BACKGROUND AND OBJECTIVE
The Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) device is a spectral-domain optical coherence tomography system that allows faster data acquisition than the previous generation StratusOCT (Carl Zeiss Meditec, Dublin, CA), which is a time-domain device. The authors compared images from both units to determine the clinical usefulness of spectral-domain optical coherence tomography technology in patients with macular diseases.
PATIENTS AND METHODS
Six consecutive patients were imaged with both the Cirrus HD-OCT and the StratusOCT devices and the images were compared.
Cirrus HD-OCT images were typically more useful than StratusOCT images for assessing fine architectural details in macular pathology. The Cirrus HD-OCT software also facilitated a better understanding of three-dimensional data volumes.
Commercially available spectral-domain optical coherence tomography is a clinically useful tool for visualizing and understanding macular diseases and offers benefits not inherent in previous generation machines.
To analyze the visual outcome of patients undergoing glue-assisted intrascleral fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsular support.
Materials and Methods:
This retrospective study analyzes 25 eyes which underwent IOL implantation by the glued intrascleral fixation technique. The pre and post-operative uncorrected visual acuity (UCVA), pre and post-operative best corrected visual acuity (BCVA), intraocular pressure (IOP), IOL position, anterior chamber reaction and central macular thickness were assessed and recorded. Immediate and late post-operative complications were also recorded.
A total of 25 eyes of 22 patients were reviewed and analyzed over a period of one year. All eyes had a foldable three-piece IOL implanted. About 84% of the eyes had a gain of one or more lines, 12% had no gain, and 4% had a fall of three lines of BCVA on Snellen's visual chart, which was attributed to cystoid macular edema (CME). Postoperatively, there was a significant improvement in the UCVA (P < 0.05) and in the BCVA (P < 0.05). Postoperative complications included decentration in one case and vitritis with chronic macular edema in another case. Optical coherence tomography (OCT) demonstrated well placed IOL with no tilt.
Although the results of one year follow-up of glued intrascleral fixation are promising, long term studies are recommended.
Fibrin glue; glued intrascleral fixation; glued intraocular lens forceps; three-piece foldable intraocular lens
We describe a suture fixation technique for a single-piece foldable acrylic closed-loop intraocular lens (IOL) (C-flex™, Rayner).
In our experimental model analyzing the stability of acrylic haptics, we confirmed that the IOL could be in counterpoise without tilt using only a two-point fixation. This new surgical technique was performed in seven patients.
The unique haptic design allows easy and secure suture fixation. The clinical outcomes were encouraging.
It is conceivable that better stabilization can be achieved by the broad arc of distal haptic-tissue contact, in addition to suture fixation, using our surgical technique with the C-flex™ IOL.
Contact; Fixation; Haptic; Stabilization; Technique
We present the first case of partial aniridia, traumatic cataract, and peripapillary subretinal hemorrhage after blunt trauma to an eye containing a foldable iris-fixated phakic intraocular lens (pIOL). Although the patient experienced visual loss because of considerable corneal astigmatism and a traumatic cataract, vision was recovered by a 2-stage primary corneal repair and cataract surgery with a toric intraocular lens. This case exhibits clinical manifestations that differ from previously reported trauma of a non-foldable iris-fixated pIOL. A relatively small corneal incision and a large optic diameter of Artiflex pIOLs may prevent posttraumatic total expulsion of intraocular tissues and present different clinical features from the case of non-foldable pIOLs (Artisan). Although the extent of the damage is different, the possibility of aniridia and traumatic cataract exists in eyes with both foldable and non-foldable iris-fixated pIOLs.
Artiflex phakic intraocular lens; Artisan phakic intraocular lens; Phakic intraocular lens; Traumatic aniridia
The purpose was to evaluate the sensitivity and specificity of measurements of central macular thickness (CMT) in diabetic macular edema using stratus time-domain and cirrus spectral-domain optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA).
Materials and Methods:
A total of 36 eyes from 19 patients with clinically significant diabetic macular edema (DME) were included. All participants underwent automated scanning patterns using cirrus HD-OCT and stratus OCT examinations on the same day. The sensitivity/specificity of retinal thickness measurements was calculated from published normative data. Agreement was calculated using Bland--Altman method. The receiver operating characteristic curves (ROC) and areas under the ROC were plotted.
