Macular Disorders Research Articles

A study of optic nerve head drusen in 38 pseudoxanthoma elasticum (PXE) patients (64 eyes). Location of optic nerve head drusen in PXE

To investigate the prevalence and location of optic nerve head drusen and their potential association with other PXE-related ophthalmic abnormalities. Thirty-eight of the 155 patients (57 male and 98 female aged 49±17 years) included in this retrospective study had optic nerve head drusen. All of the patients underwent a comprehensive ophthalmic examination, including color images using red-free, blue and red filters, autofluorescence imaging and late-phase ICG frames. Comparative analysis of both groups (optic nerve head drusen or not) was conducted using R statistical software. The prevalence of optic nerve head drusen in our cohort was 24.5%. In this study, no evidence of a significant link between optic nerve head drusen and other fundus abnormalities was detected. They were more commonly located in the nasal sector than in the temporal sector of the optic disc (P<0.001). They were more frequently situated superonasally than inferonasally (P<0.004), superotemporally (P<0.001) or inferotemporally (P<0.03). No central visual field defect was observed in OND+ patients who were unaffected by macular disorders. We hypothesized this predominantly nasal primary location may result from greater sensitivity in the nasal optic nerve fibers which follow a much more angular path once they arrive in the scleral canal, accounting for accumulation of axoplasmic debris. In PXE, optic nerve head drusen are mostly located in the superonasal quadrant, causing progressive optic nerve invasion but probably no central visual field defects.

Impact of segmentation density on spectral domain optical coherence tomography assessment in Stargardt disease.

Automated spectral domain optical coherence tomography (SD-OCT) segmentation algorithms currently do not perform well in segmenting individual intraretinal layers in eyes with Stargardt disease (STGD). We compared selective B-scan segmentation strategies for generating mean retinal layer thickness and preserved area data from SD-OCT scans in patients with STGD1. Forty-five eyes from 40 Stargardt patients were randomly selected from the ongoing Natural History of the Progression of Atrophy Secondary to Stargardt Disease (ProgStar) study. All eyes underwent SD-OCT using a standard macular volume consisting of 1024 × 49 equally spaced B-scans within a 20 × 20 degree field centered on the fovea. All 49 B-scans were segmented manually to quantify total retina, outer nuclear layer (ONL), photoreceptor inner segments, photoreceptor outer segments (OS), and retinal pigment epithelial layer (RPE). Mean thickness and total area were generated using all 49 B-scans (spaced 122μm apart), 25 B-scans (every other B-scan, spaced 240μm apart), 17 B-scans (every third scan, 353μm apart), and 13 B-scans (every fourth scan, 462μm apart), as well as by using an "adaptive" method where a subset (minimum 25 B-scans) of B-scans that the grader deemed as significantly different from adjacent B-scans were utilized. Mean absolute and percentage errors were calculated for macular thickness and area of different retinal layers for the different B-scan subset selection strategies relative to using all 49 B-scans, which was considered the reference or ground truth. Mean thickness and area measurements were significantly different for any regularly spaced reduction in B-scan density relative to the ground truth. When an adaptive approach was applied using a minimum of half the scans, the differences relative to ground truth were no longer significantly different. The mean percent differences for the area and thicknesses of the various layers ranged from 0.02 to 33.66 (p < 0.05 for all comparisons) and 0.44 to 7.24 (p > 0.05) respectively. Manual segmentation of a subset of B-scans using an adaptive strategy can yield thickness and area measurements of retinal sublayers comparable to the reference ground truth derived from using all B-scans in the volume. These results may have implications for increasing the efficiency of SD-OCT grading strategies in clinical trials for STGD and other related macular degenerative disorders.

Convolutional Mixture of Experts Model: A Comparative Study on Automatic Macular Diagnosis in Retinal Optical Coherence Tomography Imaging.

