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Ness T.,Universitats Augenklinik Freiburg | Paulus W.,Institute For Reproduktionstoxikologie
Ophthalmologe | Year: 2012

Ocular therapy is necessary even during pregnancy but the use of pharmaceutical substances bears the risk of side effects on mother and child. The article reflects current knowledge on how to treat the most important eye diseases during pregnancy and breastfeeding. The review covers the diagnostics (tonometry, mydriasis, angiography) as well as treatment of infections of the eyes, glaucoma, allergies, diabetic retinopathy, pain and inflammation. © 2012 Springer-Verlag.


Ness T.,Universitats Augenklinik Freiburg | Paulus W.,Institute For Reproduktionstoxikologie Ravensburg
Ophthalmologe | Year: 2010

Pregnancy may cause ocular changes, for example refractive changes or contact lens intolerance. A number of ocular diseases may deteriorate. Especially preexisting diabetic retinopathy may worsen. Vaginal delivery is nearly always possible. Caesarean section is not required due to myopia, peripheral retinal degenerations or after retinal surgery. Most topically applied drugs usually used in ophthalmology are safe during pregnancy. © 2010 Springer-Verlag.


Birnbaum F.,Universitats Augenklinik Freiburg | Maier P.,Universitats Augenklinik Freiburg | Reinhard T.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2011

The femtosecond laser technique allows completely new trephination procedures in penetrating and lamellar keratoplasty. With femtosecond laser-assisted penetrating keratoplasty it is possible to perform profiled trephination, such as top hat and mushroom profiles. Thus, it is easier to get a watertight wound closure intraoperatively and due to the larger wound surface wound healing is faster and allows early complete suture removal. In lamellar keratoplasty the femtosecond laser enables the surgeon to cut to any depth in the corneas resulting in thin corneal donor buttons, e. g. for DSAEK. In this manuscript an overview is given of the state of the art and of the perspectives of femtosecond laser keratoplasty. © 2011 Springer-Verlag.


Lang G.E.,Universitatsklinikum Ulm | Lang S.J.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2011

Hematological diseases can lead to ocular manifestations in up to 90% of patients and sometimes the ophthalmological findings are the presenting symptom of the disease. The ocular manifestation is often asymptomatic. The diagnosis can be difficult especially when the ocular manifestation represents the first symptoms. In most cases the conjunctiva and retina are involved and are particularly found in patients with anemia, leukemia, Hodgkin and non-Hodgkin lymphoma, myeloproliferative and myelodysplastic syndromes and coagulopathies. Even opportunistic infections in cases of hematological diseases can lead to ocular manifestations. For unexplained retinal alterations with hemorrhage and cotton-wool spots an underlying hematological disease should be excluded. © 2011 Springer-Verlag.


Eberwein P.,Universitats Augenklinik Freiburg | Reinhard T.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2011

The transplantation of limbal stem cells is one of the most challenging surgical approaches in ocular surface reconstruction. Partial and unilateral limbal stem cell insufficiency (LSCI) can be treated by fractionated abrasion or autologous limbal stem cell transplantation from the fellow eye. In cases of advanced bilateral and partial LSCI, ex vivo expansion of limbal stem cells on amniotic membranes or fibrin can be performed but all patients with complete bilateral LSCI must rely on allogenic limbal stem cell transplantation with high immunological risks. Attempts to combine allogenic limbal stem cell transplantation with mitomycin C and amniotic membrane transplantation are promising. In the laboratory, attempts to transdifferentiate bone marrow stem cells into corneal epithelial cells have been without success. Nonetheless, transdifferentiation of hair follicle stem cells into corneal epithelial cells looks promising. In parallel, research on the limbal stem cell niche is ongoing to elucidate the natural environment of limbal stem cells in order to improve ex vivo culture. © 2011 Springer-Verlag.


