Showing papers in "Retina-the Journal of Retinal and Vitreous Diseases in 2012"

Retinal angiomatous proliferation in age–related macular degeneration

Abstract: BackgroundIt is known that choroidal neovascularization (CNV) in age-related macular degeneration (ARMD) may erode through the retinal pigment epithelium, infiltrate the neurosensory retina, and communicate with the retinal circulation in what has been referred to as a retinal–choroidal anastomosis

EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy.

Abstract: Purpose:To assess the effects of verteporfin photodynamic therapy (PDT) combined with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy.Methods:In this multicenter, double-masked, primarily indocyanine green angiography–guided

Digital indocyanine green videoangiography and choroidal neovascularization.

Abstract: This report describes a new system for digital indocyanine green videoangiography (ICGV) that provides enhanced imaging of the choroidal circulation. This newly assembled system was used to study a consecutive series of 129 patients with exudative age-related macular degeneration (AMD), and ill-defined or occult choroidal neovascularization (CNV). Overall, 39% of the patients in this study with occult CNV could be reclassified as having well-delineated or so-called classic CNV by virtue of the additional findings provided by ICGV. In this series, ICGV was particularly useful in identifying occult CNV in eyes with a large, serous pigment epithelial detachment (PED) and in eyes with recurrent CNV after previous laser photocoagulation treatment. Some of these patients were selected for laser photocoagulation of the abnormal choroidal vessels in order to evaluate the feasibility of this form of treatment on the basis of combined clinical, fluorescein angiographic, and ICGV findings. The results of this study suggest that ICGV is an important adjunct in the evaluation, classification, and laser treatment of patients with occult CNV secondary to AMD.

Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study.

Abstract: BackgroundMost patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green

Type-a behavior and central serous chorioretinopathy

Abstract: A consecutive series of newly-diagnosed patients with central serous chorioretinopathy (CSC) was compared to two independent control groups chosen from the same patient population for the presence of a Type A behavioral pattern based on the Jenkins Activity Survey. The patients selected as matched controls had painless, reduced central vision and other chorioretinal diseases (Group I), or non-chorioretinal ocular conditions (Group II). The Type A behavior was significantly more frequent in study patients than in either Control Group I (X2 = 6.1 and P less than 0.025) or Control Group II patients (X2 = 17.7 and P less than 0.001). When both control groups were combined for comparison to the CSP patients, there was also a highly significant difference with regard to Type A behavior (X2 = 14.1 and P less than 0.001). A comparison of Control Group I with Control Group II revealed no significant difference in Type A behavior. Subfactor analysis of the Type A behavior pattern was also studied. The results of this clinical study were used in conjunction with experimental evidence linking catecholamines with CSP in developing a multifactorial etiologic hypothesis. The hypothesis suggests that the eyes as an organ system, and the macula as an ultimate target area, can be intermittently or continuously stimulated adversely by Type A behavior and its physiological consequences, most notably a sympathetic discharge. The multifactorial concept alludes to other potential risk factors such as age, race, sex, refractive state, or unknown tissue susceptabilities. The pathogenesis implies an inter-relationship between finely balanced components of a complex biopsychological system involving an individual's genetic endowment, his environment, and his behavioral pattern. The concept also offers new possible lines of investigation for the treatment of CSP, utilizing pharmacological regulators and for its prevention through early identification of CSP-prone individuals. A review of the pertinent cardiovasculature literature linking the Type A behavior with coronary artery disease and the significant papers in the ophthalmic literature on central serous pigment epitheliopathy are included in the discussion.

Ultra-wide-field angiography improves the detection and classification of diabetic retinopathy.

