Central Macular Thickness Measurements Research Articles

Kinetics of central macular thickness reduction in patients with macular edema after intravitreal drug therapy

BackgroundThe purpose of this study was to characterize central macular thickness and retinal volume following intravitreal injections using time domain and spectral domain optical coherence tomography (TD-OCT and SD-OCT, respectively).MethodsNine patients with macular edema secondary to diabetes or retinal vein occlusion treated with intravitreal triamcinolone 4.0 mg and/or bevacizumab 1.25 mg were enrolled. Central macular thickness and volume was measured by SD-OCT and TD-OCT scan at baseline, and 1, 3, 6, 24, 48 hours, and 1 week postinjection.ResultsEquations were derived to describe central macular thickness and volume reduction in the hours following intravitreal injection. Measurements of central macular thickness by SD-OCT were significantly reduced by 3 hours (P = 0.03) and retinal volume by 6 hours (P = 0.03). Central macular thickness measured 40.9 (28.6–53.2) μm thicker on the SD-OCT instrument while volume measured 3.47 (3.27–3.66) mm3 higher.ConclusionSignificant central macular thickness and volume reductions occur in the first hours after injection with triamcinolone and/or bevacizumab.

A Comparison of Three Different Intravitreal Treatment Modalities of Macular Edema Due to Branch Retinal Vein Occlusion

Purpose: To compare the efficacy of intravitreal injection of triamcinolone, bevacizumab, and a combination of triamcinolone-bevacizumab for the management of macular edema due to branch retinal vein occlusion.Methods: Fifty-two eyes of 52 patients (29 male, 23 female) with branch retinal vein occlusion and macular edema were included. Patients received one of the following intravitreal treatments: 4 mg triamcinolone acetonide monotherapy (n = 17), 1.25 mg bevacizumab monotherapy (n = 14) or a combination of 2 mg triamcinolone acetonide and 1.25 mg bevacizumab (n = 21). Measurements of Snellen visual acuity and central macular thickness with optical coherence tomography were done at baseline, and at months one, three, and six.Results: At baseline, the three groups did not differ in age (P = 0.12), duration of macular edema (P = 0.24), visual acuity (P = 0.62), central macular thickness (P = 0.16), and intraocular pressure (P = 0.15). All study groups showed significant reduction of central macular thickness (P = 0.02, P = 0.02, and P = 0.001, respectively) and improvement in visual acuity (P = 0.02, P = 0.02 and P = 0.02, respectively) one month after injection. At six months, there was a significant reduction in central macular thickness (P = 0.02, P = 0.02, and P = 0.04, respectively) while only bevacizumab monotheraphy group demonstrated significant improvement in visual acuity (P = 0.01).Conclusion: Intravitreal injection of triamcinolone, bevacizumab or combination of triamcinolone-bevacizumab appears to have similar therapeutic effects on macular edema due to branch retinal vein occlusion at one month. Intravitreal injection of bevacizumab yielded better results of visual acuity than the others at six months.

Reproducibility of Macular Thickness Measurements Using Cirrus SD-OCT in Neovascular Age-Related Macular Degeneration

To assess the test-retest variability of central and sectorial macular thickness measurements obtained by Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) in neovascular age-related macular degeneration (nAMD). Macular thickness measurements of nine standard ETDRS subfields were obtained and analyzed. The repeatability of macular thickness measurements by Cirrus HD-OCT was assessed by examining the intrasession within subject standard deviation (Sw), coefficient of repeatability (CR), and coefficient of variation (CV), before and after eyes with retinal segmentation errors were excluded. Forty-nine nAMD eyes of 49 consecutive patients were included in the study. The CR for the central macular subfield was 42.4 microm (10.5%) and ranged from 12.1 microm (3.7%) for the outer nasal to 41.8 microm (11.4%) for the inner nasal subfields. In a secondary analysis, eyes affected by erroneous detection of inner and outer retinal boundaries (6/49, 12.24%) were excluded. The revised coefficient of repeatability for the central macular subfield was 26.1 microm (8.1%) and ranged from 10.3 microm (3.8%) for the outer superior to 30.2 microm (8.3%) for the inner nasal subfields. Overall, the test-retest variability of Cirrus HD-OCT is good for the central and sectorial macular subfields, with a low incidence of scan artifacts.