The mean difference between the cirrus HD-OCT and stratus OCT in the central foveal zone was 49.89 μm. Bland--Altman analysis confirmed that the retinal thickness measurements had poor agreement in patients with DME. The areas under the ROC for retinal thickness measurements were 0.88 using cirrus HD-OCT and 0.94 with stratus.
In patients with DME, the cirrus HD-OCT gives a higher reading than stratus OCT with poor agreement between the devices in most regions within the nine subfield zones. The sensitivity and specificity of the stratus OCT was comparable to the cirrus.
Diabetic macular edema; optical coherence tomography; sensitivity; specificity
To compare primary implantation of foldable hydrophilic acrylic with polymethylmethacrylate (PMMA) intraocular lenses (IOLs) in pediatric cataract surgery in terms of short-term complications and visual outcomes.
This randomized clinical trial included 40 eyes of 31 consecutive pediatric patients aged 1 to 6 years with unilateral or bilateral congenital cataracts undergoing cataract surgery with primary IOL implantation. Two types of IOLs including foldable hydrophilic acrylic and rigid PMMA were randomly implanted in the capsular bag during surgery. Primary posterior capsulotomy and anterior vitrectomy were performed in all eyes. Patients were followed for at least 1 year. Intra- and postoperative complications, visual outcomes and refractive errors were compared between the study groups.
Mean age was 3.2±1.8 years in the hydrophilic acrylic group and 3.7±1.3 years in the PMMA group. Mean follow-up period was 19.6±5 (12–29) months. No intraoperative complication occurred in any group. Postoperative uveitis was seen in 2 (10%) eyes in the acrylic group versus 5 (25%) eyes in the PMMA group (P=0.40). Other postoperative complications including pigment deposition (30%), iridocorneal adhesions (10%) and posterior synechiae formation (10%), were seen only in the PMMA group. The visual axis remained completely clear and visual outcomes were generally favorable and comparable in the study groups.
In pediatric eyes undergoing lensectomy with primary posterior capsulotomy and anterior vitrectomy, hydrophilic acrylic IOLs are comparable to PMMA IOLs in terms of biocompatibility and visual axis clarity, and seem to entail less frequent postoperative complications.
Cataract; Lenses, Intraocular; Polymethylmethacrylate (PMMA)
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.
We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.
Dislocated nucleus; intraocular lens; iris claw lens; pars plana vitrectomy
Purpose. To compare central macular thickness (CMT) measurement on healthy patient using 3 different OCT devices by two operators. Methods. Prospective, monocentricstudy. Right eye's central macular thickness (CMT) of 30 healthy patients has been measured three times using a time-domain (TD) OCT (Stratus OCT, Carl Zeiss Meditec, Dublin, Ca) and two spectral domain (SD) OCTs (Cirrus HD-OCT, Carl ZeissMeditec, Dublin, Ca) and 3D-OCT 1000 (Topcon, Tokyo, Japan) by two operators. Six measurements were taken randomly for each patient the same day. Results. No significant difference between measurements obtained by the two operators has been observed, whatever the studied OCT. P value was 0.164, 0.193, and 0.147 for Stratus OCT, Cirrus HD-OCT and 3D-OCT, respectively. Mean CMT significantly differed from instrument to instrument (P < 0.001) and was, respectively, 197 μm, 254 μm, and 236 μm using Stratus OCT, Cirrus HD-OCT, and 3D-OCT 1000. Using Cirrus OCT and 3D-OCT 1000, CMT was, respectively, 57 μm and 39 μm thicker than using Stratus OCT (P < 0.05). Conclusions. Whatever the OCT device, on healthy patients CMT was not operator dependent. CMT measurements obtained by SD-OCTs are greater than those obtained by TD-OCT. These data imply that the different OCT devices cannot be used interchangeably in clinical monitoring.
