Mean Foveal Retinal Thickness Research Articles

Intravitreal aflibercept versus photodynamic therapy in Chinese patients with neovascular age-related macular degeneration: outcomes of the SIGHT study

Objective To assess the efficacy and safety of intravitreal aflibercept injection (IAI) compared with photodynamic therapy (PDT) in the treatment of Chinese patients with predominantly classic subfoveal choroidal neovascularization (CNV) lesions secondary to neovascular age-related macular degeneration (nAMD). Methods A randomized, double-blind, multi-center phase-3 clinical trial lasting for 52 weeks (from December 2011 to August 2014). Subjects were randomized in a 3:1 ratio to either IAI group or PDT-to-IAI group. Subjects in the IAI group received 2 mg IAI at baseline and at week 4, 8, 16, 24, 32, 40, 48, with sham injection at week 28, 36. Subjects in the PDT-to-IAI group were forced to receive PDT once at baseline and more time at week 12, 24 if PDT retreatment conditions were met. Sham injections were given in PDT-to-IAI group at baseline and at week 4, 8, 16 and 24, followed by 2 mg IAI at week 28, 32, 36, 40, 48. The primary outcome of efficacy were the change in mean Best Corrected Visual Acuity (BCVA) from baseline to week 28, and that of week 52. Safety evaluation included the percentage of subjects who suffered treatment emergent adverse events (TEAEs). Results Among the 304 subjects enrolled, there were 228 and 76 cases in IAI group and PDT-to-IAI group respectively. At week 28, the changes of mean BCVA in IAI group, PDT-to- IAI group compared to baseline were +14.0, +3.9 letters, respectively. At week 52, the changes of mean BCVA in two groups were +15.2, +8.9 letters respectively with the difference of +6.2 letters (95%CI 2.6−9.9, P=0.000 9). At week 52, the mean foveal retinal thickness in the two groups decreased by −189.6, −170.0 μm, respectively. Subjects with the most BCVA increase in IAI group were those aged <65, and those with active CNV lesion area <50% of total lesion area. The most common TEAEs in IAI group and PDT-to-IAI group are macular fibrosis [11.8% (27/228), 6.6% (5/76)] and BCVA decline [6.6% (15/228), 21.1% (16/76)]. There were 3 cases of arterial thromboembolic events defined in the antiplatelet experimental collaboration group, but all were considered unrelated to interventions. Conclusions The efficacy of aflibercept is superior to that of PDT in nAMD patients in China. The therapeutic effect of aflibercept persisted to week 52 in all subjects. The rate of adverse events was consistent with the safety data of aflibercept known before. Key words: Wet macular degeneration/drug therapy; Choroidal neovascularization/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Photochemotherapy

Changes in subfoveal choroidal thickness after uncomplicated cataract surgery.

Recent investigations show that phacoemulsification causing an inflammatory insult to the eye has an effect not only on retina but on the choroid as well. The purpose of this study was to evaluate the subfoveal choroidal thickness (SFCT) after uneventful phacoemulsification using swept-source optical coherence tomography (SS-OCT). This prospective study included 30 eyes of 23 patients with senile cataract undergoing uncomplicated phacoemulsification and intraocular lens implantation. SFCT and foveal retinal thickness (FRT) measurements were made at the same time, 1-2 PM preoperatively (P), 1 month (M1) and 3 months (M3) postoperatively using 1050 nm DRI Triton SS-OCT (Topcon, Tokyo, Japan). Postoperative changes in the SFCT, FRT and correlation of SFCT change with axial length, age, baseline intraocular pressure (IOP), IOP change were assessed. The mean SFCT increased statistically significantly 3 months after surgery in all sectors except the superior inner region. Of the factors affecting the SFCT, the change in the SFCT (M3/P), correlation with age and baseline IOP in almost all sectors was observed. The mean FRT increased significantly after the surgery in all sectors. Insignificant subclinical increase in SFCT was observed 1 month after the cataract surgery. Significant increment in SFCT was detected 3 months postoperatively, which was correlated with surgery-induced IOP and ocular perfusion pressure change in the short term.

Assessment of inner and outer retinal layer metrics on the Cirrus HD-OCT Platform in normal eyes.