Comparison of serum glycosylated hemoglobin levels in patients with diabetic cystoid macular edema with and without serous macular detachment

Aim:A clinical comparative trial was conducted to compare the levels of glycosylated hemoglobin (HbA1c) in patients with diabetic cystoid macular edema (CME) with and without serous macula detachment (SMD).Materials and Methods:Thirty patients (group 1) with diabetic CME in both eyes, but without SMD, and 30 patients (group 2) with diabetic CME and SMD in both eyes documented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA), were included in the study. In addition to the measurement of central macular thickness by OCT and visual acuity (VA) (as logMAR) using the the early treatment diabetic retinopathy study (ETDRS) chart, the concentrations of HbA1c were measured by high performance liquid chromatography (HPLC). Statistical analysis was done by independent samples t test.Results:The mean logMAR VA was 0.8 ± 0.22 (1.0–0.5) in group 1and 0.7 ± 0.16 (1.0–0.6) in group 2. The mean central macular thickness, as determined by OCT, was 468.70 ± 70.44 μm (344–602 μm) in group 1 and 477.80 ± 73.34 μm (354–612 μm) in group 2. The difference between the groups was not statistically significant (P = 0.626). The mean HbA1c levels were 8.16 ± 0.99% in group 1 and 10.05 ± 1.66% in group 2. The difference between the groups was statistically significant (P < 0.001).Conclusions:The presence of SMD and high HbA1c levels in the patients with diabetic CME may be indirectly suggestive of retinal pigment epithelium dysfunction.

Comparison of the Effects of Patterned and Conventional Laser Photocoagulation in Branch Retinal Vein Occlusion

Purpose: To compare the clinical effect and complications between patterned laser photocoagulation with short exposure time and conventional laser photocoagulation for neovascularization in branch retinal vein occlusion (BRVO). Methods: A prospective study was conducted on 36 patients (39 eyes) who required laser photocoagulation for neovascularization due to BRVO. The patients were divided into 2 groups, the patterned laser photocoagulation group (laser exposure time 0.02 sec, 3 3 array patterned photocoagulation) and conventional laser photocoagulation group (laser exposure time 0.2 sec). Other laser parameters (burn intensity and spot size) were the same. Pain score at the time of treatment was monitored after the laser photocoagulation. In addition, best-corrected visual acuity as well as central macular thickness measurements were performed before the treatment and after 2, 4, 8, and 12 weeks. The regression of neovascularization in fluorescein angiography was monitored during follow-up periods. Results: The patterned laser photocoagulation group had a greater reduction in pain during laser photocoagulation, and a decreased change in central macular thickness after laser photocoagulation than the conventional laser photocoagulation group. In particular, the patterned laser photocoagulation group had a statistically significant difference between the 2 groups at postoperative 8 and 12 weeks. The regression rate of neovascularization between the 2 groups had no statistically significant difference. Conclusions: Patterned laser photocoagulation with a short exposure time decreases pain and postoperative macular edema with no difference in regression of neovascularization. Patterned laser photocoagulation with a short exposure time can be considered as a useful and efficient method for neovascularization in BRVO.