To report normal macular thickness measurements and assess reproducibility of retinal thickness measurements acquired by a time domain optical coherence tomography (OCT)(Stratus [Carl Zeiss Meditec, Inc., Dublin, CA, USA]) and three commercially available spectral / Fourier domain OCT instruments (Cirrus HD-OCT [Carl Zeiss Meditec, Inc., Dublin, CA, USA], RTVue-100 [Optovue, Inc., Fremont, CA, USA], 3D OCT-1000 [Topcon, Inc., Paramus, NJ, USA]).
Forty randomly selected eyes of 40 normal, healthy volunteers were imaged. Subjects were scanned twice during one visit and a subset of 25 was scanned again within 8 weeks. Retinal thickness measurements were automatically generated by OCT software and recorded after manual correction. Regression and Bland-Altman plots were used to compare agreement between instruments. Reproducibility was analyzed by using intraclass correlation coefficients (ICC), and incidence of artifacts was determined.
Macular thickness measurements were found to have high reproducibility across all instruments, with ICC values ranging 84.8–94.9% for Stratus OCT; 92.6–97.3% for Cirrus Cube; 76.4–93.7% for RTVue MM5, 61.1–96.8% for MM6; 93.1–97.9% for 3D OCT-1000 Radial, 31.5–97.5% for 3D Macular scans. Incidence of artifacts was higher in spectral / Fourier domain instruments, ranging 28.75 to 53.16%, compared to 17.46% in Stratus OCT. No significant age or gender trends were found in the measurements.
Commercial spectral / Fourier domain OCT instruments provide higher speed and axial resolution than the Stratus OCT, although they vary greatly in scanning protocols and are currently limited in their analysis functions. Further development of segmentation algorithms and quantitative features are needed to assist clinicians in objective use of these newer instruments to manage diseases.
spectral; Fourier; optical coherence tomography; normal; macular thickness; reproducibility; artifact; segmentation
To compare the outcomes of iris claw anterior chamber intraocular lens (IC-ACIOL) with that of scleral fixation posterior chamber intraocular lens (SF-PCIOL) implantation during pars plana vitrectomy (PPV) as initial surgery to correct aphakia. Methods: Twelve patients with complicated cataract surgery or trauma who hadsuffered nucleus, whole crystalline lens or intraocular lens (IOL) drop into the vitreous cavity, and undergone PPV with IC-ACIOL implantation over a period of one year were evaluated for the purpose of this study. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central corneal thickness (CCT), spherical equivalent (SE) refractive error, astigmatism and complications were recorded. The results were compared to outcomes of another group of 13 patients who had previously undergone PPV with SF-PCIOL implantation.
Mean improvement of UCVA was greater in IC-ACIOL eyes as compared tothe SF-PCIOL group (-1.17±0.28 versus -0.89±0.21 logMAR, P=0.01), corresponding values for postoperative BCVA were 0.24±0.17 and 0.44±0.22 logMAR (P=0.041), respectively. Average postoperative SE was comparable in the IC-ACIOL and SF-PCIOL groups at 0.6±1.03 and 0.56±1.23 diopters, respectively (P=0.290). However, 10 (83.3%) IC-ACIOL eyes versus 6 (46.1%) SF-PCIOL eyes had SE within 1 diopter of emmetropia (P=0.048). Mean postoperative increase in CCT was comaparble between the study groups (P=0.126).
In the absence of sufficient capsular support, the use of an IC-ACIOLfor correction of aphakia during PPV can be a good alternative and seems to entail better visual outcomes as compared to SF-PCIOL.
Iris-Claw Anterior Chamber Intraocular Lens; Pars Plana Vitrectomy; Scleral FixationIntraocular Lens; Capsular Support; Nucleus Drop; Intraocular Lens Drop
The management of ectopia lentis in Marfan's syndrome is challenging. Multiple disease-associated factors conspire to deprive these patients of adequate vision. While optical correction with glasses and contact lenses is usually advocated early on, the irregular astigmatism and even partial aphakia that accompanies advanced cases generally warrant surgical intervention. Several surgical strategies have been devised to manage these challenging cases, including the combination of endocapsular or pars plana lensectomy and iris or scleral fixation of the intraocular lens (IOL) or IOL-bag complex. All of the reported cases have been implanted with IOLs that correct for myopia only. With toric lenses, it is now possible to correct for corneal astigmatism in these patients as well, provided that the capsular bag is maintained and can be properly centered. We report the combination of scleral-fixated Cionni endocapsular rings and toric IOLs in a pediatric patient with bilateral ectopia lentis secondary to Marfan's syndrome.
