Differences in macular morphology between polypoidal choroidal vasculopathy and exudative age-related macular degeneration detected by optical coherence tomography.

PURPOSE: To evaluate the differences in the optical coherence tomographically determined macular morphology in eyes with polypoidal choroidal vasculopathy (PCV) from eyes with exudative age-related macular degeneration (AMD) quantitatively. METHODS: The medical records of 208 eyes of 203 Japanese patients with PCV or exudative AMD who were newly treated for choroidal neovascularization were reviewed. The six linear, low-resolution, high-speed scans of 6 mm were analyzed using a manually assisted computer algorithm, which allowed us to manually draw spline lines arbitrarily on the images so that the subretinal fluid and neurosensory retina could be segmented. The thickness of the neurosensory retina and height of the serous retinal detachment (SRD) within the central 3-mm and 6-mm areas were calculated. RESULTS: SRDs were observed in 53% (63/119) of the eyes with exudative AMD and in 78% (69/89) of the eyes with PCV (P < 0.001). The height of the SRD was 21.9 +/- 3.7 microm (+/-SEMs) in eyes with exudative AMD and 56.3 +/- 7.4 microm in eyes with PCV (P < 0.001). The thickness of the neurosensory retina was 300.0 +/- 5.2 microm in eyes with exudative AMD and 275.8 +/- 4.7 microm in eyes with PCV (P < 0.001). CONCLUSION: Eyes with PCV are characterized by a higher incidence of SRDs, greater SRD height, and less intraretinal edema than eyes with exudative AMD.

Triamcinolone-assisted removal of internal limiting membrane enhances the effect of vitrectomy for diabetic macular edema.

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) peeling during vitrectomy to treat diabetic macular edema (DME). METHODS: In this nonrandomized study, we retrospectively analyzed the medical charts of 107 eyes that had undergone three-port vitrectomy to treat DME. The ILM was peeled in 65 eyes and not peeled in 42 eyes (ILM ON group). Indocyanine green (ICG) was used on 36 eyes (ICG group) and triamcinolone acetonide (TA) on 29 eyes (TA group) to make the ILM more visible. RESULTS: In all groups, the mean foveal thickness was significantly decreased after surgery. Visual acuity (VA) improved gradually after the surgery and was significantly better than the preoperative VA at 6 months in the ICG group and at 3 months in the TA group. Compared with the ILM ON group eyes, the eyes in the TA group had significantly better improvement of VA. CONCLUSION: TA-assisted ILM peeling may improve the VA outcome to treat DME.

Reduction of inner retinal thickness in patients with autosomal dominant optic atrophy associated with OPA1 mutations.

PURPOSE: To determine the morphologic changes in the retina in the macula and around the optic disc in patients with autosomal dominant optic atrophy (ADOA) associated with a mutation in the OPA1 gene. METHODS: Cross-sectional images of the macular area of the retina were obtained by optical coherence tomography (OCT) in patients with ADOA who had a heterozygous mutation in the OPA1 gene. There were 15 eyes of eight patients from five families: four men and four women. The average age of the patients was 48.1 years. In the OCT images, the cross sections of the sensory retina were divided manually into four areas. The thickness of the overall sensory retina and the divided areas were measured at 1 and 2 mm on the temporal, nasal, superior, and inferior sides of the fovea as well as at the fovea. The thickness of the retinal nerve fiber layer (RNFL) around the optic discs was measured by taking circular scans (3.4 mm in diameter) centered on the optic disc. The results in the patients with ADOA were compared with those from 11 normal control subjects. RESULTS: The overall thickness of the sensory retina in the macular area was significantly thinner in the patients with ADOA than in the control subjects at all points except the fovea (P < 0.0001). The RNFL in the macular area in the patients with ADOA was significantly thinner than that in control subjects at all points (P < 0.0001), especially at 1 mm from the fovea. The circumpapillary RNFL was significantly thinner at the temporal, superior, and inferior areas in patients with ADOA but not in the nasal area. The total cross-sectional area of the circumpapillary RNFL was significantly correlated with visual acuity. The thickness of the combined ganglion cell layer, inner plexiform layer, inner nuclear layer, and outer plexiform layer in the macular area was significantly thinner in the patients (P < 0.0056). The thickness of the outer nuclear layer and the photoreceptor inner segments and the thickness of the photoreceptor outer segments were not significantly different between the patients with ADOA and normal control subjects. CONCLUSIONS: The RNFL and the layer including the ganglion cell layer are significantly thinner in patients with ADOA associated with an OPA1 gene mutation, whereas the photoreceptor layers are not affected morphologically. The inner retina is the main area of the retina altered in ADOA.

