reduced to 31% in the IVTA group compared with a growth rate of 70% in the control group. A single 4-mg IVTA injection in eyes with predominantly classic lesions reduced lesion growth at 3 months but failed to show any difference in vision outcome at 12 months. Following high-dose IVTA with 25 mg, visual acuity increased after each injection, but the overall effect was transient during follow-up. Author Affiliations: Department of Ophthalmology, University of Vienna, Vienna, Austria (Drs Schmidt-Erfurth and Michels); and Department of Ophthalmology, Stadt Klinikum, Karlsruhe, Germany (Dr Augustin).

Verteporfin therapy and triamcinolone acetonide: convergent modes of action for treatment of neovascular age-related macular degeneration.

Abstract: PURPOSE. Choroidal neovascularization associated with age-related macular degeneration is the primary cause of blindness in the elderly in developed countries, due to a number of pathogenic effects, including angiogenesis, cell-mediated inflammation, leukocyte adhesion and extravasation, and matrix remodeling. METHODS. By producing photochemical effects at the site of target tissue (lesion), photodynamic therapy (PDT) can induce vascular damage and blood flow stasis, leading to occlusion of vascularization and lesion leakage. RESULTS. PDT with verteporfin (Visudyne, Novartis) has been shown to be safe and effective in reducing the risk of vision loss in patients with classic containing subfoveal CNV and occult with no classic CNV. However, in predominantly occult CNV, the treatment may be most effective in smaller lesions, and less in larger lesions. Most important, visual acuity rarely is improved. DISCUSSION AND CONCLUSIONS. Pilot studies and large case series suggest that a combination of PDT and intravitreal triamcinolone acetonide has the potential to improve visual outcomes and reduce the need for additional treatments. Randomized, prospective clinical trials are underway to confirm the efficacy and safety of this novel treatment modality. (Eur J Ophthalmol 2006; 16: 824-34)

Klinischer Einsatz eines intravitrealen Dexamethason-Implantats in der Behandlung des Makulaödems

Abstract: Problemstellung Das Makulaodem ist die wesentliche Ursache fur eine Visusverschlechterung nach Ast- und Zentralvenenverschlussen (AVV, ZVV) oder bei der diabetischen Retinopathie (DRP). Die derzeitigen Therapieoptionen sind unbefriedigend oder noch nicht ausreichend untersucht. Steroide sind durch ihre gefasabdichtenden Eigenschaften geeignet und intravitreale Injektionen (z. B. Triamcinolon) haben sich als erfolgversprechend erwiesen, mussen aber haufig wiederholt werden.

Retinal pigment epithelium pathologies investigated with phase resolved polarization sensitive optical coherence tomography

Abstract: A polarization sensitive optical coherence tomography (PS-OCT) instrument was used to investigate the retinal pigment epithelium (RPE). The instrument uses the polarization properties of light to record backscattered intensity, retardation and fast axis orientation simultaneously and needs only one measurement per sample location to retrieve these parameters. The polarization state of light backscattered from within the RPE was found to be random. This can be observed in PS-OCT images by random retardation and axis orientation values within the RPE layer. In diseased eyes where the normal retinal structure is corrupted (e.g. RPE atrophy, RPE detachment) the localization of the RPE within OCT images which do not provide polarization information (standard OCT) is rather difficult. Since the RPE is the only structure within the retina to cause this polarization scrambling, PS-OCT can be used for contrast enhancement and enables the exact localization of the RPE in these pathologies. Therefore it is possible to determine if the RPE is still preserved in regions of interest. Furthermore, in patients with RPE atrophy an enhanced penetration depth into the choroid and even into the sclera was observed. Because of birefringence introduced by the sclera the border between choroid and sclera could easily be determined.

