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Biomedical subjects

Carsten H Meyer

Publications and source records attributed to Carsten H Meyer.

At least 19 recordsLinked to original sources
PubMed2006

Visual hallucinations after intravitreal injection of bevacizumab in vascular age-related macular degeneration.

PURPOSE: To describe transient structured visual hallucinations in a patient with vascular age-related macular degeneration (AMD), following an intravitreal Avastin-injection. DESIGN: Interventional case reports. METHODS: A fully alert 83-year-old woman with disciform scar right eye (OD) and occult choroidal neovascularization (CNV) left eye (OS) experienced a progressive visual loss to 20/800 OD and 20/400 OS. A coherent 84-year-old woman with occult CNV both eyes (OU) experienced decreased vision of 20/800 OU. After both patients gave informed consent, an uneventful intravitreal injection of 1.25 mg Avastin was performed in the left eyes. RESULTS: One day and three days after an uneventful intravitreal injection both patients experienced structured hallucinations including trees, faces, and water for approximately 15 to 30 minutes. CONCLUSIONS: We report a typical symptoms of Charles-Bonnet syndrome (CBS) in patients with severe AMD after intravitreal Avastin-injections. The reduced retinal edema and realignment of the photoreceptors may promote the release phenomenon and trigger hallucinatory episodes.

Aged, 80 and over↗
PubMed2006

Effect of photodynamic therapy on the function of the outer blood-retinal barrier in an in vitro model.

BACKGROUND: Photodynamic therapy (PDT) is a well established clinical treatment for age-related macular degeneration (AMD), and comprises intravenous injection of verteporfin and subsequent application of a non-thermal laser beam to the area of AMD to induce selective vascular occlusion. Since there is evidence that PDT may cause outer blood-retinal barrier (BRB) breakdown and possibly RPE cell alteration, we investigated the effect of PDT on the BRB function of the RPE in an in vitro model. METHODS: Twenty-one monolayers of human RPE cells were cultured on semipermeable membranes until a stable barrier function was achieved as determined by transepithelial electrical resistance (TER) and sodium fluorescein permeability. To test the effect of PDT on the outer BRB function, non-thermal laser (692 nm), verteporfin or a combination of both were applied. TER assessment prior to and after PDT was utilized to identify changes in barrier function of the RPE in this in vitro model. Finally, monolayers of RPE cells were evaluated by transmission electron microscopy (TEM). RESULTS: No significant TER decrease was observed after application of non-thermal laser alone or after administration of verteporfin in therapeutic concentrations, but combination of these modalities resulted in significantly decreased TER within 4 h. Except for intercellular blisters, no damage to the RPE was evident in TEM. Verteporfin added at concentrations higher than therapeutic doses (2 mg/ml) resulted in an immediate decrease in TER and damage to the RPE cells. CONCLUSION: The combination of a therapeutic concentration of verteporfin and application of non-thermal laser resulted in a morphologically and functionally detectable breakdown of the outer BRB function of the RPE without any damage to the RPE cells themselves in vitro. However, increasing the concentration of verteporfin can result in RPE cell damage.

Blood-Retinal Barrier↗
PubMed2006

Visual recovery after scleral buckling surgery in macula-off rhegmatogenous retinal detachment.

PURPOSE: The primary goal of this study was to investigate the functional results after scleral buckling (SB) surgery in macula-off rhegmatogenous retinal detachment (RRD), with more or less than 7 days' duration of macular detachment (DMD). The secondary outcome measure was to determine the long-term functional results in these two groups 5 years after SB surgery. METHODS: The retrospective studies included 96 eyes of 96 patients with primary, uncomplicated, macula-off RRD. Two studies, one with a short-term follow-up and one with a long-term follow-up, were performed, and in both studies the eyes were divided into two groups according to the DMD. In study I, 96 patients were divided into DMD or=4 days and 7 days (n = 11). Additional preoperative predictive factors including DMD, preoperative visual acuity (VA) and patients' age at the time of the RRD were correlated with the postoperative VA. RESULTS: In study I, the mean final VA was significantly better (0.45) after a DMD of less than or equal to 7 days, compared to patients with a DMD of more than 7 days (0.22; Student's t test, p = 0.02). VA >or=0.4 was achieved in 68% with a subacute DMD compared to 52% in patients with prolonged DMD (chi(2) test, p < 0.001). However, the postoperative VA (0.48 +/- 0.09) in eyes with DMD of 1-3 days was similar (0.42 +/- 0.07) to eyes with DMD of 4-7 days (Student's t test, p = 0.455). We divided the 96 patients into 2 groups according to a preoperative VA. Eyes with a preoperative VA 0.1 (n = 34; Student's t test, p < 0.001). Patients 75 years of age or younger were more likely to achieve a VA of 0.4 or better after SB surgery than older patients (more than 75 years; chi(2) test, p = 0.008). In study II, VA improved (by a mean of 1.60 +/- 0.02 lines) during the follow-up period from 0.32 +/- 0.08 at the 3-month follow-up to 0.46 +/- 0.10 at the 5-year follow-up. Eyes with a subacute DMD had a significantly better VA than eyes with a prolonged DMD (Student's t test, p = 0.004). Patients aged 75 years or less were more likely to achieve a VA of 0.4 or better than patients older than 75 (chi(2) test, p = 0.003). CONCLUSION: The time point of SB surgery has no statistical impact on the final visual recovery in patients with an acute primary macular-off RRD of less than or equal to 7 days. A delay of SB surgery within this time frame does not contribute to an impaired final visual outcome. There was no evidence, that primary macula-off RRDs are emergencies, which cannot wait for a systemic evaluation of the RRD and surgical treatment at the next available scheduled day. A preoperative VA of more than 0.1 and patients' age under 60 years at presentation had an additional prognostic value on the final outcome. Surgeons should be aware that visual function after reattachment may continue to improve over a long period. This study provides useful guidelines for the clinical management of macula-off RRD and the assessment of potential visual recovery in patients after successful SB surgery.

