Average Central Subfield Thickness Research Articles

Outcomes After Switching to Faricimab for Refractive Macular Edema in Treatment-Experienced Eyes with Neovascular Age-Related Macular Degeneration.

To examine response to faricimab in neovascular age-related macular degeneration (nARMD) refractory to traditional anti-vascular endothelial growth factor (anti-VEGF) agents. Retrospective chart review was conducted on eyes with nARMD with persistent subretinal and/or intraretinal fluid despite previously receiving ≥15 injections with ≥2 different anti-VEGF agents. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters were collected at baseline, initial post-injection visit, and most recent visit with OCT following last faricimab. Nineteen eyes were included. Average logMAR BCVA was 0.47 ± 0.60 at baseline, 0.42 ± 0.47 at initial follow-up (p=0.38), and 0.51 ± 0.63 at final visit (p = 0.50). Average central subfield thickness (CST) was 310 ± 92μm at baseline, 279 ± 88μm at initial follow-up (p = 0.001), and 274 ± 100μm at last visit (p < 0.001). 9 eyes (47%) achieved resolution of fluid at both initial and final follow-up visits. Faricimab mildly decreased CST and reduced fluid in some nARMD eyes refractory to traditional anti-VEGF agents but had minimal effect on BCVA.

Interocular Symmetry and Intermachine Reproducibility of Optic Disc and Macular Parameters Measured by Two Different Models of Optical Coherence Tomography.

To compare the interocular symmetry and investigate the intermachine reproducibility of optic disc and macular data measured by spectral-domain high-definition optical coherence tomography (HD-OCT) Cirrus HD-OCT 4000 and HD-OCT 5000 from healthy subjects. Forty-three volunteers were examined with both HD-OCT 4000 and HD-OCT 5000 at the same visit. Optic nerve head (ONH) and macular data were acquired using ONH Cube 200×200 scans and macular volume cube 512×128 scans, respectively. The average age of the participants was 33 ± 8.6 years. Interocular OCT parameters of ONH and macula showed a high correlation between the right and left eyes regardless of HD-OCT models, displaying a low coefficient of variation (CV). However, the average retinal nerve fiber layer (RNFL) was thicker (96.67±11.19µm vs 95.3±10.89µm, p<0.01), and the average central subfield thickness (261.51±17.45µm vs 262.51±17.39 µm, p<0.01) and cube average thickness (283.91± 13.59µm vs 286.55±13.09µm, p<0.05) were thinner when measured by Cirrus 4000 compared to 5000. Intermachine reproducibility and reliability of RNFL and macular parameters exhibited a high intraclass correlation coefficient (ICC) (0.985) and low CV (2.4%). Ganglion cell-inner plexiform layer (GCIPL) measured by two OCT models showed similar values with an average thickness of 85 µm and had high intermachine reproducibility with high ICC (0.993) and low CV (1.2%). High interocular symmetry was observed across both HD-OCT models. Intermachine reproducibility for RNFL and all macular parameters was also high. GCIPL showed minimal intermachine differences with high reproducibility and reliability. Thus, the results imply that GCIPL values measured by two Cirrus OCT models may be used interchangeably.

Outcome of Suprachoroidal Triamcinolone Acetonide in Resistant Diabetic Macular Edema

