Foveal Center Point Thickness Research Articles

Foveal Microstructure and Visual Outcomes after Pars Plana Vitrectomy in Patients with Different Types of Epiretinal Membrane Foveoschisis

Introduction: The aim of this study was to evaluate the clinical characteristics and surgical outcomes of the epiretinal membrane foveoschisis (ERM-FS) with different morphological types. Methods: This retrospective observational study reviewed 44 consecutive ERM-FS patients who underwent ERM surgery. According to the optical coherence tomography images, ERM-FS was classified into three groups: group A, FS crossed the fovea with the foveola elevated; group B, FS located at the foveal edges with a near-normal central foveal point thickness; and group C, FS with undermined foveal edges with a near-normal central foveal point thickness. Results: There were 10 eyes in group A, 20 eyes in group B, and 14 eyes in group C. Preoperatively, eyes in group A had the best best-corrected visual acuity (BCVA), the thickest central foveal point thickness, and the highest ellipsoid zone (EZ) intact rate among the three groups. After surgery, a resolution of foveoschisis was observed in 40.0%, 45.0%, and 50.0% of the eyes in group A, group B, and group C (p = 0.928), respectively. BCVA was significantly improved postoperatively. Although there was no significant difference in BCVA among the three groups at 1 month postoperatively, BCVA of group A was the best at 4 and 10 months. Correlation analysis indicated that the type of ERM-FS, baseline BCVA, central foveal point thickness, and postoperative EZ continuity (all p < 0.05) were important factors for the final BCVA. Conclusions: The damage to the retinal structure and visual function was milder in group A ERM-FS. Our study emphasized the necessity of OCT-based subtyping in patients with ERM-FS.

Performance of retinal fluid monitoring in OCT imaging by automated deep learning versus human expert grading in neovascular AMD

PurposeTo evaluate the reliability of automated fluid detection in identifying retinal fluid activity in OCT scans of patients treated with anti-VEGF therapy for neovascular age-related macular degeneration by correlating human expert and automated measurements with central retinal subfield thickness (CSFT) and fluid volume values.MethodsWe utilized an automated deep learning approach to quantify macular fluid in SD-OCT volumes (Cirrus, Spectralis, Topcon) from patients of HAWK and HARRIER Studies. Three-dimensional volumes for IRF and SRF were measured at baseline and under therapy in the central millimeter and compared to fluid gradings, CSFT and foveal centerpoint thickness (CPT) values measured by the Vienna Reading Center.Results41.906 SD-OCT volume scans were included into the analysis. Concordance between human expert grading and automated algorithm performance reached AUC values of 0.93/0.85 for IRF and 0.87 for SRF in HARRIER/HAWK in the central millimeter. IRF volumes showed a moderate correlation with CSFT at baseline (HAWK: r = 0.54; HARRIER: r = 0.62) and weaker correlation under therapy (HAWK: r = 0.44; HARRIER: r = 0.34). SRF and CSFT correlations were low at baseline (HAWK: r = 0.29; HARRIER: r = 0.22) and under therapy (HAWK: r = 0.38; HARRIER: r = 0.45). The residual standard error (IRF: 75.90 µm; SRF: 95.26 µm) and marginal residual standard deviations (IRF: 46.35 µm; SRF: 44.19 µm) of fluid volume were high compared to the range of CSFT values.ConclusionDeep learning-based segmentation of retinal fluid performs reliably on OCT images. CSFT values are weak indicators for fluid activity in nAMD. Automated quantification of fluid types, highlight the potential of deep learning-based approaches to objectively monitor anti-VEGF therapy.

