Longitudinal ellipsoid zone and subretinal fluid mapping following ocriplasmin injection in the prospective observational ORBIT trial

2019 ◽  
Vol 104 (3) ◽  
pp. 410-415
Author(s):  
Jeremy A Lavine ◽  
Sunil K Srivastava ◽  
Neeley Dukles ◽  
Jamie L Reese ◽  
Justis P Ehlers
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Subretinal Fluid ◽  
Final Visit ◽  
Volume Loss ◽  
Ellipsoid Zone ◽  
Retrospective Reports ◽  
Baseline Levels ◽  
Feature Extraction Software

BackgroundOcriplasmin is approved for the treatment of symptomatic vitreomacular traction (VMT). However, several retrospective reports have identified ellipsoid zone (EZ) alterations on spectral domain optical coherence tomography (SDOCT) after ocriplasmin injection. This report quantitatively analysed outer retinal changes after intravitreal ocriplasmin.MethodsOcriplasmin Research to Better Inform Treatment is a prospective, observational phase IV clinical study where subjects received a single intravitreal injection of ocriplasmin for symptomatic VMT. Macular cube scans were imported into a semiautomated EZ mapping and fluid feature extraction software for SDOCT analysis. Change in visual acuity, VMT release, macular hole (MH) closure, EZ integrity/volume and subretinal fluid (SRF) volume on SDOCT macular cube scans were recorded and analysed.ResultsThis analysis included 55 participants with 6 months of follow-up. Intravitreal ocriplasmin injection caused VMT release in 67% and MH closure in 82% of participants. Visual acuity improved by 4.5 letters (p<0.05) in the whole cohort and by 6.0 letters (p<0.05) in participants with VMT release. EZ volume was reduced by 23.4% at week 1 (p<0.001) and recovered to baseline by between months 3 and 6. EZ volume loss at week 1 did not correlate with ETDRS acuity at final visit.ConclusionOcriplasmin treatment resulted in VMT release, MH closure and visual acuity gains in a significant portion of eyes. EZ volume was significantly reduced at week 1, but recovered to baseline levels by final follow-up and was not associated with final visual acuity.

scholarly journals Long-term Clinical Course of Korean Patients Diagnosed with Macular Telangiectasia Type 2

2021 ◽  
Vol 62 (8) ◽  
pp. 1098-1104
Author(s):  
Kyung Hae Kang ◽  
Ji Hyun Yoon ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim
Keyword(s):  
Visual Acuity ◽  
Final Visit ◽  
Ellipsoid Zone ◽  
Visual Deterioration ◽  
Macular Telangiectasia ◽  
Macular Telangiectasia Type 2 ◽  
The Mean

Purpose: To evaluate long-term visual prognosis and changes in the retinal microstructure in patients with macular telangiectasia type 2.Methods: Retrospective analysis of medical records were performed for 61 eyes (32 patients) diagnosed with macular telangiectasia type 2. The visual acuity at diagnosis was compared with that at the final visit. In addition, cases were classified into three grades based on optical coherence tomography (OCT) findings: grade 1, inner retinal cavities only; grade 2, outer retinal cavities with ellipsoid zone disruption; and grade 3, ellipsoid zone disruption with proliferation of retinal pigment epithelium. Change in the grade during the follow-up was verified. In addition, visual acuities were compared between eyes with and without a change in grade.Results: The mean follow-up period was 41.5 ± 33.2 months. Visual acuity had deteriorated significantly from the mean logarithm of the minimal angle of resolution 0.23 ± 0.26 at diagnosis to a mean of 0.31 ± 0.31 at the final visit (p < 0.001). When classified using OCT, 65.6%, 22.9%, and 11.5% were grades 1, 2, and 3, respectively, at diagnosis and 47.5%, 36.1%, and 16.4% at the final visit. Progression of grade was noted in 22.9%. A higher degree of visual deterioration was noted in eyes showing progression than in eyes without (p = 0.002).Conclusions: During the long-term follow-up period, visual deterioration was noted in patients with macular telangiectasia type 2. However, the degree of deterioration was not high. Progression in the disruption of the retinal microstructure was the likely cause of visual deterioration.