Ergebnisse der Mikroperimetrie bei Patienten mit Makulaloch und Makula Pucker

Abstract: In der vorliegenden Pilot-Studie untersuchten wir die Makulafunktion bei Patienten mit Makulaloch und Makula Pucker mittels Mikroperimetrie pra- und postoperativ. Je 10 Patienten mit Makulaloch und Makula Pucker wurden inkludiert. Die Patienten mit Makulaloch waren durchschnittlich 69,3 ±5,5 Jahre alt, diejenigen mit Makula Pucker 64,4±6,2 Jahre. Der optimal korrigierte Fernvisus (LogMAR) und die zentrale Gesichtsfeldmessung mit dem MP1 (Nidek) wurden vor und 12 Wochen nach Operation erhoben. Durchschnittliche dB und Fixationsstabilitat (mittels automatischem eye tracking) wurden bei der Gesichtsfeldmessung ermittelt. Praoperativ war der Fernvisus bei Makulaloch-Patienten LogMAR 0,74 ± 0,2 und LogMAR 0,55 ± 0,28 bei Patienten mit Makula Pucker. Postoperativ war der Visus in beiden Gruppen signifikant besser (LogMAR 0,56 ± 0,24 und LogMAR 0,32 ±0,24). Bei Makulaloch-Patienten ergab die Mikroperimetrie praoperativ durchschnittlich 10,9 ±2,7 dB und 10,6±3,0 dB bei Patienten mit Makula Pucker. Eine signifikante Verbesserung zeigte sich postoperativ (12,9 ± 1,6 dB und 12,6 ±2,3 dB). Ebenso verbesserte sich die Fixationsstabilitat signifikant: Die Anzahl der Patienten mit stabiler Fixation stieg bei Makulaloch-Patienten von 4 auf 8 und bei Makula-Pucker-Patienten von 3 auf 9. 50% der Patienten mit Makulaloch und 60 % der Patienten mit Makula Pucker zeigten eine Verbesserung des Fernvisus, eine signifikant hohere Zahl jedoch hatte eine Steigerung der zentralen Gesichtsfeldfunktion (70% und 80%). Die vorliegende Studie zeigt postoperativ eine signifikante Verbesserung der zentralen Gesichtsfeldfunktion bei Patienten mit Makulaloch und Makula Pucker. Diese Verbesserung war in weitaus mehr Patienten zu beobachten, als die Bestimmung des Fernvisus ergab. Dies unterstreicht den Wert der Mikroperimetrie fur diese Patienten, da eine alleinige Messung des Fernvisus die funktioneilen Vorteile einer Operation unterschatzen. To evaluate the visual performance pre- and postoperatively of patients with macular holes and macular pucker using microperimetry. 10 patients with macular hole and 10 with macular pucker were studied. The patients’ age was 69.3±5.5 years in the macular hole group and 64.4±6.2 years in the macular pucker group. Best-corrected visual acuity (LogMAR) and microperimetry were tested before and 12 weeks after operation. Microperimetry was determined with the MP1 (Nidek). Mean dB and stability of fixation performed with the automatic eye tracking during examination were evaluated. Hole closure and reduction of macular thickness, respectively, were confirmed with an OCT-scan. Preoperatively, the distance visual acuity was LogMAR 0.74 ±0.2 in macular hole patients, and LogMAR 0.55 ±0.28 in macular pucker patients. Postoperatively, visual acuity was significantly better in both groups (LogMAR 0.5 ±0.24 and LogMAR 0.32±0.24, respectively). Microperimetric measures showed a mean dB of 10.9±2.7 dB in macular hole patients and 10.6±3.0 dB in patients with macular pucker. Postoperatively, the mean dB of both groups was statistically significant better (12.9±1.6 dB and 12.6±2.3 dB, respectively). Also stability of fixation increased significantly in both groups: The number of patients with stable fixation increased in macular hole patients from 4 to 8 and in macular pucker patients from 3 to 9. 50% of macular hole patients and 60 % of macular pucker patients showed an improvement of visual acuity, but a significantly higher number (70 % and 80 %, respectively) had a better outcome in microperimetric measures. The study shows a significant increase of microperimetric measures for patients with macular hole and macular pucker postoperatively. Additionally, a higher number of patients improved in microperimetric measures than with visual acuity testing. This shows the value of the microperimetry for these patients and indicates that visual distance acuity alone underestimates the functional benefit of surgery.

