Biomedical subjects

M H Foerster

Publications and source records attributed to M H Foerster.

At least 19 recordsLinked to original sources

PubMed2007

[Juxtapapillary capillary retinal angioma with epiretinal membrane of the macula in familial Von-Hippel-Lindau-Syndrome].

A case of juxtapapillary capillary retinal angioma associated with a vascularized epiretinal membrane of the macula in a 6-year-old girl is presented. Von-Hippel-Lindau-Syndrome was revealed by molecular genetic methods, and further family members were identified as gene carriers. The retinal angioma embedded in an epiretinal membrane was removed completely with the membrane by pars plana vitrectomy with a good functional result. Histopathology confirmed the diagnosis of capillary angioma.

Child↗

PubMed2006

A randomized phase II trial of gemcitabine plus treosulfan versus treosulfan alone in patients with metastatic uveal melanoma.

BACKGROUND: Several trials demonstrated efficacy of the gemcitabine/treosulfan (GeT) combination in metastatic uveal melamoma. This randomized phase II trial compared the GeT combination versus treosulfan alone (T) in this rare disease. PATIENTS AND METHODS: Chemotherapy-naive patients with proven metastatic uveal melanoma were randomly assigned to receive 1000 mg/m(2) of gemcitabine plus 3500 mg/m(2) of treosulfan (GeT) or 3500 mg/m(2) of T. Chemotherapy was administered on days 1 and 8 in both arms, cycles were repeated on day 29. Primary end point was rate of responses and disease stabilizations. RESULTS: Forty-eight patients were randomized. Seven confirmed stable diseases (SDs) and one partial remission (PR) were observed in 24 patients treated with the GeT regimen, whereas no PR and only three SDs were observed in the T arm (P = 0.08). Median progression-free survival (PFS) was 3 months (95% CI 1.1-4.9) and 2 months (95% CI 1.7-2.3) in the GeT and T arm (P = 0.008, log-rank). Six and 12 months PFS was 34.8% and 17.9% and 16.7% and 0% always favoring the GeT arm. CONCLUSIONS: This first randomized trial in metastatic uveal melanoma showed a superior PFS and a trend for a higher response/stabilization rate of the GeT combination over T.

Adult↗

PubMed2006

[Ocular manifestations and surgical results in patients with Marfan syndrome].

AIM: This retrospective study should examine and judge the surgical indications and the therapeutic possibilities as well as their complications in patients with ocular manifestations of Marfan syndrome (MFS) diagnosed according to the criteria of the Ghent nosology. PATIENTS AND METHODS: The study included 17 patients. Operative indications were increasing subluxation of the lens, retinal detachments and secondary glaucoma. The operative procedure depended on patient age and findings. Eleven MFS patients were operated in both eyes and six MFS patients in one eye. RESULTS: Stabilization or functional improvement of visual acuity could be achieved in all patients in whom no disorders limiting visual acuity or amblyopia were present preoperatively. In six eyes of five patients, lens insertion was accomplished via a pars plana approach. Lens removal without implantation of an intraocular lens was performed in 16 eyes of 10 patients. Pars plana vitrectomy was accomplished in 12 eyes. Complications were well controlled by pars plana vitrectomy. CONCLUSIONS: Difficult preoperative situations and postoperative complications are not rare in MFS patients. However, they can be controlled well by means of modern vitreous surgery.

Adolescent↗

PubMed2006

[Nd:YAG Laser for retrohyaloidal haemorrhage after retinal branch vein occlusion].

