PubMed Health⌕ Search

Biomedical subjects

H Helbig

Publications and source records attributed to H Helbig.

At least 19 recordsLinked to original sources
PubMed2007

[Photodynamic therapy of AMD for the first (better sight) and the second (worse sight) eyes].

BACKGROUND: Photodynamic therapy (PDT) is the standard treatment procedure for many forms of exudative and/or neovascular AMD. Despite therapy, visual acuity often drops to low vision levels. The cost efficiency of treating the eye in which vision is worse is therefore the subject of some controversy. PATIENTS AND METHODS: A retrospective case-control study was conducted in all patients who were treated with PDT at the Universitätsspital Zürich between September 1999 and November 2004. Each patient's first (with worse vision) and second (with better vision) eyes were compared for situation on presentation and course during treatment. RESULTS: In 117/228 cases (51.3%) visual acuity of the treated eye was better than (or identical to) that of the fellow eye at presentation. Visual acuity before therapy was an average of 0.58+/-0.27 logMAR [Snellen: 0.26 (0.14-0.49)] in the eyes with better visual acuity and 0.69+/-0.4 logMAR [Snellen 0.20 (0.08-0.51)] in the fellow eyes (p=0.015). After therapy there was no significant difference between the patient groups in visual acuity or in the magnitude of any change in visual acuity, or in lesion size or change in lesion size. CONCLUSION: The outcome of PDT of a second eye (with better visual acuity) is not significantly better than the result obtained in the first eye (the one with worse visual acuity initially).

Case-Control Studies↗
PubMed2006

Vitreous haemorrhage in children.

BACKGROUND: Vitreous haemorrhage in early childhood is rare and may cause few symptoms. HISTORY AND SIGNS: Three children (aged 1, 2 and 6 years) with no history of trauma, presented with squint or unreactive pupil. Unilateral dense vitreous haemorrhage was found in all three children. THERAPY AND OUTCOME: Rapid clearing of the vitreous opacities within a few weeks made surgical intervention unnecessary in two children. A 6-year-old boy underwent a vitrectomy. Thorough investigations revealed angle recession, retinal pigment epithelium (RPE) scars and an orbital floor bone fracture, respectively, suggesting ocular trauma as the cause for the haemorrhage in all three cases. With early amblyopia treatment, the visual outcome was good. CONCLUSION: Trauma appears to be a likely cause for vitreous haemorrhage in small children. Even if there is a risk for the development of amblyopia, observation may be a reasonable approach in some cases, since even dense vitreous haemorrhage may resorb rapidly in young children.

Child, Preschool↗
PubMed2006

Macular atrophy after combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for retinal angiomatous proliferation (RAP).

BACKGROUND: Retinal angiomatous proliferation (RAP) is a variant of exudative AMD that appears to respond poorly to standard PDT. This pilot study explores the potential efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA). PATIENTS AND METHODS: In a prospective interventional case series 10 eyes of 8 patients with RAP were treated with combined IVTA/PDT. RESULTS: After 3 months there was no evidence of significant exudative activity in 7/10 eyes treated with IVTA/PDT, three eyes required re-treatment. After 6 months 4/10 eyes were "dry" on fluorescein angiography, visual acuity was stable (loss of less than 3 Snellen lines) or had improved in 5/10 eyes. 5/10 eyes had lost 3 or more lines, due to central macular atrophy in 4/5 eyes and secondary to a progressive exudative lesion in 1/5 eyes. CONCLUSIONS: Intravitreal steroids combined with PDT appear to be a step ahead in the treatment of RAP. Our results, however, raise the question whether combined treatment may create more atrophy leading to vision loss in some cases.

Aged↗
PubMed2006

Presumed macular toxicity of intravitreal antibiotics.

BACKGROUND: Intravitreal injection is the most effective route for administration of antibiotics in intraocular infections. PATIENTS AND METHODS: Two patients presented with a metal foreign body in the central vitreous without damage to the retina. RESULTS: Foreign bodies were removed with an intraocular magnet and limited vitrectomy was performed. Because of leukocytic infiltration of the vitreous, 1 mg vancomycin and 0.4 mg amikacin were injected in the vitreous at the end of the surgery. Postoperative visual acuity did not reach preoperative values in both patients. ERG examination revealed reduced photoreceptor activity. We speculate that amikacin may have reached the macula in a high and toxic concentration in an incompletely vitrectomized eye. CONCLUSION: The currently accepted intravitreal use of amikacin may cause retinal toxicity.

Amikacin↗
PubMed2005

Blackening of a choroidal hemangioma after photodynamic therapy.

