Association between various types of obesity and macular pigment optical density

Purpose

To elucidate the association between macular pigment optical density (MPOD) and various types of obesity in the South-Indian population.

Patients and methods

In total, 300 eyes of 161 healthy volunteers of South-Indian origin were studied. MPOD was measured psychophysically at 0.25°, 0.50°, 1.00°, and 1.75° eccentricities from fovea. Anthropometric measurements included waist circumference (WC) and waist-to-hip ratio (WHR) and body mass index (BMI). Using the WHO Expert Consultation guidelines, obesity was defined based on BMI alone (BMI≥23 kg/m²), based on WC alone (WC≥90 cm for men and ≥80 cm for women), and based on WHR alone (≥0.90 for men and ≥0.85 for women). Isolated generalized obesity was defined as increased BMI and normal WC. Isolated abdominal obesity was defined as increased WC and normal BMI. Combined obesity was defined as increased BMI and increased WC.

Results

Mean MPOD at all eccentricities was not significantly different between men and women. Mean MPOD values did not significantly differ in various types of obesity, when compared with the normal subjects. On subgroup analysis, in age group ≥60 years, mean MPOD values were significantly higher in subjects with obesity based on BMI (0.61 vs0.41, P=0.036), obesity based on WHR (0.67 vs0.41, P=0.007), and isolated generalized obesity (0.66 vs0.41, P=0.045) in comparison with normal subjects at 0.25° eccentricity.

Conclusion

We found lack of an association between MPOD and obesity in the South-Indian population. A similar finding was also noted on age group- and gender-wise analyses.     

Macular pigment optical density in wet age-related macular degeneration among Indians

PurposeTo estimate the value of macular pigment optical density (MPOD) in adult south Indian population with wet age-related macular degeneration (AMD).MethodsA total of 33 patients with wet AMD and 29 age-matched controls >50 years of age underwent MPOD measurement with the macular densitometer. The patients were also tested for their dietary intake of carotenoids, smoking history, and lifetime UV exposure.ResultsThe mean MPOD values in the Indian population with wet AMD was 0.23 (95% CI: 0.18-0.29) vs control was 0.43 (95% CI: 0.37-0.49), P<0.0001, at 0.5° eccentricity. Ex-smokers had a lower MPOD than non-smokers (0.16 (0.09-0.23) vs 0.28 (0.22-0.34), P=0.026) and the lowest level of carotenoids intake had 48% lower MPOD than the highest level (0.14 (0.08-0.21) vs 0.33 (0.24-0.43), P=0.012). There was no significant age-related decline or gender variation in MPOD.ConclusionThis study establishes the MPOD in adult Indian population with wet AMD, with a lack of macular pigment in association with wet AMD.     

Two-wavelength fundus autofluorescence and macular pigment optical density imaging in diabetic macular oedema

Purpose

To evaluate the application of 488 and 514 nm fundus autofluorescence (FAF) and macular pigment optical density (MPOD) imaging in diabetic macular oedema (DMO) and to demonstrate the typical imaging features.

Patients and Methods

A hundred and twenty-five eyes of 71 consecutive patients with diabetic retinopathy who underwent examination at a specialist university clinic employing a modified Heidelberg Retina Angiograph, using two different light sources of 488 and 514 nm wavelength, were retrospectively reviewed. MPOD images were calculated using modified Heidelberg Eye Explorer software. All images were evaluated by two independent masked graders. Features from FAF and MPOD images were correlated with optical coherence tomography (OCT) imaging findings and inter-grader variability, sensitivity and specificity were calculated using OCT as reference.

Results

Sixty-seven eyes had DMO on OCT. The inter-grader variability was 0.84 for 488 nm FAF, 0.63 for 514 nm FAF and 0.79 for MPOD imaging. Sensitivity and specificity for detection of DMO were 80.6 and 89.7% for 488 nm FAF; 55.2 and 94.8% for 514 nm FAF; and 80.6 and 91.4% for MPOD imaging. In 488 nm FAF and MPOD imaging, DMO was better visualised in comparison with 514 nm FAF imaging, P<0.01. MPOD revealed displacement of macular pigment by intraretinal cysts.