BACKGROUND: A retrohyaloidal haemorrhage can be caused by different underlying diseases. Usually dense haemorrhages are treated by early vitrectomy. We want to report the successful treatment of a retrohyaloidal haemorrhage by means of Nd:YAG laser membranotomy. MATERIALS AND METHODS: A 47-year-old man noticed two weeks before presentation a sudden visual loss in the left eye. Visual acuity on the first visit was c. c. 20/32 OD and c. c. 20/400 ex. OS. Dilated fundus examination of the left eye showed multiple intraretinal haemorrhages in the superior periphery and a dense retrohyaloidal haemorrhage over the macula. Anamnestic risk factors for ocular bleeding were systemic hypertension in connection with adiposity. RESULTS: A retinal branch vein occlusion with retrohyaloidal haemorrhage due to systemic hypertension was diagnosed. To drain the retrohyaloidal haemorrhage into the vitreous an Nd:YAG laser membranotomy of the anterior surface of the haemorrhage was performed. Visual acuity increased to 20/100 within 30 min. CONCLUSION: Possible therapeutic options to manage retrohyaloidal haemorrhages are observation, primary vitrectomy and Nd:YAG laser membranotomy. The presented case shows laser membranotomy to be a promising possibility for a rapid resolution of retrohyaloidal haemorrhage in selected patients.

Epiretinal Membrane↗

PubMed2005

[Comparison of the anatomical and functional outcome after laser or cryotherapy for retinopathy of prematurity (ROP)].

PURPOSE: To analyze and compare the anatomical and functional outcome following cryotherapy or laser therapy for ROP. METHODS: Between April 1991 and February 2002, 127 eyes with ROP (65 patients) were treated after threshold ROP was reached. Ten additional eyes with zone I disease were treated with prethreshold. All patients were followed up until a stable retinal situation occurred. RESULTS: An "unfavorable outcome," as described in the Cryo ROP study, occurred in 1 of 91 (1%) eyes with laser treatment and in 3 of 46 (6.5%) eyes with cryotherapy. Temporal dragging of vessels was noticed in 6 of 91 eyes (6.6%) with laser treatment vs 7 of 46 eyes (15.2%) with cryotherapy, respectively. Visual acuity > or =20/25 was achieved in 39.2% in eyes with laser therapy and in 17.6% with cryotherapy (p<0.05). CONCLUSION: A strict screening protocol and treatment at onset of threshold disease results in an excellent anatomical and functional outcome. The results of laser therapy were superior over cryotherapy, indicating that laser treatment is the therapy of choice.

Birth Weight↗

PubMed2005

[Photodynamic therapy with verteporfin for uveal melanoma].

BACKGROUND: The aim of this study was to evaluate whether photodynamic therapy (PDT) with verteporfin is able to induce tumor cell necrosis in human uveal melanomas. METHODS: On four eyes with an uveal melanoma, PDT with verteporfin was performed on the tumor 2-3 days before planned enucleation. The eyes were evaluated histologically. RESULTS: In two melanomas with only mild pigmentation some effects after PDT were detected on tumor tissue in a depth up to 2.5 mm at light doses > or =100 J/cm(2). Histologically, vascular occlusion and thrombosis in tumor vessels were observed. In the heavily pigmented melanoma no tumor necrosis was induced with the above-mentioned parameters. CONCLUSION: Depending on treatment parameters and tumor pigmentation, PDT with verteporfin is able to induce tumor necrosis in human uveal melanomas. Based on these results it is possible that PDT can become an adjuvant treatment method for uveal melanoma.

Cell Survival↗

PubMed2005

[Photodynamic therapy with verteporfin for recurrent choroidal neovascularisation (CNV) following prior argon laser coagulation].

BACKGROUND: Photodynamic therapy (PDT) with verteporfin has been successfully introduced to treat choroidal neovascularisations (CNV) that have more than 50% classic CNV components due to exudative age-dependent macular degeneration (AMD) and other diagnoses. However, what is still unclear is if patients with recurrent subfoveal CNV who have had prior laser coagulation can also profit from PDT for CNV. METHODS: The course of visual acuity (ETDRS) and the fluorescein angiographic findings were retrospectively analysed after standard PDT of recurrent subfoveal CNV after prior argon laser coagulation of an extrafoveal or juxtafoveal CNV in AMD or other diagnoses. RESULTS: A total of 20 consecutive eyes from 19 AMD patients were evaluated. After 12 months in 14 of the 20 eyes (70%) deterioration in visual acuity of 3 or more ETDRS lines could be avoided and likewise in 7 of 16 eyes (44%) after 24 months. After the 1st year, 5 of the 7 eyes (71%) with recurrent subfoveal CNV after laser coagulation of a myopic, postinflammatory or idiopathic CNV had deterioration of visual acuity of less than three lines or an improvement in visual acuity. CONCLUSIONS: Despite the low number of patients examined, we could see an indication for PDT in recurrent subfoveal CNV after prior argon laser coagulation of extrafoveal or juxtafoveal CNV. When the patient presented with a CNV cause other than AMD, a better prognosis for visual acuity was achieved.

