Die Chorioretinopathia centralis serosa (CCS) ist eine meist akut auftretende, exsudative Erkrankung der Makula, die primär junge Männer betrifft, aber auch bei Schwangeren und bei Frauen in der Menopause auftreten kann. In den meisten Fällen kommt es zu einer Spontanremission, die wahrscheinlich durch gezielte Aufklärung des Patienten erleichtert werden kann. Heilt die CCS nicht innerhalb von 3 Monaten ab, sollte die Durchführung einer photodynamischen Therapie mit reduzierter Laser- oder Medikamentendosis erwogen werden. Auf die Verordnung anderer Medikamente sollte verzichtet werden, weil es einerseits keine nachweislich wirksamen Medikamente gibt, andererseits durch Medikamenteneinnahme die wahrscheinlich viel wirksamere Veränderung des Lebensstils in den Hintergrund tritt.

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.

Diabetes mellitus verursacht diabetische Retinopathie, diabetisches Makulaödem, optische Neuropathie, Katarakt und Fehlfunktionen der äusseren Augenmuskeln. Die Inzidenz dieser Spätschäden korreliert mit der Dauer des Diabetes und mit dem Grad der metabolischen Kontrolle. Die Empfehlungen der Österreichischen Diabetesgesellschaft für Diagnose, Therapie und Nachkontrolle werden übersichtsweise und bezogen auf die jeweiligen Stadien der diabetischen Augenerkrankung präsentiert.

To determine the effect of the laser unit on photodynamic therapy (PDT) spot size.

Background and Objective: To estimate the efficacy and usability of preferential hyper-acuity perimetry (PHP) for monitoring patients with high-risk intermediate age-related macular degeneration (AMD). Patients and Methods: A long-term, observational, prospective case series of patients with intermediate AMD who underwent fluorescein angiography at recruitment. Eyes were examined every 3 months with PHP, visual acuity, and biomicroscopy. Optical coherence tomography (OCT) imaging was performed when PHP was outside normal limits. In case of suspected findings in OCT, fluorescein angiography was also performed. Patients diagnosed as having choroidal neovascularization (CNV) were offered anti-vascular endothelial growth factor therapy. Results: Twenty-six eyes (25 patients) were monitored for a mean follow-up period of 600 days. Of the 172 PHP tests done by these 26 eyes with intermediate AMD, 158 were within normal limits yielding a false-positive rate of 8.1%. Three of 4 eyes that converted to CNV had PHP test results outside normal limits before or on the day of diagnosis. Conclusion: PHP is useful for detecting CNV in regularly monitored eyes with intermediate AMD while maintaining a low false-positive rate.

PURPOSE Cardiovascular risk factors such as smoking, hypertension, and atherosclerosis seem to play an important role in the development of choroidal neovascularization (CNV). Recent studies have also provided evidence suggesting that choroidal and retinal blood flow is decreased in patients with AMD. On the basis of these results, the hypothesis for this study was that lower choroidal blood flow is associated with an increased risk of CNV in patients with AMD. METHODS Forty-one patients with unilateral choroidal neovascular AMD were included in this observational longitudinal study. The fellow eyes of the patients served as study eyes. Subfoveal choroidal blood flow (FLOW) and fundus pulsation amplitude (FPA) were assessed with laser Doppler flowmetry and laser interferometry, respectively. A multivariate COX-regression model was used to test the hypothesis that low choroidal perfusion parameters are associated with the development of CNV. RESULTS Of the 37 patients that were followed up until the end of the study, 17 developed CNV and 20 did not. The univariate COX-regression analysis shows that lower FLOW, systolic blood pressure, intraocular pressure, and FPA are risk factors for development of CNV. Moreover, the more advanced the AMD in the study eye, the higher the risk for CNV to develop in the fellow eye. Multivariate COX regression analysis indicated that only FLOW (P = 0.0071), FPA (P = 0.0068), and staging (P = 0.031) had statistically significant influences on the progression to CNV. CONCLUSIONS The present study indicates that lower choroidal perfusion is a risk factor for the development of CNV in the fellow eye of patients with unilateral CNV.

