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Biomedical subjects

Michael Stur

Publications and source records attributed to Michael Stur.

At least 37 records · Page 2Linked to original sources
PubMed2004

Acute severe visual acuity decrease after photodynamic therapy with verteporfin: case reports from randomized clinical trials-TAP and VIP report no. 3.

PURPOSE: To describe in detail occurrences of acute severe visual acuity decrease after photodynamic therapy (PDT) with verteporfin in the Treatment of Age-related macular degeneration with Photodynamic therapy (TAP) Investigation and the Verteporfin In Photodynamic therapy (VIP) Trial. DESIGN: Observational case series. METHODS: Retrospective review of all cases that developed acute severe visual acuity decrease after treatment. RESULTS: Of 15 acute severe visual acuity decrease events originally identified in 14 eyes of 14 patients, one event in one patient was judged unlikely to have been an acute severe visual acuity decrease event on retrospective review of these events in preparation of this report. Eleven events occurred after the first treatment. At follow-up, 10 improved by at least 1 line in visual acuity from the level noted at the time of the event. Of the nine patients returning for the month 24 examination, visual acuity decreased at least 3 lines from baseline in six, including at least 6 lines in four, and remained within 1 line in three. Associated abnormal morphology included three with a serous macular detachment and abnormal choroidal hypofluorescence, four with macular hemorrhage, three with a greenish subfoveal hemorrhage, and four with no abnormality. Events appeared to be more likely when patients had a visual acuity of 20/50 or better. CONCLUSIONS: Acute severe visual acuity decrease after PDT with verteporfin was an uncommon event; the risk did not outweigh the benefits of therapy previously reported. When considering verteporfin therapy, patients should be warned of the possibility of this serious adverse event.

Acute Disease↗
PubMed2004

Prognostic factors influencing visual outcome of photodynamic therapy for subfoveal choroidal neovascularization in pathologic myopia.

PURPOSE: To examine the influence of age, lesion size, degree of myopia, and baseline visual acuity on the visual outcome of patients with pathologic myopia and choroidal neovascularization (CNV) who received photodynamic therapy (PDT) with verteporfin. DESIGN: Retrospective, noncomparative consecutive case series. METHODS: Forty-three eyes of 41 patients were treated in a two-year time span; 36 eyes of 36 patients who had received PDT for CNV due to pathologic myopia were examined for the above-mentioned factors 24 months after first treatment. All patients had been treated according to the Verteporfin in Photodynamic Therapy (VIP) study criteria. Patients were examined in two- to three-month intervals with Snellen visual acuity, biomicroscopy, and fluorescein angiography. RESULTS: Baseline visual acuity and age were both prognostic factors for visual outcome (P =.0097, P =.0055). Lesion size (greatest linear dimension) at baseline, refractive error, or the number of treatments had no influence on the outcome. CONCLUSION: Age and baseline visual acuity have an effect on visual outcome in patients receiving PDT due to CNV secondary to pathologic myopia. Younger patients and patients with higher baseline visual acuity had a better treatment outcome.

Adult↗
PubMed2004

Incidence of laser photocoagulation and photodynamic therapy with verteporfin at a tertiary retinal center.

PURPOSE: To examine the influence of photodynamic therapy (PDT) with verteporfin on the indication and frequency of conventional thermal krypton laser photocoagulation in choroidal neovascularization. METHODS: A retrospective chart review was performed comparing laser indication and frequency 1 year before and 2 years after PDT started to be used routinely following the guidelines of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group and the Verteporfin in Photodynamic Therapy Study Group. RESULTS: Similar frequencies of laser treatment were seen in the year before and during the first year after PDT was commenced (301 [7.1% of all patients] to 281 [6.9%]). In the year thereafter, however, there was a marked decrease in laser treatments (174 [3.9%]). Interestingly, there was a steady increase in the relative frequency of laser treatments of extrafoveal and parapapillary lesions in the years after PDT was commenced (29.2%, year 1; 30.6%, year 2; and 39.6%, year 3). CONCLUSION: PDT has led to a decrease in conventional laser photocoagulation at one large tertiary retinal center in Austria. Moreover, it is our belief that patients are now referred at earlier stages of the disease, which has resulted in a shift in thermal laser indications.

