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Wykoff CC, Garweg JG, Regillo C, Souied E, Wolf S, Dhoot DS, Agostini HT, Chang A, Laude A, Wachtlin J, Kovacic L, Wang L, Wang Y, Bouillaud E, Brown DM. KESTREL and KITE Phase 3 Studies: 100-Week Results With Brolucizumab in Patients With Diabetic Macular Edema. Am J Ophthalmol 2024; 260:70-83. [PMID: 37460036 DOI: 10.1016/j.ajo.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE To report the 100-week outcomes from the KESTREL and KITE trials. DESIGN Two phase 3, double-masked, active-controlled, randomized trials. METHODS Patients with diabetic macular edema (DME) were randomized 1:1:1 to brolucizumab 3 mg/6 mg (BRO3/BRO6) or aflibercept 2 mg (AFL) in KESTREL (N = 566) or 1:1 to BRO6 or AFL in KITE (N = 360). BRO3/BRO6 arms received 5 loading doses every 6 weeks (q6w) followed by q12w dosing, with an option to adjust to q8w at predefined disease activity assessment visits. In KITE, at week 72, based on the disease stability assessment, treatment intervals could be extended by 4 weeks in the BRO6 arm. AFL arms received 5 monthly loading doses followed by fixed q8w dosing. RESULTS At week 100, change from baseline in BCVA (letters) was +8.8 for BRO6 and +10.6 for AFL in KESTREL; and +10.9 for BRO6 and +8.4 for AFL in KITE. In both studies, fewer BRO6 subjects had intraretinal fluid and/or subretinal fluid than AFL subjects. Results were achieved with 32.9% (KESTREL) and 47.5% (KITE) of BRO6 subjects maintained on q12w and q12w/q16w dosing, respectively. Intraocular inflammation rates for BRO6 vs AFL were 4.2% vs 1.1% (KESTREL) and 2.2% vs 1.7% (KITE), of which retinal vasculitis rates were 0.5% vs 0% in KESTREL, with no cases in KITE. Retinal vascular occlusion rates were 1.6% vs 0.5% (KESTREL) and 0.6% in both treatment arms in KITE. CONCLUSIONS Results show the long-term efficacy and durability of brolucizumab in improving visual and anatomical outcomes in DME; the overall safety profile of brolucizumab remained unchanged through year 2.
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Affiliation(s)
- Charles C Wykoff
- From the Retina Consultants of Texas (C.C.W., D.M.B.), Houston, Texas, USA.
| | - Justus G Garweg
- Berner Augenklinik and Swiss Eye Institute (J.G.G.), Bern, Switzerland; Department of Ophthalmology (J.G.G., S.W.), Inselspital, University of Bern, Bern, Switzerland
| | - Carl Regillo
- Retina Service (C.R.), Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Souied
- Department of Ophthalmology (E.S.), Hôpital Intercommunal de Creteil, Créteil, France
| | - Sebastian Wolf
- Department of Ophthalmology (J.G.G., S.W.), Inselspital, University of Bern, Bern, Switzerland; Bern Photographic Reading Center (S.W.), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dilsher S Dhoot
- California Retina Consultants (D.S.D.), Santa Barbara, California, USA
| | - Hansjuergen T Agostini
- Department of Ophthalmology (H.T.A.), Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Andrew Chang
- Sydney Retina Clinic (A.C.), Sydney Eye Hospital, Sydney University, New South Wales, Australia
| | - Augustinus Laude
- National Healthcare Group Eye Institute (A.L.), Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine (A.L.), Nanyang Technological University, Singapore
| | - Joachim Wachtlin
- Sankt Gertrauden Hospital (J.W.), Berlin, Germany; MHB Medizinische Hochschule Brandenburg (J.W.), Neuruppin, Germany
| | - Lidija Kovacic
- Novartis Pharma A.G. (L.W., Y.W., E.B.), Basel, Switzerland
| | - Lixin Wang
- Novartis Pharma A.G. (L.W., Y.W., E.B.), Basel, Switzerland
| | - Ying Wang
- Novartis Pharma A.G. (L.W., Y.W., E.B.), Basel, Switzerland
| | | | - David M Brown
- From the Retina Consultants of Texas (C.C.W., D.M.B.), Houston, Texas, USA
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Enders C, Duncker T, Schürks M, Scholz P, Dörner J, Müller C, Wachtlin J, Lommatzsch A. See clearer: survey on the subjective and objective information levels as well as perception and information transfer using virtual reality headsets in patients with diabetic macular edema receiving anti-VEGF treatment. Graefes Arch Clin Exp Ophthalmol 2022; 261:1563-1570. [PMID: 36562802 DOI: 10.1007/s00417-022-05942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/23/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the use of a VR Headset in routine clinical practice as an additional source of information for patients with diabetic macular edema (DME) and their companions. METHODS Survey including 121 patients with DME, 22 companions, and 14 healthcare professionals from 8 ophthalmology centers in Germany. Patients' and their companions' health literacy was assessed by questionnaires including knowledge statements before and after watching a VR-based 3-D educational video. HCPs' perspectives on the usability of a VR Headset were also assessed. RESULTS Patients' mean age was 63.4 ± 12.2 years, 64.5% were men, and 76% (92/121) had previous anti-VEGF (VEGF, vascular endothelial growth factor) injections. After using the VR Headset, over 85% of patients and companions felt better informed about DME and its treatment. Patients' mean (± SD) number of correct answers to knowledge statements increased from 13.2 ± 3.7 before to 15.5 ± 2.3 after using the VR Headset. Over 95% of patients and companions rated content and ease of understanding of the video as "very good" or "good." Most patients and all companions considered the use of a VR Headset as a positive experience, most wishing to obtain information via VR Headset in the future. Most physicians and all medical assistants rated the effect of the VR Headset on patient satisfaction as positive and suggested further VR modules. CONCLUSION After using the VR Headset, patients with DME and their companions demonstrated knowledge gains that may be meaningful individually and contribute to better adherence. This may offer an additional opportunity for knowledge transfer.