Abstract: Purpose:To evaluate patients with diabetic retinopathy using ultra–wide-field fluorescein angiography and to compare the visualized retinal pathology with that seen on an overly of conventional 7 standard field (7SF) imaging.Methods:Two hundred and eighteen eyes of 118 diabetic patients who underwen

Choroidal thickness in patients with diabetic retinopathy analyzed by spectral-domain optical coherence tomography

Abstract: Purpose—This study was designed to examine choroidal thickness in patients with diabetes using spectral-domain optical coherence tomography. Methods—Forty-nine patients (49 eyes) with diabetes and 24 age-matched normal subjects underwent high-definition raster scanning using spectral-domain optical coherence tomography with frame enhancement software. Patients with diabetes were classified into 3 groups: 11 patients with mild or moderate nonproliferative diabetic retinopathy and no macular edema, 18 patients with nonproliferative diabetic retinopathy and diabetic macular edema, and 20 patients with treated proliferative diabetic retinopathy and no diabetic macular edema (treated proliferative diabetic retinopathy). Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-μm intervals up to 2,500 μm temporal and nasal to the fovea. Results—Reliable measurements of choroidal thickness were obtainable in 75.3% of eyes examined. Mean choroidal thickness showed a pattern of thinnest choroid nasally, thickening in the subfoveal region, and thinning again temporally in normal subjects and patients with diabetes. Mean subfoveal choroidal thickness was thinner in patients with diabetic macular edema (63.3 μm, 27.2%, P < 0.05) or treated proliferative diabetic retinopathy (69.6 μm, 30.0%, P < 0.01), compared with normal subjects. There was no difference between nonproliferative diabetic retinopathy and normal subjects. Conclusion—Choroidal thickness is altered in diabetes and may be related to the severity of retinopathy. Presence of diabetic macular edema is associated with a significant decrease in the choroidal thickness.

Clinical spectrum and prognosis of uveal melanoma based on age at presentation in 8,033 cases.

Abstract: Purpose:To evaluate clinical features and life prognosis of uveal melanoma based on age at presentation.Design:Retrospective, nonrandomized, interventional case series.Results:Of 8,033 eyes with uveal melanoma, 106 (1%) were in young patients (≤20 years), 4,287 (53%) in mid adults (21–60 years), and

Type 1 (sub-retinal pigment epithelial) neovascularization in central serous chorioretinopathy masquerading as neovascular age-related macular degeneration

Abstract: Purpose The purpose of this study was to describe clinical and multimodal imaging features of patients with Type 1 neovascularization who lack findings of age-related macular degeneration but instead have features consistent with long-standing central serous chorioretinopathy (CSC). Methods Nonconsecutive, retrospective, observational case series. Two groups of patients were identified and analyzed. Group 1 included patients presenting with Type 1 neovascularization who at the time of diagnosis were found to have findings more consistent with long-standing CSC than age-related macular degeneration. Group 2 included patients with a known history of CSC who developed Type 1 neovascularization over their course of follow-up. Clinical histories and multimodal imaging findings (color and red-free photography, fundus autofluorescence imaging, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, and enhanced depth imaging optical coherence tomography) were analyzed. Results Twenty-seven eyes of 22 patients were identified. Thirteen patients presented with Type 1 neovascularization thought to be secondary to CSC (Group 1), and 9 patients with CSC were observed to develop Type 1 neovascularization over their course of follow-up (Group 2). Eight patients (36%) had polypoidal neovascular structures within their Type 1 neovascular lesions, of which 4 (18% of all patients) had bilateral Type 1 neovascularization. The mean age of patients was 61 years (range, 48-76 years), and the median age was 58.5 years. Thirteen patients (59%) were men. For those patients in Group 2, the mean duration between diagnosis of CSC and detection of Type 1 neovascularization was 139 months (range, 7-365 months). The mean subfoveal choroidal thickness was 354 μm (range, 186-666 μm). Conclusion Some patients presenting with Type 1 neovascularization may have clinical and multimodal imaging findings more consistent with long-standing CSC than with age-related macular degeneration. These patients are more likely to be younger, men, have thicker choroids, and have a higher prevalence of polypoidal neovasculopathy than those patients with Type 1 neovascularization secondary to age-related macular degeneration. Proper identification of these patients may have implications for their natural course and management.

Enhanced depth imaging optical coherence tomography of the choroid in Vogt-Koyanagi-Harada disease.

