Optical Coherence Tomography Macular Thickness Research Articles

Temporal macular thinning and vessel density correlation in children and young adults with sickle cell disease.

Optical coherence tomography angiography (OCTA) is a recent noninvasive imaging technology that has proved to provide a comprehensive evaluation of retinal vascular abnormalities in adult patients with sickle cell disease (SCD). However, the pediatric population remains less studied. The purpose of this study is to evaluate the correlation between temporal vessel density (VD) in OCTA and temporal macular thinning in optical coherence tomography (OCT) in children and young adults with SCD. We reviewed medical records, OCT and OCTA (Spectralis®) scans from a sample of 32 eyes from 16 patients (7 female + 9 male) under 25 years old. The OCT macular thickness data and OCTA image data were processed using Python 3.9 programming language, and statistical analysis was performed. Pearson Correlation Coefficient between macular thickness and VD for inner and outer temporal areas was 0.47 (p-value = 0.006) and 0.74 (p-value < 0.001), respectively. A t-test was also performed to prove that there is a statistically significant VD difference in patients with higher and lower macular thickness (p < 0.001). These results show that children with outer temporal macular thinning on OCT have lower outer temporal VD on OCTA suggesting that microvascular insults may lead to chronic ischemic changes in the inner retinal layers.

Bridging the resources gap: deep learning for fluorescein angiography and optical coherence tomography macular thickness map image translation

BackgroundTo assess the ability of the pix2pix generative adversarial network (pix2pix GAN) to synthesize clinically useful optical coherence tomography (OCT) color-coded macular thickness maps based on a modest-sized original fluorescein angiography (FA) dataset and the reverse, to be used as a plausible alternative to either imaging technique in patients with diabetic macular edema (DME).MethodsOriginal images of 1,195 eyes of 708 nonconsecutive diabetic patients with or without DME were retrospectively analyzed. OCT macular thickness maps and corresponding FA images were preprocessed for use in training and testing the proposed pix2pix GAN. The best quality synthesized images using the test set were selected based on the Fréchet inception distance score, and their quality was studied subjectively by image readers and objectively by calculating the peak signal-to-noise ratio, structural similarity index, and Hamming distance. We also used original and synthesized images in a trained deep convolutional neural network (DCNN) to plot the difference between synthesized images and their ground-truth analogues and calculate the learned perceptual image patch similarity metric.ResultsThe pix2pix GAN-synthesized images showed plausible subjectively and objectively assessed quality, which can provide a clinically useful alternative to either image modality.ConclusionUsing the pix2pix GAN to synthesize mutually dependent OCT color-coded macular thickness maps or FA images can overcome issues related to machine unavailability or clinical situations that preclude the performance of either imaging technique.Trial registrationClinicalTrials.gov Identifier: NCT05105620, November 2021. “Retrospectively registered”.

The effects of age-related macular degeneration on quality of life in a Brazilian population

BackgroundTo evaluate the impact of age-related macular degeneration (AMD) on the quality of life (QoL) in a Brazilian population using The National Eye Institute-Visual Function Questionnaire-25 (NEI-VFQ-25).MethodsThis observational study included 462 participants from the Departments of Ophthalmology of the University of Campinas and Conderg-Divinolândia. The NEI-VFQ-25 questionnaire and Rasch analysis were used to assess the vision-related quality of life (VRQoL). Patients with macular neovascularization were interviewed at enrollment and after three loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.ResultsOne hundred thirty-three patients were excluded because they had another ophthalmic disease, for a total of 349 patients included in the study (177 in the AMD group, 172 in the control group; 56.4% were women; mean ± standard deviation age, 70.6 ± 9.5 years). Most NEI-VFQ-25 subscale scores were significantly lower in the AMD group compared with the control group. The Rasch-calibrated NEI-VFQ-25 median score in the visual-functioning component was 56.41 for the AMD group and 61.53 for the control group, a difference of ± 4.00 (P = 0.0001). Separate analyses of the sociodemographic and ocular characteristics showed that the NEI-VFQ-25 scores were affected mostly by family income, educational level, descent, diet (vegetables/fruits), physical activity, and visual acuity (VA). The longitudinal component assessed a different group of 48 patients with exudative disease treated with anti-VEGF drugs. The mean logarithm of the minimum angle of resolution change in VA in treated eyes was a 0.16 decrease (P = 0.01). The mean change in the optical coherence tomography macular thickness was a 36.74-μm decrease (P = 0.012) from baseline to 4 months. The mean NEI-VFQ-25 scores improved significantly from baseline to follow-up at 4 months in almost all subscales.ConclusionsIn a Brazilian community, patients with AMD had a worse VRQoL than controls. The AMD severity and bilaterality were associated with decreased NEI-VFQ-25 scores. Higher family income, educational level, descent, and lifestyle significantly improved several subscales of the NEI-VFQ-25 questionnaire. Treated patients with exudative AMD had improvements in the VA, macular thickness, and most NEI-VFQ-25 subscale scores.

