1
|
Babst N, Gniesmer S, Sonntag SR, Furashova O, Krestanova G, Heindl LM, Müller M, Grisanti S, Kakkassery V. [Clinical approach for solid intraocular metastases]. Ophthalmologie 2024:10.1007/s00347-024-02031-7. [PMID: 38649497 DOI: 10.1007/s00347-024-02031-7] [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] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with a poor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have a special responsibility here. OBJECTIVE This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care. METHODS A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar. RESULTS Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between a curative or palliative treatment situation must always be made. CONCLUSION Intraocular metastases are the most frequent intraocular tumor and are usually associated with a poor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.
Collapse
Affiliation(s)
- Neele Babst
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Stefanie Gniesmer
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Svenja Rebecca Sonntag
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Olga Furashova
- Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland
| | | | - Ludwig Maximilian Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Martin Müller
- Klinik für Hämatologie, Onkologie und Immunologie, Klinikum Region Hannover, Hannover, Deutschland
| | - Salvatore Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland
| |
Collapse
|
2
|
Furashova O, Adrianowicz B, Engelmann K. Autologous platelet concentrate in epiretinal membrane surgery: A single-centre prospective comparative non-inferiority study. Acta Ophthalmol 2024. [PMID: 38591236 DOI: 10.1111/aos.16690] [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: 08/26/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The purpose of the study was to compare the anatomical and functional results including reading ability after epiretinal membrane (ERM) surgery in patients with and without the use of autologous platelet concentrate (APC). METHODS Design: Prospective, comparative non-inferiority series. SETTING Institutional. PATIENTS 51 eyes of 51 patients, who underwent pars-plana vitrectomy (PPV) for ERM surgery. 29 eyes additionally received intraoperative APC, 22 eyes underwent standard procedure without APC use. OBSERVATIONS anatomical and functional outcome parameters (central retinal thickness (CRT), best corrected visual acuity (BCVA) and reading ability (RA)) were compared between the two groups at 6 weeks and 6 months postoperatively. Subjective assessment of visual acuity and reading ability was also analysed. MAIN OUTCOME MEASURES BCVA, RA and CRT. RESULTS Both groups showed significant CRT reduction and RA improvement, while BCVA improvement was significant only in eyes with intraoperative APC use during the follow-up time of 6 months. There was no statistically significant difference between CRT reduction, BCVA and RA improvement between the groups. CONCLUSION Intraoperative APC use for ERM surgery results in similar anatomical and functional outcomes compared with standard ERM surgery without APC use.
Collapse
Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | | | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| |
Collapse
|
3
|
Schlosser T, Beuth F, Meyer T, Kumar AS, Stolze G, Furashova O, Engelmann K, Kowerko D. Visual acuity prediction on real-life patient data using a machine learning based multistage system. Sci Rep 2024; 14:5532. [PMID: 38448469 PMCID: PMC10917755 DOI: 10.1038/s41598-024-54482-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
In ophthalmology, intravitreal operative medication therapy (IVOM) is a widespread treatment for diseases related to the age-related macular degeneration (AMD), the diabetic macular edema, as well as the retinal vein occlusion. However, in real-world settings, patients often suffer from loss of vision on time scales of years despite therapy, whereas the prediction of the visual acuity (VA) and the earliest possible detection of deterioration under real-life conditions is challenging due to heterogeneous and incomplete data. In this contribution, we present a workflow for the development of a research-compatible data corpus fusing different IT systems of the department of ophthalmology of a German maximum care hospital. The extensive data corpus allows predictive statements of the expected progression of a patient and his or her VA in each of the three diseases. For the disease AMD, we found out a significant deterioration of the visual acuity over time. Within our proposed multistage system, we subsequently classify the VA progression into the three groups of therapy "winners", "stabilizers", and "losers" (WSL classification scheme). Our OCT biomarker classification using an ensemble of deep neural networks results in a classification accuracy (F1-score) of over 98%, enabling us to complete incomplete OCT documentations while allowing us to exploit them for a more precise VA modelling process. Our VA prediction requires at least four VA examinations and optionally OCT biomarkers from the same time period to predict the VA progression within a forecasted time frame, whereas our prediction is currently restricted to IVOM/no therapy. We achieve a final prediction accuracy of 69% in macro average F1-score, while being in the same range as the ophthalmologists with 57.8 and 50 ± 10.7 % F1-score.