Morphological Characteristics of Foveal Pit Base and Its Impact on Visual Acuity in Macular Pseudoholes

Introduction: To investigate the characteristics of macular pseudoholes (MPHs) with different foveal profiles and their impact on preoperative and postoperative visual acuity (VA). Methods: A retrospective review of 47 eyes from 46 consecutive patients with MPH who had undergone vitrectomy was conducted. The MPHs were classified into u-shape and v-shape according to the morphological description of the foveola base. The best-corrected visual acuity (BCVA), central foveal point thickness, parafoveal thickness, parafoveal inner and outer retinal thickness, stretched lamellar cleavage, microcystic macular edema (MME), disorganization of retinal inner layers (DRIL), and the integrity of outer retinal layers were recorded. Results: The eyes in the v-shaped group (n = 31) had lower BCVA, thicker retinal thickness, more intraretinal cleavage, MME, and DRIL than the u-shaped (n = 16) group (all p < 0.05). Multiple regression analysis revealed that the morphology of the foveola base was significantly related to the preoperative BCVA (p = 0.025). The VA was significantly improved in both groups, and the improvement was greater in the v-shaped group (p = 0.024). No significant difference was found in the postoperative BCVA between the two groups (all p > 0.05). Conclusion: The v-shape, reflecting the stretch in the foveola, had a significant impact on preoperative BCVA. However, the VA was improved after surgery whatever their initial foveal profile.

Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center.

To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9-53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80-78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up (p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery (p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1-12 months) after the surgery. PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.

Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with macular edema secondary to uveitis.

To assess the correlation between disorganization of the retinal inner layers (DRIL) and best-corrected visual acuity (BCVA) in patients with uveitis and macular edema (UME) who underwent systemic treatment using optical coherence tomography (OCT). A retrospective clinical study of 23 patients (30 eyes) with DRIL and 23 patients (31 eyes) without DRIL secondary to UME were included. All patients underwent comprehensive ophthalmic examinations at baseline, 3, 6, and 12mo after local and systemic treatment. The OCT-based parameters included foveal center point thickness (FCPT), mean thickness (MT), and diameters of DRIL in horizontal and vertical directions. BCVA and OCT-based parameters were compared between the two groups. The relationship between each OCT parameter and BCVA was evaluated using linear correlation and regression analysis. At the initial visit, the mean baseline FCPT was 441.03±128.68 µm in the eyes with DRIL and 337.26±99.31 µm in the eyes without DRIL (P=0.001). No significant differences were observed in MT (P=0.357). The mean size of transverse and vertical diameters of DRIL was 684.07±267.51 and 267.07±104.61 µm at baseline, respectively. There was significant improvement in BCVA and OCT-based parameters at 3, 6, and 12mo in all cases (P<0.001 for each timepoint). In addition, significant differences were detected in BCVA and OCT parameters between eyes with and without DRIL at each time point (P<0.01 for each timepoint). A greater DRIL range at baseline was associated with a worse baseline BCVA (transverse diameter of DRIL: r=0.875, P<0.001; vertical diameter of DRIL: r=0.622, P<0.001). The transverse diameter of baseline DRIL was found to be significantly correlated with the final BCVA (P=0.003). The improvement in BCVA is associated with DRIL in patients with UME. DRIL is an easy-to-determine and robust imaging biomarker that could help predict BCVA prognosis in eyes with UME.

IDENTIFICATION OF FACTORS RELATED TO SUBFOVEAL DETACHMENT SECONDARY TO EPIRETINAL MEMBRANE.

To demonstrate factors related to the presence of subfoveal detachment (SD) secondary to epiretinal membrane (ERM) and to characterize the predictors for the resolution of SD after membrane peeling. A retrospective chart review was conducted for the patients who underwent pars plana vitrectomy for the idiopathic ERM peeling. Preoperative spectral domain optical coherence tomography characteristics of the eyes including central foveal thickness, foveal center point thickness, presence of intraretinal cyst, continuity of the membrane, area of the membrane within fovea (1 mm), and entire macula (6 mm) were evaluated to find the best predictors for the presence of SD. These predictors as well as perioperative parameters including use of internal tamponade and volume of SD were considered for time of resolution of SD. Of 158 included eyes, 20.2% eyes (32 eyes) had SD, and the presence of SD was significantly related to involvement of the membrane within the macula. After surgery, SD completely resolved in 90.6% of eyes (29 eyes) at a median of 2.97 months (range: 0.03-12.0 months). The area of the membrane within fovea was the only significant predictor for time to resolution of SD (hazard ratio = 1.20, 95% confidence interval = 1.100-1.324, P = 0.021). A small percent of eyes showed some further changes including fluctuation (6.2%) or persistence (3.1%) of fluid. A larger extension of ERM over the macula is related to higher likelihood of the presence of SD. Time for resolution of subfoveal detachment does not seem to be affected by the preoperative and perioperative factors except the extent of membrane within 1,000 μm of the fovea.

