Correlation between optical coherence tomographic hyperreflective foci and visual outcomes after intravitreal bevacizumab for macular edema in branch retinal vein occlusion

Purpose

To investigate the correlation between hyperreflective foci (HF) on spectral-domain optical coherence tomography at baseline and visual outcomes after intravitreal bevacizumab injection (IVB) in branch retinal vein occlusion.

Methods

We retrospectively studied 97 eyes of 97 patients with macular edema secondary to BRVO, who were treated with IVB. The eyes were divided into three groups according to the location of HF on SD-OCT: HF in outer retinal layers, HF in inner retinal layers, and no HF. The baseline and final best-corrected visual acuity (BCVA), foveal thickness (FT), external limiting membrane (ELM) status, junction between photoreceptor inner and outer segments (IS/OS) status, and the number of HF were evaluated and compared among three groups.

Results

Baseline BCVA was correlated with baseline FT (R?=?0.366, p?R?=??0.008, p?=?0.942). Baseline BCVA was significantly better in eyes with intact ELM at baseline (p?=?0.006), and final BCVA was significantly better in eyes with intact ELM and IS/OS at final visit (p?p?=?0.003 respectively). At the final visit, 15 of 37 eyes (40.5 %) with HF in outer retinal layers had a disrupted ELM (p?=?0.001), while 28 of 37 eyes (75.7 %) with HF in outer retinal layers had a disrupted IS/OS (p?p?Conclusions HF on SD-OCT at baseline might predict the photoreceptor status and final VA after IVB in BRVO.     

Recovery of photoreceptor outer segments after anti-VEGF therapy for age-related macular degeneration

Purpose

To evaluate whether the status of the external limiting membrane (ELM) or inner segment/outer segment junction (IS/OS) improves after intravitreal injection of ranibizumab for age-related macular degeneration (AMD). We also evaluated whether the pre-operative values of these parameters are associated with the visual prognosis.

Methods

This was a hospital-based, cross-sectional study. Seventy-six eyes of 76 treatment-naive AMD patients who received three monthly intravitreal injections of ranibizumab followed for more than 6 months with additional as-needed injections were investigated. Spectral domain OCT was used to evaluate the length of ELM, IS/OS, and foveal thickness pre- and post-operatively. Changes of ELM and IS/OS length were evaluated postoperatively. Correlation coefficients between pre-operative parameters and post-operative visual acuity were also analyzed.

Results

Significant changes were noted in mean logMAR (0.66 to 0.53), foveal thickness (231.1 to 151.1 μm), and IS/OS length (514.9 to 832.3 μm) after the treatment. ELM length did not improve significantly (1,312.4 to 1,376.7 μm). Restoration of IS/OS occured where ELM is retained. Although pre-operative ELM length, IS/OS length, and foveal thickness showed correlation with post-operative logMAR (R?=?–0.51, –0.39, and 0.46, respectively), the most powerful predictive factor for visual prognosis was pre-operative logMAR (R?=?0.77, p?<?0.001).

Conclusions

IS/OS status improves in response to anti-VEGF therapy but ELM seems to have less plasticity. The status of IS/OS and ELM can be used as prognostic factors but the predictive power is inferior to that of baseline visual acuity.     

Restoration of the photoreceptor layer and improvement of visual acuity in successfully treated optic disc pit maculopathy: a long follow-up study by optical coherence tomography

Purpose

To investigate by optical coherence tomography (OCT) the evolution of the photoreceptor layer and its association with best-corrected visual acuity (BCVA) in optic disc pit (ODP) maculopathy after successful surgical treatment.

Methods

Fourteen eyes of 14 patients were included in this study, and followed up from 36 to 95?months (mean 57.36 ± 18.32?months). The follow-up period started at the time of complete subretinal fluid absorption. Examination was performed by time-domain OCT before and after treatment. Spectral-domain OCT was used after treatment. Parameters assessed were type of elevation, central foveal thickness, time elapsed from onset to treatment, type of treatment, BCVA, and inner segment outer segment (IS/OS) junction line. The IS/OS junction was characterized after treatment as intact, interrupted, or absent (not distinguishable).