Collapse
Affiliation(s)
- Tobias Schlosser
- Junior Professorship of Media Computing, Chemnitz University of Technology, 09107, Chemnitz, Germany.
| | - Frederik Beuth
- Junior Professorship of Media Computing, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Trixy Meyer
- Junior Professorship of Media Computing, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Arunodhayan Sampath Kumar
- Junior Professorship of Media Computing, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Gabriel Stolze
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, 09116, Chemnitz, Germany
| | - Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, 09116, Chemnitz, Germany
| | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, 09116, Chemnitz, Germany
| | - Danny Kowerko
- Junior Professorship of Media Computing, Chemnitz University of Technology, 09107, Chemnitz, Germany.
| |
Collapse
|
4
|
Walsch D, Furashova O, Emmert S, Kakkassery V. [Medicamentous Therapy of Malignant Eyelid Tumors]. Klin Monbl Augenheilkd 2024. [PMID: 38413000 DOI: 10.1055/a-2255-5937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Although surgical therapy is often the first-line treatment for malignant eyelid tumors, pharmacological treatment approaches can also be included and pursued in the treatment plan. METHODS Narrative review with a selective literature search on PubMed and Google Scholar. RESULTS Various pharmacological therapeutic principles are currently available. One option is the local application of agents within the tumor area. This can be achieved through cytostatically active drugs such as 5-fluorouracil for superficial basal cell carcinomas and precursors of squamous cell carcinomas, or through mitomycin C in specific cases of sebaceous gland carcinoma. Another form of pharmacological local therapy is local immunomodulation using Imiquimod for superficial basal cell carcinomas, actinic keratosis, and Bowen's disease. Furthermore, there are systemic pharmacological therapies like chemotherapies, for example in sebaceous cell carcinoma, or systemic immunomodulation using checkpoint inhibitors for example in basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and melanoma. Additionally, targeted therapies offer yet another treatment modality that exploits the molecular biological characteristics of various tumor entities. Examples of this include Hedgehog inhibitors for basal cell carcinomas, EGFR inhibitors for squamous cell carcinomas, or BRAF inhibitors for melanomas. This review addresses these treatment options for malignant tumors of the eyelid and systematically organizes them for the reader. CONCLUSION Even though the data on these eye tumors is still limited, the reported case studies using systemic therapies for malignant eyelid tumors demonstrate the potential of this treatment modality. However, the need for further research is high especially concerning the combination of different therapy principles for increasing the effectiveness of eyelid tumor therapy.
Collapse
|
5
|
Bormann C, Busch C, Rehak M, Scharenberg CT, Furashova O, Ziemssen F, Unterlauft JD. Postoperative RNFL-Changes after Successful Trabeculectomy: 2-Year Outcomes. Klin Monbl Augenheilkd 2023. [PMID: 38134909 DOI: 10.1055/a-2206-1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND The most important tool in glaucoma therapy is to lower the intraocular pressure to slow down the apoptosis of retinal ganglion cells. Trabeculectomy (TE) is considered the gold standard in glaucoma surgery. The aim of this study was to analyse the postoperative changes in retinal nerve fibre layer (RNFL) using optical coherence tomography (OCT) after TE. MATERIAL AND METHODS We examined 40 patients naïve to prior glaucoma surgery retrospectively, who received a TE for medically uncontrolled primary open-angle glaucoma (POAG). Intraocular pressure (IOP), IOP-lowering medication, mean deviation of perimetry, visual acuity and peripapillary RNFL-thickness using OCT were evaluated during the first 24 month after TE. RESULTS In total 40 eyes from 40 patients were treated with TE. Mean IOP decreased from 25.0 ± 0,9 to 13.9 ± 0.6 (p < 0.01), and the mean number of IOP-lowering eye drops from 3.3 ± 0.2 to 0.5 ± 0.2 (p < 0.01). Visual acuity and mean deviation in perimetry remained stable while mean global RNFL-thickness decreased from 67.8 ± 2.9 to 63.7 ± 2.9 (p < 0.01) and 63.4 ± 2.9 µm (p < 0.01) 12 and 24 months after TE. CONCLUSION The TE is an effective method to reduce the IOD and the amount of IOP-lowering medication. Nevertheless, a significant further loss in RNFL thickness was observed in the first 12 months after TE. Thus, RNFL changes seem to stabilise only after a protracted period.
