1,721,007 research outputs found
Venöse retinale Gefäßverschlüsse: Intravitreale Therapien und Strategien zur Behandlung des Makulaödems
No full textIntravitreal injection treatment for the management of macular edema as an expression of increased capillary permeability and leakage constitute the mainstay of treatment in retinal vein occlusion. In contrast to diabetic retinopathy or neovascular age-related macular degeneration, permanent and complete functional and morphological restoration can be achieved, as retinal vein occlusions are usually associated with risk factors, but do not represent the manifestation form of an underlying systemic or degenerative chronic disorder; however, successful long-term management of retinal vein occlusion -associated macular edema usually requires intensive and also long-term continued treatment with vascular endothelial growth factor (VEGF) inhibitors or with a less favorable side effect profile, dexamethasone. A functional treatment success can be maintained over the long term by both pro re nata (PRN) or treat and extend (T&E) regimens. In contrast, according to the currently available data, the combination of anti-VEGF administration and grid laser treatment has no additional benefit compared to monotherapy. In patients with recalcitrant macular edema, switching to another intravitreal agent may be considered during the course of treatment, although a true therapeutic benefit with respect to the development of visual acuity has not yet been proven. The current review summarizes the relevant aspects in the management of RVO-associated macular edema and provides the foundations for the application of successful treatment strategies
Biomarkers in the treatment of retinal vein occlusion
No full textHintergrund
Retinale Venenverschlüsse, subsumiert in Zentralvenen- und Venenastverschluss, gehören zu den häufigsten vaskulären Erkrankungen der Netzhaut. Sowohl bei Erstdiagnose als auch in der Therapie verschlussassoziierter Komplikationen, v. a. des Makulaödems, sind Biomarker der optischen Kohärenztomographie (OCT), OCT-Angiographie und (Ultraweitwinkel‑)Fluoreszeinangiographie von herausragender Bedeutung.
Methoden
Es erfolgte eine systematische Literaturrecherche auf pubmed.gov mit den Keywords „central retinal vein occlusion“, „branch retinal vein occlusion“, „biomarker“, „OCT“, „OCT angiography“, „ultra-widefield fluorescein angiography“ mit Priorisierung der wichtigsten Aspekte zur Umfangsreduktion.
Ergebnisse
Als relevante Biomarker konnten in der OCT Makuladicke („central retinal thickness“ [CRT]), makuläre Flüssigkeit, die Integrität der Photorezeptorbande (Membrana limitans externa [ELM] und „ellipsoid zone“ [EZ]), „disorganization of retinal inner layers“ (DRIL), hyperreflektive Foci, Aderhautdicke sowie Ischämiezeichen wie „prominent middle limiting membrane“ (p-MLM), die „paracentral acute middle maculopathy“ (PAMM) sowie „hyperreflectivity of inner retinal layers“ (HIRL) identifiziert werden. Der Stellenwert der OCT-Angiographie liegt v. a. in der Beurteilung mikrovaskulärer Veränderungen, insbesondere der „vessel density“ im tiefen retinalen Gefäßplexus, der fovealen avaskulären Zone und von Arealen ohne Kapillarperfusion. Bezüglich der Therapieentscheidung zum Netzhautlaser sind Biomarker der Ultraweitwinkelangiographie wie periphere Ischämien („ischemic index“) sowie Neovaskularisationen essenziell.
Schlussfolgerung
Eine Vielzahl simplerer und komplexer Biomarker ermöglicht heute eine effektive individualisierte Therapie- und Prognoseeinschätzung beim retinalen Venenverschluss. Eine Verschiebung von invasiven zu nichtinvasiven Biomarkern wird beobachtet.Background
Retinal vein occlusion, subdivided into central retinal and branch retinal vein occlusion, is one of the most frequent vascular diseases of the retina. Biomarkers of optical coherence tomography (OCT), OCT-angiography and (ultra-widefield) fluorescein angiography are of exceptional importance in the initial diagnosis and also in the treatment of complications associated with retinal vascular occlusion, particularly macular edema.