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Affiliation(s)
| | | | | | | | | | | | - Joachim Wachtlin
- Sankt Gertrauden Hospital, Berlin, Germany
- Medizinische Hochschule Brandenburg, Neuruppin, Germany
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Framme C, Sachs HG, Wachtlin J, Bechrakis NE, Hoerauf H, Gabel VP. Main Principles of Vitrectomy Using Intraocular Tamponades - A Basic Course in Surgery. Klin Monbl Augenheilkd 2022; 239:1337-1353. [PMID: 36410334 PMCID: PMC9678440 DOI: 10.1055/a-1929-9413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022]
Abstract
This article is intended to clearly present the basic principles for the use of intraocular tamponades in vitreous/retinal surgery in the event of retinal detachment and other pathologies using additional video footage. It examines the various gases, silicone oils and perfluorocarbon liquids with their indications, administration and in particular intraoperative handling including pitfalls and complications. Characteristic animations show the principles of use in surgery in a comprehensible way. The two lead authors dedicate this article to their teacher Prof. Dr. V.-P. Gabel, who in the early 1990s successfully established the first vitrectomy courses for ophthalmologists at Regensburg University Eye Clinic each year. Many colleagues who still work in retinal surgery today first started learning about this segment on these courses. The other coauthors participated under his supervision in annual vitrectomy wet labs run by the German Academy of Ophthalmology.
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Affiliation(s)
- Carsten Framme
- Augenklinik, Medizinische Hochschule Hannover, Deutschland
| | | | - Joachim Wachtlin
- Augenheilkunde, Sankt Gertrauden-Krankenhaus, Berlin, Deutschland
| | | | - Hans Hoerauf
- Augenheilkunde, Universitätsmedizin Göttingen, Deutschland
| | - Veit-Peter Gabel
- Augenheilkunde, Universität Regensburg, Emeritus, München, Deutschland
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Framme C, Junker B, Feltgen N, Hoerauf H, Striebe NA, Wachtlin J, Volkmann I. [Avoiding mistakes in anti-VEGF intravitreal injection therapy]. Ophthalmologe 2022; 119:309-326. [PMID: 35029746 DOI: 10.1007/s00347-021-01553-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
Intravitreal injection (IVI) of drugs for treatment of various macular diseases is now one of the most frequently performed surgical procedures worldwide. As mostly chronic diseases are treated, the indications for treatment often mean a continuous treatment over years with a corresponding effort regarding spatial, personnel and financial resources. The diagnosis and indications for treatment are nowadays mainly made by spectral domain optical coherence tomography (SD-OCT). The ability to clinically assess and evaluate a fluorescence angiography is less practiced, although these are still a component of the indications for intravitreal injections. Therefore, it can happen that despite all diligence patients may receive anti-vascular endothelial growth factor (VEGF) treatment, sometimes permanently, based on a misinterpretation of the macular diagnosis or disease activity and these indications, once made, are rarely questioned or retracted. Therefore, the aim of this manuscript is to point out possible and typical misinterpretations in the indications or continuation of IVI treatment with anti-VEGF by means of case studies and to sensitize for differential diagnoses.
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Affiliation(s)
- Carsten Framme
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - Bernd Junker
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - Nicolas Feltgen
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | | | - Joachim Wachtlin
- Augenklinik St. Gertrauden-Krankenhaus, Berlin, Deutschland.,MHB, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland
| | - Ingo Volkmann
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
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Du W, Lenz D, Köhler R, Zhang E, Cendon C, Li J, Massoud M, Wachtlin J, Bodo J, Hauser AE, Radbruch A, Dong J. Rapid Isolation of Functional ex vivo Human Skin Tissue-Resident Memory T Lymphocytes. Front Immunol 2021; 12:624013. [PMID: 33828548 PMCID: PMC8019735 DOI: 10.3389/fimmu.2021.624013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Studies in animal models have shown that skin tissue-resident memory T (TRM) cells provide enhanced and immediate effector function at the site of infection. However, analyses of skin TRM cells in humans have been hindered by the lack of an optimized isolation protocol. Here, we present a combinatorial strategy-the 6-h collagenase IV digestion and gentle tissue dissociation – for rapid and efficient isolation of skin TRM cells with skin tissue-specific immune features. In comparison with paired blood circulating memory T cells, these ex vivo isolated skin T cells express typical TRM cell markers and display higher polyfunctional properties. Moreover, these isolated cells can also be assessed for longer periods of time in ex vivo cultures. Thus, the optimized isolation protocol provides a valuable tool for further understanding of human skin TRM cells, especially for direct comparison with peripheral blood T cells at the same sample collection time.
