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Biomedical subjects

F Gelisken

Publications and source records attributed to F Gelisken.

At least 19 recordsLinked to original sources
PubMed2006

Intravitreal bevacizumab (Avastin) for occult choroidal neovascularization in age-related macular degeneration.

BACKGROUND: The purpose of the study is to report data on short-term safety of intravitreal bevacizumab treatment and its effect on visual function, central retinal thickness, and angiographical changes of occult choroidal neovascularization due to age-related macular degeneration. METHODS: A consecutive interventional case series of 30 patients with active subfoveal occult choroidal neovascularization secondary to age-related macular degeneration was followed after one intravitreal injection of 1.25 mg bevacizumab at baseline and subsequent injections following standardized criteria. At baseline and follow-up visits patients had visual acuity assessment, intraocular pressure measurement, fluorescein angiography, and optical coherence tomography imaging. RESULTS: No serious ocular or systemic adverse events were identified. A significant increase of intraocular pressure or signs of retinal toxicity or endophthalmitis were not detected in any patient. Optical coherence tomography revealed significant decrease (p < 0.001) in central retinal thickness after 1 week, 4 weeks, and 12 weeks, respectively. Fluorescein leakage decreased within 1 week and improvement was maintained at week 12 in the majority of patients. Visual acuity improved or remained stable in 29 of 30 patients; improvement of 3 or more lines was seen in 14 of 30 patients; one patients showed improvement of 6 lines. No patient had severe vision loss of 6 lines or more; moderate vision loss of 3 lines was seen in one patient. Re-injections of bevacizumab according to standard criteria were performed one to two times during the follow-up period of 12 weeks with a re-injection interval of 4 to 18 weeks (median 8 weeks). CONCLUSIONS: Short-term results suggest that intravitreal injection of bevacizumab is well tolerated and for the majority of patients with occult choroidal neovascularization in AMD results in improvement of visual acuity, decrease in central retina thickness, and reduction of angiographic leakage of the lesion. Bevacizumab as intravitreal treatment may provide a novel therapeutic option for selected patients with exudative AMD. Randomized prospective multicenter trials seem justified to further evaluate long term effects and impact of intravitreal bevacizumab on different subtypes of AMD compared to established therapies.

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PubMed2006

Effects of bevacizumab on retinal function in isolated vertebrate retina.

BACKGROUND: Bevacizumab (Avastin) is a recombinant protein that targets vascular endothelial growth factor (VEGF). In vitro, bevacizumab inhibits VEGF induced cell proliferation and tissue factor production. Abnormal angiogenesis involving VEGF is a central event during the development of choroidal neovascularisation (CNV). The present study was designed to evaluate the short term toxic effects of bevacizumab on retinal function for a therapeutic intraocular application. METHODS: Isolated bovine retinas were perfused with an oxygen pre-incubated nutrient solution. The electroretinogram (ERG) was recorded as a transretinal potential using silver/silver chloride electrodes. Bevacizumab was added in different concentrations to the nutrient solution for 45 minutes. Thereafter the retina was reperfused for 60 minutes with normal nutrient solution. The percentage of a-wave and b-wave reduction during the application of bevacizumab was calculated and compared to control recordings. RESULTS: During the application of three different concentrations of bevacizumab (0.08 mg/ml, 0.25 mg/ml, 0.8 mg/ml) no significant reduction of the a-wave and b-wave amplitude was observed. During the washout, the ERG amplitudes were unchanged. CONCLUSION: The present study suggests that an intraocular application of 0.25 mg/ml bevacizumab for the treatment of CNV is reasonable. No significant short term effects of bevacizumab on retinal function were detected, but long term effects cannot be excluded.

Angiogenesis Inhibitors↗
PubMed2006

Verteporfin photodynamic therapy induced apoptosis in choroidal neovascular membranes.

AIM: To evaluate the impact of verteporfin photodynamic therapy (PDT) on the induction of apoptosis in choroidal neovascular membranes (CNV) secondary to age related macular degeneration. METHODS: Retrospective review of 22 surgically excised CNV. 12 of these patients had been treated with PDT 3-146 days previously. Apoptotic cells were detected with the TUNEL technique and compared to the expression of CD34 (endothelial cells, EC), CD105 (activated endothelial cells), Ki-67 (proliferation marker), and cytokeratin18 (retinal pigment epithelial cells, RPE). RESULTS: CNV excised 3 days after PDT were characterised both by collapsed and patent vessels. The EC displayed a statistical significant positive TUNEL reaction when compared to the remaining treated CNV (p < 0.001) and untreated CNV (P = 0.002). The proliferative activity was reduced. CNV excised 1-5 months after PDT displayed a patent vascularisation and high proliferative activity. All membranes either treated or untreated disclosed only sporadic TUNEL positive cells within the stroma and the RPE. CONCLUSIONS: Verteporfin PDT leads to selective and effective damage of EC within CNV. Both patent and occluded vessels were lined by apoptotic EC. This finding and the increased expression of proliferation marker at later time points suggest that revascularisation after PDT is caused by angiogenesis rather than recanalisation.