BACKGROUND: Photodynamic therapy has recently advanced to a first line treatment of symptomatic circumscribed choroidal hemangiomas. HISTORY AND SIGNS: A sixty-year-old male patient was referred with progressive visual loss in his left eye. Visual acuity measured 20/80 and fundus examination revealed a prominent red subretinal lesion superior to the fovea with adjacent pigment epithelial irregularities. Thickening of the central retina was seen on OCT imaging. Sonography revealed a dome-shaped lesion with a maximal thickness of 3.3 mm and high internal reflectivity. Combined fundus indocyanine green and fluorescein angiography showed early filling of large vessels within the tumor. THERAPY AND OUTCOME: The hemangioma was treated with verteporphin photodynamic therapy. Two days after treatment, with vision unchanged, fundus examination revealed blackening of the tumor. Two months later vision increased to 20/40 and the tumor area was atrophic and bright red with a slight hyperpigmented rim. Angiography revealed the disappearance of tumor vessels and choroidal hypoperfusion in the area of treatment. CONCLUSIONS: Choroidal hemangiomas may darken initially after photodynamic therapy. This is most probably caused by large coaguli within the voluminous lacuna-like blood-filled vessel system of the hemangioma that are induced by photothrombosis.

Atrophy↗
PubMed2005

Clinical and electrophysiological course of acute syphilitic posterior placoid chorioretinitis.

BACKGROUND: Syphilis can affect the anterior as well as the posterior segment of the eye at any stage. HISTORY AND SIGNS: A 52-year-old man was referred to our clinic because of acute loss of his vision and hearing. Best corrected visual acuity (BCVA) was counting fingers (CF) right and 0.05 left eye, respectively. Fundoscopy revealed bilateral intraretinal macular haemorrhages and a large yellowish edematous lesion involving macula and midperipheral retina. Fluorescein angiography showed diffuse late edema. The visual field showed a defect corresponding to the edematous lesion. The "Ganzfeld" electroretinogram (ERG) was markedly reduced and the multifocal ERG in the affected area was not recordable. THERAPY AND OUTCOME: VDRL, FTA-Abs and TPHA tests in serum and cerebrospinal fluid were positive. Intravenous penicillin therapy was initiated. BCVA, visual field and ERG eventually recovered completely. CONCLUSIONS: Syphilis should be considered as a differential diagnosis in any unclear inflammatory ocular condition. Awareness of syphilitic posterior placoid chorioretinitis allows rapid diagnosis and therapy.

Adult↗
PubMed2005

Simultaneous fluorescein and indocyanine green angiography for exudative macular degeneration.

BACKGROUND: The present study investigates how often a simultaneous fluorescein and indocyanine green (ICG) angiography had therapeutic consequences and if it is useful as a clinical routine diagnostic tool. PATIENTS AND METHODS: 502 consecutive simultaneous angiographies in eyes with exudative macular degeneration were retrospectively studied. RESULTS: A classic extra- or juxtafoveolar choroidal neovascularisation (CNV) was found in 3.5 % of the eyes. A subfoveal predominantly classic CNV was present in 19 % of the angiographies. ICG angiography showed a vascular network in 3 % of the eyes with occult CNV in fluorescein angiography. A neovascularisation supplied by retinal vessels (retinal angiomatous proliferation) was found in 9 % and a polypoidal choroidal vasculopathy (PCV) in 6 %. Other plaques or hot spots were visible in 4 %. In 11 eyes with progressive exudation from PCV and threatening of the fovea, laser treatment was successfully performed. CONCLUSIONS: Combined angiography identifies treatable PCV. Advantages of a combined procedure (easier logistics, no missing of treatable cases) and arguments for a two step procedure with ICG angiography only in selected cases (lower costs, lower rate of adverse reactions) must be weighed against each other.

Adult↗
PubMed2005

Can eyelashes migrate?

BACKGROUND: Intraocular cilia after penetrating injuries or surgery causing acute or subclinical inflammation are a well-known problem. In a healthy young patient with acute intraocular inflammation but no history of trauma the diagnosis may be missed initially. HISTORY AND SIGNS: A young farmer presented with severe eye pain, scleritis and a circumscribed chorioretinal and vitreous infiltrate. There was no history or evidence of eye trauma or systemic disease. THERAPY AND OUTCOME: Staphylococci were identified from vitreous material. During vitreous surgery an intraretinal cilium was found and removed. After intravitreal antibiotic treatment, the vision completely recovered. CONCLUSION: Acute intraocular inflammation should alert the ophthalmologist to consider an intraocular foreign body as a possible cause even if there is no history of trauma.

Adult↗
PubMed2003

[Intravitreal chemotherapy for intraocular lymphoma].

