To introduce the concept of a stage 0 macular hole based on optical coherence tomographic observations of the vitreoretinal interface in fellow eyes of patients with unilateral idiopathic macular holes, and to evaluate the subsequent risk of progression to a full-thickness macular hole.
Retrospective observational case series.
Ninety-four patients with a unilateral stage 2, 3, or 4 full-thickness macular hole.
The medical records of patients with a unilateral macular hole diagnosed between 1994 and 2000 at the New England Eye Center were reviewed.
Main Outcome Measure
Development of a full-thickness macular hole in the fellow eye on biomicroscopic fundoscopy or optical coherence tomography (OCT).
In 27 (28.7%) of 94 clinically normal fellow eyes, OCT detected an abnormality of the vitreoretinal interface but normal foveal anatomy. The vitreoretinal abnormalities were further subclassified into severe (4 eyes), moderate (8 eyes), and mild (15 eyes) based on the intensity and morphology of the OCT signal. One of the 4 (25%) severe cases progressed to a full-thickness macular hole, 4 of the 8 (50%) moderate cases became full-thickness macular holes, and no (0%) mild cases progressed to a full-thickness macular hole. Severe and moderate eyes seemed to share characteristic features on OCT that increased their risk of macular hole development (stage 0 macular hole). The macular hole–free survival at 48 months was 94% for stage 0–negative patients, versus 54% for stage 0–positive patients. Univariate analysis revealed that the presence of a stage 0 macular hole was significantly associated with an almost 6-fold increase in the risk of macular hole formation (relative risk: 5.8, 95% confidence interval: 1.16–28.61, P = 0.03).
A stage 0 macular hole has a normal biomicroscopic appearance clinically, but has salient features on OCT as a result of oblique vitreous traction. Optical coherence tomographic findings consist of a normal foveal contour and normal retinal thickness and must include the presence of a preretinal, minimally reflective, thin band inserting obliquely on at least one side of the fovea. The presence of a stage 0 macular hole in the fellow eye is a significant risk factor for the development of a second macular hole.
The influence of serous retinal detachment (SRD) on retinal sensitivity in patients with branch retinal vein occlusion (BRVO) and macular edema remains unclear. This is despite the frequent co-existence of SRD and cystoid macular edema (CME) in BRVO patients on optical coherence tomography (OCT) and the fact that CME is the most common form of macular edema secondary to BRVO. We investigated visual function (visual acuity and macular sensitivity), macular thickness, and macular volume in patients with BRVO and macular edema.
Fifty-three consecutive BRVO patients (26 women and 27 men) were divided into two groups based on optical coherence tomography findings. Macular function was documented by microperimetry, while macular thickness and volume were measured by OCT.
There were 15 patients with SRD and 38 patients with CME. Fourteen of the 15 patients with SRD also had CME. Visual acuity was significantly worse in the SRD group than in the CME group (P = 0.049). Also, macular thickness and macular volume within the central 4°, 10°, and 20° fields were significantly greater in the SRD group (P = 0.008, and P = 0.007, P < 0.001 and P < 0.001, and P < 0.001 and P < 0.001, respectively). However, macular sensitivity within the central 4°, 10°, and 20° fields was not significantly worse in the SRD group than in the CME group.
SRD itself may decrease visual acuity together with CME, because nearly all SRD patients also had CME. SRD does not seem to influence macular function on microperimetry.
To identify a clinically meaningful threshold for change in retinal thickness measured by optical coherence tomography (OCT) for patients with uveitic macular edema, using correlation with change in visual acuity.
Cross-sectional and longitudinal study.
128 eyes (101 individuals) with macular edema enrolled in the Multicenter Uveitis Steroid Treatment (MUST) trial. At enrollment and after six months of follow-up, retinal thickness was measured at the central subfield with time domain OCT and visual acuity was measured with logarithmic (ETDRS) visual acuity charts. Participants were classified as having macular edema if the retinal thickness was ≥260μm.
A threshold for change in retinal center subfield thickness of 20% balanced the percentage of false positives and negatives for predicting greater than 10-letter change in visual acuity with sensitivity of 77% and a specificity of 75%. The results were similar for greater than 5 or 15 or greater letter changes. Those with a 20% or greater reduction in retinal thickness had a mean 11.0 letter improvement (95% CI: 7.7 to 14.3) as compared to a -0.4 letter change (95% CI: -4.1 to 3.3) in visual acuity for those without a 20% reduction (p < 0.01).