Surgical Management of Advanced Coats Disease in 32 Eyes: A 20-Year Study

2020 ◽  
Vol 4 (6) ◽  
pp. 467-471
Author(s):  
Pukhraj Rishi ◽  
Ekta Rishi ◽  
Yamini Attiku ◽  
Mahesh Uparkar ◽  
Pramod Bhende ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Subretinal Fluid ◽  
Vitreous Hemorrhage ◽  
Disease Stage ◽  
Final Visit ◽  
Kaplan Meier ◽  
Coats Disease ◽  
End Stage ◽  
Anatomical Outcome

Purpose: This work studies outcomes of external subretinal fluid (SRF) drainage in management of eyes with advanced Coats disease. Methods: Patients with advanced-stage Coats disease (≥stage 3B), who were younger than 12 years and underwent external SRF drainage from 1996 to 2016, were included in this retrospective study. Surgical intervention involved external drainage of SRF and cryotherapy. SRF drainage was performed by lamellar scleral dissection or by external needle drainage. Favorable anatomical outcome was defined as retinal reattachment with normal intraocular pressure (IOP). IOP greater than 24 mm Hg was considered raised. Univariate and multivariate analyses were performed to measure the association between preoperative or intraoperative factors and retinal status at final follow-up. Outcome measures evaluated included visual acuity, IOP, retinal status, globe status, and complications of surgery. Kaplan-Meier analysis was performed for globe salvage without pain. Results: Thirty-two eyes of 32 patients were included in the study. Mean age at surgery was 3.8 ± 3 years. The mean duration of follow-up was 7 years (range, 6 months-15.7 years). Improvement in visual acuity was seen in 5 eyes. Retina was attached at final visit in 6 eyes. IOP in the range of 8 to 24 mm Hg was noted in 16 eyes. Favorable anatomical outcome was achieved in 3 (9%) eyes. Globe salvage was achieved in 84% of eyes. Complications included intraoperative vitreous hemorrhage (n = 1) and postoperative inflammation (n = 1). Kaplan-Meier ocular survival rate without pain at 10 years was 76%. Conclusions: SRF drainage and cryotherapy in eyes with advanced Coats disease favorably alter the natural history of the disease and prevent end-stage complications. Visual outcomes remain poor.

Retinal Vasculitis Associated With Dermatomyositis Treated With Intravenous Steroids

2021 ◽  
pp. 247412642110189
Author(s):  
Austen N. Knapp ◽  
Jawad I. Arshad ◽  
Daniel F. Martin ◽  
Rula Hajj-Ali ◽  
Kimberly Baynes ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Retinal Vasculitis ◽  
Subretinal Fluid ◽  
Retrospective Case ◽  
Hand Motion ◽  
Frosted Branch Angiitis ◽  
Intravenous Steroids

Purpose: This work aims to present treatment and long-term follow-up of a 31-year-old woman with dermatomyositis who presented with hemorrhagic retinal vasculitis and macular edema. Methods: A retrospective case report is presented. Results: A 31-year-old woman with dermatomyositis treated with systemic immunosuppression was evaluated for acute, reduced vision. Best-corrected visual acuity was hand motion in the right eye and 20/200 in the left eye. Fundus examination revealed diffuse intraretinal hemorrhages, cotton-wool spots, and vascular sheathing with a frosted branch angiitis–like appearance. Optical coherence tomography revealed significant macular edema and subretinal fluid that quickly resolved after admission and treatment with intravenous steroids. Multimodal imaging at 7-year follow-up disclosed long-term sequelae including peripheral nonperfusion and retinal neovascularization. Conclusions: When vasculitis associated with dermatomyositis is treated aggressively with intravenous steroids at initial presentation, good visual acuity outcomes can be achieved, but long-term consequences of retinal nonperfusion and neovascularization persist.

scholarly journals Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and Aflibercept

2021 ◽  
Author(s):  
Maria Vadalà ◽  
Massimo Castellucci ◽  
Giulia Guarrasi ◽  
Giovanni Cillino ◽  
Vincenza Maria Elena Bonfiglio ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Subretinal Fluid ◽  
Clinical Activity ◽  
Monthly Basis ◽  
Choroidal Vasculopathy