Collapse
Affiliation(s)
- Caroline Bormann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Deutschland
| | - Catharina Busch
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Deutschland
| | - Matus Rehak
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Innsbruck, Österreich
| | | | - Olga Furashova
- Klinik für Augenheilkunde, Klinikum Chemnitz gGmbH, Deutschland
| | - Focke Ziemssen
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Deutschland
- Department für Augenheilkunde, Eberhard-Karls-Universität Tübingen, Universitätsklinikum Tübingen, Deutschland
| | | |
Collapse
|
6
|
Furashova O, Mielke S, Lindner U. ASYMPTOMATIC OCULAR MANIFESTATIONS OF ACERULOPLASMINEMIA IN TWO ADULT WHITE SIBLINGS: A MULTIMODAL IMAGING APPROACH. Retin Cases Brief Rep 2023; 17:273-278. [PMID: 34014900 PMCID: PMC10121363 DOI: 10.1097/icb.0000000000001166] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report ocular manifestations of aceruloplasminemia in two adult White siblings. METHODS The ocular findings were investigated using a multimodal imaging approach including color fundus photography, fluorescein angiography, autofluorescence imaging, and spectral-domain optical coherence tomography. RESULTS A 43-year-old woman and a 39-year-old man were diagnosed with aceruloplasminemia based on clinical symptoms, laboratory tests, liver biopsy, and genetic examination of the ceruloplasmin gene confirming the homozygotic mutation G708S. Both patients had no ophthalmologic symptoms, unremarkable anterior segment, and visual acuity of 20/20 in both eyes. Indirect ophthalmoscopy of the fundus revealed subtle yellowish color with punctate inhomogeneous pigmentation in the whole retina. The autofluorescence images demonstrated remarkable punctate hyperfluorescence involving the central and peripheral retina. Spectral-domain optical coherence tomography images showed normal retinal structure in the macular area with intact outer retinal layers. Fluorescein angiography showed a slightly inhomogeneous pattern of hypofluorescence and hyperfluorescence from the early until late angiography phase. CONCLUSION We describe two adult cases of ocular manifestations of a rare hereditary condition with systemic iron overload. Retinal degeneration in aceruloplasminemia might be overlooked on a routine ophthalmic examination and requires at least an autofluorescence image because initial damage at the level of retinal pigment epithelium is not always visible on ophthalmoscopy.
Collapse
Affiliation(s)
| | | | - Uwe Lindner
- Endocrinology and Diabetology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| |
Collapse
|
7
|
Furashova O, Engelmann K, Joussen AM, Riechardt AI. Unusual initial manifestation of choroidal melanoma in a 46-year-old adult with rapid growth over 9 months. Am J Ophthalmol Case Rep 2022; 26:101518. [PMID: 35464685 PMCID: PMC9026650 DOI: 10.1016/j.ajoc.2022.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/27/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case with unusual initial manifestation of uveal melanoma in a 46-year-old adult. Observations A 46-year-old man demonstrated a mid-peripheral temporal partially hyperpigmented lesion in his left eye. Initial clinical appearance as well as multimodal imaging approaches were similar to a chorioretinitic disease. Over the course of 9 months, a massive tumor growth and exudative retinal detachment could be observed. The diagnosis of choroidal melanoma was histopathologically confirmed after endoresection. Conclusions and importance Classical choroidal melanoma manifest as pigmented, prominent tumors with >2 mm tumor thickness, exudative retinal detachment, and orange pigment. In our case, none of these classical clinical characteristic signs of melanoma were present at initial presentation, but the tumor underwent progressive development with significant tumor growth and exudative retinal detachment during the following 9 months.
