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.

Primary Retinal Detachment Surgery: Changes in Treatment and Outcome in an Austrian Tertiary Eye Center.

PURPOSE: The surgery of choice for primary retinal detachment (RD) has shifted towards primary vitrectomy (PPV) in recent years. In this study, 2 cohorts of consecutive patients, treated by 8 retinal surgeons within a 7-year time span were compared. METHODS: Baseline demographic data, surgical procedure, and outcome of patients with primary RD surgery between January 2007 and December 2008 (group 1, G1) and January 2012 and December 2013 (group 2, G2) were compared. Statistical analysis included univariate comparisons (Wilcoxon rank-sum test and χ2 test) and ANCOVA (analysis of covariance) models. RESULTS: The most common primary procedure was scleral buckling (n = 92, 66%) in G1 and PPV (n = 252, 85%) in G2 (p < 0.0001). Primary anatomical success rates were comparable (89%). The percentage of eyes with best corrected visual acuity (BCVA) equal or better than 0.3 logMAR (6/12) at final follow-up was significantly higher in G2 (61%, n = 156) compared to 49% (n = 68) in G1 (p = 0.0223). CONCLUSIONS: Within 7 years, a complete trend reversal could be observed shifting the primary surgical approach for RD towards PPV. Primary and final anatomical success rates were comparable, yet the later group experienced a significantly higher gain in BCVA, which approves the change in treatment regimen.

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.

VISION-RELATED QUALITY OF LIFE AND VISUAL FUNCTION AFTER RETINAL DETACHMENT SURGERY.

PURPOSE: To investigate and compare the vision-related quality of life after rhegmatogenous retinal detachment (RRD) surgery with that of normal controls and to evaluate the relationship between the vision-related quality of life and visual function after surgery for RRD. METHODS: In this prospective, consecutive, comparative case series, the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was completed by 100 RRD patients at 6 months after surgery. Among the patients with RRD, 86 underwent pars plana vitrectomy and 14 received scleral buckling. Best-corrected visual acuity was obtained using ETDRS charts and converted to the logarithm of the minimum angle of resolution for statistical calculations. The VFQ-25 also was administered to 107 normal controls. RESULTS: The VFQ-25 composite score and the subscales associated with general vision, mental health, social functioning, driving, and color vision were significantly lower in the RRD group than in the normal controls (P < 0.05). The VFQ-25 composite score significantly correlated with logarithm of the minimum angle of resolution best-corrected visual acuity (P < 0.0001) on both the operated and the fellow eye. CONCLUSION: The vision-related quality of life is significantly impaired in patients after surgery for RRD. Higher age and female gender negatively influences the results of the composite score.

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.

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.

Half-fluence photodynamic therapy in acute central serous chorioretinopathy.

PURPOSE: To evaluate the results of indocyanine green angiography-guided verteporfin (Visudyne; Novartis Pharma AG, Switzerland) photodynamic therapy with half-fluence rate in the treatment of acute symptomatic central serous chorioretinopathy. METHODS: A retrospective review over 12 months was performed of 19 consecutive patients with subfoveal fluid because of acute symptomatic central serous chorioretinopathy proved by spectral-domain optical coherence tomography and fluorescein angiography, treated with indocyanine green angiography-guided verteporfin (6 mg/m) photodynamic therapy with half-fluence rate (25 J/cm). Acute symptomatic central serous chorioretinopathy was defined as first episode of symptoms and duration of symptoms before treatment of ≤12 weeks. RESULTS: Best-corrected visual acuity at baseline was 47 letters (±10; n = 19) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after photodynamic therapy, the mean best-corrected visual acuity improved to 56 letters (P = 0.003).Pretreatment central foveal thickness was 406 µm and decreased by a mean of 163 µm at Month 12 control (P < 0.001). At Month 1 after photodynamic therapy, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in all 19 patients. None of the patients developed any recurrence of symptoms over 12 months. No ocular or systemic side effects were observed during 12 months follow-up. CONCLUSION: Indocyanine green angiography-guided half-fluence photodynamic therapy with verteporfin is effective in treating acute symptomatic central serous chorioretinopathy, resulting in visual improvement and complete resolution of exudative macular detachment.

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.

Quality and reproducibility of retinal thickness measurements in two spectral-domain optical coherence tomography machines.

PURPOSE: To evaluate the accuracy and reproducibility of retinal thickness measurements in exudative age-related macular degeneration (AMD) by the Spectralis (Heidelberg Engineering, Heidelberg, Germany) and the Cirrus (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography (OCT) systems. METHODS: Eyes with exudative age-related macular degeneration were randomly assigned to one of eight groups, each different in the sequence of examiner and OCT system. The 512 × 128 cube program of the Cirrus and the 30° × 25° volume scan containing 32 lines of the Spectralis were performed twice. The correlation between the examinations was expressed by the interclass correlation coefficient (ICC). RESULTS: Enrolled in the study were 112 patients and 112 eyes (mean age, 76.5 ± 7.9 years; range 51-89), with 14 patients in each group. The mean error scores per line were 0.53 and 0.52 in the Cirrus, significantly (P < 0.001) lower than in the Spectralis (0.83 and 0.98). For automatic central retinal thickness (CRT), the ICC for Cirrus (all examinations calculated) was 0.61 for groups 1 to 4 (the same examiner) and 0.65 for groups 5 to 8 (two different examiners); for Spectralis (13.4% not calculated) the ICC was 0.93 for groups 1 to 4 and 0.86 for groups 5 to 8. After error correction, the Cirrus ICC improved to 1.0 and 0.99 and the Spectralis ICC to 1.0 in both groups. CONCLUSIONS: Considerable differences were found between the two systems, both of which incorporate the spectral-domain technology. Different positioning of segmentation lines, control of localization, density of included scan lines, and number of available maps explain the differences in segmentation quality and reproducibility. Manual correction of segmentation and centralization improves the reproducibility.