Abstract: Purpose Optical coherence tomography (OCT) using enhanced depth imaging (EDI) allows evaluation of choroidal thickness. Our objective was to analyze subfoveal choroidal thickness by EDI-OCT before and after the initiation of high-dose corticosteroid treatment in 8 patients (16 eyes) with new-onset acute Vogt-Koyanagi-Harada (VKH) disease. Methods Retrospective review of clinical records. Results The outer border of the choroid was not evident by EDI-OCT in any patients at presentation. Subfoveal choroidal thickness was measurable by 1 week after the initiation of treatment (mean, 578 μm) and decreased thereafter (mean at 1 month, 397 μm; 3 months, 392 μm; 6 months, 384 μm; 12 months, 332 μm). Rebound of choroidal thickening was observed in three patients (five eyes) during corticosteroid tapering in the absence of other evidence of increased inflammation. Peripapillary atrophy was present at 12 months in 6 of 6 eyes that had a choroidal thickness >550 μm at 1 week after initiating treatment, in contrast to none of the 8 eyes with a choroidal thickness ≤550 μm (P = 0.0003). Conclusion Enhanced depth imaging-optical coherence tomography revealed decreasing choroidal thickness with high-dose corticosteroid treatment in our patients. Choroidal thickness as measured by EDI-OCT may serve as a marker for degree of choroidal inflammation in acute VKH disease.

Choroidal thickness and visual acuity in highly myopic eyes.

Abstract: Purpose:To examine predictive factors for visual acuity in highly myopic eyes.Methods:Consecutive patients with high myopia (≥6 diopters [D]) with no other pathology such as lacquer cracks in the fovea, choroidal neovascularization, or myopic macular schisis, were evaluated. The study was performed

Macular and peripapillary choroidal thickness in diabetic patients.

Abstract: Purpose:To investigate macular and peripapillary choroidal thickness (CT) in diabetic patients with and without diabetic retinopathy (DR)Methods:One hundred and fifty subjects were enrolled: 102 diabetic patients (102 eyes) and 48 normals, as controls Exclusion criteria were previously treated DR,

Treatment of polypoidal choroidal vasculopathy with photodynamic therapy.

Abstract: PurposeTo study the effects of photodynamic therapy using verteporfin in the treatment of patients with subfoveal polypoidal choroidal vasculopathy (PCV)MethodsA retrospective chart review of 16 consecutive patients with subfoveal PCV treated with photodynamic therapy using verteporfin was performe

ACUTE MACULAR NEURORETINOPATHY: Long-Term Insights Revealed by Multimodal Imaging

Abstract: Purpose:To report the structural and functional changes in acute macular neuroretinopathy (AMN) and their long-term evolution. Multimodal retinal imaging was acquired, including Fourier domain optical coherence tomography (OCT), infrared (IR) reflectance, and near IR autofluorescence (NIA).Methods:I

Choroidal imaging using spectral-domain optical coherence tomography

Abstract: Background:A structurally and functionally normal choroidal vasculature is essential for retinal function. Therefore, a precise clinical understanding of choroidal morphology should be important for understanding many retinal and choroidal diseases.Methods:PUBMED (http://www.ncbi.nlm.nih.gov/sites/e

Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature.

Abstract: Purpose:To describe the clinical and angiographic features of a series of patients with acute syphilitic posterior placoid chorioretinitis (ASPPC) in the context of previously published cases.Methods:A retrospective, noncomparative, multicenter chart review was performed on 16 patients with active A

Long-term safety, high-resolution imaging, and tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema.

Abstract: PurposeTo determine the long-term safety of high-density subvisible diode micropulse photocoagulation (810 nm), compare the clinical findings with computational modeling of tissue hyperthermia and to report results for a subset of eyes treated for diabetic macular edema (ME) documented pre- and post

"Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling.