Background:Macular disorders, such as diabetic macular edema (DME) and age-related macular degeneration (AMD) are among the major ocular diseases. Having one of these diseases can lead to vision impairments or even permanent blindness in a not-so-long time span. So, the early diagnosis of these diseases are the main goals for researchers in the field.Methods:This study is designed in order to present a comparative analysis on the recent convolutional mixture of experts (CMoE) models for distinguishing normal macular OCT from DME and AMD. For this purpose, we considered three recent CMoE models called Mixture ensemble of convolutional neural networks (ME-CNN), Multi-scale Convolutional Mixture of Experts (MCME), and Wavelet-based Convolutional Mixture of Experts (WCME) models. For this research study, the models were evaluated on a database of three different macular OCT sets. Two first OCT sets were acquired by Heidelberg imaging systems consisting of 148 and 45 subjects respectively and set3 was constituted of 384 Bioptigen OCT acquisitions. To provide better performance insight into the CMoE ensembles, we extensively analyzed the models based on the 5-fold cross-validation method and various classification measures such as precision and average area under the ROC curve (AUC).Results:Experimental evaluations showed that the MCME and WCME outperformed the ME-CNN model and presented overall precisions of 98.14% and 96.06% for aligned OCTs respectively. For non-aligned retinal OCTs, these values were 93.95% and 95.56%.Conclusion:Based on the comparative analysis, although the MCME model outperformed the other CMoE models in the analysis of aligned retinal OCTs, the WCME offers a robust model for diagnosis of non-aligned retinal OCTs. This allows having a fast and robust computer-aided system in macular OCT imaging which does not rely on the routine computerized processes such as denoising, segmentation of retinal layers, and also retinal layers alignment.

Study of rise of intraocular pressure and effect on visual outcome in patients receiving intravitreal triamcinolone acetonide in macular disorders

Study of rise of intraocular pressure and effect on visual outcome in patients receiving intravitreal triamcinolone acetonide in macular disorders

The Relation Between Age Related Macular Degeneration and Thyroid Disorders

The Purpose of the study was to evaluate the association between thyroid -stimulating hormone (TSH), free tri-iodothyronine (T3), free thyroxine (T4), hypothyroidism, hyperthyroidism and age related macular degeneration (ARMD) incidence. Nine hundred and fifty patients with thyroid disorders versus five hundred and thirty eu-thyroid subjects were included in the study during the period from January 2014 to February 2019. Blood pressure, blood sugar level and cholesterol, smoking state were estimated. TSH, T3&T4 were measured. Retinal photography and optical coherence tomography were performed. Patients with hyperthyroidism had increased incidence of ARMD. Patients using thyroxine had also increased incidence of ARMD than non using of thyroxine. There were statistically higher significant percent of marriage, educational level and smoking in patients with thyroid disorders with ARMD than euthyroid (p=0.03. 0.06, 0.001 respectively). In thyroid disorders patients, there were a significant differences between patients had ARMD or had not as regard diabetes, hypertension and cholesterol level (p=0.04, 0.09, 0.03 respectively). We concluded that there were increased incidence of ARMD in both hyperthyroidism, and patients use the thyroxine.

The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes.

Subthreshold micropulse laser (SMPL) has been increasingly used for the treatment of different retinal and choroidal macular disorders. However, the exact mechanisms of action have not yet been clearly defined. Therefore, we aimed to examine the role of SMPL treatment in the modulation of oxidant/antioxidant systems, apoptosis and autophagy in the mice eyes. A specific laser contact lens for retina was positioned on the cornea of 40 mice (20 young and 20 old) in order to focus the laser on the eye fundus for SMPL treatment. Within 6months, 20 animals received one treatment only, whereas the others were treated three times. Eye specimens underwent histological analysis and were used for thiobarbituric acid reactive substances (TBARS) and glutathione (GSH) quantification, as well as for the superoxide dismutase 1 (SOD1) and the selenoprotein thioredoxin reductase 1 (TrxR1) expression evaluation. Western blot was performed for nitric oxide synthase (NOS) subtypes detection and to examine changes in apoptotic/autophagy proteins expression. SMPL treatment reduced TBARS and increased GSH and SOD1 in the mice eyes. It also reduced cytochrome c, caspase 3 expression and activity and cleaved caspase 9, and increased Beclin 1, p62 and LC3β. The effects were more relevant in the elderly animals. Our results showed that SMPL therapy restored the oxidant/antioxidant balance within retinal layers and modulated programmed forms of cell death. Further studies may confirm these data and could evaluate their relevance in clinical practice.

An allosteric mechanism of inactivation in the calcium-dependent chloride channel BEST1.