Ectopia lentis; Marfan's syndrome; Toric intraocular lens; Cionni endocapsular ring
With recent improvements on OCT technologies, the sheer volume of the image data keeps increasing. Automated diagnosing system is needed to assist busy clinicians by facilitating timely interpretation of OCT images.
To develop an automated method to identify the normal macula and three macular pathologies (macular hole [MH], macular edema [ME], and age-related macular degeneration [AMD]) from the fovea-centered cross sections in three-dimensional (3D) spectral-domain optical coherence tomography (SD-OCT) images.
A sample of SD-OCT macular scans (macular cube 200 × 200 or 512 × 128 scan protocol; Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA) was obtained from healthy subjects and subjects with MH, ME, and/or AMD (dataset for development: 326 scans from 136 subjects [193 eyes], and dataset for testing: 131 scans from 37 subjects [58 eyes]). A fovea-centered cross-sectional slice for each of the SD-OCT images was encoded using spatially distributed multiscale texture and shape features. Three ophthalmologists labeled each fovea-centered slice independently, and the majority opinion for each pathology was used as the ground truth. Machine learning algorithms were used to identify the discriminative features automatically. Two-class support vector machine classifiers were trained to identify the presence of normal macula and each of the three pathologies separately. The area under the receiver operating characteristic curve (AUC) was calculated to assess the performance.
The cross-validation AUC result on the development dataset was 0.976, 0.931, 0939, and 0.938, and the AUC result on the holdout testing set was 0.978, 0.969, 0.941, and 0.975, for identifying normal macula, MH, ME, and AMD, respectively.
The proposed automated data-driven method successfully identified various macular pathologies (all AUC > 0.94). This method may effectively identify the discriminative features without relying on a potentially error-prone segmentation module.
To evaluate the glaucoma discriminating ability of macular retinal layers as measured by spectral-domain optical coherence tomography (SD-OCT).
Healthy, glaucoma suspect and glaucomatous subjects had a comprehensive ocular examination, visual field testing and SD-OCT imaging (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) in the macular and optic nerve head regions. OCT macular scans were segmented into macular nerve fiber layer (mNFL), ganglion cell layer with inner plexiform layer (GCIP), ganglion cell complex (GCC) (composed of mNFL and GCIP), outer retinal complex (ORC) and total retina (TR). Glaucoma discriminating ability was assessed using the area under the receiver operator characteristic curve (AUC) for all macular parameters and mean circumpapillary (cp) RNFL. Glaucoma suspects and glaucoma subjects were grouped together for the calculation of AUCs.
Analysis was performed on 51 healthy, 49 glaucoma suspect and 63 glaucomatous eyes. The median visual field MD was −2.21dB (interquartile range (IQR): −6.92 to −0.35) for the glaucoma group, −0.32dB (IQR: −1.22 to 0.73) for the suspect group and −0.18dB (IQR: −0.92 to 0.71) for the healthy group. Highest age adjusted AUCs for discriminating between healthy and glaucomatous eyes were found for average GCC and GCIP (AUC=0.901 and 0.900, respectively), and their sectoral measurements: infero-temporal (0.922 and 0.913), inferior (0.904 and 0.912) and supero-temporal (0.910 and 0.897). These values were similar to the discriminating ability of the mean cpRNFL (AUC=0.913). Comparison of these AUCs did not yield any statistically significant difference (all p>0.05). Similar discrimination performance but with slight reduction in AUCs was achieved for comparison between healthy and the combination of glaucoma and glaucoma suspect eyes.
SD-OCT GCIP and GCC measurements showed similar glaucoma diagnostic ability and was comparable with that of cpRNFL.
It is aimed to evaluate the technical feasibility, safety, outcome, and incidence of complications after clear corneal phacoemulsification with foldable intraocular lens implantation (IOL) and triamcinolone assisted pars plana vitrectomy in patients with proliferative diabetic retinopathy.