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Affiliation(s)
- Weijie Du
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | - Daniel Lenz
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | - Ralf Köhler
- Central Lab for Microscopy, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | | | - Carla Cendon
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | - Jinchan Li
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | - Mona Massoud
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | - Joachim Wachtlin
- Sankt Gertrauden Krankenhaus, Berlin, Germany.,Medizinische Hochschule Brandenburg, Neurrupin, Germany
| | - Juliane Bodo
- Plastische und Ästhetische Chirurgie, Berlin, Germany
| | - Anja E Hauser
- Central Lab for Microscopy, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany.,Immune Dynamics, Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Radbruch
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
| | - Jun Dong
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin, Institute of the Leibniz Association, Berlin, Germany
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Abstract
PURPOSE Randomized clinical trials have demonstrated the safety and efficacy of ocriplasmin in patients with vitreomacular traction (VMT), including those with macular hole (MH). The INJECT study prospectively evaluated ocriplasmin in the setting of clinical practice. METHODS INJECT was a Phase 4, multicenter, prospective observational study. Patients were followed up for 12 months. Assessments included nonsurgical VMT resolution, nonsurgical MH closure, best-corrected visual acuity, occurrence of vitrectomy, and adverse events. RESULTS The efficacy population (N = 395) received an ocriplasmin injection and had optical coherence tomography-confirmed VMT at baseline. At Day 28, the rate of nonsurgical VMT resolution was 40.7% in the overall group, and the rate of nonsurgical MH closure was 36.0% in the VMT with MH group. At Month 12, the rate of ≥2-line best-corrected visual acuity gain (irrespective of vitrectomy) was 36.8% in the overall group and 59.6% in the VMT with MH group. The percentage of patients who underwent vitrectomy in the study eye was 29.1% in the overall group and 55.6% in the VMT with MH group. Photopsia (9.8%) and vitreous floaters (6.8%) were the most frequent adverse events. CONCLUSION The INJECT study showed that ocriplasmin is effective in a clinical setting in patients with VMT, with or without MH. No new safety signals were identified from this large and surgeon-selected patient group, although the significant limitations of the study design without an image reading center and scheduled study visit timings should be noted.
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Affiliation(s)
- David H. W. Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Theodor Stappler
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
| | - Niral Karia
- Southend University Hospital, Westcliff-on-Sea, United Kingdom
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Germany
| | - Nishal Patel
- Department of Ophthalmology, Kent and Canterbury Hospital, East Kent Hospitals University, Canterbury, United Kingdom
| | - Joachim Wachtlin
- Augenheilkunde, Sankt Gertrauden-Krankenhaus GmbH, Berlin, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany; and
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Schargus M, Wachtlin J, Aisenbrey S, Blum M, Framme C, Hattenbach LO, Hoerauf H, Kaskel-Paul S, Geerling G. [Current situation of allocation of academic medical personnel in ophthalmology departments in Germany]. Ophthalmologe 2020; 117:905-913. [PMID: 32761414 DOI: 10.1007/s00347-020-01203-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND At present minimum nursing staff numbers have been defined and are being implemented. In December 2019 the German Medical Association asked the German professional associations about their general experience with planning of medical personnel in hospital departments. As no structured data were available on this subject, the German Ophthalmological Society (DOG) founded a working group in March 2020 to answer this request. METHOD In the course of several consensus meetings, the working group on personnel planning for physicians in hospitals of the DOG prepared a questionnaire on previous experiences in personnel planning of eye hospitals, which was sent to the heads of all university eye hospitals and departments of ophthalmology in Germany. The questionnaire consisted of individual items with fixed choices and free answers regarding the procedure and current situation of staffing as well as the range of tasks and organization of the medical service. RESULTS Out of 104 departments 53 (51%) responded, of which 25 were from university departments (64% response), 23 from departments of other public or non-profit ownership (46%) and 5 from departments with private hospital ownership (33%). Of these 49% stated that there was no transparent basis for calculation of the number of medical positions in their hospital. Of the surveyed departments, outpatient tasks, services and revenues were considered in the calculations in only 47%. There was a statistically significant higher ratio of full-time personnel to the numbers of beds in university departments compared to private and publicly owned non-profit institutions (p < 0.001, t‑test). All departments have to cope with multiple additional tasks in addition to clinical patient care, which are taken into account only to a limited extent in the staffing. Approximately 70% of the departments provide a 24 h/7 day (24/7) medical on-call service on site, 91% have a 24/7 surgery on-call service and 34% have a cooperation with emergency services run by the Association of Statutory Health Insurance Physicians. CONCLUSION The results show how heterogeneously and nontransparent German departments of ophthalmology are staffed in terms of medical doctors. On average, university departments have higher personnel resources per hospital bed to cope with additional tasks in research and teaching. Outpatient tasks, which contribute significantly to the revenues of an eye department, and multiple other tasks are often not taken into account in the personnel calculation. A transparent and uniform basis for calculation of the medical staff of the departments is desirable in order to achieve a sufficient personnel staffing for a patient and employee-oriented working environment.
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Affiliation(s)
- M Schargus
- Asklepios Augenklinik Nord-Heidberg, Tangstedter Landstr. 400, 22417, Hamburg, Deutschland.
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland.