Collapse
Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 09116, Chemnitz, Germany
- Corresponding author.
| | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 09116, Chemnitz, Germany
| | - Antonia M. Joussen
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aline I. Riechardt
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
8
|
Furashova O, Thalwitzer J, Matthé E. Early Onset of Neovascular Glaucoma After Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion: A Possible Complication? Clin Ophthalmol 2022; 16:1235-1244. [PMID: 35493970 PMCID: PMC9041599 DOI: 10.2147/opth.s362019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To report on four cases of central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis with early onset neovascular glaucoma in the further disease course. Patients and Methods Retrospective analysis of the medical records of six consecutive patients treated with intra-arterial thrombolysis for CRAO of which four developed neovascular glaucoma. Results All six patients were diagnosed with acute CRAO and treated with intra-arterial thrombolysis 4.5–6 hours after symptom onset. The patients had no significant carotid artery stenosis and unremarkable ophthalmic history. No visual improvement could be achieved after treatment. Four to seven weeks after CRAO onset, four of these patients developed severe painful neovascular glaucoma. Conclusion Early onset of aggressive neovascular glaucoma following intra-arterial thrombolysis for CRAO might be a complication of CRAO itself, still possible association with intra-arterial thrombolysis in our patients should be discussed.
Collapse
Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
- Correspondence: Olga Furashova, Department of Ophthalmology Klinikum Chemnitz gGmbH, Flemmingstrasse 2, Chemnitz, 09116, Germany, Tel +49 371 333 33230, Fax +49 371 333 33223, Email
| | - Joerg Thalwitzer
- Department of Neuroradiology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Egbert Matthé
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
9
|
Furashova O, Strassburger P, Becker KA, Engelmann K. Efficacy of combining intravitreal injections of ranibizumab with micropulse diode laser versus intravitreal injections of ranibizumab alone in diabetic macular edema (ReCaLL): a single center, randomised, controlled, non-inferiority clinical trial. BMC Ophthalmol 2020; 20:308. [PMID: 32727496 PMCID: PMC7391612 DOI: 10.1186/s12886-020-01576-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate if a combination therapy with micropulse diode laser (MPL) shows non-inferiority on visual acuity (BCVA) within 12 months in comparison to standard therapy, i.e. intravitreal injection of ranibizumab alone. Setting Institutional. Prospective randomized single-center trial. Methods Patients with diabetic macular edema (DME) received three intravitreal injections of 0.5 mg ranibizumab during the upload phase and were then randomised 1:1 to receive either the same dosage of ranibizumab (0.5 mg) injections pro re nata alone (IVOM-Group; n = 9), or with two additional treatments with micropulse diode laser (IVOM+Laser-Group; n = 10). The primary endpoint was change in BCVA after 12 months. Secondary endpoints were change in central macular thickness and overall number of ranibizumab injections. Results BCVA increased significantly in both groups (IVOM: + 5.86, p < 0.001; IVOM+Laser: + 9.30; p < 0.001) with corresponding decrease in central macular thickness (IVOM: − 105 μm, p < 0.01; IVOM+Laser: − 125 μm; p < 0.01). Patients with additional laser treatment had better visual improvement (group comparison p = 0.075) and needed fewer ranibizumab injections (cumulative proportion of injections 9.68 versus 7.46 in IVOM-Group and IVOM+Laser-Group, respectively). Conclusion Non-inferiority of combination therapy in comparison to standard therapy alone could be demonstrated. Patients with additional laser therapy needed fewer ranibizumab injections. Trial registration Registered 10 February 2014 on ClinicalTrials.gov; NCT02059772.
