Long-Term Effect of Half-Fluence Photodynamic Therapy on Fundus Autofluorescence in Acute Central Serous Chorioretinopathy.

PURPOSE: To evaluate normalized short-wavelength fundus autofluorescence (SW-FAF) imaging changes over time as a predictive parameter for the retinal pigment epithelium (RPE) function in eyes compromised by acute central serous chorioretinopathy (CSCR) after indocyanine green angiography-guided verteporfin (Visudyne®, Novartis Pharma, Basel, Switzerland) photodynamic therapy (PDT) with a half-fluence rate (25 J/cm2). METHODS: Quantitative data of SW-FAF grey values (SW-FAF GV) from a 350 µm (SW-350) and 1200 µm (SW-350) and 1200 t-test was calculated to explore the differences of SW-350 and SW-1200 between one month and the long-term follow-up. RESULTS: Mean differences (95% CI) in SW-FAF GV between 1 month and 7 years after half-fluence PDT were 0.07 ± 0.11 for SW-350 ([95% CI: -0.002; 0.14], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21]. CONCLUSION: After 7 years, normalized SW-FAF GV were significantly lower in eyes with resolved acute CSCR treated with reduced-fluence PDT compared to the follow-up after 1 month without correlation to explicit pattern changes or structural damages. Half-fluence PDT remains a safe and considerable treatment option in acute CSCR.

Role of Solvent Selection on Crystal Habit of 5-Aminosalicylic Acid-Combined Experimental and Computational Approach.

Many active pharmaceutical ingredients exhibit a needle-like (acicular) crystal habit, which can significantly complicate their downstream processing. In this study, the acicular crystal habit of a model active pharmaceutical ingredient, 5-aminosalicylic acid (5-ASA), was modified by addition of selected organic solvents to the typical aqueous crystallization process. 5-ASA was crystallized by a pH shift from 7.5-8 to 4 in the presence of methanol, acetonitrile, acetone, tetramethylurea, tetrahydrofuran or dimethyl sulfoxide at 25% v/v, or butanol at 9% v/v. Changes to the experimentally observed crystal habit are rationalized by considering adsorption energy calculations for the solvent molecules onto the morphologically important crystal faces. The crystal habit was influenced most significantly by organic solvents containing a good H-bond acceptor atom, particularly oxygen in acetone, tetramethylurea, tetrahydrofuran, and dimethyl sulfoxide. Such solvents have strongly stabilizing adsorption energies onto the fast-growing crystal faces, and their presence in solution thereby serves to modify the acicular habit of 5-ASA. The developed knowledge base on crystal interface-solvent interactions can form a basis for further engineering of an optimal crystal habit for 5-ASA.

Evaluation of intraocular lens position during phacoemulsification using intraoperative spectral-domain optical coherence tomography.

PURPOSE: To assess the position of intraocular lenses (IOLs) at the end of standard phacoemulsification with intraoperative spectral-domain optical coherence tomography (SD-OCT). SETTINGS: Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria. DESIGN: Prospective case series. METHODS: Standard phacoemulsification with IOL implantation was performed. The Rescan 700 SD-OCT system was used for intraoperative imaging. The anterior segment of the eye was scanned using SD-OCT at the end of the surgery. The distance from the IOL optic center and the IOL optic edge to the posterior capsule was measured postoperatively using graphic software. RESULTS: The study comprised 74 patients (101 eyes). The mean axial length was 23.97 mm (range 21.43 to 28.61 mm). The mean IOL power was 20.39 diopters (D) (range 6.5 to 27.5 D). Contact between the IOL and posterior capsule was absent in 88 cases (87.13%), and partial or full contact was present in 13 cases (12.87%). The mean distance between the IOL central optic and posterior capsule was 0.71 pixel (range 0.06 to 1.38 pixels) in 99 cases (98.02%). In 42 cases (57.53%), partial contact between the IOL edges and the posterior capsule was noticed. The mean distance between the IOL edge and posterior capsule was 0.21 pixel (range 0.04 to 0.92 pixel). CONCLUSIONS: Intraoperative SD-OCT facilitated the imaging of IOL position during standard phacoemulsification. Contact between the IOL central optic and posterior capsule at the end of the surgery occurred rarely. Improved IOL design should be considered. FINANCIAL DISCLOSURE: Drs. Binder and Glittenberg are consultants to Carl Zeiss Meditech AG. None of the other authors has a financial or proprietary interest in any material or method mentioned.