Conclusion

MPOD imaging, and particularly its combination with 488 nm and 514 nm FAF, provides a valuable addition to OCT in the evaluation of DMO and is clinically useful in rapid en-face assessment of the central macula.     

Reconsidering the connection between vitamin D levels and age-related macular degeneration

Purpose

Recent evidence has suggested a correlation between reduced vitamin D levels and delayed angiogenesis and reduced inflammatory response, which are known to have a major role in the development and progression of age-related macular degeneration (AMD).

Design

Cross-sectional study.

Participants

Members of the Maccabi Healthcare Services (MHS, one of the four largest Israeli Health Maintenance Organization) aged ≥60 years, whose vitamin D levels were taken as part of routine examinations between 2000 and 2008.

Methods

All data for this study were obtained from MHS databases that include medical information on 1.8 million subscribers.

Main outcome measures

Serum 25-OH vitamin D levels.

Results

The total study population comprised of 1045 members diagnosed as having AMD, and 8124 as non-AMD, for whom there was information on vitamin D levels. The mean±SD level of 25-OH vitamin D was 24.1±9.41 ng/ml (range 0.8–120) for the AMD patients and 24.13±9.50 ng/ml (range 0.0–120) for the controls (P=ns). One-third (33.6%) of the AMD patients and 32.86% of the controls had a 25-OH vitamin D level <16 ng/ml, and the proportions of tests in which the 25-OH vitamin D level was >74 ng/ml were 0.19 and 0.14%, respectively (P=ns)

Conclusions

No association was detected between vitamin D levels and the presence of AMD in this cross-sectional study. These results raise some doubt about an association between reduced vitamin D levels and the prevalence of AMD.     

Complement factor B polymorphism (rs641153) and susceptibility to age-related macular degeneration:evidence from published studies

AIM

To determine whether single nucleotide polymorphism (SNP) rs641153 is associated with the risk of age-related macular degeneration (AMD), we performed a systematic meta-analysis of 15 eligible studies. SNP in the complement factor B (CFB) gene is considered to have significant association with AMD susceptibility, but there is great discrepancy in these results.

METHODS

The eligible studies were identified by searching the databases of PubMed, EMBASE, and Web of Science. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the association. All data were analyzed using Stata software.

RESULTS

The association between rs641153 and AMD risk was statistically significant under the homozygous model (AA vs GG:OR=0.26, 95%CI=0.15-0.45, P_h=0.973, I²=0.0%, fixed effects), dominant model (AA+GA vs GG:OR=0.49, 95%CI=0.40-0.59, P_h=0.004, I²=56.4%, random effects) and recessive model (AA vs GA+GG:OR=0.30, 95%CI=0.17-0.51, P_h=0.983, I²=0.0%, fixed effects). The same results were also observed in the stratified analyses by ethnicity, source of control and sample size.

CONCLUSION

Our meta-analysis suggests that rs641153 in the CFB gene may play a protective role in AMD susceptibility, the late AMD in particular, both in Caucasians and in Asians.     

Heritability of the spatial distribution and peak density of macular pigment: a classical twin study

Purpose

To elucidate the heritability of peak density and spatial width of macular pigment (MP) using a Classical Twin Study.

Methods

Fundus autofluorescence images were obtained at 488 nm from 86 subjects or 43 twin pairs (21 monozygotic (MZ) and 22 dizygotic (DZ)) (27 male, 59 female) aged from 55 to 76 years (mean 62.2±5.3 years). The relative topographic distribution of MP was measured using a grey scale of intensity (0–255 units) in a 7° eccentricity around the fovea. Relative peak MP density (rPMPD) and relative spatial distribution of MP (rSDMP) were used as the main outcome measure in the statistical analysis.

