The RAP study,report 4: morphological and topographical characteristics of multifocal macular neovascularization type 3

Graefe's Archive for Clinical and Experimental Ophthalmology - To report on the morphological characteristics and regional distribution of multifocal macular neovascularization type 3 (mMNV3)....     

Topographic Distribution and Progression of Soft Drusen Volume in Age-Related Macular Degeneration Implicate Neurobiology of Fovea

PurposeTo refine estimates of macular soft drusen abundance in eyes with age-related macular degeneration (AMD) and evaluate hypotheses about drusen biogenesis, we investigated topographic distribution and growth rates of drusen by optical coherence tomography (OCT). We compared results to retinal features with similar topographies (cone density and macular pigment) in healthy eyes.MethodsIn a prospective study, distribution and growth rates of soft drusen in eyes with AMD were identified by human observers in OCT volumes and analyzed with computer-assistance. Published histologic data for macular cone densities (n = 12 eyes) and in vivo macular pigment optical density (MPOD) measurements in older adults with unremarkable maculae (n = 31; 62 paired eyes, averaged) were revisited. All values were normalized to Early Treatment Diabetic Retinopathy Study (ETDRS) subfield areas.ResultsSixty-two eyes of 44 patients were imaged for periods up to 78 months. Soft drusen volume per unit volume at baseline is 24.6-fold and 2.3-fold higher in the central ETDRS subfield than in outer and inner rings, respectively, and grows most prominently there. Corresponding ratios (central versus inner and central versus outer) for cone density in donor eyes is 13.3-fold and 5.1-fold and for MPOD, 24.6 and 23.9-fold, and 3.6 and 3.6-fold.ConclusionsNormalized soft drusen volume in AMD eyes as assessed by OCT is ≥ 20-fold higher in central ETDRS subfields than in outer rings, paralleling MPOD distribution in healthy eyes. Data on drusen volume support this metric for AMD risk assessment and clinical trial outcome measure. Alignment of different data modalities support the ETDRS grid for standardizing retinal topography in mechanistic studies of drusen biogenesis.     

Mikrostrukturelle Ver?nderungen bei neovaskul?rer altersbedingter Makuladegeneration unter Anti-VEGF-Therapie

Background

High-definition raster scanning spectral-domain optical coherence tomography (SD-OCT) allows a precise assessment of retinal layers and a more detailed detection of subtle morphological alterations. The aim of this study was to observe such changes in patients with neovascular age-related macular degeneration (nAMD) under anti-VEGF therapy and to evaluate if they show characteristic and reversible properties.

Methods

The study included 20 consecutive patients with untreated nAMD. SD-OCT with an axial resolution of 6???m and a scan velocity of up to 25,000 A-scans/s was used for high-resolution imaging of the macular region at baseline and at months 1 and 3. Characteristic changes in the retinal microstructure were documented and analyzed.

Results

Obvious morphological changes as well as discrete intraretinal alterations showed a clear improvement until the third month following the initial ranibizumab injection. Destructions of the neurosensory retina and the outer retinal layers were partly reversible and significantly reduced after treatment was applied.

Conclusion

SD-OCT was able to detect additional information on specific morphological alterations within the retina. These changes showed a considerable reduction under consistent treatment indicating their potential value for monitoring treatment success in antiangiogenic strategies.     

Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study

Purpose

To evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs).

Design

Prospective, randomized, investigator-masked, controlled clinical study.

Methods

Twenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively.

Results

At month 3, mean BCVA improved to a eight-letter gain in each study group (P<0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P<0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups).

Conclusion

The early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.     

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation. SETTING: Department of Ophthalmology, Medical University of Vienna, Austria. METHODS: This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. RESULTS: Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.     

Effect of an acrylic intraocular lens with a sharp posterior optic edge on posterior capsule opacification

PURPOSE: To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) (Allergan Surgical) with that of the round-edged design of the Sensar AR40 IOL.Setting Department of Ophthalmology, University of Vienna, Vienna, Austria.METHODS: This prospective randomized patient- and examiner-masked study comprised 106 eyes of 53 patients with bilateral age-related cataract. Each patient had cataract surgery in both eyes and received an AR40 IOL in 1 eye and an AR40e IOL in the other eye. Postoperative examinations were at 1 week, 2 and 6 months, and 1 year. Digital slitlamp and digital retroillumination images of each eye were taken. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.RESULTS: The AR40e group had significantly less regeneratory and fibrotic PCO 1 year after surgery. The mean automated image-analysis software PCO score (scale 0 to 10) was 2.19 in the AR40 group and 1.10 in the AR40e group (P <.001). The AR40e group had less peripheral fibrotic PCO. There was no significant difference in patient-reported edge glare between the 2 IOL groups.CONCLUSIONS: The sharp-edged design of the Sensar OptiEdge AR40e IOL led to significantly less PCO than the round-edged AR40 IOL 1 year postoperatively.