| | - J Wachtlin
- Augenklinik, Sankt-Gertrauden Krankenhaus, Berlin, Deutschland
- MHB, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - S Aisenbrey
- Klinik für Augenheilkunde, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - M Blum
- Augenklinik, HELIOS Klinikum Erfurt, Erfurt, Deutschland
| | - C Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - L-O Hattenbach
- Klinik für Augenheilkunde, Klinikum Ludwigshafen am Rhein, Ludwigshafen am Rhein, Deutschland
| | - H Hoerauf
- Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S Kaskel-Paul
- Augenklinik, Klinikum Lüdenscheid, Lüdenscheid, Deutschland
| | - G Geerling
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Wachtlin J, Eter N, Hasanbasic Z, Keramas G, Rech C, Sachs H, Schilling H, Wiedemann P, Framme C. Importance of continuous treatment with intravitreal aflibercept injections in patients with neovascular age-related macular degeneration-12-month post hoc analysis of the PERSEUS real-world evidence study. Graefes Arch Clin Exp Ophthalmol 2020; 259:601-611. [PMID: 32789651 PMCID: PMC7904558 DOI: 10.1007/s00417-020-04803-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/29/2020] [Accepted: 06/13/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the influence of treatment regularity with intravitreal aflibercept injections (IVT-AFL injections) on visual acuity (VA) outcomes in patients with neovascular age-related macular degeneration (nAMD) enrolled in the PERSEUS trial who received at least 7 IVT-AFL injections during the first year. METHODS This was a post hoc analysis of the PERSEUS trial, a prospective, non-interventional, multicenter cohort study, and included 370 patients with nAMD who had received ≥ 7 IVT-AFL injections during year 1. In addition to the prespecified subgroups of treatment-naïve and previously treated patients, results were compared between patients with regular (n = 209) and irregular (n = 161) treatment. Regular treatment was defined as initial dosing with monthly IVT-AFL injections for 3 months, then bimonthly IVT-AFL injections until month 12. Irregular treatment was defined as any deviation from regular treatment (provided ≥ 7 injections were received). The outcome of primary interest was the mean change in VA from baseline after 12 months. Further outcomes of interest included VA gain or loss, proportion of patients achieving reading vision, and percentage of patients with fluid. RESULTS At month 12, the mean (± standard deviation, SD) VA improvement from baseline was 6.1 ± 15.6 Early Treatment Diabetic Retinopathy Study letters in the regular cohort and 2.5 ± 16.7 letters in the irregular cohort with ≥ 7 IVT-AFL injections (P = 0.0514). Best results were obtained in the treatment-naïve regular sub-cohort with a mean ± SD VA improvement of 8.0 ± 17.7 letters, whereas treatment-naïve patients with irregular treatment experienced a considerably lower VA gain (2.8 ± 20.0 letters). Irregular treatment consistently correlated with inferior results in treatment-naïve patients. At month 12, the proportion of treatment-naïve patients who had experienced a worsening of ≥ 5 letters was 29.6% in the irregular sub-cohort versus 13.6% in the regular sub-cohort (P = 0.0049). However, among the treatment-naïve patients, the mean number of injections was significantly higher in the irregular than in the regular sub-cohort (8.0 ± 1.2 vs. 7.4 ± 0.6; P = 0.0001). Furthermore, compared with the treatment-naïve, regular sub-cohort, patients in the irregular sub-cohort had more visits (19.1 ± 8.6 vs. 16.1 ± 5.7), VA tests (14.2 ± 6.9 vs. 12.0 ± 4.6), and optical coherence tomography examinations (5.1 ± 3.7 vs. 3.4.0 ± 3.0). CONCLUSIONS Although irregularly treated patients received more injections and more monitoring visits during the first year of IVT-AFL treatment, they experienced worse VA outcomes than regularly treated patients.
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Affiliation(s)
- Joachim Wachtlin
- Abteilung für Augenheilkunde, Sankt Gertrauden-Krankenhaus, Paretzer Straße 12, 10713, Berlin, Germany.
- MHB, Medizinische Hochschule Brandenburg, Neuruppin, Germany.
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Germany
| | - Zoran Hasanbasic
- Medizinische Fachabteilung, Bayer Vital GmbH, Leverkusen, Germany
| | - Georgios Keramas
- Medizinische Fachabteilung, Bayer Vital GmbH, Leverkusen, Germany
| | | | - Helmut Sachs
- Augenklinik, Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Germany
| | - Harald Schilling
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Dortmund, Germany
| | - Peter Wiedemann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carsten Framme
- Klinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Germany
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Abstract
Modern macular hole surgery results in high closure rates of over 90% and good functional results especially in macular holes up to 400 µm in diameter. The standard of care in most of these cases consists of transconjunctival sutureless pars plana vitrectomy, peeling of the inner limiting membrane (ILM) around the hole, followed by gas tamponade and positioning of the patient. As closure rates and functional results decrease with larger macular hole diameters over approximately 400 µm, alternative surgical techniques have been introduced to improve anatomical and functional results in these cases. These techniques include the positioning of tissue within the macular hole to improve hole closure. This can be performed using an ILM flap or free flap technique and the transplantation of autologous retinal tissue, lens capsule or homologous amniotic tissue in or under the defect. An alternative promising approach is the attenuation of the rim of the hole by induction of a localized retinal detachment at the posterior pole which is achieved by subretinal injection of balanced salt solution (BSS) using a 41 gauge needle. The operation is completed by an endotamponade using gas or silicone oil.
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Affiliation(s)
- Christos Haritoglou
- Augenklinik Herzog Carl Theodor, Nymphenburger Str. 43, 80335, München, Deutschland.
| | - Armin Wolf
- Augenklinik, Ludwig-Maximilians-Universität, München, Deutschland
| | - Joachim Wachtlin
- Sankt Gertrauden Krankenhaus, Berlin, Deutschland
- Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
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Abstract
BACKGROUND In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in a lack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice. OBJECTIVE This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies. MATERIAL AND METHODS The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany. RESULTS In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated. CONCLUSION Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has a good prognosis for functional and anatomical rehabilitation.
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Affiliation(s)
- Denise Vogt
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland.
