ABSTRACT
PURPOSE: Spectral-domain optical coherence tomography (SD-OCT) enables high-resolution analysis of retinal layers and previously unseen hyperreflective dots (HRD). HRD morphological characteristics, evolution, possible origin and prognostic value are discussed. METHODS: We conducted a prospective study of 100 patients with exudative age-related macular degeneration (AMD), who were treated and followed up with monthly imaging examinations. Statistical correlations between visual acuity (VA) and pre-/post- treatment HRD characteristics were evaluated. RESULTS: HRD were present in all cases, mainly in the outer retinal layers but also elsewhere. After treatment, HRD regressed in a few days, 1 month (p < 0.04) and 3 months (p < 0.01). Regression was evident in all VA and morphological subsets. Resolution was associated with better final VA (p < 0.001). CONCLUSIONS: Presence of initial/recurrent HRD, rapid treatment response and the growing role that early biological inflammatory reaction plays in AMD suggests HRD are activated microglia cells. The correlation between VA and HRD could make HRD a clinical marker for early decisions about treatment and retreatment.
Subject(s)
Macula Lutea/pathology , Tomography, Optical Coherence/methods , Wet Macular Degeneration/diagnosis , Aged , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Prognosis , Prospective Studies , Reproducibility of Results , Visual AcuityABSTRACT
BACKGROUND: A diode laser can be used to create a subthreshold (invisible end point) lesion in patients with age-related macular degeneration (AMD). This has the potential benefit of localizing the treatment effect to the retinal pigment epithelium and sparing more of the overlying sensory retina. We performed a study to compare the safety and efficacy of argon laser and subthreshold infrared (810-nm) diode laser macular grid photocoagulation in reducing the number of drusen in patients with AMD. METHODS: We reviewed the charts of 144 patients with bilateral early-stage nonexudative AMD, characterized by soft drusen. One eye of each patient was treated, and the other eye served as a control. Seventy-eight eyes of 78 patients with a mean age of 67.5 (standard deviation [SD] 8.3) years underwent argon laser macular grid photocoagulation at a university-affiliated hospital in Bologna, Italy, and 66 eyes of 66 patients with a mean age of 66.4 (SD 6.3) years underwent subthreshold infrared (810-nm) diode laser macular grid photocoagulation at a private clinic in Bologna. Each group was classified into three subgroups based on the number of drusen (more than 20, 10 to 20, or less than 10). The patients underwent fluorescein angiography, fundus examination, measurement of far (Snellen chart) and near (Jaeger chart) best corrected visual acuity, and visual field and contrast sensitivity testing. The mean length of follow-up was 18 (SD 0.5) months. RESULTS: At 18 months, far and near best corrected visual acuity were statistically significantly improved in the treatment groups compared with the untreated group (p < 0.001, Mann-Whitney U test). There was no significant difference in visual acuity between the treatment groups. Compared with baseline, the number of drusen was significantly reduced in both treatment groups (p < 0.001). Evolution of the disease was observed in the untreated group. The visual field was slightly but significantly reduced after argon laser treatment (p < 0.001) but not diode laser treatment; the difference in visual field between the two groups was not significant. There was a slight reduction in contrast sensitivity, particularly with night vision, after argon laser treatment but not diode laser treatment. The difference between the two treatment groups was significant (p < 0.01). INTERPRETATION: Subthreshold infrared diode macular grid photocoagulation may be a safe and viable method for preventing progression of nonexudative AMD.
Subject(s)
Laser Coagulation/methods , Macular Degeneration/surgery , Aged , Contrast Sensitivity , Exudates and Transudates , Female , Fluorescein Angiography , Humans , Laser Coagulation/instrumentation , Male , Middle Aged , Postoperative Complications , Retinal Drusen/surgery , Visual Acuity , Visual FieldsABSTRACT
BACKGROUND: Antioxidants may affect the lipid components of membrane receptors. The purpose of this study was to determine whether treatment with antioxidants after photodynamic therapy for age-related macular degeneration (AMD) improves visual acuity recovery time after a flicker test METHODS: The study was conducted in a university-affiliated ophthalmology clinic in Bologna, Italy, from April 2000 to April 2001. Thirty-five patients (21 men and 14 women aged 55 to 86 years [mean 72 (standard deviation [SD] 8.4) years]) with bilateral AMD and neovascular membranes were enrolled in the study. Patients were randomly assigned to either receive (20 patients) or not receive (15 patients) vitamin E (200 mg/d given orally) and polyunsaturated fatty acids (1,000 mg/d given orally) after photodynamic therapy. The outcome measures were visual acuity (logMAR) after 20, 40 and 60 days, and retinal metabolic function, as evidenced by visual acuity recovery after the Magder flicker test. RESULTS: There was no significant difference in visual acuity between the two groups at 20, 40 or 60 days. At 20 days, the visual acuity recovery time was significantly shorter in the group that received antioxidants than in the group that received photodynamic therapy only (phase II .94 [SD 0.39] minutes vs. 2.56 [SD 0.57] minutes, phase II 2.13 [SD 0.68] minutes vs. 2.83 [SD 0.60] minutes, and phase III 2.19 [SD 0.70] minutes vs. 2.92 [SD 0.65] minutes) (p < 0.001). There was no significant difference between the two groups at 40 or 60 days. INTERPRETATION: Treatment with antioxidants after photodynamic therapy for AMD improves retinal metabolic function in the short term but not in the medium term.