INTRAVITREAL BEVACIZUMAB INJECTION FOR CENTRAL SEROUS CHORIORETINOPATHY

The purpose of this study was to evaluate the effectiveness of intravitreal injection of bevacizumab for treatment of central serous chorioretinopathy. In this retrospective case series, six patients (six eyes) with central serous chorioretinopathy were treated with an intravitreal injection of bevacizumab. The outcome measures included visual acuity with Early Treatment Diabetic Retinopathy Study letters, central macular thickness measurement with optical coherence tomography, changes in fluorescein angiography, and indocyanine green angiography. The mean age of the patients was 42.3 years and the mean follow-up period was 9.0 months (range, 5-12 months). Mean visual acuity +/- standard deviation increased from 40.8 +/- 8.3 Early Treatment Diabetic Retinopathy Study letters at baseline to 49.0 +/- 5.0 Early Treatment Diabetic Retinopathy Study letters at 1 month (P = 0.046) and to 53.3 +/- 5.2 Early Treatment Diabetic Retinopathy Study letters at 3 months (P = 0.028). Mean central macular thickness +/- standard deviation decreased from 331.5 +/- 93.4 microm to 164 +/- 34 microm at 3 months (P = 0.043). Leakage on fluorescein angiography and hyperpermeability on indocyanine green angiography decreased in conjunction with improvement in central macular thickness observed by optical coherence tomography. Intravitreal bevacizumab injections resulted in improved visual acuity and anatomical results for central serous chorioretinopathy.

ANATOMIC AND FUNCTIONAL OUTCOME AFTER 23-GAUGE VITRECTOMY, PEELING, AND INTRAVITREAL TRIAMCINOLONE FOR IDIOPATHIC MACULAR EPIRETINAL MEMBRANE

To report both the functional and anatomic outcome and safety profile of 23-gauge pars plana vitrectomy combined with membrane peeling and intravitreal injection of triamcinolone acetonide in eyes with idiopathic macular epiretinal membranes. Retrospective study of 39 consecutive patients who underwent 23-gauge transconjunctival sutureless vitrectomy, membrane peeling, and intravitreal triamcinolone acetonide injection for an idiopathic macular epiretinal membrane between February 2007 and February 2008. Minimum follow-up was 6 months. Thirty-nine eyes of 39 patients were included in the study. The mean follow-up was 7 +/- 2.2 months (range, 6-15 months). Twenty-two eyes (56%) were pseudophakic and 17 (44%) were phakic at the time of surgery. Five of the phakic eyes (29.4%) had worsening of cataracts during the follow-up period. Mean preoperative intraocular pressure was 14 +/- 3.5 mmHg. At the final follow-up, mean intraocular pressure was 14.5 +/- 2.7 mmHg, which did not differ significantly from the intraocular pressure at baseline (P = 0.14, two-tailed t-test). Five (13%) patients needed topical antiglaucoma treatment. Mean preoperative best-corrected visual acuity (BCVA) was 0.28 decimal equivalent (20/71 Snellen equivalent; logarithm of the minimum angle of resolution 0.54 +/- 0.2, range: 1.0-0.2) and improved significantly (P < 0.0001, two-tailed t-test) to a mean of 0.6 decimal equivalent (20/33 Snellen equivalent; logarithm of the minimum angle of resolution 0.22 +/- 0.16, range: 0.6-0) at the final follow-up. The BCVA improved by a mean of 3.2 +/- 2.1 lines (range: 0-8). Twenty-nine patients (74%) demonstrated a gain of > or =3 lines. Mean central macular thickness was 456 +/- 77 microm (mean +/- SD) at baseline, which was significantly reduced at the final follow-up to 327 +/- 79 microm (mean +/- SD; P < 0.0001, two-tailed t-test). Average central macular thickness reduction was 131 +/- 77 microm (mean +/- SD; range: 36-380 microm). A subgroup analysis of 15 selected cases, which had central macular thickness and BCVA measurements after the first postoperative week, demonstrated that 84% of the total final reduction in central macular thickness and 84% of the total final improvement in BCVA occurred already during the first postoperative week. Twenty-three-gauge sutureless transconjunctival vitrectomy is a safe and effective technique for the treatment of idiopathic macular epiretinal membranes. The concomitant administration of intravitreal triamcinolone acetonide after pars plana vitrectomy may speed up and improve the anatomic and functional outcome.