Abstract Introduction To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV).Methods Patients with PPCV were treated with PDT combined with 3 IVA injections on a monthly basis, followed by pro re nata criteria. The 12-month follow-up consisted of multiple revaluations of visual acuity and SSOCT parameters of clinical activity.Results Nineteen eyes were included in the study; mean age was 65.5 years. Visual acuity improved after 12 months (0.35 ± 0.25 to 0.2 ± 0.20 logMAR, p = 0.005). Percentage of eyes with intraretinal and subretinal fluid reduced from baseline to the 12-month follow-up (from 52.6–10.5%, p = 0.12, and from 89.5–5.3% p = 0.0009, respectively). Central retinal and mean macular thicknesses reduced (258 ± 39.6 to 204.8 ± 38.8 µm p = 0.04 and 293.8 ± 32.1 to 248.1 ± 29.6 µm p = 0.017 respectively). Central choroidal and mean choroidal thicknesses also displayed a reduction (328.6 ± 54.9 to 289.8 ± 44.6 µm p = 0.001 and 314.5 ± 55.3 to 287.9 ± 47.6 µm p = 0.015 respectively). The mean number of injections was 4.6/year.Conclusion The results support the use of a combined therapy with Aflibercept and PDT in PPCV. This treatment would act in synergy, with anti-VEGF controlling exudation and PDT closing the aneurysmal vessel and reducing choroidal congestion.

scholarly journals Different Types of Maculopathy in Eyes after a High-Voltage Electrical Shock Injury

2019 ◽  
Vol 10 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Hye Rim Choe ◽  
Un Chul Park
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
High Voltage ◽  
Electrical Current ◽  
Final Visit ◽  
Electrical Injury ◽  
Electrical Shock ◽  
Retinal Atrophy ◽  
Different Types ◽  
The Right

Background: We report a case of different types of maculopathy in eyes after a high-voltage electrical shock injury. Case Report: A 43-year-old male suffered high-voltage electrical injury through his left arm. He underwent cataract surgery in both eyes 3 months after the injury, but there was no vision improvement. Ocular examination, including spectral domain optical coherence tomography, revealed diffuse retinal atrophy in the left eye which did not change until the final visit. In the right eye, an impending macular hole was observed but regressed spontaneously 9 months after the injury, and the visual acuity improved to 20/32 at the final visit. Conclusion: Two different types of maculopathy can occur in each eye after high-voltage electrical shock injury, and this might be due to asymmetric pathogenesis of the eyes according to the proximity to the route of electrical current.

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

2019 ◽  
Vol 30 (5) ◽  
pp. 1082-1090
Author(s):  
Jordi Monés ◽  
Marc Biarnés ◽  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Endothelial Growth Factor ◽  
Best Corrected Visual Acuity

Importance: To provide new insights into aflibercept effect in non-naive-treated patients with neovascular age-related macular degeneration. Purpose: To assess the efficacy of intravitreal aflibercept in patients with neovascular age-related macular degeneration without optimal response to previous anti-vascular endothelial growth factor A therapy. Design: Single-arm, multi-centre, prospective study. Participants: Patients ⩾50 years with active neovascular age-related macular degeneration, best-corrected visual acuity between 20/32 and 20/320 with suboptimal response to ranibizumab or bevacizumab. Methods: Aflibercept was administered monthly (3-first months), and bimonthly thereafter until month 8. Anatomical and functional outcomes were assessed. Main outcome measure: Percentage of eyes without intra or subretinal fluid on optical coherence tomography after 3-monthly loading doses of aflibercept. Results: A total of 46 patients were included. At week 12, 45.7% (95% confidence interval: 31.5%–60.1%) of eyes showed no fluid on optical coherence tomography. The mean (standard deviation) best-corrected visual acuity increased from 65.1 (8.3) to 69.6 (8.1) letters (+4.5 (5.8) p < 0.0001) and was stabilized at week 40 as compared to baseline. Mean central macular thickness decreased from 430 (119) µm to 323 (100) µm at week 12 (–107 (90) µm, p < 0.0001) and was reduced at week 40 (–46 (111) µm, p = 0.0056). At week 40, 21.7% (95% confidence interval: 9.8%–33.7%) had no fluid. There was a case of presumed noninfectious endophthalmitis that was successfully managed. Conclusion: Almost half of patients presented no fluid on optical coherence tomography at week 12, and there was a clinically significant improvement in best-corrected visual acuity. At week 40, one in five patients did not show intra or subretinal fluid, central macular thickness decreased and best-corrected visual acuity was stabilized compared to baseline.

