To evaluate and compare paralesional and perilesional choriocapillaris vascular impairment in eyes with geographic atrophy with and without outer retinal tubulations (ORT).
Using swept-source optical ...coherence tomography angiography, 6 × 6 mm scans of eyes with geographic atrophy with and without ORT were acquired. Choriocapillaris en-face flow and structural images were binarized, before flow signal deficit (FD) analysis in the paraatrophy zone (a 500-µm-wide band adjacent to the geographic atrophy) and the periatrophy zone (a 500-µm-wide band adjacent to the latter).
Twenty-four eyes of 19 patients with ORT and 18 eyes of 15 patients without ORT were analyzed. With and without ORT, mean percental area of FD (%FD) was greater in para- than in periatrophy zone. The difference of %FD between para- and periatrophy zone (deltaFD) was lower in eyes with ORT (mean 1.8477%, 95% confidence interval 0.8607-2.8346) than without ORT (mean 4.0018%, 95% confidence interval 2.8622-5.1414).
In eyes with geographic atrophy caused by non-neovascular age-related macular degeneration, smaller reductions in FDs were found between the para- and periatrophy zone in eyes with ORT. In both cohorts, the paraatrophy zone had more FD than the periatrophy zone.
We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for ...macular hole (MH).
This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed.
At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multiregression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively.
The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs.
Purpose To evaluate changes in contrast sensitivity after surgery for macula-on rhegmatogenous retinal detachment (RRD). Design Prospective, interventional, consecutive, case-control study. Methods ...This study included 84 eyes of 84 patients with unilateral macula-on RRD undergoing primary scleral buckling or vitrectomy without postoperative macular complication. We examined the logarithm of the minimal angle of resolution best-corrected visual acuity (logMAR BCVA) and contrast sensitivity at 4 spatial frequencies (3, 6, 12, and 18 cycles/degree) using the CSV-1000E (Vector Vision) before and after surgery. From the data obtained with the CSV-1000E, the area under the log contrast sensitivity function was calculated. The logMAR BCVA and contrast sensitivity in the contralateral normal eyes also were measured and were used as normal controls. Clinical data were collected, including age, gender, surgical procedures, the number of retinal tears, circumferential dimension of retinal tears, and area of retinal detachment, to determine the clinical factors related to visual function. Results Preoperative contrast sensitivity was significantly worse in eyes with RRD than in normal controls, but the preoperative logMAR BCVA was not different from that of normal controls. Contrast sensitivity decreased significantly after surgery, but logMAR BCVA did not change by surgery. Multiple regression analysis revealed that postoperative contrast sensitivity had a significant correlation with the circumferential dimension of retinal tears, whereas no clinical parameters were associated significantly with postoperative BCVA. Conclusions Surgery for macula-on RRD did not change visual acuity, whereas contrast sensitivity was affected significantly in association with the extent of retinal tears.
Purpose To investigate intraocular pressure (IOP) fluctuation during various vitrectomy maneuvers using the vitrectomy system (Alcon Constellation Vision System). Design An experimental study as ...laboratory investigation. Methods In porcine eyes, 23- and 25-gauge vitrectomy was performed, and IOP fluctuations were evaluated in vitreous cutting mode, in aspiration mode, and during scleral compression. The measurements were performed with the IOP control setting turned on or off. Results Using the 23-gauge system with the IOP control setting turned on, IOP decreased from 30 to 23.7 mm Hg after starting vitreous cutting, and then returned to 30 mm Hg in 2.6 seconds. When the IOP control setting was turned off, IOP decreased to 19.1 mm Hg in 0.9 seconds, and remained at that pressure. Under aspiration at 650 mm Hg without cutting, IOP showed a sharp depression from 30 to 12.2 mm Hg, and then returned to 30.6 mm Hg in 2.6 seconds with the IOP control setting turned on. When the IOP control setting was turned off, IOP decreased to 2.2 mm Hg in 9.7 seconds, and did not recover. When the sclera was compressed without aspiration, IOP rapidly increased to 70-100 mm Hg, and then slowly decreased to 30 mm Hg in 3.5-4.0 seconds, with or without the IOP control system. Similar data were obtained with 25-gauge vitrectomy. Conclusions The IOP control system can attenuate IOP fluctuations during vitrectomy maneuvers. There was no significant difference in IOP fluctuations between 23- and 25-gauge systems.
To evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes ...in these eyes.
This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes.
Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy.
Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.
