gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Subretinal surgical intervention of severe exudation with bilateral retinal teleangiectasia and ischemic retinopathy associated with a possible disorder of the cholesterol degradation pathway

Meeting Abstract

  • corresponding author K. A. Becker - Department of Ophthalmology, University Hospital Bonn
  • M. C. Dwinger - Department of Ophthalmology, University Hospital Bonn
  • K. U. Löffler - Department of Ophthalmology, University Hospital Bonn
  • D. Lütjohann - Department of Clinical Pharmacology, University Hospital Bonn
  • K. von Bergmann - Department of Clinical Pharmacology, University Hospital Bonn
  • F. G. Holz - Department of Ophthalmology, University Hospital Bonn

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.01.10

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Veröffentlicht: 22. September 2004

© 2004 Becker et al.
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Case report

A 36-year-old female presented with a severe visual deterioration in OS at the age of 15 due to an exudative retinal detachment and proliferative ischemic retinopathy. Coats disease was considered at that time. In 2003 there were prominent teleangiectasia in the midperiphery, ischemic areas, and massive subretinal exudation in OD. Exudation subsequently progressed towards the fovea. Cryo- and laser-coagulation did not prevent further central progression. Subretinal surgery was performed with removal of exudates via a peripheral retinotomy. Laser-coagulation was performed at midperiphery and at the margin of the retinotomy. So far no further subretinal exudations have recurred. Visual acuitiy remained stable in OD at 20/40. A diagnostic investigation including biochemical analysis of the serum and the extracted intraocular material showed a significant elevation of 27-hydroxycholesterol, an oxidative degradation product of the cholesterol. Histological examination of the extracted material during vitrectomy showed gliotic altered retina with strong abnormalities of the vessels including fibrinoid necrosis of vessel walls, thromboses with recanalisation and neovascularisation, and teleangiectatic vessels.


After unsuccessful coagulation massive subretinal exsudation moving towards the fovea can be removed by surgical intervention. In this case bilateral disease my be due to a systemic disorder of the cholesterol-pathway with secondary alterations of the retinal vasculature. Leading to an insufficiency of the blood-retinal-barrier with consecutive severe subretinal exudation.