Effect of photodynamic therapy on short-wavelength fundus autofluorescence in eyes with acute central serous chorioretinopathy.

PURPOSE: To evaluate short-wavelength FAF as a parameter of retinal pigment epithelium function in eyes with acute symptomatic central serous chorioretinopathy after indocyanine green angiography-guided verteporfin photodynamic therapy with half-fluence rate. METHODS: A retrospective review over a period of 1 year of short-wavelength FAF images of 15 consecutive patients treated with half-fluence rate (25 J/cm) indocyanine green angiography-guided verteporfin photodynamic therapy due to acute symptomatic central serous chorioretinopathy was performed. Short-wavelength (488 nm) FAF gray values were evaluated with a confocal scanning laser ophthalmoscope at a 350-µm diameter and a 1,200-µm diameter circle centered on the fovea. The change in short-wavelength (488 nm) FAF gray values for the 2 circles was evaluated by calculating the differences of respective values between the first month after treatment and the 3, 6, 9, and 12 months follow-up. RESULTS: Mean differences (95% confidence interval) in short-wavelength (488 nm) FAF gray values of the 350-µm and 1,200-µm diameter circle between the 1-month and the 3-month (n = 15) follow-up were -0.03 (-0.11 to 0.05) (P = 0.46) and -0.03 (-0.17 to 0.10) (P = 0.6). Respective differences between the 1 month and the 6 (n = 15), 9 (n = 14), and 12 months (n = 13) of follow-up were -0.03 (-0.11 to 0.05) (P = 0.42) and -0.04 (-0.16 to 0.08) (P = 0.5); -0.05 (-0.12 to 0.03) (P = 0.23) and -0.06 (-0.18 to 0.07) (P = 0.33); -0.03 (-0.12 to 0.07) (P = 0.57) and -0.07 (-0.20 to 0.05) (P = 0.22). CONCLUSION: Half-fluence rate (25 J/cm) indocyanine green angiography-guided verteporfin photodynamic therapy did not significantly affect short-wavelength FAF at a 350-µm diameter and a 1,200-µm diameter circle in eyes with resolved acute symptomatic central serous chorioretinopathy throughout 12 months of follow-up.

Long-term results of mucosal advancement flap combined with platelet-rich plasma for high cryptoglandular perianal fistulas.

BACKGROUND: The long-term closure rate of high perianal fistulas after surgical treatment remains disappointing. OBJECTIVE: The goal of this study was to improve the long-term closure rate of high cryptoglandular perianal fistulas combining mucosal advancement flap with platelet-rich plasma. DESIGN: This study was retrospective in design. SETTING: This study was conducted at 2 secondary and 1 tertiary referral hospitals. PATIENTS: Patients presenting with high cryptoglandular perianal fistulas involving the middle/upper third of the anal sphincter complex were included. INTERVENTIONS: A staged surgical treatment was performed; After seton placement, a mucosal advancement flap was combined with platelet-rich plasma. MAIN OUTCOME MEASURES: Recurrence was the main outcome. Incontinence was the secondary outcome. RESULTS: We operated on 25 patients between 2006 and 2012. Thirteen (52%) patients had previous fistula surgery. The median follow-up period was 27 months. One patient (4.0%) was lost to follow-up after 4 months. Freedom from recurrence at 2 years was 0.83 (95% CI, 0.62-0.93). Two of the 4 patients with a recurrence (8%) had a repeated treatment and healed. One patient (4.0%) refused another treatment, but agreed to stay in follow-up. One patient (4.0%) requested a colostomy, resulting in closure of the fistula. Complications occurred in 1 patient (4.0%). Incontinence numbers were low with a median Vaizey score of 3.0 out of a maximum of 24. LIMITATIONS: The study was limited by its retrospective design, lack of preoperative incontinence data, selection bias, and phone interview follow-up. CONCLUSION: The long-term outcome results of patients with primary and recurrent high cryptoglandular perianal fistulas treated with a seton followed by mucosal advancement flap and platelet-rich plasma show low recurrence, complication, and incontinence rates. Therefore, this technique seems to be a valid option as treatment. Larger and preferably randomized controlled studies are needed to further explore this surgical technique.

Non-responders to treatment with antagonists of vascular endothelial growth factor in age-related macular degeneration.

