Showing papers by "Richard F. Spaide published in 2008"
TL;DR: In this paper, a method to obtain images of the choroid using conventional spectral-domain optical coherence tomography (OCT) and to evaluate choroidal thickness measurements using these images was described.
1,759 citations
TL;DR: FAF imaging has been shown to be useful with regard to understanding of pathophysiologic mechanisms, diagnostics, phenotype–genotype correlation, identification of predictive markers for disease progression, and monitoring of novel therapies.
Abstract: Fundus autofluorescence (FAF) imaging is a novel imaging method that allows topographic mapping of lipofuscin distribution in the retinal pigment epithelium cell monolayer as well as of other fluorophores that may occur with disease in the outer retina and the subneurosensory space. Excessive accumulation of lipofuscin granules in the lysosomal compartment of retinal pigment epithelium cells represents a common downstream pathogenetic pathway in various hereditary and complex retinal diseases, including age-related macular degeneration. FAF imaging has been shown to be useful with regard to understanding of pathophysiologic mechanisms, diagnostics, phenotype-genotype correlation, identification of predictive markers for disease progression, and monitoring of novel therapies. FAF imaging gives information above and beyond that obtained by conventional imaging methods, such as fundus photography, fluorescein angiography, and optical coherence tomography. Its clinical value coupled with its simple, efficient, and noninvasive nature is increasingly appreciated. This review summarizes basic principles and FAF findings in various retinal diseases.
497 citations
TL;DR: Most of the eyes with VMT had concurrent ERM, whereas several eyes with idiopathic ERM had attachment of the vitreous to some portion of the ERm, which suggests there is significant overlap between VMT and idiopathy ERM.
219 citations
TL;DR: The physical separation of the Retinal outer segments from the retinal pigment epithelium hinders proper phagocytosis of the outer segments.
Abstract: Purpose:To review the pathophysiologic principles underlying increased autofluorescence from the outer retina and subretinal space using selected diseases as examples.Methods:The ocular imaging information and histopathologic features, when known, were integrated for diseases causing increased autof
185 citations
TL;DR: In this paper, the incidence of suspected and proven endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents was determined from the injection log books and billing records.
181 citations
TL;DR: The spectral-domain OCT finding of IS/OS boundary defects, implicating photoreceptor OS perturbation, appears to explain the blind spot enlargement in patients with AZOOR-complex diseases.
166 citations
TL;DR: The photoreceptor layer appears to be involved for a much larger area than that occupied by the macular hole itself, and the abnormality in the IS–OS boundary line may reflect perturbation of a higher level of retinal organization and not an absolute loss of photoreceptors.
Abstract: PURPOSE: To examine the relationship between visual acuity and morphologic characteristics of macular holes as determined using spectral domain optical coherence tomography (SD OCT). METHODS: A retrospective analysis was performed of eyes with open and closed macular holes at a single, referral-based retina practice. The main outcome measures included best-corrected Snellen visual acuity and SD OCT findings, including the size of the macular hole and the disruption of the junction between inner segments (ISs) and outer segments (OSs) of the photoreceptors. RESULTS: The mean visual acuity for eyes with open (n = 24) and closed (n = 17) macular holes was 20/166 (range, 5/400 to 20/40) and 20/39 (range, 20/80 to 20/25), respectively. The mean macular hole diameter was 859 microm. A disruption of the IS-OS junction was observed in all eyes, and this disruption had a mean diameter of 1,947 microm in eyes with an open macular hole and 626 microm in those with a closed macular hole. There was a negative correlation between both the size of the macular hole (P < 0.001) and the IS-OS disruption (P = 0.01) and visual acuity in eyes with open macular holes. In eyes with closed macular hole, the size of the IS-OS disruption was not correlated with visual acuity (P = 0.82). CONCLUSIONS: The photoreceptor layer appears to be involved for a much larger area than that occupied by the macular hole itself. The abnormality in the IS-OS boundary line may reflect perturbation of a higher level of retinal organization and not an absolute loss of photoreceptor OSs.