Results

A significantly higher correlation was found within MZ pairs as compared with that within DZ pairs for rPMPD, (r=0.99, 95% confidence interval (95% CI) 0.93 to 1.00) and 0.22, 95% CI −0.34 to 0.71), respectively, suggesting strong heritability of this trait. When rSDMP was compared, there was no significant difference between the correlations within MZ pairs (r=0.48, 95% CI −0.02 to 0.83) and DZ pairs (r=0.63, 95% CI 0.32 to 0.83), thus rSDMP is unlikely to have a considerable heritable component. In addition, there was no difference between any MP parameter when normal maculae were compared with early age-related macular degeneration (AMD) (rPMPD 0.36 vs 0.34, t=1.18 P=0.243, rSDMP 1.75 vs 1.75, t=0.028 P=0.977).

Conclusions

rPMPD is a strongly heritable trait whereas rSDMP has minimal genetic influence and a greater influence by environmental factors. The presence of macular changes associated with early AMD did not appear to influence any of these pigment parameters.     

Brain-derived neurotrophic factor in patients with advanced age-related macular degeneration

AIM: To investigate the serum level of the brain-derived neurotrophic factor (BDNF) in age-related macular degeneration (AMD) and healthy control subjects. The disruption in the tight balance of neuroinflammatory and neuroprotective processes in an immune-privileged site like retina is proposed to contribute to the pathogenesis of AMD. One of the main neuroprotective mediators in the central nervous system is BDNF with its serum level notably affected in several neurodegenerative disorders.METHODS:Thirty-six patients with AMD and 36 age-matched controls were enrolled in this study. The serum level of BDNF was measured using the enzyme-linked immunosorbent assay method. Results were analyzed to compare case and control values. Comparisons were also made between the BDNF level of wet- vs dry-AMD, and male vs female patients and controls. Analysis of variance (ANOVA) and Student’s t-test were employed to analyze the data.RESULTS: The mean BDNF levels in AMD group were significantly higher than the control group. Furthermore, our analysis revealed greater BDNF values in all AMD subgroups compared to controls (P=0.004, 0.005, 0.001 and 0.02 for male wet-AMD, male dry-AMD, female wet-AMD and female dry-AMD vs controls, respectively). The BDNF level however did not vary between wet- and dry-AMD patients (P=0.74). While within-group comparisons in males and females of AMD and control groups did not show any difference in BDNF (P=0.16, 0.64 and 0.85 for wet-AMD, dry-AMD and control groups, respectively), between-group data showed a higher mean BDNF in both male and female AMD subjects than their peer controls.CONCLUSION: This study demonstrated that the serum BDNF level is different in patients with AMD as compared to subjects without AMD. Future attempts should be done to unravel beneficial or deleterious effect of this neurotrophin in the pathogenesis of AMD.     

Macular pigment optical density measurements: evaluation of a device using heterochromatic flicker photometry

Purpose

Accurate assessment of the amount of macular pigment (MPOD) is necessary to investigate the role of carotenoids and their assumed protective functions. High repeatability and reliability are important to monitor patients in studies investigating the influence of diet and supplements on MPOD. We evaluated the Macuscope (Macuvision Europe Ltd., Lapworth, Solihull, UK), a recently introduced device for measuring MPOD using the technique of heterochromatic flicker photometry (HFP). We determined agreement with another HFP device (QuantifEye; MPS 9000 series: Tinsley Precision Instruments Ltd., Croydon, Essex, UK) and a fundus reflectance method.

Methods

The right eyes of 23 healthy subjects (mean age 33.9±15.1 years) were measured. We determined agreement with QuantifEye and correlation with a fundus reflectance method. Repeatability of QuantifEye was assessed in 20 other healthy subjects (mean age 32.1±7.3 years). Repeatability was also compared with measurements by a fundus reflectance method in 10 subjects.