Correlation of Central Versus Peripheral Macular Structure-Function With Acuity in Age-Related Macular Degeneration.

PurposePatients with advanced age-related macular degeneration (AMD) may have preserved visual function despite significant retinal structural changes. We aimed to evaluate the relationships among retinal thickness, macular sensitivity, and visual acuity (VA) in advanced AMD.MethodsWe examined 43 eyes of 22 patients with advanced AMD (ages 66–93 years), prospectively recruited from the Canberra Hospital Ophthalmology Department. Visual function was measured on participants with low and high contrast visual acuity (LCVA and HCVA) and 10-2 Matrix visual fields. Retinal structure was determined with spectral domain optical coherence tomography (OCT), and customized software mapped the 64 OCT macular thickness regions onto the 44 regions of the 10-2 test.ResultsMedian retinal thickness at each 10-2 region was near normal. Just 7 of 88 regions from the OCT analysis that were thicker than the median had sensitivity that declined significantly with increasing thickness (r = −0.698 ± 0.082, mean ± SD), whereas 17 of 88 thinner regions showed significantly decreasing sensitivity with decreasing thickness (r = 0.723 ± 0.078). The absolute value of deviations from median optical coherence tomography thickness (aOCT) outside the central eight degrees was significantly correlated with HCVA (r = −0.34, P = 0.047). Thickness in the central eight degrees was not. Similarly, matrix sensitivities inside the central eight degrees were significantly correlated with outer aOCT (r = −0.49, P = 0.002).ConclusionsRetinal thickness outside eight degrees were significantly associated with HCVA and macular sensitivity. These results suggest that outer macular thickness may be a useful prognostic indicator in AMD.Translational RelevanceRetinal structure at the borders of the macula may be a surrogate marker of vision and retinal thickness near fixation.

Prognostic Utility of Optical Coherence Tomography for Long-Term Visual Recovery Following Pituitary Tumor Surgery

To investigate the association between optical coherence tomography (OCT) parameters and long-term visual recovery following optic chiasm decompression surgery. Prospective cohort study. Consecutive patients who underwent pituitary or parasellar tumor resection between January 2009 to December 2018 were recruited in a single-center, 2-year prospective, longitudinal cohort study. Best-corrected visual acuity, visual fields, and OCT retinal nerve fiber layer (RNFL) thickness, macular thickness and volume were assessed preoperatively, and at 6weeks, 6months, and 2 years postoperatively. Long-term visual field recovery and maintenance were defined as a mean deviation of >-3 at 24months, and visual acuity recovery and maintenance were defined as a logarithm of minimal angle of resolution (logMAR) of 0 (Snellen 20/20) or better at 24months. A total of 239 patients (129 men, 110 women; mean ± SD age: 52 ± 16 years) were included. Multiple logistic regression analysis demonstrated that increased inferior RNFL thickness (per 10μm) was associated with higher odds of long-term visual field recovery and maintenance (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.12-1.41; Q < 0.001), and greater superior RNFL thickness (per 10μm) was associated with higher odds of visual acuity recovery and maintenance (OR: 1.13; 95% CI: 1.03-1.27; Q= 0.031). A multivariable risk prediction model developed for long-term visual field recovery and maintenance that incorporated age, preoperative visual function, and RNFL thickness demonstrated C-statistics of 0.83 (95% CI: 0.72-0.94). Preoperative RNFL thickness was associated with long-term visual recovery and maintenance following chiasmal decompression. The multivariable risk prediction model developed in the present study may assist with preoperative patient counseling and prognosis.

Ganglion cell layer thinning in diabetic patients without retinopathy: related or unrelated to total macular thickness?