Aged↗
PubMed2004

Photodynamic therapy and vitelliform lesions.

PURPOSE: To investigate the effect of photodynamic therapy (PDT) with verteporfin on patients with vitelliform lesions caused by cuticular drusen or adult-onset foveomacular vitelliform dystrophy (AOFVD). DESIGN: Observational case series. PATIENTS AND METHODS: Eight eyes of seven patients from two centers were examined prospectively. Each patient received PDT with verteporfin applied to the vitelliform lesions. RESULTS: Photodynamic therapy did not significantly affect the median visual acuity outcome (20/50 before PDT and 20/66 after PDT) in all seven treated patients. Of note, however, were four eyes of four patients who experienced a severe decrease in visual acuity after PDT with verteporfin. The temporary relationship of the vision loss to the treatment suggests that this may represent an adverse effect from therapy. The fluorescein angiographic appearance was virtually unchanged in all treated patients, whereas indocyanine green angiography showed typical PDT-associated reduction of choroidal perfusion in the treatment area. CONCLUSION: Photodynamic therapy does not have a positive influence on the visual outcome in patients with vitelliform lesions and may have a negative impact on vision in some treated patients. It is important for physicians using PDT to exercise caution in distinguishing between choroidal neovascular membranes and vitelliform lesions because the outcome in this latter group may be worse with application of PDT than with the natural course.

Aged↗
PubMed2004

[Diagnosis, therapy and follow-up of diabetic eye diseases].

Diabetes mellitus causes diabetic retinopathy and maculopathy, optical nerve neuropathy, cataract and defects of the eye muscles. The incidence of these defects correlates with duration and quality of the metabolic control. The recommendations of the Austrian Diabetes Association for the diagnosis, the therapeutic measures and requirements for adequate follow-up depending on the stages of the different forms of diabetic eye diseases are summarized.

Austria↗
PubMed2003

Enhanced visualization of macular pathology with the use of ultrahigh-resolution optical coherence tomography.

OBJECTIVES: To demonstrate a new generation of ophthalmic optical coherence tomography (OCT) technology with unprecedented axial resolution for enhanced imaging of intraretinal microstructures and to investigate its clinical feasibility to visualize intraretinal morphology of macular pathology. METHODS: A clinically viable ultrahigh-resolution ophthalmic OCT system was developed and used in clinical imaging for the first time. Fifty-six eyes of 40 selected patients with different macular diseases including macular hole, macular edema, age-related macular degeneration, central serous chorioretinopathy, epiretinal membranes, and detachment of pigment epithelium and sensory retina were included. OUTCOME MEASURES: Ultrahigh-resolution tomograms visualizing intraretinal morphologic features in different retinal diseases. RESULTS: An axial image resolution of approximately 3 micro m was achieved in the eyes examined, nearly 2 orders of magnitude better than conventional ophthalmic ultrasound. Ultrahigh-resolution OCT images provided additional diagnostically important information on intraretinal morphologic features that could not have been obtained by standard techniques. CONCLUSIONS: Ultrahigh-resolution ophthalmic OCT enables unprecedented visualization of intraretinal morphologic features and therefore has the potential to contribute to a better understanding of ocular pathogenesis, as well as to enhance the sensitivity and specificity for early ophthalmic diagnosis and to monitor the efficacy of therapy. This study establishes a baseline for the interpretation of ultrahigh-resolution ophthalmic OCT imaging of macular diseases.

Adult↗
PubMed2003

Topical fundus pulsation measurement in patients with active central serous chorioretinopathy.