Bestrophin proteins are calcium (Ca2+)-activated chloride channels. Mutations in bestrophin 1 (BEST1) cause macular degenerative disorders. Whole-cell recordings show that ionic currents through BEST1 run down over time, but it is unclear whether this behavior is intrinsic to the channel or the result of cellular factors. Here, using planar lipid bilayer recordings of purified BEST1, we show that current rundown is an inherent property of the channel that can now be characterized as inactivation. Inactivation depends on the cytosolic concentration of Ca2+, such that higher concentrations stimulate inactivation. We identify a C-terminal inactivation peptide that is necessary for inactivation and dynamically interacts with a receptor site on the channel. Alterations of the peptide or its receptor dramatically reduce inactivation. Unlike inactivation peptides of voltage-gated channels that bind within the ion pore, the receptor for the inactivation peptide is on the cytosolic surface of the channel and separated from the pore. Biochemical, structural, and electrophysiological analyses indicate that binding of the peptide to its receptor promotes inactivation, whereas dissociation prevents it. Using additional mutational studies we find that the "neck" constriction of the pore, which we have previously shown to act as the Ca2+-dependent activation gate, also functions as the inactivation gate. Our results indicate that unlike a ball-and-chain inactivation mechanism involving physical occlusion of the pore, inactivation in BEST1 occurs through an allosteric mechanism wherein binding of a peptide to a surface-exposed receptor controls a structurally distant gate.

Macular dysfunction in patients with macula-on rhegmatogenous retinal detachments

AimsTo assess macular function in patients with macula-on rhegmatogenous retinal detachments (RRDs) using focal macular electroretinography (FMERG).MethodsThis is a prospective, observational case series of 27 patients diagnosed with a macula-on...

Why does vitreoretinal traction create macular oedema?

A 65-year-old taxi driver was referred due to blurry vision in the right eye of two-day duration and described his symptoms as if he was ‘looking through ice’. There were no other symptoms. Visual acuity (VA) was 0.7 in the right eye and 0.8 in the left eye. Slit lamp examination revealed macular oedema in the right eye (Fig. 1). Optical coherent tomography (OCT, Topcon 3D OCT-2000 FA plus) revealed vitreomacular traction (VMT) and macular oedema involving the inner layers of the retina in the right eye. In the left eye, a partial posterior vitreous detachment (PVD) was seen, without VMT (Fig. 1). A diagnosis of VMT syndrome, due to incomplete PVD, was entertained. The patient was advised of the situation and did not receive any treatment. A follow-up appointment was scheduled few weeks later. Before that appointment, he came to the clinic complaining of floaters in the right eye. On examination, the vision was 1.0 in both eyes, a Weiss ring was visible on biomicroscopy in the vitreous cavity of the right eye and there were no signs of maculopathy. Optical coherent tomography (OCT) imaging was normal, except for minimal shadows on the image due to vitreous floaters. He was diagnosed with complete PVD. Vitreomacular traction is caused by an incomplete PVD where the vitreous remains attached to the posterior retina, exerting traction on the macula. The traction causes retinal distortion and can cause various macular disorders, including cystoid macular oedema, macular hole and epiretinal membrane (Duker et al. 2013). In our case, the initial OCT image showed clear vitreous traction on the central macular area resulting in distortion and macular oedema. No epiretinal membrane was noted. The distortion is easy to understand, but what is the mechanism that translates mechanical traction into tissue oedema? Newton's third law states: ‘To every action there is always opposed an equal reaction’ (Newton 1726), which in current terminology means that for every force, there is a counter-force acting in the opposite direction. The force exerted by the vitreous gel pulls anteriorly on the retina, and this is met by an equal force in the retina pulling posteriorly towards the back of the eye. The opposite pulling forces lower the hydrostatic pressure in the tissue between the forces (Fig. 2). Starling's law describes the formation of oedema in tissues. It states that fluid transport between tissue and blood vessels is controlled by hydrostatic and osmotic forces. The hydrostatic pressure difference (created by the heart) between blood vessels and tissue drives water down a pressure gradient into the interstitial space. The osmotic pressure difference pulls water from tissue into blood vessels due to high osmotic activity of the macromolecules in blood. In normal conditions, the hydrostatic and osmotic pressure differences between tissue and blood vessels are equal and opposite and no net transport of water takes place; oedema is neither formed nor reduced (Hall & Guyton 2011). This steady state is upset by the VMT. The traction reduces the hydrostatic pressure in the retina, thus increasing the pressure difference between blood vessel and retinal tissue. Water flows down this pressure gradient and accumulates in the tissue as oedema. Water accumulation lowers the osmotic pressure in the interstitial space and increases the osmotic pressure difference, until a new equilibrium is established between the hydrostatic and osmotic pressure differences. At this time, the net transport of water again is zero and the tissue reaches a steady state – with macular oedema (Stefánsson 2009). Vitreomacular traction (VMT) with macular oedema can be managed conservatively as spontaneous resolution occurs in some cases. When the VMT is persistent, it is usually treated surgically with pars plana vitrectomy, but pharmacological vitreolysis with ocriplasmin and pneumatic release with intravitreal gas have also shown to be effective (Jackson et al. 2013). Surgical, spontaneous, pneumatic or enzymatic release of the VMT reverses the situation described above. Hydrostatic pressure in the retina increases back to normal, water flows back into the blood vessels, and the macular oedema disappears.