Results

We found low agreement between test and retest measurements with Macuscope. The average difference and the limits of agreement were −0.041±0.32. We found high agreement between test and retest measurements of QuantifEye (−0.02±0.18) and the fundus reflectance method (−0.04±0.18). MPOD data obtained by Macuscope and QuantifEye showed poor agreement: −0.017±0.44. For Macuscope and the fundus reflectance method, the correlation coefficient was r=0.05 (P=0.83). A significant correlation of r=0.87 (P<0.001) was found between QuantifEye and the fundus reflectance method.

Conclusions

Because repeatability of Macuscope measurements was low (ie, wide limits of agreement) and MPOD values correlated poorly with the fundus reflectance method, and agreed poorly with QuantifEye, the tested Macuscope protocol seems less suitable for studying MPOD.     

Dietary and lifestyle risk factors associated with age-related macular degeneration: A hospital based study

Aim:

To establish the frequency, associations and risk factors for age-related macular degeneration (AMD) in hospital population of South India.

Materials and Methods:

In this cross-sectional hospital based study, 3549 subjects (2090 men and 1459 women) above 45 years of age were screened randomly for AMD. Participants underwent ocular evaluation and were interviewed for lifestyle variables and dietary intake of carotenoids by structured food frequency questionnaire. AMD was defined according to the international classifications and grading system.

Results:

Either form of AMD was detected in 77 (2.2%) participants. Of which, early and late AMD was present in 63 (1.8%) and 14 (0.4%) subjects, respectively. Binary logistic analysis showed that the incidence of AMD was significantly higher with increasing age (Odds ratio [OR] 1.17; 95% CI 1.13-1.22) and diabetes (OR 3.97; 95% CI 2.11-7.46). However, AMD was significant among heavy cigarette smokers (OR 5.58; 95% CI 0.88-7.51) and alcoholics (OR 4.85; 95% CI 2.45-12.22). Dietary lutein/zeaxanthin (L/Z) and β-carotene intake were associated (P < 0.001) with the reduction in risk for AMD, with an OR of 0.38 and 0.65, respectively.

Conclusions:

Higher dietary intake of carotenoids, especially L/Z, was associated with lower risk for AMD. Risk of AMD is higher with increasing age and was prevalent among subjects with diabetes. Cessation of smoking and alcohol may reduce the risk of AMD in this population.     

Comparing fixation location and stability in patients with neovascular age-related macular degeneration treated with or without Ranibizumab

Purpose

To compare fixation location and stability in patients with neovascular age-related macular degeneration (AMD) treated with or without ranibizumab.

Methods

Patients were recruited from the Macular Clinic of the King''s College Hospital in London. Two groups of patients with neovascular AMD with at least 12 months of follow-up were included in the study. The treated group was treated with ranibizumab while the untreated group did not have any treatment. Best corrected visual acuity (BCVA) with modified ETDRS chart, fixation location and stability as measured with Nidek MP1, central retinal thickness as measured by Zeiss Cirrus SD-optical coherent tomography (OCT), and lesion size as measured by Topcon TRC-50IX camera were analysed and correlated.

Results

In total, 102 eyes were included in the study with 76 in the ranibizumab-treated group and 26 in the untreated group. There were no significantly demographic differences between the two groups. However, as expected, the treated group has significantly better vision (48.5 vs15.5 letters, P<0.0001) and smaller lesions (10.8 vs18.3 mm², P=0.004), the central macular thickness as measured by OCT also showed a trend of normalised macular thickness (252 vs282 microns, P=0.07). The location of fixation was significantly more central in the ranibizumab-treated group (χ² 17.9, P<0.0001) with over 50% of eyes with predominantly central fixation. Majority (84.6%) of the patients in the untreated group had predominantly eccentric fixation. Fixation stability was significantly better in the ranibizumab-treated group as compared with the untreated group, using both the software provided by the MP1 machine (χ² 21.8, P<0.0001) and the mean log bivariate contour ellipse area calculated from the raw data obtained from the machine (3.64 vs4.39 in treated and untreated group respectively, P<0.0001).