In addition to being above the level of measurement uncertainty, a 20% change in retinal thickness in patients with macular edema appears to be optimal for clinically important changes in visual acuity and may be considered as an outcome for clinical trials of treatments for uveitic macular edema.
Purpose. To compare the macular thicknesses in diabetic macular edema (DME) measured with spectral-domain optical coherence tomography (SD-OCT) and time-domain (TD) OCT. Patients and Methods. The average macular thicknesses of 50 eyes of 29 patients with DME were measured using SD-OCT and TD-OCT. Results. The mean macular thicknesses measured with TD-OCT and SD-OCT were 401.5 ± 117.8 μm (mean ± SD) and 446.2 ± 123.5 μm, respectively. The macular thicknesses measured with the two devices were well correlated (Pearson's product moment correlation, r = 0.977, P < 0.001). A significant correlation was found between the best-corrected visual acuity and the retinal thickness measured by TD-OCT and SD-OCT (Pearson's product moment correlation, TD-OCT, r = 0.34; P < 0.05; SD-OCT, r = 0.32; P < 0.05). Discussion. The mean macular thickness measured with SD-OCT was about 45 μm thicker than that measured with TD-OCT. Attention should be paid when comparing data obtained using different OCT machines.
To assess the efficacy of the intravitreal (IVT) injection of Triamcinolone Acetonide (TA) as compared to posterior subtenon (SBT) capsule injection for the treatment of cystoid diabetic macular edema.
Fourteen patients with type II diabetes mellitus and on insulin treatment, presenting diffuse cystoid macular edema were recruited. Before TA injection all focal lakes were treated by laser photocoagulation. In the same patients one eye was assigned to 4 mg IVT injection of TA and the fellow eye was then treated with 40 mg SBT injection of TA. Before and one, three and six months after treatment we measured visual acuity with ETDRS chart as well as thickness of the macula with optical coherence tomography (OCT) and intraocular pressure (IOP).
The eyes treated with an IVT injection displayed significant improvement in visual acuity, both after one (0.491 ± 0.070; p < 0.001) and three months (0.500 ± 0.089; p < 0.001) of treatment. Significant improvement was displayed also in eyes treated with an SBT injection, again after one (0.455 ± 0.069; p < 0.001) and three months (0.427 ± 0.065; p < 0.001). The difference between an IVT injection (0.809 ± 0.083) and SBT injection (0.460 ± 0.072) becomes significant six months after the treatment (p < 0.001).
Macular thickness of the eyes treated with IVT injection was significantly reduced both after one (222.7 ± 13.4 μm; p < 0.001) and after three months (228.1 ± 10.6 μm; p < 0.001) of treatment. The eyes treated with SBT injection displayed significant improvement after one (220.1 ± 15.1 μm; p < 0.001) and after three months (231.3 ± 10.9 μm; p < 0.001). The difference between the eyes treated with IVT injection (385.2 ± 11.3 μm) and those treated with SBT injection (235.4 ± 8.7 μm) becomes significant six months after the treatment (p < 0.001).
Intraocular pressure of the eyes treated with IVT injection significantly increased after one month (17.7 ± 1.1 mm/Hg; p < 0.020), three (18.2 ± 1.2 mm/Hg; p < 0.003) and six month (18.1 ± 1.3 mm/Hg; p < 0.007) when compared to baseline value (16.1 ± 1.402 mm/Hg). In the SBT injection eyes we didn't display a significant increase of intraocular pressure after one (16.4 ± 1.2 mm/Hg; p < 0.450), three (16.3 ± 1.1 mm/Hg; p < 0.630) and six months (16.2 ± 1.1 mm/Hg; p < 0.720) when compared to baseline value (16.2 ± 1.3 mm/Hg).
The parabulbar subtenon approach can be considered a valid alternative to the intravitreal injection.
Current Controlled Trials ISRCTN67086909
To evaluate macular thickness and volume measurements and their intrasession repeatability in two optical coherence tomography (OCT) systems: the Stratus OCT, a time domain system, and the Cirrus HD-OCT, a spectral domain system (both by Carl Zeiss Meditec, Inc., Dublin, CA), in the context of diabetic macular edema (DME).