| | - Joachim Wachtlin
- Augenabteilung, Sankt Gertrauden Krankenhaus, Berlin, Deutschland.,MHB, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - Siegfried G Priglinger
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland
| | - Ricarda G Schumann
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland
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Wachtlin J, Schumann RG, Maier M, Haritoglou C. [Macular changes in optic disc pits-Optic disc pit maculopathy (ODP-M) : Pathophysiology and possibilities of surgical treatment]. Ophthalmologe 2019; 116:1026-1032. [PMID: 31338589 DOI: 10.1007/s00347-019-0933-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An optic disc pit is a rare congenital abnormality of the optic nerve, which in most cases presents as a unilateral finding. Clinically, a greyish oval excavation is seen, most commonly on the temporal side of the optic nerve disc. The optic disc pit alone normally does not lead to substantial symptoms or functional limitations; however, when a maculopathy with intraretinal and/or subretinal fluid and additional other morphological changes in the macula occur, this leads to a decrease in visual acuity. With spectral domain optical coherence tomography (SDOCT) it is possible to identify the various forms of expression, which show different natural courses. Especially the presence of subretinal fluid and defects in the outer retinal layers have a poor prognosis and have the highest risk for further deterioration. Spontaneous resolution can occur but is rare. Observation is recommended in the first step. In cases of progression or pronounced deterioration, surgical intervention is indicated. Many different techniques have been proposed but there is no gold standard at the moment. Most of the surgical approaches comprise pars plana vitrectomy with peeling of the internal limiting membrane (ILM) and gas endotamponade. Newer methods, such as the ILM flap technique also show good results. Generally, it is important to know that postoperative healing and resorption of the fluid often take a long time period of up to 1 year or even longer.
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Affiliation(s)
- J Wachtlin
- Augenabteilung, Sankt Gertrauden Krankenhaus, Paretzer Str. 12, 10713, Berlin, Deutschland. .,MHB, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland.
| | - R G Schumann
- Augenabteilung, Ludwig-Maximilians-Universität, München, Deutschland
| | - M Maier
- Augenklinik, Klinikum rechts der Isar, Technische Universität, München, Deutschland
| | - C Haritoglou
- Augenklinik, Herzog Karl Theodor, München, Deutschland
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Ziemssen F, Wachtlin J, Kuehlewein L, Gamulescu MA, Bertelmann T, Feucht N, Voegeler J, Koch M, Liakopoulos S, Schmitz-Valckenberg S, Spital G. Intravitreal Ranibizumab Therapy for Diabetic Macular Edema in Routine Practice: Two-Year Real-Life Data from a Non-interventional, Multicenter Study in Germany. Diabetes Ther 2018; 9:2271-2289. [PMID: 30288700 PMCID: PMC6250630 DOI: 10.1007/s13300-018-0513-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The prospective, non-interventional OCEAN study examined the use of intravitreal ranibizumab injections for the treatment of diabetic macular oedema (DME) in a real-world setting in Germany. METHODS Adults with DME receiving ≥ 1 ranibizumab (0.5 mg) injections were recruited by 250 ophthalmologists. Best-corrected visual acuity (VA) testing, imaging and treatments were performed according to the investigators' routine practice and documented over 24 months. RESULTS The full analysis set included 1226 participants. Mean baseline VA was 60.6 [95% CI: 59.7; 61.5] Early Treatment Diabetic Retinopathy Study letters. VA improved by ≥ 15 letters in 21.5% and 23.5% of the participants at 12 months and 24 months, respectively. They received a mean number of 4.42 [95% CI: 4.30; 4.54] injections in the first year and 5.52 [95% CI: 5.32; 5.73] injections over 24 months, which was markedly lower than in clinical trials. Only 33.4% of the participants received an upload with four initial monthly injections as recommended by the German ophthalmologic societies. Time-to-event analyses that account for missing data inherent to a non-interventional study design demonstrated that participants receiving ≥ 7 injections in the first year had a faster response, but the duration of the response was shorter compared to the subgroups receiving 1-3 and 4-6 injections. Serious adverse events were reported for 143/1250 (11.4%) participants in the safety population. CONCLUSION Under-treatment is a major problem of DME anti- vascular endothelial growth factor therapy under real life conditions. Despite fewer injections given compared to randomised controlled trials with a consequently reduced overall mean visual gain, a profound functional improvement (≥ 15 letters) was achieved over 2 years in 23.5% of eyes with DME. TRIAL REGISTRATION NUMBER NCT02194803, ClinicalTrials.gov. FUNDING Novartis Pharma GmbH, Nuremberg, Germany.
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Affiliation(s)
- Focke Ziemssen
- Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
| | - Joachim Wachtlin
- St. Gertrauden Krankenhaus, Berlin, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Laura Kuehlewein
- Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | | | - Thomas Bertelmann
- Artemis Eye Clinic, Dillenburg, Dillenburg, Germany
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Nikolaus Feucht
- Klinikum Rechts der Isar, Technical University, Munich, Germany
| | | | - Mirja Koch
- Novartis Pharma GmbH, Nuremberg, Germany
| | - Sandra Liakopoulos
- Centre for Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Georg Spital
- Augenzentrum am St. Franziskus Hospital, Muenster, Germany
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Paul C, Krug P, Müller HH, Wachtlin J, Mennel S, Müller S, Schmitz-Valckenberg S, Bertelmann T, Schumann RG. Comparison of the horizontal diameter to a modeled area of traction in eyes with vitreomacular traction: is the diameter close enough to the truth? Graefes Arch Clin Exp Ophthalmol 2018; 256:1817-1822. [PMID: 29955972 DOI: 10.1007/s00417-018-4055-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In daily practice, vitreomacular traction (VMT) is described by the horizontal diameter of its attachment site implying a regular round shape of VMT. We investigated the deviation from this circular area of vitreous traction in patients with VMT. METHODS A retrospective analysis of optical coherence tomography (OCT) scans was performed. The area of vitreomacular attachment was determined using six radial OCT scans (Ameasured). The assumed circular area of traction was calculated based on measuring the maximal horizontal diameter for comparison (Acircular). RESULTS Thirty-seven eyes of 37 patients with pure VMT were included. Patients' mean age was 72.8 ± 8.2 years. Mean horizontal VMT diameter was 400.8 ± 230.5 μm (median 361 μm; range 44-991 μm). While there was no difference between mean areas of traction for Acircular and Ameasured (P = 0.93), the individual difference (|Acircular - Ameasured|) was 0.042 (± 0.044) mm2 in mean or relative 73.0% (± 135.8%). A difference of ≥ 30% of Ameasured to Acircular was found in 16 eyes (43.2%) and ≥ 100% in 7 eyes (18.9%), respectively. CONCLUSION Vitreous attachment sites possess an irregular non-circular shape in a significant number of eyes with VMT. Consequently, the area of traction appears inaccurately described by its horizontal VMT diameter alone. As the area of traction is important for therapeutic recommendation, our results emphasize the need for a more precise description of the area of traction in eyes with VMT.