Complications and Safety Profile of Posterior SubTenon Injection of Triamcinolone Acetonide

Purpose: Posterior Sub-Tenon injection (PSTI) is a common route of drug delivery for triamcinolone acetonide (TA) for intraocular inflammation. The aim of this study was to evaluate indications, complications and safety of PSTI of TA for intraocular inflammation. Method: This is a retrospective study. The duration of study was from October 2007 to December 2016. The patients with minimum 1 year after PSTI of TA follow-up were included in the study. All complications of injection procedure and drug itself were included. Patients with pre-existing lenticular opacity, glaucoma, blepharoptosis, traumatic macular edema, subconjunctival hemorrhage, traumatic uveitis, postoperative uveitis, and retinal vascular occlusive disorder were excluded from the study. Results: A total of 112 eyes of 110 patients who were treated with PSTI of TA were included in the study group. The mean age was 50±8.4 years. Out of 110 patients, 80 (72.72%) were females and 30 (27.27%) males. The recurrent anterior uveitis was the most common indication (44.64%). Out of 112 eyes, 100 eyes (89.28%) were injected once, 10 eyes (8.92%) twice, and 2 eyes (1.78%) thrice. Following PSTI of TA, 14 eyes (12.5%) developed ocular hypertension 6 eyes (5.35%) ptosis, and 3 eyes (2.67%) cataract. Conclusion: PSTI of TA has higher risk of steroid-induced glaucoma; hence these patients should be monitored for intraocular pressure.

Macular assessment of preoperative optical coherence tomography in ageing Chinese undergoing routine cataract surgery

This retrospective consecutive case series aimed to evaluate spectral-domain optical coherence tomography (SD-OCT) for occult macular disease recognition preoperatively in patients scheduled for routine cataract surgery. All patients scheduled for cataract surgery underwent macular SD-OCT. Scans were reviewed for retinal, retinal pigment epithelium and vitreomacular interface abnormalities. For the subgroup analysis, the following information was collected: age; sex; and diabetes, hypertension, myopia, glaucoma, post intra-ocular surgery, endophotocoagulation, retinal vasculopathy and uveitis statuses. One-thousand-one-hundred-seventy-six consecutive scans were acquired from 1,176 patients. Macular pathology was found in 294 eyes. The most common macular disorders were an epiretinal membrane (n = 130), myopia atrophy (n = 61) and a dome-shaped macular with pathologic myopia (n = 32). One-hundred-thirty eyes (11.05%) presented macular epiretinal membranes not detected by dilated fundus examination, accounting for 44.22% of the abnormalities in diseased eyes and was higher than in previous Chinese studies. Some had multiple macular disorders. The most common ocular history was myopia, including high myopia. The pooled prevalence rate of macular diseases detected by OCT was 0.24 (95% CI 0.14–0.34) using meta-analysis. SD-OCT should be performed for routine cataract surgery patients to evaluate visual outcomes, especially in myopic patients and those considering advanced-technology intraocular lenses.

Pachychoroid disease of the macula

Progress in optical coherent tomography (OCT) has recently provided new insights into variety of chorioretinal disorders. The use of EDI (Enhanced Depth Imaging) during OCT examinations and as well as OCT angiography provides a more accurate analysis of the choroid both quantitatively and qualitatively. "Pachychoroid" (greek pachy- [παχύ] - thick) is defined as an abnormal and sustained increase in choroidal thickness 300 μm, which is mainly due to dilated choroidal vessels in the Hallers layer and other structural changes in physiological choroidal architecture. Central serous chorioretinopathy is one of many macular diseases associated with "pachychoroid". Another diseases that belong to the group of macular pachychoroid disorders are: pachychoroid pigment epitelopathy, pachychoroid neovasculopathy, polypoid choroidal vasculopathy. In this paper we summarize the current view on pachychoroid macular diseases and describe characteristics that are observed in multimodal imaging analysis of choroidal changes. Key words: optical koherence tomography, OCT, pachychoroid, EDI scan.

Segmentation of Intra-Retinal Cysts From Optical Coherence Tomography Images Using a Fully Convolutional Neural Network Model.

