Eine Auswahl unserer Vortragsthemen aus dem Jahr 2016

2RT Nano-Laser on chronic central serous chorioretinopathy

Authors: Detlev R.H. Breyer (1), Roxana Fulga (1), Andreas Fricke (1), Hakan Kaymak (1), Karsten Klabe(1), Florian T.A. Kretz (2) Gerd U. Auffarth (2)

(1) Breyer, Kaymak & Klabe Augenchirurgie, (2) Universitaets-Augenklinik Heidelberg

Purpose: In modern ophthalmological laser therapy cell gentle laser technologies are increasingly used. Those technologies promise a good treatment success, due to their mode of action, the stimulation of cell regeneration processes by short low-energy-pulses. This paper reported about the current success of selective laser therapy in our practice on patients with chronic central serous chorioretinopathy (CSR) by treatment with a Nano-Laser.

Method: Our retrospective study includes 21 eyes with chronic CSR (duration of disease more than 4 months; partly nonresponders to Diamox, photodynamic therapy (PDT), Eplerenone and Spironolactone). We analyzed microperimetry, angiography images, OCT results, autofluorescence images, visual acuity with ETDRS charts and Amsler. The treatment (Pattern scanning) of the leakages were performed using the 2RT (Retinal Rejuvenation) Nano-Laser from Ellex Medical Lasers Ltd. with an average laser power of 0.14 to 0.21 mJ/spot, a pulse rate of 70 spots with a spot size of 400 microns and an exposure time of 3 ns.

Results: A complete decline of subretinal fluid was observed in 28.5% of treated eyes four weeks after the Nano-Laser therapy. Further 48% of analyzed eyes showed a reduction of the leakage, 14% did not show any changes and 9.5% resulted in a worsening of the condition. 57.1% of treated eyes showed a stable finding eight weeks after treatment. The remaining 9 of 21 eyes were retreated with a second Nano-Laser therapy. For all eyes analyzed, a complete absorption of the edema was observed four weeks after the second treatment.
The first patient has developed a transient macular edema 2 days after Nano-Laser therapy, to avoid this all other patients were preventively treated with Nevanac. In one patient a recurrence of disease activity occurred during the follow-up period.

Conclusion:Overall, our results show that the applied selective laser therapy with 3 ns exposure time represents an interesting alternative to PDT. Further studies must confirm this trend by larger sample size. A concomitant therapy with non-steroidal antiphylogistika is to recommend to prevent the formation of a macular edema.

First results with fluocinolone acetonide implant in second line therapy for the treatment of diabetic macular edema.

Authors: Roxana Fulga, Andreas Fricke, Florian T.A. Kretz, Detlev R.H. Breyer, Karsten Klabe, Gerd U. Auffarth, Hakan Kaymak

Purpose: To investigate the efficiency and safety of fluocinolone acetonide intravitreal implant in eyes with persistent diabetic macular edema (DME) over a follow-up period up to 18 months.

Setting: Breyer, Kaymak & Klabe Augenchirurgie, Düsseldorf, Germany; International Vision Correction Research Center Network, Germany

Method: Main outcome measures included the changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline at scheduled visits following injection.

Results: In this retrospective study, 11 eyes of 8 patients, who underwent an injection of intravitreal fluocinolone acetonide implant for the treatment of persistent diffuse DME, were reviewed. Mean BCVA at baseline and at days 7, 30 and 120 were 0.57 ± 0.31, 0.62 ± 0.35, 0.49 ± 0.37 and 0.47 ± 0.35 LogMAR, respectively. The evaluation of CST had shown a continuous improvement of the diabetic macular edema. Mean CST at baseline and at days 7, 30 and 120 were 454 ± 95 μm, 405 ± 117 μm, 386 ± 114 μm and 284 ± 58 μm, respectively.
One eye (9%) showed an increase in IOP of ≥10 mmHg from baseline and needed an antiglaucoma treatment.

Conclusion: Patients with persistent DME, switching to intravitreal fluocinolone acetonide implant injection provides functional and anatomical improvement, and might be an effective therapeutic option for long-standing diffuse DME.

First results with dexamethasone implant as first line therapy versus second line therapy for the treatment of diabetic macular edema.

Authors: Detlev R.H. Breyer (1), Roxana Fulga (1), Andreas Fricke (1), Hakan Kaymak (1), Karsten Klabe(1), Florian T.A. Kretz (2) Gerd U. Auffarth (2)

We evaluated the efficacy of intravitreal dexamethasone implant for the treatment of diabetic macular edema (DME) in nonglaucomatous eyes over a follow-up period up to 120 days in subgroup of native versus non-native patients.

This was a retrospective observation. Patients with persistent DME who were phakic or pseudophakic and did not have a glaucoma or ocular hypertension history were included. After an initial administration of dexamethasone changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure (IOP) were evaluated.

The study included 28 eyes of 25 patients, 10 eyes were treated with dexamethasone in first line therapy. For both subgroups summarized the mean BCVA at baseline and at weeks 1, 6, and 12 were 0.54 ± 0.36, 0.5 ± 0.4, 0.6 ± 0.38 and 0.4 ± 0.3 LogMAR, respectively. Mean CST at baseline and at weeks 1, 6, and 12 were 428 ± 128 μm, 388 ± 62 μm, 305 ± 83 μm and 380 ± 143 μm, respectively. Four of the 28 eyes (14%) showed an increase in IOP of ≥10 mmHg and three of them needed antiglaucoma medication.

In nonglaucomatous eyes with DME, intravitreal dexamethasone implant was found to be beneficial in regard to visual and anatomic success and seemed safe in this selected group of patients.

Laser Vitreolysis for Vitreous Floaters. Our first 2 Year experience.

Authors : Detlev R.H. Breyer (1), Roxana Fulga (1), Andreas Fricke (1), Hakan Kaymak (1), Karsten Klabe(1), Florian T.A. Kretz (2) Gerd U. Auffarth (2)

Purpose: Vitreous opacities are usually harmless, but can be in some cases annoying, because they disturb the patients reading ability or patients have difficulties with or can no longer exercise their profession. The vitrectomy was so far the only treatment option. As a novelty, the laser UltraQ from Ellex has the property that the illumination and laser beams are coaxial and has a precise focus in the middle and posteriour vitreous. This enables accurate YAG laser treatment of vitreous floaters.

Method: Retrospectively 300 eyes were evaluated after performing a YAG laser vitreolysis. We did the following investigation pre- and postoperative: subjective refraction, eye pressure, Optomap scans, OCT, direct ophthalmoscopy. We kept a safety distance of 3 mm to the retina and the lens. The treatments were carried out over a period of 2 years. We treated the patients that have to deal every day with problems due to floaters and we excluded the patients with acute posterior vitreous detachment and uveitis.

Results: 79% of the patients were pseudophakic. 15% of patients underwent retinal photocoagulation for retinal degenerations or retinal tears before YAG Vitreolysis treatment. On average from 2.1 sessions Vireolyse were needed. The rate of shots was between 250 and 600 with a mean energy of 6mJ/shot. It showed postoperatively in no case a retinal detachment or macular edema (follow-up 3 to 12 months). The anatomical success rate was for a well-defined floaters about 95%, for multiple floaters 70% and for ill-defined 10%.

Conclusion: Not all vitreous opacities are suitable for the treatment with the Laser Vitreolysis. Individual vitreous opacities such as white ring and other well-defined floaters can be treated without problems. A good selection of the patients ist the key to successful therapy.