Thirty-three eyes of 33 diabetic patients with clinically significant macular edema (CSME) were scanned in a single session by a single operator on both OCT systems. Macular thickness measurements of nine standard macular subfields and total macular volume were obtained and analyzed. Bland-Altman plots were constructed to assess agreement in macular measurements. Intraclass correlation coefficients (ICCs), coefficients of repeatability (CRW), and coefficients of variation (CVW) were used to assess intrasession repeatability.
Macular thickness in nine retinal subfields and macular volume were significantly higher in the Cirrus HD-OCT system compared with the Stratus OCT system. Subfield thickness and total volume measurements, respectively, were 30 to 55 μm and 3.2 mm3 greater for the Cirrus HD-OCT system compared with the Stratus OCT system. Both Stratus OCT and Cirrus HD-OCT systems demonstrated high intrasession repeatability, with overlapping ranges for CRW, CVW, and ICC. Repeatability measures (CRW and CVW) differed significantly between systems in only one of nine subfields (outer temporal subfield).
Absolute measures of macular thickness and volume in patients with DME differed significantly in magnitude between the Stratus OCT and Cirrus HD-OCT systems. However, both OCT systems demonstrated high intrasessional repeatability. Although the two systems may not be used interchangeably, they appear equally reliable in generating macular measurements for clinical practice and research.
To determine whether the extensiveness of diabetic macular edema (DME) using a ten step scale based on optical coherence tomography (OCT) explains pretreatment variation in visual acuity and predicts change in macular thickness or visual acuity after laser photocoagulation.
323 eyes from a randomized clinical trial of two methods of laser photocoagulation for DME were studied. Baseline number of thickened OCT subfields was used to characterize DME on a ten step scale from 0 – 9. Associations were explored between baseline number of thickened subfields and baseline fundus photographic variables, visual acuity (VA), central subfield mean thickness (CSMT), and total macular volume (TMV). Associations were also examined between baseline number of thickened subfields and changes in VA, CSMT, and TMV at 3.5 and 12 months after laser photocoagulation.
For baseline visual acuity, the number of thickened subfields explained no more variation than did CSMT, age and fluorescein leakage. A greater number of thickened subfields was associated with a greater baseline CSMT, TMV, area of retinal thickening, and degree of thickening at the center of the macula (r=0.64, 0.77, 0.61–0.63, and 0.45, respectively) and with a lower baseline visual acuity (r=0.38). Baseline number of thickened subfields showed no association with change in visual acuity (r≤0.01–0.08) and weak associations with change in CSMT and TMV (r from 0.11–0.35).
This OCT based assessment of the extensiveness of DME did not explain additional variation in baseline visual acuity above that explained by other known important variables nor predict changes in macular thickness or visual acuity after laser photocoagulation.
It has been reported that microperimetry is effective for evaluating macular function. The aim of this paper is to report and discuss changes seen in macular sensitivity and macular thickness after intravitreal injection of triamcinolone acetonide (IVTA) in two patients with macular edema and central retinal vein occlusion (CRVO). Two eyes from two patients with CRVO (one each with ischemic and nonischemic CRVO) received IVTA for macular edema. Microperimetry was performed to measure macular sensitivity within the central 4, 10, and 20 degree fields, while the macular thickness within these fields was measured by optical coherence tomography. The mean macular thickness and macular sensitivity within the central 4, 10, and 20 degree fields improved after IVTA in the patient with nonischemic CRVO. In contrast, the mean macular thickness and sensitivity within the central 4, 10, and 20 degree fields showed little change after IVTA in the patient with ischemic CRVO. IVTA improves macular sensitivity and morphology in nonischemic CRVO, so further evaluation of this treatment is justified.
central retinal vein occlusion; macular edema; triamcinolone acetonide; macular sensitivity
To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT).
We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (ΔCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed.
Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. ΔCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded.
The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.
Cataract extraction; Diabetic retinopathy; Macular edema; Macular thickness
To compare change of macular thickness after uneventful cataract surgery and after cataract surgery complicated with vitreous loss, using optic coherence tomography (OCT).