Optical coherence tomography (OCT) is an imaging modality that is used extensively for ophthalmic diagnosis, near-histological visualization, and quantification of retinal abnormalities such as cysts, exudates, retinal layer disorganization, etc. Intra-retinal cysts (IRCs) occur in several macular disorders such as, diabetic macular edema, retinal vascular disorders, age-related macular degeneration, and inflammatory disorders. Automated segmentation of IRCs poses challenges owing to variations in the acquisition system scan intensities, speckle noise, and imaging artifacts. Several segmentation methods have been proposed in the literature for IRC segmentation on vendor-specific OCT images that lack generalizability across imaging systems. In this paper, we propose a fully convolutional network (FCN) model for vendor-independent IRC segmentation. The proposed method counteracts image noise variabilities and trains FCN models on OCT sub-images from the OPTIMA cyst segmentation challenge dataset (with four different vendor-specific images, namely, Cirrus, Nidek, Spectralis, and Topcon). Further, optimal data augmentation and model hyperparametrization are shown to prevent over-fitting for IRC area segmentation. The proposed method is evaluated on the test dataset with a recall/precision rate of 0.66/0.79 across imaging vendors. The Dice correlation coefficient of the proposed method outperforms that of the published algorithms in the OPTIMA cyst segmentation challenge with a Dice rate of 0.71 across the vendors.

Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade.

Epiretinal membranes (ERM) are macular disorders leading to loss of vision and metamorphopsia. Vitrectomy with membrane peeling displays the gold standard of care. Aim of this study was to assess risk factors for postoperative intraretinal cystoid changes in a study population randomized for balanced salt solution and air-tamponade at the end of surgery. A prospective randomized study, including 69 eyes with idiopathic ERM. Standard 23-gauge three-port pars plana vitrectomy with membrane peeling, using intraoperative optical coherence tomography (OCT), was performed. Randomization for BSS and air-tamponade was performed prior to surgery. Best-corrected visual acuity improved from 32.9 letters to 45.1 letters 3months after surgery. Presence of preoperative intraretinal cystoid changes was found to be the only risk factor for presence of postoperative intraretinal cystoid changes 3months after surgery (p=0.01; odds ratio: 8.0). Other possible risk factors such as combined phacoemulsification with 23G-ppv and membrane peeling (p=0.16; odds ratio: 2.4), intraoperative subfoveal hyporeflective zones (p=0.23; odds ratio: 2.6), age over 70years (p=0.29; odds ratio: 0.5) and air-tamponade (p=0.59; odds ratio: 1.5) were not found to be significant. There is strong evidence that preoperative intraretinal cystoid changes lead to smaller benefit from surgery.

Application of remote screening system for diabetic retinopathy in Beijing Desheng Community

Objective To develop a remote diabetic retinopathy (DR) screening system and to evaluate the effectiveness of the screening system in community. Methods A cross-sectional study was carried out under the informed consent of subjects in Peking University People's Hospital and Beijing Xicheng District Desheng Community Health Service Center from June 2015 to December 2016.A remote DR screening system was established in Peking University People's Hospital and Beijing Xicheng District Desheng Community Health Service Center during June 2015 to December 2016.Based on non-mydriatic digital eye fundus camera photography and the internet transmission technology, anterior ocular segment and fundus images of 2 473 eyes from 1 355 community subjects with type 2 diabetes mellitus were transmitted from Beijing Xicheng District Desheng Community Health Service Center to the reading center of Peking University People's Hospital, and the results were provided to the subjects after analysis, including visual examination, diagnosis and follow-up rate of the subjects, the agreement between remote screening system and conventional screening method was analyzed and compared. Results The visual acuities of the 2 473 eyes of 1 355 subjects were obtained by trained community physician, and the visual acuity was ≤0.05 in 103 eyes (4.2%), >0.05-0.3 in 780 eyes (31.5%), >0.3 in 1 590 eyes (64.3%). A good consistency was found in the diagnosis and grading of DR (Kappa value=0.895) and in diagnosis of macular disorder (Kappa value=0.763) between the remote screening system and conventional screening method.In addition, the diagnosis results of retinal photocoagulation were consistent between the two methods (Kappa value=1.000). The mean duration of the remote screening system for one subject was 10 minutes, which was shorter than 23 minutes of conventional screening method.The follow-up rate of remote screening system was 75.2%. Conclusions There is a high consistency in the DR diagnosis and evaluation between the remote non-mydriatic screening system and conventional screening method.The screening program with follow-up requests has a satisfying follow-up rate, which could meet the demand of DR screening. Key words: Diabetic retinopathy/diagnosis; Mass screening; Health care services accessibility; Telemedicine; Cross-sectional studies