Rolle der makulären Funktionsanalyse für die Bestimmung der Funktionsfähigkeit der Makula bei charakteristischen Makulapathologien

Abstract: Hintergrund Aufgrund zunehmender Therapieoptionen fur unterschiedliche Makulapathologien besteht ein zunehmendes Interesse an einer verlasslichen Bestimmung der Funktionsfahigkeit der Makula. Das Mikroperimeter 1 (MP 1, Nidek) ermoglicht eine fundusorientierte, zentrale Funktionsanalyse und verfugt zudem uber eine automatische Schwellenbestimmung und eine automatische Fixationskorrektur („Eye Tracking“).

Preferential Hyperacuity Perimeter: Früherkennung der feuchten altersbedingten Makuladegeneration

Abstract: Patienten mit Makulalasionen sehen Linien verzerrt, verbogen oder luckenhaft. Die entsprechend verandert gesehenen Zonen werden am Amsler-Testblatt vom Patienten eingetragen. Der Amsler-Test erlaubt daher eine subjektive Fruherkennung und Uberwachung des Fortschreitens von Makula-Lasionen. In den letzten Jahren wurde ein neues Gerat, das Preferential Hyperacuity Perimeter (PHP) entwickelt, das sowohl subjektive als auch objektive Defekte im Gesichtsfeld fruhzeitig entdecken soll. Beim PHP-Test wird ein punktiertes lineares Signal auf verschiedene Makulastellen innerhalb eines perifovealen Radius von 7° projiziert. Jede Verzerrung oder Skotom, das vom Patienten wahrgenommen wird, wird notiert und automatisch analysiert. Ein Makuladiagramm wird mit quantitativen Werten des Bereichs und der Intensitat der Metamorphopsien erstellt. Ziel dieser Arbeit ist es, mittels eines Literaturuberblicks die klinische Relevanz des PHP-Gerates zu bewerten. Die PHP- und Amsler-Testergebnisse fur die Fruherkennung von neovaskularer altersbedingter Makuladegeneration (AMD), geographischer Atrophie und trockener AMD mit hohem Progredienz-Risiko zur feuchten AMD, werden gegenubergestellt und diskutiert. Patients with lesions of the macula see lines distorted or incomplete. The corresponding changed zones are registered by the patient on the map. The Amsler grid allows an early subjective detection and a subjective documentation of progress of macular lesions. The “Preferential Hyperacuity Perimeter (PHP)” is a new diagnostic device for the early objective registration and monitoring the progress of lesions of the macula. With the PHP-test, a dotted linear signal is flashed across different macular loci to a perifoveal radius of 7 degrees. Each distortion or scotoma, which is noticed by the patient, is recorded and analyzed automatically. A diagramm of macula is produced with quantitative values of the range and the intensity of the metamorphopsia. This literature review tries to evaluate the clinical relevance of the PHP device. The Amsler- and PHP-test results are confronted and discussed in order to discover the sensitivity in early detection and monitoring of neovascular age-related macular degeneration (AMD), geographic atrophy and AMD with high-risk characteristics.

Sinnhaftigkeit der Fundusbegutachtung vor Marcoumarisierung

Abstract: Vor geplanter Marcoumarisierung eines Patienten ist es ublich, diesen, unabhangig von der Indikation zur Antikoagulation sowie etwaiger Begleiterkrankungen, zur „Marcoumarfreigabe“ zum Ophthalmologen zu schicken. Mittels dieses Literaturuberblicks versuchen wir, die klinische Relevanz der Fundusbegutachtung zu bewerten. Im Vordergrund steht hier insbesondere die Frage, inwieweit der Ophthalmologe eine „Freigabe“ zur systemischen Antikoagulation aussprechen kann. Weiters wird besonderes Augenmerk auf ophthalmologische Erkrankungen mit erwiesenem erhohten lokalen Blutungsrisiko gerichtet und der Frage nachgegangen, inwieweit aufgrund der retinalen Gefasveranderungen auf die allgemeine Gefassituation geschlossen werden kann.