Adult↗

PubMed2005

[Screening for retinopathy of prematurity: results of one centre between 1991 and 2002].

PURPOSE: The aim of this study was to analyse the results of retinopathy of prematurity (ROP) screening, stage of disease and time of treatment from one tertiary care centre. PATIENTS AND METHODS: Between 1991 and 2001, 666 infants with a gestational age (GA) < 33 weeks or birth weight (BW) less than < 1501 g were examined. Coagulation treatment was performed in accordance with the Cryo-ROP study, after reaching the threshold. All infants were followed-up until a stable retinal situation was reached. RESULTS: Mean GA of the 666 infants was 28.5 +/- 2.3 weeks. Mean BW was 1180 +/- 372 g. During the years of screening, the GA and BW significantly decreased, but no significant change in the yearly incidence of ROP was detected. 460 (69.1 %) of the infants did not develop any stage of ROP. Maximum stage of ROP in the worse eye was stage one in 51 (7.6 %) infants, stage two in 59 (8.9 %) infants and stage three below threshold in 62 (9.3 %) infants. 34 (5.1 %) infants were treated with coagulation treatment. Mean time of treatment was 36.5 weeks postmenstrual age, or 10.7 weeks postnatal age. Postnatal age showed a better correlation to treatment time than postmenstrual age. No infant was treated before seven weeks of life and not before 32 weeks postmenstrual age. CONCLUSION: In spite of the increasing survival of children with lower GA and BW the incidence of ROP has not increased, and the incidence of ROP in our centre appears to be comparable to other international studies. In contrast to the Cryo-ROP study, treatment time correlates better to postnatal age than to postmenstrual age. All infants who underwent treatment were detected at an appropriate time using German screening guidelines.

Age Factors↗

PubMed2004

[Endoresection following proton beam irradiation of large uveal melanomas].

PURPOSE: Large uveal melanomas located close to the optic nerve and/ or to the fovea have an unfavourable prognosis with regard to visual preservation and eye retention, due to the high incidence of radiation and tumour necrosis induced complications. Endoresection of the tumour after proton beam irradiation, is an alternative approach, aiming to reduce the incidence of ocular morbidity caused by tumour necrosis after sole radiotherapy. PATIENTS AND METHODS: 32 patients with large uveal melanomas (mean tumour thickness: 9.1 mm, mean tumour volume: 0.77 cc), received a primary proton beam irradiation (60 CGE) and underwent subsequent endoresection via a 3-port pars plana vitrectomy. The median pretreatment visual acuity was 0.2. The mean follow-up was 13.9 months. RESULTS: The postoperative visual acuity after 12 months was 0.12 (median, mean visual acuity loss 0.08). The probability of developing radiation retinopathy or papillopathy within the first year after treatment was 35% and 28% respectively and the probability of enucleation was 9% within the first postoperative year. No tumour recurrences were observed and 2 patients developed liver metastases. CONCLUSIONS: Endoresection following irradiation of large uveal melanomas located close to the optic nerve and/ or the fovea seems to be a useful and safe alternative to the traditional irradiation or enucleation. The incidence of complications following our approach seems to be lower when compared to radiation alone, where tumour necrosis is a substantial problem.

Combined Modality Therapy↗

PubMed2004

[Molecular genetic findings in patients with congenital cone dysfunction. Mutations in the CNGA3, CNGB3, or GNAT2 genes].

