Correlation Between Optical Coherence Tomography and Visual-Acuity in Chronic Central Serous Chorioretinopathy Treated with Half Dose Photodynamic Therapy

PURPOSE: To evaluate the results of half-dose photodynamic therapy (PDT) and determine the correlation between morphological changes measured by spectral-domain optical coherence tomography (SD-OCT) and visual acuity in patients with chronic central serous chorioretinopathy (CSC). METHODS: Twenty-five eyes of 25 patients with chronic CSC who had received half-dose verteporfin PDT were enrolled in the present study. The best-corrected visual acuity (BCVA), outer nuclear layer (ONL) thickness, and the integrity of the photoreceptor inner and outer segment junction (IS/OS) using SD-OCT were evaluated at baseline and at 3 and 6 months after treatment. RESULTS: The neurosensory retinal detachment disappeared in all eyes 6 months after treatment. The BCVA improved significantly from 0.50 +/- 0.32 to 0.31 +/- 0.29 log MAR at 6 months (p < 0.001). The average ONL thickness at the central fovea was 88.76 +/- 19.95 microm at 6 months and the ONL thickness was well correlated with the BCVA (gamma = -0.64; p = 0.001). There was no significant correlation between the status of IS/OS and the BCVA. CONCLUSIONS: Half-dose PDT is effective in treating chronic CSC resulting in visual improvement and complete resolution of neurosensory retinal detachment. The ONL thickness which was positively correlated with the BCVA could be an indicator for visual prognosis of chronic CSC.

Photodynamic Therapy for Subretinal New Vessels

Photodynamic therapy (PDT) involves the induction of endothelial cell death or occlusion of blood vessels. On the basis of this mechanism of action, PDT is used in the treatment of predominant classic choroidal neovascularization (CNV), if the classic component is over 50%, and in myopic CNV. This study describes 2 cases of distinctive, abnormal, large, subretinal new vessels that are thought to have originated from the choroids. Diminishment of the new vessels was observed following treatment with PDT.

Effects of Pars Plana Vitrectomy Comparing with Intravitreal Triamcinolone Acetonide Injection in Diabetic Macular Edema

PURPOSE: The purpose of this study is to evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in diabetic macular edema, and to compare the effects of PPV and removal of ILM with intravitreal triamcinolone acetonide injection. METHODS: Fifteen eyes of 14 patients on whom PPV and removal of the ILM (group A) were performed and 14 eyes of 14 patients who received single intravitreal triamcinolone acetonide injection (group B) for diabetic macular edema over six months were included in this study. The main outcome measures were macular thickness, as measured by optical coherence tomography and visual acuity at 1, 3, and 6 months postoperatively. RESULTS: The mean preoperative visual acuity was 0.06+/-0.05 and macular thickness 516.01+/-120.29 micrometer in group A. At 1 month postoperatively, this group showed no significant improvement of visual acuity. However, there was significant improvement at 3 and 6 months postoperatively. Macular thickness also decreased significantly at 1, 3, and 6 months postoperatively. In group B, the mean preoperative visual acuity was 0.10+/-0.08 and macular thickness was 548.82+/-116.44 micrometer. At 1 and 3 months postoperatively, significant improvement of visual acuity was noted in this group. However, there was no significant difference at 6 months postoperatively. Macular thickness also decreased significantly at 1, 3, and 6 month postoperatively. Between two groups, visual acuity and macular thickness improved in Group B at 1 month postoperatively but at 6 months, visual acuity improved in Group A and there was no significant difference of macular thickness between the two groups. CONCLUSIONS: PPV and removal of the ILM are good therapeutic options for diabetic macular edema to improve visual acuity and macular thickness. These also offer more long term efficacy than intravitreal tiamcinolone acetonide injection.

Laser Photocoagulation Repair of Recurrent Macula-Sparing Retinal Detachments

Laser photocoagulation was performed around a detached retina in 4 patients who developed localized retinal detachment after successful scleral buckling. The range of retinal redetachment in all 4 patients was no larger than that of the initial retinal detachment and did not go over the vascular arcade. No evidence of vitreous traction or proliferative vitreoretinopathy was observed in these cases. Laser photocoagulation was performed in 3 lines of gray-white burn around the detached retina. Retinal attachment occurred between 4 and 14 days of laser treatment in all cases. No procedure related complications were seen. Laser photocoagulation may be an alternative procedure for the treatment of redetached retina with little and shallow detachment, before considering resurgery.

Phacoemulsification Using Microhook Iris Retractor for the Management of Ectopia Lentis in Marfan Syndrome

PURPOSE: We evaluated the clinical results of phacoemulsifacation using microhook iris retractor for the management of ectopia lentis in Marfan syndrome. METHODS: Seventeen eyes of 9 patients with Marfan syndrome were included. All the patients had undergone phacoemulsifacation with microhook iris retractor capsule stabilization between May 1997 and January 2000. RESULTS: Mean patient age was 11.6 +/-8.2 years old. Superior nasal(38%) and superior temporal(38%) were the most common direction of lens dislocation. Fifteen eyes demonstrated improvement in best corrected visual acuity by 2 lines or more following average follow-up period of 22.9 +/-9.2 months. As postoperative complications retinal detachment developed in 3 eyes. CONCLUSIONS: Phacoemulsifacation using microhook iris retractor for capsule stabilization appears to be a good technique for the management of ectopia lentis in Marfan syndrome.

Availability of Optical Coherence Tomography in Diagnosis and Classification of Choroidal Neovascularization

PURPOSE: The author used optical coherence tomography (OCT) in the identification and classification of choroidal neovascularization to evaluate the potential of this imaging technique for better defining choroidal neovascularization. METHODS: Optical coherence tomography was performed on 20 eyes of 20 patients with the clinical diagnosis of choroidal neovascularization. Its result was compared with fluorescein angiography and indocyanine green angiography RESULTS: Of the 20 eyes, 6 eyes (30%) were identified as classic choroidal neovascularization on fluorescein angiography. Of the 6 eyes, 5 cases were identified as well-demarcated choroidal neovascularization on indocyanine green angiography and optical coherence tomography. One case was identified as fibrovascular pigment epithelial detachment on optical coherence tomograpphy. Of the 13 eyes identified as occult choroidal neovascularization on fluorescein angiography, 6 eyes were identified as well-demarcated choroidal neovascularization on indocyanine green angiography and 7 eyes were identified as well-demarcated choroidal neovascularization on optical coherence tomography. Of the 20 eyes identified as choroidal neovascularization on fluorescein angiography, 3 eyes were missed as choroidal neovascularization on optical coherence tomography. Optical coherence tomography was useful to identify the position and the size of choroidal neovascularization. CONCLUSIONS: OCT was able to distinguish the cross-sectional morphology of various lesions accompanying choroidal neovascularization. This study suggests that OCT may have potential in diagnosing and managing choroidal neovascularization.