Elevated C-reactive protein levels in patients with polypoidal choroidal vasculopathy and patients with neovascular age-related macular degeneration.

PURPOSE: To determine the relationship between systemic C-reactive protein (CRP) levels and polypoidal choroidal vasculopathy (PCV) and advanced neovascular age-related macular degeneration (AMD) in Japanese patients. DESIGN: Case-control study. PARTICIPANTS: Ninety-seven patients with PCV, 176 with advanced neovascular AMD, and 262 control subjects without any macular abnormality were studied. METHODS: Color fundus photographs of the macular area were taken from both eyes in all subjects. Indocyanine green angiography and fluorescein angiography were performed for diagnosis. The CRP level was measured by a high-sensitivity assay using a latex aggregation immunoassay, and the levels in patients with PCV and neovascular AMD were compared with that in the control group using the Kruskal-Wallis test. Associations between CRP and PCV or neovascular AMD were compared using logistic regression analysis by computing the odds ratios (ORs) and 95% confidence intervals (CIs) after the study populations were divided into quartiles. MAIN OUTCOME MEASURES: The CRP levels in patients with PCV, patients with neovascular AMD, and control subjects. Standard univariate and multivariate analyses between groups. RESULTS: Median CRP levels were significantly higher in cases with PCV (0.94 mg/l) or with advanced neovascular AMD (0.95 mg/l) than in control subjects (0.43 mg/l) (P<0.001 for Kruskal-Wallis test). After adjusting for baseline characteristics such as age, gender, smoking status, alcohol use, body mass index, history, and use of antiinflammatory drugs, the increase in risk was significant for the highest quartile of CRP for both PCV (OR, 3.53; 95% CI, 1.49-8.40) and neovascular AMD (OR, 4.08; 95% CI, 1.94-8.56), and for the third quartile of CRP for neovascular AMD (OR, 2.29; 95% CI, 1.07-4.91). The trends for an increase in risk of disease with increase in CRP were statistically significant for both PCV (P = 0.001) and neovascular AMD (P<0.001). CONCLUSIONS: The significant associations between elevated serum CRP levels and PCV or neovascular AMD in the Japanese strongly suggest that inflammatory processes are involved in the pathogenesis of PCV and neovascular AMD.

Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes.

PURPOSE: To investigate the characteristics and incidence of a dissociated optic nerve fiber layer (DONFL) appearance in eyes after idiopathic macular hole surgery. DESIGN: Retrospective, nonrandomized, comparative interventional case series. PARTICIPANTS: Ninety-one eyes with idiopathic macular holes that were closed after 1 pars plana vitrectomy were studied. Among these, 67 eyes had the internal limiting membrane (ILM) peeled (ILM-peeled), and 24 did not have the ILM peeled (ILM-unpeeled). METHODS: All patients received a complete ophthalmologic examination and color fundus photography preoperatively and postoperatively. Twenty ILM-peeled eyes and 9 ILM-unpeeled eyes were also examined by optical coherence tomography (OCT3), microperimetry by scanning laser ophthalmoscope (SLO), and macular sensitivity measurements by Humphrey visual field testing more than 4 months after the vitrectomy. MAIN OUTCOME MEASURES: Development of a DONFL on fundus photographs and OCT3, and the functional evaluation of a DONFL by best-corrected visual acuity, SLO-microperimetry, and Humphrey visual field testing. RESULTS: In 67 ILM-peeled eyes, a DONFL appearance was found in 36 eyes (54%) in color fundus photographs. A DONFL appearance was not detected in any of the 24 ILM-unpeeled eyes. Focal dehiscence of the optic nerve fiber layer was found in all 20 examined eyes by OCT3. No scotoma was found corresponding to the DONFL by SLO microperimetry. The best-corrected visual acuity and macular sensitivity were not significantly different in eyes with and without a DONFL appearance (P>0.05). A DONFL appearance was not detected in all 20 eyes examined within 1 month after surgery, was detected in all 16 eyes examined between 1 and 3 months, and no new cases were detected after 3 months. The DONFL appearance became more distinct until about 6 months after first detection and seemed not to change subsequently. CONCLUSIONS: The DONFL appearance in about half of the eyes with ILM peeling and none in eyes without ILM peeling strongly suggest that the DONFL appearance is related to ILM peeling. The OCT findings in eyes with no functional abnormality by SLO microperimetry suggested that the DONFL is due to a dehiscence of the optic nerve fiber layer and not a true nerve fiber layer defect.