PURPOSE: Most of the publications on modern therapy of neovascular age-related macular degeneration focus on the effect of the treatment. The purpose of this study is to determine the frequency of non-responders to anti-vascular endothelial growth factor (anti-VEGF) treatment and find possible reasons for their failure to respond. METHODS: The records of patients treated until the end of 2008 the first time with either bevacizumab or ranibizumab were reviewed. Based on the availability of measurable results and according to prior publications showing the effect of the therapy, loss of three lines of distance acuity, increase of retinal thickness or lesion size were identified as indicators of non-responders. Two of these three signs had to be present. RESULTS: 334 eyes of 283 patients were included; 74.55% received bevacizumab and 25.45% received ranibizumab. Overall 14.37% of the eyes were identified as non-responders (14.06% in the bevacizumab group and 15.29% in the ranibizumab group). Baseline distance acuity and vitreo-retinal adhesions were significantly correlated with non-responders. Correlations with age, gender, lesion type, other morphologic features, and the kind of anti-VEGF agent failed to be significant. 10.4% of the non-responders showed a delayed but good response to anti-VEGF treatment. CONCLUSIONS: About 15% did not sufficiently respond to anti-VEGF treatment. Vitreo-retinal adherences were the only ophthalmologic factor which could be identified to be significantly correlated with insufficient response.

Half-fluence photodynamic therapy in chronic central serous chorioretinopathy.

PURPOSE: To evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin (Visudyne®; Novartis Pharma, Switzerland) photodynamic therapy (PDT) with half-fluence rate in the treatment of chronic central serous chorioretinopathy. METHODS: A retrospective review was conducted of 20 eyes of 19 consecutive patients with subfoveal fluid cause by chronic central serous chorioretinopathy with choroidal hyperpermeability on ICGA and symptoms of at least 6 months. ICGA-guided verteporfin (6 mg/m) PDT with half-fluence rate (25 J/cm) was performed. ICGA findings were classified as intense, intermediate, or minimal hyperfluorescence depending on the degree of choroidal hyperpermeability. The resolution of the subretinal fluid and recurrence rates were assessed in relation to the different degrees of choroidal hyperfluorescence. RESULTS: Best-corrected visual acuity at baseline was 40 letters (±13; n = 20) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after PDT, the mean best-corrected visual acuity improved to 44 letters (P < 0.01). Pretreatment central foveal thickness 325 µm and decreased by a mean of 103 µm at Month 12 control (P < 0.05). At Month 1 after PDT, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in 100% of eyes regardless to their degree of choroidal hyperfluorescence. Two eyes of the intense hyperfluorescence group and 1 eye of the intermediate hyperfluorescence group developed recurrence of symptoms over 12 months and received another PDT with half-fluence rate within the 12-month control period. Treatment effect was not depending on the degree of choroidal hyperpermeability at baseline. No systemic side effects were observed during the 12-month follow-up. CONCLUSION: ICGA-guided half-fluence PDT with verteporfin is effective in treating chronic symptomatic central serous chorioretinopathy with choroidal hyperpermeability in ICGA, resulting in both visual improvement and reduction of central foveal thickness.

The effect of photodynamic therapy on macular sensitivity in eyes with acute central serous chorioretinopathy.

BACKGROUND: To evaluate the effect of half-fluence rate indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) on macular sensitivity (MS) in eyes with acute symptomatic central serous chorioretinopathy (CSC). METHODS: Single-center consecutive case series by retrospective chart review. Sixteen eyes of 16 patients with acute CSC of 3 months duration or less, treated with half-fluence (25 mJ/cm(2)) ICGA-guided verteporfin PDT were reviewed. At baseline and after 1, 3, and 6 months, all patients underwent MS testing of the central 20 °, MS testing of the retinal area covered by the PDT laser spot (MSLS), and evaluation of fixation stability (FS) for the central two degrees with the MP-1 microperimeter (Nidek, Vigonza, Italy). RESULTS: Macular sensitivity improved from 16.4 ± 3.0 dB at baseline (n = 16) to 18.2 ± 2.4 dB (p < 0.001) at 1 month (n = 16). At the 3-month (n = 13) and 6-month (n = 12) follow-up, MS stabilized at 19.5 ± 0.9 dB (p = 0.21) and 19.0 ± 1.3 dB (p = 0.74), without changes when compared to respective precedent follow-up. Mean MSLS improved from 12.9 ± 5.4 dB at baseline to 16.4 ± 4.9 dB (p < 0.001) after 1 month. At the 3- and 6-month follow-up, MSLS was 19.1 ± 1.2 dB (p= 0.1) and 18.9 ± 1.9 dB (p = 0.8) respectively. Mean FS at the central 2 ° was 78.8 ± 30.4 % before treatment and 81.8 ± 29.5 % (p = 0.7), 81.9 ± 27.5 % (p = 0.7) and 83.6 ± 17.1 % (p = 0.5) respectively 1, 3 and 6 months after treatment. CONCLUSION: Half-fluence (25 mJ/cm(2)) PDT significantly increased mean MS of central 20 ° and mean MSLS, in eyes with acute symptomatic CSC. Fixation stability was stable at baseline and throughout 6 months of follow-up.