OBJECTIVE: To determine regional pulsatile choroidal blood flow using laser interferometry in patients with active central serous chorioretinopathy (CSC). METHOD: The study compared an equally sized age-, sex-, and refractive error-matched control group of healthy volunteers obtained from the Department of Clinical Pharmacology with 18 consecutive patients who had newly diagnosed active, unilateral CSC obtained from the University of Vienna Eye Clinic, Vienna, Austria. MAIN OUTCOME MEASURES: Regional fundus pulsation amplitude as assessed using laser interferometry. RESULTS: The median age of the patients was 40 years; the male-female ratio was 16:2. Foveal fundus pulsation amplitude was significantly higher in eyes with CSC (mean [SD], 5.5 [1.7] micro m) than in the eyes of the control subjects (4.1 [1.1] micro m; P =.005). In addition, eyes with CSC had a significantly higher variability in fundus pulsation amplitude (mean [SD], 48% [20%]) assessed at different fundus locations around the leak than the controls did (20% [9%]; P<.001). CONCLUSIONS: To our knowledge, this is the first study that measures topical fundus pulsations in patients who have active, unilateral CSC. These data indicate a generally increased foveal pulsatile choroidal blood flow and an abnormal distribution of fundus pulsation amplitude in the area close to the leak. Whether these findings reinforce the concept that choroidal perfusion abnormalities play a role in the pathogenesis of CSC remains to be established.

Adult↗
PubMed2003

Effect of lesion size, visual acuity, and lesion composition on visual acuity change with and without verteporfin therapy for choroidal neovascularization secondary to age-related macular degeneration: TAP and VIP report no. 1.

PURPOSE: To determine whether differences in baseline lesion size and visual acuity might explain differing results found in three different lesion compositions (predominantly classic, minimally classic, and occult with no classic) among three placebo-controlled, randomized clinical trials evaluating photodynamic therapy with verteporfin (Visudyne, Novartis AG), also termed verteporfin therapy, in patients with subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). METHODS: Exploratory analyses were conducted in patients with predominantly classic or minimally classic lesions at enrollment in the Treatment of AMD with Photodynamic Therapy (TAP) Investigation and in AMD patients with occult with no classic CNV in the Verteporfin In Photodynamic Therapy (VIP) Trial. Baseline characteristics of patients among these three lesion compositions were compared. In addition, multiple linear regression modeling was used to explore the effect of baseline lesion size, visual acuity, and lesion composition on mean change in visual acuity from baseline to 24 months. RESULTS: At baseline, the mean size of predominantly classic lesions (3.4 disk areas) was smaller than that of minimally classic (4.7 disk areas) and occult with no classic lesions (4.3 disk areas). In the multiple linear regression model of individual lesion compositions, there was a significant treatment-by-lesion-size interaction for minimally classic and occult with no classic lesions, but not for predominantly classic lesions. Interaction between treatment and baseline visual acuity was not significant for any lesion composition. Small verteporfin-treated lesions lost less vision than large verteporfin-treated lesions in each lesion composition. In the multiple linear regression model that included all lesion compositions, lesion size was a more significant predictive factor for the magnitude of treatment benefit than either lesion composition or visual acuity. Smaller (4.0 disk areas or less) minimally classic and occult with no classic lesions had similar visual acuity outcomes to those observed in predominantly classic lesions. CONCLUSIONS: Based on exploratory analyses, lesion size in the TAP Investigation and VIP Trial was an important predictor of the magnitude of treatment benefit with verteporfin therapy in occult with no classic and minimally classic lesion compositions. In patients with AMD, treating smaller rather than larger neovascular lesions, regardless of lesion composition, likely will result in a better level of visual acuity.

Aged↗
PubMed2003

Scotoma size and reading speed in patients with subfoveal occult choroidal neovascularization in age-related macular degeneration.