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PubMed2006

[Bevacizumab for treatment of macular edema secondary to retinal vein occlusion].

Application of VEGF inhibitors represents a treatment option for macular edema secondary to retinal vein occlusion that targets the disease at the causal molecular level. First reports on intravitreal injections of bevacizumab show promising morphological and functional effects and demonstrate that bevacizumab is a potent antiedematous agent in this context. A significant reduction of the central retinal thickness followed by a rapid improvement of visual acuity may be achieved within days. In a pilot study with a review period of 3 months, we found a significant improvement of one or more lines in 93% and four or more lines in 27% of eyes. This was associated with a concomitant significant reduction in central retinal thickness, which, however, was not sustained by a single injection (64% reduction after 1 month and 28% after 3 months). No relevant adverse events were noted. The duration of action after intravitreal bevacizumab administration is currently unknown. Reinjections will be necessary to maintain a lasting beneficial effect. Prospective, controlled long-term studies are mandatory to develop standardized treatment protocols that allow a safe and effective application of this off-label therapy.

Angiogenesis Inhibitors↗
PubMed2005

[Anticoagulative therapy in patients with exudative age-related macular degeneration: acute angle closure glaucoma after massive intraocular hemorrhage].

BACKGROUND: Acute secondary angle closure glaucoma after massive vitreous and subretinal hemorrhage from exudative age related macular degeneration is a seldom, but devastating complication of an anticoagulative therapy. PATIENTS: Four patients (age range 70-76 years) developed unilateral acute angle closure glaucoma after massive intraocular bleeding due to exudative age-related macular degeneration and anticoagulative therapy. Three patients received Phenprocomoun and one patient thrombolytic therapy with heparin. One eye had led to blindness at initial investigation. Pars plana vitrectomy was performed in the remaining three eyes. Within a few months, 2 of these 3 eyes were blind, one eye had light perception and all three eyes developed hypotonia. CONCLUSION: Acute angle closure glaucoma after intraocular bleeding may be the initial clinical manifestation of overtreatment with anticoagulants. Early pars plana vitrectomy probably will increase the surveillance rate of the eye but not the visual prognosis.

Acute Disease↗
PubMed2004

Clinicopathological findings of choroidal neovascularisation following verteporfin photodynamic therapy.

AIMS: To report the clinicopathologic findings of surgically excised choroidal neovascularisation (CNV) three days after verteporfin photodynamic therapy (PDT). METHODS: In three patients (three eyes) with age related macular degeneration, the CNV was surgically removed three days after PDT. The CNV specimens were examined by light microscopy. RESULTS: The patients had subfoveal classic CNV. Fluorescein angiography revealed non-perfusion of the CNV after PDT and before surgery in all eyes. The light microscopy of the CNV membranes showed swollen and damaged endothelium. Thrombus formation or vascular occlusion in the CNV vessels was not detected. CONCLUSION: PDT did not cause a thrombosis of the vessels within the CNV three days after PDT. Severe endothelial damage of the CNV was observed and is likely a primary effect of PDT. Non-perfusion of the CNV at this stage is possibly secondary to occlusion at a deeper level, namely the underlying feeding choroid.

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PubMed2004

Histopathological analysis in experimental macular surgery with trypan blue.

AIM: To analyse the effect of trypan blue on the retina in an experimental setting of macular surgery. METHODS: Porcine eyes were used within 3 hours after death. The eyes were hemisected and the vitreous removed. Trypan blue (0.15%) was applied over the trephined posterior pole, whereas the rest of the eye cup was filled with a balanced salt solution (BSS). The dye and the BSS were removed after 1 minute and the complete eye cup irrigated and filled with fresh BSS. Both the treated and untreated retinas were illuminated with a standard surgical light pipe and source at maximum power for 10 minutes. Both the trypan blue exposed retina and the non-treated surrounding retina were processed for histology. RESULTS: Exposure of the retina to trypan blue for 1 minute, followed by illumination caused no histologically detectable damage compared to the controls. No microarchitectural disorganisation, cellular disruption, or affection of the vitreoretinal interface was detected. CONCLUSIONS: These findings indicate that a 1 minute exposure of trypan blue followed by illumination does not cause an acute morphologically detectable toxic effect on the porcine retina.

Animals↗
PubMed2002

[Visual prognosis and patient selection].

Choroidal neovascularization (CNV) is one of the leading causes of central vision loss. Laser photocoagulation and photodynamic therapy may reduce the risk of severe loss of visual acuity in subfoveal CNV secondary to age-related macular degeneration. However, the most favorable effect of these therapies is the slowing of the vision loss. Macular translocation surgery, removing the neurosensory retina away from the area of choroidal neovascularization to a healthier underlying tissue, may improve or stabilize the visual acuity. Several pilot studies of this surgery reported visual recovery in selected patients. Well-designed, controlled randomized studies are needed to clarify the role of the macular translocation surgery in treatment of choroidal neovascularization. Given the severe complications of this surgery, it is of utmost importance to discuss the potential risks and advantages of this procedure with the patient.