Results

Significant restoration of the IS/OS junction line was first noticed between 6 and 12?months after fluid absorption (p?=?0.02; Wilcoxon signed rank test). Restoration was continuous up to the 24th month of postoperative examination after fluid absorption (p?=?0.14; Wilcoxon signed rank test). BCVA was 0.99 ± 0.38 logMar before treatment, 0.81 ± 0.26 logMar (p?=?0.011; paired t-test) immediately after fluid absorption and 0.61 ± 0.33 logMar (p?=?0.026; one-way ANOVA) 24?months after fluid resolution. BCVA was significantly positively correlated with the integrity of the IS/OS junction line during follow-up (Pearson r?=?0.775; p?<?0.001).

Conclusions

The IS/OS junction restoration cannot be detected immediately after fluid resolution in the majority of cases. It became evident 6–12?months later and was completed 24?months after fluid absorption. Improvement in BCVA was noticed only during the first 2?years of follow-up. No significant changes were noticed in BCVA or the IS/OS line after 2?years. Among the studied variables, the final photoreceptor layer condition and BCVA immediately after fluid absorption are the main factors predicting final BCVA after successful surgical treatment of ODP maculopathy.     

External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy

Background

To evaluate the predictors of visual improvement using spectral-domain optical coherence tomography (SD-OCT) in eyes with resistant diabetic macular edema (DME) treated with pars plana vitrectomy.

Methods

Thirty-four eyes with resistant DME were evaluated in a retrospective manner. Several SD-OCT variables including photoreceptor inner segment/outer segment (IS/OS) junction, external limiting membrane (ELM) integrity, and central macular thickness (CMT) before and after the surgery, were evaluated by two experienced observers, masked to visual acuity. The visual improvement was used as the outcome measure for a stepwise regression, while the OCT factors were used as predictors.

Results

The strongest predictor of vision improvement was pre-operative damage to the ELM (p?=?0.0277) compared to IS/OS junction (p?=?0.03). Pretreatment central macular thickness was a very weak predictor (p?=?0.18) of visual improvement. For each percentage increase of ELM integrity there was a 0.13 letter gain in vision. ELM integrity explained 16% of the visual acuity improvement after treatment, which rose to 21% with the addition of CMT. The addition of IS/OS junction in the model did not add predictive information.

Conclusions

Evaluation of ELM preoperatively predicts the vision improvement more accurately than the IS/OS junction and CMT in eyes with DME.     

Restoration of macular structure as the determining factor for macular hole surgery outcome

Objective

The aim of this work is to evaluate the preoperative and postoperative spectral domain optical coherence tomography (SD-OCT) findings as predictors of visual acuity for macular hole (MH) surgery.

Methods

Fifty eyes of 46 patients diagnosed with MH and that had undergone 25-g vitrectomy with internal limiting membrane peeling were included in this retrospective study. A complete clinical examination and SD-OCT were performed before and after surgery. Three groups were considered on the basis of the postoperative integrity of photoreceptor inner and outer segment (IS-OS) junction and the external limiting membrane (ELM): group A (11 eyes, both lines disrupted), group B (ten eyes, disrupted IS/OS line and complete ELM), and group C (29 eyes, both lines restored).

Results

LogMAR BCVA improved significantly after surgery from an average 0.60?±?0.29 to 0.19?±?0.19 (p?p≥0.18). Postoperative BCVA was significantly better in group C compared to groups A and B (p?≤?0.01). A significant correlation was found between ELM restoration and postoperative BCVA (r?=?–0.63, p?r?=?–0.55, p?Conclusions Outer retina restoration seems to be the best determining factor for a good visual rehabilitation after MH surgery.     

Spectral domain ocular coherence tomography findings pre- and post vitrectomy with fibrovascular membrane delamination for proliferative diabetic retinopathy

Purpose

To describe the intraretinal microstructure using serial spectral domain optical coherence tomography (SD-OCT) preceding and following pars plana vitrectomy and delamination of fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR).

Methods

This retrospective, interventional case series includes 28 eyes. Outcome measures included LogMAR distance best-corrected visual acuity (BCVA), SD-OCT integrity of photoreceptor inner and outer segments junction (IS/OS), and integrity of external limiting membrane (ELM).