PURPOSE: To investigate the correlation between reading speed and scotoma size in patients with subfoveal occult with no classic choroidal neovascularization (CNV) in age-related macular degeneration (AMD) participating at 2 of 28 centers in the Verteporfin in Photodynamic Therapy trial. DESIGN: Prospective, observational case series. PARTICIPANTS: Twenty-two eyes of 22 patients with occult with no classic CNV in AMD. METHODS: Patients' reading speed was examined using a German-language reading test (Radner Lesetest). Scotoma size was measured using the microperimetry program 2.01 of the Rodenstock Scanning Laser Ophthalmoscope. MAIN OUTCOME MEASURES: Reading acuity, reading speed, size of absolute (AS) and relative scotoma (RS). RESULTS: There was a significant correlation between the size of AS and reading speed (r = -0.48, P = 0.023), as well as AS and reading acuity (r = 0.52, P = 0.013). No correlation was seen between RS and reading speed or reading capacity. CONCLUSION: The size of absolute scotoma correlated significantly with reading capacity and reading speed and may influence these measures.

Aged↗
PubMed2003

[The potential and the limits of photodynamic therapy - a review].

BACKGROUND: The spectrum of possible treatments for choroidal neovascularisation has been considerably increased with the introduction of photodynamic therapy. On the other hand the technical complexity and high cost associated with this new method require a pinpointed and dedicated application to achieve not only treatment benefits for the patients, but also not to exceed the available resources. This focussed application of the new treatment method can only be performed if the basics of diagnosis, indication, treatment and follow-up care are sufficiently known and used. MATERIAL, METHODS AND RESULTS: The standard treatment protocol, the results of published clinical trials as well as many published clinical observations are presented and discussed. CONCLUSIONS: Photodynamic therapy with verteporfin can prevent massive loss of vision in many cases of subfoveal choroidal neovascularisation, but the treatment outcome depends on many factors, the most important being the underlying disease process. Hence, indication for photodynamic therapy should adhere to the published treatment guidelines. In the future, additional medications or alterations of the treatment protocol might improve treatment outcome.

Aged↗
PubMed2002

Evaluation of pulsatile choroidal blood flow in branch retinal vein occlusion.

BACKGROUND: The present study was undertaken to compare pulsatile choroidal blood flow in patients with branch retinal vein occlusion (BRVO) with the values in normal controls. METHODS: The study included male and female patients with manifest BRVO (n=16) and a healthy sex- and age-matched control group (n=36). Fundus pulsation amplitude (FPA) was measured in the fovea by laser interferometry to assess pulsatile choroidal blood flow. RESULTS: The FPA in eyes with BRVO (4.4 microm) was significantly higher than in the fellow eye (3.8 microm; P<0.0005). There was also a significant difference between the affected eye of the patients and the healthy control group (3.3 microm; P<0.0009). CONCLUSION: The increase in FPA indicates increased choroidal blood flow resulting from some local mechanisms compensating for the decrease in retinal blood flow.

Aged↗
PubMed2002

Magnification characteristic of a +90-diopter double-aspheric fundus examination lens.

PURPOSE: To investigate the magnification characteristic of the +90-D double-aspheric fundus examination lens for biomicroscopic measurement of the optic disc. METHODS: A calibrated Gullstrand-type model eye adjusted for axial ametropia between -12.5 and +12.6 D was used to measure the change in magnification of the system with refractive error and variation in fundus lens position. A correction factor p (in degrees per millimeter) at different axial ametropias was also calculated. RESULTS: The total change in magnification of the system from myopia to hyperopia was -15.1% to +13.7%. When the fundus lens position was altered with respect to the model eye by +/-2 mm under myopic conditions, the change in magnification of the system was -4.8% to +8.1%. In the hyperopic condition the change was -4.8% to +6.0%. The fundus lens exhibited a linear relationship between p and the degree of ametropia of the model eye and a constant relationship between p and ametropia of -5 to +5 D. CONCLUSIONS: Axial ametropia has a significant effect on biomicroscopic measurement of the optic disc with the +90-D lens. Therefore, a correction factor (p) was calculated that can be used in calculations for determining true optic disc size. These findings may be important for improving clinical disc biometry.

Fundus Oculi↗
PubMedDate not supplied

Quality of life in patients with age-related macular degeneration: impact of the condition and benefits of treatment.