Twenty eyes of 20 patients who underwent cataract surgery complicated with posterior capsular tear participated in this retrospective study (Group 2). The fellow eyes of those patients who underwent uneventful cataract surgery served as the control group (Group 1). Best spectacle-corrected visual acuity (BCVA), refraction, keratometry, axial length measurement, intraocular lens power calculation, intraocular pressure, and biomicroscopic and posterior segment examinations were done preoperatively. BCVA was evaluated at the postoperative 1st day, 1st week, 1st month, and 3rd month. Macular thickness and volumetric measurements with OCT with MM5 protocol were conducted at the postoperative 3rd month.
Logarithm of the minimum angle of resolution BCVA of Group 1 was significantly better than Group 2 at all intervals (P < 0.05). Foveal, parafoveal (superior and temporal), and perifoveal (superior and temporal) macular thickness measurements were significantly higher in Group 2 at month 3 (P < 0.05). Foveal volume was also significantly higher in Group 2 when compared with Group 1 (P < 0.05). In Group 2, two eyes (10%) were diagnosed with clinically significant cystoid macular edema at the 1-month visit.
Macular thickness was found to be significantly high in eyes undergoing complicated cataract surgery (with posterior capsular tear) when compared with uneventful cataract surgeries of fellow eyes.
BCVA; posterior capsular tear; vitreous loss
Vitreomacular traction syndrome has recently been recognized as a distinct clinical condition. It may lead to many complications, such as cystoid macular edema, macular pucker formation, tractional macular detachment, and full-thickness macular hole formation.
We report a case of vitreomacular traction syndrome with eccentric traction at the macula and a partial-thickness macular hole in a 63-year-old Pakistani Punjabi man. The patient was evaluated using optical coherence tomography, and he underwent a successful pars plana vitrectomy. After the operation, his foveal contour regained normal configuration, and his visual acuity improved from 20/60 to 20/30.
Pars plana vitrectomy prevents the progression of a partial thickness macular hole in vitreomacular traction syndrome. The relief of traction by vitrectomy restores foveal anatomy and visual acuity in this condition.
It is unclear how retinal ischemia influences the changes of visual acuity, macular sensitivity, macular thickness, and macular volume after the performance of pars plana vitrectomy (PPV) for macular edema in patients with central retinal vein occlusion (CRVO).
Ten patients (10 eyes) with CRVO and macular edema underwent PPV. Retinal ischemia was evaluated from the area of capillary nonperfusion on fluorescein angiography, and the patients were classified into ischemic or nonischemic groups. Microperimetry was performed with a Micro Perimeter 1. Macular thickness and volume were measured by optical coherence tomography.
In both groups, the mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly from baseline to 3 and 6 months after PPV (all P < 0.05). In the ischemic group, the mean macular sensitivity within the central 4°, 10°, and 20° fields increased from baseline to 3 and 6 months after PPV, but no significant difference was observed.
These results suggest that PPV may be effective for improving macular thickness, volume, and sensitivity in patients with macular edema secondary to ischemic CRVO, although there was no significant difference.
To explore the correlation between optical coherence tomography (OCT) and stereoscopic fundus photographs (FP) for the assessment of retinal thickening (RT) in diabetic macular edema (DME) within a clinical trial.
OCT, FP, and best corrected visual acuity (VA) measurements were obtained in both eyes of 263 participants in a trial comparing two photocoagulation techniques for DME. Correlation coefficients (r) were calculated comparing RT measured by OCT, RT estimated from FP, and VA. Principal variables were central subfield retinal thickness (CSRT) obtained from the OCT fast macular map and DME severity assessed by a reading center using a seven-step photographic scale combining the area of thickened retina within 1 disc diameter of the foveal center and thickening at the center.
Medians (quartiles) for retinal thickness within the center subfield by OCT at baseline increased from 236 (214, 264) μm in the lowest level of the photographic scale to 517 (455, 598) μm in the highest level (r = 0.67). However, CSRT interquartile ranges were broad and overlapping between FP scale levels, and there were many outliers. Correlations between either modality and VA were weaker (r = 0.57 for CSRT, and r = 0.47 for the FP scale). OCT appeared to be more reproducible and more sensitive to change in RT between baseline and 1 year than was FP.