Methods
A systematic literature review was carried out in PubMed with the keywords central retinal vein occlusion, branch retinal vein occlusion, biomarker, OCT, OCT angiography, ultra-widefield fluorescein angiography with prioritization of the most important aspects.
Results
Relevant biomarkers in OCT include central retinal thickness (CRT), macular fluid, the integrity of the photoreceptor bands (external limiting membrane and ellipsoid zone), disorganization of retinal inner layers (DRIL), hyperreflective foci, choroidal thickness and signs of ischemia, such as a prominent middle limiting membrane (p-MLM), paracentral acute middle maculopathy (PAMM) as well as hyperreflectivity of inner retinal layers (HIRL). The importance of OCT-angiography lies particularly in the assessment of microvascular alterations, especially vessel density in the deep retinal vascular plexus, the foveal avascular zone and of areas with no capillary perfusion. Biomarkers of ultra-widefield angiography, such as peripheral ischemia (ischemic index) and neovascularízation are essential with respect to treatment decisions for retinal laser.
Conclusion
A multitude of simple and complex biomarkers currently enable an effective individualized evaluation of treatment and prognosis in retinal vein occlusion. A shift from invasive to noninvasive biomarkers can be observed
Ophthalmic Outpatient and Inpatient Care Under Pandemic Conditions: Hygiene, Triage and New Challenges
No full textAbstract Background The progression of the COVID-19 pandemic has caused significant changes in the environment for outpatient and inpatient care in ophthalmology, with limitations on access to medical care but also new observations and challenges. We now describe major developments in recent months and provide an outlook on the expected consequences. Methods PubMed literature search, clinical survey. Results To date, the course of the COVID-19 pandemic has been characterised by several new but overall rare ocular manifestations, the ophthalmological shared management of COVID-19 patients on intensive care units, and a significant decrease in case numbers, associated with an increase in case severity and relative proportion of emergencies, as a result of delayed presentation of patients and reduced treatment adherence. With the introduction of hygiene measures and infection control procedures, ophthalmic patient care was maintained – including emergencies and urgent treatments. Due to the extensive postponement of elective surgeries, scarce therapeutic and health care professional resources, and the prioritisation of critically ill patients from other specialties, there is a reasonable likelihood that urgent treatments will be delayed as infection rates rise. Conclusion Outpatient and inpatient care in ophthalmology during the COVID-19 pandemic is primarily accompanied by additional organisational or medical challenges and a decline in case volume. Although to date emergency and urgent ophthalmic treatments have been maintained, long-term persistence of pandemic conditions will require additional strategies to provide continuation of ophthalmic care at the required level.Zusammenfassung Hintergrund Mit fortschreitender Dauer hat die COVID-19-Pandemie zu einer deutlichen Veränderung der Rahmenbedingungen für die ambulante und stationäre Augenheilkunde mit Einschränkungen bei der medizinischen Versorgung, aber auch neuen Beobachtungen und Herausforderungen geführt. Der vorliegende Beitrag beschreibt wesentliche Entwicklungen der vergangenen Monate und gibt einen Ausblick auf die zu erwartenden Folgen. Methoden Literaturrecherche über PubMed, klinische Beobachtungen. Ergebnisse Neben neuen, aber insgesamt seltenen okulären Manifestationen sowie der augenärztlichen Mitbetreuung intensivmedizinisch behandelter COVID-19-Patienten wurde im bisherigen Verlauf der COVID-19-Pandemie weltweit vor allem ein Rückgang der Fallzahlen bei gleichzeitigem Anstieg der Fallschwere und des relativen Anteils an Notfällen beobachtet, was u. a. auf eine verzögerte Vorstellung der Patienten und eine niedrigere Therapieadhärenz zurückzuführen ist. Mit der Einführung von Hygienemaßnahmen und Abläufen für den Infektionsschutz konnten sowohl die Notfallversorgung als auch die Durchführung dringlicher