Time-course and characteristic morphology of retinal changes following combination of verteporfin therapy and intravitreal triamcinolone in neovascular age-related macular degeneration.

PURPOSE: To identify characteristic morphological changes of the retina over time and the association with visual function after combined photodynamic therapy (PDT) and intravitreal triamcinolone (IVTA). METHODS: In this retrospective study, 40 patients (40 eyes) were treated with PDT and same-day IVTA. Optical coherence tomography (OCT), fluorescein angiography (FA) and evaluation of distance visual acuity (VA) were performed. The anatomical changes within intra- and subretinal compartments and their detailed analysis and grading were the main outcome measures. RESULTS: Intraretinal fluid (IRF) and subretinal fluid (SRF) by OCT decreased until 3 months (p < 0.01). At month 3, intraretinal cystoid spaces (ICS) had resolved or decreased in 84% of eyes, SRF in 58% and pigment epithelial detachment (PED) in 50%. Mean best-corrected VA (BCVA) improved significantly at month 1 (p < 0.01). Mean central retinal thickness (CRT) increased from 334 microm at baseline to 439 microm at day 1 (p = 0.03) before decreasing to 286 microm at day 7 (p = 0.06), 233 microm at month 1 (p = 0.001) and 255 microm at month 3 (p = 0.001). CONCLUSION: Combined verteporfin/IVTA therapy induces distinct time-related effects on the retina within the different intra- and subretinal compartments.

Efficacy of intravitreal bevacizumab (Avastin) therapy for early and advanced neovascular age-related macular degeneration.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age-related macular degeneration (ARMD). METHODS: A consecutive series of eyes with neovascular ARMD treated with monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml) as long as there was evidence of activity on fluorescein angiography (FA) and optical coherence tomography (OCT) was included and observed for 6 months. For further analysis they were assigned to either an early (untreated/newly diagnosed) or an advanced (predominantly fibrotic/pre-treated) ARMD group. We examined distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central retinal thickness with OCT, as well as lesion size and safety aspects. RESULTS: Forty-four patients (44 eyes) were enrolled (21 early lesions, 23 advanced lesions). Mean VA changed from 0.74 logMAR at baseline to 0.68 logMAR at month 6 (P = 0.01). Improvement in VA was statistically significant only in eyes with early lesions (n = 21) from month 1 (P = 0.015) up to month 6 (P = 0.03). The changes in central retinal thickness (CRT) (P < 0.001) and total lesion size (P < 0.001) were significant in both groups (early and advanced) at all time-points during follow-up. No significant ocular or systemic adverse effects were observed. CONCLUSION: Intravitreal bevacizumab was tolerated well by our patients and we did not identify any apparent short-term safety concerns. We observed stabilization in VA overall, with significant improvement in the early lesion group.

Quality of the threshold algorithm in age-related macular degeneration: Stratus versus Cirrus OCT.

PURPOSE: Automatically generated measurements of the retinal volume or the central retinal thickness are based on correctly set threshold lines on the retinal surface and the retinal pigment epithelium. The purpose of this study was to compare the accuracy of threshold algorithm lines of Stratus optical coherence tomography (OCT) with those of Cirrus OCT. METHODS: A consecutive series of patients at least 50 years of age with exudative age-related macular degeneration was included. Stratus OCT (retinal thickness program) and Cirrus OCT (macular cube 512 x 128) were performed by the same examiner, the sequence of the examinations was randomized. Two independent examiners evaluated the positioning of the threshold algorithm lines and performed a grading of the failures. Logistic regression analysis was applied for evaluation of the failure rate. RESULTS: One hundred four patients were included. For the entire OCT examination (6 scans Stratus OCT, 128 scans Cirrus OCT) algorithm line failures were detected in 69.2% of the Stratus OCT and in 25% of the Cirrus OCT examinations, with the difference reaching statistical significance (P < 0.001). The median failure grade was 1 (0-6) for Stratus and 0 (0-5.15) for Cirrus OCT. Age, measurement sequence, and investigator did not influence the error rates. CONCLUSIONS: With Cirrus OCT automatically performed and therefore objective measurements of central retinal thickness and retinal volume were provided correctly in 69.2% of the scans. Furthermore, this latest software version offers the possibility of manual correction of false positioned algorithm lines (ClinicalTrials.gov number, NCT00568191).