Conclusion

Low vision rehabilitation strategy for this group of patients in the ranibizumab era will be very different from those used in untreated patients with dense central scotoma. Further studies on the visual rehabilitation in the ranibizumab-treated patients should consider fixation characteristics of the patients.     

Development of polypoidal lesions in age-related macular degeneration

Purpose

To investigate the development of polypoidal lesions using indocyanine green angiography (IA) in eyes with typical age-related macular degeneration (AMD).

Methods

We retrospectively reviewed the medical records of 47 consecutive patients (47 eyes) with typical AMD who had been followed up with IA for at least 2 years.

Results

At the initial visit, although all eyes showed classic and/or occult choroidal neovascularization (CNV) associated with AMD, no eyes showed polypoidal lesions by IA. However, during follow-up, 13 (27.7%) of the 47 eyes did show polypoidal lesions. All polypoidal lesions developed at the edge of persistent CNV or, more often, at the terminus of recently progressed CNV. Of 12 eyes with a final lesion area >8 disc area, 7 (58.3%) showed newly developed polypoidal lesions. In the eyes with these newly developed polypoidal lesions, the mean area of the vascular lesion had extended significantly from 10.50±7.88 mm² to 20.87±10.21 mm² during follow-up (P=0.0018).

Conclusion

The current observation suggests that IA of active AMD sometimes reveals polypoidal lesions if there is progression of the CNV in the subretinal pigment epithelium space.     

Detection of progressive macular thickness loss using optical coherence tomography in glaucoma suspect and glaucomatous eyes

Aims

To examine the rate of macular thickness loss using time-domain optical coherence tomography (OCT) in functionally progressing versus non-progressing eyes, determined by standard automated perimetry (SAP).

Methods

Glaucoma suspects (GS) and glaucomatous (G) eyes underwent SAP and OCT imaging every 6 months. Functional progression was determined using pointwise linear regression, defined as 2 contiguous locations losing ≥1.0 dB/year at P<1.0% in the same hemifield. The annual rate of macular thickness loss was calculated from inner and outer regions of the macular map.

Results

72 eyes (43 GS and 29G) with ≥30 months of follow-up were enroled. Fourteen eyes demonstrated SAP progression. The annual rate of macular thickness loss (μm/year) in progressing eyes was faster (all P<0.05) than non-progressing eyes in temporal outer (−1.90±2.97 vs 0.33±2.77), nasal inner (−1.70±2.66 vs 0.14±2.76), superior inner (−2.15±4.57 vs 0.51±2.99), temporal inner quadrants (−2.58±5.05 vs −0.38±2.34), and the average of inner macular quadrants (−1.84±2.90 vs 0.03±2.10). The rate of loss in the nasal inner (P=0.02) and temporal outer (P=0.02) macular regions was associated with optic disc haemorrhage.

Conclusions

Eyes with SAP progression have significantly greater rates of macular thickness loss consistent with glaucomatous retinal ganglion cell atrophy, as compared with non-progressing eyes.     

Age-related macular degeneration and protective effect of HMG Co-A reductase inhibitors (statins): results from the National Health and Nutrition Examination Survey 2005–2008

Purpose

To determine the association of hydroxymethylglutarylcoenzyme A (HMG Co-A) reductase inhibitor (statin) use with the prevalence of age-related macular degeneration (AMD).

Methods

This cross-sectional study included 5604 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008, ≥40 years of age, who were ascertained with regard to the diagnosis of AMD, the use of statins, and comorbidities and health-related behaviors such as smoking.

Results

The mean age of participants denying or confirming a history of AMD was 68 (SEM 0.90) and 55 (SEM 0.36) years, respectively. Individuals 68 years of age or older who were classified as long-term users of statins had statistically significant less self-reported AMD (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.49–0.84; P=0.002), after adjusting for potential confounding variables. No significant association was found between the prevalence of AMD and statin consumption among subjects between 40 and 67 years of age (OR 1.61, 95% CI 0.85–3.03; P=0.137).

Conclusions

Our results suggest a possible beneficial effect of statin intake for the prevention of AMD in individuals 68 years of age or older.     