117 citations
TL;DR: The adhesion between the vitreous and fovea in vitreomacular traction syndrome is accompanied by fibrocellular proliferation along the exposed surfaces of the inner retina and the posterior surface of the Vitreous, which may account for the prominent OCT signal seen along the posteriorsurface of the vitREous in these cases.
115 citations
TL;DR: Patients with MCP have much more widespread involvement of the RPE than would be suspected by other means of imaging, and autofluorescence photography supplies information about inflammatory damage and secondary CNV in a noninvasive manner.
78 citations
TL;DR: Subfoveal CNV secondary to non-AMD causes treated with intravitreous bevacizumab responded favorably and similarly, despite varying underlying etiologies.
Abstract: Objective To report the results of intravitreous bevacizumab (Avastin) treatment for choroidal neovascularization (CNV) from causes other than age-related macular degeneration (AMD). Methods We performed a retrospective analysis of eyes that received intravitreous bevacizumab, 1.25 mg, for subfoveal non-AMD CNV at a referral-based retinal practice. Repeated treatment with intravitreous bevacizumab occurred if there were signs of persistent or recurrent exudation. The main outcome measure was visual acuity (VA). Results The study included 39 eyes of 36 patients with subfoveal CNV secondary to multifocal choroiditis (n = 12), angioid streaks (n = 11), myopic degeneration (n = 10), idiopathic disease (n = 4), or other disease (n = 2). The median baseline VA was 20/60 (logMAR, 0.48). The mean follow-up was 58.8 weeks, and the mean number of injections per eye was 3.4. After 3-month follow-up, the median VA was 20/30 (logMAR, 0.18) (P = .004 vs baseline). At last follow-up, the median VA was 20/40 (logMAR, 0.30). This remained an improvement compared with baseline (P Conclusion Subfoveal CNV secondary to non-AMD causes treated with intravitreous bevacizumab responded favorably and similarly, despite varying underlying etiologies.
72 citations
TL;DR: The authors investigated the characteristics of fundus autofluorescence in bird shot chorioretinopathy (BSCR) and found that retinal pigment epithelium atrophy in the macula may be an important cause of poor central visual acuity.
TL;DR: There were consistent trends throughout the study that suggest that a 4 mg IVTA may be more effective than a 2 mg dose, and visual improvement was more likely in cystoid-type DME than diffuse DME.
Abstract: Purpose : To determine safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for refractory clinically significant diabetic macular edema (DME). Design : Prospective, randomized, dose-escalation pilot study comparing single injection of 2 mg versus 4 mg doses of IVTA. Methods : Inclusion criteria included clinically significant DME persisting >/=3 months after maximal laser treatment and visual acuity Results : Mean change in visual acuity at 3 months compared to baseline was 7.1 letters (P = 0.01) in the 2 mg group and 12.5 letters in the 4 mg group (P 15 letters at 3 months in 23% (3/13) of 2 mg group and in 33% (5/15) of 4 mg group (P = 0.69), and 0% (0/11) and 21% (3/14) at 6 months, respectively (P = 0.23). Visual improvement was more likely in cystoid-type DME than diffuse DME. Intraocular pressure rise of >/=10 mmHg occurred in 19% (3/16) of 2 mg group and 41% (7/17) of 4 mg group. Conclusions : Both doses of IVTA were well tolerated and had significant positive effects on refractory DME for short term. There were consistent trends throughout the study that suggest that a 4 mg IVTA may be more effective than a 2 mg dose. The benefit of IVTA was greater for cystoid-type DME.
TL;DR: F Frequencies of all major AMD-associated alleles in the CFH locus indicate a strong, statistically significant association of CFH gene single nucleotide polymorphisms and MFC.