PurposeEllipsoid zone (EZ) and outer retinal integrity are strongly linked to visual prognosis, but quantitative normative data is lacking. This study evaluates the EZ, outer retina, and inner retina in eyes without macular disease across a wide age spectrum.MethodsAn IRB-approved study was performed for eyes without macular pathology undergoing Spectral Domain Optical Coherence Tomography (SD-OCT) scans on the Cirrus HD-OCT system (Carl Zeiss Meditec, Oberkochen, Germany). Scans were analyzed using a previously described automated EZ mapping tool with line-by-line manual verification. Segmentation included internal limiting membrane (ILM), outer nuclear layer/Henle fiber layer complex (ONL/HFL), EZ, and the retinal pigment epithelium (RPE). The output included metrics for the inner retina (ILM-OPL/HFL), outer retina (ONL/HFL-RPE), EZ-RPE area and volume, and en face EZ mapping. EZ-RPE attenuation on en face mapping was defined as EZ-RPE thickness < 20 um, and total attenuation was 0 um. Imaging parameters were assessed for the group and compared to age, sex, visual acuity and spherical equivalent.Results167 eyes from 167 subjects were included. Mean age was 49.7 years (range 10–84 years). The mean foveal retinal thickness was 200.58 ± 19.22 um. Mean inner retinal thickness was 21.47 ± 13.60 um. Mean outer retinal thickness was 179.11 ± 18.52 um. Mean EZ-RPE thickness was 50.58 ± 6.01um. The mean EZ-RPE volume was 1.20 ± 0.10 mm3. Mean EZ attenuation percentage per macular map area was 0.87% ± 1.13% and mean percentage total attenuation was 0.12% ± 0.14%. Total and inner retinal thickness metrics decreased with age. Mean outer retinal thickness increased with age. EZ-RPE parameters were unchanged with age. However, EZ attenuation was negatively correlated with age.ConclusionThis study provides important information for inner and outer retinal parameters. Future research on quantitative EZ integrity can utilize this data for comparison.

Choroidal Thickness Influences Near-Infrared Reflectance Intensity in Eyes With Geographic Atrophy Due To Age-Related Macular Degeneration.

To evaluate the effects of retinal and choroidal thickness on near-infrared reflectance (NIR) scanning laser ophthalmoscopy in eyes with geographic atrophy (GA) secondary to non-neovascular age-related macular degeneration (AMD). This was a cross-sectional review of the clinical records and multimodal imaging data of eyes diagnosed with GA secondary to non-neovascular AMD. Imaging modalities included color fundus photography, fundus autofluorescence, NIR, and structural spectral-domain optical coherence tomography (SD-OCT). On SD-OCT images, the foveal retina thickness and the subfoveal choroidal thickness were measured by two independent readers. Near-infrared reflectance intensity within areas of GA was subjectively graded as hyperreflective, isoreflective, or hyporeflective and objectively estimated by using ImageJ to calculate the mean gray scale value within each GA area. A linear regression analysis was performed to model the relationship between mean NIR gray scale value and retinal and choroidal thickness. One hundred four eyes of 104 patients with a mean age of 81.3 years (SD: ±8.3) were included. The area of GA was hyperreflective on NIR in 88 eyes (85%), isoreflective in 13 eyes (12%), and hyporeflective in 3 eyes (3%). The mean foveal retinal thickness was 101.5 μm (SD: ±54) showing no significant relationship with mean NIR (P = 0.464); and the mean subfoveal choroidal thickness was 172.6 μm (SD: ±114.7) showing a statistically significant relationship with mean NIR intensity in the linear regression analysis (r = 0.590; r2 = 0.348; P < 0.00001). Variations in choroidal thickness appear to influence NIR intensity in areas of GA and have the potential to affect image interpretation. The recognition of this relationship may provide useful information regarding choroidal thickness.

Foveal Thickness Alterations in Patients with Migraine.

Aim:To investigate the alterations in foveal retinal thickness (FT) values in patients with migraine and to reveal the correlations between FT and clinical characteristics of migraine disease.Methods:This study included sixty-eight eyes of 34 migraine patients [twenty-eight eyes of 14 patients with aura (group 1), and forty eyes of 20 patients without aura (group 2)] and forty eyes of 20 healthy volunteer who served as the control group (group 3). FT values were measured by optical coherence tomography (OCT) in each group.Results:Mean age of patients in group 1, 2, and 3 was 34.0± 6.82, 35.2±10.12, and 35.1± 6.85 years, respectively (p=0.84). Mean FT was 211.07±7.36, 220.0±12.01, and 221.85±12.27 in groups 1, 2, and 3, respectively. There was statistically significance among the group 1-2 and 1-3 (p=0.002 and p< 0.001). There was no statistically significance between group 2-3 (p=0.88).Conclusion:This study suggests that in particular migraine with aura may lead to a reduction in FT values. This finding can be explained by the blood flow decrease theory in migraine; however larger studies seem mandatory.