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Affiliation(s)
- Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - P Krug
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - H H Müller
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - J Wachtlin
- Department of Ophthalmology, Sankt Gertrauden-Krankenhaus, Berlin, Germany.,The Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - S Mennel
- Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria
| | - S Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - T Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany.,ARTEMIS Eye Clinic, Dillenburg, Germany
| | - R G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
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Paul C, Heun C, Müller HH, Hoerauf H, Feltgen N, Wachtlin J, Kaymak H, Mennel S, Koss MJ, Fauser S, Maier MM, Schumann RG, Mueller S, Chang P, Schmitz-Valckenberg S, Kazerounian S, Szurman P, Lommatzsch A, Bertelmann T. Calculating the individual probability of successful ocriplasmin treatment in eyes with VMT syndrome: a multivariable prediction model from the EXPORT study. Br J Ophthalmol 2017; 102:1092-1097. [DOI: 10.1136/bjophthalmol-2017-310874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/07/2017] [Accepted: 10/07/2017] [Indexed: 02/03/2023]
Abstract
Background/AimsTo evaluate predictive factors for the treatment success of ocriplasmin and to use these factors to generate a multivariate model to calculate the individual probability of successful treatment.MethodsData were collected in a retrospective, multicentre cohort study. Patients with vitreomacular traction (VMT) syndrome without a full-thickness macular hole were included if they received an intravitreal injection (IVI) of ocriplasmin. Five factors (age, gender, lens status, presence of epiretinal membrane (ERM) formation and horizontal diameter of VMT) were assessed on their association with VMT resolution. A multivariable logistic regression model was employed to further analyse these factors and calculate the individual probability of successful treatment.Results167 eyes of 167 patients were included. Univariate analysis revealed a significant correlation to VMT resolution for all analysed factors: age (years) (OR 0.9208; 95% CI 0.8845 to 0.9586; p<0.0001), gender (male) (OR 0.480; 95% CI 0.241 to 0.957; p=0.0371), lens status (phakic) (OR 2.042; 95% CI 1.054 to 3.958; p=0.0344), ERM formation (present) (OR 0.384; 95% CI 0.179 to 0.821; p=0.0136) and horizontal VMT diameter (µm) (OR 0.99812; 95% CI 0.99684 to 0.99941, p=0.0042). A significant multivariable logistic regression model was established with age and VMT diameter.ConclusionKnown predictive factors for VMT resolution after ocriplasmin IVI were confirmed in our study. We were able to combine them into a formula, ultimately allowing the calculation of an individual probability of treatment success with ocriplasmin in patients with VMT syndrome without FTHM.
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Eter N, Mohr A, Wachtlin J, Feltgen N, Shirlaw A, Leaback R. Dexamethasone intravitreal implant in retinal vein occlusion: real-life data from a prospective, multicenter clinical trial. Graefes Arch Clin Exp Ophthalmol 2016; 255:77-87. [PMID: 27460280 PMCID: PMC5203822 DOI: 10.1007/s00417-016-3431-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/22/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the relationship between duration of macular edema associated with retinal vein occlusion (RVO) and the achievement of vision gain in patients receiving dexamethasone intravitreal implant (DEX implant) in real-world clinical practice, and to define patterns of use of DEX implant and its efficacy and safety in the treatment of patients with RVO in clinical practice. METHODS This prospective, open-label, multicenter, 6-month observational phase IV study conducted at 70 sites in Germany enrolled patients diagnosed with macular edema following branch or central RVO (BRVO, CRVO) who were given DEX implant. Follow-up visits and evaluations occurred in accordance with normal clinical practice. Re-treatment with DEX implant and use of other RVO therapies was at the discretion of the treating physician. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from baseline at week 12. RESULTS The analysis population consisted of 573 patients (64 % BRVO, 36 % CRVO). Patients received a mean of 1.17 DEX implant treatments during the study period; 84.3 % of patients received a single DEX implant and 19.9 % received adjunctive other RVO treatment. Among patients with analyzable BCVA data at baseline and week 12 (n = 351), mean change from baseline BCVA at week 12 was -0.16 (standard deviation, 0.30) logMAR (+7.8 approximate Early Treatment Diabetic Retinopathy Study [ETDRS] letters) (p < 0.001), and 33.9 % of patients had gained at least 3 lines in BCVA from baseline. Mean change from baseline BCVA at week 12 was +9.5, +7.3, and +5.4 approximate ETDRS letters in patients with macular edema duration < 90 days, from 90 to 180 days, and >180 days respectively. Improvement in BCVA through week 24 and decreases in central retinal thickness were seen in both BRVO and CRVO. The most common adverse drug reaction was increased intraocular pressure. No glaucoma incisional surgeries were required. CONCLUSIONS DEX implant was effective in improving BCVA and central retinal thickness in patients with BRVO and CRVO in real-world clinical practice. The largest gains in BCVA over 6 months occurred in patients with recent onset macular edema, confirming the benefit of early treatment. DEX implant was well tolerated and had an acceptable safety profile.
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Affiliation(s)
- Nicole Eter
- Department of Ophthalmology, University of Münster Medical School, Domagkstr 15, D-48149, Münster, Germany.