Reduction of ganglion cell layer thickness may occur in diabetic patients without retinopathy. The relationships of this preclinical finding with retinal thickness or reduced parafoveal vessel density have not been established. This study investigated the relationships of ganglion cell layer thickness with retinal thickness and parafoveal vessel density in patients with and without diabetes. This was an observational, cross-sectional, prospective study that used optical coherence tomography angiography to compare non-diabetic patients (group 1) with diabetic patients without retinopathy (group 2). Ganglion cell layer thickness, macular thickness, and parafoveal vessel density (central, inner, and complete) medians were compared between groups (Mann-Whitney U test), and their relationships were assessed in each group (Spearman Rho test). In total, 68 eyes were included in this study: 34 in group 1 and 34 in group 2. Ganglion cell layer thickness did not differ between groups in any sector. There were strong positive correlations between fields 2 (superior parafoveal), 3 (temporal parafoveal), and 4 (inferior parafoveal) of the optical coherence tomography macular thickness map and the ganglion cell layer thickness in all sectors in both groups. Central vessel density mean was lower in diabetic patients. In group 1 alone, thickness changes in the inferior and nasal inferior ganglion cell layer sectors were partially explained by inner vessel density (r2=0.32 and r2=0.27). Mean ganglion cell layer thickness was not lower in diabetic patients without retinopathy than in non-diabetic patients. Moreover, it exhibited a substantial correlation with total macular thickness. Parafoveal vessel density decreased before ganglion cell layer thinning was observed.

Evaluation of early changes of macular function and morphology by multifocal electroretinograms in patients with nasopharyngeal carcinoma after radiotherapy.

To assess the role of multifocal electroretinograms (mfERGs) and optical coherence tomography (OCT) for detecting early changes in macular functions of patients with nasopharyngeal carcinoma (NPC) after radiotherapy. mfERGs and OCT were used to examine a NPC group (36 NPC patients after radiotherapy without clinically visible radiation retinopathy, 36 eyes) and a normal control group (25 healthy individuals, 25 eyes) with the same procedure and parameters. The two groups of mfERG were summarized by calculating ring averages, response density, N1 amplitude and P1 and N1 latencies were analysed. OCT scan thickness was summarized into ETDRS regions for comparison. Compared with controls, the NPC group had significantly decreased P1 response densities in 1-4 ring regions and N1 amplitudes in 1-3 rings (P < 0.01). P1 latencies were obviously prolonged in rings 1 (P < 0.01). In four quadrants (inferonasal, superonasal, inferotemporal and superotemporal) of the mfERG response waveforms, the NPC group had significantly decreased P1 response densities and N1 amplitudes mainly in the inferonasal and inferotemporal quadrants, showing statistically significant differences from the control group (P < 0.0125). But for the OCT results, there is no statistically significant difference between the NPC group and the control group. In NPC patients after radiotherapy, there may be changes in the mfERGs before any visible fundus lesions appeared as radiation macular oedema. Since the global OCT macular thickness analysis cannot reveal early changes, the mfERGs can objectively and quantitatively assess the earlier changes in macular function in NPC patients.

Impact of retinal pigment epithelium pathology on spectral-domain optical coherence tomography-derived macular thickness and volume metrics and their intersession repeatability.

To determine the impact of retinal pigment epithelium (RPE) pathology on intersession repeatability of retinal thickness and volume metrics derived from Spectralis spectral-domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany). Prospective cross-sectional single centre study. A total of 56 eyes of 56 subjects were divided into three groups: (i) normal RPE band (25 eyes); (ii) RPE elevation: macular soft drusen (13 eyes); and (iii) RPE attenuation: geographic atrophy or inherited retinal diseases (18 eyes). Each subject underwent three consecutive follow-up macular raster scans (61 B-scans at 119μm separation) at 1-month intervals. Retinal thicknesses and volumes for each zone of the macular subfields before and after manual correction of segmentation error. Coefficients of repeatability (CR) were calculated. Mean (range) age was 57 (21-88) years. Mean central subfield thickness (CST) and total macular volume were 264 and 258μm (P=0.62), and 8.0 and 7.8mm3 (P=0.31), before and after manual correction. Intersession CR (95% confidence interval) for CST and total macular volume were reduced from 40 (38-41) to 8.3 (8.1-8.5) and 0.62 to 0.16mm3 after manual correction of segmentation lines. CR for CST were 7.4, 23.5 and 66.7μm before and 7.0, 10.9 and 7.6μm after manual correction in groups i, ii and iii. Segmentation error in eyes with RPE disease has a significant impact on intersession repeatability of Spectralis spectral-domain optical coherence tomography macular thickness and volume metrics. Careful examination of each B-scan and manual adjustment can enhance the utility of quantitative measurement. Improved automated segmentation algorithms are needed.

