A population‐based study of macular thickness in full‐term children assessed with Stratus OCT: normative data and repeatability

Purpose: We aimed to determine normal macular thickness values, assessed with optical coherence tomography (OCT), in a population of full‐term children of normal birthweight. Methods: A total of 56 children, aged 5–16 years, randomly chosen from the population register, were examined with Stratus OCT. Only children with visual acuity < 0.2 logMAR, spherical equivalent of ? 3 to + 3 D and astigmatism < 2 D were included. The fast macular map protocol was used and three examinations were performed in each eye. One eye was then randomized for further analyses. Mean values for the nine ETDRS areas, foveal minimum thickness and macular volume were calculated for 55 eyes. Coefficients of variance and intraclass correlations were calculated for each area. Results: All children co‐operated well and no child was excluded for lack of concentration. Mean ± standard deviation central macular thickness was 204 ± 19 μm. Mean total macular volume was 7.11 ± 0.35 mm³. No correlations were found between age, gender and macular thickness. Coefficients of variance were < 2% and intraclass correlations were > 0.9 in all areas, except the foveal minimum. Conclusions: Normal values for macular thickness in healthy full‐term children were reported. As the Stratus OCT provides normal values only for adults, these data are a better alternative for comparison with children with retinal abnormalities. We concluded that OCT is suitable for examining the retina in children aged 5–16 years and has the same high level of repeatability as in adults.     

Three‐year results of visual outcome with disease activity–guided ranibizumab algorithm for the treatment of exudative age‐related macular degeneration

Purpose: To evaluate 3‐year follow‐up treatment outcomes with ranibizumab (Lucentis^®) 0.5 mg administered either monthly or quarterly on a pro re nata (PRN) basis according to a disease activity–guided monitoring and treatment algorithm. Methods: A total of 316 treatment‐naive eyes of 316 patients with exudative age‐related macular degeneration met the criteria for inclusion in this retrospective, interventional case series. Patients were treated with ranibizumab 0.5 mg according to a disease activity–guided algorithm with monthly monitoring. Optical coherence tomography and fluorescein angiography were routinely used to assess disease activity: active lesions were treated with a series of three monthly injections, whereas inactive lesions were treated with quarterly injections. Results: Mean Early Treatment Diabetic Retinopathy Study best‐corrected visual acuity improved from 52 letters at baseline to 59 letters at 12 months, achieved with a mean of 7.1 injections, 61 letters at 24 months with a mean of 5.0 injections administered in the second year and 60 letters at 36 months with a mean number of 5.2 injections. Conclusions: Monthly visits and a morphology‐driven PRN regimen with 3 injections in case of recurrence plus quarterly injections in case of inactive CNV resulted in an average VA gain of 7–9 letters that could be maintained over 3 years.     

Functional and morphological changes in diabetic macular edema over the course of anti‐vascular endothelial growth factor treatment

Purpose:  To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti‐vascular endothelial growth factor (VEGF) treatment with Ranibizumab. Methods:  A consecutive series of 39 study eyes with centre‐involving DME were included in this study. In all subjects, best‐corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD‐OCT) cross‐sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross‐sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Results:  Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = ?1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = ?3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = ?4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = ?1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = ?0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = ?2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. Conclusions:  ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti‐VEGF therapy with Ranibizumab in patients with DME.     

重复抗VEGF治疗对DME患者玻璃体黄斑界面的影响及其危险因素

目的:探讨糖尿病性黄斑水肿(DME)患者重复接受玻璃体腔注射抗血管内皮生长因子(VEGF)治疗对玻璃体黄斑界面(VMI)的影响及其相关危险因素。方法:回顾性分析2018-01/2021-12于遵义市第一人民医院眼科接受玻璃体腔注射康柏西普治疗(3+PRN)的DME患者31例55眼的临床资料。比较发生VMI改变(VMI改变组,9例13眼)和未发生VMI改变(VMI无改变组,22例42眼)的患者治疗前后最佳矫正视力(BCVA)、中央视网膜厚度(CRT)、中心凹下脉络膜厚度(CCT)情况,并分析发生VMI改变的危险因素。结果:纳入患者平均随访9.58±8.32mo,平均接受抗VEGF治疗4.07±2.17次,且VMI改变组患者玻璃体腔注射次数多于VMI无改变组(5.77±2.09次vs 3.55±1.93次,P=0.001)。末次随访时,与治疗前相比,两组患者治疗后BCVA均显著改善(均P<0.05),而CCT均无明显变化(均P>0.05),VMI无改变组患者CRT显著减小(P=0.039),但VMI改变组患者CRT未见明显变化(P=0.627)。Logistic回归分析结果显示...     