Results

Pre-operative central macular thickness (CMT) was significantly correlated with the final post-operative LogMAR BCVA (Pearson''s coefficient r=0.89; P=0.001). The eyes were categorised into three groups based on post-operative IS/OS integrity (group 0: IS/OS intact; group 1: IS/OS irregular but not completely disrupted; group 2: IS/OS completely disrupted). Mean BCVA improved significantly in group 0 (n=9) from 1.13±0.75 preoperatively to 0.34±0.21 (Student''s t-test: P=0.06), in group 1 (n=10) the BCVA improved from 0.88±0.56 to 0.58±0.31 (Student''s t-test: P=0.053) and in group 2 (n=9) the BCVA improved from 1.64±0.53 to 1.53±0.75 (Student''s t-test: P=0.652).IS/OS integrity and ELM integrity at 3 months post operatively, were significantly and positively correlated with final BCVA (Pearson''s coefficient: r=0.83, P<0.001 and r=0.72, P<0.001, respectively).

Conclusions

Pre-operative CMT and post-operative disruption of the IS/OS and ELM are useful prognostic indicators in fibrovascular delamination surgery for patients with PDR.     

Long-term chorioretinal changes after photodynamic therapy for chronic central serous chorioretinopathy

Purpose

To evaluate morphological and functional chorioretinal changes 5 years after standard photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).

Methods

A retrospective, nonrandomized study, including patients with chronic CSC treated with standard PDT and followed for at least 60 months. All patients underwent a complete ophthalmological examination, and the location and number of treatments were registered. Five or more years after treatment, subfoveal and non-subfoveal treated areas were evaluated with Spectralis optical coherence tomography and microperimetry.

Results

Seventeen eyes of 15 patients were included, with mean age of 48.3?±?8.4 years and a mean follow-up of 80.6?±?12.4 months (range from 62 to 104 months). All eyes had neurosensory detachment (NSD) at baseline. Treatment was performed under the fovea in 58.8 % and in a non-foveal area in 41.2 % of the eyes. At the final visit all eyes had resolution of the NSD, with a statistical significant reduction in central macular thickness (p?=?0.005) and preserved neuroretinal thickness (p?=?0.839). There was a statistical difference between initial and final BCVA (p?<?0.001) and a mean gain of 8.4?±?7.8 letters. Subfoveal morphological changes in external limiting membrane (ELM) and in photoreceptor inner and outer segment junction (IS/OS) were correlated with final BCVA (p?=?0.015 and p?=?0.014 respectively), but not with the variation of BCVA. There was a statistical correlation between morphological changes in IS/OS line and retinal sensitivity in the central 12° and 2° (p?=?0.003 and p?=?0.002 respectively). The morphological changes in the subfoveal layers were not dependent on treatment location (p?=?0.154, p?=?0.644, and p?=?1.0 for ELM, IS/OS line, and retinal pigment epithelium respectively). Subfoveal final mean choroidal thickness was 295.1?±?68.7 μm, and showed no statistical difference from the normal population (p?=?0.633).

Conclusions

Morphological and functional chorioretinal changes, observed 5 or more years after standard PDT for chronic CSC, were not correlated with the location of treatment, neither with the progression of visual acuity or with the location of treatment, and are more likely to be related to the disease itself than with the treatment provided.     

Surgical treatment of lamellar macular hole secondary to epiretinal membrane

Background

To examine the surgical results of lamellar macular hole (LMH) secondary to epiretinal membrane (ERM).

Methods

A 3-year retrospective review was performed of patients with LMH secondary to ERM that underwent ERM and internal limiting membrane (ILM) peeling. The main outcome measures included best-corrected visual acuity (BCVA) and postoperative macular structure. The results were compared with cases of idiopathic ERM with similar baseline demographic characteristics.

Results

Thirty eyes in 30 patients were collected. The mean BCVA improvement was 3.4 Snellen lines after a mean follow-up period of 16.9 months. Optical coherence tomography (OCT) showed improved macular contour in 27 cases. Patients with intravitreal gas tamponade exhibited a higher percentage of restoration of macular contour than those without (P?=?0.016). Final BCVA was correlated with an intact photoreceptor inner segment–outer segment (IS–OS) junction (P?=?0.03). The degree of visual improvement is less than that observed in idiopathic ERM patients.