PURPOSE: This study compares clinical and molecular genetic findings in patients with congenital cone dysfunction. METHODS: In this study 28 patients underwent a basic ophthalmologic examination. Except for a 1-year-old boy, color vision, perimetry, and full-field ERG (ISCEV standard) were evaluated in all patients. Blood samples were taken for molecular genetic analysis of the CNGA3, CNGB3, or GNAT2 genes. RESULTS: Two patient groups could be distinguished: patients without and with residual cone function in the ERG. In 14 of 17 patients without cone function, mutations in one of the three genes were detected, and except for one patient mutations in both alleles could be determined. In these patients, visual acuity was reduced to 20/400 and color discrimination was absent. In 2 of 11 patients with residual cone function, mutations in one allele of the CNGB3 gene were detected. It is of interest that 6 of 16 patients with mutations perceived their disease as progressive; in three of them we could determine a progression. Only in 4 of 16 patients was the ocular fundus normal. The other patients with mutations presented with central pigment irregularities, attenuated vessels, or pale optic disk. CONCLUSION: In patients with congenital cone dysfunction without cone function in the ERG, an analysis of the CNGA3, CNGB3, or GNAT2 gene is advisable. In contrast, patients with residual cone function did not show clear association with mutations in one of the three genes. In patients with mutations, retinal alterations and nystagmus are frequent. In contrast to the designation of these disorders as stationary, in some patients with mutations in the CNGA3 and CNGB3 gene slow progression was observed.

Adolescent↗

PubMed2004

[Photodynamic treatment with verteporfin for patients with idiopathic choroidal neovascularization. Two-year results].

BACKGROUND: The aim of this study was the evaluation of safety and effectiveness of photodynamic therapy (PDT) as a treatment option for idiopathic choroidal neovascularization (CNV). METHODS: We performed a retrospective analysis of 11 eyes of 9 patients who were treated with standard PDT. The follow-up period was at least 1 year and included regular standardized ETDRS visual acuity measurement and fluorescein angiography. RESULTS: Eight sub- and three juxtafoveal CNV were treated. The mean follow-up was 23.2 months (12-41 months), the mean change in visual acuity was +2.1 lines (+3 for juxtafoveal and +1.9 for subfoveal localization), and a mean of 1.9 (1-3) treatments were performed. Visual acuity improved > or =2 lines in 6 of 11 eyes (54.5%) and 5 eyes (45.5%) remained stable (+/-1 lines). Alterations of the retinal pigmented epithelium (RPE) with window defects in fluorescein angiography occurred in 7 of 11 eyes (63.6%) but did not alter visual acuity. In 4 of 11 cases (36.4%), we saw recurrences after initially successful therapy, which were retreated successfully with PDT. CONCLUSION: Stabilization or even an improvement of visual acuity in idiopathic CNV is possible with PDT treatment. Side effects such as RPE changes and recurrences are possible, but do not seem to influence visual acuity.

Adolescent↗

PubMed2004

[Clinical diagnostic prerequisites for adult vitelliform macular dystrophy].

BACKGROUND: Adult vitelliform macular dystrophy (AVMD) was first described in 1974 (Gass) but is still often misdiagnosed. Large studies using modern morphological and functional diagnostic methods do not exist. PATIENTS AND METHODS: The records of 67 consecutive AVMD patients (1994-2003) were reviewed regarding color vision, perimetry, RPE autofluorescence, fluorescein angiography, EOG, ERG, and mfERG. RESULTS: The mean age was 54.8 years. Symptoms, visual loss, color vision deficits, and visual field defects were highly variable. Autofluorescence was increased centrally in 77% of the eyes. In the ERG, the 30 Hz flicker response was reduced in 71% of the eyes. MfERGs showed a marked central amplitude reduction in 62% of the eyes and a continual normalization of the P1 amplitude towards the periphery. CONCLUSION: The enhanced autofluorescence indicates increased lipofuscin in the vitelliform lesions. The electroretinographic recordings reveal a moderate generalized cone dysfunction with increased severity towards the fovea. Ophthalmoscopy, autofluorescence, and recording of mfERG are prerequisites to diagnose AVMD correctly.

Adult↗

PubMed2004

[Dry eye symptoms following retinal surgery and ocular tumour therapy].