There was a moderate correlation between OCT and FP assessments of RT in patients with DME and slightly less correlation of either measure with VA. OCT and FP provide complementary information but neither is a reliable surrogate for VA.
To estimate the short-term variability of macular thickness in eyes with refractory and regressed diabetic macular edema (DME).
In this retrospective review of consecutive cases from a retina practice, optical coherence tomography (OCT) measurements of macular thickness were extracted from the clinical charts of patients with refractory DME and regressed DME. Variation in macular thickness was defined as maximal central subfield mean thickness (CSMT) minus minimal CSMT during a period of observation in which clinical macular status did not change.
There were 36 eyes of 29 patients in the refractory DME group and 93 eyes of 93 patients in the regressed DME group. Median intervals during which macular status was unchanged and OCTs were collected were 7 months for the refractory DME group and 22 months for the regressed DME group. Baseline CSMTs were 321 μm for the refractory DME group and 217 μm for the regressed DME group. The median variation in CSMT was 89 μm for the refractory DME group and 19 μm for the regressed DME group. Results for total macular volume paralleled those for CSMT.
In consonance with eyes having treatment-naïve DME, eyes with refractory DME have short-term fluctuation in macular thickness larger than OCT measurement variability. In eyes with regressed DME, short-term fluctuation is less than in eyes with refractory DME, yet can also exceed measurement variability. This information is clinically important in deciding whether subsequent treatment is indicated.
The purpose of this study was to characterize central macular thickness and retinal volume following intravitreal injections using time domain and spectral domain optical coherence tomography (TD-OCT and SD-OCT, respectively).
Nine patients with macular edema secondary to diabetes or retinal vein occlusion treated with intravitreal triamcinolone 4.0 mg and/or bevacizumab 1.25 mg were enrolled. Central macular thickness and volume was measured by SD-OCT and TD-OCT scan at baseline, and 1, 3, 6, 24, 48 hours, and 1 week postinjection.
Equations were derived to describe central macular thickness and volume reduction in the hours following intravitreal injection. Measurements of central macular thickness by SD-OCT were significantly reduced by 3 hours (P = 0.03) and retinal volume by 6 hours (P = 0.03). Central macular thickness measured 40.9 (28.6–53.2) μm thicker on the SD-OCT instrument while volume measured 3.47 (3.27–3.66) mm3 higher.
Significant central macular thickness and volume reductions occur in the first hours after injection with triamcinolone and/or bevacizumab.
retinal vein occlusion; intravitreal injection; diabetic retinopathy
To investigate peripapillary retinal nerve fiber layer (RNFL), macula and ganglion cell layer thicknesses (GCC) in amblyopic eyes with spectral domain optical coherence tomography (SD-OCT).
Thirty six patients with a history of unilateral amblyopia and thirty two children who had emmetropia without amblyopia were included in this study. In this institutional study, 36 eyes of 36 patients with amblyopia (AE), 36 fellow eyes without amblyopia (FE), and 32 eyes of 32 normal subjects (NE) were included. RNFL, GCC and macular thickness measurements were performed with RS-3000 OCT Retina Scan (Nidek Inc CA. USA).
The mean global thicknesses of the RNFL were 113.22±21.47, 111.57±18.25, 109.96±11.31µm in the AE, FE, and NE, respectively. There was no statistically significant difference for mean global RNFL thickness among the eyes (P=0.13). The mean thicknesses of the macula were 258.25±18.31, 258.75±19.54, 248.62±10.57µm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of macula among the eyes (P=0.06). The GCC was investigated into two parts: superior and inferior. The mean thicknesses of superior GCC were 102.57±13.32, 103.32±10.64, 100.52±5.88µm in the AE, FE, and NE, respectively. The mean thicknesses of inferior GCC were 103.82±12.60, 107.82±12.33, 105.86±10.79µm in the AE, FE and NE, respectively. There was no statistically significant difference for thickness of superior and inferior GCC between the eyes (P=0.63, P=0.46).
The macular thicknesses of AE and FE were greater than the NE, although it was not statistically significant. Amblyopia does not seem to have a profound effect on the RNFL, macula and GCC.
amblyopia; retinal nerve fiber layer; macula; ganglion cell complex
To determine the prevalence of serous retinal detachments (SRD) using optical coherence tomography (OCT) in a large database of patients with uveitis from a tertiary referral setting, to describe clinical features of patients with SRD, and to ascertain retinal architectural features found in association with SRD.