scholarly journals Changes in Metamorphopsia, Visual Acuity, and Central Macular Thickness after Epiretinal Membrane Surgery in Four Preoperative Stages Classified with OCT B-Scan Images

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Jianbo Mao ◽  
Hanfei Wu ◽  
Chenyi Liu ◽  
Chenting Zhu ◽  
Jimeng Lao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Thickness ◽  
Final Visit ◽  
Central Macular Thickness ◽  
Epiretinal Membranes ◽  
Stage 4 ◽  
Significant Difference ◽  
Three Stages ◽  
B Scan Images

Purpose. To observe the changes in metamorphopsia, visual acuity, and central macular thickness (CMT) in patients undergoing vitrectomy for idiopathic epiretinal membranes (iERM); all of which were preoperatively stratified into 4 stages according to the anatomical structure of the macula seen on the optical coherence tomography (OCT) b-scan images. Methods. A total of 108 eyes of 106 patients were included. We evaluated and classified the severity of each preoperative ERM based on OCT. Changes in the best-corrected visual acuity (BCVA), metamorphopsia, and CMT were studied by comparing the pre- and postoperative measurements. The follow-up time was at least 6 months. Results. There were 41 eyes at stage 2, 35 at stage 3, 32 at stage 4, and none at stage 1. BCVA and metamorphopsia significantly improved at the final visit in all patients (P<0.01). However, comparing the pre- and postoperative measurements at each stage, only the BCVA and CMT improved significantly for all stages (P<0.001). For stages 2 and 3 ERMs, the horizontal (MH) and vertical (MV) metamorphopsia scores decreased significantly after surgery (P<0.05). No significant difference was found in either MH or MV for stage 4 ERMs (P both >0.05). The preoperative BCVA, MH, and CMT had significant difference among the three stages (P<0.05). Similarly, the postoperative values in the three variables mentioned above also had significant difference among the three stages (P<0.05). For stage 2 ERMs, the baseline MH and MV were positively correlated with the baseline CMT. The MH and MV at the final follow-up also presented a significant positive correlation with the baseline CMT. For stage 3 ERMs, only the baseline MV showed significant correlation with the CMT. Conclusion. Categorization of the preoperative ERMs is a useful method to predict the postoperative improvement in metamorphopsia, which would aid in surgical decisions for patients with ERMs.

scholarly journals Changes in Retinal Vasculature and Thickness After Femtosecond Laser-assisted Cataract Surgery and Conventional Cataract Surgery Using Optical Coherence Tomography Angiography

2022 ◽  
Author(s):  
Hong Zhang ◽  
Liangzhang Tan ◽  
Fang Tian ◽  
Xue Gong ◽  
Lu Chen ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Optical Coherence Tomography Angiography ◽  
Macular Thickness ◽  
Retinal Vasculature ◽  
Optical Coherence ◽  
Age Related

Abstract Purpose To assess the changes in retinal vasculature and thickness after femtosecond laser-assisted cataract surgery (FLACS) using optical coherence tomography angiography (OCTA).Methods Fifty-six eyes of 56 patients with age-related cataract were enrolled in this study. Patients were divided into FLACS or conventional phacoemulsification surgery (CPS) due to the choice of operation. Vessel density (VD) and thickness at the macular area and optic nerve head (ONH) were checked by OCTA at baseline and at 1 day, 1 month and 3 months after cataract surgery.Results In the FLACS group: The radial peripapillary capillary (RPC) density displayed a significant reduction during the follow-up (P < 0.05), even when the retinal nerve fiber layer (RNFL) thickness was not significantly changed. There was a significant negative correlation between the changes in RPC density and femtosecond laser-assisted pre-treatment time (FLAPT) at 1 day and 1 month after cataract surgery respectively (both P < 0.05). At 3 months postoperatively, the macular thickness had a significant increase in all regions (all P < 0.05). In the CPS group, the retinal VD and thickness did not show statistically significant changes in all regions during the follow-up (all P > 0.05). However, the best corrected visual acuity (BCVA) was significantly improved in both groups postoperatively (both P < 0.001).Conclusions OCTA provided a promising analysis of retinal vascular alterations, demonstrating the reduction of RPC density and the increase of macular thickness after FLACS. However, these changes had no effect on the improvement of visual acuity after cataract surgery.