Choroidal Neovascularization Associated With Birdshot Chorioretinopathy.

Patients with birdshot chorioretinopathy (BCR) may develop visual compromise due to choroidal neovascularization (CNV), and few series address management strategies in the anti-vascular endothelial growth factor (VEGF) era. The purpose of this study was to describe the clinical outcomes of combination anti-VEGF and immunosuppressive therapy for CNV associated with BCR. Retrospective, interventional case series. Patients with BCR from two tertiary uveitis and retina practices were reviewed. Patients with CNV in association with BCR were identified and reviewed in detail. Clinical features, treatments utilized (ie, anti-VEGF injections, immunosuppressive therapy), and functional and structural outcomes over long-term follow-up were recorded. Outcomes measured included Snellen visual acuity, spectral-domain optical coherence tomography macular thickness during treatment, number and type of anti-VEGF injections, the need for initiation or escalation of immunosuppression, and incidence of CNV in macula-involved versus macula-sparing BCR. Four of 36 BCR patients were diagnosed with choroidal neovascularization (11%). Identification of CNV in all patients prompted treatment with intravitreal anti-VEGF injections and an increase or initiation of local or systemic immunosuppression. Mean Snellen visual acuity improved from 20/60 to 20/30 at final follow-up (P = .02). Mean central subfield thickness improved from 443 μ to 254 μ (P = .04). CNV in association with BCR occurred at a rate of 0.11 events per patient-year (95% CI, 0.02-0.31) in macula-involved BCR versus zero events/patient-year in macula-spared BCR (95% CI, 0-0.058; P = .009). Anti-VEGF therapy was effective for the treatment of CNV in BCR patients. A combination of systemic or local immunosuppression and anti-VEGF therapy may be useful in the management of CNV associated with BCR. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:450-457.].

Analysis of Retinal Peripapillary Segmentation in Early Alzheimer's Disease Patients.

Decreased thickness of the retinal nerve fiber layer (RNFL) may reflect retinal neuronal-ganglion cell death. A decrease in the RNFL has been demonstrated in Alzheimer's disease (AD) in addition to aging by optical coherence tomography (OCT). Twenty-three mild-AD patients and 28 age-matched control subjects with mean Mini-Mental State Examination 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision, were considered for study. OCT peripapillary and macular segmentation thickness were examined in the right eye of each patient. Compared to controls, eyes of patients with mild-AD patients showed no statistical difference in peripapillary RNFL thickness (P > 0.05); however, sectors 2, 3, 4, 8, 9, and 11 of the papilla showed thinning, while in sectors 1, 5, 6, 7, and 10 there was thickening. Total macular volume and RNFL thickness of the fovea in all four inner quadrants and in the outer temporal quadrants proved to be significantly decreased (P < 0.01). Despite the fact that peripapillary RNFL thickness did not statistically differ in comparison to control eyes, the increase in peripapillary thickness in our mild-AD patients could correspond to an early neurodegeneration stage and may entail the existence of an inflammatory process that could lead to progressive peripapillary fiber damage.

DOES MICROPERIMETRY HAVE A PROGNOSTIC VALUE IN CENTRAL SEROUS CHORIORETINOPATHY?

To investigate the relationship between retinal sensitivity and persistence of subretinal fluid and then to analyze microperimetry as a prognostic predictor of acute central serous chorioretinopathy. A prospective observational study. Fourteen eyes of 14 patients presenting with first episode acute central serous chorioretinopathy were enrolled and underwent ocular examination, spectral domain optical coherence tomography, and MAIA microperimetry were performed. After three months of follow-up, without any treatment, visual acuity and spectral domain optical coherence tomography macular thickness assessments and microperimetry were repeated. The main outcome was to find a relation between initial macular sensitivity and persistence of subretinal fluid. A receiver operating characteristic curve was plotted to indicate the best macular sensitivity cutoff point that would be able to predict whether a patient with acute central serous chorioretinopathy would progress to the chronic form. According to the cutoff, we calculated the sensitivity, specificity, and positive and negative predictive values for macular sensitivity as a method to predict persistence of subretinal fluid. On the basis of the receiver operating characteristic curve, a cutoff of 20 dB macular sensitivity was obtained, as the best balance between sensitivity and specificity to predict chronicity. Using this cutoff, the method had a sensitivity of 71% and specificity of 100% with a positive predictive value of 100% and negative predictive value of 78%. Furthermore, it was found that eyes with acute central serous chorioretinopathy and microperimetry of less than 20 dB had a relative risk of 4.5 to develop subretinal fluid persistence. Microperimetry with a cutoff of 20 dB may be a useful test to predict the persistence of subretinal fluid, allowing the ophthalmologist to use treatment tools earlier, preventing extracellular damage and visual impairment.