BACKGROUND: Dry eye symptoms can often be observed following vitreo-retinal operations, however, little is known about the frequency and severity of these postoperative problems. METHODS: Examination of 140 patients following vitreo-retinal surgery ( n=31), brachytherapy ( n=76), proton beam radiation ( n=33) and controls ( n=54) using a questionnaire together with a clinical examination of the anterior segment, tear break-up time and a Schirmer test. RESULTS: Of the treated patients 63% complained of dry eye symptoms versus 40% of the controls ( p=0.004). The tear break-up time was decreased in treated patients ( p<0.001, medians: 15 vs. 20 s). No significant difference was seen on the Schirmer test ( p=0.825; medians: 12 vs. 12 mm). CONCLUSIONS: Dry eye symptoms are a common postoperative complication following vitreo-retinal surgery and ocular tumour therapy.

Adult↗

PubMed2004

[Retinopathy of prematurity].

This review summarizes the knowledge and highlights recent advances in clinical research of retinopathy of prematurity (ROP). This disease is still important, because improvements in neonatal intensive care during the last years have increased the survival of the most immature newborns, but did not diminish the ROP frequency. Ophthalmologic screening and, if applicable, laser treatment at the optimal time for advanced ROP prevents blindness in most cases. The history, classification and the modern concepts of ROP pathophysiology are described. The results of various multicenter treatment trials are summarized. The current German screening guidelines are discussed with the guidelines of other nations. The therapeutic treatment strategies and the treatment results are discussed. The ophthalmologic disorders of former preterm infants, as higher rates of amblyopia, strabismus, and refractive error, are mentioned. Possible future therapies, e. g. anti-angiogenic factors are discussed.

Amblyopia↗

PubMed2003

[Clinical characteristics of choroidal metastasis].

BACKGROUND: Choroidal metastasis (CM) is the most common malignant intraocular tumor. The aim of this study was the characterization of the ophthalmoscopic aspect, the underlying tumor disease and differential diagnosis of this entity. STUDY DESIGN: Retrospective observational case series. PATIENTS AND METHODS: A total of 71 consecutive patients with CM were evaluated. Special attention was given to ocular symptoms, the ophthalmoscopic and sonographic aspects and the characteristics of the underlying tumor disease. All patients had undergone screening (CCT, CT of thorax and abdomen; bone scintigraphy) for the primary tumor and further organ metastases. RESULTS: Of the patients 95% had symptomatic CM, in 5% of the patients CM was detected by chance, 60% had a single CM, 40% showed multiple (2-14) lesions and 18% ( n=13) had no history of tumor disease. In 12 of these patients lung cancer could be diagnosed. In 53% of the patients the primary tumor was breast cancer, in 26% lung cancer, in 3% kidney cancer, bowel cancer, choroidal or cutaneous melanoma and in single patients cervical, ovarian, thymus or prostate cancer. In one patient who died from disseminated metastases, no definite primary tumor could be detected. Of the patients 96% had further metastases, CM occurred with a mean interval after diagnosis of the primary of 9 months in lung cancer and 68 months in breast cancer. CM was the first clinical sign of tumor disease in 58% of patients with lung cancer and the first clinical sign of metastatic disease in 28% of patients with breast cancer. CONCLUSIONS: Choroidal metastasis occurs almost exclusively in metastatic disease. In breast cancer it typically occurs years after diagnosis of the primary tumor and may be the first sign of metastatic disease. In lung cancer choroidal metastasis may be the first sign of the tumor disease.

Adult↗

PubMed2003

[MR-based volumetric analysis of small tumor volumes: accuracy of phantom examinations of simulated eye tumors].

PURPOSE: The determination of tumor volume in ocular tumors is very important for the planning and success of radiation therapy. This study uses an animal model to evaluate the accuracy of MR-based volumetry of ocular tumors. MATERIALS AND METHODS: In a total of 25 porcine eyes obtained from the slaughterhouse, ocular tumors were produced by injecting a mixture of hand creme and Gd-DTPA under ophthalmoscopic guidance. The injected volume varied between 0.05 ml and 2.7 ml. The eyes were examined with a 1.5 Tesla scanner and a 4 cm circular surface coil especially developed for ocular MRI. After data transfer to a separate workstation, volumetric analysis was carried out by three independent radiologists using semiautomated software. The determined volume was compared with the injected volume. RESULTS: Of the 25 prepared porcine eyes, 23 were suitable for volumetric analysis. The injection of the mixture of hand creme and Gd-DTPA produced two different types of tumors. Ophthalmoscopically, 14 ellipsoid and 9 lobulated to mushroom-shaped tumors were found and confirmed by MRI. Minor deviation was found between injected volume and volume calculated by MRI, with a correlation coefficient of 0.96. CONCLUSION: Using appropriate technique, MRI is capable of determining small tumor volumes with high accuracy in an animal model. Minor differences can be expected when transferring the results to clinical studies.