One of the most frequent cause of central vision deterioration in people with retinopathy due to diabetes is diabetic macular edema. Suprachoroidal injections offer a novel way of delivery for the administration of corticosteroids that may have various benefits. Objective: To observe outcome of triamcinolone acetonide given by suprachoroidal route for the treatment of resistant diabetic macular edema. Methods: A descriptive case series study which was carried out at Department of Ophthalmology, Layton Rahmatullah Benevolant Trust Hospital Multan Road Lahore from July 14, 2021 till Jan 14, 2022. A total of 60 cases meeting selection criteria was taken after taking approval from hospital ethical committee. All injections were given by a single surgeon to avoid any related bias. 30-gauge 1cc insulin syringe was used in all cases. Results: The study included patients aged between 30 and 70 years, and the average age was 52.73 ± 10.99 years. There were 39(65%) male with 21(35%) female cases. The average central subfield thickness before and after one month was 593.62 ± 116.87 µm and 303.55 ± 31.29 µm with statistically significantly less mean central subfield thickness after 1 month, p-value less than 0.001. The mean visual acuity after correction before and after one month was 0.81 ± 0.16 and 0.45 ± 0.03 respectively, with statistically significantly less mean optimally corrected visual acuity after 1 month, p-value less than 0.001. Conclusions: It was found that suprachoroidal triamcinolone acetonide is useful in managing the central subfield and optimally corrected visual acuity in resistant diabetic macular edema.

Combination of half-dose photodynamic therapy and anti-VEGF versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy

Introduction: Polypoidal choroidal vasculopathy (PCV) is an abnormality of the inner choroidal vasculature. The recommended treatment for PCV is a combination of standard verteporfin photodynamic therapy (PDT) with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). There have been reports ofsuccess with combination of half-dose PDT (hd-PDT) and anti-VEGF in the treatment of PCV. hd-PDT might be a cost-effective method with favourable outcome in the treatment of PCV and fewer side effects.Purpose: To explore the efficacy of hd-PDT combined with anti-VEGF and anti-VEGF monotherapy in PCV.Study design: Retrospective nonrandomized comparative study.Material and methods: We conducted a retrospective nonrandomized comparative records review of all patients with PCV received a combination of hd-PDT and anti-VEGF vs anti-VEGF monotherapy from November 2017 to November 2019 at Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Patients received a half-dose of verteporfin over 10 minutes and were irradiated by the standard fluence combined with intravitreal ranibizumab or aflibercept injections. The monotherapy group received either intravitreal ranibizumab or aflibercept. Primary outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 6 months post-treatment. Secondary outcome measure was documentation of sideeffects.Results: The study included a total of 16 patients, with 8 patients (8 eyes) in the combination group and 8 patients (10 eyes) in the monotherapy group. At 6 months post-treatment, the BCVA changes in logarithm of the minimum angle of resolution (logMAR) were -0.06 in the combination group and +0.02 in the monotherapy group (p = 0.928). The average CST reduction was 51.6 μm in the combination group and 106.1 μm in the monotherapy group (p = 0.214). One eye developed subretinal haemorrhage after hd-PDT and one eye developed retinal atrophy in the monotherapy group.Conclusion: hd-PDT combined with anti-VEGF was able to produce similar functional outcomes in terms of BCVA when compared to anti-VEGF monotherapy. However, monotherapy is shown to be superior to combination treatment for anatomical improvement.

Comparison of macular thickness in myopia, hypermetropia and emmetropia: An OCT based study

Aim: To make a comparative evaluation of macular thickness in myopia and hypermetropia versus emmetropia. Materials and Methods: A cross-sectional OCT based study was done in randomly selected 100 emmetropes, 93 myopes, 67 hypermetropes aged between 18 to 30 years regardless of sex. Results: Average outer macular thickness in emmetropia, myopia and hypermetropia is 276.63±12.5, 275.43±12.1, 286.56±11.4 respectively. Average inner macular thickness was 316.45±11.5, 308.83±11.3, 310.70±12.1 respectively and average central subfield thickness was 243.80±11.2, 248.51±22.9, 240.05±21.9 respectively. Conclusion: Overall macular thickness in various quadrants was uniform in emmetropia. As compared to emmetropia in myopia average outer and inner subfield macular thickness is lower while average central thickness is higher. In hypermetropia average inner macular and central subfield thickness is lower while outer macular thickness is higher (p=0.001). Keywords: Macular thickness, Myopia, Hypermetropia, Emmetropia.

Atrophy of the central neuroretina in patients treated for diabetic macular edema.