Abstract: Purpose To examine volume-rendered spectral-domain optical coherence tomography images in patients who had undergone vitrectomy, many of whom had internal limiting membrane removal to investigate a condition termed "dissociated optic nerve fiber layer appearance." Methods Patients who had undergone vitrectomy for either macular hole or epiretinal membrane were evaluated. Spectral-domain optical coherence tomography B-scan images were acquired with the use of eye tracking at an interval of either 30 μm or 60 μm. These were registered and exported to a volume-rendering program, and the resultant volume-rendered images were evaluated. The images were graded for the presence of inner retinal abnormalities, and correlates were made to corresponding alterations seen in fundus photographs and B-scan spectral-domain optical coherence tomography images. Results There were 25 eyes of 24 patients with a mean age of 72.4 (± 7.3) years, 15 of whom were women. The primary preoperative diagnosis was macular hole in 10 eyes (40%) and epiretinal membrane in 15 eyes (60%). As part of the surgery, 18 eyes (72%) had planned peeling of the internal limiting membrane. Volume rendering showed that 13 eyes had pitting or dimples of the inner retinal surface that seemed to follow the course of the nerve fiber layer in the region of the macula. The inner retinal dimples occurred only in eyes that had internal limiting membrane peeling. Correlation of the volume-rendered images with B-scan spectral-domain optical coherence tomography showed focal areas of thinning of the ganglion cell layer with decreased reflectivity from the nerve fiber layer in the areas of the dimples. Conclusion A high proportion of eyes with internal limiting membrane peeling develop inner retinal dimples that course along the path of the nerve fiber layer. The dimples seem to be the result of an interplay between trauma and healing processes constrained by nerve fiber layer and do not appear to be because of dissociation of optic nerve fibers. The true nature of the abnormalities induced should be investigated to evaluate the long-term risks and benefits of routine internal limiting membrane peeling.

Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling.

Abstract: Purpose:The purpose of the study is to report the incidence of changes of the retinal nerve fiber layer in the early postoperative period after internal limiting membrane peeling for idiopathic macular hole and epiretinal membrane surgery.Methods:Interventional, noncomparative retrospective case ser

Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy. 1984.

Abstract: Twenty-five patients with central serous pigment epitheliopathy (CSP), also known as central serous chorioretinopathy, have been observed to have inferior hemispheric retinal pigment epithelial atrophic tracts, presumptive of antecedent retinal detachments. Five of these patients were noted to have clinically discernible, dependent peripheral retinal detachments. The clinical and fluorescein angiographic features of these patients are reviewed. Alterations in the retina, the retinal pigment epithelium (RPE) and the choroid are also described. They include the commonly associated manifestations of CSP such as RPE leaks and macular detachment as well as some newly recognized disturbances such as retinal capillary dilatation (telangiectasia), retinal capillary leakage, retinal lipid deposition, cystoid macular edema, choriocapillaris atrophy, choroidal neovascularization and disciform scarring.

Segregation of ophthalmoscopic characteristics according to choroidal thickness in patients with early age-related macular degeneration.

Abstract: PURPOSE To investigate the association of fundus features with choroidal thickness in eyes with early age-related macular degeneration. METHODS Consecutive patients with age-related macular degeneration were evaluated. Major exclusionary criteria included late age-related macular degeneration (central geographic atrophy or choroidal neovascularization), macular laser therapy, myopia greater than -6 diopters, past vitreoretinal surgery, or central serous chorioretinopathy. Charts and multimodal imaging were reviewed for refraction, cataract, hypertension, diabetes, open-angle glaucoma, β-zone peripapillary atrophy, fundus tessellation, pigmentary changes, drusen, subretinal drusenoid deposits (also known as reticular pseudodrusen). Data measured from enhanced-depth imaging spectral-domain optical coherence tomography included subfoveal choroidal thickness, central foveal thickness, outer nuclear layer thickness, inner segment to retinal pigment epithelium aggregate thickness, presence of subretinal drusenoid deposit, and outer retinal hyperreflective layers (including the band corresponding to overlap between retinal pigment epithelium apical processes and outer segments). Correlations were calculated among the measured variables, fundus features, open-angle glaucoma, and visual acuity. RESULTS In 90 eyes of 70 early age-related macular degeneration patients with mean visual acuity 20/31 (logarithm of the minimum angle of resolution 0.193), subfoveal choroidal thickness showed a significant inverse correlation with age (P = 0.004) and increasing myopic spherical equivalent refractive error (P = 0.023). Subfoveal choroidal thickness was thinner in eyes with fundus tessellation (P < 0.001), subretinal drusenoid deposit (P = 0.023), an absence of conventional drusen (P < 0.001), the presence of β-zone peripapillary atrophy (P < 0.001), and in eyes with a diagnosis of open-angle glaucoma (P = 0.003) or an absent band on optical coherence tomography corresponding to overlap between outer segment and retinal pigment epithelium apical processes (P = 0.022). CONCLUSION Major ocular manifestations in early age-related macular degeneration and open-angle glaucoma are associated with the choroid-the main blood supply in the eye. Theories concerning the pathogenesis of these two diseases should incorporate interactions involving the choroid.