Reproducibility of segmentation error correction in age-related macular degeneration: Stratus versus Cirrus OCT.

INTRODUCTION: The accuracy of retinal thickness measurement in age-related macular degeneration by optical coherence tomography (OCT) is affected by threshold algorithm line errors. The reproducibility of error correction in Stratus and Cirrus OCT should be examined. METHODS: OCT examinations of a consecutive series of 104 patients with neovascular age-related macular degeneration included in another study were reviewed. 72 eyes exhibited failures in Stratus OCT and 32 eyes in Cirrus OCT and were included in this new study. Algorithm line failures of Stratus OCT (retinal thickness program) and Cirrus OCT (Macular Cube 512×128 program) were corrected independently twice by two ophthalmologists and two residents, respectively, using the Stratus and Cirrus OCT built-in software. Reproducibility was assessed by the interclass correlation coefficient (ICC). RESULTS: The corrected values of central retinal thickness were significantly lower than the automated measured values in Stratus OCT for all examiners (p<0.001), while in Cirrus OCT the differences were not significant (p=0.06-0.09). For Stratus OCT, the ICC for central retinal thickness was 0.991 and 0.997 for the experienced ophthalmologists and 0.89 and 0.97 for the residents. For Cirrus OCT, the ICC was 1.0 and 1.0 for the experienced ophthalmologists and 0.99 and 0.95 for the residents. CONCLUSION: The reproducibility of threshold algorithm line failure correction was good overall in Stratus and Cirrus OCT and can therefore be recommended to improve retinal thickness measurement, particularly when experienced examiners perform the corrections.

Comparing treatment of neovascular age-related macular degeneration with sequential intravitreal Avastin and Macugen versus intravitreal mono-therapy--a pilot study.

PURPOSE: To examine if the sequential treatment of Avastin and Macugen is safe and more efficient than the mono-therapies in a prospective randomized masked pilot study. MATERIALS AND METHODS: Subjects with exudative age-related macular degeneration were randomized to receive three intravitreal injections of either 1 mg of Avastin, 0.3 mg Macugen, or first 1 mg Avastin followed by retreatment of 0.3 mg Macugen. Follow-up examinations were performed after 1, 6, 12 weeks, and 6 months. RESULTS: Forty-eight subjects were included (13:18:17). Avastin resulted in lasting significant changes in visual acuity at 6 weeks, increase in contrast sensitivity at 6 weeks, and a significant decrease in macular thickness after 6 and 12 weeks. Macugen showed a significant decrease in retinal thickness after 6 weeks, but a significant decrease in visual acuity after 6 months, and a significant decrease in contrast sensitivity after 12 weeks and 6 months. The sequential treatment showed a decrease in retinal thickness after 1 and 12 weeks. CONCLUSION: Avastin alone is more effective in increasing visual acuity and contrast sensitivity and decreasing retinal thickness, than Macugen or the sequential treatment. We conclude that the sequential treatment of Avastin with Macugen is safe, but the single treatment of Avastin is more efficient.

Conversion of Stratus optical coherence tomography (OCT) retinal thickness to Cirrus OCT values in age-related macular degeneration.