Collapse
|
10
|
Furashova O, Matthé E. Foveal crack sign as a predictive biomarker for development of macular hole in fellow eyes of patients with full-thickness macular holes. Sci Rep 2020; 10:19932. [PMID: 33199791 PMCID: PMC7670431 DOI: 10.1038/s41598-020-77078-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022] Open
Abstract
To investigate the prevalence and predictive value of the foveal crack sign (FCS) in fellow eyes of patients with full-thickness macular holes (FTMH) regarding future macular hole (MH) formation. In a retrospective observational case series, 113 fellow eyes of 113 patients with FTMH have been observed during a mean follow-up time of 21 months. According to baseline SD-OCT images, patients were divided into 4 separate groups: patients with FCS and vitreous adhesion, patients with FCS and vitreous detachment, patients without FCS with vitreous adhesion, patients without FCS with vitreous detachment. Progression rate to MH formation, predictive value of FCS and of vitreous interface status were calculated and compared across the four groups. FCS was observed in 19 of 113 fellow eyes (17%) of patients with FTMH, 10 of them with progression to MH during the mean follow up time of 21 months. 2 other eyes with progression to MH showed no FCS at baseline. Progression rate was shown to be 77% (10 of 13 eyes) in patients with FCS and vitreous adhesion, 0% (none of 6 eyes) in patients with FCS and vitreous detachment, 4% (2 of 48 eyes) in patients without FCS with vitreous adhesion, 0% (none of 46 eyes) in patients without FCS with vitreous detachment. FCS had sensitivity of 83.3% (95% CI 50.9–97.1%) and specificity of 91.1% (95% CI 83.3–95.6%) in predicting MH formation, positive predictive value of FCS was 52.6% (95% CI 29.5–74.8%) and negative predictive value 97.9% (95% CI 91.8–99.6%). Having simultaneously FCS and vitreous adhesion showed 83.3% (95% CI 50.9–97.1%) sensitivity and 97.1% (95% CI 91.1–99.2%) specificity in predicting macular hole formation; positive predictive value was 76.9% (95% CI 46.0–93.8%) and negative predictive value was 98.0% (95% CI 92.4–99.7%). Fellow eyes of patients with FTMH with foveal crack sign are at a very high risk (77%) of FTMH development, as long as posterior vitreous adhesion is present.
Collapse
Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, 09116, Chemnitz, Germany.
| | - Egbert Matthé
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| |
Collapse
|
11
|
Furashova O, Matthè E. Hyperreflectivity of Inner Retinal Layers as a Quantitative Parameter of Ischemic Damage in Acute Retinal Vein Occlusion (RVO): An Optical Coherence Tomography Study. Clin Ophthalmol 2020; 14:2453-2462. [PMID: 32921978 PMCID: PMC7457850 DOI: 10.2147/opth.s260000] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the reflectivity changes of inner retinal layers in acute retinal vein occlusion (RVO) on spectral-domain optical coherence tomography (SD-OCT) and to correlate these values with other known parameters of acute ischemic damage. Patients and Methods In this retrospective and observational case series, 230 eyes from 115 patients with acute RVO (central or branch) were categorized as ischemic or non-ischemic depending on fluorescein angiography (FA) images at baseline. Thickness and reflectivity of selected retinal layers were measured from SD-OCT images at baseline. Reflectivity values were correlated with other parameters of acute ischemic damage (best-corrected visual acuity (BCVA), retinal thickness, extent of macular edema, ischemic area on fluorescein angiography). The data were compared with contralateral eyes (controls). Prominent middle limiting membrane sign (p-MLM) was also registered. Results RVO reflectivity values differed significantly in all retinal layers compared to controls (P<0.001). Ischemic RVO eyes had higher optical intensity values for the innermost retinal layer (IMRL; P=0.008) and inner retinal layer (P=0.019) compared to non-ischemic cases. For all RVO eyes as well as central RVO, severity parameters like BCVA, central and total retinal thickness showed a strong correlation with the IMRL reflectivity. In branch RVO, BCVA remained significantly correlated with the IMRL reflectivity, while the thickness values showed significant correlation only for central foveal thickness in non-ischemic branch RVO type. The p-MLM was seen on OCT in 94% of the ischemic and in 66% of the non-ischemic RVO cases. Conclusion Acute RVO leads to increased reflectivity of inner retinal layers with significantly higher values in the ischemic vs non-ischemic type. Increased inner retinal layers’ reflectivity correlated significantly with BCVA, retinal thickness of separate retinal layers, as well as ischemic area on FA. Quantitative non-invasive measurement of inner retinal layers’ reflectivity might be used to determine the extent of acute ischemic retinal damage in RVO.