Visual function 5 years or more after macular translocation surgery for myopic choroidal neovascularisation and age-related macular degeneration

Purpose

To evaluate the changes in the best-corrected visual acuity (BCVA) after 1 year and after ≥5 years after macular translocation for age-related macular degeneration (AMD) or myopic choroidal neovascularisation (mCNV).

Methods

The medical records of 61 consecutive patients who underwent macular translocation with 360° retinotomy for AMD (35 eyes) or mCNV (26 eyes) were reviewed. Overall, 40 patients, 17 mCNV and 23 AMD, were followed for at least 5 years. BCVA and area of the Goldmann visual field (VF) measured before, 12 months after surgery, and at the final visit.

Results

In the 23 AMD eyes followed for ≥5 years, the mean preoperative BCVA was 1.149±0.105 logMAR units, which significantly improved to 0.69±0.06 logMAR units at 1 year (P<0.001). This BCVA was maintained at 0.633±0.083 logMAR units on their final examination. In the 17 eyes with mCNV followed for ≥5 years, the mean preoperative BCVA was 1.083±0.119 logMAR units, which was significantly improved to 0.689±0.121 logMAR units at 1 year (P=0.001). This BCVA was maintained at 0.678±0.142 logMAR units on their final examination. The area of the VF was significantly decreased at 12 months and did not change significantly thereafter.

Conclusions

Our results show that macular translocation surgery significantly improves the BCVA and significantly decreases the VF area of eyes with mCNV or AMD after first 1 year. The BCVA and VF area do not change significantly from the values at 1 year for at least 5 years.     

Validity of EuroQOL-5D, time trade-off, and standard gamble for age-related macular degeneration in the Singapore population

Background/aims

Utility values of age-related macular degeneration (AMD) in Asian patients are unknown. This study aims to assess utility values and construct validity of the EuroQOL-5D (EQ-5D), time trade-off (TTO), and standard gamble (SG) instruments in the Singapore multi-ethnic AMD population.

Methods

Cross-sectional, two-centre, institution-based study. Visual acuity (VA), clinical AMD severity, and utility scores on the EQ-5D, TTO, and SG were obtained from 338 AMD patients. VA was analysed in terms of the better-seeing eye (BEVA), worse-seeing eye (WEVA), and weighted average of both eyes (WVA). We evaluated SG on the perfect health-death (SG(death)) and binocular perfect vision-binocular blindness (SG(blindness)) scales. Construct validity was determined by testing a priorihypotheses relating the EQ-5D, TTO, and SG utility scores to VA and clinical AMD severity.

Results

The mean utilities on the EQ-5D, TTO, SG(death), and SG(blindness) were 0.89, 0.81, 0.86, and 0.90, respectively. EQ-5D scores correlated weakly with BEVA, WEVA, and WVA (Pearson''s correlation coefficients −0.291, −0.247, and −0.305 respectively, P<0.001 for all). SG(death) and SG(blindness) demonstrated no correlation with BEVA, WEVA, or WVA (Pearson''s correlation coefficients, range −0.06 to −0.125). TTO showed weak association only with WEVA and WVA (correlation coefficients −0.237, −0.228, P<0.0001), but not with BEVA (correlation coefficient −0.161). Clinical AMD severity correlated with EQ-5D and SG(death), but not with TTO and SG(blindness) (P=0.004, 0.002, 0.235, and 0.069, respectively).

Conclusions

AMD has a negative impact on utilities, although utility scores were high compared with Western cohorts. EQ-5D, TTO, and SG showed suboptimal construct validity, suggesting that health status utilities may not be sufficiently robust for cost-utility analyses in this population.     