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.

Trends in primary retinal detachment surgery: results of a Bicenter study.

PURPOSE: To assess trends and outcomes in retinal detachment (RD) surgery based on a retrospective, interventional, bicenter study. METHODS: Baseline demographic data, surgical procedures, and outcomes from 230 patients with a diagnosis of primary rhegmatogenous RD, who underwent surgery between January 2007 and December 2008 at the Rudolf Foundation Clinic, Vienna (Center 1) and the Weill Cornell Medical College, New York, (Center 2) were analyzed using a regression model. RESULTS: Besides the baseline parameters, lens status (P = 0.01), refraction (P = 0.01), retinal tears (P < 0.02), proliferative vitreoretinopathy (P = 0.02), and previous treatment (P < 0.02), the primary RD procedure (P < 0.0001) was significantly different between the 2 centers. In Center 1, scleral buckling was the most common primary RD procedure (66.19%) compared with vitrectomy (82.42%) in Center 2. Primary retinal reattachment (88.49% Center 1 vs. 84.62% Center 2, P = 0.43) and best-corrected visual acuity at the final follow-up (best-corrected visual acuity ≥ 0.3 logarithm of minimum angle of resolution 48.92% Center 1 vs. 47.25% Center 2, P = 0.78) were not significantly different between the 2 centers. CONCLUSION: Although there is a trend toward primary vitrectomy, scleral buckling was preferred in the center in Vienna and primary vitrectomy in the center in New York. Despite the different primary RD procedures, anatomical and visual outcomes were comparable.

Outcome after silicone oil removal and simultaneous 360° endolaser treatment.

PURPOSE: To evaluate the outcome after silicone oil removal combined with a 360° endolaser treatment in complex retinal detachment (RD) cases and to assess prognostic factors. METHODS: This is a retrospective, consecutive interventional study in Vienna, Austria with data from 111 patients following silicone oil removal and simultaneous 360° endolaser treatment for at least 6 months. Stepwise regression analysis between anatomic and visual outcome, baseline demographics, and type and number of RD procedures was performed. RESULTS: One hundred and one patients (91%) showed a retinal reattachment after silicone oil removal, which was associated with a low overall number of RD procedures (p = 0.01) and male gender (p < 0.03). Sixty-five patients (59%) showed an improvement (two or more lines) of best-corrected visual acuity (BCVA) at the final follow-up visit. Improvement of BCVA and a better BCVA after silicone oil removal were associated with a better BCVA before silicone oil removal (p < 0.01) and a low overall number of RD procedures (p < 0.01). CONCLUSION: The overall number of RD procedures can be used to predict the anatomic and visual outcome after silicone oil removal. Adding a simultaneous 360° endolaser therapy to silicone oil removal is associated with a high anatomic success rate and an excellent visual outcome.

Cirrus OCT versus Spectralis OCT: differences in segmentation in fibrovascular pigment epithelial detachment.

BACKGROUND: Automatically measurements of retinal thickness by optical coherence tomography (OCT) facilitate the assessment of various retinal diseases.The aim of this retrospective study was to report macular thickness measurements in eyes with vascular pigment epithelial detachment (PED) due to age-related macular degeneration (AMD) by using two different commercially available spectral domain (SD) OCT instruments and to consequently point out differences in their algorithm software.systems. METHODS: OCT images of patients with vascular PED due to AMD, obtained with Cirrus and Spectralis OCT, were retrospectively analyzed. Main objectives were to observe differences in central retinal thickness (CRT) values and failures in automated threshold delineation, as well as central point thickness values obtained after manual correction of threshold lines. Scanning with the Cirrus HD OCT was performed with the 512 × 128 scan pattern; scans performed with the Spectralis OCT were 20 × 15 degree raster scans consisting of 19 high-speed line scans. RESULTS: OCT images of 34 eyes of 28 patients with a mean age of 71 years and a mean distance visual acuity (VA) of 0.70 ETDRS were analyzed. Mean central retinal thickness (CRT) was 262.38 µm ± 133.18 (176-507 µm) in Cirrus and 337.82 µm ± 137.75 (277-790 µm) in Spectralis scans,mainly caused by different software approaches in positioning the posterior threshold line, following the PED in Cirrus OCT whereas remaining unelevated in Spectralis OCT. There were failures in positioning the outer retinal boundary line in 50% of Cirrus scans and in 73.52% of Spectralis scans. We obtained the mean value of central point neurosensory retinal thickness of each central single scan after manual delineation, and found a significant correlation (r = 0.819, p < 0.001). CONCLUSIONS: Our study indicates that there are significant differences in CRT values in patients with vascular PED, due to different segmentation algorithms and a high error rate in automatically set threshold lines. When planning and conducting multicenter studies, one has to be especially aware of the differences in delineating threshold algorithm lines by different SD OCT devices.

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.