The purpose of this study was to evaluate absorbable polyethylene glycol (PEG)-based synthetic hydrogel as a sealant for retinal breaks in rhegmatogenous retinal detachment (RD). A three-port, ...25-gauge vitrectomy was performed on nine Dutch pigmented rabbit eyes. Subsequently, RD was induced by creating a retinal break. The retina was then reattached by fluid-air exchange. In six of nine eyes (RD-PEG group), PEG sealant was applied to completely cover the retinal breaks, and then photopolymerized with light; thereafter, intravitreous air was replaced with balanced salt solution (BSS). In the remaining three eyes (RD group), PEG sealant was not applied, but the intravitreous air was replaced with BSS. Ophthalmological examinations and intraocular pressure measurements were conducted preoperatively, and at 1 and 7 days, and 1, 3, and 6 months postoperatively. Histological examinations of the eyes were performed after 6 postoperative months. At surgery, retinal reattachment with PEG sealant was achieved in all eyes in the RD-PEG group. Fundoscopic and optical coherence tomographic examinations revealed that the retina remained attached in all the eyes of the RD-PEG group throughout the 6-month observation period. Histological examination revealed no signs of damage in the retinal layers at the edges of the retinal breaks that were in contact with the sealant. In the RD group, the retinas detached in all eyes within 7 days postoperatively. The PEG sealant closed the retinal breaks and maintained retinal reattachment. Intraocular tamponade was not necessary.
•PEG sealant may be effective for patching retinal breaks in retinal detachment.•Retinas remained attached during the 6-month follow-up period.•No intraocular gas was needed to keep the retina reattached.
Purpose
We aimed to investigate the relationship between the severity of metamorphopsia and the foveal microstructure measured with spectral-domain optical coherence tomography (SD-OCT) in patients ...with cystoid macular edema caused by branch retinal vein occlusion (BRVO-CME).
Methods
The study included 30 eyes of 30 patients with BRVO-CME. We examined visual acuity and the severity of metamorphopsia using M-CHARTS. Central foveal thickness, central retinal thickness at the fovea (CRT-1 mm), and macular volume were measured with SD-OCT software. The status of ellipsoid zone (EZ), external limiting membrane (ELM), outer retinal cyst, and inner retinal cyst was also evaluated.
Results
The mean metamorphopsia score was 0.77 ± 0.50, with 28 of 30 patients (93 %) having metamorphopsia (metamorphopsia score ≥ 0.2). The vertical metamorphopsia score (0.89 ± 0.54) was significantly higher than the horizontal metamorphopsia score (0.64 ± 0.53) (
p
< 0.005). The status of EZ and ELM was significantly associated with visual acuity, but not with the mean metamorphopsia score. The mean metamorphopsia score was significantly related to CRT-1 mm (
p
< 0.05) and the presence of inner retinal cyst (
p
< 0.05).
Conclusions
The severity of metamorphopsia was significantly associated with central retinal thickness and the presence of inner retinal cyst.
To describe the presence of subretinal lipid globules (SLG), analyze the multimodal imaging features inherent in their optical properties, and provide a means to distinguish them from other retinal ...structures and clinical signs.
Retrospective cohort study.
The clinical data and multimodal imaging features of 39 patients (49 eyes) showing SLG were evaluated. Patients underwent color fundus photography, near-infrared reflectance (NIR), spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) and OCT angiography. In vitro phantom models were used to model OCT optical properties of water, mineral oil, and intralipid droplets and to investigate the optical mechanisms producing hypertransmission tails beneath SLG.
The SLG were not visible in color fundus photographs or in NIR images. With both SD- and SS-OCT B-scans, SLG appeared as 31-157 μm, round, hyporeflective structures demonstrating a characteristic hypertransmission tail previously described with lipid globules found in the choroid and in neovascular membranes. Similarly, with en face OCT, SLG appeared as small, round, hyporeflective structures. SLG were encountered most often in eyes with neovascular age-related macular degeneration (AMD) that had type 1 macular neovascularization (MNV) (91.1%). Of those eyes, 93.3% were receiving intravitreal antivascular endothelial growth factor (VEGF) therapy (median of 15 injections) with a mean follow-up of 52.6 months. The number of prior injections positively correlated with the number of SLG. The detection of MNV preceded the presence of SLG in 66.7% of cases. En face OCT showed that, in many eyes (49%), SLG appeared in clusters of >10. In 38.8% of eyes, SLG were found overlying type 1 MNV, and in 44.9% of eyes, often those with more numerous SLG, the SLG were located near the lesion border. In 2 eyes with AMD followed for nonexudative type 1 MNV, SLG were detected prior to the detection of other imaging signs of exudation. SLG were observed in several other exudative macular diseases. Phantom models demonstrated that the hypertransmission tail beneath SLG is related to a lensing effect produced by these hyporeflective spherical structures.
SLG are a newly recognized OCT feature frequently seen in eyes receiving intravitreal anti-VEGF therapy for type 1 MNV due to AMD. OCT B-scans show SLG as small, round, hyporeflective structures with a characteristic hypertransmission tail. This OCT signature is influenced by the OCT focal plane, and it relates to reduced signal attenuation through oil and a lensing effect created by a higher refractive index compared to surrounding tissue.
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