OUTER RETINAL LAYER THICKNESS AS GOOD VISUAL PREDICTOR IN PATIENTS WITH DIABETIC MACULAR EDEMA.

To evaluate the relationship between outer retinal layer (ORL) thickness in diabetic macular edema to visual acuity (VA). Ninety-five eyes were included in this prospective nonrandomized case-control study. They divided into 30 cases of healthy normal subjects and 65 cases of nonproliferative diabetic retinopathy with diabetic macular edema. Complete ophthalmic examination and spectral domain-optical coherence tomography were done for all cases and analyzed to measure central foveal point thickness (CFT), ORL thickness at fovea, and subfoveal choroidal thickness. The ORL thickness was significantly thinner in diabetic macular edema group (85.3 μm) than controls (99.9 μm) (P = 0.002). There was higher significant correlation between ORL thickness and logMAR VA (r = -0.87, P < 0.001) than correlation between CFT and VA (r = 0.18, P = 0.16). The cutoff point of the relationship between ORL thickness and VA was 88 μm with moderate sensitivity (81%) and high specificity (88%), below which vision is affected. Outer retinal layer thickness is significantly related to subfoveal choroidal thickness but not CFT. This study revealed reduction in ORL thickness in diabetic macular edema. There is a higher and stronger correlation between ORL thickness and vision than that between CFT and vision.

Foveal Avascular Zone and Vessel Density in Healthy Subjects: An Optical Coherence Tomography Angiography Study.

Purpose:To report the normal characteristics and correlations of the foveal microvascular networks using optical coherence tomography angiography (OCTA) in a healthy Iranian population.Methods:Enface 3x3 OCTA images were obtained using the RTVue Avanti spectral-domain optical coherence tomography with AngioVue software (Optovue, Fremont, CA, USA). Foveal avascular zone (FAZ) area, central foveal point thickness and inner retinal thickness at the foveal center and the vascular density of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in the fovea were recorded.Results:Seventy normal eyes of 70 subjects (range, 9 to 71 years) were studied. Mean FAZ area was 0.32 ± 0.11 (range, 0.13-0.67) mm2 in SCP and 0.50 ± 0.13 (range, 0.19-0.94) mm2 in DCP. Mean SCP vessel density was 29.6 ± 4.7 (range, 16.3-40.3) % in the fovea. Mean DCP vessel density was 27.0 ± 5.9 (range, 15.0-45.2) % in the fovea. The FAZ area at SCP level was negatively correlated to the central subfield thickness (P < 0.001). The FAZ area at DCP level correlated negatively to the central subfield thickness and was significantly associated to age (both P < 0.001). The foveal SCP vessel density significantly correlated with foveal thickness and the foveal DCP vessel density correlated significantly with central foveal subfield thickness and was inversely related to age (all P < 0.05).Conclusion:In this study, central foveal subfield thickness was a major determinant of the FAZ size and foveal vessel density. Age was a determinant for FAZ area and whole image vessel density in DCP.

INTEGRITY OF OUTER RETINAL LAYERS AFTER RESOLUTION OF CENTRAL INVOLVED DIABETIC MACULAR EDEMA.