The results of combined phacoemulsification, in the capsular bag foldable intraocular lens implantation and triamcinolone assisted pars plana vitrectomy in 75 eyes of 72 patients, were retrospectively evaluated. Surgery was performed using general anesthesia in 9 cases, and monitored retrobulbar block in 66 cases. In all cases, phacoemulsification with clear corneal incision and foldable acrylic IOL implantation were performed before vitreoretinal surgery. The main investigation points were preoperative and postoperative best corrected visual acuity (BCVA), and intraoperative and postoperative complications.
The mean age at surgery was 62.07 ± 9.51 years (range 22 to 78 years) and the postoperative follow-up time was 17.17 ± 7.25 months. All eyes had clinically significant cataract that interfered with visualization of the retina preoperatively. All eyes had proliferative diabetic retinopathy. Postoperatively, visual acuity improved in 65 eyes (86.7%), was unchanged in 9 eyes (12.0%), and decreased in 1 eye (1.3%). The most postoperative complications consisted of a mild iritis in 8 eyes (10.7%), recurrent vitreous hemorrhage in 8 eyes (10.7%), posterior capsule opacification in 7 eyes (9.3%), transient intraocular pressure increase in 6 (8.0%), iatrogenic retinal tear in 6 (8.0%), epiretinal membrane in 5 (6.7%).
The results of combined phacoemulsification in the capsular bag foldable IOL implantation and triamcinolone assisted pars plana vitrectomy show that visual acuity outcomes are generally favorable and complications are acceptable in diabetic patients. Visual results and complications depend primarily on the underlying posterior segment pathology. The use of triamcinolone acetonide may simplify surgery and decreases the postoperative inflammation.
Phacoemulsification; triamcinolone assisted vitrectomy; intraocular lens implantation; proliferative diabetic retinopathy.
To investigate the reproducibility of choroidal thickness measurements in normal subjects on three Spectral Domain Optical Coherence Tomography (SDOCT) instruments, Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc, Dublin, California, USA), Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Optovue RTVue (Optovue Inc., Fremont, CA).
Cross-sectional non-interventional study
Images were obtained in 28 eyes of 28 healthy undilated volunteers without ocular pathology in a clinical setting.
All subjects were imaged on the fovea using Cirrus HD 1-line raster, Spectralis enhanced depth imaging and RTVue retina-cross.
Main Outcome Measures
The choroid was measured subfoveally, 750 μm temporal and 750 μm nasal to the fovea. All measurements were performed by 2 independent observers. Two way analysis of variance (ANOVA) with Bonferroni's post-test, Pearson correlation and the Bland-Altman analysis were used to compare measurements.
The group of 28 subjects consisted of 7 men and 21 women, with an average age of 35.2 years (range, 23 to 64 years). A two way ANOVA with Bonferroni's post-test revealed no significant difference in the average subfoveal choroidal thickness (P >0.05) between systems for any location: subfoveally, 750μm temporal and 750 μm nasal to the fovea. The measurements of choroidal thickness from any pair of three instruments (Cirrus vs. Spectralis, Cirrus vs. RTVue, Spectralis vs. RTVue) were also strongly correlated. The Pearson correlation between all two system pairs of the three systems was greater than 0.9 p <0.0001. The 95% limits of agreement between four choroidal thickness measurements between Cirrus and RTVue were +11.21% to -13.57% (Bias -1.17), between Spectralis and RTVue +10.85% to -12.45% (Bias -0.80) and between Cirrus and Spectralis +12.81% to -13.33% (Bias -0.25).
In our population of young healthy adults with normal vision, there was good reproducibility between choroidal thickness measurements of images acquired with Cirrus, Spectralis and RTVue.
The retinal ganglion cell–inner plexiform layer, which is known to get thinner with worsening glaucoma, can be measured with excellent reproducibility using spectral domain–optical coherence tomography. This may prove useful in following up patients for glaucoma progression.
To demonstrate the capability of SD-OCT to measure macular retinal ganglion cell–inner plexiform layer (GCIPL) thickness and to assess its reproducibility in glaucomatous eyes.