AIM: Spectral domain optical coherence tomography (SD OCT) is of increasing importance and is gradually replacing time domain OCT (TD OCT). Our aim was to determine a formula to convert Stratus OCT (TD OCT) to Cirrus OCT (SD OCT) retinal thickness. METHODS: Central retinal thickness (CRT) and retinal volume (RV) were obtained by the macular thickness program of Stratus OCT and the cube 512 × 128 program of Cirrus OCT in patients with exudative age-related macular degeneration (AMD). Algorithm line failures were corrected. A linear model with Stratus OCT CRT as fixed factor and Cirrus OCT CRT as dependent variable was applied to calculate the conversion formula. RESULTS: OCT examinations of 104 eyes of 104 patients were reviewed and corrected when necessary. Stratus and Cirrus OCT CRT were significantly correlated (p<0.0001). For CRT the formula Cirrus CRT=58.63+0.94 × Stratus CRT was calculated. The correlation was significantly influenced by the height of the CRT values (p<0.0001), but not by whether correction was necessary. For RV the formula Cirrus OCT RV=3.098+0.98 × Stratus OCT RV was calculated. CONCLUSION: Stratus OCT and Cirrus OCT use a different posterior reference line within the hyper-reflective band of the outer retina. Therefore a conversion formula is necessary to compare Stratus and Cirrus OCT CRT values, and this has been determined in our study.

Reproducibility and comparison of retinal thickness and volume measurements in normal eyes determined with two different Cirrus OCT scanning protocols.

PURPOSE: To assess reproducibility and compare raster scanning protocols of Cirrus high-definition optical coherence tomography (Carl Zeiss Meditec, Dublin, CA). METHODS: Five hundred and twenty-eight computed tomography scans were performed in 17 healthy subjects. Four sessions were performed at each visit including two 200 × 200 and two 512 × 128 macular cube scans per session. The examined eye, observer, and order of scanning protocols in-between each session were randomly chosen. Reproducibility was described with intraclass correlation coefficients, coefficients of variance, intervisit, interrater, intersession intra-, and intersubject standard deviations. RESULTS: Intraclass correlation coefficients ranged from 80.4% to 97.8% and the coefficients of variance from 0.7% to 2.3% for retinal volume and retinal thickness measurements. Intersubject, intervisit, interrater, intersession, and intrasubject standard deviations ranged from 0 µm to 18.54 µm. Differences in retinal thickness between protocols were small (range 3.55 ± 1.95 µm to 0.81 ± 0.59 µm) but significant for the central (P < 0.0001), the outer superior (P = 0.0036), temporal (P = 0.0026), and nasal subfield (P < 0.0001). Average difference of retinal volume between protocols was 0.05 ± 0.04 mm (P = 0.0001). CONCLUSION: Both raster scanning protocols of the Cirrus optical coherence tomography showed excellent reproducibility of retinal thickness and volume measures. Significant differences between protocols for retinal thickness in four macula thickness map subfields and for retinal volume were found.

Comparison of visual performance with blue light-filtering and ultraviolet light-filtering intraocular lenses.

PURPOSE: To compare the contrast sensitivity, glare, color perception, and visual acuity at different light intensities with yellow-tinted and clear intraocular lenses (IOLs) by different manufacturers. SETTING: Ludwig Boltzmann Institute of Retinology and Biomicroscopic Laser-Surgery, Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria. DESIGN: Comparative case series. METHODS: Eyes were randomized to 1 of the following IOLs: AF-1 (UY) (yellow tinted), AcrySof SN60AT (yellow tinted), AF-1 (UV) (clear), or AcrySof SA60AT (clear). One week and 2 months postoperatively, monocular contrast sensitivity function and color discrimination were tested and the corrected distance and near visual acuities were evaluated. All tests were performed under different light intensities (10 to 1000 lux). RESULTS: Of the 80 patients enrolled, 76 completed the study; there were 37 eyes in the yellow-tinted IOL group and 39 in the clear IOL group. There were no significant differences between yellow-tinted IOLs and clear IOLs except in color vision under mesopic conditions (10 lux). Patients with a yellow-tinted IOL made significantly more mistakes in the blue-light spectrum than patients with clear IOLs (P = .00015). There was no significant difference under photopic conditions (1000 lux). CONCLUSIONS: The yellow-tinted IOLs were equivalent to the clear IOLs in postoperative contrast sensitivity, visual acuity, and color perception under photopic conditions. Patients with yellow-tinted IOLs made statistically significantly more mistakes in the blue range under dim light than patients with clear IOLs.

Repeatability and reproducibility of retinal thickness measurements by optical coherence tomography in age-related macular degeneration.

