Optical coherence tomography findings in autoimmune retinopathy.

PURPOSE: To report optical coherence tomography (OCT) features of patients with autoimmune retinopathy. DESIGN: Consecutive case series. METHOD: Eight patients who presented with unexplained loss of central vision, visual field defects, and/or photopsia were diagnosed with autoimmune retinopathy based on clinical features, electroretinogram (ERG) findings, and serum antiretinal antibody analysis. All patients underwent OCT testing of the macula and nerve fiber layer (NFL). RESULTS: Outer retinal abnormalities and/or decreased macular thickness on OCT were seen in all patients. Macular OCT showed reduced central macular and foveal thicknesses in 6 patients (mean thickness 143±30 µm and 131±29 µm respectively). In all but 1 patient, loss of the photoreceptor layer or disruption of the photoreceptor outer and inner segment junction was noted. Three patients showed only mild to moderate focal NFL loss. CONCLUSIONS: Retinal atrophy and reduced macular thickness on OCT are predominant features in patients with autoimmune retinopathy. OCT provides objective measures of retinal damage and may offer clues toward understanding the mechanism of visual dysfunction and the diagnosis of autoimmune retinopathy.

Quantification of error in optical coherence tomography central macular thickness measurement in wet age-related macular degeneration.

PURPOSE: To assess error indicators encountered during optical coherence tomography (OCT) automated retinal thickness measurement (RTM) in neovascular age-related macular degeneration (NVAMD) before and after bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) treatment. DESIGN: Retrospective observational cross-sectional study. METHODS: Each of the 6 radial lines of a single Stratus fast macular OCT study before and 3 months following initiation of treatment in 46 eyes with NVAMD, for a total of 552 scans, was evaluated. Error frequency was analyzed relative to the presence of intraretinal, subretinal (SR), and subretinal pigment epithelial (SRPE) fluid. In scans with edge detection kernel (EDK) misplacement, manual caliper measurement of the central macular (CMT) and central foveal (CFT) thicknesses was performed and compared to the software-generated values. The frequency of the various types of error indicators, the risk factors for error, and the magnitude of automated RTM error were analyzed. RESULTS: Error indicators were found in 91.3% and 71.7% of eyes before and after treatment, respectively (P = .013). Suboptimal signal strength was the most common error indicator. EDK misplacement was the second most common type of error prior to treatment and the least common after treatment (P = .005). Eyes with SR or SRPE fluid were at the highest risk for error, particularly EDK misplacement (P = .039). There was a strong association between the software-generated and caliper-generated CMT and CFT measurements. The software overestimated measurements by up to 32% and underestimated them by up to 15% in the presence of SR and SRPE fluid, respectively. CONCLUSIONS: OCT errors are very frequent in NVAMD. SRF is associated with the highest risk and magnitude of error in automated CMT and CFT measurements. Manually adjusted measurements may be more reliable in such eyes.

Intravitreal triamcinolone for the management of macular edema due to nonischemic central retinal vein occlusion.

OBJECTIVE: To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to nonischemic central retinal vein occlusion (CRVO). METHODS: Twenty consecutive patients were selected with a 3- to 4-month history of nonischemic CRVO and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide (40 mg/mL). The follow-up period ranged from 10 to 12 months. The amount of macular edema was assessed by the amount of retinal thickening on clinical examination using the Goldmann contact lens and by the area and intensity of staining on fluorescein angiography. Treated patients were compared with a retrospectively matched group of patients who were managed with observation only. MAIN OUTCOME MEASURES: Changes in visual acuity and amount of macular edema were assessed in the treated patients and compared with the observation group. RESULTS: The mean baseline visual acuity in the treatment group was 20/132 vs 20/123 for the observation group (P =.57). After 1 week, the treated group had a mean visual acuity of 20/51. At final follow-up, the treated group had a mean visual acuity of 20/37 while the observation group had a mean visual acuity of 20/110 (P =.001). Sixty percent of treated patients had a final visual acuity of 20/40 or better vs only 20% in the observation group (P =.01). Forty percent of the untreated patients had a final visual acuity worse than 20/200 while none of the treated patients did (P<.001). At final follow-up, 75% of treated patients had complete resolution of macular edema on clinical examination vs only 20% of the untreated patients (P<.001). Two of the treated patients had recurrence of macular edema at 6 months, and 3 had elevated intraocular pressure. CONCLUSION: This study shows a treatment benefit from intravitreal triamcinolone in terms of visual acuity and macular edema for nonischemic CRVO.

Intermittent exotropia with high AC/A ratio: is it a bane to surgical cure? Some facts and fictions of the two clinical tests: occlusion of one eye and the use of +3.00 spherical lenses.

BACKGROUND AND PURPOSE: To review the multiple factors in intermittent exotropia (X(T)) responsible for the discrepancy between the distance and near deviations; to challenge the classification of X(T) into types according to the two standard clinical tests of occlusion of one eye and the use of +3.00 D spherical lenses at near by demonstrating the pitfalls of these two tests, as in X(T), masquerading as high AC/A ratio at times or as strong proximal fusional convergence at other times. METHODS OF STUDY: Fifteen patients demonstrating findings characteristic of X(T) with so-called high AC/A ratio are reported. Fourteen patients had an exodeviation initially. The fifteenth had become exotropic following medial rectus recessions for infantile esotropia. Fourteen patients had bilateral lateral rectus recession and one had unilateral lateral rectus recession. RESULTS: The only patient who did develop a long term postoperative overcorrected high AC/A ratio esotropia was the patient who had initially an infantile esotropia. Of the other 14 patients initially X(T) none developed a long term postoperative overcorrected high AC/A ratio esotropia. Fifty % of these were "cured" (OT +/- 8 delta) and 50% had a "significant (> or = 8 delta) recurrence" of their exodeviation. CONCLUSION: Patients with intermittent exotropia and significantly more exodeviation at distance than at near, and classified to have high AC/A ratio by occlusion of one eye and the use of +3.00 spheres at near, do not necessarily have a high accommodation-convergence relationship but rather, other factors mimicking this high AC/A relationship. They do not necessarily develop a postoperative overcorrected high AC/A ratio esotropia.