To evaluate the integrity of outer retina layers after resolution of central involved diabetic macular edema (DME) and to demonstrate the effect of various baseline factors for the final vision and final external limiting membrane (ELM) integrity. Fifty-nine eyes of 48 patients with resolved DME were included. Several optical coherence tomography parameters including central subfield thickness, maximum foveal thickness, foveal center point thickness, and the extent of the ellipsoidal (ISe) layer and ELM damage were assessed at the time of DME and after resolution of DME. Eyes having laser scars near the fovea were excluded. Final visual acuity was classified as good (Snellen≥20/40, logarithm of the minimum angle of resolution ≤0.3) or impaired (Snellen <20/40, logarithm of the minimum angle of resolution >0.3) for the logistic regression analysis. Zero Inflated Poison Regression model was used to find the best predictors for post-treatment ELM damage. External limiting membrane and inner segment ellipsoidal band layers were disrupted in 16 eyes (27.2%) and 21 eyes (35.5%) at the final visit, respectively. Baseline ELM damage (p=0.001), baseline impaired vision (p= 0.013), and the most recent glycosylated hemoglobin level (p=0.018) were the best set of parameters for having impaired final visual acuity. Baseline vision, severity of diabetic retinopathy, absence of intravitreal injection, central subfield thickness, and history of extrafoveal macular laser (not within 1 mm of fovea) (p<0.001, for all parameters) were independent predictors for the final ELM damage. Outer retinal layers may be damaged even after complete resolution of DME, where inner segment ellipsoidal band layer damage appeared to be more common than ELM damage. Poorly controlled diabetic patients with damaged ELM and worse vision at the time of DME were more likely to have ELM damage and subsequent impaired vision after complete resolution of DME.

Longitudinal study of retinal status using optical coherence tomography after acute onset endophthalmitis following cataract surgery

PurposeTo analyse the macula imaged with optical coherence tomography (OCT) in patients treated for acute postcataract endophthalmitis.MethodsPatients presenting with acute postcataract endophthalmitis were included in this observational and multicentre study...

Functional and anatomic efficacy of a conversion to aflibercept in eyes with age-related macular degeneration after long-term ranibizumab treatment.

It was the aim of this retrospective study to analyse the functional and anatomic efficacy of a conversion from ranibizumab to aflibercept treatment in eyes with exsudative age-related macular degeneration (AMD) with recently unsatisfactory response to a ranibizumab treatment. 40 eyes of 37 patients (age: 80.6±7.7 years [mean±1 standard deviation (SD)] were included. The average visual acuity (VA) was 0.56±0.33 logMAR [mean±standard error (SE)] at the time of the first aflibercept injection. The eyes had received a mean of 21.5±11.7 (mean±SD) injections of ranibizumab within 3.15±1.79 (mean±SD) years. Follow-up covered 6 months in all patients. Before and after treatment and conversion of treatment, a PRN regimen with monthly visual acuity and OCT examinations was applied. After conversion to aflibercept the mean gain of VA was 0.45±1.26 lines at month 1 (mean±SE, p=0.04), 0.26±1.60 at months 3 (p=0.067), and 0.65±1.77 (p=0.03) at month 6. Total OCT central foveal point thickness decreased from 417±215 µm (mean±1 SD) before the first injection of aflibercept to 299±139 (p<0.001), 325±174 at month 3 (p<0.001), and 321±150 µm at month 6 (p<0.001). The average number of aflibercept injections was 4.0±1.1 (mean±SD). At the end of follow up 61% of eyes had gained ≥1 line, 22%≥2 lines, and 12%≥ 3 lines. 10% had lost ≥1 line, 5%≥2 lines, and 2%≥3 lines. The results of this case series show that conversion from ranibizumab to aflibercept can significantly reduce retinal thickness and improve visual acuity in patients with age-related macular degeneration with increasingly unsatisfactory response to long-term ranibizumab treatment.

Aqueous cytokines as predictors of macular edema in patients with diabetes following uncomplicated phacoemulsification cataract surgery.

This study aims to ascertain whether cytokines in the aqueous humor can predict macular edema (ME) in diabetic patients following uncomplicated phacoemulsification cataract surgery. Undiluted aqueous humor samples were obtained from 136 consecutive type 2 diabetic patients who underwent cataract surgery. The concentrations of 27 cytokines were measured in aqueous humor using the multiplex bead immunoassay. At the final follow-up examination, 116 patients completed 4 weeks of follow-up, and the incidence of macular edema was 29.31% (34 patients) 4 weeks after cataract surgery. Compared to the ME (−) patients, the concentrations of interleukin-1β (IL-1β) (P < 0.001), IL-6 (P < 0.001), IL-8 (P < 0.001), interferon-induced protein-10 (IP-10) (P = 0.003), monocyte chemotactic protein-1 (MCP-1) (P < 0.001), and vascular endothelial growth factor (VEGF) (P < 0.001) in the ME (+) patients were significantly higher. In addition, the aqueous levels of IL-1β (r = 0.288), IL-6 (r = 0.345), IL-8 (r = 0.256), IP-10 (r = 0.377), MCP-1 (r = 0.423), and VEGF (r = 0.279) were positively correlated with the postoperative foveal center point thickness (FCPT). However, the aqueous levels of IL-10 (P = 0.003) and IL-12 (P = 0.017) were significantly lower in patients with ME. These results suggest IL-1β, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, and VEGF may be potential predictors of postoperative macular thickness in patients with diabetes following uncomplicated phacoemulsification cataract surgery.