PURPOSE: To evaluate the repeatability and reproducibility of retinal thickness measurements in exudative age-related macular degeneration (AMD) using Stratus optical coherence tomography (OCT) (Carl Zeiss Meditec, Inc., Dublin, CA). DESIGN: Prospective, observational case series. PARTICIPANTS: A total of 200 eyes of 200 subjects with exudative AMD. METHODS: Macular thickness and fast macular thickness programs of Stratus OCT were performed twice by the same examiners or 2 different examiners. The sequence of examiners was randomized 1:1:1:1. The variability of 1-mm subfield central retinal thickness (CRT), center point thickness (CPT), and retinal volume (RV) was calculated. MAIN OUTCOME MEASURES: Interobserver and intraobserver variability of retinal thickness measurements. RESULTS: Ninety-nine patients/eyes were enrolled in study arm 1 (repeated by the same examiner), and 101 patients/eyes were enrolled in study arm 2 (repeated by different examiners). Values of CPT, CRT, and RV were well correlated (interclass correlation coefficient, 0.71-0.93) in both study arms, revealing better results for the macular thickness program than for the fast macular thickness program. Threshold algorithm line failures were significantly correlated to the absolute differences of 2 repeated measurements for CPT, CRT, and RV but not with manually corrected maximum retinal thickness (MRT). Maximum retinal thickness was significantly influenced by the examiner performing the measurement. Age, lesion composition, examiner performing OCT examination, and sequence of examination had no significant influence. CONCLUSIONS: The repeatability and reproducibility of retinal thickness measurements were high, presenting better results for CRT and RV versus CPT, and for the macular thickness program versus the fast macular thickness program. The reliability of retinal thickness measurement was most frequently affected by algorithm line failures and fixation problems. A possible solution may be manually corrected measurement, such as MRT.

Contrast sensitivity after intravitreal antivascular endothelial growth factor therapy for myopic choroidal neovascularization.

BACKGROUND: To evaluate contrast sensitivity (CS) using Pelli-Robson charts after intravitreal ranibizumab (IVR) (Lucentis, Novartis, Basel, Switzerland) or bevacizumab (IVB) (Avastin, Genentech, South San Francisco, California, USA) in eyes with myopic choroidal neovascularization (mCNV). METHODS: A retrospective review was performed of 17 consecutive patients treated with IVR (n = 10; 0.5 mg) or IVB (n = 7; 1.25 mg) for mCNV from July, 2006 with follow-ups through September, 2009. Re-treatment was performed at monthly or longer intervals if there was fluorescein leakage in fluorescein angiogram (FAG) and or apparent subretinal fluid in optical coherence tomography (OCT) persisted. RESULTS: CS improved by a mean of one letter at 1 month (n = 17; p = 0.32), four letters at 3 months (n = 17; p = 0.02), four letters at 6 months (n = 15; p = 0.01), five letters at 9 months (n = 14; p = 0.04) and six letters at 12 months (n = 13; p = 0.03). The mean number of IVR/IVB was 1.6/1.6, 2.6/2.3, 3.1/3.2, 4.1/4.2 and 4.5/4.6 at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. CONCLUSIONS: Improvements in Pelli-Robson CS scores were observed during the first year after IVR/IVB in eyes with mCNV.

Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery.

PURPOSE: To assess prognostic factors in epiretinal membrane (ERM) surgery using spectral-domain (SD) optical coherence tomography (OCT). DESIGN: Prospective, interventional case series. PARTICIPANTS: Forty-one patients. METHODS: Patients with a diagnosis of ERM were examined with spectral-domain and time-domain (TD) OCT before and after surgery. MAIN OUTCOME MEASURES: Main outcome measures were functional results and predefined OCT patterns. Cofactors analyzed were the type of ERM, the duration and grading of subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, and age. A multivariate regression analysis was performed. RESULTS: Thirty-nine patients (95%) showed an improved or stable best-corrected distance visual acuity (DVA) at 3 months, whereas 36 patients (88%) showed an improved or stable best-corrected near visual acuity (NVA) at 3 months. Significant correlations (P>0.4) were found between the course of central retinal thickness (CRT) assessed using SD OCT and TD OCT (P<0.02). No clinically relevant correlations (P<0.3) were seen between CRT and VA (P>0.1). Baseline DVA and NVA were found to be significant prognostic values for the postoperative decrease in CRT in both OCT systems (P<0.04) as well as for the visual outcomes (P<0.007) at 3 months. In addition, the integrity of the junction between the photoreceptor inner segment and outer segment (IS/OS) significantly influenced the visual outcomes at 3 months (P<0.038). The baseline profile of the internal limiting membrane (ILM) significantly influenced the NVA at 3 months (P<0.009), whereas the postoperative foveal contour significantly influenced the DVA at 3 months (P<0.025). The type of ERM, subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, or age had no significant influence on patient outcome (P>0.05). Compared with TD OCT, SD OCT allowed for a more precise differentiation between the ERM and the retinal surface and for a better evaluation of the IS/OS line. CONCLUSIONS: Besides the baseline VA, the integrity of the IS/OS line, better visualized by SD OCT, can be used to predict the functional outcomes after surgery. Additionally, analyzing the ILM profile and the foveal contour may help to understand limited visual outcomes after surgery. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Repeated measures of macular pigment optical density to test reproducibility of heterochromatic flicker photometry.