PurposeTo examine the prevalence of central retinal atrophy in patients treated for diabetic macular edema (DME) in a clinical setting.MethodsRetrospective data analysis of patients with DME, focusing on those who developed central retinal thinning after DME treatment at the Department of Ophthalmology, Medical University Vienna. Patient characteristics and clinical data including best‐corrected visual acuity (BCVA), spectral domain optical coherence tomography and fluorescence angiography images were reviewed and DME treatment strategies analysed using descriptive statistics. The correlation between visual acuity and ocular, systemic or DME treatment factors was calculated using linear regression models and ancovas.ResultsA total of 6684 outpatient visits by 1437 patients with diabetes were analysed. Out of 149 patients, who had had a central subfield thickness (CST) below 200 μm, 32 (36 eyes) had previously been diagnosed with a centre involving DME with an average CST of 473 ± 103 μm and average visual acuity of 0.62 ± 0.44 logMAR at first presentation. At the time of central atrophy, 29 (81%) out of 36 eyes had a history of laser treatment, 11 (31%) a vitrectomy, 32 (88%) repeated intravitreal injections of anti‐vascular endothelial growth factor (VEGF; mean 5.3 ± 3.8) and 22 (61%) intravitreal corticosteroid injections (mean 2.5 ± 2.7). Visual function (0.67 ± 0.43 logMAR) at the time of atrophy was not significantly correlated to central retinal thickness (191 ± 7 μm) or any other ocular, systemic or treatment factors.ConclusionsOnly 4% of patients treated for DME developed central retinal thinning in our observation period. On average, our atrophy patients had higher CST and lower BCVA when they first presented with DME compared to the overall DME cohort, and they received a combination of intravitreal injections and laser for DME treatment. Central retinal atrophy might not be attributed to excessive use of intravitreally applied anti‐VEGF or any other DME therapy alone.

Baseline Ocular Characteristics of Patients Undergoing Initiation of Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema.

Patients with diabetic macular edema (DME) have variable anatomic and visual responses to anti-vascular endothelial growth (VEGF) treatments based on their presenting visual acuity (VA). The aim of study is to report the baseline ocular and imaging characteristics of patients presenting with DME who were treatment-naïve and who initiated anti-VEGF in routine clinical practice. Single-center, cross-sectional study of 638 patients. Subjects were divided into two VA groups: Early Treatment Diabetic Retinopathy Study (ETDRS) less than 70 and ETDRS greater than 70 and ocular variables were compared between groups. Average central subfield thickness (CST) was 363.5 μm, cube volume was 11.7 mm3, and cube average thickness (CAT) was 326.1 μm. Additionally, 21.5% had subretinal fluid (SRF), and 50.5% had hard exudates on presentation. Eyes with ETDRS less than 70 had greater CAT (338.5 μm3 vs. 313.2 μm3; P < .001), greater cube volume (12.2 mm3 vs. 11.3 mm3; P < .001), greater CST (383.5 μm vs. 350.0 μm; P < .001), and SRF (25.5% vs. 17.3%; P = .012). Furthermore, 7.64% had glaucoma, 1.3% had dry age-related macular degeneration, 4.5% of patients were vitrectomized, and 28.7% were pseudophakic. Regarding diabetic stage, 37% had proliferative diabetic retinopathy (PDR) and 63% presented with nonproliferative diabetic retinopathy. Patients presenting with ETDRS less than 70 were more likely to have a history of vitrectomy (7.1% vs. 1.9%, P = .002) and presence of PDR (42.3% vs. 31.4%, P = .004). The results describe a population of patients from a routine clinical practice not entirely represented in clinical trials, with key differences in ocular characteristics seen between VA groups. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:69-75.].

Effect of Posterior Subtenon Triamcinolone Acetonide Injection on Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection.