Conclusion

In LMH secondary to ERM with significant visual decrease, ERM and ILM peeling may improve BCVA. Postoperative gas tamponade is associated with better restoration of macular configuration. Final BCVA is related to an intact photoreceptor IS–OS junction rather than to the normalization of the macular contour.     

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6‐month follow‐up – The SOLO study

Purpose:  To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. Methods:  The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24‐week period. Slit‐lamp biomicroscopy, measurement of best‐corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral‐domain optical coherence tomography (SD‐OCT) were performed at baseline and at every follow‐up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti‐VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. Results:  In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow‐up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow‐up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow‐up visit. Conclusions:  Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.     

Optical coherence tomography study of foveal microstructure after successful retinal detachment surgery

PurposeTo evaluate foveal anatomical abnormalities after the successful repair of rhegmatogenous retinal detachments (RRDs) and to investigate the relationship between foveal microstructural changes and postoperative best-corrected visual acuity (BCVA).Materials and methodsThis study was a retrospective consecutive case series comprising all RRD patients with anatomical reattachment performed by a single surgeon from January 2009 to June 2010. Complete medical and ophthalmic histories, BCVA, duration of symptoms, number of breaks, extent of the retinal detachment (RD), lens status, and type of surgery were preoperatively recorded. The main outcome measurements for data analysis were postoperative BCVA and optical coherence tomography (OCT) imaging of the foveal microstructure.ResultsClinical data and OCT images were obtained from 83 eyes of 80 patients who underwent successful RRD surgeries. Anatomic foveal abnormalities were identified in 72% of eyes, including disruption of the junction between the inner and outer photoreceptor segments (IS/OS) in 59% of all cases with or without external limiting membrane (ELM) disruptions, residual subretinal fluid (7%), epiretinal membranes (22%), cystoid macular edema (7%), uneven surface (4%), retinal pigment epithelium (RPE) defects (1%), RPE folding (1%), and macular holes (2%). Multiple linear regression analysis showed that the significant factors associated with postoperative BCVA were ELM disruption and macular holes. Foveal photoreceptor layer integrity as determined by OCT imaging after a successful macula-off RD repair was used to classify each eye included in the study into one of three subgroups: intact IS/OS junction and ELM (11), disrupted IS/OS junction but intact ELM (11), and disruption of the IS/OS junction and ELM (37). Mean postoperative BCVA (0.18 ± 0.13 logMAR units, 0.43 ± 0.26 logMAR units, and 0.69 ± 0.42 logMAR units, respectively) was significantly different among these subgroups (p < 0.001).ConclusionOCT is a useful, noninvasive tool for evaluating foveal microstructural abnormalities and predicting visual outcomes after a successful RRD repair.     

Structural Recovery of the Detached Macula after Retinal Detachment Repair as Assessed by Optical Coherence Tomography

Purpose

To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD).

Methods

We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT.

Results

The mean duration of macular detachment was 15.5 ± 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 ± 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017).

Conclusions

Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.     

Visual acuity measured with a smartphone app is more accurate than Snellen testing by emergency department providers

Purpose

To assess the accuracy of best-corrected visual acuity (BCVA) measured by non-ophthalmic emergency department (ED) staff with a standard Snellen chart versus an automated application (app) on a handheld smartphone (Paxos Checkup, San Francisco, CA, USA).

Methods

The study included 128 subjects who presented to the Stanford Hospital ED for whom the ED requested an ophthalmology consultation. We conducted the study in two phases. During phase 1 of the study, ED staff tested patient BCVA using a standard Snellen test at 20 feet. During phase 2 of the study, ED staff tested patient near BCVA using the app. During both phases, ophthalmologists measured BCVA with a Rosenbaum near chart, which was treated as the gold standard. ED BCVA measurements were benchmarked prospectively against ophthalmologists’ measurements and converted to logMAR.