Behandlungen aufrechterhalten werden. Aufgrund der umfangreichen Verschiebung elektiver Operationen, knapper personeller und operativer Ressourcen sowie der Priorisierung der Behandlung vitaler Indikationen anderer Fachrichtungen muss bei steigenden Infektionszahlen zunehmend auch mit einer Verzögerung dringlicher Eingriffe gerechnet werden. Schlussfolgerung Die ambulante und stationäre Augenheilkunde während der COVID-19-Pandemie wird vor allem durch zusätzliche organisatorische und medizinische Herausforderungen sowie einen Rückgang der Fallzahlen begleitet. Obwohl ophthalmologische Notfallbehandlungen und dringliche Therapien bis dato gewährleistet werden konnten, würde ein langfristiges Andauern der Pandemiebedingungen zusätzliche Strategien erfordern, um eine Patientenversorgung auf dem erforderlichen Niveau weiterhin zu gewährleisten.Abstract Background The progression of the COVID-19 pandemic has caused significant changes in the environment for outpatient and inpatient care in ophthalmology, with limitations on access to medical care but also new observations and challenges. We now describe major developments in recent months and provide an outlook on the expected consequences. Methods PubMed literature search, clinical survey. Results To date, the course of the COVID-19 pandemic has been characterised by several new but overall rare ocular manifestations, the ophthalmological shared management of COVID-19 patients on intensive care units, and a significant decrease in case numbers, associated with an increase in case severity and relative proportion of emergencies, as a result of delayed presentation of patients and reduced treatment adherence. With the introduction of hygiene measures and infection control procedures, ophthalmic patient care was maintained – including emergencies and urgent treatments. Due to the extensive postponement of elective surgeries, scarce therapeutic and health care professional resources, and the prioritisation of critically ill patients from other specialties, there is a reasonable likelihood that urgent treatments will be delayed as infection rates rise. Conclusion Outpatient and inpatient care in ophthalmology during the COVID-19 pandemic is primarily accompanied by additional organisational or medical challenges and a decline in case volume. Although to date emergency and urgent ophthalmic treatments have been maintained, long-term persistence of pandemic conditions will require additional strategies to provide continuation of ophthalmic care at the required level.Zusammenfassung Hintergrund Mit fortschreitender Dauer hat die COVID-19-Pandemie zu einer deutlichen Veränderung der Rahmenbedingungen für die ambulante und stationäre Augenheilkunde mit Einschränkungen bei der medizinischen Versorgung, aber auch neuen Beobachtungen und Herausforderungen geführt. Der vorliegende Beitrag beschreibt wesentliche Entwicklungen der vergangenen Monate und gibt einen Ausblick auf die zu erwartenden Folgen. Methoden Literaturrecherche über PubMed, klinische Beobachtungen. Ergebnisse Neben neuen, aber insgesamt seltenen okulären Manifestationen sowie der augenärztlichen Mitbetreuung intensivmedizinisch behandelter COVID-19-Patienten wurde im bisherigen Verlauf der COVID-19-Pandemie weltweit vor allem ein Rückgang der Fallzahlen bei gleichzeitigem Anstieg der Fallschwere und des relativen Anteils an Notfällen beobachtet, was u. a. auf eine verzögerte Vorstellung der Patienten und eine niedrigere Therapieadhärenz zurückzuführen ist. Mit der Einführung von Hygienemaßnahmen und Abläufen für den Infektionsschutz konnten sowohl die Notfallversorgung als auch die Durchführung dringlicher Behandlungen aufrechterhalten werden. Aufgrund der umfangreichen Verschiebung elektiver Operationen, knapper personeller und operativer Ressourcen sowie der Priorisierung der Behandlung vitaler Indikationen anderer Fachrichtungen muss bei steigenden Infektionszahlen zunehmend auch mit einer Verzögerung dringlicher Eingriffe gerechnet werden. Schlussfolgerung Die ambulante und stationäre Augenheilkunde während der COVID-19-Pandemie wird vor allem durch zusätzliche organisatorische und medizinische Herausforderungen sowie einen Rückgang der Fallzahlen begleitet. Obwohl ophthalmologische Notfallbehandlungen und dringliche Therapien bis dato gewährleistet werden konnten, würde ein langfristiges Andauern der Pandemiebedingungen zusätzliche Strategien erfordern, um eine Patientenversorgung auf dem erforderlichen Niveau weiterhin zu gewährleisten