Durch die transsklerale intravitreale Medikamenteneingabe von Angiogenese-Inhibitoren (Anti-VEGF) hat sich der Verlauf der feuchten AMD in den letzten Jahren entscheidend verbessert, erstmals kann der Visus zuverlässig stabilisiert und in vielen Fällen sogar verbessert werden. Durch diesen positiven Verlauf hat die Frequenz dieser Eingriffe dramatisch zugenommen und wird auch noch weiter steigen. Um so mehr ist auf die Wirksamkeit und Zuverlässigkeit dieses Eingriffes Augenmerk zu legen. Diese Arbeit versucht, einen Überblick zu rezenten Studien zu allen drei gängigen Substanzen hinsichtlich des Wirk- und Nebenwirkungsprofils zu geben. Auch wenn derzeit noch große, randomisierte Multizenter-Studien für Avastin® fehlen, zeigen die Anwendungsbeobachtungen an tausenden Augen ein ähnlich sicheres Profil wie für Lucentis®. Wie zahlreiche Studien beweisen, handelt es sich um eine sichere und effektive Methode. Da es sich aber prinzipiell um einen intraokularen Eingriff mit entsprechendem Komplikationsrisiko handelt, muss auf sterile Operationsbedingungen und eine adäquate Injektionstechnik größtes Augenmerk gelegt werden.

PURPOSE:To investigate in patients with neovascular age-related macular degeneration (ARMD) the changes in ocular perfusion caused by single treatment with photodynamic therapy (PDT) by different non-invasive methods; to evaluate correlations between relative changes of ocular haemodynamic parameters after PDT among each other and compared to morphological parameters; and to assess this in relation to early changes of visual acuity.METHODS:STUDY POPULATION:17 consecutive patients with subfoveal choroidal neovascularization (CNV) caused by ARMD scheduled for PDT without previous PDT treatment (four patients with predominantly classic CNV and 13 patients with occult CNV).OBSERVATION PROCEDURES:best-corrected visual acuity (before PDT, 6 and 8 weeks after PDT), fundus photography, fluorescein angiography, haemodynamic measurements with laser Doppler flowmetry (LDF), laser interferometry and ocular blood flow (OBF) tonometry (baseline and 1, 2, 6 and 8 weeks after treatment).MAIN OUTCOME MEASURES:choroidal blood flow (CHBF), fundus pulsation amplitude (FPA), pulsatile ocular blood flow (POBF), visual acuity. Changes smaller than 20% were considered clinically irrelevant.RESULTS:Ocular haemodynamic parameters did not change significantly in the follow-up period. Changes of haemodynamic parameters showed no correlation to treatment spot, morphological changes or visual acuity. Changes of visual acuity were comparable to results of earlier studies.CONCLUSION:Single treatment with PDT did not modify ocular blood flow parameters above 20% as assessed with different non-invasive methods.

Nach Einführung der intravitrealen Therapie ist es zu einem deutlichen Rückgang der Anwendung der photodynamischen Therapie (PDT) mit Verteporfin gekommen, weil die Resultate nach PDT schlechter sind als nach intravitrealer Applikation von Bevacizumab oder Ranibizumab. Ob in Zukunft die PDT – in Kombination mit intravitrealer Therapie – noch eine Rolle bei der Therapie der neovaskulären altersbedingten Makuladegeneration spielen wird, wird derzeit im Rahmen mehrerer randomisierter Multizenterstudien untersucht. Für die Behandlung der akuten und chronischen Chorioretinopathia centralis serosa, von retinalen und choroidalen Hämangiomen und von polypoidaler choroidaler Vaskulopathie ist die PDT mit Verteporfin aber nach wie vor als Therapie der ersten Wahl indiziert.