Central retina vein occlusion: visual acuity correlate with focal electroretinogram, but not with optical coherence tomography

AbstractPurpose central retina vein occlusion(CRVO) is a retinal vascular disorder associated with various degrees of retinal ischemia leading to macular oedema and visual acuity loss. The standard method to detect and measure the macular oedema is the Optical Coherence Tomography(OCT). The focal electroretinogram (FERG) is a part of the electroretinography that investigate functionally the macula.The aim of our study was to investigate the relationship between visual acuity, morphologic aspects and functional results in CRVO.Methods we examined 24 eyes affected by CRVO. All the patients had complete survey comprehending ETDRS visual acuity(VA), FERG, OCT. The FERG was performed via ERG dome, using a background light of 300 cd/m2 and a led stimulus alternating at 5,1 hz. The OCT values of macular volume and thickness, the a and b wave values of latency and amplitude were collected and analyzed. The results were matched with 19 eyes not affected of the same sample and with 20 eyes of healthy subjects. Multiple statistical relationship analysis of the r and p were done by mean of Kruskal‐Wallis test. The sensitivity and specificity were analyzed with Roc curve.Results we do not found correlations between VA and OCT macular volume and thickness. A significant correlation with VA was found in a and b FERG amplitudes between the CRVO group, healthy subjects and the healthy eyes of CRVO group and also between the healthy eyes of CRVO and healthy subjects.Significant sensitivity and specificity (72.1 and 80 respectively) were found in Roc curveConclusion in our study functional alterations of the FERG correlate and probably precede VA loss

Visual results following intravitreal Bevacizumab in neovascular age-related macular degeneration.

To determine the visual and anatomic outcome of intravitreal Bevacizumab injection in the treatment of neovascular age-related macular degeneration (AMD). Quasi-experimental study. Layton Rahmatulla Benevolent Trust Eye Hospital (LRBT), Lahore, from January to July 2010. Patients who received, one or more intravitreal Bevacizumab injections (1.25 mg per 0.05 ml) for exudative AMD were included in the study. Outcome measures included standardized visual acuity, optical coherence tomography (OCT), macular thickness, intraocular pressure, and blood pressure at 24 or more weeks follow-up. Descriptive statistics were obtained. Fifty eyes with exudative AMD were observed for six months. The mean VA improved from 0.21 ± 0.11 before injections to 0.43 ± 0.11 after injections at six months. Overall, mean OCT macular thickness decreased by 99 micron at last follow-up. At last follow-up, all eyes received an average of 3.28 ± 0.85 injections. There was no incidence of severe vision loss or adverse effects like endophthalmitis or retinal detachment. Intravitreal Bevacizumab has the potential for improvement of vision in exudative AMD for at least 6 months.

Coupled parametric model for estimation of visual field tests based on OCT macular thickness maps, and vice versa, in glaucoma care

The current standard of care for glaucoma patients consists of functional assessment of vision via visual field (VF) testing, which is sensitive but subjective, time-consuming, and often unreliable. A new imaging technology, Fourier domain optical coherence tomography (OCT), is being introduced to assess the structural characteristics of the macula. This new complementary exam is efficient, objective, and reliable. A complex, but consistent, relationship exists between the structural information provided by macular OCT and the functional information gathered by VF maps. We propose a learning-based framework with the ability to estimate the VF map based on OCT macular thickness measurements as input (and vice versa). Central to this algorithmic framework is a coupled parametric model that captures not only the individual variabilities of the OCT macular thickness measurements and the VF maps, but also their co-dependencies. This model is derived by applying principal component analysis (PCA) to a library consisting of various pairs of OCT and VF maps. The parameters of this coupled model are obtained by solving a linear least squares problem. Next, these estimated parameters are used, in conjunction with the eigenvectors derived from PCA, to compute the estimate. The accuracy of this coupled parametric estimation model was evaluated by performing multiple leave-one-out cross validation experiments.