Age-related macular degeneration (AMD) is a chronic, progressive, degenerative disease of the macula and is the leading cause of central vision loss among elderly people in the western world. Traditionally, clinical studies of AMD have described the impact of AMD, and treatments for AMD, in terms of the patient's visual acuity. However, visual acuity alone does not provide information about a patient's perception of his or her quality of life. Researchers have used a variety of instruments to measure quality of life. Several studies have shown that AMD can severely impair quality of life and that increasing vision loss is associated with increasing impairment of quality of life and frequently causes depression. Interestingly, patients with only one eye affected may become more depressed than those with both eyes affected, possibly because of uncertainty surrounding future vision loss in patients with one eye affected and a greater acceptance of the condition in those with both eyes affected. Studies also have provided some information on the possible quality of life benefits of therapy for AMD. By incorporating measurements of quality of life into the design of future prospective studies, clinical researchers may be able to obtain more comprehensive data on the impact of AMD on patients and the relative benefits of different therapies.

Choroidal Neovascularization↗
PubMedDate not supplied

Primary silicone oil tamponade without retinopexy in highly myopic eyes with central macular hole detachments.

BACKGROUND: In highly myopic macular hole central retinal detachments, the ideal treatment is still under discussion. In our study, we analyzed anatomic and functional outcomes for eyes undergoing vitrectomy with primary silicone oil filling without central photocoagulation, using the oil as inductor and scaffold for glial closure of the causative macular hole. METHODS: Eleven patients with central macular hole detachments and myopia ranging from -10.0 to -23.0 diopters underwent vitrectomy and primary silicone oil filling without laser photocoagulation of the central retina. After at least 3 months (mean +/- SD, 5.2 +/- 2.0 months), the oil was removed from all eyes. RESULTS: In all eyes, the retina was attached by the first postoperative day and remained attached after silicone oil removal until the end of the follow-up period. No severe intra- or postoperative complications were noted. Visual acuity increased in 7 (63.6%) of 11 eyes, remained unchanged in 3 (27.3%) of 11, and deteriorated in 1 (9.1%) of 11. CONCLUSION: Vitrectomy plus primary silicone oil tamponade without endophotocoagulation is an effective method to treat central macular hole detachments in highly myopic eyes.

Aged↗
PubMedDate not supplied

Prevalence of patients presenting with neovascular age-related macular degeneration in an urban population.

PURPOSE: To determine the number and type of new cases of neovascular age-related macular degeneration (AMD) present in a defined urban population and to establish the proportion that would be recommended for treatment with verteporfin or laser photocoagulation. METHODS: Patients referred to an ophthalmic center in Vienna during a 10-week period because of recent deterioration in vision caused by newly diagnosed neovascular AMD were included. RESULTS: Neovascular AMD was diagnosed in 168 eyes in 153 patients. One hundred one eyes (60.1%) had lesions that were occult with no classic choroidal neovascularization (CNV); of these, 70 were subfoveal, 19 were juxtafoveal, and 12 were extrafoveal. Thirty-five eyes (20.8%) had predominantly classic lesions; of these, 27 were subfoveal, 6 were juxtafoveal, and 2 were extrafoveal. Thirty-two eyes (19.0%) had minimally classic lesions, of which 31 were subfoveal and 1 was extrafoveal. In accordance with consensus guidelines from a panel of experts and with American Academy of Ophthalmology's Preferred Practice Pattern guidelines, 33 lesions (17%) would be considered for treatment with verteporfin therapy. A further 37 subfoveal lesions with occult with no classic CNV and 7 juxtafoveal lesions with occult with no classic CNV might also benefit from verteporfin therapy if there is evidence of presumed recent disease progression. Five lesions (3.0%) could have been treated with laser photocoagulation according to Macular Photocoagulation Study criteria. CONCLUSIONS: These results suggest that verteporfin therapy substantially increases the number of patients with treatable neovascular AMD.

Aged↗