Correlation between spectral-domain optical coherence tomography findings and visual outcome after primary rhegmatogenous retinal detachment repair.

Abstract: Purpose:To correlate the postoperative visual outcome with the spectral-domain optical coherence tomography (SD-OCT) findings in the fovea after successful rhegmatogenous retinal detachment repair. Cross-sectional, observational study.Methods:Thirty-five patients with preoperative macula-on rhegmato

Cytokine concentration in aqueous humor of eyes with diabetic macular edema.

Abstract: PURPOSE: To measure cytokine concentrations in aqueous humor of eyes with diffuse diabetic macular edema. METHODS: The interventional clinical comparative study included a study group of 23 patients with diffuse diabetic macular edema and a control group of 22 patients undergoing cataract surgery. Cytokine concentrations were measured in aqueous humor samples using a Luminex xMAP suspension array technology. RESULTS: In the study group as compared with the control group, significantly higher concentrations were measured for epidermal growth factor (P < 0.001), human growth factor (P < 0.001), intercellular adhesion molecule-1 (ICAM-1; P < 0.001), interleukin (IL)-1a2 (P = 0.04), IL-6 (P = 0.001), IL-8 (P < 0.001), interferon gamma-induced protein (P = 0.004), monocyte chemoattractant protein-1 (P < 0.001), monokine induced by interferon gamma (P < 0.001), matrix metalloproteinase 1 (P = 0.02), matrix metalloproteinase 9 (P < 0.001), plasminogen activator inhibitor 1 (P < 0.001), placenta growth factor (P < 0.001), tissue growth factor beta (P = 0.003), vascular cell adhesion molecule (P < 0.001), and vascular endothelial growth factor (P < 0.001). Retinal macula thickness was significantly associated with the concentrations of the epidermal growth factor (P = 0.005; ρ = 0.45), ICAM-1 (P < 0.001; ρ = 0.65), IL-3 (P = 0.002; ρ = 0.48), IL-6 (P = 0.003; ρ = 0.47), IL-8 (P < 0.001; ρ = 0.71), monocyte chemoattractant protein-1 (P = 0.001; ρ = 0.53), monokine induced by interferon gamma (P < 0.001; ρ = 0.57), matrix metalloproteinase 9 (P < 0.001; ρ = 0.61), tissue growth factor beta (P = 0.01; ρ = 0.42), placenta growth factor (P = 0.004; ρ = 0.46), vascular cell adhesion molecule (P = 0.006; ρ = 0.44), and vascular endothelial growth factor (P = 0.01; ρ = 0.42). In multivariate analysis, macular thickness remained to be significantly associated with the concentration of ICAM-1 (P = 0.03; r = 0.30). Vascular endothelial growth factor concentrations were correlated with concentration of placenta growth factor (P < 0.001; ρ = 0.78), plasminogen activator inhibitor 1 (P = 0.001; ρ = 0.54), ICAM-1 (P < 0.001; ρ = 0.47), monokine induced by interferon gamma (P = 0.004; ρ = 0.44), monocyte chemoattractant protein-1 (P = 0.003; ρ = 0.43), vascular cell adhesion molecule (P = 0.01; ρ = 0.38), IL-6 (P = 0.02; ρ = 0.35), IL-8 (P = 0.02; ρ = 0.37), epidermal growth factor (P = 0.01; ρ = 0.39), and macrophage migration inhibitory factor (P = 0.01; ρ = 0.37). CONCLUSION: Numerous cytokines are associated with the presence and the amount of diabetic macular edema. Among these cytokines, ICAM-1 was the most significantly associated with the disease parameters.

