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2.
Eye (Lond) ; 23(3): 567-75, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18344954

RESUMO

PURPOSE: To describe the occurrence of discrete arcs of increased fundus autofluorescence (FAF) associated with various retinal dystrophies and to assess their functional significance by fundus-controlled microperimetry. METHODS: Seven patients, three with pigmented paravenous retinochoroidal atrophy (PPRCA), one with sector retinitis pigmentosa (RP), one with typical RP, and two with macular dystrophy were assessed by retinal imaging including FAF imaging. Serial images were obtained within a review period of 6 and 10 years in a patient with PPRCA and macular dystrophy, respectively. Fundus-controlled microperimetry was performed in eight eyes of five patients to determine light increment sensitivity. RESULTS: A discrete arched line of increased FAF was observed without obvious correlate on fundus biomicroscopy. The orientation of this line differed from ring shape in RP and macular dystrophy, a semi-circle structure in sector RP to crescent shape with tiplike extensions towards branching retinal veins in PPRCA. Longitudinal investigation revealed slight migration of the arc in PPRCA and peripheral extension of the ring diameter in macular dystrophy. Microperimetry revealed that the arc of increased FAF sharply delineated areas of severely impaired retinal sensitivity. CONCLUSIONS: The findings indicate that arcs of increased FAF in PPRCA and other retinal dystrophies demarcate areas of impaired retinal function and may migrate over time. FAF imaging may therefore reveal the exact extent of neurosensory dysfunction that may exceed the dimensions anticipated by conventional examinations.


Assuntos
Degeneração Retiniana/diagnóstico , Adolescente , Adulto , Atrofia/diagnóstico , Atrofia/fisiopatologia , Criança , Corioide/patologia , Eletrorretinografia , Feminino , Fluorescência , Fundo de Olho , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/fisiopatologia , Masculino , Oftalmoscopia/métodos , Degeneração Retiniana/fisiopatologia , Retinose Pigmentar/diagnóstico , Retinose Pigmentar/fisiopatologia , Acuidade Visual/fisiologia , Testes de Campo Visual/métodos , Adulto Jovem
3.
Ophthalmologe ; 105(2): 125-38, 140-2, 2008 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-18256841

RESUMO

Age-related macular degeneration (AMD) is one of the most common causes of blindness in western industrialised nations. Most AMD patients suffer from the dry early form of AMD; however, wet AMD with choroidal neovascularization (CNV) is the main cause of blindness in all AMD patients. New prospects have been developed in AMD treatment using pharmacological methods available for treating all subtypes of exudative AMD. A number of inhibiting and inducing growth factors, such as vascular endothelial growth factor (VEGF), are particularly important in the pathophysiology of wet AMD. The secreted VEGF appears to play a crucial role in the pathogenesis of CNV and macular edemas as a result of its angiogenetic and permeability-enhancing effect. This recognition led to the treatment approach now used, i.e., competitive VEGF blocking through intravitreal adminsitration of anti-VEGF drugs. The anti-VEGF durgs lead to a rapid decrease in retinal thickness. Optical coherence tomography (OCT) is a valuable monitoring tool, but may only be used to assist in decision-making. Clinical follow-up of patients and further treatment recommendations must always be guided by the overall clinical picture. Visual acuity is regarded as the decisive criterion for repeat treatment.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Aptâmeros de Nucleotídeos/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Aptâmeros de Nucleotídeos/administração & dosagem , Bevacizumab , Cegueira/etiologia , Ensaios Clínicos Fase III como Assunto , Angiofluoresceinografia , Seguimentos , Humanos , Injeções , Degeneração Macular/complicações , Degeneração Macular/diagnóstico , Metanálise como Assunto , Monitorização Fisiológica , Estudos Multicêntricos como Assunto , Fotoquimioterapia , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/uso terapêutico , Porfirinas/administração & dosagem , Porfirinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ranibizumab , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Verteporfina , Testes Visuais , Acuidade Visual , Corpo Vítreo
4.
Klin Monbl Augenheilkd ; 224(10): 791-3, 2007 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-17952824

RESUMO

We report the case of an asymptomatic unilateral pigmented paravenous retinochoroidal atrophy (PPRCA) in a 43-year-old patient. The right eye showed chorioretinal atrophy with bone-spicule-like pigmentations along the retinal veins. Visual acuity was 20 / 20 and perimetry revealed scotomas correlating to the chorioretinal atrophy. Electrophysiological examination showed decreased signals in ERG and EOG. Fundus autofluorescence and angiography findings are presented. Pathogenetically, a classification as hereditary retinal dystrophy (as in retinitis pigmentosa) as well as a post-inflammatory residuum are discussed.