Poloschek C.M.,Universitats Augenklinik Freiburg | Jagle H.,Universitats Augenklinik Regensburg
Ophthalmologe | Year: 2012

This article reviews the current pharmacological strategies to treat inherited retinal degeneration. To date there is no causal therapy despite growing knowledge of the particular pathomechanisms. However, treatment is available for complications, such as cystic macular changes and cystoid macular edema. To reduce retinal thickness systemic or topical carboanhydrase inhibitors can be applied and in rare cases combined with steroids when indicated, however reduction of retinal thickness is not always accompanied by improvement of visual acuity. Regular follow-up with optical coherence tomography is required. In some cases, potentially neuroprotective agents (valproic acid, ciliary neurotrophic factor and Ca2+ channel inhibitors) or food supplementation (vitamin A, lutein, synthetic retinoids and decosahexaenoic acid) may have a positive impact on disease progression (e. g. reduction in progression of visual field loss or individual electrophysiological parameters). However, beneficial effects and side effects, e. g. of vitamin A substitution, depend not only on the disease phenotype (such as retinitis pigmentosa) but also on the actual genotype. Furthermore, no data are available regarding the application of pharmaceuticals in the pediatric population. © 2012 Springer-Verlag.


Junker B.,Universitats Augenklinik Freiburg | Hansen L.L.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2010

Coats disease is characterized by idiopathic congenital retinal telangiectasis and exudative retinopathy. Mostly young males are affected. The disease is usually unilateral. Visual prognosis varies from full visual acuity to blindness according to the extent of retinal exudation. Retinoblastoma is a major differential diagnosis particularly in small children but other causes of exudative retinopathy must also be considered. Treatment aims include obliteration of the telangiectasis in order to resolve retinal exudation and achieve reattachment of the retina. Therapeutic options comprise laser coagulation or cryotherapy, drainage of subretinal fluid, buckling surgery and pars plana vitrectomy. In more advanced cases with therapy-resistant secondary glaucoma enucleation may be required. More recently, intravitreal administration of VEGF inhibitors has become an option. © 2010 Springer-Verlag.


Ness T.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2010

Multidrug-resistant bacteria have emerged as an increasing threat in many areas of medicine. The most prominent multidrug-resistant pathogens are methicillin-resistant S. aureus (MRSA), vancomycin-resistant MRSA (VMRSA), vancomycin-resistant enterococci (VRE), and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL). In particular, MRSA and VRE cause infections seen in ophthalmology. The lids, lacrimal duct, and ocular surface are frequently involved. © 2010 Springer-Verlag.


Poloschek C.M.,Universitats Augenklinik Freiburg | Bach M.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2012

The two currently used most successful techniques for early detection of glaucoma are described. (1) The pattern electroretinogram (PERG) allows detection of incipient glaucomatous damage in eyes with ocular hypertension up to 4 years ahead of manifest glaucoma with a sensitivity and specificity of approximately 75%. This is achieved by selecting optimized stimulation (check size and stimulation frequency) and analysis protocols (amplitude ratio to different check sizes). The major disadvantage is the requirement for best corrected visual acuity to be at least 0.8(decimal) to avoid false positive results. (2) The photopic negative response (PhNR), a component of the Ganzfeld ERG, does not suffer from optical factors reducing visual acuity. It is also affected in early glaucoma but so far has not achieved the same sensitivity and specificity as the PERG. © 2012 Springer-Verlag.


Heinzelmann S.,Universitats Augenklinik Freiburg | Maier P.,Universitats Augenklinik Freiburg | Reinhard T.,Universitats Augenklinik Freiburg
Ophthalmologe | Year: 2011

Corneal endothelial diseases, such as Fuchs' endothelial dystrophy and bullous keratopathy represent the most common indications for keratoplasty. Replacement of the entire cornea by penetrating keratoplasty has been the gold standard in treating corneal endothelial diseases for many decades. However, recently new and innovative surgical techniques for selective endothelial replacement have been developed. These are Descemet stripping (automated) endothelial keratoplasty (DS(A)EK), Descemet membrane endothelial keratoplasty (DMEK) and hybrid techniques of both. The distinct advantages and drawbacks of lamellar and penetrating techniques reveal the need of comparative studies to find out which method is suitable for which patient, particularly with regard to long-term visual rehabilitation. © 2011 Springer-Verlag.

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