Fundus hypertonicus: Okuläre Veränderungen bei systemischen Erkrankungen

Zusammenfassung: Gefäß- und Herzerkrankungen gehören zu den häufigsten Todesursachen der westlichen Welt. Trotz Aufklärung wissen 30% der Männer und 15% der Frauen nicht, dass ihre Blutdruckwerte zu hoch sind. Die Definition der arteriellen Hypertonie ergibt sich aus mehrfachen Überschreitungen der durch die WHO festgelegten Grenzwerte. Die Lebenserwartung sinkt mit steigendem Blutdruck und ist die Folge der Arterioskleroseentwicklung mit konsekutiver Endorganschädigung. Studien zeigten für Patienten mit arterieller Hypertonie eine deutlich erhöhte Apoplexierate sowie die Zunahme der kardialen Insuffizienz und der koronaren Herzkrankheit. Der Augenarzt spielt bei der Abschätzung der systemischen Gefäßveränderungen eine entscheidende Rolle, da er die Gefäßveränderungen an der Netzhaut exakt einschätzen und klassifizieren kann. Parenchym- und Gefäßveränderungen an der Netzhaut erlauben, die Diagnose richtig zu stellen und den Patienten einer stadiengerechten Therapie zuzuführe

Jahreszeitliche Schwankungen und Einfluss der Ernährung auf die makuläre Pigmentdichte

Zusammenfassung: Hintergrund: Wir haben gezeigt, dass die makuläre Pigmentdichte (MPD) mit einem modifizierten konfokalen Scanning-Laser-Ophthalmoskop (HRA, Fa. Heidelberg Engineering, Heidelberg, Deutschland) bestimmt werden kann. In dieser Studie untersuchten wir, ob Schwankungen der MPD bei gesunden Probanden im Verlauf eines Jahres auftraten und ob die MPD von wechselnden Ernährungsgewohnheiten abhängig ist. Methode: Die MPD wurde mithilfe von Autofluoreszenzbildern, die mit einem HRA aufgenommen wurden, dargestellt und in einem auf die Fovea zentrierten Messfeld von 2° Durchmesser bei den Probanden im Abstand von 2Monaten innerhalb eines Jahres bestimmt. Ergebnisse: Wir schlossen 30 gesunde Probanden im Alter von 19-34Jahren (Mittel: 23±2Jahre) in die Studie ein. Die mittlere MPD war an Untersuchungszeitpunkt1 0,215±0,056D.U., bei der 2.Untersuchung 0,235±0,051D.U., bei der 3. 0,218±0,055D.U., an Untersuchungszeitpunkt4 0,228±057D.U., bei der 5.Untersuchung 0,225±0,053D.U. und bei der letzten 0,203±0,050D.U.. Die statistische Analyse zeigte keine signifikanten Unterschiede der MPD im Verlauf eines Jahres. Zusammenfassung: Die Studie zeigt, dass bei jungen und gesunden Probanden die MPD keinen jahreszeitlichen und diätetischen Schwankungen unterlieg

Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment

Abstract. Horn L-C, Schnurrbusch U, Bilek K, Hentschel B, Einenkel J. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004;14:348-353. In most cases, the endometrioid adenocarcinoma of the endometrium is preceded by hyperplasia with different risk of progression into carcinoma. The original histologic slides from 560 consecutive cases with complex and atypical hyperplasia were re-examined to assess the interobservercorrelation. The hyperplasias were analyzed separately for their likelihood of progression to carcinoma in patients with and without progestogen hormonal therapy. In all cases, a fractional re-curreting was performed to establish the state of the disease. The leading symptom was vaginal bleeding in 65.5% of the cases in the postmenopausal period. Eighty-six percent of the patients presented with obesity (BMI > 30 kg/m 2 ), 23% had had an exogeneous use of estrogens. Twenty-two cases were reclassified as simple hyperplasia and excluded from further analysis. The interobserver-correlation was 91% for complex, 92% for atypical hyperplasia, and 89% for endometrioid carcinoma, representing an overall correlation of 90%. Two percent of the cases with complex hyperplasia (8/390) progressed into carcinoma and 10.5% into atypical hyperplasia. Fifty-two percent of the atypical hyperplasias (58/112) progressed into carcinomas. In the case of progestogen treatment (n = 208; P < 0.0001) 61.5% showed remission confirmed by re-curetting, compared with 20.3% of the cases without hormonal treatment (n = 182; P < 0.0001). Endometrial hyperplasia without atypia is likely to respond to hormonal treatment. Especially in postmenopausal situation, atypical hyperplasia should be treated with total hysterectomy

