In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration

A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as 揳typical� osteoma caused by failure to identify their extrachoroidal location.

Retrospective study of changes in ocular coherence tomography characteristics after failed macular hole surgery and outcomes of fluid-gas exchange for persistent macular hole

Purpose: The aim is to study the changes in ocular coherence tomography (OCT) parameters of large (?400 ?) full-thickness macular holes (FTMHs) after a failed surgery and evaluate the outcome of fluid-gas exchange (FGE) in the treatment of persistent macular hole and role of OCT in predicting outcome after the secondary intervention. Methods: Changes occurring in the OCT parameters of FTMH after a failed vitrectomy were evaluated. FGE was done in an operating room with three pars plana sclerostomy ports. The anatomical and functional outcomes of FGE for these persistent macular holes were also assessed. Anatomical closure was defined as the flattening of the hole with resolution of subretinal cuff of fluid. Anatomical success after FGE was defined as flattening of macular hole with the resolution of subretinal cuff of fluid and neurosensory retina completely covering the fovea. Functional success was defined as an improvement of at least one line of best-corrected visual acuity (BCVA). Results: Twenty-eight eyes (28 patients) were included in the study. After the failed vitrectomy, OCT showed an increase in the base diameter, opening diameter, and height of the hole. After the secondary procedure, anatomical closure was achieved in 89.3% eyes. Mean BCVA improved from logMAR 0.88 � 0.24 (20/152) to logMAR 0.66 � 0.24 (20/91) (P < 0.001). Eight (28.6%) patients achieved final BCVA ?20/60. Functional success was obtained in 19 patients (67.9%). There was no association between anatomical success after FGE and any of the pre-FGE OCT parameters or indices. Conclusion: Unsuccessful surgery causes swelling of the outer and middle retinal layers with retraction of inner layers of the retina. Performing FGE while visualizing the retina is a good option for the treatment of large persistent macular holes as it causes complete drying of the macula, better success rates, and a reduced complication rate. Pre-FGE OCT does not help in predicting the outcome of FGE for persistent macular hole.

Visual Functions And Retinal Morphology In Patients With Polypoidal Choroidal Vasculopathy Seen In An Age Related Macular Degeneration Referral Centre Of Malaysia

@#The aim of the present study was to evaluate visual functions and retinal morphology of Polypoidal Choroidal Vasculopathy (PCV) patients seen in an AMD referral centre of Malaysia and to further explore association between visual functions and optical coherence tomography (OCT) parameters in PCV eyes. In this single centre, cross sectional study, best corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS) were measured in naïve PCV eyes. Selective parameters such as integrity of external limiting membrane (ELM), inner segment and outer segment junction (IS-OS), retinal pigment epithelium and Bruch’s membrane (RPE-BM) complex, average retinal thickness (ART) and volume (ARV), central retinal thickness (CT), centre maximum (CTmax) and centre minimum (CTmin) thickness were assessed using spectral-domain OCT. Forty-three new PCV eyes of 42 patients were evaluated. Mean (±SD) DVA, NVA, CS, RS were 0.83 ± 0.35 logMAR, 0.77 ± 0.3 logMAR, 0.69 ±.26 log CS and 59.56 ±14 words per minutes respectively. ART and CT showed good correlation with DVA (r=0.571& 0.546) and CS (r= 0.576 & 0.586). ARV and CTmax showed good correlation with CS (r=0.516 &, 0.513). The mean DVA, NVA and CS between three ELM and IS-OS status were significantly different (p=.002 & .000; p=.012 & .029; p=.005 & .001). In conclusion, present study reports visual functions and OCT characteristics of PCV patients in an AMD referral centre of Malaysia. Many of the quantitative and qualitative OCT parameters showed good association with the visual functions in eyes with PCV.

OCT as a monitoring tool for assessment of the stage and severity of multiple sclerosis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To identify a link between optical coherence tomography(OCT), length of multiple sclerosis(MS)and the expanded disability status scale(EDSS).<p>METHODS: In a prospective double blind study, 29 patients with a diagnosis of MS were compared with 29 healthy patients, matched by age and sex. All participants underwent an OCT study and neurological EDSS test on the same day.<p>RESULTS: The mean EDSS score was 3.2 in the MS group <i>vs</i> 0.03 in the control group, and the duration of MS was 11.7y. The mean retinal nerve fiber layer(RNFL)thickness was significantly thinner in those with MS <i>(P</i><0.001). Correlation was found between duration of MS and RNFL thinning. EDSS and thinning of RNFL showed a tendency to correlate but without statistical significance.<p>CONCLUSION: RNFL is thinner in MS patients than in the general population. MS duration has a direct statistically significant effect on RNFL thickness. There seems to be a tendency of a relationship between RNFL thinning and EDSS. OCT is suggested as a monitoring and evaluation tool of MS patients.

Changes in Intraocular Pressure and Choroidal Thickness after Hemodialysis in Chronic Renal Failure Patients

PURPOSE: To evaluate the change of choroidal thickness and intraocular pressure (IOP) as a result of hemodialysis with chronic renal failure patients. In addition, the correlation between the change of choroidal thickness and IOP were evaluated. METHODS: A total of 48 eyes of 48 chronic renal failure patients undergoing hemodialysis were included in the present study. IOP, blood pressure (systolic and diastolic), serum osmolality, central corneal thickness (CCT), and choroidal thickness were measured before and after hemodialysis. Choroidal thickness was measured using spectral domain ocular coherence tomography (SD-OCT). RESULTS: After hemodialysis, IOP significantly decreased from 14.9 +/- 2.3 mm Hg to 14.3 +/- 2.1 mm Hg (p < 0.001) and choroidal thickness significantly decreased from 352.2 +/- 31.6 microm to 306.6 +/- 29.0 microm (p < 0.001). The other factors that significantly decreased after hemodialysis included serum osmolality (p < 0.001) and blood pressure (p < 0.001) except CCT (p = 0.285). There was a positive correlation between changes in IOP and choroidal thickness after hemodialysis (r = 0.319, p = 0.027). CONCLUSIONS: Decreased choroidal volume and thickness due to fluid loss may be involved in the mechanism of decreased IOP during hemodialysis.

Short-term Effects of Intravitreal Bevacizumab Injection and Macular Edema Patterns in Branch Retinal Vein Occlusion

PURPOSE: We attempt to distinguish the patterns of macular edema due to branch retinal vein occlusion (BRVO) and to find correlations between the 24 hour short-term and three month long-term therapeutic effects of an intravitreal bevacizumab injection. METHODS: Forty-four eyes in 44 patients with macular edema due to BRVO underwent an intravitreal bevacizumab injection. Ophthalmoscopic examinations, fluorescein angiographic evaluations, and optical coherence tomography (OCT) examinations performed made before the injections, after 24 hours, and at one, two and three month follow-ups. OCT yielded three patterns of macular edema: diffuse macular edema, cystoid macular edema, and serous retinal detachment. RESULTS: Macular edema significantly improved 24 hours after the injections. The change in central macular thickness after 24 hours had a statistically significant correlation with the three month central macular thickness (Pearson correlation, r=0.757 p=0.011). Cystoid macular edema showed better improvement than the others after 24 hours, but no differences after three months. CONCLUSIONS: OCT treatment 24 hours after an intravitreal bevacizumab injection was found to be highly correlated to the long term prognosis. It is therefore useful in determining therapy and predicting the progress of macular edema in patients with BRVO.