Ocular morphology and function in juvenile neuronal ceroid lipofuscinosis (CLN3) in the first decade of life

Purpose: CLN3 is a rare lysosomal storage disorder. The majority of the patients suffer from neurological degeneration in the first decade of life leading to death in the second or third decade. One of the first symptoms is a rapid visual decline from retinal degeneration. The aim of this study was to correlate the retinal changes in CLN3 as seen with spectral domain optical coherence tomography (SD-OCT) with functional data in patients in the first years after the subjective onset of ocular symptoms.

Methods: Three unrelated children aged from 5.6 to 8.8 years, and with molecularly confirmed CLN3, underwent a comprehensive ophthalmological examination including visual acuity, fundus photography, fundus autofluorescence (FAF), electrophysiology (multifocal ERG), Goldmann visual fields, and SD-OCT.

Results: A predominant loss of the first and second neuron retinal layers progressing from the macula to the periphery was identifed. The retinal nerve fibre layer (RNFL) displayed gliosis and an irregular lining of the inner limiting membrane. Compared to the preferential reduction of photoreceptor layer thickness in other maculopathies with pan-retinal involvement, the thickness of the first and second neuron layers was reduced simultaneously in CLN3. Functional testing by multifocal ERG reflected the degenerative progress. Semiquantitative evaluation revealed a generally reduced FAF.

Conclusion: This is the first detailed morphological evaluation of CLN3 patients in the first years after the subjective onset of ocular symptoms. CLN3 is characterized by an early degeneration predominant of the first and second neuron compared to other macular and generalized retinal dystrophies. Imaging is instrumental for early diagnosis and gene-directed molecular analysis of this fatal disorder.     

不同抗VEGF药物治疗糖尿病性黄斑水肿的疗效及其与OCT分型的关系

目的:探究不同抗血管内皮生长因子(VEGF)药物治疗糖尿病性黄斑水肿(DME)临床疗效,并分析其与光学相干断层扫描(OCT)分型的关系。方法:选取45例进行雷珠单抗治疗的DME患者(本院于2020-02/2022-02收治)作为雷珠单抗组,同期45例进行康柏西普治疗的DME患者作为康柏西普组。其中雷珠单抗组给予视网膜光凝术联合雷珠单抗治疗,康柏西普组给予视网膜光凝术联合康柏西普治疗。比较两组患者症状改善情况(黄斑水肿改善时间、视网膜厚度恢复正常时间、新生血管消失时间及眼底出血吸收时间),血清白细胞介素-6(IL-6)、VEGF水平,黄斑中心凹视网膜厚度(CMT)、最佳矫正视力(BCVA)水平及并发症发生情况,并分析其临床疗效与不同OCT分型的关系。结果:两组黄斑水肿改善时间、视网膜厚度恢复正常时间、新生血管消失时间及眼底出血吸收时间比较均无明显差异(P>0.05);与治疗前比较,两组治疗后血清IL-6、VEGF、BCVA值均明显降低(P<0.01),但组间比较均无明显差异(P>0.05);与治疗前比较,两组治疗后CMT均明显降低(P<0.05),且与雷珠单抗组比...     

Dynamic retinal vessel response to flicker in age‐related macular degeneration patients before and after vascular endothelial growth factor inhibitor injection

Purpose: Retinal vessel responses to flickering light are different in various systemic and ocular diseases and can be improved after successful therapy. We investigated retinal vessel response to flickering light in age‐related macular degeneration (AMD) patients before and after treatment with a single intravitreal bevacizumab (Avastin^®) injection. Methods: In 10 patients with exudative AMD [age: median (1.quartile; 3.quartile) 76.0 (73.5; 80.0) years], retinal vessel reactions were examined by Dynamic Vessel Analyser (DVA) before and 3 months after a single intravitreal application of bevacizumab (1.25 mg). A baseline measurement was followed by three consecutive monochromatic flicker stimulations (530–600 nm, 12.5 Hz, 20 seconds). Temporal retinal vessel reaction was analysed and compared with the reaction in healthy controls. Results: Mean arterial dilation at the end of flicker was not different in all groups. For veins this parameter amounted to: pre‐treatment, 2.6 (1.7; 3.9)%; post‐treatment, 2.9 (2.4; 4.0)%; control, 4.3 (3.2; 5.7)%; significant: pre‐treatment – control (Dunnett’s procedure, p < 0.05). Maximal dilation occurred in arteries at: pre‐treatment, 17.5 (14.8; 32.5) seconds; post‐treatment, 18.0 (16.6; 30.6) seconds; control, 14.5 (10.8; 17.3) seconds. Both AMD groups were slower (p < 0.05): in veins at 17.0 (14.5; 20.0) seconds, 12.8 (8.6; 14.8) seconds and 18.5 (17.1; 19.9) seconds, respectively; significant post‐treatment – control (p < 0.05). In the post‐treatment AMD group arterial constriction after stimulation occurred more slowly compared with the control group (p < 0.05). Conclusion: Dynamic retinal arterial and venous reactions to flickering light are altered in AMD compared with controls. Three months after a single injection of a vascular endothelial growth factor inhibitor, the investigated retinal dynamic vascular parameters were not altered in our study.     