Comparison of visual acuity outcomes between ranibizumab and bevacizumab treatment in neovascular age-related macular degeneration

AIM: To compare visual acuity (VA) outcomes between intravitreal injection of bevacizumab and ranibizumab in the treatment of neovascular age-related macular degeneration (AMD). METHODS: We conducted a consecutive, retrospective case series study in patients with newly diagnosed all type choroidal neovascularization (CNV) secondary to AMD who received an intravitreal injection of bevacizumab (1.25mg) or ranibizumab (0.3mg) at Lions Eye Institute, Western Australia from Mar. 2006 to May 2008. All patients received injection at baseline with additional monthly injections given at the discretion of the treating physician. Main outcome measures were changes in VA. RESULTS: There were 371 consecutive patients received injection at least in one eye with at least 6 months of follow up (median of 12.0 months). Bevacizumab treatment prevented 221 out of 278 (79.5%) patients from losing < 15 letters in VA compared with 79 out of 93 (84.9%) of ranibizumab treated patients (P=0.25). While 68 (24.5%) of bevacizumab treated patients gained ≥15 letters of VA compared with 24 (25.8%) of ranibizumab treated patients (P=0.79). 75.3% and 66.2% patients benefited from ranibizumab and bevacizumab respectively with final VA better than 6/60 (P=0.10). Multivariate analysis showed that pre-treatment VA was negatively associated with benefit outcome. Assignment of injection was not associated with VA outcome of benefit after adjusting the covariate (P=0.857). CONCLUSION: There are no difference in treatment efficacy in terms of VA between bevacizumab and ranibizumab in routine clinical condition.     

Macular atrophy after combined intravitreal triamcinolone and photodynamic therapy to treat choroidal neovascularization

AIM: To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) to treat choroidal neovascularization (CNV) associated with age related macular degeneration (AMD). METHODS: The present study was retrospective about non-randomized interventional case series. Fifty-one consecutive eyes with subfoveal (all types) CNV associated with AMD were treated by PDT and intravitreal (19.4±2.1)mg per 0.1mL TA at the Alicante Institute of Ophthalmology. The appearance of macular choriocapillaris and retinal pigment epithelium (RPE) atrophy was considered at two years follow-up. Thirty consecutive eyes treated by PDT alone, matched for age, sex, and type and size of CNV were considered as control group. RESULTS: Twenty-one of 47 eyes in the study group (45%) and 7 of 30 eyes in the control group (23%) developed macular RPE and choriocapillaris atrophy in the treated area at month 24 (P=0.04, Chi-square test). The greatest diameter of the atrophic areas averaged (5044±1666)μm in the study group vs (4345±1550)μm in the control group. Mean final best corrected visual acuity (logarithm of minimal angle of resolution) was (0.87±0.33) in the cases with RPE atrophy vs (0.66±0.26) in the cases with no RPE atrophy in the study group (P=0.11, Mann-Whitney U test). CONCLUSION: The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.     

Variability of subfoveal choroidal thickness measurements in patients with age-related macular degeneration and central serous chorioretinopathy

Purpose

To evaluate the variability in subfoveal choroidal thickness measurements in patients with age-related macular degeneration (AMD) and central serous chorioretinopathy using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods

One hundred and sixty eyes of 160 patients who were diagnosed with early AMD (N=40), exudative AMD (N=40), polypoidal choroidal vasculopathy (PCV, N=40), or central serous chorioretinopathy (CSC, N=40) were included in this retrospective observational study. In addition, we included 40 normal eyes of 40 subjects. Subfoveal choroidal thickness was measured manually by two masked observers based on EDI-OCT images. The correlation of choroidal thickness with the absolute value of the difference in the choroidal thickness measurement was estimated for all 200 eyes. Intraobserver and interobserver coefficients of repeatability (CRs) were calculated.

Results

There was a significant positive correlation between subfoveal choroidal thickness and both intraobserver (P<0.001) and interobserver (P<0.001) difference in choroidal thickness measurements. The mean intraobserver CRs in nonexudative AMD, exudative AMD, PCV, CSC, and normal eyes were ∼15–21, 23–29, 24–35, 32–38, and 19–25 μm, respectively. The mean interobserver CRs were ∼24–28, 30–36, 39–45, 46–57, and 26–35 μm, respectively.