Results

ED logMAR BCVA was 0.21 ± 0.35 (approximately 2 Snellen lines difference ± 3 Snellen lines) higher than that of ophthalmologists when ED staff used a Snellen chart (p?=?.0.00003). ED BCVA was 0.06 ± 0.40 (less than 1 Snellen line ± 4 Snellen lines) higher when ED staff used the app (p?=?0.246). Inter-observer difference was therefore smaller by more than 1 line (0.15 logMAR) with the app (p?=?0.046).

Conclusions

BCVA measured by non-ophthalmic ED staff with an app was more accurate than with a Snellen chart. Automated apps may provide a means to standardize and improve the efficiency of ED ophthalmologic care.

     

特发性黄斑裂孔手术后视力和光感受器内外节连接的变化

目的 观察微创玻璃体切割手术治疗特发性黄斑裂孔（IMH）手术后视力和光感受器内外节连接（IS/OS）的改变。方法 行玻璃体切割手术治疗的连续IMH患者40例40只眼纳入研究。其中，男性12例，女例28例；平均年龄（62.43±5.68）岁；平均病程2.78个月。均行最佳矫正视力（BCVA）、眼压、裂隙灯显微镜联合前置镜检查，眼底彩色照相和频域光相干断层扫描检查。BCVA检查采用标准对数视力表，统计分析时换算为最小分辨角对数（logMAR）视力。患眼BCVA 0.05～0.5，平均logMAR BCVA 0.71±0.19。黄斑裂孔Ⅱ、Ⅲ、Ⅳ期分别为4、16、20只眼。平均黄斑裂孔颈部最小直径（410.13±175.72） μm；平均底部最大直径（775.00±264.77） μm。IS/OS破坏直径618.00～2 589.00 μm，平均破坏直径（1 682.08±484.11） μm。均行23G联合25G微创玻璃体切割手术。手术后平均随访时间33.75个月。观察手术后1、3个月和末次随访时的BCVA、黄斑中心凹结构；分析末次随访logMAR BCVA和IS/OS破坏直径的影响因素及其与随访时间的关系。结果 手术后1、3个月和末次随访平均logMAR BCVA分别为0.49±0.31、0.37±0.26、0.30±0.26。与手术前平均logMAR BCVA比较，差异均有统计学意义（Z=-4.598、-5.215、-5.218， P＜0.05）。手术前logMAR BCVA、黄斑裂孔最小直径与末次随访logMAR BCVA相关（r=0.401、0.392,P＜0.05）；手术前、末次随访IS/OS的破坏直径大小和末次随访logMAR BCVA相关（r=0.339、0.353,P＜0.05）；末次随访时间的长短与末次随访logMAR BCVA、IS/OS破坏直径的大小无相关(r=0.000、0.018，P＞0.05)。末次随访时，黄斑裂孔完全闭合39只眼，占97.5%。IS/OS完全连接32只眼；仍有破坏8只眼。结论 IMH手术后患者视力稳定，IS/OS完全连接率高。     

Intravitreal Anti-vascular Endothelial Growth Factor versus Observation in Acute Central Serous Chorioretinopathy: One-year Results

Purpose

To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) compared with observation for treating acute central serous chorioretinopathy (CSC).

Methods

A retrospective study of 36 patients with acute CSC, including 21 patients treated with anti-VEGF (anti-VEGF group) and 15 patients with observation (observation group). Patients in the anti-VEGF group received a single dose of bevacizumab or ranibizumab at baseline. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) were assessed. The integrity of the foveal inner segment/outer segment (IS/OS) line at 12 months was also analyzed.

Results

Resolution of SRF was achieved in 20 of 21 eyes in the anti-VEGF group and in 12 of 15 eyes in the observation group (p = 0.151). Mean BCVA and CFT were not different between the two groups at 12 months (p > 0.05). The amount of change in BCVA, however, differed significantly between the groups (p = 0.044). Final OCT more frequently detected the foveal IS/OS line in the anti-VEGF group than in the observation group (p = 0.012).

Conclusions

In terms of BCVA, anti-VEGF and observation only had similar therapeutic effects in acute CSC patients. In some patients, however, the rapid resolution of SRF by anti-VEGF might reduce the risk of photoreceptor degeneration and improve long-term visual acuity.     