Main outcome measures
Prevalence of SRD in uveitis patients imaged with OCT, correlation of visual acuity with SRD, anatomic subtypes of uveitis identified, and association of SRD with various subtypes of macular edema (focal and diffuse) and retinal architectural abnormalities.
Retrospective, single-setting cross-sectional study of all OCTs in a digital imaging base ordered on patients from a tertiary referral uveitis clinic between July 2006 and March 2008.
SRD were identified in 17 of 111 uveitis patients (15 %) reviewed; bilateral SRD were found in 5 of 17 patients (29 %). Intermediate uveitis was the most common disease association (47 %), but other conditions identified included Vogt-Koyanagi-Harada syndrome, multifocal choroiditis/panuveitis, and sarcoidosis. Retinal architectural features identified in association with SRD included focal macular edema (59 %), diffuse macular edema (50 %), any intraretinal edema (77 %), both diffuse and focal macular edema (32 %), and retinal pigment epithelial alteration (27 %). Moderate or severe visual impairment, defined as visual acuity 20/50 or poorer was seen in 71 % of patients with SRD. Poorer visual acuity was correlated with increased central subfield thickness in patients with SRD (r2 = 0.41, p < 0.001).
SRD were present in 15 % of the uveitis patients reviewed. Moderate to severe vision impairment was present in the majority of eyes (71 %) with SRD. Diffuse macular edema and focal cystoid macular edema were the OCT features most commonly associated with SRD. Intermediate and panuveitis were the most common anatomic sites of inflammation. A variety of pathogenic mechanisms, both inflammatory and non-inflammatory, may be involved in SRD in uveitis patients; identification of the precise mechanism is important for appropriate therapy.
Optical coherence tomography; OCT; Uveitis; Serous retinal detachment; Macular edema; Vogt-Koyanagi-Harada syndrome; Sarcoidosis; Acute posterior multifocal placoid pigment epitheliopathy; Pars planitis; Hypotony maculopathy; Choroidal neovascularization
To describe an association between extrafoveal vitreoretinal traction and chronic macular edema, either diffuse (DiME) or cystoid (CME), by the use of optical coherence tomography (OCT).
Charts and OCT findings of two patients with persistent DiME or persistent DiME accompanied by CME, both associated with extrafoveal vitreous traction membranes were analyzed. Excluded were eyes that either had another vitreoretinopathy that could affect the analysis, had undergone pars plana vitrectomy or that had been treated by intravitreal medications. An age-matched normal control group for OCT (n=12) allowed for the quantification of the normal macular thicknesses.
One patient (one eye) following perforating ocular injury and one patient (one eye) of idiopathic origin, both with chronic macular edema refractive to conventional treatment, were found to be associated with extrafoveal vitreoretinal traction in each eye. Retinal edema that was underlying the traction site in each eye was in continuum with the central macular edema, thus manifesting as diffuse macular edema. The automatic central 6-radial lines program in the OCT enabled the detection of the traction site in one eye, while in the other eye the diagnosis was achieved only with the additional use of the Line group program.
Chronic diffuse macular edema might be related to extrafoveal vitreoretinal traction. Careful search with the diverse OCT programs should be made in order to detect extrafoveal traction sites. Further studies and a larger cohort are required to compare the efficacy of early vitrectomy or pharmacologic vitreolysis versus the current therapeutic approaches in these situations.
