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Cayless A.,Open University Milton Keynes | Bende T.,Universitats Augenklinik Tubingen
Zeitschrift fur Medizinische Physik | Year: 2015

Background: This paper presents preliminary observations on the use of a commercial pupillometric instrument (Albomed PupilX) for the detection and quantification of Relative Afferent Pupillary Defect (RAPD). In this pilot study, video-based pupillometry was used in conjunction with calibrated LED illumination to simulate the effects of the traditional swinging-flashlight test using neutral density filters. Methods: The results presented in this study follow a method described by Wilhelm et al. (Tübingen SWIFT-test) in which the eyes are illuminated alternately and the response in pupil diameter measured by video pupillometry. Using the PupilX instrument, the LED intensity can be programmed in logarithmic steps starting from a maximum intensity of 1000 lux (lx), with each reduction of 50% in illumination intensity corresponding to a 0.3 log-units increase in filter density. Results: The eyes were stimulated unilaterally with illumination intensities corresponding to a neutral density range of 0.0 to 0.9 log-units. In all normal subjects a symmetrical pupil reaction was seen, independent of which eye was stimulated. In contrast, in a subject with known RAPD, a clear asymmetry in the reaction to stimulation of the left and the right eyes was seen. Conclusions: These measurements were compared with typical results from the original Tübingen SWIFT study and good qualitative agreement was seen. Furthermore, the method can clearly differentiate between healthy subjects and those with a known RAPD, indicating that the PupilX, programmed with specific stimulus sequences and in conjunction with a suitable analysis software, has the potential for recognition and quantification of RAPD, and prompting the suggestion for further study involving a range of patients including both normal subjects and those with a known and quantified RAPD. © 2015. Source

Krohne T.U.,Universitats Augenklinik Bonn | Aisenbrey S.,Universitats Augenklinik Tubingen | Holz F.G.,Universitats Augenklinik Bonn
Ophthalmologe | Year: 2012

Retinopathy of prematurity is one of only few potentially blinding retinal diseases of infancy amenable to prevention of visual loss by appropriate and timely therapeutic measures. Retinal ablative therapies, such as laser coagulation eliminate the disease-causing secretion of vascular endothelial growth factor (VEGF) by the avascular peripheral retina. Blockage of VEGF activity by intravitreal administration of VEGF-inhibitory drugs has likewise proven effective in recent clinical studies. Advanced stages of the disease may require surgical intervention. Knowledge of indications and techniques of the different currently available treatment options is crucial to ensure an optimal visual outcome for the affected children. © 2012 Springer-Verlag Berlin Heidelberg. Source

Voykov B.,Universitats Augenklinik Tubingen | Rohrbach J.M.,Universitats Augenklinik Tubingen
Ophthalmologe | Year: 2016

Canaloplasty is a recently introduced non-penetrating surgical technique for glaucoma, which seeks to improve the natural outflow of aqueous humor through Schlemm’s canal and the collector channels. Just as in all forms of glaucoma surgery there are a certain number of failures of the procedure and further surgery is often needed to reduce the intraocular pressure in these cases. This article describes some of the revision procedures after canaloplasty. © 2016 Springer-Verlag Berlin Heidelberg Source

Inhoffen W.,Universitats Augenklinik Tubingen | Ziemssen F.,Universitats Augenklinik Tubingen | Bartz-Schmidt K.U.,Universitats Augenklinik Tubingen
Klinische Monatsblatter fur Augenheilkunde | Year: 2012

Central neurosensory detachments (NSD) with time-dependent height constitute a disease called central serous chorioretinopathy (CSC), if not arising from uveitis, choroidal neovascularisations (CNV) or leaking retinal vessels. In 10 % of these patients, CSC develops into a chronic disease with recurrent NSD, atrophy of photoreceptors and severe drop in visual acuity. This review article summarises recent progress in understanding this disease and its appearance in funduscopy, FLA, ICG, OCT, autofluorescence as well as its progress, therapy and possible development into secondary CNV. The provided examples illustrate the progression of acute CSC into chronic CSC and with CNV over years. The different appearance of polypoidal choroidal vasculopathy (PCV) in ICG and some of the signs of atypical chronic CSC are discussed. To distinguish between cCSC and wet AMD - both exhibiting leakage in FLA - typical signs are helpful, e.g., "gravitational trackso", retinal precipitates and missing drusen. However, in small lesions, it may be difficult or almost impossible to ensure the correct diagnosis of the underlying disease. The same holds for occult and classic secondary CNV in cCSC vs. CNV in AMD, where photodynamic therapy (PDT) can be successful only in cCSC-CNV and in cCSC without CNV. Corticosteroids often lead to further impairment, even in cases of atypical cCSC, when frequently misdiagnosed as uveitis. As a duration of NSD of more than 4 months is suspected to induce an impairment of photoreceptors, regular examinations are necessary not only in chronic CSC but also after acute CSC (as this form can develop into chronic CSC), while effective therapies are available to resolve the NSD (PDT, anti-VEGF). © Georg Thieme Verlag KG Stuttgart · New York. Source

Doycheva D.,Universitats Augenklinik Tubingen | Deuter C.,Universitats Augenklinik Tubingen | Zierhut M.,Universitats Augenklinik Tubingen
Ophthalmologe | Year: 2014

Intermediate uveitis is a form of intraocular inflammation in which the vitreous body is the major site of inflammation. Intermediate uveitis is primarily treated medicinally and systemic corticosteroids are the mainstay of therapy. When recurrence of uveitis or side effects occur during corticosteroid therapy an immunosuppressive treatment is required. Cyclosporine A is the only immunosuppressive agent that is approved for therapy of uveitis in Germany; however, other immunosuppressive drugs have also been shown to be effective and well-tolerated in patients with intermediate uveitis. In severe therapy-refractory cases when conventional immunosuppressive therapy has failed, biologics can be used. In patients with unilateral uveitis or when the systemic therapy is contraindicated because of side effects, an intravitreal steroid treatment can be carried out. In certain cases a vitrectomy may be used. © 2014, Springer-Verlag Berlin Heidelberg. Source

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