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Wachtlin J, Ringwald A, Maulhardt T, Pohl K, Wiedon A. Cooperation of German ophthalmologists in routine care of patients with neovascular age-related macular degeneration: results of the non-interventional BRIDGE study. Graefes Arch Clin Exp Ophthalmol 2015; 254:1529-1536. [PMID: 26678412 DOI: 10.1007/s00417-015-3242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the non-interventional ophthalmological study 'BRIDGE' the routine care of patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab was observed in Germany. A patient regularly sees the general ophthalmologist (GO) for monitoring and, if needed, the injecting ophthalmologist (IO) for intravitreal injections (IVI). Thus, patients are routinely treated by two ophthalmologists in parallel and patient care depends on their collaboration. This cooperation was evaluated based on network questionnaires. METHODS 'BRIDGE' was a multicenter, national, open-label, prospective, observational study, conducted between July 2010 and December 2012. The network questionnaire for GOs consisted of 51 questions, while the similar questionnaire for IOs consisted of 43 questions, addressing the type and details of the individual collaboration. The statistical analysis was purely descriptive. RESULTS The network questionnaire for GOs was completed by 152 GOs, regularly cooperating with 2.5 ± 1.1 IOs, while the questionnaire for IOs was completed by 43 IOs, regularly cooperating with 23.2 ± 23.6 GOs. Generally, both GOs and IOs stated that they regularly exchange information regarding the patients' situation. Diagnostic standards were only established for 15 % of the GOs' collaborations and for 35 % of the IOs' collaborations. After initial treatment, both GOs and IOs agreed on the medical significance of regular monitoring visits performed by the GOs. Agreements on re-treatment criteria were only established in the case of 16 % of the GOs and 28 % of the IOs. Overall, both GOs and IOs were satisfied with the current situation, with regard to the medical treatment situation for patients and to the cooperation within the networks. CONCLUSIONS The network questionnaires revealed well-established cooperation between IOs and GOs in Germany with an accepted division of responsibilities for the routine care of patients with nAMD. However, the cooperation between two ophthalmologists treating one patient harbors risks. Agreements on diagnostic and re-treatment criteria would help to improve network performance and outcomes.
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Affiliation(s)
- Joachim Wachtlin
- Augenabteilung Sankt-Gertrauden Krankenhaus, Paretzer Strasse 12, 10713, Berlin, Germany.
| | - Andreas Ringwald
- Augenklinik Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Tobias Maulhardt
- Facharzt für Augenheilkunde, Augentagesklinik, Flemmingstraße 8 / Haus 9, 09116, Chemnitz, Germany
| | - Karin Pohl
- Novartis Pharma GmbH, Roonstr.25, 90429, Nürnberg, Germany
| | - Annette Wiedon
- Novartis Pharma GmbH, Roonstr.25, 90429, Nürnberg, Germany
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Schellert N, Wachtlin J. Therapieoptionen bei retinalem Makroaneurysma. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kaster AT, Wachtlin J. Keratoplastik à chaud-Indikationen, OP-Verfahren und postoperative Ergebnisse. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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van den Berg C, Wachtlin J. Trabekulektomie bei Zustand nach Vitrektomie – Schlechteres Outcome? Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bendschneider D, Naffouje R, Janzen A, Wachtlin J. Neuer Therapieansatz bei Patienten mit Offenwinkelglaukom und okulärer Hypertension. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Naffouje R, Randow K, Wachtlin J. Vergleich der Kammelwinkelanatomie im Vorderabschnitts-SD-OCT vor und nach Kanaloplastik. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schmartz C, Kauhausen A, Wachtlin J. Effekt wiederholter Re-Implantation des intravitrealen Dexamethason-Implantats Ozurdex® auf Makulaödem, Visus und Druckentwicklung. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schellert N, Krause N, Wachtlin J. Verbliebene Indikationen der Photodynamischen Therapie (PDT). Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Randow KV, Bendschneider D, Krause N, Schellert N, Wachtlin J. Effekt der Kanaloplastik in Abhängigkeit von Ausgangsdruck und Diagnose. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kaster AT, Schellert N, Wachtlin J. Funktionelle und morphologische Ergebnisse bei Patienten mit vitreomakulärer Traktion mit oder ohne Makulaforamen nach intravitrealer Injektion von Ocriplasmin (Jetrea). Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wachtlin J. Pucker und Traktion. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schwärmer I, Muresan S, Wachtlin J. Tausch von endokapsulär implantierten Intraokularlinsen (IOL) bei Refraktionsstörungen oder Qualitätsmängeln. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Randow KV, Bendschneider D, Kauhausen A, Wachtlin J. 1-Jahres-Ergebnisse nach Kanaloplastik mit der Glaucolight-Sonde. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schellert N, Veltrup I, Wachtlin J. Indikation, Wirksamkeit und Nebenwirkungen der intravitrealen Injektion von Ocriplasmin (Jetrea®) zur Lösung vitreomakulärer Traktionen. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schwärmer I, Schellert N, Wachtlin J. Systemische Gabe von Aldosteronantagonisten bei Retinopathia centralis serosa (RCS) als neuer Therapieansatz. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bendschneider D, Wachtlin J. Erfassung der Glaukomprogression mit einem hochauflösenden spectral-domain OCT (SD-OCT). Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muresan S, Wachtlin J. Langzeitergebnisse nach sekundäre Intraokularlinsenversorgung: Vergleich zwischen nahtloser skleraler Haptikfixierung und retroiridale Irisclip IOL. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Veltrup I, Schellert N, Zhang EP, Wachtlin J. Präoperative intravitreale Bevacizumabinjektion vor geplanter 25-Gauge-Vitrektomie bei schwerer proliferativer diabetischer Retinopathie. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kauhausen A, Randow KV, Bendschneider D, Wachtlin J. Effekte der Augendrucksenkung bei kombiniertem Vorgehen (Kanaloplastik + Phako + HKL) gegenüber alleiniger Kanaloplastik mit dem Glaucolight. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bezatis A, Spital G, Höhn F, Maier M, Clemens CR, Wachtlin J, Lehmann F, Hattenbach LO, Feltgen N, Meyer CH. Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up -- the SOLO study. Acta Ophthalmol 2013; 91:e340-7. [PMID: 23638803 DOI: 10.1111/aos.12020] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. METHODS The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. RESULTS In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit. CONCLUSIONS Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.