Abstract: Objective To analyze the frequency of major age-related macular degeneration (AMD)-associated alleles in patients with multifocal choroiditis (MFC). Methods A cohort of 48 patients with MFC was compared with previously characterized cohorts of patients with advanced AMD (368 samples) and matched unaffected controls (368 samples). Allele and genotype frequencies of single nucleotide polymorphisms for the following AMD-associated alleles were evaluated: risk alleles in complement factor H ( CFH ) gene (Y402H and IVS14) and LOC387715/HTRA1 gene on 10q26 (A69S) and protective alleles in CFH (IVS1, IVS6, and delCFHR1-3) and complement factor B loci (H9L and R32Q). Results Frequencies of all major AMD-associated alleles in the CFH locus indicate a strong, statistically significant association of CFH gene single nucleotide polymorphisms and MFC. However, the same analysis for the single nucleotide polymorphisms in complement factor B and 10q26 loci matched the results in the control group. Conclusions Like AMD, the MFC phenotype is strongly associated with the major alleles/haplotypes in the CFH locus. Clinical Relevance We report compelling evidence of a strong association between CFH polymorphisms and MFC, which contributes to the understanding of MFC pathogenesis and suggests new potential therapeutic targets.
Journal Article•
TL;DR: The areas of RPE atrophy did not necessarily correspond to the hypopigmented lesions, which suggested that both the choroid and the RPE can be affected independently.
Abstract: Purpose To investigate the characteristics of fundus autofluorescence in birdshot chorioretinopathy (BSCR). Design Retrospective, observational case series. Participants Sixteen eyes of 8 consecutive patients with BSCR (3 men, 5 women). Methods Color and autofluorescence photography and optical coherence tomograms of patients with BSCR seen in a referral practice were evaluated. Main Outcome Measures Autofluorescent characteristics in BSCR. Results The 8 patients ranged in age from 35 to 73 years (mean, 56.9 years). Of the 16 eyes, 11 eyes (69%) of 6 patients had retinal pigment epithelium (RPE) atrophy as evidenced by hypoautofluorescent regions. Some of the hypoautofluorescent areas corresponded to the hypopigmented birdshot lesions, but the others did not necessarily show a correspondence. Eight eyes (50%) of 4 patients showed linear hypoautofluorescent streaks along the retinal vessels, most of which corresponded to visible changes at the level of the RPE. Placoid hypoautofluorescence in the macula was seen in 6 eyes (38%) of 3 patients and was correlated significantly with best-corrected visual acuity of 20/50 or less ( P Conclusions Autofluorescence photography demonstrated the RPE atrophy, which was hard to see by other means of investigation. The areas of RPE atrophy did not necessarily correspond to the hypopigmented lesions, which suggested that both the choroid and the RPE can be affected independently. Retinal pigment epithelium atrophy in the macula may be an important cause of poor central visual acuity in eyes with BSCR.
TL;DR: It is suggested that during embryogenesis a full thickness defect was present in the eye wall, but due to differential growth rates, the scleral and retinochoroidal defects ceased to be superimposed and persistent hypotony implies continued flow of liquefied vitreous or aqueous through the defect.
Abstract: BACKGROUND Spontaneous scleral rupture in association with retinochoroidal coloboma is a rare and poorly understood event, with few reports in the literature. METHODS Interventional case report. RESULTS A 40-year-old man had a spontaneous decline in visual acuity with hypotony in the right eye. Photographic, fluorescein angiographic, optical coherence tomographic, ultrasonographic, and computed tomographic findings demonstrated that the cause was spontaneous rupture of ectatic sclera adjacent to a retinochoroidal coloboma. Surgical repair with primary suture imbrication and support with a segmental scleral buckle restored the intraocular pressure and baseline visual acuity. CONCLUSIONS The adjacent but distinct locations of the retinochoroidal coloboma and ectatic sclera in this case suggest that during embryogenesis a full thickness defect was present in the eye wall, but due to differential growth rates, the scleral and retinochoroidal defects ceased to be superimposed. Persistent hypotony implies continued flow of liquefied vitreous or aqueous through the defect. Suture imbrication and scleral buckling can be a successful treatment option.
TL;DR: Stem cell based therapies offer interesting possibilities of being able to grow new replacement tissue to replace failing ocular structures, and discovery of additional pieces of the puzzle laid hints at a much larger world of possibilities.