extrafoveal vitreous traction; macular edema; optical coherence tomography; ocular perforation
Purpose. To evaluate macular thickness, agreement, and intraclass repeatability in three optical coherence tomography (OCT) devices: the time domain (TD) Stratus OCT and two spectral domain (SD) OCTs, Spectralis and Cirrus SD-OCT, in eyes with macular edema secondary to diabetic retinopathy (DR) and retinal vein occlusion (VO). Methods. In a prospective observational study at a university-based retina practice, retinal thickness tomography was performed simultaneously for fifty-eight patients (91 eyes) with DR and VO employing a time domain and two spectral domain OCTs. Agreement in macular measurements was assessed by constructing Bland-Altman plots. Intraclass repeatability was assessed by intraclass correlation coefficients (ICCs). Results. Based on the Bland-Altman plots for central macular thickness, there was low agreement between the measurements of Cirrus SD-OCT and Stratus OCT, Spectralis OCT and Stratus OCT, as well as Spectralis OCT and Cirrus SD-OCT among DR and RVO patients. All three devices demonstrated high intraclass repeatability, with ICC of 98% for Stratus OCT, 97% for Cirrus SD-OCT, and 100% for Spectralis OCT among DR patients. The ICC was 97% for Stratus OCT, 79% for Cirrus SD-OCT, and 91% for Spectralis OCT among RVO patients. Conclusion. There are low agreements among interdevice measurements. However, intraclass repeatability is high in both TD and SD-OCT devices.
The aim of this study was to compare the efficacy of spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) in the guidance of macular laser photocoagulation for diabetic macular edema.
This was a prospective interventional clinical comparative pilot study. Forty eyes from 24 consecutive patients with diabetic macular edema were allocated to receive laser photocoagulation guided by SD-OCT or FA. Best-corrected visual acuity (BCVA), central macular thickness, and retinal volume were assessed at baseline and two months after treatment.
Subjects treated using FA-guided laser improved BCVA from the logarithm of the minimum angle of resolution (logMAR) 0.52 ± 0.2 to 0.37 ± 0.2 (P < 0.001), and decreased mean central macular thickness from 397.25 ± 139.1 to 333.50 ± 105.7 μm (P < 0.001) and retinal volume from 12.61 ± 1.6 to 10.94 ± 1.4 mm3 (P < 0.001). Subjects treated using SD-OCT guided laser had improved BCVA from 0.48 ± 0.2 to 0.33 ± 0.2 logMAR (P < 0.001), and decreased mean central macular thickness from 425.90 ± 149.6 to 353.4 ± 140 μm (P < 0.001) and retinal volume from 12.38 ± 2.1 to 11.53 ± 1.1 mm3 (P < 0.001). No significant differences between the groups were found in two-month BCVA (P = 0.505), two-month central macular thickness (P = 0.660), or two-month retinal volume (P = 0.582).
The short-term results of this pilot study suggest that SD-OCT is a safe and effective technique and could be considered as a valid alternative to FA in the guidance of macular laser photocoagulation treatment for diabetic macular edema.
spectral-domain optical coherence tomography; fluorescein angiography; macular laser photocoagulation; diabetic macular edema
The influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO).
Twenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (−) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded.
In both the SRD (−) group and the SRD (+) group, the mean macular thickness within the central 4° field and the 10° and 20° fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P <0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P <0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4° field and the 10° and 20° fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P <0.05). The trend profiles of macular thickness within the 10° and 20° fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4° field and the 10° and 20° fields of the occluded region.
These results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.
The pathogenesis of macular pucker and macular holes is poorly understood. Anomalous posterior vitreous detachment (PVD) and vitreoschisis have been proposed as possible mechanisms. This study used clinical imaging to seek vitreoschisis and study the topographic features of macular pucker and macular holes.
Combined optical coherence tomography and scanning laser ophthalmoscopy (OCT/SLO) was performed in 45 eyes with macular hole and 44 eyes with macular pucker. Longitudinal imaging was used to identify vitreoschisis and measure retinal thickness. The topographic features of eyes with macular hole with eccentric macular contraction were compared to 24 eyes with unifocal macular pucker using coronal plane imaging.
Vitreoschisis was detected in 24 of 45 eyes (53.3%) with macular hole and 19 of 44 (43.2%) with macular pucker. Retinal contraction was detected eccentrically in the macula of 18 of 45 eyes (40%) with macular hole. In eyes with macular hole with unifocal retinal contraction, the average surface area of contraction (23.12 ± 18.79 mm2) was significantly smaller than in eyes with macular pucker (63.20 ± 23.68 mm2; P = .006). The distance from the center of retinal contraction to the center of the macula was significantly greater in eyes with macular hole (8.64 ± 2.33 mm) than eyes with macular pucker (4.45 ± 1.90 mm; P = .0001).