Primary CNS and intraocular non-Hodgkin's lymphoma is currently mostly treated with systemic chemotherapy. After initially successful tumor regression, recurrence is common and usually treated with radiotherapy. However, after good primary therapeutic response, new tumor growth is frequently observed. Because of actinic complications, radiotherapy can be applied only once. For an intraocular recurrence of primary CNS and intraocular lymphoma, intravitreal chemotherapy (0.4 mg methotrexate and 0.4 mg dexamethasone weekly for 4 weeks and once a month thereafter) can be performed. A few weeks after initiation, regression of intraocular tumors and eventually improvement of vision can be achieved. Eyes remained free of recurrence up to 2 years after initiation of intravitreal injections. Intravitreal chemotherapy is an effective treatment for ocular recurrence of primary CNS and intraocular lymphoma after systemic chemotherapy and radiotherapy.

Antimetabolites, Antineoplastic↗
PubMed2001

[Acute zonal occult outer retinopathy (AZOOR)].

BACKGROUND: The "white dot syndromes" are a clinically heterogeneous group of inflammatory chorioretinopathies with an inconsistent classification. It is not yet clear if they represent distinct entities or if they are only different forms of the same basic disease. CASE REPORT: A 53-year-old female patient presented with unilateral photopsia and reduced vision in the left eye. Funduscopy of the left eye showed peripapillary confluent whitish infiltrates in the deep retinal layers with corresponding enlargement of the blind spot. Slow progression of the lesions was observed followed by the development of subretinal fibrosis in the macula. The ERG was reduced in the left eye. In both eyes there were small round, partly confluent areas of RPE atrophy in the lower fundus periphery without inflammatory reaction in the vitreous body or anterior chamber. CONCLUSION: The presented case shows overlapping features of acute zonal occult outer retinopathy (AZOOR), multifocal choroiditis and diffuse subretinal fibrosis and uveitis. This case and other previously described cases with overlaps between different clinical entities support the theory that clinically different inflammatory chorioretinal diseases may represent parts of a spectrum of one common disease.

Acute Disease↗
PubMed2000

[Double vision caused by double intraocular lenses].

An 80-year-old man had intraoperative loss of an intraocular lens (IOL) in the vitreous and simultaneous implantation of an anterior chamber lens. For the first 3 years his course was uncomplicated, but after this time he noted monocular double vision. The IOL in the vitreous had moved into the optic axis of the eye. The case presented here underlines the possibility of complications occurring even years after surgery due to an IOL left behind in the vitreous. The double IOL implant technique should be reserved for very few selected indications.

Aged↗
PubMed2000

Phacoemulsification following treatment of choroidal melanoma.

BACKGROUND: Little is known about the risks, effects and results of phacoemulsification following treatment with different modalities of choroidal melanoma. METHODS: In a retrospective study, records were evaluated of 72 patients who underwent cataract surgery after treatment of choroidal melanoma (35 were treated with iodine-125 plaques, 27 with ruthenium-106 plaques, eight by tumor excision, and two with proton beam irradiation). The data were analyzed with respect to complications, effects on postoperative tumor care and visual outcome. RESULTS: Phacoemulsification was performed at a mean interval of 21.5 months after primary tumor therapy. An intraocular lens (IOL) was implanted in 93% of the cases. The mean postoperative follow-up time was 16.2 months. Preoperative problems were rubeosis iridis (30.5%), secondary glaucoma (34.7%) and posterior synechiae (41.6%). Intraoperatively, defects of the posterior capsule occurred in 12.5%. Visual acuity equal to or better than preoperative vision was found in 95.8% of the patients as the best postoperative measurement and in 72.2% at the last follow-up measurement. A deterioration of more than two lines in visual acuity was observed in 4.2% as the best postoperative vision and in 27.8% at the last documented examination. Phacoemulsification was not the cause of deterioration in any of the cases. After cataract surgery, tumor retreatment was necessary in 19.4%. Treatment of radiation retinopathy was performed for the first time in 13.8%. Metastases developed in six patients (8.3%). CONCLUSION: Phacoemulsification following treatment for choroidal melanoma is both possible and advisable. The majority of patients have enhanced visual acuity. No decrease of vision occurred as a result of cataract extraction. The postoperative care of intraocular tumors and the treatment of radiation retinopathy is improved by timely cataract surgery.

Adult↗
PubMed2000

[Simultaneous ICG- and fluorescein-angiography for fundus examination].