Cardiovascular risk factors, haemostasis and antithrombotic treatment in retinal vessel occlusion
No full textL-arginine-nitric oxide pathway-related metabolites in the aqueous humor of diabetic patients
No full textPURPOSE. Nitric oxide (NO) is an important signal-transduction molecule that plays a significant role in the regulation of cardiovascular functions. In the L-arginine-NO pathway, NO synthase (NOS) converts L-arginine (L-Arg), the only known biologic substrate for NO formation, to NO and L-citrulline (L-Cit). Excessive NO production mediated by the inducible isoform of NOS has been implicated in the pathogenesis of various diseases. In the present study it was hypothesized that in vitreoretinal disorders such as diabetic retinopathy the production of L-Arg-NO pathway-related metabolites may be upregulated as a result of increased NO generation. METHODS. From 20 eyes of nondiabetic subjects and 22 eyes of diabetic patients with (n = 14) and without (n = 8) diabetic retinopathy, undiluted samples of aqueous humor were drawn before cataract surgery. Levels of L-Arg, L-Cit, and the specific NOS byproduct NG-hydroxy-L-arginine (HOArg) were measured by high-performance liquid chromatography. RESULTS. L-Arg, L-Cit, and HOArg were detected in all aqueous humor samples from diabetic and nondiabetic patients (n = 42). Comparison of HOArg levels in nondiabetic and diabetic subjects showed significantly higher levels in diabetic patients (P = 0.002). Concentrations of HOArg were higher in samples from patients with (P = 0.005) and without diabetic retinopathy (P = 0.033) than in control subjects. No statistically significant differences were observed in L-Arg or L-Cit levels. CONCLUSIONS. Elevated levels of HOArg in the aqueous humor of diabetic patients reflect the possible role of NO as a significant factor in the regulation of retinal vascular functions and intraocular proliferative changes in diabetes mellitus in vivo. The control of intraocular NO production may constitute a potential therapeutic approach in diabetic retinopathy
L-arginine-nitric oxide pathway-related metabolites in the aqueous humor of diabetic patients
No full textPURPOSE. Nitric oxide (NO) is an important signal-transduction molecule that plays a significant role in the regulation of cardiovascular functions. In the L-arginine-NO pathway, NO synthase (NOS) converts L-arginine (L-Arg), the only known biologic substrate for NO formation, to NO and L-citrulline (L-Cit). Excessive NO production mediated by the inducible isoform of NOS has been implicated in the pathogenesis of various diseases. In the present study it was hypothesized that in vitreoretinal disorders such as diabetic retinopathy the production of L-Arg-NO pathway-related metabolites may be upregulated as a result of increased NO generation. METHODS. From 20 eyes of nondiabetic subjects and 22 eyes of diabetic patients with (n = 14) and without (n = 8) diabetic retinopathy, undiluted samples of aqueous humor were drawn before cataract surgery. Levels of L-Arg, L-Cit, and the specific NOS byproduct NG-hydroxy-L-arginine (HOArg) were measured by high-performance liquid chromatography. RESULTS. L-Arg, L-Cit, and HOArg were detected in all aqueous humor samples from diabetic and nondiabetic patients (n = 42). Comparison of HOArg levels in nondiabetic and diabetic subjects showed significantly higher levels in diabetic patients (P = 0.002). Concentrations of HOArg were higher in samples from patients with (P = 0.005) and without diabetic retinopathy (P = 0.033) than in control subjects. No statistically significant differences were observed in L-Arg or L-Cit levels. CONCLUSIONS. Elevated levels of HOArg in the aqueous humor of diabetic patients reflect the possible role of NO as a significant factor in the regulation of retinal vascular functions and intraocular proliferative changes in diabetes mellitus in vivo. The control of intraocular NO production may constitute a potential therapeutic approach in diabetic retinopathy
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