Vitreoschisis was detected in about half of all eyes with macular hole and macular pucker. The topographic and structural features in eyes with macular hole with retinal contraction differed in comparison to eyes with macular pucker alone, suggesting that although each condition may begin with anomalous PVD, differences in subsequent cell migration and proliferation probably result in the different clinical appearances detected in this study.
By adjusting for iris color and central foveal retinal thickness, the authors show that macular pigment optical density is directly related to serum lutein in a large cohort of patients with retinitis pigmentosa. In addition, macular pigment optical density in this disease tends to be reduced in eyes with moderate to marked swelling due to cystoid macular edema.
To determine whether macular pigment optical density (MPOD) is related to serum lutein or serum zeaxanthin in patients with retinitis pigmentosa.
The authors measured MPOD with heterochromatic flicker photometry, serum lutein and serum zeaxanthin by high performance liquid chromatography, and central foveal retinal thickness by optical coherence tomography (OCT) in 176 patients (age range, 18–68 years) with typical forms of retinitis pigmentosa; 37 (21%) of these patients had cystoid macular edema (CME) by OCT. The authors performed multiple regression analysis with MPOD as the dependent variable and with loge serum lutein and loge serum zeaxanthin as independent variables adjusting for age, sex, iris color, central foveal retinal thickness, and, in some analyses, serum total cholesterol.
MPOD increased with increasing serum lutein (P = 0.0017) and decreased with increasing serum total cholesterol (P = 0.0025) but was unrelated to serum zeaxanthin. MPOD was higher in patients with brown irides than in patients with lighter irides (P = 0.014) and was nonmonotonically related to central foveal retinal thickness (P < 0.0001), being lower in eyes with more photoreceptor cell loss and in eyes with moderate to marked CME.
MPOD is independently related to serum lutein, serum total cholesterol, iris color, and central foveal retinal thickness in patients with retinitis pigmentosa.
To quantify the prevalence and effect on visual acuity of macular cysts in a large cohort of patients with retinitis pigmentosa.
In 316 patients with typical forms of retinitis pigmentosa, we measured visual acuities with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, detected macular cysts with optical coherence tomography (OCT), and quantified retinal thicknesses by OCT. We used the FREQ, LOGISTIC, and GENMOD procedures of SAS to evaluate possible risk factors for cyst prevalence and the MIXED procedure to quantify the relationships of visual acuity to retinal thickness measured at different locations within the macula.
We found macular cysts in 28% of the patients, 40% of whom had cysts in only one eye. Macular cysts were seen most often in patients with dominant disease and not at all in patients with X-linked disease (p = 0.006). In eyes with macular cysts, multiple regression analysis revealed that visual acuity was inversely and independently related to retinal thickness at the foveal center (p = 0.038) and within a ring spanning an eccentricity of 5° to 10° from the foveal center (p = 0.004).
Macular cysts are a common occurrence in retinitis pigmentosa, especially among patients with dominantly-inherited disease. Visual acuity is influenced by edema in the parafovea, as well as in the fovea.
To characterize foveal atrophy in a heterogeneous group of uveitis patients using clinical findings and high-definition optical coherence tomography (HD-OCT).
Cross-sectional, retrospective case series.
HD-OCT scans of 140 patients seen in a tertiary referral center were reviewed and 23 patients (33 eyes) with foveal atrophy were identified. All patients with foveal atrophy were diagnosed with intermediate uveitis, posterior uveitis, or panuveitis. The status of the photoreceptor layer as visualized with HD-OCT was associated with significant differences in mean visual acuity (p<0.0001). Clinical findings associated with foveal atrophy included atrophy of the retinal pigment epithelium (RPE) and/or choroid (91%), macular ischemia (39%), cystoid macular edema (15%), choroidal neovascularization (12%), retinal detachment involving the macula (6%), and serum antiretinal antibodies (6%).
Foveal atrophy can be a complication of intraocular inflammation in a variety of uveitic syndromes. The etiology of foveal atrophy is multi-factorial and may include dysfunction and atrophy of the RPE and/or choroid, cystoid macular edema, macular ischemia secondary to occlusive retinal vasculitis, choroidal neovascularization, retinal detachment, and possibly antibody-mediated damage directed against photoreceptors. Careful observation of the photoreceptor layer using HD-OCT may help to identify patients who are at risk for visual loss secondary to foveal atrophy.