Animals↗

PubMed2003

High resolution magnetic resonance imaging of retinoblastoma.

BACKGROUND/AIMS: Diagnosis of retinoblastoma is mainly based on indirect ophthalmoscopy, but additional imaging techniques are indispensable for the staging of the disease. A new high resolution magnetic resonance imaging (MRI) technique for the examination of the eye was evaluated. A new surface coil with a diameter of 5 cm allows a field of view of 60 mm with an in-plane resolution of 0.8 mm. We compared preoperative MRI scans with the histology after enucleation in 21 cases of retinoblastoma. Parameters studied were appearance of retinoblastoma, choroidal and scleral infiltration, extraocular extension, optic nerve infiltration, and vitreous seeding. RESULTS: All retinoblastomas could be visualised as hypointense to vitreous on T2 weighted images and slightly hyperintense to vitreous on plain T1 weighted images with a moderate enhancement after contrast application. Histology revealed seven cases with infiltration of the optic disc or optic nerve. Preoperative MRI scans depict juxtapapillary tumour masses, but it was impossible to differentiate between a juxtapapillary retinoblastoma, a prelaminar infiltration of the optic disc, or a just postlaminar optic nerve infiltration. In five of 14 cases with a proved tumour infiltration of the choroid, MRI scans showed an inhomogeneous contrast enhancement of the choroid in enhanced T1 weighted sequences beneath the retinoblastoma. Whether this sign is specific for a choroidal infiltration or is just an artefact remains unclear. High resolution MRI scans did not allow the exclusion of this form of intraocular tumour extension. All nine cases with proved vitreous seeding were not detected by MRI scans. None of these cases showed scleral infiltration or orbital tumour extension. Therefore, it is not possible to judge the rank of this technique in detecting orbital tumour growth. CONCLUSION: The new MRI technique is of limited value in visualisation of prelaminar or postlaminar infiltration of the optic nerve. Advanced choroidal infiltration might be visualised by contrast enhanced T1 weighted MRI scans, but the available spatial resolution did not allow the exclusion this critical form of tumour growth by MRI scans. Nevertheless, high resolution MRI with the new surface coil has superior contrast and spatial resolution compared to computed tomograph (CT) or other available imaging techniques. MRI cannot replace CT in detecting tumour calcification but with increasing experience with this new technique it should be possible to renounce CT scans in the majority of cases of retinoblastoma.

Child↗

PubMed2002

[Indocyanine green angiography in choroid metastases].

BACKGROUND: Up to now the diagnosis of choroidal tumors was mainly based on ophthalmoscopy and ultrasound examination. Indocyanine green angiography allows the identification of vascular patterns in these tumors, which could be helpful in the differential diagnosis. The aim of the study was to characterize the staining patterns of choroidal metastases. METHODS: In the years 1996-2000 we performed ICG-A of 15 choroidal metastasis using the scanning laser ophthalmoscope from Rodenstock. The mean tumor height was 3.7 mm (2.0-9.0). These angiographies were compared to the angiographies of 38 choroidal malignant melanomas with a mean height of 3.6 mm (1.4-6-6). RESULTS: All metastases showed a blockage of the background staining and a patchy staining of the tumor surface. Intratumoral vessels could be detected in 13% of all cases of metastases. The choroidal melanomas examined showed a blockage of the background staining in all cases and tumor vessels in 89%. CONCLUSION: The angiographic picture of the metastatic lesions was characteristic. Intratumoral vessels could not be detected using ICG-A. Most of the metastases showed a patchy staining of the tumor surface.

Angiography↗