scholarly journals Quantitative analysis of optical coherence tomography angiography metrics in diabetic retinopathy

2020 ◽  
Vol 12 ◽  
pp. 251584141989745 ◽  
Author(s):  
Hamid Safi ◽  
Pasha Anvari ◽  
Dariush Naseri ◽  
Hamideh Shenazandi ◽  
Pegah Kazemi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Optical Coherence Tomography Angiography ◽  
Macular Thickness ◽  
Foveal Avascular Zone ◽  
Central Macular Thickness ◽  
Optical Coherence ◽  
Ellipsoid Zone ◽  
Avascular Zone

Purpose: To evaluate the correlation of the visual acuity and diabetic retinopathy stage using optical coherence tomography and optical coherence tomography angiography metrics. Methods: In this prospective study, optical coherence tomography and optical coherence tomography angiography images of patients with different stages of diabetic retinopathy were obtained. In optical coherence tomography angiography images, the size of foveal avascular zone, central macular thickness, and vessel density at superficial and deep capillary layers of the macula were measured. In optical coherence tomography images, the presence of intraretinal cyst, disorganization of retinal inner layer, and ellipsoid zone and external limiting membrane disruption were evaluated. The associations between the variables with visual acuity and diabetic retinopathy stage were analyzed. Results: In total, 68 eyes of 38 patients with a mean age of 58.96 ± 10.59 years were included. In total, 34 eyes were categorized as non-proliferative diabetic retinopathy, 14 as active, and 20 as regressed proliferative diabetic retinopathy. Univariate analysis showed deep parafoveal vessel density, central macular thickness, ellipsoid zone disruption, disorganization of retinal inner layer, and external limiting membrane disruption had a significant relationship with visual acuity. However, in multivariate analysis, only central macular thickness and ellipsoid zone disruption had significant association with visual acuity ( p = 0.02 and p = 0.01, respectively). There was a significant difference in deep parafoveal vessel density ( p = 0.04), but not in foveal avascular zone area, between different stages of diabetic retinopathy. Conclusion: In this study, the foveal avascular zone area did not correlate with visual acuity and different stages of diabetic retinopathy. Structural abnormalities on optical coherence tomography images with especial focus on outer retinal disruption provided more reliable predictors for visual acuity outcomes in patients with diabetic retinopathy.

Usher syndrome in a patient with Ellis–van Creveld syndrome

2019 ◽  
Vol 30 (2) ◽  
pp. NP38-NP40
Author(s):  
Francesco Romano ◽  
Giorgia Carlotta Albertini ◽  
Alessandro Arrigo ◽  
Pier Pasquale Leone ◽  
Francesco Bandello ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Retinitis Pigmentosa ◽  
Usher Syndrome ◽  
Fundus Photography ◽  
Optical Coherence ◽  
Genetic Tests ◽  
Ellis Van Creveld Syndrome ◽  
Atypical Presentations

Purpose: To describe a case of Ellis–van Creveld syndrome with concomitant Usher syndrome. Methods: A 24-year-old lady with a diagnosis of Ellis–van Creveld syndrome came to our attention in 2015 complaining of nyctalopia. She underwent yearly ophthalmologic examinations, including visual acuity, dilated fundoscopy, optical coherence tomography and colour fundus photography. Results: On the day of her first examination, her visual acuity was 20/20, whereas fundus examination revealed diffuse peripheral retinal atrophy with pigmented bone spicules, waxy pallor of the disc and macular sparing in both eyes, compatible with retinitis pigmentosa. Due to the severe retinitis pigmentosa phenotype for the age and the concomitant neurosensory hearing loss, ancillary electrophysiological and genetic tests were requested. At the end of follow-up, visual function remained stable, with electroretinogram tests confirming the peripheral dysfunction. Interestingly, next generation sequencing test revealed a mutation in USH2A gene, suggestive of an overlapping Usher syndrome. On optical coherence tomography angiography, all plexuses appeared altered, with some degree of impairment also in the choriocapillaris of the spared macula. Conclusion: Our report emphasizes the advantage of new genetic tests to investigate atypical presentations of known retinal disorders found in syndromic settings. In addition, we speculate that the underlying ciliopathy might possibly aggravate the phenotype of this case of Usher syndrome.

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