Why Poor Vision Despite an Attached Retina following Primary Vitrectomy in Egyptian Patients?

Objective: To correlate findings on spectral domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) following primary vitrectomy for rhegmatogenous retinal detachment (RRD). Methods: In this prospective, interventional, non-randomized case series, 71 eyes with RRD of intermediate severity underwent primary vitrectomy followed by SD-OCT one month later. Main outcome measures were inner segment/outer segment (IS/OS) junction line and external limiting membrane (ELM) disruption. Results: All patients achieved reattachment with mean BCVA of 0.77 ± 0.36 logMAR. There was statistically significant correlation between each length of IS/OS and ELM defect on the one hand, and BCVA on the other hand. Conclusion: The extent of IS/OS and ELM disruption explains the poor visual outcome in successful RD surgery with an otherwise normal foveal contour.     

Descemet membrane endothelial keratoplasty in iridocorneal endothelial syndrome and posterior polymorphous corneal dystrophy

Objective

To report the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) in cases of corneal decompensation secondary to iridocorneal endothelial syndrome (ICE) or posterior polymorphous corneal dystrophy (PPCD).

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

AIM: To compare three initial monthly intravitreal ranibizumab (IVR) injections followed by pro re nata (PRN) dosing with one initial monthly IVR injections followed by PRN dosing for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection (1+PRN group) and 24 eyes received 3 monthly IVR injections (3+PRN). At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography (SD-OCT) was performed. Central macular thickness (CMT), the integrity of the external limiting membrane (ELM), the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment (IS/OS) defect were determined. RESULTS: At baseline the mean CMT was 521.3±153.2 µm in the 3+PRN group while it was 438.1±162.4 µm in 1+PRN group. At the final visit, mean CMT was 278.3±87.8 µm in the 3+PRN group and 285.2±74.2 µm in the 1+PRN group (P=0.079). The changes in CMT over the entire study period were also comparable in both groups (243±160 µm in the 3+PRN group, and 152.9±175.3 µm in the 1+PRN group; P=0.090). At baseline, best-corrected visual acuity (BCVA) was 0.92±0.60 logarithm of the minimal angle of resolution (logMAR) in the 3+PRN group, while it was 0.72±0.46 logMAR in the 1+PRN group. Final BCVA was 0.42±0.55 logMAR in the 3+PRN group and 0.38±0.50 logMAR in the 1+PRN group (P=0.979). Additionally, the BCVA changes from baseline to final visit were not significantly different (-0.50±0.45 logMAR in the 3+PRN group, and -0.33±0.39 logMAR in the 1+PRN group; P=0.255). CONCLUSION: No significant differences in the anatomical or functional results are found between 3+PRN and 1+PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.     

Decreased photoreceptor inner segment/outer segment junction reflectivity in patients with idiopathic epimacular membrane

Purpose

To assess the effects of idiopathic epimacular membrane (IEMM) on retinal pigment epithelium (RPE), photoreceptor inner segment/outer segment (IS/OS) junction, and external limiting membrane (ELM) reflectivities to determine functional alterations in these layers using optical coherence tomography (OCT) image analysis.

Methods

Fifty eyes of 50 patients with untreated IEMM and 41 eyes of 41 age- and sex-matched healthy controls with normal OCT scans were retrospectively reviewed. A single masked physician analyzed OCT images randomly. Reflectivity values of RPE, IS/OS junction, and ELM were obtained using ‘plot profile'' mode of a medical image processing computer software.

Results

The study comprised 50 patients with untreated IEMM and age- and sex-matched 41 control subjects (P>0.05). Image analysis demonstrated that IS/OS junction and ELM had significantly lower reflectivity in patients with IEMM compared with those of the control eyes (P=0.008, P=0.009, respectively). However, RPE reflectivity did not differ between two groups (P=0.100). Correlation analyses showed no significant associations between reflectivity values and corrected visual acuity (P>0.05).

Conclusion

In patients with IEMM, photoreceptor IS/OS junction and ELM seem to have lower reflectivity, which might indicate impaired functionality even though these layers are not apparently damaged on OCT imaging.     