Fifty-one glaucomatous eyes (26 mild, 11 moderate, 14 severe) of 51 patients underwent macular scanning using the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) macula 200×200 acquisition protocol. Five scans were obtained on 5 days within 2 months. The ganglion cell analysis (GCA) algorithm was used to detect the macular GCIPL and to measure the thickness of the overall average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL. The reproducibility of the measurements was evaluated with intraclass correlation coefficients (ICCs), coefficients of variation (COVs), and test-retest standard deviations (TRTSDs).
Segmentation and measurement of GCIPL thickness were successful in 50 of 51 subjects. All ICCs ranged between 0.94 and 0.98, but ICCs for average and superior GCIPL parameters (0.97–0.98) were slightly higher than for inferior GCIPL parameters (0.94–0.97). All COVs were <5%, with 1.8% for average GCIPL and COVs for superior GCIPL parameters (2.2%–3.0%) slightly lower than those for inferior GCIPL parameters (2.5%–3.6%). The TRTSD was lowest for average GCIPL (1.16 μm) and varied from 1.43 to 2.15 μm for sectoral GCIPL
The Cirrus HD-OCT GCA algorithm can successfully segment macular GCIPL and measure GCIPL thickness with excellent intervisit reproducibility. Longitudinal monitoring of GCIPL thickness may be possible with Cirrus HD-OCT for assessing glaucoma progression.
This study evaluated the surgical outcome and complications of phacoemulsification and the implantation of an acryl foldable intraocular lens (IOL) with a squared edge in dogs with cataracts. Thirty-two eyes from 26 dogs were examined. The mean follow up period was 75.9 days ranging from 23 to 226 days. The complications after phacoemulsification were posterior capsular opacity (PCO) around the IOL (n = 11), ocular hypertension (n = 4), focal posterior synechia (n = 4), hyphema (n = 3) and corneal ulcer (n = 2). The complications associated with the IOL were decenteration of the optic (n = 2) and ventral haptic displacement (n = 1). Most cases of PCO were found only around the margin of the IOL, and all eyes had vision during the observation period. In conclusion, the implantation of an acryl-foldable lens with a squared edge at the time of phacoemulsification is an effective method for preserving the central visual field of dogs with cataract.
cataract; dog; foldable; intraocular lens; phacoemulsification
The present study evaluates the effect of disease severity on the performance of the Cirrus HD-OCT in glaucoma diagnosis. This study adds important information when interpreting and comparing results from this device under different clinical scenarios.
To evaluate the effect of disease severity on the diagnostic accuracy of the Cirrus Optical Coherence Tomograph (Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA) for glaucoma detection.
One hundred thirty-five glaucomatous eyes of 99 patients and 79 normal eyes of 47 control subjects were recruited from the longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). The severity of the disease was graded based on the visual field index (VFI) from standard automated perimetry. Imaging of the retinal nerve fiber layer (RNFL) was obtained using the optic disc cube protocol available on the Cirrus HD-OCT. Pooled receiver operating characteristic (ROC) curves were initially obtained for each parameter of the Cirrus HD-OCT. The effect of disease severity on diagnostic performance was evaluated by fitting an ROC regression model, with VFI used as a covariate, and calculating the area under the ROC curve (AUCs) for different levels of disease severity.
The largest pooled AUCs were for average thickness (0.892), inferior quadrant thickness (0.881), and superior quadrant thickness (0.874). Disease severity had a significant influence on the detection of glaucoma. For the average RNFL thickness parameter, AUCs were 0.962, 0.932, 0.886, and 0.822 for VFIs of 70%, 80%, 90%, and 100%, respectively.
Disease severity had a significant effect on the diagnostic performance of the Cirrus HD-OCT and thus should be considered when interpreting results from this device and when considering the potential applications of this instrument for diagnosing glaucoma in the various clinical settings.
We report a novel technique characterized by sutureless scleral fixation of three-pieces foldable intraocular lens (IOL) using 25-gauge transconjunctival sutureless vitrectomy (TSV) trocars in patients with insufficient posterior capsule support.
Materials and Methods
We performed this technique on the eight eyes of the seven patients. The scleral tunnels (STs) are prepared by insertion of the 25-gauge TSV microcannulas using the trocars, and anterior vitrectomy is performed through the clear corneal paracentesis with the aid of anterior chamber maintainer (ACM). Finally, the three-piece foldable IOL haptics are incarcerated into the prepared STs.