PURPOSE: To report the reproducibility of macular pigment optical density (MPOD) values assessed with heterochromatic flicker photometry (HFP) in healthy individuals. METHODS: Twenty-four volunteers from our department underwent MPOD testing of both eyes by flicker photometry on three separate occasions. To test reproducibility of MPOD, the coefficient of variance was calculated separately for right and left eyes. In addition, we investigated MPOD averages of right and left eyes and interocular correlations (Pearson's r) at every visit. RESULTS: The mean MPODs at the first visit were 0.61 +/- 0.24 and 0.72 +/- 0.27 in right and left eyes, respectively. Mean values of 0.58 +/- 0.29 and 0.60 +/- 0.21 (second visit) and 0.62 +/- 0.27 and 0.63 +/- 0.24 (third visit) were assessed for right and left eyes, respectively. Differences of the mean values between eyes were not significant. Correlations were weak at visits one and two (r = 0.49, p < 0.014 and r = 0.43, p < 0.038, respectively) and moderate at visit three (r = 0.58, p < 0.003). The coefficients of variance were 36.1% and 23% for right and left eyes, respectively. CONCLUSION: Our mean MPODs are higher and the interocular correlations weaker compared to the literature. The coefficient of variance in both eyes is high and does not imply good reproducibility of obtained MPOD values.

Retinal angiomatous proliferation: morphological changes assessed by Stratus and Cirrus OCT.

BACKGROUND AND OBJECTIVE: Spectral domain optical coherence tomography (SD-OCT) should be used to examine lesions containing retinal angiomatous proliferation (RAP) to achieve a better understanding of the origin of this pathology. PATIENTS AND METHODS: In this prospective, observational case series, patients with RAP underwent retinal thickness imaging with Stratus OCT and cube 200 X 200 imaging with Cirrus OCT. RESULTS: A total of 12 eyes from 11 patients were included in the study. Of these, eight eyes had stage III RAP and four eyes had stage II RAP. Cirrus OCT detected the hyperreflective area corresponding to the neovascularization in all 12 eyes and Stratus OCT detected this pathology in 10 of the 12 eyes. All stage III lesions contained a retinal pigment epithelial break, which was more visible in the 200 x 200 scans obtained from Cirrus OCT compared with six radial scan lines obtained from Stratus OCT. CONCLUSION: Cirrus OCT had considerable advantages compared with Stratus OCT, particularly in investigation of juxtafoveal pathology.

Advantages of using a ray-traced, three-dimensional rendering system for spectral domain Cirrus HD-OCT to visualize subtle structures of the vitreoretinal interface.

BACKGROUND AND OBJECTIVE: To create a ray-traced, three-dimensional display system for Cirrus high-definition optical coherence tomography (Carl Zeiss Meditec, Inc., Dublin, CA) that improves the visualization of subtle structures of the vitreoretinal interface. PATIENTS AND METHODS: High-definition optical coherence tomography (HD-OCT) data for epiretinal membranes (17 eyes), macular holes (11 eyes), and posterior vitreal detachments (17 eyes) were collected. A display system that visualizes the acquired data using ray-tracing algorithms was designed and compared with the Cirrus HD-OCT 2.0 advanced visualization software system. The area around the vitreoretinal interface was visualized using a 100-microm-thick internal limiting membrane (ILM) fitted slab as well as ILM and retinal pigment epithelium surface reconstructions. RESULTS: Subtle structures could be visualized more distinctly using the ray-traced, three-dimensional rendering software. CONCLUSION: A ray-traced visualization system improves the visualization of subtle structures in and around the vitreoretinal interface.