INTRAVITREAL RANIBIZUMAB FOR RETINAL VEIN OCCLUSION THROUGH 1 YEAR IN CLINICAL PRACTICE

To evaluate the efficacy and safety of intravitreal ranibizumab for branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in daily clinical practice. A prospective study enrolling all patients diagnosed with BRVO or CRVO who received intravitreal ranibizumab therapy at our department. Fifty-seven patients had BRVO and 49 had CRVO. By 12 months, the patients with BRVO improved a mean of 11.6 (P < 0.0001) ETDRS (Early Treatment Diabetic Retinopathy Study) letters, whereas the patients with CRVO improved a mean of 1.8 letters (P = 0.50). The proportion of patients gaining ≥ 15 ETDRS letters was 26.3% for BRVO and 16.7% for CRVO. The proportion of patients losing ≥ 15 ETDRS letters was 0% for BRVO and 8.3% for CRVO. The reduction in foveal center point thickness at 12 months was 248 μm for BRVO (P < 0.0001) and 222 μm for CRVO (P < 0.0001). Functional outcome did not mirror anatomical outcome, and younger patients had better outcome. Our 12-month results of BRVO treated with intravitreal ranibizumab in daily clinical practice are similar to the results of the BRAVO trial that led to the approval of the therapy. However, our results for CRVO failed to reproduce the results of the CRUISE trial.

CORRELATION OF OUTER RETINAL MICROSTUCTURE AND FOVEAL THICKNESS WITH VISUAL ACUITY AFTER PARS PLANA VITRECTOMY FOR COMPLICATIONS OF PROLIFERATIVE DIABETIC RETINOPATHY

To compare spectral domain optical coherence tomography (SDOCT)-measured macular thickness, outer retinal layers architecture, and best-corrected visual acuity (BCVA) in eyes with proliferative diabetic retinopathy after pars plana vitrectomy. In this retrospective case study, consecutive eyes operated by single surgeon were included. Retinal thickness was measured with SDOCT (Cirrus OCT; Carl Zeiss Meditec, Inc) as follows: automated central 1-mm subfield thickness (CFT), manually measured central foveal point thickness (CPT), integrity of external limiting membrane (ELM), and photoreceptor inner and outer segments (IS/OS). Three vitreoretinal-trained masked experts independently graded ELM and IS/OS layers. Of the 36 eyes included, 50% were those of women whose mean age was 49 years (range, 24-66 years). Mean preoperative BCVA was 20/600 (range, light perception to 20/80) and mean postoperative follow-up was 19 months (range, 4-43 months). Mean postoperative BCVA improved to 20/80 (range, counting fingers to 20/25; P < 0.0001) with mean SDOCT 1 mm CFT of 260 μm and manual CPT of 236 μm. Mean ELM integrity grade was 1.9 (range, 0-5), while the mean grade of IS/OS integrity was 2.2 (range, 0-5). The correlation coefficients (r) were 0.17 (P = 0.32) for logarithm of the minimum angle of resolution BCVA versus SDOCT automated CFT, 0.192 (P = 0.26) for BCVA versus SDOCT CPT, 0.52 (P = 0.012) for BCVA versus ELM, and 0.55 (P = 0.006) for BCVA versus IS/OS. SDOCT-measured CFT and CPT correlate weakly with BCVA, while ELM and IS/OS integrity correlates well with BCVA. Outer retinal microstructure may represent anatomically better level of postoperative visual function than retinal thickness after pars plana vitrectomy for complications of proliferative diabetic retinopathy.