Safety and Efficacy of Ranibizumab in Diabetic Macular Edema (RESOLVE Study*): A 12-month, randomized, controlled, double-masked, multicenter phase II study

The expression of vascular endothelial growth factor (VEGF) is elevated in diabetic macular edema (DME). Ranibizumab binds to and inhibits multiple VEGF variants. We investigated the safety and efficacy of ranibizumab in DME involving the foveal center

Repeatability of Foveal Measurements Using Spectralis Optical Coherence Tomography Segmentation Software

PURPOSE: To investigate repeatability and reproducibility of thickness of eight individual retinal layers at axial and lateral foveal locations, as well as foveal width, measured from Spectralis spectral domain optical coherence tomography (SD-OCT) scans using newly available retinal layer segmentation software. METHODS: High-resolution SD-OCT scans were acquired for 40 eyes of 40 young healthy volunteers. Two scans were obtained in a single visit for each participant. Using new Spectralis segmentation software, two investigators independently obtained thickness of each of eight individual retinal layers at 0°, 2° and 5° eccentricities nasal and temporal to foveal centre, as well as foveal width measurements. Bland-Altman Coefficient of Repeatability (CoR) was calculated for inter-investigator and inter-scan agreement of all retinal measurements. Spearman's ρ indicated correlation of manually located central retinal thickness (RT0) with automated minimum foveal thickness (MFT) measurements. In addition, we investigated nasal-temporal symmetry of individual retinal layer thickness within the foveal pit. RESULTS: Inter-scan CoR values ranged from 3.1μm for axial retinal nerve fibre layer thickness to 15.0μm for the ganglion cell layer at 5° eccentricity. Mean foveal width was 2550μm ± 322μm with a CoR of 13μm for inter-investigator and 40μm for inter-scan agreement. Correlation of RT0 and MFT was very good (ρ = 0.97, P 0.05); however this symmetry could not be found at 5° eccentricity. CONCLUSIONS: We demonstrate excellent repeatability and reproducibility of each of eight individual retinal layer thickness measurements within the fovea as well as foveal width using Spectralis SD-OCT segmentation software in a young, healthy cohort. Thickness of all individual retinal layers were symmetrical at 2°, but not at 5° eccentricity away from the fovea

Structural and Functional Changes of the Human Macula during Acute Exposure to High Altitude

Background: This study aimed to quantify structural and functional changes at the macula during acute exposure to high altitude and to assess their structure/function relationship. This work is related to the Tuebingen High Altitude Ophthalmology (THAO) study. Methodology/Principal Findings: Spectral domain optical coherence tomography and microperimetry were used to quantify changes of central retinal structure and function in 14 healthy subjects during acute exposure to high altitude (4559 m). High-resolution volume scans and fundus-controlled microperimetry of the posterior pole were performed in addition to best-corrected visual acuity (BCVA) measurements and assessment of acute mountain sickness. Analysis of measurements at altitude vs. baseline revealed increased total retinal thickness (TRT) in all four outer ETDRS grid subfields during acute altitude exposure (TRTouter = 2.8061.00 mm; mean change695%CI). This change was inverted towards the inner four subfields (TRT inner = 21.8960.97 mm) with significant reduction of TRT in the fovea (TRT foveal = 26.6260.90 mm) at altitude. BCVA revealed no significant difference compared to baseline (0.0660.08 logMAR). Microperimetry showed stable mean sensitivity in all but the foveal subfield (MSfoveal = 21.1260.68 dB). At baseline recordings before and.2 weeks after high altitude exposure, all subjects showed equal levels with no sign of persisting structural or functional sequels. Conclusions/Significance: During acute exposure to high altitude central retinal thickness is subject to minor, ye