Changes in Aqueous Vascular Endothelial Growth Factor and Pigment Epithelium-derived Factor after Ranibizumab Alone or Combined with Verteporfin for Exudative Age-related Macular Degeneration

To investigate changes in aqueous vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after ranibizumab (Lucentis; Genentech Inc, South San Francisco, California, USA) monotherapy or combined with photodynamic therapy (PDT). Prospective, interventional, case-control study. We recruited 34 patients with CNV secondary to AMD and 10 controls. Baseline examinations, including visual acuity (VA), central macular thickness (CMT), fluorescein angiography, and indocyanine angiography, were performed, and the measurements of VA and CMT were repeated 1 month after treatments. Seventeen of 34 patients received a single intravitreal injection of 0.5 mg ranibizumab, and the remaining 17 patients underwent combined PDT on the same day. Aqueous samples were collected at the time of injection and 1 month after treatment and were measured by enzyme-linked immunosorbent assay. Main outcomes measures were the changes in VA and CMT and the changes in VEGF and PEDF levels. Demographic features, lesion characteristics, and mean changes in VA and CMT were similar between the two groups. Aqueous VEGF and PEDF levels were reduced significantly 1 month after treatment in all patients. The reduction levels of VEGF and PEDF were similar between the two groups. There was a positive correlation between the reduction levels of aqueous VEGF and the reduction levels of aqueous PEDF. The reduction levels of VEGF and PEDF were correlated positively with the decrease in CMT, but were not positively correlated with the improvements in VA. Ranibizumab therapy for CNV secondary to AMD is associated with reduced levels of aqueous VEGF and PEDF regardless of combined therapy with PDT. The reduction levels of VEGF and PEDF are correlated with anatomic improvements in the macula.

Intravitreal Bevacizumab in Refractory Uveitic Macular Edema: One-year Follow-up

Uveitis is a major cause of ocular morbidity in developed countries. It has been demonstrated that macular edema is a significant cause of decreased visual acuity and macular edema in these patients. In this article, we evaluate the long-term outcome of intravitreal bevacizumab in the treatment of refractory uveitic macular edema. In this retrospective, noncomparative, interventional case series, uveitic patients with macular edema who were refractory to conventional therapy and who were treated with intravitreal bevacizumab were identified and assessed. Best-corrected visual acuity and optical coherence tomography central macular thickness measurements were collected and analyzed with correlative statistical analysis, including the use of Student paired t-test, Kaplan-Meier, and linear regression analysis. Twenty-nine eyes of 27 patients with diverse uveitic etiologies were analyzed and followed up at 1 year. Thirteen patients received a single intravitreal bevacizumab injection. Six patients required a second intravitreal bevacizumab injection, while 10 patients received combination therapy of intravitreal bevacizumab and triamcinolone acetonide. Baseline mean logMAR visual acuity was -0.59. At 1 year, the mean logMAR visual acuity was -0.42-/+ 0.36 (p=0.0045). Baseline mean central macular thickness was 383.66 microm. At 1 year, the mean thickness was 294.32-/+110.87 (p=0.0007). Intravitreal bevacizumab is a useful and therapeutically beneficial agent in the treatment of refractory uveitic macular edema. Some patients will require adjunctive intravitreal bevacizumab injections or the use of combination therapy with intravitreal triamcinolone acetonide.