ANGIOID STREAK-RELATED CHOROIDAL NEOVASCULARIZATION TREATED BY INTRAVITREAL RANIBIZUMAB

The purpose of this study was to report the visual outcome of intravitreal therapy with ranibizumab of choroidal neovascularization secondary to angioid streaks after 1-year follow-up. Nine patients (age, 58 +/- 4 years; range, 53-65 years) were treated with off-label intravitreal injections of 0.3 mg ranibizumab. Primary outcomes were best-corrected visual acuity changes (Early Treatment Diabetic Retinopathy Study logarithm of the minimum angle of resolution and letters) and optical coherence tomography macular thickness changes. Mean follow-up was 14 months (+/-2; range, 12-18 months). Mean visual acuity was 0.52 logarithm of the minimum angle of resolution and 30 letters (range, 0.2-1.2; 0-47 letters) at baseline and 0.37 logarithm of the minimum angle of resolution (P = 0.014) and 37 letters (range, 0-1.2; 2-55 letters) (P = 0.01) at the last examination. Seven of 9 patients (78%) gained vision (mean, 2 lines), 1 patient (11 %) was stable, and 1 patient (11 %) lost 1 line of vision (5 letters). Two patients (22%) gained >or=3 lines of visual acuity, no patient lost >1 line. Mean optical coherence tomography macular thickness was 262.4 microm (+/-34.4 standard deviation) at baseline and 216.4 microm (+/-19 standard deviation) at the last examination (P = 0.05). The mean number of injection was 5 (range, 3-7); 78% of patients needed to be retreated after the loading dose of 3 monthly injections. Ranibizumab can be considered as an effective therapy in angioid streak-related neovascularization, even if in an off-label setting.

African Descent and Glaucoma Evaluation Study (ADAGES)

To define differences in optic disc, retinal nerve fiber layer, and macular structure between healthy participants of African (AD) and European descent (ED) using quantitative imaging techniques in the African Descent and Glaucoma Evaluation Study (ADAGES). Reliable images were obtained using stereoscopic photography, confocal scanning laser ophthalmoscopy (Heidelberg retina tomography [HRT]), and optical coherence tomography (OCT) for 648 healthy subjects in ADAGES. Findings were compared and adjusted for age, optic disc area, and reference plane height where appropriate. The AD participants had significantly greater optic disc area on HRT (2.06 mm(2); P < .001) and OCT (2.47 mm(2); P < .001) and a deeper HRT cup depth than the ED group (P < .001). Retinal nerve fiber layer thickness was greater in the AD group except within the temporal region, where it was significantly thinner. Central macular thickness and volume were less in the AD group. Most of the variations in optic nerve morphologic characteristics between the AD and ED groups are due to differences in disc area. However, differences remain in HRT cup depth, OCT macular thickness and volume, and OCT retinal nerve fiber layer thickness independent of these variables. These differences should be considered in the determination of disease status.

EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE IN LONG STANDING DIABETIC MACULAR EDEMA

To investigate the efficacy of intravitreal triamcinolone acetonide in patients suffering from diffuse long standing diabetic macular edema, by the assessment of retinal thickness and retinal function by means of optical coherence tomography (OCT) and microperimetry-1. Twenty eyes received 8 mg in 0.2 mL preservative free intravitreal triamcinolone injection delivered through the pars plana. The best corrected visual acuity (BCVA), foveal thickness, and the average retinal sensitivity of the 45 stimuli were considered in our study. Patients were instructed to attend for OCT and microperimetry-1 follow-up at baseline, 1, 3, and 6. At the baseline, mean macular thickness was 692 micro +/- 70 micro; mean visual acuity was 0.13 +/- 0.09. Mean macular sensitivity determined with the microperimetry-1 was 6.85 dB +/- 2.1 dB. At the 1 month follow-up, mean OCT macular thickness decreased to 348.28 micro +/- 132.10 micro (P = 0.0001); mean BCVA improved to 0.23 +/- 0.15 (P = 0.019); mean retinal sensitivity improved to 8.71 dB +/- 2.79 dB (P = 0.03). At the 3 months follow-up, mean OCT macular thickness changed to 363.7 micro +/- 123.52 micro (P = 0.0002); mean BCVA was 0.23 +/- 0.15 (P = 0.0024); mean retinal sensitivity 8.54 dB +/- 2.78 dB (P = 0.048). Six months after the injection, mean OCT macular thickness was 460.61 micro +/- 104.9 micro (P > 0.05); mean BCVA was 0.15 (P > 0.05); mean retinal sensitivity 7.54 dB +/- 2.58 dB (P > 0.05). In our study, we found intravitreal effective in improving BCVA, macular thickness, and retinal sensitivities during the first 3 months. At 6 months, follow-up of the data were not dissimilar to those obtained at baseline. Further investigation is warranted to asses the correlation among daily life visual performance, retinal sensitivities, and macular thickness.