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Muresan S, Wachtlin J. Nahtlose sklerale IOL-Versorgung. Ergebnisse nach sekundärer Intraokularlinsenversorgung mittels nahtloser skleraler Haptikfixierung. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Randow KV, Bendschneider D, Wachtlin J. Erste Ergebnisse nach Viskokanaloplastik mit einem neuen Sondensystem (Glaucolight®). Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wachtlin J, Wehner A, Köhler AK, Zhang EP, Schindewolf J. Elektive Makulachirurgie (MF, MP) – Indikationsstellung, Nutzen, Risiken, Nebenwirkungen bei moderner transkonjunktivaler, nahtloser Kleinschnittechnik (23/25Gauge). Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kauhausen A, Schellert N, Köhler AK, Zhang E, Lechner S, Wachtlin J. Erfahrungen zur Wirkung und Wirkdauer des implantierbaren Dexamethasonspellets Ozurdex am vitrektomierten Auge. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schellert N, Lechner S, Zhang E, Wachtlin J. Besondere Merkmale von Patienten mit Pseudoendophthalmitis nach intravitrealer Triamcinolon- Injektion. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1331514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wachtlin J, Gamulescu MA. [Age-related macular degeneration. Part 2: Therapeutic procedures]. Klin Monbl Augenheilkd 2012; 229:1049-59; quiz 1060-1. [PMID: 23225325 DOI: 10.1055/s-0032-1315134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J Wachtlin
- Augenabteilung, Sankt-Gertrauden Krankenhaus Berlin
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Wachtlin J, Gamulescu MA. Altersabhängige Makuladegeneration. Augenheilkunde up2date 2012. [DOI: 10.1055/s-0032-1315133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Wachtlin
- Augenabteilung, Sankt-Gertrauden Krankenhaus Berlin
| | - M.-A. Gamulescu
- Klinik und Poliklinik für Augenheilkunde der Universität Regensburg
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Wachtlin J, Gamulescu MA. Altersabhängige Makuladegeneration. Klin Monbl Augenheilkd 2012; 229:941-55; quiz 956-7. [DOI: 10.1055/s-0032-1315136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J. Wachtlin
- Augenabteilung, Sankt-Gertrauden Krankenhaus Berlin
| | - M.-A. Gamulescu
- Klinik und Poliklinik für Augenheilkunde der Universität Regensburg
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Huber M, Wachtlin J. Vitreous levels of proteins implicated in angiogenesis are modulated in patients with retinal or choroidal neovascularization. ACTA ACUST UNITED AC 2012; 228:188-93. [PMID: 22868384 DOI: 10.1159/000339952] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/21/2012] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to investigate the levels of pigment epithelium-derived factor (PEDF), angiopoietin 2, vascular endothelial growth factor (VEGF), and soluble VEGF receptor 1 (sVEGFR-1) in vitreous samples of patients suffering from age-related macular degeneration with choroidal neovascularization or from proliferative diabetic retinopathy (PDR). METHODS Proteins in vitreous samples of 29 patients were quantified via enzyme-linked immunosorbent assays. RESULTS Vitreous levels of sVEGFR-1 were significantly higher in age-related macular degeneration with choroidal neovascularization (p = 0.005) and in PDR (p = 0.003) versus controls. In analogue comparisons, PEDF was significantly decreased (p < 0.01). PDR was associated with significantly increased angiopoietin 2 and VEGF levels (p = 0.001 for both). CONCLUSION The vitreous in retinal or choroidal neovascularization revealed a pro-angiogenic potential indicated by decreased PEDF or increased angiopoietin 2 levels compared to controls. However, higher amounts of sVEGFR-1 were concomitant, pointing to activation of an endogenous anti-angiogenic system in the protein network.
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Affiliation(s)
- Matthias Huber
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Germany. matthias.huber @ charite.de
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Wachtlin J, Gamulescu MA. Altersabhängige Makuladegeneration. Augenheilkunde up2date 2012. [DOI: 10.1055/s-0032-1315135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Wachtlin
- Augenabteilung, Sankt-Gertrauden Krankenhaus Berlin
| | - M.-A. Gamulescu
- Klinik und Poliklinik für Augenheilkunde der Universität Regensburg
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Michels S, Becker M, Wachtlin J, Binder S. The intravitreal injection: Variations in regulations, cost and reimbursement in Europe. Spektrum Augenheilkd 2012. [DOI: 10.1007/s00717-012-0072-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wachtlin J, Schellert N, Köhler A, Schindewolf J, Zhang EP. Operation der rhegmatogenen Ablatio retinae mit nahtloser 23 und 25 Gauge Vitrektomie. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Lechner S, Köhler A, Bezatis A, Spital G, Maier M, Horn M, Clemens C, Lehmann F, Höhn F, Meyer C, Wachtlin J. Anatomische und funktionelle Ergebnisse der klinischen Anwendung von Ozurdex® bei Venenast- (VAV) und Zentralvenenverschlüssen (ZVV) aus 8 Zentren in Deutschland. Klin Monbl Augenheilkd 2011. [DOI: 10.1055/s-0031-1297328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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