Quantification of Error in Optical Coherence Tomography Central Macular Thickness Measurement in Wet Age-related Macular Degeneration

To assess error indicators encountered during optical coherence tomography (OCT) automated retinal thickness measurement (RTM) in neovascular age-related macular degeneration (NVAMD) before and after bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) treatment. Retrospective observational cross-sectional study. Each of the 6 radial lines of a single Stratus fast macular OCT study before and 3 months following initiation of treatment in 46 eyes with NVAMD, for a total of 552 scans, was evaluated. Error frequency was analyzed relative to the presence of intraretinal, subretinal (SR), and subretinal pigment epithelial (SRPE) fluid. In scans with edge detection kernel (EDK) misplacement, manual caliper measurement of the central macular (CMT) and central foveal (CFT) thicknesses was performed and compared to the software-generated values. The frequency of the various types of error indicators, the risk factors for error, and the magnitude of automated RTM error were analyzed. Error indicators were found in 91.3% and 71.7% of eyes before and after treatment, respectively (P = .013). Suboptimal signal strength was the most common error indicator. EDK misplacement was the second most common type of error prior to treatment and the least common after treatment (P = .005). Eyes with SR or SRPE fluid were at the highest risk for error, particularly EDK misplacement (P = .039). There was a strong association between the software-generated and caliper-generated CMT and CFT measurements. The software overestimated measurements by up to 32% and underestimated them by up to 15% in the presence of SR and SRPE fluid, respectively. OCT errors are very frequent in NVAMD. SRF is associated with the highest risk and magnitude of error in automated CMT and CFT measurements. Manually adjusted measurements may be more reliable in such eyes.

Intravitreal bevacizumab in the treatment of refractory uveitic macular edema‐A one year follow up observational study

Abstract Purpose: To evaluate the long term outcome of intravitreal bevacizumab in the treatment of refractory uveitic macular edema (UME). Methods: Retrospective, non comparative, interventional case series.SETTING: Massachusetts Eye Research and Surgery Institute.PATIENT POPULATION: All uveitic patients with macular edema who were refractory to conventional therapy and who were treated with intravitreal bevaclizumab were identified and assessed. MAIN OUTCOME MEASURES: Best corrected distance visual acuities (VA) and optical coherence tomography (OCT) central macular thickness measurements. Correlative statistical analysis includes the use of the student's t‐paired test, Kaplan‐Meier, and linear regression analysis. Results: 29 eyes of 27 patients with diverse uveitic etiologies were analyzed and followed up for a period of one year. Thirteen patients received a single intravitreal bevacizumab injection. Six patients required a second intravitreal bevacizumab injection, while ten patients received combination therapy of intravitreal bevacizumab and triamcinolone acetonide. Baseline mean LogMAR VA was –0.59. At one year the mean LogMAR VA was ‐0.42± 0.36 (P=0.0045). Baseline mean OCT central macular thickness was 383.66 microns. At one year the mean thickness value was 294.32±110.87. (p=0.0007). Conclusions: Intravitreal bevacizumab is a useful and therapeutically beneficial agent in the treatment of refractory UME. Some patients will require adjunctive intravitreal bevacizumab injections or the use of combination therapy with intravitreal triamcinolone acetonide.

Identification of diabetic macular oedema using retinal thickness measurements

Identification of clinically significant macular oedema (CSMO) involves human depth perception, which is subject to a degree of uncertainty. However, although the ability to obtain objective thickness measurements of the central macular region may be advantageous, the topography of the macular region suggests that average thickness measurements represent a simplification of the topographic profile of the region. This study explored the applicability of additional sub-analysis of central macular thickness measurements. The study included 47 eyes of 47 normal subjects and 158 ocular examinations of 38 eyes from 22 diabetic subjects with and without CSMO. All eyes underwent central macular thickness measurements using retinal thickness analysis equipment. Eyes of diabetes subjects were classified as being without CSMO (n = 53), with focal CSMO (n = 50) and with diffuse CSMO (n = 55). The central macular region was subdivided into narrow concentric rings around the foveola, using a new invention, and the thicknesses of the individual concentric rings were calculated. The sensitivity and specificity of the CSMO diagnosis were established using the average thickness and the thicknesses of the concentric rings. The average thickness of the central macular region was found to be 165.1 microm in eyes of normal subjects and 192.3 microm in eyes without CSMO. It increased non-significantly to 198.2 microm in eyes with focal CSMO and significantly to 236.9 microm in eyes with diffuse CSMO. Sensitivity for focal CSMO was 48.0% with average thickness measurements and 83.6% with concentric rings. Corresponding values for detection of diffuse CSMO were 91.7% and 96.1%, respectively. Specificity was 77.4% with average thickness measurements and 79.7% with concentric rings. Thickness measurements of the central macular region can be used to distinguish between eyes with and without diffuse CSMO, but not between eyes with and without focal CSMO. Additional sub-analysis based on concentric rings around the foveola seems to be a useful clinical tool that increases diagnostic certainty in these eyes.