Choroidal Neovascularization↗
PubMed2001

[Clinical characteristics of idiopathic polypoidal choroid vasculopathy].

BACKGROUND: Originally, idiopathic polypoidal choroidal vasculopathy (IPCV) was thought to present as a bilateral disorder with peripapillary location of the polipoidal lesions in predominantly black patients. Until now, only a few patients have been described in Europe. MATERIALS AND METHODS: A retrospective study of the clinical spectrum of nine Caucasian patients with IPCV using standard clinical fluorescein and indocyanine green angiography (ICGA) techniques. RESULTS: ICGA demonstrated the typical vascular dilatations in the inner choroid in all patients. The polypoidal lesions were unilateral in six, bilateral in three patients, isolated in the macular in six and peripapillar in three patients. During the course of follow-up (range 6-92 months, mean 29.4 months) vitreous hemorrhage occurred in one eye, the polypoidal lesions spontaneously disappeared in three eyes and new lesions grew in two eyes. Laser photocoagulation was beneficial in three out of five treated eyes. CONCLUSION: The clinical manifestations of IPCV overlap with those of exudative age-related macular degeneration and central serous retinopathy. However, there are differences in the natural course, the visual prognosis and the response to laser treatment. ICGA is helpful to differentiate these entities.

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PubMed2001

Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization.

PURPOSE: To report a case of retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. METHODS: Case report. A 74-year-old woman with exudative age-related macular degeneration and classic subfoveal choroidal neovascularization RE underwent photodynamic therapy with verteporfin. RESULTS: Ophthalmoscopy and fluorescein angiography RE disclosed a retinal pigment epithelial tear in the area of photodynamic therapy. CONCLUSION: This case presents the first report of a retinal pigment epithelial tear after photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration.

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PubMed1998

Detection of choroidal aneurysms with indocyanine green videoangiography.

BACKGROUND: Aneurysms of the choroidal vasculature have been described only in histopathological studies. METHODS: Indocyanine green videoangiograms obtained with the scanning laser ophthalmoscope from 32 patients with geographic atrophy were reviewed. RESULTS: In 8 of 32 patients indocyanine green videoangiography (ICGVA) showed hyperfluorescent aneurysms along choroidal arteries. The same aneurysmal formations were found in two of the eight patients on very early images of fluorescein videoangiography before dye leakage occurred. Seven of eight patients with choroidal aneurysms had a history of hypertension. CONCLUSIONS: ICGVA is a useful diagnostic tool in detecting choroidal aneurysms. Multiple mechanisms are probably involved in the pathogenesis of choroidal aneurysms, among them the higher hemodynamic stress in the macular region, hypertension and aging.

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PubMed1998

Indocyanine green videoangiography of occult choroidal neovascularization: a comparison of scanning laser ophthalmoscope with high-resolution digital fundus camera.

PURPOSE: To compare the indocyanine green (ICG) angiographic findings of occult choroidal neovascularization (O-CNV) taken by scanning laser ophthalmoscope and high-resolution digital fundus camera. METHODS: We examined 100 eyes of 100 consecutive patients with ICG angiographic evidence of CNV secondary to age-related macular degeneration. All patients were diagnosed with O-CNV based on fluorescein angiography. Indocyanine green videoangiography was carried out using the scanning laser ophthalmoscope and high-resolution digital fundus camera at the same session. RESULTS: Indocyanine green videoangiography revealed well-defined vessel structure of the O-CNV in 28% of eyes examined by scanning laser ophthalmoscope and in 8% of eyes examined by digital fundus camera. Well-defined focal spots were demonstrated in 37% of eyes examined by scanning laser ophthalmoscope and in 52% of eyes examined by digital fundus camera. Plaques (well-defined) were found in 13% and 35% of eyes examined by scanning laser ophthalmoscope and digital fundus camera, respectively. CONCLUSION: Indocyanine green videoangiography with scanning laser ophthalmoscopy seems to be superior to the digital fundus camera in delineation of the vessel architecture of O-CNV. Focal spots and plaques are best detected by digital fundus camera.

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PubMed1997

Indocyanine green angiographic findings in fellow eyes of patients with unilateral occult neovascular age-related macular degeneration.

PURPOSE: To determine the role of indocyanine green angiography (ICGA) in the prediction of the development of choroidal neovascularization (CNV). METHODS: We reviewed the ICG angiograms of 124 patients with newly diagnosed unilateral occult CNV secondary to age-related macular degeneration (AMD) in whom the fellow eye had only drusen by biomicroscopy and fluorescein angiography. Follow-up data of at least 12 months were obtained in all eyes. RESULTS: 113 fellow eyes had a normal ICG study, while 11 fellow eyes revealed plaque-like late hyperfluorescence. During an average follow-up time of 18.2 months exudative AMD developed in 7 of 11 eyes with late hyperfluorescence on ICGA and in 6 of 113 with a normal ICGA study. CONCLUSION: ICGA may help to predict which fellow eyes are at higher risk of developing future exudative changes.

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