Conclusions

Relatively great measurement variability should be considered when investigating eyes with pathologic conditions related to a thick choroid, including PCV or CSC.     

Low-fluence photodynamic therapy combinations in the treatment of exudative age-related macular degeneration

AIM: To compare the efficacy of low-fluence photodynamic therapy (PDT) combinations in the treatment of age-related macular degeneration (AMD). METHODS: Forty-five previously untreated eyes of 45 patients with exudative AMD whose best-corrected visual acuity (BCVA) was ≥0.3 (Snellen) were enrolled. 15 patients in Group I underwent low-fluence PDT (25J/cm2-300mW/cm2-83sec) and intravitreal pegaptanib combination, 15 patients in Group II underwent PDT (50J/cm2-600mW/cm2-83sec) and intravitreal pegaptanib combination while, 15 patients in Group III underwent intravitreal pegaptanib monotherapy. Complete ophthalmologic examinations were performed in pre and post treatment visits, and the results were statistically analised. A clinical activity score (CAS) was calculated by using changes in lesion size, amount of hemorrhage, staining pattern in FA and OCT measurement of intra/subretinal fluid. ≤ 3 logMAR lines of decrease in BCVA and decrease in CAS were considered as successful treatment. RESULTS: The mean age of 19 female (42.2%) and 26 male (57.8%) patients was 72.82±8.02 years. Mean follow-up was 13.93±5.87 months. Lesion type was occult in 28 eyes (62.2%). Treatment success rates according to BCVA assessments were 86.7%, 80%, 60% and mean BCVA decrease were 0.3, 1.0, 2.2 logMAR lines in Group I, II and III, respectively (P>0.05). According to the changes in central macular thickness and CAS, no difference was found among the study groups (P=0.850 and P=0.811, respectively). Patients treated with combination regimens had lower intravitreal injection frequencies (P=0.015). CONCLUSION: Combination regimen with intravitreal pegaptanib and low-fluence PDT seems to be safe and effective in stabilizing the clinical activity and BCVA in exudative AMD.     

Association between complement factor I gene polymorphisms and the risk of age-related macular degeneration: a Meta-analysis of literature

AIM: To systematically review the association between complement factors I (CFI) polymorphisms and age-related macular degeneration (AMD) and to explore whether CFI polymorphisms are associated with AMD. METHODS: Meta-analysis of articles published from 1995 to January 2015 of articles involved with AMD and polymorphisms of the CFI gene. Eligible data were pooled in a Meta-analysis, analyzing using STATA software (version 12.0), Review Manager (version 5.2) and different models based on the heterogeneity of effect sizes. Egger’s test, Begg’s rank correlation methods were used to evaluate for publication bias. RESULTS: Thirteen articles were eligible, describing two loci polymorphisms of the CFI gene (of which 12 articles focus on rs10033900T>C and 3 articles focus on rs2285714C>T). For rs10033900T>C, the results of our study revealed that having a mutant allele C, TC, CC and TC+CC was associated with a decreased risk of AMD in all population groups studied (C versus T models, OR=0.84, 95%CI: 0.72-0.99, P=0.04; TC versus TT models OR=0.89, 95%CI: 0.88-0.99, P=0.04; CC versus TT models, OR=0.76, 95%CI: 0.60-0.98, P=0.03; TC+CC versus TT models, OR=0.81, 95%CI:0.65-0.99, P=0.04). We found that C allele were related to lower AMD risk in the Caucasian population by subgroup analysis, but there was no association with AMD under the allele and genotypes comparison in Asian studies. For rs2285714 C>T, the TC, TT genotypes contributed to a higher risk of AMD, compared with the CC carriers and TC+CC (OR=1.34, 95%CI: 1.09-1.63, P=0.004; OR=1.50, 95%CI: 1.25-1.80, P<0.0001). CONCLUSION: This Meta-analysis suggests that CFI rs10033900T>C and rs2285714C>T polymorphisms may contribute to AMD.