The patients were followed up 5–8 months. None of the patients had complications such as postoperative endophthalmitis, glaucoma, IOL tilt or decentralization, and retinal detachment. Injection of a foldable IOL through a clear corneal small incision also contributes the less surgical-induced astigmatism.
The presented novel sutureless scleral IOL fixation technique may provide minimal trauma to the surrounding tissues, good IOL stabilization decreasing the incidence of IOL tilt along with shorter operation time, and postoperative quiet eye.
intraocular lens; posterior chamber; scleral fixation; sutureless; vitrectomy trocar
To evaluate optical coherence tomography thickness of the macula in people with diabetes but minimal or no retinopathy and compare these findings with published normative data in the literature from subjects reported to have no retinal disease.
Setting: Multicenter, community- and university-based practices.
Study Population: 97 subjects with diabetes with no or minimal diabetic retinopathy and no central retinal thickening on clinical examination and a center point thickness ≤225 microns on a Stratus™ (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography (Stratus OCT™).
Observation Procedures: Electronic-ETDRS best-corrected visual acuity, 7-field stereoscopic color fundus photographs, Stratus OCT™ fast macular scan.
Main Outcome Measures: Central subfield thickness measured on Stratus OCT™.
On average, central subfield thickness was 201 ± 22 microns. Central subfield thickness was significantly greater in retinas from men than retinas from women subjects (mean 209 ± 18 microns versus 194 ± 23 microns, P<0.001). After adjusting for gender, no additional factors were found to be significantly associated with central subfield thickness (P>0.10).
Central subfield thicknesses on Stratus OCT™ in people with diabetes and minimal or no retinopathy are similar to thicknesses reported from a normative database of people without diabetes. Central subfield thickness is greater in men than in women, consistent with many, but not all, previous reports. Studies involving comparisons of retinal thickness to expected norms should consider different mean values for women and men.
To determine the rate of progression of eyes with subclinical diabetic macular edema (DME) to clinically apparent DME or DME necessitating treatment during a 2-year period.
In all, 43 eyes from 39 study participants with subclinical DME, defined as absence of foveal center edema as determined with slit lamp biomicroscopy but a center point thickness (CPT) between 225 and 299 μm on time domain (Stratus, Carl Zeiss Meditec) optical coherence tomography (OCT) scan, were enrolled from 891 eyes of 582 subjects screened. Eyes were evaluated annually for up to 2 years for the primary outcome, which was an increase in OCT CPT of at least 50 μm from baseline and a CPT of at least 300 μm, or treatment for DME (performed at the discretion of the investigator).
The cumulative probability of meeting an increase in OCT CPT of at least 50 μm from baseline and a CPT of at least 300 μm, or treatment for DME was 27% (95% confidence interval (CI): 14%, 38%) by 1 year and 38% (95% CI: 23%, 50%) by 2 years.
Although subclinical DME may be uncommon, this study suggests that between approximately one-quarter and one-half of eyes with subclinical DME will progress to more definite thickening or be judged to need treatment for DME within 2 years after its identification.
diabetic macular edema; optical coherence tomography; subclinical diabetic macular edema
Posterior capsule opacification (PCO) is still a major long‐term complication of modern cataract surgery. We evaluated the impact of sharp‐edged intraocular lenses (IOLs) with different haptic designs made from the same hydrophobic acrylic material on posterior and anterior lens capsule opacification.
Eye clinic of Kaunas University of Medicine, Lithuania. Prospective randomised clinical study.
Seventy‐four eyes of 74 patients scheduled for cataract surgery were included in a prospective randomised clinical study. Thirty‐seven eyes of 37 patients received a three‐piece acrylic hydrophobic (AcrySof, MA3OBA, Alcon) IOL; and thirty‐seven eyes of 37 patients received a one‐piece acrylic hydrophobic (AcrySof, SA3OAL, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsular folds, capsulorrhexis/optic overlapping and posterior capsule opacification (PCO) were evaluated. ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3 mm optic zone were assessed using a photographic image‐analysis system (EPCO2000). Follow‐ups were performed postoperatively at 1 day, 6 months, 1 year and 2 years.