VISUAL IMPROVEMENT FOLLOWING INTRAVITREAL BEVACIZUMAB (AVASTIN) IN EXUDATIVE AGE-RELATED MACULAR DEGENERATION

To study the visual and anatomic outcome of intravitreal bevacizumab injection in the treatment of exudative age-related macular degeneration (AMD). Retrospective review of patients who received one or more intravitreal bevacizumab injections for exudative AMD. Outcome measures include standardized visual acuity, optical coherence tomography (OCT), macular thickness and volume, intraocular pressure, and blood pressure at 24 or more weeks follow-up. Fifty eyes of 48 patients were identified. Patients were observed for a median length of follow-up of 34 weeks (range, 24-50 weeks). Thirty-six eyes (72%) had prior treatment with pegaptanib (Macugen) and/or photodynamic therapy (PDT) and 14 eyes (28%) were treatment-naive. Mean visual acuity increased by 6.5 letters (P < 0.01) at 4 weeks and 5.3 letters (P < 0.01) at 24 weeks after initial bevacizumab injection. At 24 weeks, naive eyes had a mean increase of 14.2 letters (P < 0.001) and previously treated eyes had a mean increase of 2.8 letters (P = 0.06). Overall, mean OCT macular thickness and volume decreased by 73 micro m (P < 0.001) and 1.0 mm3 (P < 0.001) respectively at last follow-up. At last follow-up, all eyes received an average of 3.5 injections and experienced an average of 1.08 recurrences. There was no incidence of severe vision loss or adverse effect. Intravitreal bevacizumab has the potential for improvement in vision in both naive and previously treated eyes for at least 6 months. The benefit is more pronounced in eyes without prior pegaptanib and/or PDT.

Correlations between optical coherence tomography measurement of macular thickness and visual acuity after cataract extraction

To investigate correlations between optical coherence tomography macular thickness measurements and visual acuity after cataract surgery. Sixty-two patients underwent routine cataract surgery as part of a randomized clinical trial of oral Cox-2 inhibitor prophylaxis of cystoid macular oedema. Optical coherence tomography was used to quantify several parameters of macular thickness. Optical coherence tomography measurements were obtained before surgery, day one, week two and week six after surgery. These measurements were then correlated with logMAR best-corrected visual acuity. Optical coherence tomography macular thickness parameters increased after surgery by up to 20%. A significant correlation was identified between foveal minimum macular thickness and best-corrected visual acuity at day one and week six after surgery. Other macular parameters failed to show any significant correlation. At day one and week six, the 10 patients with greatest macular thickness had significantly lower visual acuity than the other patients. In this study routine cataract surgery caused an increase in macular thickness. Some significant positive correlations between macular thickness and best-corrected visual acuity were found, although not for all parameters or time points. There may be a threshold relationship between degree of foveal anatomic change and significant loss of visual acuity.

Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases

Intravitreal triamcinolone acetonide (IVTA) has increasingly been applied as treatment for various intraocular neovascular and oedematous diseases. Comparing the various diseases with respect to effect and side-effects of the treatment, the best response in terms of gain in visual acuity (VA) has been achieved for intraretinal oedematous diseases such as diffuse diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion and pseudophakic cystoid macular oedema. In eyes with various types of non-infectious uveitis, including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, VA increased and the degree of intraocular inflammation decreased. Some studies have suggested that intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischaemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration (AMD), particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure (IOP) and may stabilize the eye. The complications of intravitreal triamcinolone therapy include: secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high IOP leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% of elderly patients within 1 year of injection; postoperative infectious endophthalmitis occurring at a rate of about one per 1000; non-infectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudo-endophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other intraocular surgeries, including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated if the resultant benefits decrease after the initial IVTA injection. In non-vitrectomized eyes, the duration of the effect and side-effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. So far, it has remained unclear whether the solvent agent should be removed, and if so, how.