Abstract: The Potential of Pluripotent Cells in Vitreoretinal Diseases The retina is a terminally differentiated structure with seemingly limited ability at repair or regeneration. Even the retinal vasculature seems to have little ability to reconstitute itself after loss or injury, although retinal vessels can grow in aberrant ways in certain diseases. Underlying the retina is an important monolayer of cells, the retinal pigment epithelium (RPE). With age, the RPE seems to lose its ability to replicate in vitro, and by observation of patients with conditions such as geographic atrophy, the ability of effective replication by RPE cells in vivo seems questionable. Transplantation of RPE cells has not proven to be efficacious in humans,1 possibly because the target site in diseases like geographic atrophy may be inhospitable to RPE cells, but also because the cells being transplanted may have limited replicative potential. Stem cell based therapies offer interesting possibilities of being able to grow new replacement tissue to replace failing ocular structures. In vivo creation of tissue leads to the next question—how can this tissue be transplanted into a person? Growing a retina is one thing, getting the ganglion cell extensions to connect correctly well within the brain is quite another. Do we really need to grow fully structured replacement tissue in a laboratory? After all, the original tissues developed in situ. The first application of stem cell transplantation came with bone marrow transplantation,2 in which ionizing radiation and cytotoxic drugs are used to kill the patient’s bone marrow. After bone marrow cells are infused, the contained stem cells give rise to erythrocytes, platelets, and immunologically active leukocytes. In this type of transplantation, the stems cells are injected, recognize the need, home to the appropriate region, and do the appropriate job. A little more than a decade ago, Asahara et al3 identified CD34 cells circulating in the blood like angioblasts in an embryo, had the capability to differentiate into vascular endothelial cells. Discovery of additional pieces of the puzzle laid hints at a much larger world of possibilities. Endothelial cell precursors that originated in the bone marrow could be mobilized by cytokines, particularly vascular endothelial growth factor,4 and then traveled by means of the circulatory system to where they were needed, to form newly growing vessels. The bone marrow-derived endothelial progenitor cells participate in a permissive and even instructive sense in the initiation of blood vessel growth, a process known as the angiogenic switch, in physiologic and pathologic new vessel growth including the growth of vessels in metastatic cancer.5 Circulating endothelial progenitor cells are also involved in healing injuries of the cardiovascular system, and infusion of endothelial progenitor cells leads to improved outcomes in hind limb ischemia,6 cerebral infarction,7 and myocardial infarction models.8 Among patients at risk, prospective studies have shown that development of cardiovascular events and cardiac deaths occurred more commonly in patients with lower baseline numbers of circulating endothelial progenitor cells.9,10 After myocardial infarction, endothelial progenitor cells limits the perfusion defect through ischemia driven neovascularization and vascular repair and bone marrow-derived cells also have the potential to differentiate into cardiomyocytes.11–13 After infarction, a significant proportion of the fibroblasts and myofibroblasts, which function in scar formation and cardiac remodeling, actually arise from bone marrow-derived stem cells.14 The bone marrow has been found to be home to a wide variety of stem cells of both hematopoietic and nonhematopoietic tissues. The nonhematopoietic cells are referred to as mesenchymal stem cells and they are Reprint requests: Richard F. Spaide, MD, Vitreous, Retina, Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022; e-mail: rickspaide@yahoo.com
TL;DR: Hypoautofluorescence confirmed the known absence of lipofuscin in the retinal pigment epithelium cells of CHRPE lesions and may provide useful information in evaluating pigmented lesions of the fundus.
Abstract: PURPOSE To report the autofluorescence features of congenital hypertrophy of the retinal pigment epithelium (CHRPE). METHODS Four patients with CHRPE were evaluated using autofluorescence in a camera-based system. RESULTS All CHRPE lesions studied had well demarcated borders and were hypoautofluorescent. Presence of a hypopigmented halo and lacunae did not alter the homogeneous hypofluorescence. CONCLUSION Hypoautofluorescence confirmed the known absence of lipofuscin in the retinal pigment epithelium cells of CHRPE lesions. Autofluorescence imaging may provide useful information in evaluating pigmented lesions of the fundus.