Techniques, rationale, and outcomes of internal limiting membrane peeling.

Abstract: Background:The internal limiting membrane represents the structural interface between the retina and the vitreous and has been postulated to serve several essential functions. Recently, internal limiting membrane peeling has been used in the treatment of a variety of retinal disorders. We review the

Polypoidal choroidal vasculopathy: simultaneous indocyanine green angiography and eye-tracked spectral domain optical coherence tomography findings.

Abstract: Purpose:To describe simultaneous scanning laser ophthalmoscope indocyanine green angiographic and eye-tracked spectral-domain optical coherence tomography findings in eyes with polypoidal choroidal vasculopathy (PCV).Methods:Eighteen eyes of 18 patients with PCV because of a variety of different dia

Effect of combination therapy with bevacizumab and dexamethasone intravitreal implant in patients with retinal vein occlusion

Abstract: Objective:The objective of this study was to determine if dexamethasone intravitreal implant 0.7 mg (Ozurdex; Allergan, Inc) with bevacizumab (Avastin; Genentech, Inc) therapy can be synergistic, providing further improvements in visual acuity, sustainability, and macular thickness when compared wit

Evaluation of peripapillary intrachoroidal cavitation with swept source and enhanced depth imaging optical coherence tomography

Abstract: Purpose To investigate the anatomic characteristics of peripapillary intrachoroidal cavitation using optical coherence tomography methodologies that are capable of deeper tissue penetration and consider pathophysiologic mechanisms of disease on the basis of the derived imaging information. Methods Consecutive eyes with peripapillary intrachoroidal cavitation were imaged with swept source optical coherence tomography with a 1-mm light source and in one eye with enhanced depth imaging spectral domain optical coherence tomography and 3-dimensional rendering. The anatomic layers were identified, and the induced abnormalities were evaluated. Results There were 16 eyes of 13 patients who had a mean age of 50.3 years and a mean spherical refraction of -12.5 diopters in the affected eyes. The lesion appeared as a yellowish-orange lobular region, usually inferior to the optic nerve, which was invariably tilted. The sclera was bowed posteriorly under the region of the intrachoroidal cavitation, while the overlying retina-retinal pigment epithelium-Bruch membrane complex showed little, if any deformation. Full-thickness defects in the retina at the inferior border of the conus were seen in four eyes and were associated with prominent cavitation within the choroid with marked posterior bowing of the sclera, but negligible deformation of the overlying retina inferior to the nerve. Conclusion Newer imaging modalities provided information about deeper structures in the eye not available in older studies that were performed with time-domain optical coherence tomography. This study demonstrated posterior deformation of the sclera in regions previously thinned by the ocular expansion that occurs in high myopia and imaged the resultant effects on the involved choroid.

Two-year results of a randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus laser in diabetic macular edema

Abstract: PurposeThe purpose of this study was to report the 24-month findings of a randomized clinical trial comparing intravitreal bevacizumab (IVB) injection alone or in combination with intravitreal triamcinolone acetonide (IVT) versus macular laser photocoagulation (MPC) as a primary treatment for diabet

Safety and effect on rod function of ACU-4429, a novel small-molecule visual cycle modulator.

Abstract: Background:ACU-4429 is a first in class small-molecule visual cycle modulator that inhibits the isomerase complex and, in mouse models of retinal degeneration, prevents the accumulation of A2E.The purpose of this study was to assess the tolerability, pharmacokinetics, pharmacodynamics, and safety of

Prevalence and risk factors for diabetic retinopathy: the Beijing Communities Diabetes Study 6.

Abstract: BackgroundTo examine prevalence and associated factors of diabetic retinopathy in patients with Type 2 diabetes mellitus in urban communities of Beijing.MethodsThe community health care center–based study included subjects with diabetes mellitus and an age of 20 years to 80 years, who were recruited