Attenuation of the retinal nerve fibre layer and reduced retinal function assessed by optical coherence tomography and full‐field electroretinography in patients exposed to vigabatrin medication

Purpose: To investigate the clinical value of assessment of peripapillary retinal nerve fibre layer (RNFL) thickness with OCT in addition to the evaluation of retinal function measured by full‐field electroretinography (ff‐ERG) in patients with suspected vigabatrin (VGB)‐attributed visual field defects. Methods: Visual fields from adult patients in our clinical follow‐up program for VGB medication were analysed. Twelve patients with suspected VGB‐attributed visual field defects were selected for the study. They were re‐examined with computerized kinetic perimetry, ff‐ERG and OCT (2D circle scan). Results: Constricted visual fields were found in all patients. Comparative analysis of ff‐ERG parameters showed reduced b‐wave amplitudes for the isolated and the combined rod and cone responses (p < 0.0001). The a‐wave, reflecting photoreceptor activity, was reduced (p = 0.001), as well as the summed amplitude of oscillatory potentials (p = 0.029), corresponding to inner retinal function. OCT measurements demonstrated attenuation of the RNFL in nine of 12 patients, most frequently superiorly and/or inferiorly. No temporal attenuation was found. Significant positive correlations were found between the total averaged RNFL thickness, superior and inferior RNFL thickness and reduced ff‐ERG parameters. Positive correlations were also found between RNFL thickness and isopter areas. Conclusion: OCT measurements can detect attenuation of the RNFL in patients exposed to VGB medication. RNFL thickness correlates with reduced ff‐ERG parameters and isopter areas of constricted visual fields, indicating that VGB is retino‐toxic on several levels, from photoreceptors to ganglion cells. The study also supports previous studies, suggesting that OCT measurement of the RNFL thickness may be of clinical value in monitoring patients on vigabatrin therapy.     

Analysis of complement factor H Y402H,LOC387715, HTRA1 polymorphisms and ApoE alleles with susceptibility to age‐related macular degeneration in Hungarian patients

Purpose: Recent studies strongly support the role of genetic factors in the aetiology of age‐related macular degeneration (AMD). We investigated the frequency of Tyr402His polymorphism of the complement factor H (CFH) gene, Ser69Ala polymorphism at LOC387715, rs11200638 polymorphism of the HTRA1 gene and different apolipoprotein E (ApoE) alleles in Hungarian patients with AMD in order to determine the disease risk conferred by these factors. Methods: In a case‐control study, we performed clinical and molecular genetic examination of 105 AMD patients (48 patients in the early and 57 in the late subgroup) and 95 unrelated healthy controls. Detailed patient histories were recorded with the use of a questionnaire focusing on known risk factors for AMD. Results: In the early AMD subgroup, homozygous CFH, LOC387715 or HTRA1 polymorphisms conferred a 4.9‐fold (95% confidence interval [CI] 1.7–14.2), 7.4‐fold (95% CI 2.1–26.2) or 10.1‐fold (95% CI 2.5–40.8) risk of disease, respectively. In the late AMD subgroup, carriers of two CFH, LOC387715 or HTRA1 risk alleles were at 10.7‐fold (95% CI 3.7–31.0), 11.3‐fold (95% CI 3.2–40.4) or 13.5‐fold (95% CI 3.3–55.4) greater disease risk, respectively. Two CFH and one LOC387715 risk alleles in combination conferred a 15.0‐fold (95% CI 3.2–71.0) increase in risk, whereas two LOC387715 risk alleles combined with one CFH risk allele was associated with a 14.0‐fold (95% CI 2.1–95.1) increased risk for late AMD. ApoE alleles neither increased disease risk nor proved to be protective. Conclusions: The CFH, LOC387715 and HTRA1 polymorphisms are strongly associated with the development of AMD in the Hungarian population. The association is particularly pronounced when homozygous risk alleles are present and in the late stages of the disease.