Microperimetry,fundus autofluorescence,and retinal layer changes in progressing geographic atrophy

Objective

To analyze correlation among microperimetry, inner and outer retinal layers, and fundus autofluorescence (FAF) changes in eyes with progressing geographic atrophy (GA) secondary to age-related macular degeneration.

Methods

Microperimetry, spectral-domain optical coherence tomography (SD-OCT), standard short-wavelength FAF (SW-FAF), and near-infrared-wavelength FAF (NIR-FAF) were performed for all patients at both baseline and follow-up visits. FAF pattern, integrity of photoreceptor inner segment/outer segment (IS/OS) junction, total retinal thickness (RT), inner retinal layers (IRL), and outer retinal layers (ORL) thickness changes of every microperimetry extrafoveal tested point were analyzed.

Results

A total of 366 microperimetry tested points were analyzed (6 patients, 7 eyes). Mean retinal sensitivity significantly decreased (p = 0.0149), and the percentage of dense scotomas significantly increased (p = 0.0125). Mean RT and mean ORL thickness significantly decreased (both p < 0.0001). Mean IRL thickness significantly increased (p = 0.0001). The decrease of ORL thickness was inversely correlated to the IRL thinning (rho = –0.710). FAF pattern at baseline was correlated to RT and ORL thickness (both p < 0.0001) and was significantly correlated to the risk to evolve to dense scotoma during follow-up (p = 0.0001 at SW-FAF, p < 0.0001 at NIR-FAF). Tested points showing at baseline the loss of photoreceptor IS/OS junction had a greater risk for evolving to dense scotoma compared with those with intact photoreceptor IS/OS junction (odds ratio 3.56, 95% CI 2.41–5.27).

Conclusions

Retinal sensitivity changes are correlated to IRL and ORL thickness changes, and to photoreceptor IS/OS junction integrity. FAF patterns remain a relevant factor in predicting GA evolution. Microperimetry, SW-FAF and NIR-FAF, and SD-OCT should be combined to obtain adequate morphologic and functional prospective information.     

Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence

Background

To review vascularized-pigment epithelial detachment (V-PED) treatment visual outcome, and to assess acute retinal pigment epithelium (RPE) tear incidence.

Methods

One hundred and thirty-two eyes of 125 consecutive patients with age-related macular degeneration and V-PED were included. Ninety-four eyes (71.2%) were associated with choroidal new vessels (CNV), 38 (28.8%) with retinal angiomatous proliferation (RAP). Patients, treated over a 10-year period with the time-current therapy, received: verteporfin photodynamic therapy (PDT) (group 1, 38 eyes), combined intravitreal triamcinolone acetonide (IVTA) and PDT (group 2, 44 eyes) or intravitreal anti-VEGF injection (bevacizumab or ranibizumab) (group 3, 50 eyes).

Results

Mean follow-up was 20.5?months. At month 12, all eyes treated with PDT or with IVTA and PDT showed a mean significant severe visual decrease. Eyes with CNV lost ?0.67 and ?0.37 logMAR (p?p?p?p?=?0.01 respectively). RPE tear occurred in 14 eyes (36.8%) and in six eyes (13.6%) in groups 1 and 2 respectively. Eyes treated with anti-VEGF therapy showed slight mean visual acuity decrease at month 12. Those with CNV had a mean baseline best-corrected visual acuity (BCVA) of 0.36 ±?0.24 logMAR, final of 0.44 ±?0.30 logMAR (?0.08 logMAR, n.s.). In eyes with RAP, mean baseline BCVA was 0.58 ±?0.39 logMAR, final was 0.78 ±?0.47 logMAR (?0.20 logMAR, n.s.). RPE tear occurred in 14 eyes (36.8%). Patients with either V-PED with CNV or a better baseline BCVA showed greater risk of acute RPE tear (p?=?0.01 and p?=?0.003 respectively).

Conclusions

Effective treatment for vascularized PED is still lacking. Until now, only stabilization of the disease has been achieved using anti-VEGF therapy, but the risk of RPE tear can further hamper our expectations. Baseline characteristics are helpful for prognosis, but patients must be informed of the uncertain response. New therapeutic strategies are needed.