The introduction of intravitreal therapy resulted in a significant decrease in the use of photodynamic therapy (PDT) with verteporfin due to the superior results of the intravitreal application of Bevacizumab and Ranibizumab. The question whether PDT - in combination with intravitreal therapy - will have a role in the future for management of cases with neovascular macular degeneration is currently investigated by several randomized controlled multicenter trials. Nevertheless, PDT with verteporfin is still the first choice for the treatment of acute or chronic central serous chorioretinopathy, of retinal and choroidal hemangiomas and of polypoidal choroidal vasculopathy.

Grundproblematik und Fragestellung: Patienten und Methodik: Ergebnisse: P Folgerung: Objective: Patients and methods: Results: P Conclusion:

BACKGROUND:To present a method for performing photodynamic therapy (PDT) with a constant predictable light fluence based on actual laser spot magnification.METHODS:A calibrated Gullstrand-type model eye with a scale of half circles in the centre of the artificial fundus was used for this study. The axial length of the model eye was set to different values ranging from 20 to 31 mm, and the actual laser spot magnification of four indirect condensing laser lenses were determined using a PDT laser unit.RESULTS:Equations for determining the actual laser spot magnification were calculated for each laser lens. The total change in laser spot magnification from hyperopia (axial length 20 mm) to myopia (axial length 31 mm) was -20% to +24.8% for Mainster Standard lens (Ocular Instruments Inc, Bellevue, Washington, USA), -15.7% to +27.7% for Mainster Wide Field lens (Ocular Instruments Inc), -16.3% to +33.1% for Volk Transequator lens (Volk Optical Inc, Mentor, Ohio, USA), and -19.2% to +24.4% for Volk PDT Laser lens (Volk Optical Inc).CONCLUSIONS:Axial length of the eye has a considerable effect on PDT laser spot magnification when an indirect laser lens is used. By calculating the actual laser spot magnification in conjunction with knowledge of the true greatest linear dimension of the neovascular lesion, the clinician may be able to deliver a constant predictable amount of light fluence to the fundus independent of the axial length of the PDT treating eye.

Retinal degenerations and retinal breaks are causative for rhegmatogenous retinal detachment. Retinal detachment has to be treated by one or more surgeries to reattach the retina. Functional results are limited, especially when the macula is involved. Therefore, the occurrence of retinal detachment should be avoided. Prophylactic treatment can be perfomed with retinal laser photocoagulation and retinal cryopexy to treat retinal degenerations and retinal breaks. Additionally, the patient has to be included in the prophylactic treatment by explaining visual symptoms for early consultation.

Ocular photodynamic therapy (PDT) was introduced as a novel treatment for neovascular forms of age-related macular degeneration and choroidal neovascularization (CNV) secondary to pathologic myopia in the mid/end 1990s. The current treatment recommendations are based on the results of two large, prospective, multicenter, randomized clinical trials (Treatment of Age-Related Macular Degeneration with Photodynamic Therapy and Verteporfin in Photodynamic Therapy Studies) and thousands of patients have been treated worldwide over the last years. Meanwhile, PDT has been performed in several other ocular pathologies with some remarkable results, however, with most reports being case reports and small case series without statistical significance. These extended applications include CNV secondary to choroiditis and retinochoroiditis, angioid streaks, central serous chorioretinopathy, retinal angiomatous proliferation, parafoveal telangiectasia or CNV associated with macular dystrophy and idiopathic CNV, as well as diseases without CNV, such as choroidal hemangioma, retinal hamartoma, choroidal melanoma, chronic central serous chorioretinopathy, angiomatous lesions secondary to systemic diseases, rubeosis iridis or neovascular glaucoma. To date, with the introduction of anti-VEGF therapy, the role of PDT will certainly change. However, it is reasonable to believe that it will maintain an important role in combination therapy due to its unique properties of selective vascular targeting. Therefore, it is essential for the ophthalmologist to be familiar with the extended applications and their modifications of treatment parameters. This review will summarize the standard and experimental applications of PDT based on our own results and the literature.