Universitats Augenklinik Tubingen

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Universitats Augenklinik Tubingen

Germany

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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.


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.


PubMed | Open University Milton Keynes and Universitats Augenklinik Tubingen
Type: Journal Article | Journal: Zeitschrift fur medizinische Physik | Year: 2016

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.The results presented in this study follow a method described by Wilhelm et al. (Tbingen 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.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.These measurements were compared with typical results from the original Tbingen 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.


PubMed | Augenabteilung Am St Franziskus Hospital Munster, Universitats Augenklinik Bonn, Novartis, Universitats Augenklinik Tubingen and Cologne Image Reading Center
Type: Journal Article | Journal: Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft | Year: 2016

The prevalence of blindness as defined by law could be reduced by the introduction of anti-vascular endothelial growth factor (VEGF) therapy. Because the treatment is governed by patient needs, mostly using morphological criteria, imaging diagnostics are of particular importance. The non-interventional OCEAN study investigates the treatment with ranibizumab in the clinical routine practice. In a subgroup of patients the interpretation of spectral domain optical coherence tomography (SD-OCT) scans by the treating physicians will be analyzed (ORCA module).Over a period of 24 months data from patients with exudative age-related macular degeneration (AMD), macular edema due to retinal vein occlusion or diabetes mellitus, who are receiving intravitreal injections of ranibizumab, will be assessed. Information on examinations, visual acuity, treatment and recordings from imaging techniques will be documented using a questionnaire. The SD-OCT scans, fluorescence angiography and fundus photography will be independently analyzed by the ophthalmologist of the study center and by three reading centers (CIRCL Cologne, GRADE Bonn and M3 Mnster). Automated measurements of retinal thickness by the manufacturers software will be checked and if necessary manually corrected. A qualitative interpretation in terms of morphological criteria for (further) treatment will be performed.A thorough assessment of SD-OCT images during anti-VEGF therapy provides the basis for the best possible needs-oriented treatment regimen. The control of the quality of data from daily routine practice may indicate possible weaknesses allowing explicit training and therefore optimization of patient treatment.


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.


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


Petermeier K.,Universitats Augenklinik Tubingen | Szurman P.,Universitats Augenklinik Tubingen | Bartz-Schmidt U.K.,Universitats Augenklinik Tubingen | Gekeler F.,Universitats Augenklinik Tubingen
Klinische Monatsblatter fur Augenheilkunde | Year: 2010

Cataract formation is one of the most common complications after vitrectomy and cataract extraction in such cases will have to be performed under more difficult conditions. A knowledge of the different types of cataract, their frequency and causes may help to develop strategies to prevent this complication. In addition to a progressive nuclear opacification, which may occur after any type of vitrectomy, transient feathering of the lens often occurs after intraocular gas tamponade, while permanent subcapsular opacification may occur in silicone oil-filled eyes. Nuclear opacification after vitrectomy morphologically and histologically resembles age-related cataracts, but shows a faster progression: two years after vitrectomy half of the eyes require cataract extraction and there seems to be an age limit: the opacification progresses faster in patients over 50 years old. The main cause for nuclear cataracts most probably is oxidative stress. Oxygen in the avascular lens is provided by diffusion, meaning that the surrounding oxygen content is crucial for the oxygen content within the lens and thus for the formation of reactive oxygen species. In rabbits and also in humans the partial oxygen pressure is highly elevated in the vitreous cavity after vitrectomy and posterior to the lens since the vitreous is lacking as a diffusion barrier for the oxygen. The partial oxygen pressure might be additionally elevated by ventilation with oxygen and a high oxygen pressure in the infusion fluid during surgery. This elevated partial oxygen pressure may lead to increased oxygen stress and thus to lens opacification by oxidation of structural proteins. The key for the prevention of cataract formation therefore seems to be avoidance of oxidative stress, factors that might increase the protective or repair systems are so far not available. Ventilation with oxygen should be minimised as should be the partial oxygen tension in the infusion fluid. New hydrogels as vitreous substitutes might have a beneficial influence on intraocular partial oxygen tension. © Georg Thieme Verlag KG Stuttgart New York.


Nessmann A.,Universitats Augenklinik Tubingen | Schramm C.,Universitats Augenklinik Tubingen | Gelisken F.,Universitats Augenklinik Tubingen
Ophthalmologe | Year: 2016

A 64-year-old female patient complained of a bilateral reduction in vision. The foveal reflex was remarkable bilaterally and optical coherence tomography (OCT) demonstrated the absence of a foveal depression. After exclusion of possible diseases foveal hypoplasia was diagnosed. This rare alteration of the fovea should not be mistaken for foveal edema. A volume scan with a narrow grid is advisable to avoid a misinterpretation. © 2015, Springer-Verlag Berlin Heidelberg.


PubMed | Universitats Augenklinik Tubingen
Type: Journal Article | Journal: Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft | Year: 2015

Choroidal lymphoma is a rare disease and can be classified into primary and secondary choroidal lymphomas. Primary choroidal lymphoma is a low-grade extranodal marginal zone B-cell lymphoma and secondary choroidal lymphomas present ocular manifestations of disseminated systemic lymphomas. Typical clinical features of choroidal lymphoma are multifocal, yellow-whitish choroidal infiltrates. The vitreous body is usually clear and cell-free. Choroidal lymphoma has a tendency to extend through the sclera. In contrast to primary choroidal lymphoma, which is more often unilateral, does not show signs of anterior segment involvement and has a slow progression, secondary choroidal lymphoma is more often bilateral, has a rapidly progressive course with anterior segment and vitreous involvement and belongs to the high-grade lymphomas. The definitive diagnosis of choroidal lymphoma can only be confirmed by histopathological examination of biopsy tissue. The choroidal biopsy is the gold standard in the diagnostics of choroidal lymphoma. To date, no standardized treatment for choroidal lymphoma has been established. The treatment modalities include external beam radiotherapy, immunotherapy with rituximab and chemotherapy. The prognosis for survival of primary choroidal lymphoma is usually good. The prognosis of secondary choroidal lymphoma depends on the malignancy grade of systemic lymphoma.


PubMed | Universitats Augenklinik Tubingen
Type: Journal Article | Journal: Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft | Year: 2016

A 64-year-old female patient complained of a bilateral reduction in vision. The foveal reflex was remarkable bilaterally and optical coherence tomography (OCT) demonstrated the absence of a foveal depression. After exclusion of possible diseases foveal hypoplasia was diagnosed. This rare alteration of the fovea should not be mistaken for foveal edema. A volume scan with a narrow grid is advisable to avoid a misinterpretation.

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