Collapse
Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz 09116, Germany
| | - Egbert Matthè
- Ophthalmology Department, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| |
Collapse
|
12
|
Furashova O, Engelmann K. To Peel or Not to Peel: Pars Plana Vitrectomy with Macular Membrane Peel in Eyes with Abnormalities of Vitreomacular Interface and Coexisting Dry Age-Related Macular Degeneration. Clin Ophthalmol 2020; 14:389-396. [PMID: 32103885 PMCID: PMC7023885 DOI: 10.2147/opth.s240480] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/03/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the outcome of macular surgery with ILM- and epiretinal membrane peel associated with significant dry age-related macular degeneration (AMD) as defined by the Age-Related Eye Disease Study (AREDS). Patients and Methods Institutional. Retrospective case-control study. A total of 42 pseudophacic eyes of 39 patients (7 with full thickness macular hole and 35 with epiretinal membrane) with coexisting dry AMD underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) and epiretinal membrane peel. Preoperative and postoperative data including best corrected visual acuity (BCVA), AMD grade according to AREDS, central retinal thickness (CRT), development of choroidal neovascularization (CNV), and central retinal atrophy have been evaluated. Twenty-eight fellow eyes with dry AMD of the included 39 patients served as a control group. Results A significant improvement in the visual acuity could be observed after surgery (initial BCVA 0.47±0.31 logarithm of the minimal angle of resolution (logMAR) vs 0.33±0.29logMAR 9 months postoperatively; p=0.006). CRT decreased significantly after surgery (p<0.001). In the surgery group, there were 4 eyes (9.5%) with CNV and 1 eye (2.5%) with new central retinal atrophy development after surgery. All these eyes had preoperative AREDS 3 (4 eyes) or AREDS 4 (1 eye) AMD category. In the control group, there was 1 eye (4%) with CNV and 4 eyes (14%) with new central retinal atrophy development during the follow-up of 9 months. These eyes had initially AREDS 2 (1 eye), AREDS 3 (3 eyes) or AREDS 4 (1 eye) AMD category. Conclusion Eyes with dry AMD of AREDS 3 and AREDS 4 with coexisting VMI abnormalities improve significantly after PPV with membrane peel. While there is a higher risk of CNV development after surgery (9.5%) in these eyes, the vitrectomy does not seem to accelerate central retinal atrophy progression compared to the fellow eyes course.
Collapse
Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| |
Collapse
|
13
|
Furashova O, Matthé E. Retinal Changes in Different Grades of Retinal Artery Occlusion: An Optical Coherence Tomography Study. ACTA ACUST UNITED AC 2017; 58:5209-5216. [DOI: 10.1167/iovs.17-22411] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Olga Furashova
- Ophthalmology Department, Hospital Chemnitz, Chemnitz, Germany
| | - Egbert Matthé
- Ophthalmology Department, University Hospital Dresden, Dresden, Germany
| |
Collapse
|
14
|
Pillunat KR, Spoerl E, Jasper C, Furashova O, Hermann C, Borrmann A, Passauer J, Middeke M, Pillunat LE. Nocturnal blood pressure in primary open-angle glaucoma. Acta Ophthalmol 2015; 93:e621-6. [PMID: 25913492 DOI: 10.1111/aos.12740] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/07/2014] [Accepted: 03/18/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the nocturnal blood pressure (BP) dipping-pattern in patients with manifest primary open-angle glaucoma (POAG) and to find possible associations with the severity of visual field damage. METHODS A number of 314 patients suffering from POAG were consecutively enrolled in this cross-sectional hospital-based study. Each patient had diurnal intraocular pressure (IOP) measurements, 24-hr BP monitoring and computerized perimetry with the Humphrey 30-2 sita Standard program. Inclusion criteria were a mean IOP of less than 15 mmHg with fluctuations of less than 5 mmHg and a visual acuity of at least 20/40. One eye was randomly selected. Based on the night-day BP ratio, a mean arterial nocturnal BP drop of less than 10% was considered as non-dipping, between 10% and 20% as physiological dipping and of more than 20% as over-dipping. RESULTS Glaucoma patients with daytime systemic normotension on the average had more visual field loss in the over-dipper group (MD = - 16.6 dB, IQR = -18.9 to -2.7 dB) than glaucoma patients with daytime systemic hypertension, who had less visual field defects in the over-dipper group (MD = -3.9 dB, IQR = -6.2 to -1.9 dB) (p = 0.004). This result was also found taking age, glaucoma duration, visual acuity, gender, systemic and topical medication as covariates into account. CONCLUSIONS To judge the nocturnal BP situation of an individual patient, it is important to do this in relation to the daytime BP level. Twenty-four-hour BP evaluation might be important for all patients with POAG, as nocturnal BP could be a modifiable risk factor for glaucoma severity and progression.