Macular and retinal nerve fiber layer thickness changes after small-incision lenticule extraction and femto-LASIK

Introduction Femtosecond laser flap creation exerts less intraocular pressure (IOP) fluctuation but requires more procedural time compared with microkeratome flap creation. This IOP elevation during suction may affect the macular and retinal nerve fiber layer thickness that can be assessed with optical coherence tomography. Purpose The aim of this study was to compare the influence of the transient elevation of IOP during suction on the macular and retinal nerve fiber layer thickness after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (femto-LASIK). Patients and methods A total of 80 and 75 eyes that received SMILE and femto-LASIK procedures for myopia and myopic astigmatism, respectively, were enrolled in this study. Spectral-domain optical coherence tomography was used to measure macular and peripapillary retinal nerve fiber layer thickness preoperatively, at 1 week, and 1, 3, and 6 months postoperatively. Results The study included 155 eyes. In both the SMILE group and the femto-LASIK group, the mean foveal, parafoveal, and perifoveal retinal thickness did not change significantly from the preoperative to any postoperative timepoint (P > 0.05). The mean foveal retinal thickness was significantly greater in the femto-LASIK group than in the SMILE group (P 0.05). The differences in the retinal nerve fiber layer between the SMILE group and the femto-LASIK group were not statistically significant at any follow-up visit (P > 0.05). Conclusion Both SMILE and femto-LASIK procedures had no significant effects on the macular and retinal nerve fiber layer thickness postoperatively.

Total Macular Volume and Foveal Retinal Thickness Alterations in Healthy Pregnant Women

ABSTRACTPurpose: To evaluate whether there are alterations in total macular volume (TMV) and foveal retinal thickness (FT) values during pregnancy. Methods: This study included 60 healthy pregnant women in their first, second, and third trimester (groups 1, 2, and 3) and 20 nonpregnant women (group 4). TMV and FT values were measured by optical coherence tomography (OCT) in each group. Results: Mean TMV was 1.43 ± 0.56 mm3, 1.88 ± 0.54 mm3, 2.04 ± 0.66 mm3 and 1.35 ± 0.41 mm3 in groups 1, 2, 3, and 4, respectively. Mean FT was 199.20 ± 64.35 µ, 274.35 ± 67.45 µ, 287.95 ± 95.50 µ and 192.100 ± 58.61 µ in groups 1, 2, 3, and 4, respectively. There was statistical significance among group 1–2 (p1 = 0.014, p2 = 0.001), group 1–3 (p1 = 0.003, p2 = 0.002), group 2–4 (p1 = 0.001, p2 = 0.001), and group 3–4 (p1 = 0.001, p2 = 0.001) for both TMV and FT, respectively. Conclusion: The increase of fluid in the body, in particular in the second and last trimester, may cause an increase of TMV and FT.

Changes in choroidal thickness and optical axial length accompanying intraocular pressure increase

To measure changes in choroidal thickness (CT), retinal thickness (RT), and axial length (AL) accompanying intraocular pressure (IOP) increase and to investigate the changes in axial eye dimensions induced by IOP increase. Thirty-four eyes of 34 patients undergoing a diagnostic provocative test for primary angle closure (PAC). Patients with other macular diseases were excluded. Patients underwent the darkroom prone provocative test (DR-PPT) for 1 h. We measured CT and RT at the fovea by optical coherence tomography with the enhanced depth imaging method and AL with noncontact, partial coherence laser interferometry before and after the DR-PPT. There was a statistically significant increase in the mean (SD) IOP of 7.3 (9.2) mmHg and the mean (SD) AL of 0.06 (0.12) mm after the DR-PPT (P < 0.001 and P = 0.014, respectively). There was a statistically significant decrease in the mean (SD) subfoveal CT of 30.0 (36.8) μm (P < 0.001), while there was no significant change in the mean foveal RT. The change in subfoveal CT was negatively correlated with the changes in IOP (r = -0.71, P < 0.001) and AL (r = -0.54, P = 0.004). In eyes suspected of having PAC, acutely increased IOP accompanies choroid thinning and corresponding elongation of the optical axis.