BACKGROUND: An indocyanine-green (ICG) angiography is rarely used as the only diagnostic procedure. Almost always it is performed additionally to a fluorescein angiography. The use of simultaneous ICG and fluorescein (SIF) angiography therefore makes sense. Several examples for the application of SIF-angiography are presented. MATERIALS AND METHODS: SIF-angiography was performed using a 2-wavelength scanning laser ophthalmoscope (SLO). Images were digitally recorded in real time with a graphics workstation. The following cases will be presented: choroidal neovascularization in age-related macular degeneration, choroidal hemangioma, inflammatory fundus disease (APMPPE) and idiopathic polypoidal choroidal vasculopathy. RESULTS: ICG and fluorescein angiography can be simultaneously recorded with the 2-wavelenghth SLO. The quality of the combined pictures is comparable to single-channel recordings of separate ICG and fluorescein images. We show results of the above mentioned cases. CONCLUSIONS: SIF angiography is time efficient and allows precise comparison and analysis of the transit of both dyes through retinal and choroidal circulation. The topographic relation of pathologic findings in ICG angiograms with the critical retinal vascular landmarks is facilitated.

Adult↗
PubMed1998

Rubeosis iridis after vitrectomy for diabetic retinopathy.

BACKGROUND: Iris rubeosis and neovascular glaucoma (NVG) are serious complications of vitrectomy for proliferative diabetic retinopathy. The present study analyzes incidence and risk factors of these complications. METHODS: Preoperative and postoperative iris rubeosis were compared in 389 diabetic eyes after vitrectomy. Minimum follow-up was 6 months (median 26 months). Risk factors were studied using multivariate logistic regression analysis. RESULTS: Following vitrectomy, in 8.5% of the eyes stromal iris rubeosis developed de novo; NVG occurred in 5%. Significant risk factors for postoperative rubeosis were preexisting iris neovascularizations and postoperative retinal detachment. Six months after surgery, regression of preexisting iris rubeosis was observed in 57% of the eyes. In eyes without preoperative iris rubeosis, progression was found in 13% of cases 6 months postoperatively. CONCLUSION: With current surgical techniques iris rubeosis is more commonly regressive than progressive after vitreous surgery in diabetic eyes.

Adult↗
PubMed1998

Electrophysiological evaluation of visual loss in Müller cell sheen dystrophy.

AIMS: To describe the clinical picture and electrophysiological findings in Müller cell sheen dystrophy, a recently reported retinal dystrophy. METHOD: A basic ophthalmological evaluation as well as recording of standard electro-oculography and electroretinography were performed in one patient at the onset of visual loss and after 1 year of follow up. RESULTS: A 61 year old woman presented with visual loss in the right eye. Multiple folds at the level of the internal limiting membrane were seen at the posterior pole in both eyes. Macular oedema was present in the right eye. The visual acuity of the right eye was 6/30 and of the left 6/9. A paracentral scotoma was found in the right eye. Electro-oculographic examination of both eyes gave normal results. Electroretinography (ERG) revealed reduced b-wave and flicker amplitudes in the right eye; these potentials were normal for the left eye. The ON response in the right eye was reduced and delayed; it was normal in the left eye. A further loss of visual function was noted 1 year later in the right eye, but the ophthalmoscopic findings were unchanged. The ERG of the right eye had a negative waveform when dark adapted. Light adapted responses showed an unusual delayed b-wave, broad and delayed ON and OFF responses and a missing flicker response, suggesting a Müller cell dysfunction. Light adapted responses were slightly reduced in the left eye. CONCLUSIONS: Electrophysiological data indicate Müller cell dysfunction as a background of functional loss in Müller cell sheen dystrophy. This is in agreement with previously reported histological findings in this disorder.

Dark Adaptation↗
PubMed1998

[Vitrectomy in diabetic retinopathy: outcome, risk factors, complications].

BACKGROUND: Functional results, risk factors and complications of vitrectomy for diabetic retinopathy were studied to improve our estimation for benefits and risks of vitreous surgery with current techniques. MATERIALS AND METHODS: The course of 389 consecutive eyes, who had undergone vitreous surgery for complications of diabetic retinopathy within a four year period, was retrospectively reviewed. The minimum follow-up was 6 months, the median 26 months. Risk factors were studied using multivariate logistic regression analysis. RESULTS: Six months postoperatively 25% of the eyes had a visual acuity of 20/60 or better, a vision of less than 5/200 was found in 25% of the eyes. The most important risk factors were detachment of the macula and iris rubeosis. Only 16% of the eyes with tractional detachment of the macula had a postoperative vision of 20/200 or better, although in 86% the macula was anatomically successfully reattached. Postoperative retinal detachment was observed in 18% of all eyes. The incidence of this serious complication was only 5% after surgery for vitreous hemorrhage, but 54% after vitrectomy for tractional detachment of the macula. CONCLUSIONS: In eyes with advanced stages of long-standing tractional detachment of the macula, the functional prognosis is very poor due to the underlying microvascular disease. In less advanced stages with vitreous hemorrhage and flat retina the risk of vitreous surgery is low.

Adult↗