Interexaminer and intraexaminer reliability of the microperimeter MP-1.

PURPOSE: To evaluate the interexaminer and intraexaminer reliability of macular microperimetry using the microperimeter MP-1. METHODS PARTICIPANTS: Fifteen healthy volunteers younger than 40 years of age (Group 1), 15 healthy subjects over 60 years (Group 2), and five patients with age-related macular degeneration (Group 3). OBSERVATION PROCEDURE: Two examiners (E1 and E2) measured, in random order, interexaminer (E2-E1a) reliability. Another examination was undergone by one of the examiners a week later to evaluate the intraexaminer (E1b-E1a) reliability. MAIN OUTCOME MEASURES: Macular sensitivity (mean threshold (decibel)) and stability of fixation were determined using MP1 microperimetry. Agreement was analysed by means of Bland-Altman plots and by the determination of the intraclass correlation coefficient.ResultsThe interexaminer (E2-E1a) and the intraexaminer (E1b-E1a) differences in the mean threshold values were not statistically significant (P=0.850, 95% confidence Interval (CI)=-0.265 to 0.319; P=0.246, 95% CI=-0.099 to 0.375, respectively). Limits of agreement and intraclass correlation coefficients also showed good agreement in each group. CONCLUSIONS: A good reliability was found for the mean threshold values in all the three groups, indicating examiner-independent measurements.

[How much waiting time is acceptable for cataract patients?]. / Welche Wartezeiten auf Kataraktoperationen sind für Patienten akzeptabel?

BACKGROUND: Lengthy waiting times are linked to a decline in visual acuity and quality of life. The aim of our study was to evaluate patients' maximum acceptable waiting time (MAWT). PATIENTS AND METHODS: A total of 300 consecutive cataract patients were asked to fill out a questionnaire. The main question addressed the patient's MAWT to undergo cataract surgery. Patients' visual impairment (VF-14 score), best corrected visual acuity (BCVA), education, profession, and social status were evaluated. RESULTS: The mean MAWT was 3.25+/-2.3 months. A significant correlation between VF-14 score and MAWT (r=0.241, p=0.001) and between MAWT and BCVA (r=0.187, p=0.01) was found. Well-educated patients (4.30+/-2.53 months, p=0.004) and patients living with a partner (3.62+/-2.41 months, p= 0.031) were more likely to tolerate longer MAWT. Patients living alone (2.94+/-2.21 months, p= 0.107) and patients who had to take care of a nursing case (2.83+/-1.90 months, p=0.589) tended to shorter MAWT. CONCLUSIONS: MAWT is dependent on subjective visual impairment and objective BCVA. Availability of social services was also a strong predictor from the patients' perspective.

Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration.

BACKGROUND: To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy. METHODS: This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed. RESULTS: Mean baseline VA was 0.15+/-0.2 and 0.25+/-0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1+/-0.14; P=0.003), and a stabilization in group B (mean difference: +0.008+/-0.2; P=0.94). CRT decreased significantly by 70 microm in group A (P=0.001) and by 84 microm in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm(2) and 19.1 mm(2) at baseline and 0.0 mm(2) and 2.0 mm(2) at month 4, respectively. The anti-VEGF treatment rate was 1.6 in group A and 3.0 in group B. CONCLUSION: In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.

Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone: short-term results of a randomised study.

BACKGROUND: To compare early treatment effect of reduced fluence versus standard photodynamic therapy (rPDT, sPDT, respectively) in combination with intravitreal triamcinolone (IVTA) in neovascular age-related macular degeneration. METHODS: Forty patients received either sPDT (group A, n = 20) or rPDT (group B, n = 20) each followed by same-day 4 mg IVTA. Patients were examined at baseline, day 1, week 1, 4 and 12. Main outcomes were visual acuity, central retinal thickness (CRT), choroidal perfusion and macular sensitivity (MS). RESULTS: Baseline characteristics were well balanced in both groups (p>0.05). At week 12, patients in group A had a mean loss of -3.7 letters compared with a gain of 3.4 letters in group B (p = 0.04, between both groups). Both treatment groups showed a similar course regarding CRT as well as MS (p>0.05). In 70% (14/20) of group A and 15% (3/20) of group B, a choroidal hypoperfusion in the area of treatment was observed after treatment (p<0.001). In 70% of group A and 55% of group B, a repeat treatment was indicated at week 12 (p = 0.55). CONCLUSIONS: At month 3, the rPDT+IVTA group showed a significantly better visual outcome, less alteration of the choroid and a trend for lower recurrence rate than the sPDT+IVTA group. Further follow-up of this study will provide information on long-term functional results and treatment durability.

[Intravitreal bevacizumab versus verteporfin and intravitreal triamcinolone acetonide in patients with neovascular age-related macula degeneration]. / Intravitreales Bevacizumab vs. Verteporfin und intravitreales Triamcinolon Acetonid bei Patienten mit neovaskulärer AMD.

AIM: The aim of this study was to compare intravitreal bevacizumab (IVB) and verteporfin therapy in combination with 4 mg intravitreal triamcinolone (PDT-IVTA) in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: A total of 30 eyes of 30 patients with neovascular AMD were included in a prospective, randomized study. Ten eyes received PDT-IVTA with a standard light fluence of 50 J/cm(2) (SPDT-IVTA), ten were treated with PDT-IVTA with a reduced light fluence of 25 J/cm(2) (RPDT-IVTA) and ten received IVB. The main outcome was evaluated using early treatment diabetic retinopathy study (ETDRS) visual acuity, fluorescein angiography and optical coherence tomography (OCT) at baseline as well as at day 1, week 1, 1 month and 3 months after therapy. RESULTS: At the beginning of therapy, the distribution of the groups was balanced. After 3 months, the SPDT-IVTA group showed a non-significant vision loss of seven letters (p<0.3) while a vision loss of 0.5 letters (p<0.9) was found in the RPDT-IVTA group. At the same time, the IVB group had a vision improvement of 11.8 letters (p<0.001). This vision improvement was statistically significant compared to the results of both PDT-IVTA groups (p<0.005). Central retinal thickness (CRT) decreased up to month 3 in the SPDT-IVTA group by 132 microm, in the RPDT-IVTA group by 78 mum and in the IVB group by 138 microm, (p<0.05 in the three groups). No significant difference in the decrease of CRT was found between the treatment groups after 3 months. CONCLUSION: IVB shows significantly better results in vision improvement in the short-term compared to the two PDT-IVTA groups. Within 3 months, all groups showed a comparable decrease in CRT. Long-term follow-up is required to evaluate the safety and treatment efficacy of all treatment modalities.