Adolescent↗
PubMed2006

Patent blue: a novel vital dye in vitreoretinal surgery.

PURPOSE: To determine a novel vital dye (patent blue; Blueron) for vitreoretinal surgery in a prospective consecutive case series. METHODS: Five patients with either idiopathic epiretinal membrane (ERM; n = 2), proliferative vitreoretinopathy (n = 2), or a macular hole (n = 1) underwent a three-port pars plana vitrectomy. Patent blue assisted staining of the retinal surface followed by a consecutive peeling of the ERM (n = 4) or of the internal limiting membrane (ILM; n = 1) was performed. The main outcome measures were quality of intraoperative visualization of preretinal structures and postoperative visual acuity. RESULTS: The dye induced a moderate staining (++) of the ERM and a mild staining (+) of the ILM. Complete ERM and ILM removal was successfully achieved in all cases. A mean visual improvement of three Snellen lines was observed 6 months postoperatively. No visual field defects or visible retinal pigment epithelial changes were present 6 months postoperatively. CONCLUSION: Patent blue, a novel dye for intraocular applications, may be added as an alternative dye in chromovitrectomy.

Absorption↗
PubMed2006

Functional and anatomical findings in acute Purtscher's retinopathy.

INTRODUCTION: To determine the anatomical location and functional impairment in acute Purtscher's retinopathy (PR). MATERIAL AND METHODS: A 15-year-old boy with acute PR was examined with optical coherence tomography (OCT) and microperimetry (MP). RESULTS: His initial best corrected visual acuity was 20/30 OD and 20/80 OS, the MP demonstrated absolute scotomas in the central and peripapillary area of the cotton-wool spots. On the OCT, there was a hyporeflective area in the inner aspect of the retina, corresponding to white patches on funduscopy. After he had been treated with oral prednisolone 100 mg, his visual acuity improved to 20/20 OU within 4 weeks and there were no scotomas on the MP. The central retinal architecture returned to normal with no sub- or intraretinal fluid. DISCUSSION: Cotton-wool spots in PR represent infarctions of the retinal nerve fiber layer. Deeper layers of the retina may also be involved, causing a breakdown of the inner blood-retina barrier with temporary intra- and subretinal edema.

Acute Disease↗
PubMed2005

Benefits and side effects of bandage soft contact lens application after LASIK: a prospective randomized study.

PURPOSE: To evaluate benefits and side effects of bandage soft contact lens (BSCL) insertion after LASIK in relation to patients' characteristics. DESIGN: Prospective, randomized, bicenter comparative investigational trial. PARTICIPANTS: One hundred patients (200 eyes) with myopia and/or myopic astigmatism. METHODS: Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours. MAIN OUTCOME MEASURES: Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients' subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal-Wallis 1-way analysis of variance on ranks test. RESULTS: Fifty-four percent of patients felt discomfort in the eye that had the BSCL (contra-BSCL subgroup), whereas 27% enjoyed having a BSCL (pro-BSCL subgroup). The remaining 19% felt no difference. The average Schirmer II value was 16.6 mm (+/-7.7) in the pro-BSCL subgroup, 14.9 mm (+/-6.4) in the no difference subgroup, and 12.3 mm (+/-7.7) in the contra-BSCL subgroup. There was a female preponderance in the contra-BSCL (39:15) and no difference (15:6) subgroups. A preoperative history of poor contact lens tolerance was recorded in 50% of the contra-BSCL subgroup patients; 41%, no difference; and 33%, pro-BSCL. Postoperative parameters such as first-day UCVA, number of eyes with microstriae, folds requiring stretching, or cases of diffuse lamellar keratitis did not differ significantly. Eyes with flap microstriae had a significantly deeper mean ablation (114.5 microm [range, 52-146 microm]) than eyes without any flap abnormalities (75.4 microm [39-120 microm]). No significant differences were found between the consecutive and simultaneous groups. CONCLUSION: The majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.

Adult↗
PubMed2005

Functional changes after photodynamic therapy with verteporfin.

OBJECTIVE: To investigate image preferences after photodynamic therapy (PDT). DESIGN: Prospective, cross-sectional study. METHODS: Seventeen patients with neovascular age-related macular degeneration were tested by color vision, contrast sensitivity, and near visual acuity (VA) with positive images and negative images before, 1 week after, and 3 months after PDT. RESULTS: Before PDT, 13 patients (76%) preferred positive images; the difference was not significant (P < .04). One week after PDT, 16 patients (94%) preferred negative images. The average near VA improved to 27 letters on positive images and to 32 letters on negative images (P < .00001). Three months after PDT, near VA declined to 19 letters on positive images and to 26 letters on negative images (P < .000001). Color vision and contrast sensitivity remained constant during all examinations. CONCLUSION: Although PDT may not alter the neurosensory retina, it may affect intraretinal function by changing image preference.

Choroidal Neovascularization↗