There were no significant differences in best corrected visual acuity, grade of ACO and capsulorrhexis/optic overlapping between IOL types during the follow‐up period. Patients in the one‐piece acrylic hydrophobic IOL group more frequently presented with capsular folds behind the IOL optic area than those in the three‐piece IOL group. In the three‐piece acrylic hydrophobic IOL group, PCO values (mean (SD)) of the entire IOL optic area were significantly lower six months postoperative (three‐piece: 0.002 (0.009); one‐piece: 0.007 (0.017); p = 0.04), one year postoperative (three‐piece: 0.004 (0.016); one‐piece: 0.026 (0.041); p = 0.001) as well as one year postoperative in the central 3 mm optic zone (three‐piece: 0.000 (0.0002); one‐piece: 0.019 (0.049); p = 0.001). However, two years postoperative, the PCO values of the groups did not show significant differences (entire IOL optic area: three‐piece, 0.136 (0.223); one‐piece, 0.154 (0.190); p = 0.18; central zone: three‐piece, 0.023 (0.065); one‐piece: 0.020 (0.039); p = 0.44).
The 2 year follow‐up after cataract surgery showed no significant difference in ACO and PCO development between three‐piece and one‐piece acrylic hydrophobic intraocular lenses.
posterior capsule opacification; intraocular lens; hydrophobic acrylic; single‐piece; three‐piece
The purpose of this study was to visualize the aqueous outflow system in three dimensions (3D) in living human eyes, and to investigate the use of commercially available Spectral-domain optical coherence tomographic (SD-OCT) systems for this purpose.
This was a prospective observational study.
Participants and/or Controls
One randomly determined eye in each of six normal healthy subjects was included.
3D SD-OCT imaging of the aqueous humor outflow structures was performed with two devices: Cirrus HD-OCT (Carl Zeiss Meditec, Inc., Dublin CA) and Bioptigen SDOIS (Bioptigen, Inc., Research Triangle, NC).
Main Outcome Measures
3D virtual castings of Schlemm’s canal (SC) and more distal outflow structures created from scan data from each device.
Virtual casting of SC provided visualization of more aqueous vessels branching from SC than could be located by interrogating the 2D image stack. Similarly, virtual casting of distal structures allowed visualization of large and small aqueous outflow channel networks that could not be appreciated with the conventional 2D visualization.
The outflow pathways from SC to the superficial vasculature can be identified and tracked in living human eyes using commercially available SD-OCT.
To evaluate the visual outcomes, intraoperative and postoperative complications of Cionni ring implantation in eyes with a subluxated lens associated with Marfan Syndrome.
This case series included 15 eyes of 12 patients aged 19–56 years with a subluxated lens secondary to Marfan's syndrome operataed at the Departament of Ophtalmology, Toronto Western Hospital between 2003 and 2007. A 2‐eyelet Cionni ring and an AcrySof® (Alcon) foldable intraocular lens (IOL) were implanted in 13 eyes. Two eyes had trans‐scleral IOL fixation in the ciliary sulcus.
Best‐corrected visual acuity, wavefront evaluation of eye aberration and complication rates were analysed.
In all eyes, capsular bag centration was excellent. Preoperative visual acuity ranged from 20/50 to counting fingers, and improved to better than 20/40 in all eyes. The mean follow‐up duration was 14±9.49 months. The most frequent postoperative complication was posterior capsule opacification, which occurred in 3 eyes (18.7%), 2 of which required a neodymium:YAG posterior capsulotomy. No eye developed retinal detachment. Total eye aberration, tilt and high‐order aberrations with a 6‐mm pupil diameter decreased significantly after surgery (n = 5): Total eye aberration decreased from a mean of 14.8±5.5 preoperatively to 2.1±4.3 microns after the operation. Tilt was decreased from 4.1±2.5 to 0.12±2.1 microns, and high‐order aberrations decreased from 4.37±3.8 microns, before the operation, to 1.47±3.5 after the operation.
Cionni ring implantation is an effective procedure to correct partial lens subluxation and has few complications (during 14 months of follow‐up) in patients with Marfan's Syndrome.