Assuntos
Corioide/patologia , Hiperpigmentação/patologia , Retina/patologia , Veia Retiniana/patologia , Adulto , Atrofia , Cicatriz/patologia , Eletrorretinografia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Oclusão da Veia Retiniana/patologia , Campos Visuais/fisiologia
5.
Ophthalmologe ; 103(6): 463-70, 2006 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-16763862

RESUMO

The efficacy and safety of the therapeutic anti-VEGF concept has already been demonstrated for pegaptanib and ranibizumab. Bevacizumab acts as an antibody against all VEGF-A isoforms and has been developed for oncological indications with intravenous application. Initial reports on intravitreal administration in patients with neovascular age-related macular disease (AMD) have shown beneficial morphological and functional effects. In the meantime, bevacizumab has been used off-label in thousands of patients with AMD. However, data from prospective, controlled, randomized trials on both safety and efficacy are lacking. Herein recent experiences with bevacizumab are summarized and discussed. Furthermore, a web-based platform for online data registration and pooled analyses is presented.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados , Bevacizumab , Neovascularização de Coroide/etiologia , Ensaios Clínicos como Assunto , Aprovação de Drogas , Rotulagem de Medicamentos , Medicina Baseada em Evidências , Humanos , Injeções Intralesionais , Degeneração Macular/complicações , Padrões de Prática Médica , Resultado do Tratamento , Corpo Vítreo
6.
Ophthalmologe ; 103(6): 537-51; quiz 552-3, 2006 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-16763870

RESUMO

Pseudoxanthoma elasticum (PXE) is an inherited disorder that is associated with accumulation of mineralized and fragmented elastic fibers in the skin, vessel walls, and Bruch's membrane. Clinically, patients exhibit characteristic lesions of the skin (soft, ivory-colored papules in a reticular pattern that predominantly affect the neck), the posterior segment of the eye (peau d'orange, angioid streaks, choroidal neovascularizations), and the cardiovascular system (peripheral arterial occlusive disease, coronary occlusion, gastrointestinal bleeding). There is no causal therapy. Recent studies suggest that PXE is inherited almost exclusively as an autosomal recessive trait. Its prevalence has been estimated to be 1:25,000-100,000. The ABCC6 gene on chromosome 16p13.1 is associated with the disease. Mutations within the ABCC6 gene cause reduced or absent transmembraneous transport that leads to accumulation of substrate and calcification of elastic fibers. Although based on clinical features the diagnosis appears readily possible, variability in phenotypic expressions and the low prevalence may be responsible that the disease is underdiagnosed. This review covers current knowledge of PXE and presents therapeutic approaches.


Assuntos
Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/terapia , Pseudoxantoma Elástico/diagnóstico , Pseudoxantoma Elástico/terapia , Neovascularização de Coroide/epidemiologia , Neovascularização de Coroide/etiologia , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Pseudoxantoma Elástico/complicações , Pseudoxantoma Elástico/epidemiologia
7.
Internist (Berl) ; 47(2): 192-8, 2006 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-16341677

RESUMO

Age-related macular degeneration (AMD) is now the most common cause for blind registration in all developed countries. Epidemiologic data indicate that there are 4.5 millions affected in Germany with constant increase in incidence and prevalence with subsequent considerable health economic implications. Late manifestations of the disease result in the inability to read and to perform daily tasks. Therefore, there is an urgent need for efficacious prophylactic and therapeutic measures to prevent irreversible loss of central vision. Based on a better understanding of the underlying molecular mechanisms new therapeutic approaches have been brought forward and expand previous approaches such as thermal laser surgery or photodynamic therapy. Repeated intravitreal injection of anti-VEGF (vascular endothelial growth factor) agents as well as corticosteroids have a beneficial effect on growth and permeability of neovascular membranes. The risk for progression from early to late stages of AMD can be reduced with certain antioxidative preparations (AREDS medication) in presence of defined funduscopic signs. Early diagnosis is key for all currently available interventions since a beneficial effect can only be achieved in early stages of the disease process.


Assuntos
Corticosteroides/uso terapêutico , Proteínas Angiogênicas/uso terapêutico , Antioxidantes/uso terapêutico , Degeneração Macular/tratamento farmacológico , Padrões de Prática Médica/tendências , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Humanos , Guias de Prática Clínica como Assunto
8.
Br J Ophthalmol ; 89(12): 1609-15, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16299141

RESUMO

BACKGROUND: With the advent of digital confocal scanning laser ophthalmoscopy it is possible to detect low levels of fluorescence. Here we used a novel confocal scanning laser ophthalmoscope (cSLO) to determine lower limits of dye required for fluorescein (FL) and indocyanine green (ICG) angiography. METHODS: A cSLO (Heidelberg retina angiograph 2, Heidelberg Engineering, Dossenheim, Germany) with an optically pumped solid state laser (488 nm) for FL and a diode laser (790 nm) for ICG angiography (FL/ICG-A) was used. 62 FL-As were performed in 53 patients and 45 ICG-As were performed in 39 patients with neovascular age related macular degeneration. The volume and overall dye content of bolus injections was gradually tapered (FL: 500 mg, 250 mg, 200 mg, 166 mg, 100 mg; ICG: 25 mg, 20 mg, 15 mg, 10 mg, 5 mg, 2.5 mg), while dye concentrations were kept constant at 100 mg/ml for FL and at 5 mg/ml for ICG. Images were obtained 1, 5, 15, and 30 minutes after dye injection. Image quality was evaluated by two independent readers using standardised criteria. RESULTS: For amounts down to 166 mg for FL and to 5 mg for ICG, sufficient image quality was achieved during all phases following injection. Only late phase images showed less contrast compared to typically used dye amounts, which was irrelevant for interpretation and clinical management. CONCLUSIONS: With the increased sensitivity of this novel cSLO system, amounts of injected dye during FL-A can be reduced to one third for FL and to one fifth for ICG without relevant loss of image quality or information compared to conventionally used dye levels. These amounts can be used for routine angiography and allow relevant savings for units performing FL-A.


Assuntos
Angiofluoresceinografia/métodos , Fluoresceína/administração & dosagem , Verde de Indocianina/administração & dosagem , Degeneração Macular/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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