Fundus Images-Based Detection and Grading of Macular Edema Using Robust Macula Localization

The macula is an oval-shaped area near the center of the human retina, and at its center, there is a small pit known as the fovea. The fovea contains large concentrations of cone cells and is responsible for sharp, colored vision. Macular disorders are the group of diseases that damage the macula, resulting in blurred vision or even blindness. Macular edema (ME), one of the most common types of macular disorder, is caused by fluid accumulation beneath the macula. In this paper, we present an automated system for the detection of ME from fundus images. We introduce a new automated system for the detailed grading of the severity of disease using knowledge of exudates and maculae. A new set of features is used along with a minimum distance classifier for accurate localization of the fovea, which is important for the grading of ME. The proposed system uses different hybrid features and support vector machines for segmentation of exudates. The detailed grading of ME—as both clinically significant ME and non-clinically significant ME—is done using localized foveae and segmented exudates. The proposed algorithm is validated using public and local data sets. We have achieved an average accuracy of 96.1% in the detection and grading of ME with our proposed method.

Режимы применения антиангиогенной терапии для лечения заболеваний макулы в офтальмологии. Обзор литературы

Режимы применения антиангиогенной терапии для лечения заболеваний макулы в офтальмологии. Обзор литературы

Optical coherence tomography in neurophthalmology

Optical coherence tomography (OCT), widely used in the management of macular disorders and glaucoma, has proved its usefulness in many neurophthalmic disorders. OCT can quantify the retinal nerve fiber layer thickness and ganglion cell layer thickness and provides an idea about the neuronal integrity of the anterior visual pathway, which cannot be picked up by routine fundoscopy. Here, we are discussing some neurophthalmic and neurologic diseases where OCT can contribute to the diagnosis, disease monitoring and can provide prognostic information.

Current management strategy of polypoidal choroidal vasculopathy.

Polypoidal choroidal vasculopathy (PCV) is a retinal disorder commonly found in Asians presenting as neovascular age-related macular degeneration and is characterized by serous macular detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage, and occasionally visible orange-red subretinal nodular lesions. PCV is diagnosed using indocyanine green angiography (ICGA), and the lesions appear as polypoidal aneurysmal vascular lesions with or without abnormal branching vascular network. Although ICGA remains the gold standard for the diagnosis of PCV, various imaging modalities have also facilitated the diagnosis and monitoring of PCV. Recent advances in imaging technology including the use of high resolution spectral domain optical coherence tomography (OCT) and OCT angiography have provided new insights on the pathogenesis of PCV, suggesting a link between PCV and pachychoroid spectrum of macular disorders. With the evolving understanding on the pathogenesis and clinical characteristics of PCV, different therapeutic options have been proposed. These include intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy, combination therapy with anti-VEGF and verteporfin photodynamic therapy, and thermal laser photocoagulation. In recent years, major multi-center randomized clinical trials such as EVEREST, EVEREST II, and PLANET studies have been conducted to compare the efficacy and safety of various treatment options for PCV. This review aims to summarize the results of recent literature, clinical trials and studies to provide an update on the management options of PCV. An overall management strategy for PCV will also be proposed.

OCT Based Macular Thickness in a Normal Indian Pediatric Population.

Purpose:Cirrus optical coherence tomography (OCT) provides high resolution cross-sectional images of the retina, vitreous humor, and optic nerve head with an axial resolution of 5 μm and a reproducibility of 1.6 μm. An integrated normative database is available only for adult subjects ≥18 years of age; the normal reference ranges of the macular thicknesses of pediatric subjects are not available. The purpose of this study was to determine the normal reference range of macular thickness of pediatric.Methods:A total of 340 eyes of 170 children 5-17 years of age were recruited for this study. Participants received a full ophthalmic examination including a vision assessment, cycloplegic refraction, fundus examination, intraocular pressure measurement, assessment of ocular motility, and alignment. Macular thickness measurements were obtained through dilated pupils using Cirrus HD-OCT.Results:The mean macular thickness was 114.88 ± 14.74 in the right eye and 113.99 ± 15.62 in the left eye (P = 0.589). On further evaluation, macular thickness was highest in the inner macula, followed by the outer macula and central fovea (P < 0.001).Conclusion:The normative data of macular thickness in pediatric subjects 5-17 years of age will help diagnose macular disorders.