A Pilot Study of Fourier-Domain Optical Coherence Tomography of Retinal Dystrophy Patients

To characterize the macular anatomy of retinal dystrophy eyes using high-speed, high-resolution, Fourier-domain optical coherence tomography (FD-OCT). Case-control study. Retinal dystrophy patients and normal age- and gender-matched controls underwent FD-OCT imaging using the RTVue (Optovue Inc., Fremont, California, USA). Vertical and horizontal 8-mm scans of 1024 lines/cross-section were obtained. Based on boundaries manually drawn on computer displays of OCT cross-sections, the thicknesses of the retina, inner retinal layer (IRL), and outer retinal layer (ORL) were averaged over both 5-mm (macular) and 1.5-mm (foveal) regions centered at the fovea. The IRL was the sum of nerve fiber layer (NFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) thicknesses. Total retinal thickness (RT) was measured between the internal limiting membrane (ILM) and the retinal pigment epithelium. ORL thickness was calculated by subtracting IRL thickness from RT. Fourteen patients (three retinitis pigmentosa, two cone-rod degeneration, two Stargardt disease, and seven normal controls) underwent FD-OCT imaging. Mean foveal RT was 271.3 +/- 23.3 microm for controls and 158.4 +/- 47.1 microm for retinal dystrophy patients (P < .001). Mean macular RT was 292.8 +/- 8.1 microm for controls and 199.1 +/- 32.6 microm for retinal dystrophy patients (P < .001). Mean macular ORL was 182.9 +/- 4.7 microm for controls and 101.3 +/- 18.7 microm for retinal dystrophy patients (P < .001); mean macular IRL was 109.9 +/- 6.4 microm for controls and 97.9 +/- 20.7 microm for retinal dystrophy patients (P = .06). Eyes with retinal dystrophy had a small (11%) decrease in macular IRL and severe (45%) decrease in macular ORL compared to normal controls.

Use of optical coherence tomography in myopia.

To measure retinal thickness and retinal nerve fiber layer thickness using optical coherence tomography in patients with myopia. Thirty patients (13 girls and 17 boys) 14 to 18 years old were included in the study. The control group consisted of 15 patients. Each patient was subjected to routine ophthalmic investigations, which included the assessment of visual acuity for near and distant objects, autorefractometry, measurement of intraocular pressure, biometry, and assessment of the static visual field. The foveal retinal thickness and the peripapillary nerve fiber layer thickness were measured using optical coherence tomography. The mean foveal retinal thickness was 231.0 microm in eyes with low myopia, 218.0 microm in eyes with medium myopia, and 178.0 microm in eyes with high myopia. The mean thickness of the retinal nerve fiber layer was 150.0 microm, 140.0 microm, and 152.0 microm, respectively. Statistically significant differences were revealed between patients with high myopia and the control group. Optical coherence tomography can be employed to assess the retinal thickness and thus facilitate the detection of the evolution of alterations in myopia.

Surgical posterior vitreous detachment combined with gas/air tamponade for treating macular edema associated with branch retinal vein occlusion: retinal tomography and visual outcome.

To assess the effectiveness of surgical posterior vitreous detachment (PVD) together with gas/air tamponade in treating visual impairment from macular edema associated with branch retinal vein occlusion (BRVO-macular edema). A cohort study was conducted. To treat visual disturbance caused by BRVO-macular edema in 19 consecutive patients at a University Hospital, phacoemulsification, intraocular lens implantation, and vitrectomy were performed, together with gas/air tamponade. Patients were followed up postoperatively for 3-18 months. Foveal structure was defined using optical coherence tomography (OCT). Preoperative visual acuity, central retinal thickness, and interval between BRVO onset and operation were compared between patients with postoperative visual improvement and those without improvement. Ten patients recovered normal or near-normal foveal configuration, while nine patients did not. Mean postoperative visual acuity in the former group of patients was significantly higher than in the latter. Mean foveal retinal thickness decreased significantly after the operation. The interval from onset of BRVO until operation was significantly shorter in patients with improved postoperative vision than in other patients, and patients operated on within 11 months had significantly increased postoperative visual acuity. Surgical PVD and gas/air tamponade appears effective in treating BRVO-macular edema, although relatively short duration from disease onset until operation is critical for improvement of vision. When a good postoperative foveal contour is seen, it seems to be associated with better visual outcome.