PurposeTo evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure.MethodsPatients with DME and central subfield thickness (CST) >300 µm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after ≥3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography.ResultsForty eyes of 34 patients were included. The average baseline CST was 476 µm. The average CST decreased to 368 µm at 2 months, 374 µm at 4 months, and 427 µm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected.ConclusionsPosterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.

Macular structural characteristics in children with congenital and developmental cataracts

To investigate macular structural characteristics in children with congenital or developmental cataracts. Children 5-16 years of age with a history of surgery for congenital or acquired cataract were enrolled. Eligible patients had visual acuity of 20/400 or better and ≥37 weeks gestational age at birth. Patients were divided into two groups: unilateral (n = 22) and bilateral (n = 19). Fourier domain optical coherence tomography (FD-OCT) was used to image the retinal structure. Retinal volume scans centered on the fovea were obtained. Using the instrument's segmentation software, central subfield thickness (CST) and the thickness of the inner and outer retinal layer regions were measured. In the unilateral group, 1 child with persistent fetal vasculature had unidentifiable retinal structure and was excluded. Most unilateral eyes (20/21) had a CST within the normal range. However, the CST, superior, nasal, inferior, and temporal sectors were all significantly thicker in the cataractous eye compared to the noncataractous eye (all P < 0.01 [paired t test]). The interocular difference for CST was not associated with age at surgery or interocular difference for visual acuity. In the bilateral group, although 34 of 38 eyes were within the normal range, the average CST of this group was significantly thicker than the noncataractous eye in the unilateral group. Following cataract extraction during infancy or childhood, most cataractous eyes had normal macular structure. Cataractous eyes of both unilaterally and bilaterally affected children have thicker CST values compared to the noncataractous eye.

Anatomical and visual outcomes following ocriplasmin treatment for symptomatic vitreomacular traction syndrome

ObjectiveTo evaluate the anatomical and visual outcomes of patients treated with ocriplasmin for the treatment of symptomatic vitreomacular adhesion (sVMA), including vitreomacular traction syndrome and macular holes.DesignRetrospective, interventional, single centre,...

Correlation between central subfield thickness, visual acuity and structural changes in diabetic macular edema

To correlate the central subfield thickness (CST) measured by Cirrus™ SD-OCT with best-corrected visual acuity (BCVA) and structural changes in diabetic macular edema (DME). The transversal study evaluated 200 patients with non-proliferative diabetic retinopathy (NPDR) and selected 55 eyes with DME between January, 2010 and April, 2011. Spectral domain OCT was performed in patients with type 2 diabetes and DME. CST and BCVA were correlated with the edema morphology and the ELM (external limiting membrane) integrity. Statistical tests were applied to validate the results. There was no difference between genders in the NPDR classification. 47.3% of the patients showed moderate NPDR. The CST average for male was of 393.58 µm and 434.16 µm for female, with no statistically significant difference. The patients with continuous ELM showed lower CST average (368.73 µm) than those with disrupted ELM (521.43 µm). There was a strong correlation between the macular volume and CST (59.63%), but poor correlation between age and CST (2.9%). Also, there was a significant difference between the average CST and the type of macular edema. Patients with serous detachment showed higher CST average (488.71 µm) than those with cystoid macular edema (CME) and diffuse edema. Patients with severe NPDR showed higher CST average (491.45 µm), if compared to mild and moderate NPDR. Cystoid macular edema was the most common type of edema (49.1%) and showed the worse VA. Patients with disrupted ELM showed worse BCVA. Patients with higher CST showed worse BCVA. There was a significant difference between the CST average of the case group (407.6 ± 113,1 µm) and the control group (diabetic patients without DME: 252 ± 12.5 µm). There was also a significant difference in the BCVA variables and macular volume between case and control groups. The study suggests that the CST of diabetic patients with edema is higher than the control group, the increase in CST of diabetic patients with edema leads to worsening of BCVA and macular volume. Continuous ELM showed lower CST average, and the serous detachment showed higher CST average. Cirrus™ proved to be an important tool in the DME evaluation.