Retinal surface en face optical coherence tomography: a new imaging approach in epiretinal membrane surgery.

PURPOSE: To describe the clinical effectiveness of a new imaging approach: en face spectral domain optical coherence tomography of the retinal surface before and after epiretinal membrane (ERM) and internal limiting membrane peeling. METHODS: Retrospective analysis of preoperative and postoperative en face spectral domain optical coherence tomography images of the inner face of the macula obtained from 20 eyes of 20 patients undergoing vitrectomy with internal limiting membrane peeling for ERM. RESULTS: Preoperatively, en face spectral domain optical coherence tomography imaging of the retinal surface clearly showed plaques surrounded by radiating folds because of ERM. It could also disclose areas possibly devoid of internal limiting membrane secondary to ERM contraction. A rough retinal surface was visible in the peeled area during the first postoperative month. At 3 months, various amounts of dimples were progressively observed in 13 of 15 eyes (87%). In all these cases, they lasted or increased in size and number at the last follow-up examination. Some residual epiretinal tissue was also detected by this technique. CONCLUSION: En face spectral domain optical coherence tomography of the retinal surface is an interesting complement to standard retinal optical coherence tomography section that provides an easy-to-understand global overview of the retinal surface. It can detect and classify tiny progressive morphologic changes in the texture of the retinal surface occurring after internal limiting membrane peeling.

Photodynamic therapy for nonsubfoveal choroidal neovascularization in 100 eyes with pathologic myopia.

PURPOSE: To evaluate the visual and anatomic outcome of photodynamic therapy (PDT) in eyes with nonsubfoveal choroidal neovascularization (CNV) associated with pathologic myopia (PM). DESIGN: Interventional, noncomparative cases series. METHODS: Ninety-seven patients (100 eyes) who were treated with PDT at three centers and followed up for three to 44 months (mean 16.5 months). Outcome measures were visual acuity, lesion size, and the occurrence of subfoveal invasion. RESULTS: Median baseline visual acuity was 20/40(-2) and ranged from 20/20 to 20/160(+2). On average, visual acuity was stable throughout follow-up after a modest increase of about 0.5 lines between three and six months. The probability of losing 3 or more lines was 10% to 15% during the second year. Lesion size (median: 710 microns) slightly decreased after the first PDT and tended to increase later, but not to a statistically significant extent compared with baseline. The probability of developing subfoveal CNV stabilized at 10% in the second year. The mean number of PDTs per individual was 2.9 in the first year and 0.6 in the second. CONCLUSIONS: Visual and anatomic outcomes of PDT, in this large group of patients with nonsubfoveal myopic CNV and good visual acuity, suggest that it may halt the progression of the disease in most cases.

Macular function after PDT in myopic maculopathy: psychophysical and electrophysiological evaluation.

PURPOSE: To evaluate the effects of photodynamic therapy (PDT) on macular function in myopic subfoveal choroidal neovascularization (CNV). METHODS: Fourteen eyes of 14 patients (mean age, 48.1 +/- 13.3 years) with myopic CNV (myopia ranging from -6.50 to -20 D) were enrolled. In each eye, at baseline and at 15 and 90 days after PDT with verteporfin, logMAR visual acuity (logarithm of the minimum angle of resolution VA), macular sensitivity by scanning laser ophthalmoscope microperimetry, and focal (central 9 x 9 degrees ) ERGs (FERGs) and pattern ERGs (PERGs) were assessed. RESULTS: At 15 days after PDT, myopic CNV eyes showed, in relation to baseline values, a significant (ANOVA, P < 0.01) reduction in the diameter of the lesion that correlated (Pearson test, P < 0.01) with the significant (ANOVA, P < 0.01) increase in FERG and PERG amplitudes, VA, and scanning laser ophthalmoscopy (SLO) microperimetry results obtained from the central 1 degrees to 2 degrees of the macular area (SLO-CM). At 90 days after PDT, myopic CNV eyes showed, in comparison with baseline values, a nonsignificant (ANOVA, P > 0.01) reduction in the diameter of the lesion, a nonsignificant increase in VA and SLO-CM, and a still significant increase in FERG and PERG amplitudes. CONCLUSIONS: In myopic CNV eyes, PDT induces an increase, though not significant, in VA and macular sensitivity. These changes may be related to a reduction in the diameter of the lesion, with an improvement in the function of both ganglionic and preganglionic elements of the macular region, as suggested by the improvement in FERG and PERG responses.