Collapse
Affiliation(s)
- Karin R. Pillunat
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Eberhard Spoerl
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Carolin Jasper
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Olga Furashova
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Cosima Hermann
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Anne Borrmann
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Jens Passauer
- Department of Internal Medicine; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Martin Middeke
- Hypertension Center Munich; Excellence Centre of the European Society of Hypertension; Munich Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| |
Collapse
|
15
|
Pillunat KR, Ventzke S, Spoerl E, Furashova O, Stodtmeister R, Pillunat LE. Central retinal venous pulsation pressure in different stages of primary open-angle glaucoma. Br J Ophthalmol 2014; 98:1374-8. [DOI: 10.1136/bjophthalmol-2014-305126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Häntzschel J, Terai N, Furashova O, Pillunat K, Pillunat LE. Comparison of normal- and high-tension glaucoma: nerve fiber layer and optic nerve head damage. Ophthalmologica 2013; 231:160-5. [PMID: 24334967 DOI: 10.1159/000355326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to investigate differences in the nerve fiber layer and glaucoma-induced structural optic nerve head (ONH) damage in patients with normal- (NTG) and high-tension (HTG) glaucoma. METHODS In this retrospective pair-matched comparative study, 22 NTG and 22 HTG eyes were matched according to the same glaucomatous damage based on rim volume, rim area and disk size, as measured by Heidelberg retinal tomography (HRT III). Visual fields (VF) were assessed by Humphrey perimetry, and nerve fiber layer thickness was determined both by scanning laser polarimetry (GDxVCC) and spectral-domain optical coherence tomography (SD-OCT). Comparisons of all measured parameters were made between NTG and HTG groups. RESULTS Based on HRT results, both NTG and HTG eyes displayed comparable structural damage to the ONH (NTG/HTG, mean: disk area, 2.30/2.31 mm(2), p = 0.942; rim area, 1.02/0.86 mm(2), p = 0.082; rim volume, 0.19/0.17 mm(3), p = 0.398). NTG eyes had significantly less VF damage than HTG eyes (NTG/HTG, mean deviation: -4.23/-12.12 dB, p = 0.002; pattern standard deviation: 5.39/8.23 dB, p = 0.022). The inferior nerve fiber layer of NTG patients was significantly thicker than that of HTG patients (NTG/HTG, mean: GDx inferior: 53.5/46.3 µm, p = 0.046). SD-OCT revealed a significantly thicker nerve fiber in NTG compared with HTG patients in all quadrants (NTG/HTG, total mean: 72.72/58.45 µm, p = 0.002). CONCLUSION At comparable glaucomatous stages, nerve fiber loss was more advanced in HTG patients compared with NTG patients.
Collapse
Affiliation(s)
- Janek Häntzschel
- Department of Ophthalmology, Carl Gustav Carus University Hospital, Dresden, Germany
| | | | | | | | | |
Collapse
|