Assessing the Reliability of Automated OCT Retinal Thickness Measurements in Patients With Choroidal Neovascularization Due to Age-Related Macular Degeneration

To compare automated versus manual retinal measurement using Stratus optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA) in patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Patients with subfoveal CNV due to AMD underwent Stratus OCT imaging. Each scan was evaluated for automated: foveal center point thickness, central subfield thickness, signal strength, and manual: central retinal thickness, central retinal/lesion thickness, CNV thickness, pigment epithelial detachment thickness, and number of correct retinal boundaries (CRBs). A total of 209 OCT visits (49 patients) were assessed. On fast macular thickness map, 52% of scans had less than 4 (of possible 6) CRBs placed by the automated OCT algorithm. There was a mean difference of 34 microm between automated foveal center point thickness and manual central retinal thickness (P < .00005). Only 40% and 27% of automated foveal center point thickness and central subfield, respectively, lay within +/- 25 microm of manual central retinal thickness. As the number of CRBs or signal strength increased, the difference between manual and automated measurements decreased. Manual retinal thickness measurements differ significantly from those calculated by the current automated Stratus OCT software in exudative AMD.

Retinal thickness measurement and evaluation of natural history of the diabetic macular edema through optical coherence tomography

1) Diagnose, through optical coherence tomography (OCT) exam, the occurrence of diabetic macular edema in patients with diabetic retinopathy and visual acuity of 20/40 or better, by measuring the foveal center point thickness, during one year. 2) Evaluate the edema natural history, during this period, associating the center point thickness with hemoglobin A1c and changes in visual acuity. 3) Correlate the obtained results with the control group. A prospective study was done, of a sample of 30 patients with diabetic macular edema and visual acuity of 20/40 or better. Measurements of the best corrected visual acuity, hemoglobin A1c level, biomicroscopy with 78-diopter lens, fluorescein angiogram and optical coherence tomography were made. The retinal thickness was selected as the main variable. Besides descriptive statistics, additional tests were applied to analyze the results and determine the correlation between these variables, such as t-Student, Chi-Square, Tukey and ANOVA. The relation of optical coherence tomography with visual acuity and hemoglobin A1c was studied through linear regression. It was found that there is no significant difference between patients and normal individuals, for the variables age and gender. The values of center point thickness found for men were greater than those for women, showing the influence of gender on that thickness. As many as 83.33% of the diabetic patients with clinically significant macular edema presented moderate non-proliferative diabetic retinopathy (NPDR), 10% presented mild NPDR and 6.66% severe non-proliferative diabetic retinopathy. Patients under combined treatment of insulin and oral hypoglycemiant presented influence on the results of center point thickness (through OCT) and visual acuity. The mean duration of diabetes was 9.63 years. Values of center point thickness were always found greater for patients than those for normal eyes. Levels of hemoglobin A1c did not have influence on the center point thickness data, whereas values of visual acuity were significantly correlated with it. This study presents the optical coherence tomography applicability in the detection and semiologic evaluation of diabetic macular edema in patients with visual acuity 20/40 or greater, during one year, showing the retinal thickening in the early stages of diabetic retinopathy. Further, it evidenced the correlation between the increase in foveal thickness and the reduction in visual acuity. Levels of hemoglobin A1c did not influence the center point thickness data. An early detection of clinically significant macular edema leads us to a redefinition of the real meaning of incipient retinopathy and can prevent further significant reduction of vision.

Duration of action of intravitreal ranibizumab and bevacizumab in exudative AMD eyes based on macular volume measurements

Background/aims:Sequential macular volume and central foveal point thickness (CFPT) measurements on optical coherence tomography (OCT) were used to determine the efficacy and duration of action of ranibizumab versus bevacizumab in...