Quantitative Assessment of Macular Edema with Optical Coherence Tomography

Objective: To evaluate optical coherence tomography, a new technique for high-resolution cross-sectional imaging of the retina, for quantitative assessment of retinal thickness in patients with macular edema. Design: Survey examination with optical coherence tomography of patients with macular edema. Setting: Referral eye center. Patients: Forty-nine patients with the clinical diagnosis of diabetes or diabetic retinopathy and 25 patients with macular edema secondary to retinal vein occlusion, uveitis, epiretinal membrane formation, or cataract extraction. Main Outcome Measures: Correlation of optical coherence tomograms with slit-lamp biomicroscopy, fluorescein angiography, and visual acuity. Results: Optical coherence tomograms of cystoid macular edema closely corresponded to known histopathologic characteristics. Quantitative measurement of retinal thickness is possible because of the well-defined boundaries in optical reflectivity at the inner and outer margins of the neurosensory retina. Serial optical coherence tomographic examinations allowed tracking of both the longitudinal progression of macular thickening and the resolution of macular edema after laser photocoagulation. In patients with diabetic retinopathy, measurements of central macular thickness with optical coherence tomography correlated with visual acuity, and optical coherence tomography was more sensitive than slit-lamp biomicroscopy to small changes in retinal thickness. Conclusions: Optical coherence tomography appears useful for objectively monitoring retinal thickness with high resolution in patients with macular edema. It may eventually prove to be a sensitive diagnostic test for the early detection of macular thickening in patients with diabetic retinopathy.

Efficacy and safety of Pro Re Nata regimen without loading dose ranibizumab injections in retinal vein occlusion.

Objectives:To evaluate the effects and safety of intravitreal ranibizumab on visual acuity and anatomic results in the treatment of macular edema due to retinal vein occlusion (RVO).Methods:Forty Six eyes of 45 patients who were administered intravitreal ranibizumab because of macular edema due to Retinal Vein Occlusion (RVO) were included in this retrospective clinical study. During monthly follow-up, the best corrected visual acuity values in terms of LogMAR with The Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT), and complications were examined. Cases were classified as central retinal vein occlusion (CRVO), superotemporal branch retinal vein occlusion (BRVO), and inferotemporal BRVO. We only included RVO patients but using ETDRS chart for the vision measurement.Results:In all follow-up months, there was a significant increase in BCVA in all RVO cases and in superotemporal BRVO cases after the first injection of ranibizumab. Although there was no significant increase in the 1st month of follow-up period compared to pre-treatment, there was significant increase in 2-6 months in inferotemporal BRVO patients. There was no statistically significant increase in 1st and 2nd month follow-up periods compared to pre-treatment; however there was a significant increase in 3-6 months in the CRVO patients. There was a significant decrease in average CMT measurements in all follow-up months compared to pre-treatment in all RVO cases, in superotemporal and inferotemporal BRVO cases. There was no significant decrease in average CMT measurements in the 1st, 2nd, and 3rd months compared to pre-treatment although there was a significant decrease in 4-6 months in cases included in the CRVO patients.Conclusions:Intraocular ranibizumab injections provided rapid, effective treatment for macular edema due to RVO with low rates of ocular and nonocular safety events. However, repeated injections and frequent follow-up intervals may be required.