Evaluation of Optical Coherence Tomography Retinal Thickness Parameters for Use in Clinical Trials for Neovascular Age-Related Macular Degeneration

To investigate the relationship between automated and manually derived measurements of central retinal thickness from optical coherence tomography (OCT) and to determine the relationship between the foveal center point (FCP) and the foveal central subfield (FCS) in neovascular age-related macular degeneration (AMD). Data were collected from 216 patients with newly diagnosed neovascular AMD, who underwent StratusOCT imaging at diagnosis. Raw StratusOCT images for each patient were analyzed with the publicly available custom software OCTOR, which allows accurate manual grading of OCT B-scans. Manually derived central retinal thickness measurements were compared with measurements obtained from automated StratusOCT analysis. Manually obtained measurements of FCP and FCS were also compared. The mean (+/-SD) difference in thickness between automated and manually derived FCP thickness was 7.9 microm (+/-90.8), but the maximum difference was 455 microm. The limits of agreement (95% confidence interval), between automated and manually obtained FCP thicknesses, were -173.7 microm (lower limit) and 189.6 microm (upper limit), with a coefficient of determination (R(2)) of 0.49 (P < 0.001). In contrast, the R(2) for manually derived FCP and manually derived FCS thickness was 0.94 (P < 0.001), with a smaller mean (+/-SD) difference in thickness of 13.8 microm (+/-29.8). Manual correction of errors in automated OCT segmentation may be necessary for accurate interpretation of anatomic outcomes for clinical trials of neovascular AMD. In addition, although measurement of FCS remains preferable for assessment of central retinal thickness, accurate measurement of FCP may represent an adequate alternative when FCS is unavailable.

Optical Coherence Tomography Findings for Nanophthalmic Eyes

To describe the optical coherence tomography (OCT) findings for nanophthalmic eyes. : In this retrospective, single-center, observational case series, 15 patients (28 eyes) with axial lengths of <or=20.5 mm were included. Ultrasonography (A- and B-scans), keratometry, and OCT were performed. The main outcome measures were average foveal thickness, foveal center point thickness, total macular volume, and a new quantitative measure of foveal depression, relative foveal depression (RFD). Reference values for RFD were obtained by examining 57 healthy eyes with axial lengths of 21.5 mm to 27 mm. The foveae of nanophthalmic eyes had diminished foveal depression due to thickened outer retinal layers. One patient with papillomacular folds was identified as having posterior microphthalmos. There was a good correlation between axial length on one hand and foveal thickness, foveal center point thickness, macula volume, and RFD on the other hand (r = -0.58, -0.61, -0.56, and -0.70 with P = 0.003, 0.001, 0.004, and 0.000, respectively). The average RFD for eyes with normal axial lengths was 0.43. OCT findings for nanophthalmic eyes with foveal underdevelopment are different from posterior microphthalmos and foveal hypoplasia seen in other disorders. The new measure RFD is a useful tool in ocular tomography.

Reproducibility of Quantitative Optical Coherence Tomography Subanalysis in Neovascular Age-Related Macular Degeneration

To determine the intergrader reproducibility for computer-assisted grading of optical coherence tomography (OCT) images in eyes with neovascular age-related macular degeneration (AMD), by using a standardized grading procedure. Sixty OCT image sets (of six radial lines each) were independently analyzed by two graders using validated custom software (OCTOR) to draw boundaries manually on OCT B-scans. Spaces delineated by these boundaries included retina, subretinal fluid, subretinal tissue, and pigment epithelial detachments (PEDs). Volume measurements for the nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields and the mean foveal center point (FCP) thickness were calculated by the software and compared by using weighted kappa statistics and intraclass correlation coefficients (ICCs). Intergrader comparison of the foveal central subfield (FCS) volume, total volume, and mean FCP thickness showed a high level of agreement and strong correlation between measurements for all spaces (kappa(weighted) = 0.72-0.97; ICC = 0.92-0.99). The best agreement was observed for total volume of the combination of all four graded spaces (kappa(weighted) = 0.97, mean difference = 0.31 mm(3), or 2.51%). The highest ICCs were seen for FCP thickness measurements. The poorest agreement was found for grading of subretinal tissue. Eyes with advanced choroidal neovascularization (CNV) and poor visibility of the retinal pigment epithelium (RPE) band appeared to show the greatest intergrader discrepancies. Analysis of OCT images by trained graders using computer-assisted grading software allows for highly reproducible quantitative measurements, even in eyes with complex diseases such as neovascular AMD. Quantitative subanalysis may be useful in studying the differential morphologic effect of therapies on various anatomic components.